"Like Medicare?" We Love It!
Published May 19, 2009 @ 10:44PM PT
You’re hearing a lot of bashing of government-run health care these days, but notice the bashers don't call out the programs out by name. There’s a reason for that. SCHIP is hugely popular. The VA is arguably the best system of care in the country. Medicaid has less of a sterling reputation, but that's largely because no one really understands how it works or who is eligible for what state-by-state. And Medicare? Well, as a new Commonwealth Fund poll confirms, Americans are significantly more satisfied with Medicare than private insurance. It’s time to get back to basics. “Government-run” may be scary to some, but it’s lovable in practice.
Single-payer advocates often call their plan “Medicare for All.” The public health insurance option touted by Obama, Baucus and most of the Democratic leaders is usually referred to as “like Medicare.” Clearly there’s magic in the program, but how strong is it? The poll compared the responses of those over 65 with Medicare to a random assortment of those with private insurance. Now this isn’t exactly apples to apples – Medicare beneficiaries in this poll were nearly three times as likely as those with private insurance to list their condition as “fair or poor” (the lowest ranking), almost four times as likely to have multiple chronic conditions, and twice as likely to be 200% of the poverty line or below. To no one’s surprise, Medicare beneficiaries are older, sicker, more in need of care, and poorer – the exact reasons why Lyndon Johnson and JFK wanted to create the program in the first place.
But despite their higher needs for consistent and likely expensive care, the magic of Medicare is that it’s more responsive to the customer than private health insurance. 32% of beneficiaries report having a negative incident with Medicare – a number that’s clearly too high and indicative of how much Medicare needs some reforms to improve the program. But that number is 44% for private insurance. Still, we keep hearing Medicare ain’t as good as it used to be. Think of the developments over the past few years that call into question how satisfied someone might be with Medicare – turns out many of them aren’t as bad as we’d think.
First, we hear all the time that more and more doctors accept it because of declining reimbursement rates. We’re even warned that single-payer or a public health insurance plan would lost doctors like a leaky boat if the Medicare reimbursement rates were universal. But you know what? Private insurance is worse: “Ten percent of Medicare beneficiaries’ physicians did not accept their insurance, compared with 17 percent of respondents with employer-sponsored plans.” If you want a choice of doctors, you’ve got slightly better odds with Medicare.
We hear about frustration with Medicare Part D’s “doughnut hole,” where prescription drug coverage is cut off for many beneficiaries after a certain spending threshold, causing them to pay out of pocket. It definitely has an effect: “Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints.” But that number is over double – 26% - for those with employer-based insurance. Suffice to say, it’s much, much higher for the uninsured.
Earlier today, John Goodman pooh-poohed the results, saying “One of the building blocks of economics is the proposition that people reveal their preferences through their actions and such revelations are far more reliable than polls.” Very well – then explain the consumer preference in Medicare Advantage, where, as the GAO reports, “21% of Medicare beneficiaries enrolled in [Medicare Advantage] plans decide to leave during the year, compared with 9% of those enrolled in other private Medicare plans.”
We’re not talking about Canadians, or Brits, or the Taiwanese. We’re talking about Americans – how satisfied they are in polls, and how they show their preferences through their actions. Really, one of the main barriers to reform for years has been that so few of us know people on SCHIP, on Medicaid, at the VA -- not enough to trust the managers of those programs. But all of us know people on Medicare. It has its problems – so does any health care system – but it also has strengths. Lower costs. Better satisfaction. Better health outcomes (compared to Medicare Advantage, which, by the way, markets itself aggressively to healthier beneficiaries). That doesn’t seem scary to me.
(Photo credit: Ward on Flickr.)
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.
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I have been on Medicare for 1.5 years (since age 65). For more than 35 years prior to that my coverage was proviced through my employer. Medicare is fine with me, although I have to pay a higher percentage than I did under private insurance. One of the most important advantages is the cap on the fee that Medicare will authorize.
Sure, I wish that Medicare would pay 100% (it does on some services), but this is just a troublesome detail that can be chipped away at. Sure, I dread the "donut hole" in Medicare's drug coverage, but this again is a troublesome detail that can be attacked--perhaps through changing patent laws for new name-brand drugs. The truly important thing is that the framework of Medicare already exists. It is a good framework.
Another advantage is that I am covered no matter where I travel within the U.S.--no hassle. Further, the charges and payments are handled through one "carrier"--no patchwork.
The problems younger people are going through now in just obtaining coverage, and the waste and inefficiency of the patchwork quilt of private insurance, make me wish everyone had coverage under a system similar to Medicare.
Posted by C W on 05/20/2009 @ 03:17AM PT
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This is the best breakdown on public vs. private insurance I've read in a long while.
Posted by Jeff Muck on 05/21/2009 @ 08:13AM PT
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How about instead of doctors worrying about getting paid from Medicare or any other insurance plan, government-funded or private, they just focus on providing quality care at a price that average Americans can afford to pay?
Doctors who rely on insurance get paid whether they do a good job or a bad one. A patient lives or dies, the pay's the same. Misdiagnosis or wrong prescription? Oh, well, just get the name on the check right. It's not like most people can afford to sue for malpractice.
Of course, most people can't afford much these days, and Medicare does need to get funding from somewhere. Where might that come from, I wonder? How about higher taxes, which results in being unable to afford anything, anyhow.
And when the medicare bucket of cash starts to run low, you think they're going to keep paying out for any old procedure? Say hello to rationing, where only a certain amount of medical procedures will be covered. If you need a life-saving procedure but the government doesn't think it's a high enough priority, well, just drop dead like a good patriot.
Government-funded healthcare is not the solution to this problem, but a privatized healthcare system that focuses on a quality product at a good price. Good business.
Posted by Mike Conway on 05/22/2009 @ 09:30AM PT
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Hi Mike--
I appreciate the recycling of the Frank Luntz Memo. It's definite a hot item these days.
For those interested in playing Frank Luntz bingo, you can download cards here:
http://blog.healthcareforamericanow.org/wp-content/uploads/2009/05/luntzbingo.pdf
Oh wait -- I think your comment wasn't meant as parody. My bad!
Posted by Timothy Foley on 05/22/2009 @ 09:46AM PT
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You're right, it wasn't meant as parody. This is something that I'm quite passionate about. If you put your life in the hands of the government, you're going to be sorely disappointed. It's already impossible for many people to get on Medicare or any other government-run welfare project. This comes from personaly experience, both with me and people I know and love. Any government program will always be selective.
A privately-run healthcare industry, on the other hand, is open for everybody. You choose who your doctor is, your medical plan, whatever. And if your doctor does a bad job, you can always choose a new doctor. I'd call that sufficient motivation to give services well-rendered.
Posted by Mike Conway on 05/22/2009 @ 10:28AM PT
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Yes, I know no system would be perfect. I would however have to argue one point of view; "private run, is open to everybody." Privatized is open to everybody THAT CAN AFFORD IT!!! Our privatized healthcare has turned into a monster that employers can't afford to let employees afford. This is a big reason we are in this recession and having massive lay-offs. In order for an employee to offer the health insurance fringe benefits he has to charge more for his products; because of this customers buy from oversea manufacturers and vendors.
You have to have a job to have health insurance, a darn good one at that. Hello.
It is true, however; wonderful things have happened in US, because healthcare was good business.
If Medical debts and obtaining healthcare is "Personal Responsibility" who will be the first one unable to carry the "personal responsibility?" My guess is the sick. Also, largely, some having a mild disability, too well off to qualify for public assistance; but not well enough to compete in job market in order to have insurance.
John Doe picked up a bio-terrorism virus. He didn't check with a doctor because he was afraid he couldn't afford the financial obligation. Meanwhile, he got sicker, and spread the deadly viruses to others. If he didn't have to think twice of whether he could afford it he may have gotten the illness treated in the incubation and not spread the deadly viruses. Do you want to catch the deadly virus from John Doe?
Why can't a government FOR THE PEOPLE, BY THE PEOPLE produce a successful healthcare funding system? Those who have universal healthcare are not perfect, but insurance companies make them sound a whole lot worse.
Posted by John W. Knapp on 05/22/2009 @ 11:41AM PT
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Well, when we actually have a government that's for the people and by the people, maybe we can get something done. As it stands, we don't have such a government. We have a government for and by the donkeys and elephants and special interests. Nobody benefits from that.
Also, I'm not talking about privatized health insurance. I'm talking about eliminating insurance altogether and leaving healthcare to be run as a business.
