Health Care Reform

[BobHamburger]

So, my friends out there in LAVAland, you must have all noticed that I've been posting a bit more over the past few days. As I mentioned in this posting, I've had some medically-enforced time off lately, and I've been told not to do any work at home. Which leaves me with time on my hands to ponder life, the universe, and everything.

I logged on to my health insurance provider today to look at my claims history. I was horrified to see that my 5 day hospital stay, triple angioplasty, and associated tests and physician charges totaled to roughly $95K. Of course, that's not the negotiated amount that the insurance company will be paying; that figure is closer to $22K. Still a lot, but not almost six figures. A Chevy vs. a Benz. Let's think about this for a second. The hospital etc. will accept 25% of the full retail charge and consider that complete payment. My cardiologist and the rest of his buddies are still making a tidy living from the Medicare-agreed-upon standard rates.

This is simply not right. The health care system has a two-tier pricing system: they agree to heavily discount (or charge appropriately, depending on your viewpoint) the group of patients who can guarantee payment, and the people with no insurance get royally screwed. I've heard the arguments before: hospitals get stiffed so often by cash customers that they need to recover the costs wherever they can. Maybe it's the only way they can keep operating, but I'll say it again: this is simply not right.

EDIT: just in case you were wondering, my out-of-pocket cost for this escapade is the $200 hospital stay co-pay. Everything else is covered 100%.

Edited December 4, 2009 by BobHamburger

[PaulG.]

Oh, gosh darn. You must think I'm a sucker. OK. I'll bite.

Don't feel guilty because you have good health care insurance. You work for a living. And from what I gather you are a typical engineer who has worked most or all of your adult life, paying your half of health care premiums for all these years. Now, after a long and very productive career you find yourself pushing 50 and having health "issues".

Don't sweat it. Don't worry about it. And again, for God's sake don't feel guilty about it. You have already PAID FOR your RIGHT to health care.

If you think a socialist government health care system can do better I pose a question: name one program. ONE. ONE program the government - ANY GOVERNMENT - has taken over and made better or more cost-effective or fair. One program. Any country. Any time in history. Just one.

I don't think you can. And if you think the US government can (for the first time is history) do better I'll freely give you this: If our government comes up with health care reform I will support it 100%, NO QUESTIONS ASKED on ONE condition: that any health care system they come up with MUST provide the same level of health care coverage for the welfare mother with children in inner-city Detroit as it does for 0bama and the rest of the elite in Washington.

Fair enough?

PS: Looking forward to many, many years of banter with you here, Bob. I just hope someday you and I can argue about something that relates to LabVIEW.

Edited December 4, 2009 by PaulG.

[Val Brown]

OK, so here's a comment and an example of system that works and, at worst, works far better than any of the US systems. I live in British Columbia, Canada and, because I'm a "Landed Immigrant", have complete access tot he health care system. I just got my free vaccine for H1N1 yesterday -- the whole process took maybe 15 mins. No matter what you may believe -- because of what you've been told by US media, the Canadian health care system works.

[jcarmody]

[...] Which leaves me with time on my hands to ponder life, the universe, and everything.[...]

I don't want to ruin your recovery plans, but the answer to that has already been figured out.  It's 42.

Jim

[Cat]

I don't want to ruin your recovery plans, but the answer to that has already been figured out. It's 42.

Darn! You beat me to it!

If our government comes up with health care reform I will support it 100%, NO QUESTIONS ASKED on ONE condition: that any health care system they come up with MUST provide the same level of health care coverage for the welfare mother with children in inner-city Detroit as it does for 0bama and the rest of the elite in Washington.

Fair enough?

I'm surprised. That's definitely fair enough. Every American should have the option of having just as good health care insurance as their tax dollars are providing their elected representatives.

