Universal Healthcare...an idea whose time has come??

[DuneAHH]

Punzy, you make valid points, just curious if you've seen these numbers and what you're take is on it?

The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis (14).
Hospitals provide about $34 billion worth of uncompensated care a year (14).
Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage (14).
The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300 (14).
The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices (11).

So, if the US were to move to a single pay healthcare system and indigents and
un-insured people were able to get preventive care, is it not possible that the funds saved could be given back to the physicians and hospitals in compensation?

Punzy -- or anyone -- know any stats on the numbers of ESSENTIALLY HEALTHY baby boomers that are turned down for health insurance due to that pre-existing condition called "LIFE"?? I personally know several people that can afford to pay for insurance but have been turned down on some inane premise. IMO...If the health insurance underwriters weren't so *&&&$$@@@" there could be many fewer uninsured folks --- therefore more ESSENTIALLY HEALTHY people paying premiums (& probably not making many claims) --- more money in the the till to cover the resulting fewer # of uninsureds (along the lines of Mango's rebate idea). Seems like a better business strategy....

The members of my family that work in the healthcare profession are constantly talking about skyrocketing use of ER's by the uninsured due to the fact that ER's are the only healthcare option for many uninsureds since ER's HAVE to provide treatment. The "charity" hospital where my family lives is CLOSING the inner-city hospital & rebuilding a whole brand new facility WITHOUT an ER in the "wealthier" area of town. It will end up forcing all the acute care onto the other "for profit" hospital in town. Don't see how the quality of care can help but go down in this scenario.

Reformation is needed...but I just can't get my arms around an already inefficient govt. administering a health care system.. That thought makes me sick enough for a visit to the ER .

 

[30A Skunkape]

Keep an eye on West Virginia's new Medicaid system. Here is a snippet from a recent New England Journal of Medicine article:

The redesign of the West Virginia Medicaid program has recently become a leading but controversial example of efforts to reward personal responsibility. West Virginia has a population of 1.8 million; as compared with the United States, it has a higher percentage of residents with Medicaid coverage and near-poor or poor incomes (see graphs). In May 2006, the federal government approved the state's plan to provide reduced basic benefits to most healthy children and adults who are eligible for Medicaid because of low income while allowing them to qualify for enhanced benefits by signing and adhering to a "Medicaid Member Agreement" (see box).3 The enhanced benefits include all mandatory services as well as additional age-appropriate services that focus on wellness. Examples include diabetes care beyond basic inpatient and outpatient services, cardiac rehabilitation, tobacco-cessation programs, education in nutrition, and chemical-dependency and mental health services. Under the basic plan, prescriptions are limited to four per month; under the enhanced plan, there is no monthly limit. According to Nancy Atkins, the commissioner of the Bureau for Medical Services in the West Virginia Department of Health and Human Resources, the goals of the redesign are to streamline administration; tailor benefits to specific groups; coordinate care, especially for members with chronic conditions; and "provide members with the opportunity and incentive to maintain and improve their health."

To remain in the enhanced plan, members must keep their medical appointments, receive screenings, take their medications, and follow health improvement plans; West Virginia will monitor "successful compliance with these four responsibilities."3 Members whose benefits are to be reduced because they have not met these criteria will receive advance notice and have the right to appeal. Those who meet their health goals will receive "credits" that will be placed in a "Healthy Rewards Account" to be used for purchasing services that are not covered by the Medicaid plan. Although details about how these accounts will work and what services will be eligible for purchase are forthcoming, the services might include fitness-club memberships for adults or vouchers for healthful foods for children. In July 2006, transition to the new plan began in three West Virginia counties; the program will eventually include about 160,000 people ? or about half the state's Medicaid beneficiaries. Beneficiaries who are 65 years of age or older or who have disabilities will retain their current level of coverage, as will some others, such as children in foster care.

 

[Beach Runner]

I personally know several people that can afford to pay for insurance but have been turned down on some inane premise.

I know several people (including people in their 20's) who can't get private insurance because they've taken an anti-depressant in the past. If these people don't get a job with group health insurance, they're screwed.

For example, I know a healthy woman who was covered under her husband's insurance (she didn't work). He divorced her, and because she had taken an antidepressant during the divorce, she can't get health insurance. She's gotta find a job with group health insurance, or else she'll be a bag lady if she gets a serious illness.

 

[DuneAHH]

I know several people (including people in their 20's) who can't get private insurance because they've taken an anti-depressant in the past. If these people don't get a job with group health insurance, they're screwed.

For example, I know a healthy woman who was covered under her husband's insurance (she didn't work). He divorced her, and because she had taken an antidepressant during the divorce, she can't get health insurance. She's gotta find a job with group health insurance, or else she'll be a bag lady if she gets a serious illness.

One of my friends got rejected for the same reason...rejected for a temporary situation. If that's a problem for the insurer, it's beyond me why they couldn't still insure w/ a particular exclusion?.

 

[Mango]

Now Skunky, a plan like that W. Virgina one has possibilities nationwide for people seeking standard healthcare.
I don't understand why clinics can not be set up with Physicians Assistants with a doctor on staff for them to consult in the event they have questions?