Competition drives down prices, and businesses have to provide value to keep customers. Value in healthcare means making people well, not keeping them alive but sick, which is the current model. Doctors that do that can expect to keep people coming back when they get sick.
Having trouble paying for a doctor? Let's talk about charitable organizations that can help with funds. Let's talk about doctors tithe their time by helping out in low-income areas. That helps in multiple ways. There was a volunteer organization for dentists that would have provided low-cost dental care for poor families that was outlawed by the American Dental Organization. Take out that regulation and establish those organizations for dental and medical.
We're the people. We can take care of our own. We don't need the government for that.
On top of that, there's always payment plans, or any other ways that privately-run practices and hospitals can work out with patients.
So far, government-run has been a bust, and that's not going to change.
Posted by Mike Conway on 05/22/2009 @ 12:22PM PT
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Interesting theory.
The average cost for a single-round of chemotherapy for leukemia is $150,000. If a bone marrow transplant is required, as is decently often the case, it's $250,000. I'm lucky enough to make a better than average salary, but that's approximately 7 years of me doing nothing but paying medical bills with my full pre-tax salary.
That's a lot of charity.
Posted by Timothy Foley on 05/22/2009 @ 12:39PM PT
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You must have either missed or ignored the part where I said "competition cause the price to go down."
Then there's the "providing value" part. Chemo isn't the best value for the buck by a long shot, and it's only one way to treat cancer. But right now, under the current system, there's no incentive for the medical community to look for other ways to treat leukemia or other forms of cancer. You get that diagnosis, immediately put you on chemo.
Under a competitive system, though, medical scientists will be more inclined to research less painful and more effective solutions, solutions which would cost less to both doctors and consumers. There would be more diverse solutions to choose from as a result (and we all know that every person's body is different).
Paying $150k to $250k for that treatment is ludicrous, just like paying $150 for a bottle of pills is. It's utter nonsense, but it's the insurance companies and the medical special interests that are keeping them that high. It just seems like blackmail to me, too. "You wanna live, you'll have to pay for it..."
And with lower prices, it would be easier for charities to be able to reach out and help people who need it.
Posted by Mike Conway on 05/22/2009 @ 01:57PM PT
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Hello again Tim,and for you Mike I'm here to tell you I'm a recipient of government-run healthcare.This after being without healthcare for 22 years,except for 11 months in 2005,when my wife,who worked in a nursing home,had me added to her coverage.My coverage under her insurance took effect 1Jan.2005,and on the 21st I went to the Dr.I had been seeing for 3 years for my semi-annual checkup.The result of my PSA test had escalated like the rate of health insurance premiums,from 1.9 to 5.6 in the three months since my last test.
The total cost of the radiation treatments,blood tests and copays which I had to pick up,came to over $195,000.
After my treatments the insurance company raised my part of the premiums for the employer-provided insurance coverage to $100 per WEEK,in addition to the $80 a week being withheld for my wife's coverage.Needless to say we agreed to take me off the policy,otherwise she would have been working only to pay for our healthcare.
So I decided to ignore the media reports that coverage at the VA was underfunded to provide care for the millions of vets who are eligible.I went to the nearest VA hospital on 27Jan.2009,and after writing letters to the editor,my Senators and Congressman,and all my friends,after joining the advocacy groups Physicians for a National Health Program,the California Nurses Association,and every other group trying to get the attention of Congress and now President Obama for a single-payer healthcare system,I am now one of the lucky few Americans who enjoy the benefits of a great "socialized medicine" program.I couldn't be happier with the services I've received,and the costs are just great!! $00.00 for services and $8.00 for 90 days for prescriptions!!
The only thing preventing us from scuttling the present system,which costs us $2.2TRILLION A YEAR,of which $400BILLION is administrative costs,inefficiences,and waste,is the political will to stand up to the entrenched health insurance beauracracy,call them out on their false and misleading advertising campaigns,their $512Million in election contibutions,and all the billions they spend on lobbying.Those are healthcare premium dollars which are not providing any services.And with 46 million-and-growing people with NO healthcare our sense of shame should amp up our political will.
Sen Baucus said the reason we don't have single-payer,even though over half of people want it,is because it can't pass.And since he receives more money from the insurance companies than ANY OTHER member of Congress,it's not hard to fathom why it can't pass.It also helps to prevent passage by saying,on the day of the first roundtable discussion,that single-payer was "off the table".And on the third day he had Dr.s and Nurses arrested for speaking out after they were denied a seat at the table.
So,it looks as though,as it has been for 38 years,we must be satisfied with the promises that were repeated again the other day,that the insurance companies who got us to where we are,will get costs under control,sometime in the NEXT 10 YEARS.
I'll probably be dead by then,but I going to keep working for the only system which can cover everyone AND be sustainable:SINGLE-PAYER.
Posted by Lonnie D.Ward on 05/22/2009 @ 08:31PM PT
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Hello Mike,
I refer you to a great show tonight on PBS on the Health Care industry and its insurance. It is Bill Moyers Journal, and the guests easily refute your statements. You sound more like a paid representative of the health insurance companies who spend millions to spread the same comments you just did.
Posted by Stan Prosinski on 05/22/2009 @ 10:36PM PT
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Personally, Stan, with as many people as I've seen being denied coverage for life-saving procedures, I'd like to see the people running the insurance agencies and HMO's tried and executed for multiple accounts of murder.
Posted by Mike Conway on 05/22/2009 @ 11:48PM PT
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Rick,
First of all, try debating my ideas instead of name calling. Only emotional crybabies do that.
Second, spare me the sob stories of medical school and overhead. When you go into business, you have to pay for overhead, plain and simple, and you have to pay for the training. If that's a problem for you, then you shouldn't be going into the business.
I do agree that people should quit overutilizing their insurance, but I find it funny that these companies will approve payment for little crap like colds and flu, and then deny critical transplants or other procedures to people that really need it, especially those people who serve our country in the military or even volunteering at ground zero.
Now, once everyone is in the country under this magic umbrella of Medicare For All, what's to stop Medicare from becoming just like the very private companies this is designed to replace? Frankly, the government's track record for running anything is pure shit, and the idea of entrusting my health or the health of my family to them scares me. I'd rather have an emergency fund squirreled away somewhere and then just pay for it with cash.
Posted by Mike Conway on 05/23/2009 @ 12:02AM PT
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Mike,
I apologize for asking if you were stupid, It was actually meant for another I decided to remove the rant and didn't take the cut up far enough nor did I preview before I posted.
From what I read your ideas are just pinned to your worldview and economy.
The overhead costs of a medical practice aren't a sob story they are just facts not considered in your ideas. You, ignorantly, like others in this thread, think an office visit should cost $10-20. You correctly state that going into business incurs the overhead and training costs. What you don't mention, either purposefully or ignorantly, is that it is then up to the business owner to set their own prices for their services. So, the physician should be free to charge what he or she desires for their services, it is then up to the consumer to decide if they will pay it. What you need to wrap your head around is that your are not entitled to health care, it is not a constitutionally guaranteed right. Its a provided service. If you cannot afford health care so be it, welcome to the big boys world where we take care of ourselves and decide on our own if we will help others out of our increase.
Instead of whining about the cost of items in a hospital stay maybe you should attempt to gain the knowledge of why those costs are what they are. Maybe when you understand the federal, state, and local laws that govern the dispensing of that ibuprofen, the staff costs, the physical plant costs, mandated liability insurance costs, etc, you will understand that it is not a profit center for the hospital. The cost is just covering the overhead of dispensing it. Do you really thing that keeping the physical plant operating, the staff paid, the state, local, and federal laws obeyed, the federally mandated free-care absorbed, the cutting edge technology that we demand purchased, myriad federal and state mandated insurances paid, legally mandated waste storage and removal laws obeyed, losses from being forced to accept medicare and medicaid, HIPPA, hundreds of millions in land and construction costs, (I could go on for pages) are all paid for that your care should cost next to nothing? Do you know the cost of machines like MRI, CT, Fast CT, IT, Lab equipment, Echo, Nuclear Scanners, and cath labs? Should a hospital not make a profit? Do you not want them to expand beds, services and locations? The data exists for you to actually see the real cost of medical services, then you can look at the average payments and calculate the profit...maybe you will change your tune when you see scrounges like Medicare pay, on average, 5-10% below the actual costs for the service, which by the way increases the costs the rest of us pay. What I see in your posts is that you are applying your personal economy to the provision of health care and they are far to disparate for you to do so.