I had a surreal conversation with someone a few weeks ago on this topic. She was adamently opposed to any sort of gov't intervention in the health care system in any way shape or form. I asked her what she would do if she lost her job and her health insurance and got sick. "Go live with family and have them take care of me" was the reply. Then I asked what she would do if she didn't have any family. She replied, "I would just go off somewhere and die."

Well, alrighty then...

[BobHamburger]

I asked her what she would do if she lost her job and her health insurance and got sick. "Go live with family and have them take care of me" was the reply.

This illustrates how most people are either ignorant of -- or in complete denial about -- the absolutely crushing costs to which they could be subjected. A simple hospital stay and surgery and you're looking at a $100K bill. This kind of thing would financially wipe out most middle-class families.

[Francois Normandin]

If you think a socialist government health care system can do better I pose a question: name one program. ONE. ONE program the government - ANY GOVERNMENT - has taken over and made better or more cost-effective or fair. One program. Any country. Any time in history. Just one.

Hi Paul,

I really like your combativity in those lounge subjects... but I can't resist to bite too because I sit on the other side.

In Quebec (Canada again), the government introduced a universal childcare system where parents can, for a meager 7$ a day, leave their children in the good care of professionals while they go to work. This measure has grown in popularity so much that A- we need to create hundreds of new childcare centers every year (6 millions population); B- the average price in the private system is 40$ a day; C- after a stagnation of the percentage of women joining the workforce, their number has started to increase again, thus increasing overall productivity and D- there's a baby boom (finally) that's gonna be needed to take care of the babyboomers that will all take their pension soon and will very likely get massively sick in about 20 years. There are also some side effects that are difficult to pinpoint exactly because the causes are multiple, but one can't help to notice that child molestation has dropped steadily since the implantation of those childcare centers.

[Grampa_of_Oliva_n_Eden]

Years ago I made a living serving computers with many of my customers being hospitals. So while backups were running I'd talk to the administrators. There main use of the computer was to keep track of who was paying and who was not. They didn't really care about not getting paid because of teh Good Samaratan Law the state reimbersed them for the non-payers. My point is that required health care has been available. Yes it was only available thru the emergencies rooms. (I'll try to get back to that).

Rather than throw up a cloud of examples of where the US government (apart from the miliraty) has never done anything right, I'll focus on what the one condition under which I would go with gov't health care.

Under the current situation the American Indians are covered by a Us gov'g run health care system. On the reservation there is a saying "Don't get sick after July" (I may have the month wrong). This saying is due the the fact that after the years funds have dried up, there is nothing to pay for any supplies.

Before we even think about doing anything about health care for anyone else, I feel the US is obligated to come thru with a good system for the Indians. So why dift off to the Idians?

When the American Indians recommend the health care provided by the US gov't, then I'll concidering going along with it.

Live up to our existing obligation before we commit to more.

Ben

[Antoine Chalons]

I think many people in the US don't really know how their health system works. In september I was reading an article in French (or maybe it was Swiss) paper about it.

The global picture I remember from the article is this :

- 47 millions people in the US don't have any health insurance (16% of the people),

- there are two "special systems", one for people over 65 and invalids and another one for the poorest people and handicapped (20% of the people), these two systems cost $500 billions,

- the 64% left have an insurance either paid by the employer (who gets big tax discount when they pay for health insurance) or by themselves.

The state puts "some" money (don't know how and how much) in the system but most US citizens ignore that.

Overall it's a very expensive system (only 2 countries have a system less efficient: Turkey and Mexico).

All the above is not what I think, but what I remember from what I read. I can't really verify all this, and I learned to not believe everything I read.

I can talk about the French and Swiss systems, they are quite different from one another, but the basic idea of both is roughly that whoever works gets a health minimal insurance and can decide to pay for a extension (which of course covers more) and those who don't work get the minimal insurance paid by the state and can also pay for an extension to have a better protection.

That seems rather fair to me that people who work and people who don't get the same minimal protection, that means basically that people who work pay for those who don't ; this is called solidarity.