When it comes to our active military and vets I agree with you. There is nothing in health care that should be spared them. The best and the brightest should be employed in their care and the best of technology should be used. They should get it rather than some federal legislator or employee.
I also agree with you about everyone being under federal health care, it will be a wreck like medicare/medicaid. Like you say we should have an emergency fund and take care of ourselves.
Posted by Rick Curtis on 05/23/2009 @ 09:01PM PT
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A "privatised healthcare system that focuses on a quality product at a good price"? Get real. Private insurance companies are focused on maximising profit. That is accomplished by maximising premiums and minimising payouts. This means, among other things, not insuring people who are sick, and searching for excuses to cancel the policies of people who get sick. There is a fundamental conflict between the companies' interests and the patients'.
The only way I know of to solve this problem is government sponsored health insurance. There is also the matter of efficiency; private insurers pay out about 70% of the money they collect, vs about 95% for Medicare.
National health insurance can work well. The British and Canadian systems do not, and it would be foolish to copy either. But the systems of Sweden, France, and Switzerland work very well, delivering quality care for half or less the cost of our non-system. These are the systems we should emulate.
I would like to retain a private system alongside the government one. If there is only one payer, there is only one option, one decider, with no escape for those unhappy with the government offering. Alternatives are necessary to keep the government honest.
There is a compelling and fundamental economic reason that coverage must be universal for the system to be efficient and fair. Obama seems to disagree; I have not heard him address these issues.
Posted by Brooke Jennings on 05/24/2009 @ 12:57PM PT
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"There Are many factories moved oversea,
still one remains, hope long it will be,
it's the charger plant, the brave white knight,
good going friend, keep up the good fight.
A-For-Da-Ble Health* will save our economy,
it is in the best interest of everybody,
if every job moves out of the country,
than "tell me" whose gonna pay the medical fee?"
Healthcare is for everybody, not just the filthy rich. I'm not talking about "I want a Plazma TV; I want a Mercedes Benz; I want a nice big house." I'm talking about a basic necessity. I'm also afraid that someone will catch a bio-terrorism disease, not consult a physician at first sign because he is afraid he can't afford the financial obligation; then he gets sicker and passes the deadly bio-terrorism disease germs unto me. Is our privatized system that cuts out 1 in 6 Americans worth starting an epidemic of life threatening communicable diseases?
Healthcare is a military and a police coming up on an enemy called "diseases." If I'm wrong about single-payer healthcare; then let's privatize our police, fire dept, our public school, and military.
I too hear much bashing about single-payer healthcare "govt run." Seems like the biggest opponents are the Christians. Like "what ever happened to caring for the needy?" People remember Canada and UK; I grant they are not perfect; but their failures are overemphasized.
Is our privatized healthcare okay??? Ask the one who lost his job and his insurance in this unfreindly economic climate!! Someone with heart disease just doesn't give up having insurance if it can be helped.
Health insurance is a business; which means they profit best when they don't have to pay claims. Dec 2007 a young girl, Nataline Sarkisyan had Leukemia, a bone marrow transplant. Due to complecations her liver gave out and she needed a liver transplant. The insurance company refused to pay for liver transplant, calling it experimental. Then, after it was already too late to save her the insurance company has agreed to pay for the surgery; she died few hours later. Not saying the surgery on time would absolutely have saved her life; but that was her doctors professional opinion.
The right way is HR 676.
"What can we do, we must remove the insurers and their crimes,
install H R 6 7 6 for now it is the time,
with a single-payer health care everybody's covered and noone's left behind.
At last health care will be our right, oh won't it be so fine.
Hand and Hand we'll fight the fight,
HEALTHCARE WILL BE OUR RIGHT!!! boom boom boom
Bang Bang then our silver hammer falls on insurers heads,
bang bang then their wicked practice will one day be all dead!
bang bang then our silver hammer falls on insurers heads,
bang bang then their wicked practice will one day all be dead!
Posted by John W. Knapp on 05/22/2009 @ 09:44AM PT
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The more things change, the more they really stay the same. And an ounce of prevention's worth [more than] a pound of cure. Just a couple of age-old sayings that really do apply to this colossal mess we find ourselves in with the healthcare debacle. And while we're at it, some more clarification's required. As long as the health insurance lobby and the pHarmco lobby keep paying their advocates to go buy the votes up on the hill, nothing's gonna change, as in if nothing changes, nothing changes.
What has long been needed in this country is true healthcare vs. the massive "sick" care which is the current status quo. I heard some years ago that they have medication in Germany that cures cancer. But they also pay alot of money to keep that under wraps. Why? Because alot more money can be made by putting people on chemo, and the usual treatments to alleviate the ill effects of cancer. Same thing with the Swine flu and other flu epidemics. It's a money maker to keep people sick.
But then, let's play this tape all the way out. We got a bunch of sick people in this country and we do end up paying for it in the long run. People going to the ER because they don't have a regular doctor for care that many more times than not, could have been avoided had they had a preventative wellness care plan in place to start with. Hence the ounce of prevention proverb.
I have a foreclosure on my record directly related to inadequate healthcare. It's a long, drawn-out story, but it IS the causal event of my demise; financially, physically, mentally, emotionally, socially. Thank God they haven't stolen my spirituality.
The Max Baucuses and the other cronies up on the hill keep their very seats up there because of campaign donations from the healthcare insurance and pHarma lobbies. Surely, it doesn't take a brain surgeon to see the connect/disconnect here. "Show me the money!" That's what it's all about, folks.
Posted by Lisa Holt on 05/22/2009 @ 09:54AM PT
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Lisa, you did give some very important info. I am really afraid much of it is terribly real. The medical establishment is rewarded for treating sickness, not keeping us healthy. What we have in this country is not a healthcare system, we have a disease control system, a sick care system.
A few years ago a Dr Burzinski come up with "antenioplastins" (sp), a non-toxic form of chemotherapy, has some proven track record, including for brain cancer. The drug companies didn't like it, not because they were concerned about people with cancer, but because it was in competition with their business. They moved on the FDA to have Dr Burzinski arrested.
While conventional chemotherapy has saved lives it has also killed, too.
The answer is HR-676. Not saying it is perfect, but far better than this non-system we have.
Posted by John W. Knapp on 05/22/2009 @ 11:52AM PT
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All I know is I am 46, have diabetes, make very little money, and have no insurance. I can't afford to go to a doctor. I don't care what happens, but it is a shame that everyone in this country can't see a doctor
Posted by tony couch on 05/22/2009 @ 12:03PM PT
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I have used the HMO's under Medicare and now the VA. The HMOs were satisfactory. The VA is excellent. I would have been dead and long forgotten without these programs.
Posted by Otto VonAuchvetter on 05/22/2009 @ 06:39PM PT
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I am a nurse and have seen the realities of healthcare and believe that Americans deserve to have health care available without depending on insurance plans. Healthcare that made up of preventive care and education as well as treatment, down the road of time, will make us a healthier and happier country. It will take brave people willing to step out of the box, people not entangled with insurance lobbyists, to change our system.
Someone suggested to me recently that if healthcare is available free to all, our system would be overwhelmed with sick people looking for care, such that the long feared waiting lists would become a reality. Here is where we look outside the box! The way we do healthcare now is to visit a doctor or nruse practitioner who all practice by the medical model, look at the symptoms and write a prescription. Many times there is no time to figure out why they have those symptoms, or the patient can't afford the tests, so they go without.
I'm suggesting that if we redesign the system of the provision of care, there will be plenty of caregivers to go around. I really like the idea a pharmacy has recently started to have nurse clinics to answer questions, and treat people with the colds and flus, cut fingers, etc. The same system that pays for the health care could set up these clinics, even some with docs, and pay a salary. Even the pharmacies can pay salaries. I have to laugh each time I have to listen to the pharmacist read a label to me and then ask if I have any questions... such a waste of time, energy, money. Why is there no education for people to know that they shouldn't eat grapefruit if they are taking medication for stomach acid, a potentially fatal issue if they go out and spray pesticide on their lawn that day. Why should I have to wait weeks for a doctor appointment, pay a fee for that appointment for them to write a prescription for eye ointment which will cost about $45. They are afraid the person will use it incorrectly and then sue them. Nurses in clinics would be well suited to triaging patient care IF the doctors were not so egotistical. I've worked with some of the best docs who always listen to nurses opinions, obviously secure in their own practice to not be intimidated by someone that just might have a better option than them.
An older man I know just recently after reading an article on alternative options for acid reflux, stopped his proton-pump inhibitor medication that was not working, and his doctor kept refusing to change it to a different one, he started eating a dill pickle every evening and ever since has had no problem with acid reflux. There are so many options like this out there that are neglected by docs because it was not part of their training. I don't know but that kind of thing was not part of my nursing training, but I still learn more by reading and talking to people. Our medical system is so based on clinical research, it misses the boat about true health care.
I was part of an Evidenced Based Practice committee where I worked, where everyone on the committee was excited about all these practice policies based on recent clinical research. I tried to point out that all the work of this committee is a moot point if the facility is poorly staffed, over-worked, poor morale, and closed minded nurses and doctors. Health care facilities are always enacting all these great policies and procedures that take time away from caring for the patients and piss off the staff. There are so many rules and regulations that are basically set into practice because of our litigious society. And then the really important issues that come up like staff and doc abuses of patients, managment abuses of staff don't get addressed because management would rather spin their wheels in cover-ups because of the fears of litigation. You wonder about all the loud outcry that we have a shortage of nurses in this country... well think again. In reality, there are so many good nurses that have left the field of nursing due to these problems and a healthy understanding that they don't have to put with such an unhealthy environment.
In a new system, they could have nurses by phone working with people with health issues. Obviously this has worked for insurance companies now. I would suggest that we could have a government program, and have private companies that implement the requirments of the program, hire the people , pay salaries, develop and master programs for patient education, for those nurse clinics, phone triage centers, and for monitoring the safety and effectiveness of health care, other than what we have now accrediting agencies who are paid to survey, and don't hold anyone accountable for failures. This would be like revamping medicare and the insurance companies. Leave the docs to have time to find the cause of problems, like Dr House, except with better manners.
Posted by Jerri Bedell on 05/22/2009 @ 06:49PM PT
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This is exactly the kind of thinking that the medical industry needs. There are certainly more than enough ways to provide quality care to people and make them well, while balancing out the needs of the practitioners. A little creativity.
My only issue here is not holding anybody accountable for failures. Doctors who make mistakes need to be retrained and possibly required to compensate the patient, but not subject to these outlandish lawsuits that lawyers would have us do ("My client needs 10 million for all of his pain and suffering"). Accountibility is not a bad thing, just that unethical lawyers have made it harder.
But, I think that the model you suggest here could easily have a chance of working. I could see it easily driving the costs to patients down while still giving doctors and nurses a nice living wage. That's what I call a true win-win situation.
Posted by Mike Conway on 05/22/2009 @ 07:13PM PT
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I really like your comments - up to the last paragraph. As for the guy who cured his heartburn due to the dill pickle, it's probably due to the vinegar. Many believe that putting a tablespoon or so of apple cider vinegar in a glass of water and drinking it before a meal (a brand like Bragg - available at health food stores) will work.
I would like to see health care costs cut by innovative means but see no need for the government to take on this responsibility. The government is one entity that is virtually never innovative, efficient, or caring.
We do have problems with insurance companies, doctors who won't think outside the box, and government regulations and programs that don't really fix the problems. We actually don't have a free market in health care and I believe that is what is needed to make health care better and more affordable.
Posted by Janice Moerschel on 05/24/2009 @ 03:18PM PT
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I've been on Medicare for two years now and think it works just fine, especially compared to my life long experiences with private insurance. I believe strongly in Medicare for all. The people who argue that competition makes prices go down are deaf, dumb and blind. If competition makes prices go down (which is normally the case), then why have health care insurance costs gone UP consistently over the years. Each time the industry feels threatened, they say they will voluntarily reduce costs. Of course they will. They will increase the percentage of health insurance claims denials.
I'm tired of people arguing that we can't do single payer in the U.S. because we are "different". In other words, the rest of the industrialized world is wrong and we are right. That's why we pay so much and get so little for health care coverage. That's why Congress is owned by the health care insurance industry. And that's why I don't think we the people will ever win.
Posted by Judith Auerbach on 05/22/2009 @ 08:30PM PT
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The reason that prices haven't gone down is because there is NO COMPETITION when it all comes down to it. There are so few choices for private insurance and because of high health care costs, insurance is needed just for regular people to be able to afford to see a doctor, and that's if you can even get accepted.
Healthcare providers and drug companies don't lower their costs because no matter the quality of care the give, whether it's fantastic or crap, they get paid the same thing from the insurance companies. Why would they want to stop that from coming in? Why change?
And here's a question from the blind man: if big daddy government gives away Medicare to everybody like candy, where is the money going to come from to pay for it all? The Federal Reserve is either going to have to print more and more money, thereby devaluing our dollar further, or there is going to have to be a pretty good increase in taxes. I'm pretty sure Medicare doesn't come from magical fairy dust.
Posted by Mike Conway on 05/22/2009 @ 08:59PM PT
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Dear Judith,
A good place for us to start,on the path to winning,would be to stop re-electing the same in-the-pockets-of-the-corporations politicians who have been slopping at the corporate trough for too many years!!
Posted by Lonnie D.Ward on 05/22/2009 @ 08:38PM PT
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Lonnie, I've tried voting them out, the one (in spite of promises) voted in turns out the same.
Posted by Rose Newburg on 05/23/2009 @ 07:51AM PT
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Watch "Bill Moyers/PBS.org" tonite, re: Single Payer. Go for it!!
Posted by Peter Parsons on 05/22/2009 @ 08:40PM PT
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I think this is a very good post. Something absolutely has to be done, and soon! I am all for a govt. run healthcare system and from what little I've heard it sounds like a definite improvement over the current health insurance companies. Because of injuries from a car accident 25 yrs. ago, I am unable to work outside of my home. The insurance companies after first denying me coverage because of my injury, then agreed to cover me, as long as I continued to pay the monthly fees. They put me in a group called Major Risk because of my condition and charge the highest premiums in their program. They seem to raise the rates at least once a year, to the tune of hundreds of dollars- per month!! They are now charging me $1,280/mo.!! For someone like me, whose work only pays a pittance, these rates are astronomical. My income last year was only $9,000. My health insurance premiums alone cost $15,360!! I think there is something seriously wrong with this picture! If it weren't for my parent's help, the insurance company would have kicked me out many years ago. I hate to think what that might have resulted in, and also, what the future holds if nothing is changed.
Posted by Judy Chalifour on 05/22/2009 @ 08:47PM PT
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I realized I left out a couple issues, like one what you, Mike, brought up, that of accountability. I absolutely agree. I am currently a Federal Whistleblower, having been fired by the VA for reporting abuses. I was not the only one on their hit list, just the only one willing to stand up and try to hold them accountable. To date, there was an investigation of the abuses and the final report will be delivered late June. The investigation started Jan 09, but yet reported back in April of 08! The really good staff have all mostly left (getting fired or getting out in time), the abusers are all still there, including the management that is covering all this up. Staff there now tell me it is worse than is ever was. And the biggest thing I find confounding is the fact that this so called investigation has not yet interviewed one witness! I'm hoping they found all their evidence upon their visit. The positive outlook! There are so many staff and veterans that came forward offering to be witnesses, supporting my claims, and reporting so many others, and living with this overwhelming fear of retaliation (even vets fearing the retaliation of losing their benefits!). It is hard to understand this process that takes so long, and most likely will have the same outcome of no accountability. I have had so many people from other VA's contact me in this process reporting similar situations of abusive care and mismangement, but can't find any accountability. The poor veterans, older from long ago wars and conflicts. And now I hear the organizations supporting veterans of Iraq feel the VA will support them. What makes them think an abusive health care system will care what age the veteran is or what war this veteran patient served? I'm trying to make a difference but it really is an uphill battle, having been fired, having my good name run through the mud, being called disgruntled by management. Managment even filed charged against me for reporting the abuses to Sen McCain and thus violating HIPPA regulations. I was the third person to report this particular VA to Sen McCain and for him to fail to take action, order investigation, or anything. He took the word of management that there was no problem. The other two were high ranking decorated Vietnam Vets. There is NO accountability in the VA system. I did love working there and working with the Vets and the wonderful other nurses and cna's. The VA could be a wonderful health care system with appropriate managment! The concept of VA healthcare is pretty good, but when there is no accountability then physicians are able to overmedicate patients they believe are trouble makers, hiding sedative medication in food, or allow physicians to intimidate nurses into following their personal mandates like making sure every hospice patient has to have a foley catheter, and every hospice patient must have a whirlpool bath before they die, some dying while in the bath, and making sure that patients have empty bowels all the time ending up being overmedicated with bowel medication leaving them many times laying in pools of liquid stool, cna's going from patient to patient with the same gloves on in this era of the spread of MRSA, staff raising the beds to highest level to keep debilitated patients from getting into their beds when they want to, etc. I guess you get my drift.