In France, money is taken from the salary (it's an insurance tax) and the state is managing the minimal insurance, the extension are private companies.

In Switzerland they separate accident insurance from health insurance, the accident insurance is paid by the employer (that's compulsory for the employer) and those who don't work have to get a private accident insurance (this is surprisingly cheap). I don't really know of the Swiss health insurance works because being French and working in Switzerland I don't get the French health inurance, I get the accident insurance (which I use a lot because I play rugby) paid by the company and and paid for a private heath insurance that covers the same as the french minimal one.

Now what's fair and what US citizens what... I'm not going to judge on that. Like Val I'm just saying some systems do work so feel free to have a look and get inspiration to try to make an even better system.

[PaulG.]

OK, so here's a comment and an example of system that works and, at worst, works far better than any of the US systems. I live in British Columbia, Canada and, because I'm a "Landed Immigrant", have complete access tot he health care system. I just got my free vaccine for H1N1 yesterday -- the whole process took maybe 15 mins. No matter what you may believe -- because of what you've been told by US media, the Canadian health care system works.

Maybe Canada's system works well for you where you live. Call me skeptical. I've heard numerous stories from people in Canada who have a lot of complaints, mostly due to having to wait for specilized care. Besides, if the Canadian system works that well we should be hearing a lot of folks in Washington talking about modeling it. That's not the case.

[hooovahh]

If you think a socialist government health care system can do better I pose a question: name one program. ONE. ONE program the government - ANY GOVERNMENT - has taken over and made better or more cost-effective or fair. One program. Any country. Any time in history. Just one.

While I generally agree with you I would like to make an argument for the US post office. I realize they are not the most cost-effective. But I still find it amazing that for $0.42 I can mail a piece of paper across the country in a few days.

That being said when was the last time I had to mail a letter where I could just as easily send information electronically instead. Wonder if it's possible to just get rid of the post office for mailing paper. Could the post office be replaced with a more digitized version where people email/fax letters to send, and they can email/fax/deliver the information. Then we wouldn't need mail trucks to deliver documents from a city to another, just have the a document email from city to city, and then delivered that way. I'm sure there's alot of problems with what I said and someone has surly thought of it before me.

[Grampa_of_Oliva_n_Eden]

While I generally agree with you I would like to make an argument for the US post office. I realize they are not the most cost-effective. But I still find it amazing that for $0.42 I can mail a piece of paper across the country in a few days.

That being said when was the last time I had to mail a letter where I could just as easily send information electronically instead. Wonder if it's possible to just get rid of the post office for mailing paper. Could the post office be replaced with a more digitized version where people email/fax letters to send, and they can email/fax/deliver the information. Then we wouldn't need mail trucks to deliver documents from a city to another, just have the a document email from city to city, and then delivered that way. I'm sure there's alot of problems with what I said and someone has surly thought of it before me.

My Father is retired US post office. The ineficiencies drove my Father crazy so he retired at the frist oppertunity. AS I understand it that 0.42 cents sponsored by tax dollars.

Back about 1980 the US PO was offering a service where mailing could be sent electronically and printed at the local office (it ran on a PDP 11/44 and used RM03 RM02 disk drives). From what I hear from buddies still in the buisness the hardware has been upgraded and is still available. It lets them send out up to date info.

Ben

Edited December 4, 2009 by neBulus

[PaulG.]

My Father is retired US post office. The ineficiencies drove my Father crazy so he retired at the frist oppertunity. AS I understand it that 0.42 cents sponsored by tax dollars.

Back about 1980 the US PO was offering a service where mailing could be sent electronically and printed at the local office (it ran on a PDP 11/44 and used RM03 RM02 disk drives). From what I hear from buddies still in the buisness the hardware has been upgraded and is still available. It lets them send out up to date info.

Ben

The reason postage keeps going up is that the PO needs to keep buying more of those little signs that say: "Next Window Please"

[Gary Rubin]

I've heard numerous stories from people in Canada who have a lot of complaints, mostly due to having to wait for specilized care.

That can be the case here too. I have a friend who's a kidney doc in Oregon. He's in a private practice with 3 or 4 other doctors. Last I talked to him, they were looking to hire another doctor to try to help alleviate the 3 months that their patients had to wait to get an appointment.

Also, some doctors are being driven out of the market by the current system.

• The OB that delivered our first kid had to throw in the towel because she couldn't afford the malpractice insurance. From what I heard, it was cheaper for her to become a stay-at-home mom than a practicing OB (at the workload she was interested in working).
• In the family practice that we see, most of the MD's have switched to concierge medicine in order to avoid dealing with the insurance companies. We now typically see physicians assistants, who are overseen by those MDs.
• Before he switched to concierge medicine, my doctor stopped working with the insurance company my employer used at the time. He told me that it was just not worth it. The straw that broke the camel's back was when he received recognition from the insurance company as one of their "top providers". The next month, he received a letter from them saying that he was providing too many expensive services and all of his claims would have to be pre-approved by one of their doctors. I had to find a new practice until my employer switched insurance providers the next year.

I think all of these are signs that the current system needs some work.

[PaulG.]

I think all of these are signs that the current system needs some work.

I guess I have been extremely blessed. The only beef I have had with health coverage are the huge deductables. Fortunately my current plan has no deductable so I don't even have that to complain about at the moment. And the few times I've needed care I got it and got it quickly.

If we had a strong and healthy economy with less regulation a lot of these issues would resolve themselves through competition between insurance companies.

The government absolutely cannot fix these problems by taking control of the health care system.

[JasonXCX]

In France we have "securité sociale" health universal insurance . As a worker I pay a third of the cost my employer 1/3 and state 1/3.

For the unemployed it is free . I pay a small amount for a complementary "mutuelle" a kind of co op to have a private room at the hospital and about 100 % coverage. I had to stay a week at an hospital for surgery of the knee it cost me nothing . The surgery was first class performed by a famous surgeon . The system is costly of course but the big huge problem come from private insurance compagny they want to make money with health and they are lobbying very hard to break the system ( born in 1946) They have already some succes with our new president . By exemple he decide a special tax for the coop and he is trying to downsize the public hospitals ( universities ) to favorise the private one .

The total in GNP is about 14% the US one is about 16% ( to be verified ) . And medical studies , as all universties studies are free .

In France we have "securité sociale" health universal insurance . As a worker I pay a third of the cost my employer 1/3 and state 1/3.

For the unemployed it is free . I pay a small amount for a complementary "mutuelle" a kind of co op to have a private room at the hospital and about 100 % coverage. I had to stay a week at an hospital for surgery of the knee it cost me nothing . The surgery was first class performed by a famous surgeon . The system is costly of course but the big huge problem come from private insurance compagny they want to make money with health and they are lobbying very hard to break the system ( born in 1946) They have already some succes with our new president . By exemple he decide a special tax for the coop and he is trying to downsize the public hospitals ( universities ) to favorise the private one .

The total in GNP is about 14% the US one is about 16% ( to be verified ) . And medical studies , as all universties studies are free .

[crelf]

The government absolutely cannot fix these problems by taking control of the health care system.

My understanding is that the public option that most people are getting their knickers in a twist over is just a non-profit, no-cost competitor in the health insurance pool. It's not the government controlled healthcare, and it's not socialist (if it were socialsit, the government would own and control all the hospitals, doctors, nurses, drug companies, etc).

In France we have "securité sociale" health universal insurance . As a worker I pay a third of the cost my employer 1/3 and state 1/3.