The other issue is about how this new type of health care system is paid for...I believe the competition will lower costs of care, yes competition even in a single payor plan. I know someone that does have employer provided insurance, and at the beginning of the year needed a CT scan to determine what was making her so sick. Because of the high deductible which was not paid so early in the year, the scan company refused to do the scan until she paid $1600 up front, money she didn't have and so didn't get the scan. Now how would someone that has no insurance and maybe not even a job ever get anything close to quality health care if they needed any type of test, even lab tests are above our ability to pay without insurance. A new system would set standard limits on the costs and providers would only get that amount. Of course, now everyone would be eligible to obtain care, so it would all work out, they just might have to work a little harder for their fortune. And, I believe when we remove the waste from most health care systems, the money that goes into medicare system now would pay probably for 2/3 of the cost of the new system. And besides, with more education, prevention, natural remedies like those pickles in the evening this nation will be made up of a healthier population. We just need to start now, break the mold of the medical model of health care, and build a better system with accountability this time!
Posted by Jerri Bedell on 05/22/2009 @ 09:05PM PT
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Thanks for your effort, Jerri. In 3/08, a VA doc. called an invasive melanoma on me a seborrheic kertoses, and failed to refer me to a dermatologist. By 2/09, it had progressed to a 2-c grade and a different VA doc. referred me to a dermatologist who biopsied it. Then the VA delayed removing it. Fortunately, I turned 65 in March and qualified for Medicare. A private surgeon removed it. But from what the oncologist said, it may not be gone. Currently undetectable melanoma cells could become large enough to detect years down the road. Also, sarcoidosis was found via the PET scan the surgeon ordered. Some of the lymph nodes were 6 times bigger than normal. So it appeared to have been there for some time. The VA doc missed it, as well. The VA doc was either incompetent, or didn't care. And now, as a member of our state's national guard that has been shipped overseas, he is, most likely, mistreating our troops over there. There is no accountability for him.
Posted by Jerry Scott on 05/23/2009 @ 12:16AM PT
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It's not as if similar - and in some cases worse - doesn't happen with "private" insurance. What about the recent fine Kaiser Permanente of Southern California got slapped with because of their hospital employees who were found to have more than once viewed the medical records of the "Octo Mom"? As to missing diagnoses, I have seizures that private insurance refused to even test for - or with one exception even refer me to a neurologist about - I have gastroparesis that private insurance kept refusing to allow testing for because the symptoms easily "could be" Irritable Bowel Syndrome, and I have PTSD that I had to go years without treatment for because of the way "private" insurance discriminates against mental illness in coverage. Then Medicaid docs (which is why I make comments about how some docs shouldn't see live patients) decided the seizures (which are temporal lobe so they're mostly cognitive symptoms and sometimes neurological hallucinations) were psychosis and put me on antipsychotics which worsened the seizures and never would admit to even a possibility of a mistake. Finally after years of this - 20 years in the case of the gastroparesis - I got to see neurologists and GI docs only to find out what conditions I really have and that the use of antipsychotics not only was the wrong treatment but very possibly could be why my gastroparesis and seizures have worsened in the last couple of years because they're contraindicated by both conditions and are known to have potential to worsen both (especially seizures).
The only part of "government" health care that I'd say might be prone - systemically - to bad care on any wide spread basis is Medicaid.
Posted by Danetta Amschler on 05/23/2009 @ 09:32AM PT
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I heard Rep.Boner say the other day that we have the best healthcare delivery system in the world,which might be true,but we definetly have the worst healthcare financing system in the world.
For $2.2 trillion we should be able to deliver healthcare to ALL our citizens.Of couse we wouldn't be able to continue siphoning off 30% of each healthcare premium dollar to cover the profits of the insurance companies.And some of those adminstrators,who outnumber Dr.s by 30/1,and make all those profits possible, by denying as many claims as possible,would have to go into some other line of work. And if all that money went to cover the healthcare of Americans,then the politicians would have to find new sources of campaign contributions,or just try to run on their records!!
Posted by Lonnie D.Ward on 05/22/2009 @ 09:36PM PT
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As far as access to care, Medicare does a MUCH better job of that than ANY "private" coverage I've ever had. Medicaid didn't do too badly either, if you're willing to ignore a whole lot of trouble finding any providers and that many of the providers who DO take Medicaid are the ones who shouldn't be allowed to see live patients. Actually, if you're willing to ignore trouble finding providers, the 2nd best access to care I've had (next to Medicare) was being uninsured, looking for providers who did sliding scale or who'd do charity care and then getting either cheap meds or going for brand name meds that were available through patient assistance programs. By far the WORST access to care has consistently been my "private" insurance - and it really (with the exception of perhaps Kaiser Permanente of Northern CA) hasn't mattered AT ALL which insurance company or what plan.
How did I end up on Medicare? Good question. No insurance companies want to issue insurance at even kind of affordable rates - especially not to those with pre-existing conditions and particularly not if the conditions include mental health conditions. If you've got pre-existing conditions and can even find insurance, you can pretty much write off finding a plan you can afford to USE - that is, if you can afford to BUY it. So I ended up uninsured. Then I found out I needed insurance to access public health where I'd ended up - only to find out that being childless required getting rated disabled to be eligible for Medicaid (Medi-Cal, since this was in CA). Thus, I ended up on SSI, then SSDI and eventually Medicare. Similar things have happened to quite a few of the childless disabled adults I know.
As to quality of care, unfortunately, I have yet to find ANY insurance company that gives the southbound end of a northbound rat about that - unless you can show SPECIFICALLY where said provider isn't so much necessarily providing subquality care as violating the provider contract as issued by the insurance company. The insurance companies tend to care a lot more about the money than the quality. And as far as quality, even the licensing boards often don't care - or don't care soon enough. In too many cases it takes a really egregious example that's reached a point where criminal charges are involved or the claim is being advanced by the patient's surviving family - rather than when it's "simply" issues of quality of care, clear problems with ethics, issues of professionalism, or even when a provider is making medical mistakes so bad the patient catches them as long as there's no "serious" injuries or deaths. If you want to see some examples of this, try looking in many states at the public health (esp. public mental health) providers - quite a few shouldn't be allowed to practice medicine on live patients. Not that their supervisors or the licensing boards seem to care.
Posted by Danetta Amschler on 05/22/2009 @ 09:37PM PT
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Call your legislators and tell them you support the SINGLE PAYER option. It is obvious that a huge outcry from the constituency is the only way these people are going to grow the necessary organs required to stand up to Big Health and Big Pharma (those elections don't come cheap you know AND no one wants to pass up a cushy industry job when one grows tired of that hectic DC scene). DO IT. DO IT NOW. DO IT TOMORROW. DO IT THE NEXT DAY. AND THE DAY AFTER THAT. AND THE DAY AFTER THAT. AND THE DAY AFTER THAT. AND THEREAFTER UNTIL THEY SHOW THAT THEY HAVE HEARD US.
Aren't you getting just a little impatient over all this "discussion"? How many insurance plans can one have?
Mike, your theory of the "no insurance solution" is unrealistic. For people who are unfortunate enough to get sick, the frequency of medical service used would quickly prove financially burdensome, esp. if they were stricken with an illness that made it hard for them to work. Remember Mike, sick people sometimes can't work because THEY ARE SICK. So are the doctors and hospitals not supposed to charge sick people for care?? Insurance is about the healthy helping the sick with the financing of health care services. Actually, if administered correcly (single payer, well run) it is quite a beautiful system of a societal effort ensuring that the sick are helped when they need it.
Fight for single payer. Fight for your basic human right to health care protection. Fight for those who are too sick to fight.
Posted by Lauren Serven on 05/22/2009 @ 10:03PM PT
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I find statistics,or at least the way they are manipulated,interesting.
The population of this country is around 320 million.One half of those,about 160 million,are covered by employer provided health insurance.About half of those,or 80 million,tell pollsters that they are satisfied with their insurance.I'm thinking,although it's never stated,that those are young, healthy workers who don't cost the insurane companies very much money.
So,we have 25% of the population who are satisfied,and 1/7 or 14% who have no coverage at all,so does that mean that the other 61% of the 320 million are dissatisfied? Where's the outrage,the outcry from the masses? It would seem that there should have been more than 60 Doctors and Nurses,and a lot more private citizens protesting in Washington.After all,with unemployment around 20 million,it's not like we had to be at our jobs!!!