We have universal free healtcare in Australia, and we also have a parallel competitive private healthcare system. If you want to use the free healtcare system, you might need to wait longer for an elective proceedure (emergency proceedures are taken care of immediately of course). If you don't want to wait for an elective proceedure, or you want to choose your own doctor, or you want a private room in a hospital, you can take out private health insurance. It costs employees between 0% and 2% (depending on thier salary level) of their salaries ot fund the public system - and if you private health insurance (and are therefore not a burden on the public system) you pay 0% to support the public system.

One thing that amazed me when I came to the USA is how low taxes are here - I pay less than half the prorata tax here in the US than what I paid back home. I'm not surprised that the level of service and number of programs offered per captia is lower here - it's because you're paying less into them. I'm not saying that's good or bad, just pointing out the way it is.

That being said when was the last time I had to mail a letter where I could just as easily send information electronically instead. Wonder if it's possible to just get rid of the post office for mailing paper. Could the post office be replaced with a more digitized version where people email/fax letters to send, and they can email/fax/deliver the information. Then we wouldn't need mail trucks to deliver documents from a city to another, just have the a document email from city to city, and then delivered that way. I'm sure there's alot of problems with what I said and someone has surly thought of it before me.

USPS deliver (pun intended) far more services than letter envelope delivery. I'd like to see you electronically deliver a package to someone

Don't sweat it. Don't worry about it. And again, for God's sake don't feel guilty about it. You have already PAID FOR your RIGHT to health care.

I may have misinterpreted Bob's post, but I don't thin khe's feeling guilty. Also, I don't think healthcare is a "right" if you only qualify to that right by paying for it.

If you think a socialist government health care system can do better I pose a question: name one program. ONE. ONE program the government - ANY GOVERNMENT - has taken over and made better or more cost-effective or fair. One program. Any country. Any time in history. Just one.

Firstly, what's being proposed (as far as I can tell) isn't socialist (see my socialism comment above). It's been branded socialist be a lot of media that are politically backed to try to not get the current flavor of healthcare reform through. Secondly, the Australian piblic healthcare system works pretty well - sure, like every system, public and private, there are inefficiences and yucky stories, but in general it's served millions of people well over the years - there's your one program, any country, any time in history. I'm sure there are examples of others.

I don't think you can. And if you think the US government can (for the first time is history) do better I'll freely give you this: If our government comes up with health care reform I will support it 100%, NO QUESTIONS ASKED on ONE condition: that any health care system they come up with MUST provide the same level of health care coverage for the welfare mother with children in inner-city Detroit as it does for 0bama and the rest of the elite in Washington.

Oh, I'm toally for that! I *think* that the current system being suggested *could* achieve that if it's implemented properly. My understanding is that the pubdits in Washigton could choos ethe public option if they wanted to. That said, some republicans are trying to introduce a limitation on the public option in that it only be available where private options aren't competitive - if that gets in there, then I don't expect your wish to come true.

[BobHamburger]

I may have misinterpreted Bob's post, but I don't think he's feeling guilty.

Absolutely correct, Chris. I don't feel guilty one bit. I've been paying into this system for almost 30 years, and now I need to use it; seems to me this is the whole basis of insurance. I put up money and I say, "Bet ya I'm gonna get sick!" The insurance carrier counters with, "Bet you're not gonna get sick!" One of the things that's not right about the current system is that insurance carriers sometimes drop customers just when they need the coverage. I don't even understand how that can be legal, but we hear horror stories all the time of people who get their policies canceled just as they get diagnosed with cancer or some other chronic, expensive-to-treat condition.

[Irene_he]

I love the place I live here in Canada, but one thing I have to say, it does take a long time to book any appointments with Doctors. Getting a family doctor is hard here too, for a couple of years I just used walk in clinic for no family doctors would accept new patients. Like today, I have called the doctor's office more than 5 times and phone has only message saying (a woman's voice) "I am away from my desk or busy with other patients, if you need emergency service, please go to xxxx hospital" . So I gave up, like everytime before, I have to postpone my pain checkout, and then ignore it until it comes back and try the doctor's phone again in case someone does pickup the phone... The hardness getting an appointment make me skip lot of checks already for not bothering myself or wasting time. But now that I think I am going to call doctor again very early in the morning tomorrow and telling them that I am very painful and feel dying (but only if I can even get hold of the phone. ) Or have to go in person to the doctor's office to just get an appointment.