Posted by Lonnie D.Ward on 05/22/2009 @ 10:46PM PT
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Speaking in reference to above mentioned points about the "cost of medical care", I'd *love* to see some *honest* justification of the costs I've seen some of my doctors try to bill Medicare for a basic office visit. I realize that I live in a city so office space isn't exactly "cheap", and that you have to have office staff, etc. - but $380 for a follow up visit that never lasts more than 10 minutes? Just how stupid does doc think everyone is? That follow up visit lasts one question about symptoms, one question about side effects, one walk across the room and back flat footed, one similar walk on toes, one similar on heels, and a few other quick neuro checks. Unless said doc is throwing away gold tools after each appointment, I can't see any way to justify $380 per appointment - and yeah, I get that not every insurance company actually pays what he wants. Medicare paid 1/3 or so of what he hoped to receive (which IMHO was still an awful lot based on this particular doc's quality of care).
If it's the cost of schooling that's the problem, as some sources suggest, maybe the best fix would be to change how we fund college educations and medical school in particular. Maybe more med students could be encouraged to go into programs like the ones where your loans are forgiven in return for a few years service certain programs such as IHS or even change student aid so more of it is grants and less of it is loans. If it's the cost of research as Big Pharma likes to suggest, why do so many sources have credible statistics to show that at least as much if not more is spent on marketing? Or that a lot of the research money actually comes from sources that aren't internal (like grants, etc.)? Maybe stopping advertising could drop the cost of medications quite a bit - and stop the number of patients (and doctors) pursuing (or pushing) the "new" pill just because it is new which would ultimately drop the overall cost of care at least somewhat.
Still, I'm personally of the opinion that health care - being so central to life and quality of life for so many of us - is a basic human right. As such, health care - at the very least, basic care, maintenance care and preventive care - should be guaranteed to all without regard to things like are you employed or not, can or can't you pay for the care and if your answer is no to either of these questions why is it no...
Posted by Danetta Amschler on 05/22/2009 @ 11:44PM PT
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"Unless said doc is throwing away gold tools after each appointment, I can't see any way to justify $380 per appointment"
These are the kind of costs I'm talking about. I understand that time is a valuable commodity, but come on!
I know a man who was in the hospital for a month and racked up 3 million dollars in bills. You take a look at bill and see $10 for a single pain pill. This isn't some esoteric pain pill, but a simple ibuprofin-type pill. Over-the-counter medicine. This is nonsense.
"Maybe stopping advertising could drop the cost of medications quite a bit"
Especially considering that the advertising is pure PR - "Look at us, all our hard work. Ain't we great?" No, you suck. Your cost of materials is pennies and even the hours spent in research can't justify a small bottle of pills costing $150 a bottle.
I agree with you here, Danetta. I wouldn't mind seeing a system where you could walk into a doctor's office and plop down $10-20 for a checkup. 10 minutes and a bit of cash well spent. Anything more? It doesn't have to cost that much, and payments can be worked out. There's no excuse for people to not be able to see a doctor for any reason.
I wouldn't mind seeing a little more focus on health education in schools, including in school lunches, so that children can grow up to take care of themselves and not stuff doctors and hospitals with piddly little ailments that they can take care of at home, or prevent entirely (that way, they'll mostly be spending their health money on checkups, and not something serious later).
Ounce of prevention and all that, right?
Posted by Mike Conway on 05/23/2009 @ 12:19AM PT
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What it boils down to Danetta is that health care is not a right. It is a service. Providers of health care should be able to make any level of profit the market will allow them. Plain and simple.
It is definitely not incumbent upon me to pay for your or anyone else's care.
Mike, there is a reason for someone not to be able to see a doctor, if they cannot afford the care. Now if I or any charitable organization choose to pay if you cannot not afford it (like the myriad Christian owned and founded hosptials and clinics on the planet), that is another thing all together.
Posted by Rick Curtis on 05/23/2009 @ 09:17PM PT
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Now you do realize that even comparatively not-so-directly-necessary-to-or-impacting-upon-life "services" like trash pick-up were long ago deemed necessary services in such a way that the courts can ban strikes, the rates can be controlled as utilities, etc. - and all because if we fail to pick up trash we *may* develop issues like spreading diseases or infestations of insects and/or rodents. Why is it ok to make TRASH a necessary service but *not* HEALTH CARE when it's well documented that without access to health care, many people WILL die or face disability and that as a result not just their families but ultimately SOCIETY pays a price?
If we allow medical providers, pharmaceutical companies, hospitals, lab companies, insurance companies, etc. to each operate on whatever terms they feel appropriate and at whatever prices they feel appropriate, then it's pretty much assured that greed will ultimately make many decisions to the detriment of those who most need services but who can least afford them or who would cost the providers the most - like those of us with disabilities or pre-existing conditions. Basically, instead of a neutral third party that MIGHT ration care, we've got a greedy party in control of the systems that ARE rationing care - and doing their darnedest to charge as much as they can while denying as much as they can get away with denying or at least delaying.
Didn't we learn ANYTHING as a society from the travails that got our government to pass and at least for a while ENFORCE monopoly laws? Or from the laws that made stuff impacting health able to be controlled like utilities? Or from any of the many philosophies - or various Charters and Treaties (like the UN Declaration of Human Rights) - that tell us that not only are human rights basic and important but that they include the right to health care?
Besides, the line about self responsibility is clap trap when taken beyond a certain point. Sure one has a responsibility to be REASONABLY self-sufficient - but the key word is REASONABLY. Reasonably doesn't mean ALWAYS self-sufficient, no matter what happens, no matter what the conditions at the time, no matter how long that thing lasts and all without EVER even thinking about asking anyone for the smallest amount of help. Part of being part of society is that at various points in our lives sometimes we help others and sometimes we're the ones needing help.
As far as it goes too, I don't mind paying others for their services. However, I DO mind paying obscene profits just because someone has decided to price gouge and no one is bothering to stop the practice. I really don't care that said doctor had a BA, an MD, those years of residence and intership, overhead, etc. - there is no way on the face of this green earth that ANYONE'S services are HONESTLY worth $380 for 10 minutes of their time. At $380 for 10 minutes, they're seriously overpriced - and that's even for a GOOD doctor - which this particular one decidedly was NOT. Based on the mistakes I caught him making, I'm not convinced of his ability to read. I only have a BA and I can do that much - besides I'm the patient and I know what my history and allergies are, a doctor shouldn't be arguing with me about either of those (which this $380 per 10 minutes doctor did on two different occasions - I dropped him as my doc the 2nd time).
Posted by Danetta Amschler on 05/23/2009 @ 10:54PM PT
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Danetta, great response!
Posted by Jerri Bedell on 05/24/2009 @ 04:09PM PT
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Rick,
I liked your post for the most part, except for this statement:
"Your feeling that no one should be able to charge $380 for 10 minutes is irrelevant and it shows that you don't have even a basic grasp of healthcare pricing. I suggest you learn about CPT coding, the prices that are set, how they are calculated, and the reality of reimbursement before you offer an uniformed OPINION of healthcare costs/charges."
In her post, Danetta was asking for that kind of cost to be justified. For most people in the lower to middle class, $300 for 10 minutes of time is beyond comprehension, especially when you consider that most jobs pay anywhere from whatever minimum wage is this month to around $10-15 per HOUR. If we take an average of $10/hour, it takes 30 hours of work to make that $300. Compare 30 hours to 10 minutes, and WOW!
If you have a source, especially a link, this would be the place to put it (we can post links here, right? - if not, there's way around that).
In a free market situation, I feel pretty certain that costs on services and products would come down quite a bit. I gave the example of $10 for a single ibuprofin tablet. Seeing as how the market currently doesn't support a 50-count bottle of Advil costing $500, I think hospitals would be motivated to start cutting certain costs if insurance were not a factor.
Since all business works on systems, a free-market healthcare industry would have to adapt to what a market is willing and able to pay for. If people are having trouble with the idea of $380 doctor visits, and are unwilling/unable to pay that, then the system needs to be changed so that it can accomodate lower prices that most people can pay.
As a similar example, nobody cares how a car is made. People want a good value with good milage at a good price. They're not the ones who take into account materials, employee pay, time, overhead - they just want a quality car that their pocketbooks can handle. If one dealer isn't willing to give a good deal, then there's other dealers out there.
Along the same lines, people don't care what goes into making gasoline, no one wants to pay $5 a gallon for it, and the market generally feels it isn't worth it. And if that's what the gas companies drive the prices up to again, then people will find alternate ways to get to work and will stay home for vacation, thereby putting less money into the gas companies' pockets.
Otherwise, I'm in full agreement with your post. A free market is the way to go, no forced coercion and encouraging people to be self-sufficient. People have blasted me already saying "So you think that some poor person who's sick in the hospital should be figuring out a way to pay for their bills" or some foolishness like that, but you and I both know that the best place to start is before you get sick.
I don't like the idea of being a drain on the country's resources. If charities choose to help me in a pinch, I won't turn them down, but people shouldn't have to be forced to pay for my sorry hide if I didn't have the sense to plan ahead.
Posted by Mike Conway on 05/26/2009 @ 08:33AM PT
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I really resent what is being implied about me. First off, despite my disabilities, I'm well educated, hold several IT certifications, I'm multilingual, I have held very well paying jobs and have both owned my own business and managed businesses for others. I know quite a bit about money management, cost of doing business, etc. I know that what some do is worth more than what others do. That, for example, writing code in C# takes a lot more talent and education than standing around asking questions like "do you want fries with that" or "would you like your purchase gift wrapped".
However, I'd still posit that ANYONE who HONESTLY proposes that his or her time is worth $380 for 10 minutes, appointment after appointment, day after day, has good back up career choices in things like fraudulently selling bridges, fraudulently selling inland beachfront property or in pricing street drugs. Why? Because that someone is seriously huckstering. Even if said doctor HAD been an amazingly talented doctor (and this doctor wasn't), that figures out to $1900/hour if I allow him the last ten minutes of every hour to do paperwork or even just pick his nose. At $1900/hour that's $15200/day (based on 8 hours of appointments) which becomes $76000/week (presuming 5 work days) and if he works the typical 50 weeks, that's $3,800,000. Do you still really believe a doctor is worth almost 4 MILLION per year or that he/she has costs to justify such? I don't, and I know what Seattle office costs can be - but then again, I also know that this particular doctor saves at least some costs by subcontracting through a clinic system AND I know that he can't keep his patients straight and is so bad at it that it's potentially VERY dangerous. No, at least a zero needs to come off of that figure to make it reasonable even with operating costs.
Posted by Danetta Amschler on 05/26/2009 @ 11:27AM PT
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Question: How do we pay for "universal health care"?
Answer: If our companies do not have to add the cost of outrageous insurance premiums to the price of their products, we will be competitive in the global market place.
Also, if our citizens are healthy, they will be more productive. If their medical problems are addressed early, the cost of healing should be much lower -- and a lot less toxic!
Both of these should result in increasing the gross national product, providing the financing needed.
None of this will work if doctors can opt out as they can with Medicare. If that is allowed, we will continue to have a two-class system: not acceptable.
And, yes, I think medical education should be drastically changed. Medical students should be in school longer, with healthy hours (not 36-hour work days -- do you really want to be treated by someone who has worked for 36, or even 12 hours?). They should be encouraged to earn money while they are going to school, utilizing knowledge as they acquire it. Their hours should be carefully monitored (in other words, they should be learning how to lead healthy lives). This will also lessen the debt problem.
Elizabeth Barrett
New York City
Posted by ELIZABETH BARRETT on 05/23/2009 @ 01:50AM PT
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A couple of years ago, I attended the annual meeting of the International Society of Certified Employee Benefit Specialists (ISCEBS), the organization of employee benefit professionals. That year's meeting was in Toronto, Canada. For many years, a big topic at such conferences has been the prospects for health care reform.
Holding the meeting in Canada gave us the opportunity to hear about the Canadian system up close.
Two of the speakers told us that the model for health care reform was in the United States, not Canada. They were talking about the the Veterans Administration (VA). I have heard that theme repeated many times since.
It was extremely unusual during the last administration, to hear good things about the USA from those beyond our borders.
Thanks, Tim, for reminding us that many Americans know what some of our public officials won't concede.
The real shame is that we have leaders (and followers) who won't admit when public programs work.
But there is a logic to their thinking. If we fall for the mantra that government is the problem and not the solution, we will flock into the arms of the private insurance carriers.
When we take that bait, we wind up as some one's dinner.
http://thehealthcaremaze.wordpress.com
Posted by james mcgee on 05/23/2009 @ 05:36AM PT
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You forgot to another government health care system to attack. How about military healthcare for active duty, their dependents, and retirees.
I,m retired military reserves as well as retired U.S. Civil Service. Guess we just are a bench of pirates. I can assure you I'm proud to have served my country. You might try it.
Next time you have a rant or tirade, please have your facts straight.
Posted by Norman Davis on 05/23/2009 @ 07:13AM PT
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The current Greed based Medical, Insurance, and Pharmetphueticals are respinsible for this health care mess, So many other Countries out do this so called greatest Nation in health care. We NEED a major reform and fast, let those happy with there coverage and greed of insurance companies keep theirs and cover everyone else witha one payer care system, Somewhat like we already have with the V.A. but improved ALOT more
Posted by kathy k on 05/23/2009 @ 07:42AM PT
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I volunteered at the VA. I've also had several experiences with my dad and grandparents @ the VA. If you enjoy your trip to the DMV, you'll love government healthcare!!! The VA is famous for operating on the wrong leg, etc. Doctors have told me other doctors are there because they are mediocre and don't want to be sued in a private hospital (Gov. employees are exempt from being sued).
The government also doesn't honor medical "Power of Attorney", so I've gone through a lot of aggrevation trying to help my dad. He's in a wheelchair and can hardly speak, but they still forced him to attend "VA Orientation" even though the nursing home pleaded with them. So there he sat at 83 years old, with dementia, viewing the "how to order meds online" video. After 2 outbursts of "I can't stand it", they let us leave.
Posted by Mara Rajput on 05/23/2009 @ 08:22AM PT
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My mom recently had to take up VA as her insurance provider; because of a divorce she lost her private insurance. I was pretty concerned about the quality of care that she would get with a government-run health care program. She and I have been pleasantly surprised. The VA does a good job of controlling costs (my mom has been required to attend a pain management group therapy course instead of just throwing drugs and more doctor's visits at the problem) and getting to the root of the condition, while not sacrificing on care. My mom has had all of the tests done that she needs, seen specialists, but has also been put on a regular exercise program. I have to say that I am impressed with what I've seen from the VA. I am hoping that our new national health care system will focus on remedying what is making our society so sick (unhealthy lifestyles resulting from poor diet, lack of exercise, & stress) instead of profits for insurance, medical, & drug companies.
Posted by Lauri Owen on 05/23/2009 @ 08:23AM PT
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Lauri, I liked the report you gave. As an advocate for HR-676, a single-payer national health insurance system I can't tell you I am not at all afraid of it. But, I am far more afraid of what we have now. In our present economy we clearly don't have the job base to support our privatized healthcare system. People lose their insurance because they lose their jobs; or in the case of your mom, divorce or widow; or spouse earning the health insurance work benefit becomes unable to work.
You gave some very important items. I also hope by, and I understand it to be the intentions of John Conyers, that we will work at preventing illness.
"What can we do, we must remove the insurers and their crimes,
install H R 6 7 6 for now it is the time,
with a single-payer healthcare everyone is covered and noone's left behind,
at last healthcare will be our right, oh won't it be so fine,
hand and hand we'll fight this fight, health care will be our right!!! bom bom bom
Bang bang then our silver hammer falls on insurers heads,
bang bang then their wicked practice will one day be all dead..."
Posted by John W. Knapp on 05/23/2009 @ 09:05AM PT
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John, maybe attempting something like that last line would at least bring about honest reform - if nothing else, we'd finally be holding insurance companies responsible for their actions. After all, by delay or denying care or by changing care from what the doctor orders they DO in many cases (and quite a lot more than any insurance exec would like to admit to) cause disability or even death. I'm thinking it's time to move this out of the civil arena and into the criminal arena... They HAVE to know there are consequences and risks to their actions beyond what we're choosing is cheaper.
Posted by Danetta Amschler on 05/23/2009 @ 09:50AM PT
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If you give this to everyone - guess who suffers... the poor. The more we have to give this money to individuals that felt it was more of a 'necessity' to buy a 52" HD TV, than to pay for insurance, or save for a 'rainy day' - it's gonna be the disabled, the elderly... the ones who can't march in the mobs to demand more, more, more... who will lose out. They'll have to institute quotas - as they have in every country with socialized healthcare.
Things were great with Reagan. After Hillary 'fixed' it, it's much harder to get decent care. I talk from experience.