It is said many Canadian doctors are moving to US. We don't have enough doctors here.

[crelf]

It is said many Canadian doctors are moving to US. We don't have enough doctors here.

So it's not the healthcare system that's the issue per se, it's the lack of doctors. That's a pretty common issue irrespective of what country you're in - areas of low population generally have an even lower percentage of doctors. Often local communities throw together extra money to entice city doctors out to the rural areas, even for a couple of years at a time. I know a few of the more remote areas in my homeland rotate a lot of younger city doctors every few years - it actually works out well for them: they get docs with the latest training (and 5 - 10 yrs experience), and the docs get a taste of the outback. The drawback is that there's less contiguous interaction between doctor and patient, but you can't have everything

[Irene_he]

So it's not the healthcare system that's the issue per se, it's the lack of doctors. That's a pretty common issue irrespective of what country you're in - ...

I get an appointment just next week by check in person and telling the pain. So I am happy now, feel life is safer now. I think doctors are really very busy, the lists are really full.

[crelf]

Besides, if the Canadian system works that well we should be hearing a lot of folks in Washington talking about modeling it.

Take what's good from it and discard what's not, I say.

[jcarmody]

So it's not the healthcare system that's the issue per se, it's the lack of doctors.  That's a pretty common issue irrespective of what country you're in [...]

Lack of supply is a common issue irrespective of what commodity you're talking about, when artificial price controls exist.

[Irene_he]

...... but you can't have everything

If human is created with the mind and desire of owning everything, but not the reality of possibilities, then is this a feature or a bug?

[John Lokanis]

Lack of supply is a common issue irrespective of what commodity you're talking about, when artificial price controls exist.

Be careful where you take this argument. There have been several studies (listen to this: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1320 or read this: http://www.npr.org/templates/story/story.php?storyId=113571111 and this: http://patriciashannon.blogspot.com/2009/10/telltale-wombs-of-lewiston-maine.html) that have shown increasing the number of doctors does not increase the level of care or access to care, but just the cost of care. The reason is, if you put too many doctors into one population area, the doctors will lower their thresholds on what procedures they will do in order to keep busy. You see, the rate of medical needs in a fixed population is constant. But a doctor need to pay their staff, their rent, their student loans, etc... So, if they don't have enough to bill for, they will (whether they are aware or not) start ordering tests or doing procedures for people that might not really need them.

There are some European countries (Germany, I think, does this) that licence doctors to practice in certain areas in order to avoid over supply of medical services.

Also, another study by Johns Hopkins university (http://www.marketwatch.com/story/us-health-costs-highest-malpractice-no-factor-study) found that one of the primary drivers of high medical costs was the income level doctors required in the US. Medical malpractice insurance/claims only accounted for 0.5% of the rise in costs. They also stated that while doctors in the US routinely make ~$200k, they could not find a doctor in other countries who make over $100k (USD). The underlying reason for this was the high cost of eduction and the huge loans that someone graduating with a medical degree in the US is saddled with. This can often exceed the cost of a mortgage on a nice home. In the European countries they studied, higher education was free.

So, one way to bring down the cost medical care in the US would be to fund education for people wanting to pursue a medical degree while also controlling the number of medical licences to practice in a given geographical area based on population.

Also, changing from a fee for service to a salary based reimbursement system for doctors would remove the financial incentive to over prescribe treatments.

Doctors might end up less wealthy and the golf industry might suffer, but the rest of us would likely have better and more affordable health care.

Unfortunately, the current bills in congress do not address any of this. Why? Because there is no profit in it for anyone (especially the lobbyists)