Posted by Bobby Steele on 05/23/2009 @ 02:24PM PT
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People aren't born with an equal amount of health or money to spend on health care. What good does it do society to have unhealthy people? If people are sick and contagious, they are likely to make others ill, causing great expense in both getting them treatment and in down time at their jobs.
If they are not contagious, their pain or incapacity will make them less effective as workers (and/or parents), again causing great expense to their employers and society.
As it was determined a long time ago, an educated population makes for a more productive society. Why is it so hard to understand that is even more true of health? How can one even get an education if one is sick (contagious or with a chronic disease)? How is this the fault of the person with the illness? (And, no, I'm not talking about people with self-induced illness: we need better education and other incentives to handle that problem.)
My understanding was that competition was supposed to improved quality and lower costs. Competition certainly doesn't seem to be doing this.
Medical care is not better; drugs are more dangerous; time with a doctor who actually listens is rare; prevention is rarely discussed (unless it involves a product like a vaccination which puts money in someone's pocket): need I go on?
Universal health care, like universal education seems like the only solution. As there are still problems with education, there will be problems with health care. But privatization of either of these has not led to perfection either.
Elizabeth Barrett
elizabeth.barrett@yahoo.com
Posted by ELIZABETH BARRETT on 05/23/2009 @ 11:57PM PT
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"My understanding was that competition was supposed to improved quality and lower costs. Competition certainly doesn't seem to be doing this."
The question here, Elizabeth, is where is the competition? Doctors get paid no matter what they do, or the quality of their work.
Businesses survive by creating systems. They have systems in place that govern product creation, user experience, value, and so on. If a company creates a better and more effective system than another company, then they have a chance of customers migrating to their business.
If a company loses customers to a competitor, then they need to adapt and change to draw them back, or they'll likely go out of business. They can do this by changing their product, lowering prices, adding to the user experience, or even all the above.
Mainstream medical practitioners all practice under the same system. Insurance companies don't generally pay for "alternative medicine," at least to my knowledge, and people can't afford to try it out, so they just go under the system that's there.
Since all doctors under the mainstream work under the same system, and the alternatives might as well be non-existant (especially with FDA regulations clamping down on them), there's no reason for providers on all levels to change anything. It works for them.
Change it by removing insurance from the equation and forcing health care providers to stand on their own two feet, and we'll see a change in how health care is provided to everyone else.
Posted by Mike Conway on 05/24/2009 @ 12:54PM PT
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Worker's Compensation is, at least in most states, a government mandated system that's operated by PRIVATE insurance companies in which employers participate. In many cases, it's not even the insurance companies in Worker's Compensation dragging their feet - it's the employers. This has little, if anything, to do with "government health care".
Private insurance companies already ration health care - they just do it by deciding who even gets access to the system AT ALL. Got a chronic illness, a disability, a risk factor for either of these? You almost certainly won't get insurance unless you go through employers.
Health Savings Accounts work mostly for those who are both young AND healthy - who can with reasonable safety bet that they won't get sick and who would almost certainly need their insurance at most for an annual bout of the flu or sinusitis and perhaps an annual exam...but hopefully NEVER anything major. Why? Because if you have any chronic conditions or have anything happen that requires major care or testing, the out of pocket will be flat out atrocious. It's this factor right here that quickly prices HSA's out of range for many, if not most, people despite any tax advantages.
Not everybody who can't afford insurance is greedy. I've never had a new car, any new furniture besides one new sofa, a TV larger than 21", or anything else that could fairly be considered wasteful. Yet I can't afford private insurance and never have been able to. Why? I have disabilities and I get quotes like $850/mo with specific exclusions for anything that even might relate to my disabilites, extra premiums because I'm female but specific exclusions for a whole lot of women's health services, no chance at all of getting a prescription rider, deductibles usually around $1000 or more per year and copays typically something like 80% of "reasonable and customary" in network or 50% of "reasonable and customary" out of network - but there are never any in network docs available - and this is of course, when I can get quotes at all thanks to my disabilities (since many companies flat out won't insure me or won't in many states).
Posted by Danetta Amschler on 05/24/2009 @ 11:58AM PT
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Danetta
I think this was in response to someone's comment. but I don't see the comment anymore. Anyway, you are right on the money. Anyone who thinks workers' compensation is a model for anything, let alone health care, is sorely misinformed or misguided.
Posted by james mcgee on 05/24/2009 @ 03:37PM PT
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There is something that many here either don't know, or choose to ignore. Not only do we pay more for health care per person than anybody else in the world. But we as taxpayers spend more per person of our tax dollars on health care , than is spent anywhere else on the planet.
Let me try to make that point a little clearer. if we drop off all of the money that corporations spend on health care, and if we drop off all of the money that we as private citizens pay out of pocket for health care, what is left is what our various federal, state and local governments pay for health care.
That amount per person, is more that what any other fully tax supported government health care system pays to deliver comprehensive health care services to ALL of its citizens.
Why? you may ask (I hope).
Because we can't let go of some of the notions that appear in the comments to Tim's post. The private sector does it better. People like my son who had an unfortunate encounter with a fire hydrant in New York City that landed him in the hospital for two days. There are some people, reflected in some of the comments here, who think he should have saved the $20,000 + to pay for that hospital stay. Or that some how in his semi-conscious state, he should have been a smarter shopper. He was fortunate to be a 24 year old employed with health insurance.
We keep experimenting with private sector Medicare ideas, even though they consistently have been 5-15% more expensive than traditional Medicare.
When we mix private sector approaches and public sector approaches we need rules to separate who passes through this door and who has to go through that door, and, oops, no door for you. Rules require bureaucracies and bureaucracies cost money. That's why, in a nutshell, our system is so expensive.
The beauty of Tim's post is that he is showing us that when we listen to the people, they tell us they like the government programs. Listen to the people and not to the knee jerk ideologues.
Everyone will be better off. Let common sense prevail over ideology. Or maybe I should rephrase that - Let the sense of the Commons prevail over the nonsensical.
http://thehealthcaremaze.wordpress.com
Posted by james mcgee on 05/24/2009 @ 04:06PM PT
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Let's talk about nonsense, james.
The reason that the people like the idea of government healthcare is that the medical industry alongside Medicare and insurance has done such a bang-up job of messing it up, so any solution probably looks good.
The funny thing is that the whole insurance thing was cooked up by the government. While it's run both privately and by the government, it's a government idea.
Now that we're in the weakened state we're in, we have the government stepping in and offering the desperate their own solution. They're saying "Don't worry, we'll take care of you, just turn it all over to us and you'll be fine." Well, desperate people will believe just about anything.
I'm leary about trusting the government with that kind of power, especially given their track record. I'd be willing to bet that the problems we're having right now will only be magnified once the g-men take over. There won't be enough money, and people will start getting turned away, just like before.
The true definition of insanity is doing the same thing over and over, thinking you'll get a different result.
Just because people want it, doesn't mean it's the right thing to do. Look at how many parents make their children fat by giving them fast food. That's not right, but that's what they do.
Let's pull ourselves off of the government teat and start taking care of ourselves. Throw off the regulations of the FDA and the AMA and let private medical industry and charity florish.
Posted by Mike Conway on 05/24/2009 @ 04:26PM PT
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Hmmm… Health Care for ALL Americans is Simple!
By Utilizing Existing Systems...
1) MERGE Medicare with Medicaide into one single "Income Based" system for poor and elderly citizens.
2) REQUIRE insurance companies to provide the same basic coverage for ALL Non-Medicare/Medicaide citizens, regardless of health status, at affordable rates.
3) ALLOW insurance companies to "Profit" by offering additional benefits and options to those who qualify and are willing to pay the difference.
As for Funding…
1) Changing from an "Emergency Treatment" to a "Preventive Care" system will save local communities billions, maybe even trillions of taxpayer dollars!
2) Consolidating, standardizing and utilizing existing systems will make administration more efficient and cost effective!
3) Small business will be able to compete globally and hire additional taxpaying employees!
4) Wealthy seniors will pay their fair share!
The Tremendous Burden on Future Generations will be Greatly Reduced!
Posted by John jpinsatx on 05/26/2009 @ 07:20AM PT
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Ladies and gents--
Although we've had a good conversation over the last few days, the tone of the most recent comments is getting a bit hot, and we appear to have pretty far downstream from the original topic. As such, I am closing this comments thread for this post for the time being.
Posted by Timothy Foley on 05/26/2009 @ 11:39AM PT
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