I've met many a P.A. who had quite a bit of experience and for follow up, they are invaluable.

 

[6thGen]

I don't have the attention span for reading through all of this, but I will state that if we got rid of the FDA, drug prices would be lower, drug companies would have many more options, treatments and cures, and fatalities from poor drugs wouldn't hold a candle to fatalities resulted from the drugs that make it to market years later and the drugs that never make it to market. Anyway, just wanted to throw that in. Carry on.

 

[rapunzel]

And this, my friends, is why we'll never get anything done. Our lefty friends jump in with their perspectives on providing healthcare to the uninsured, our righty friends advocate throwing out all consumer protection services provided by the government. People with a strong political perspective come to the issue with their minds made up. They muddy the waters for everyone else.

From my perspective, I have seen the best surgeons go into plastics instead of neurosurgery because they want to make money. I have seen the lobbying efforts of HCA, Tenet, Pfizer, Astra Zeneca, et.al., as well as some medical specialties such as orthopedic surgery and cardiology pay off a hundredfold. I have seen the chilling effect of the Medicare fee schedule on physician encounters.

For those of you who don't like the fact that your doctor doesn't spend more than fifteen minutes for you, does it help you to understand why now that you realize they are paid $33.18 per encounter and all their staff and overhead must be paid out of that? Does it bother you that the best doctor in a market is paid at the same rate as the worst? Well, that is what the Medicare fee schedules conversion to a relative value scale allowing insurers to use it to pay providers has done. The only way for a doctor to make a better living for himself is to see more patients. That is not the way a free market works. As I've stated before, we already have nationalized healthcare -- it is just administered by insurance companies and hospitals and drugs remain unregulated. It's not working. Quality of care has gone down for most Americans in the last ten years, the cost of that care has gone up. It's the very lack of a market driven system that has caused these problems. There is no correlation between what is charged for things and what they cost, the quality of service has not impact on what can be charged for that service.

As for those of you who have family and friends that can't get coverage, I respectfully disagree. They can get coverage, it just costs too much. It costs so much because they underwrite into groups that spend as much as those premiums plus 3-5% as a group. Those charges are completely out of touch with reality because the party that pays the bills is not the party that consumes the services.

No one in this country goes without healthcare. The last surgical group I managed did 10% of their $80,000, best in the world, breast reconstructions for free. If they are truly poor, they qualify for Medicaid. If they are not poor enough for Medicaid, they have been priced out of the market for healthcare by the problems with our over-regulated system and it's lack of consumer-driven decision-making. If they can afford a haircut, they can afford to pay $35 dollars for an office visit and $4 for a prescription.

 

[rapunzel]

Incidentally, this is an excerpt from a previous post to which I've referred above...

We have three healthcare systems in America. If you divided the population into three tiers based on socio-economic levels (and to some extent the states they live in - in Kansas, Missouri, and California only the top 2-3% have first tier care).

If you fall into the first tier -- you have ample personal reserves, good insurance coverage with out of network benefits or a healthcare spending account and a hospital/surgical indemnity policy, and possibly are a member of a boutique medicine clinic -- you have the best healthcare in the world and it is two to three times better than what you'd get anywhere else in the world.

The second tier (from about the 20th to 80th percentiles) have access to healthcare through insurance coverage that has limited out of network benefits and a provision that it's reimbursements are tied to the government's fixed prices for Medicare and you are responsible for any difference in costs if you go out of network for care. People in this group basically already have social medicine, it is just administered by private companies like Blue Cross, United Healthcare, Humana, etc. These people get adequate care, but the insurance companies make it so difficult and expensive for doctors to deviate one bit from the basic standard of care that it is the rare patient that gets the best care available. The patients in this group get care comparable to what is available in Canada and Great Britain, etc.

The third tier is uninsured or undersinsured with so little in the way of personal reserves that they may actually be worse off than people who qualify for Medicaid. These people often can't afford to see private doctors and end up in public indigent clinics or emergency rooms. After seeing these doctors, they often can't afford the medicines prescribed for them. The people in this bottom group have some of the worst healthcare in the developed world.

The reason this is all so disgusting is that we spend so much for healthcare that everyone of us should have top tier care. The third party payors and hospital-pharmaceutical complex combined with a government that doesn't understand the industry they are regulating cause so much waste and misallocation of resources as to make it laughable. That's why I don't support any of the single payor models for universal healthcare.

 

[scooterbug44]

As for those of you who have family and friends that can't get coverage, I respectfully disagree. They can get coverage, it just costs too much.

No one in this country goes without healthcare. If they are truly poor, they qualify for Medicaid. If they are not poor enough for Medicaid, they have been priced out of the market for healthcare by the problems with our over-regulated system and it's lack of consumer-driven decision-making. If they can afford a haircut, they can afford to pay $35 dollars for an office visit and $4 for a prescription.

I know people who COULD NOT get coverage because of preexisting conditions. They wanted it and knew they would need it and could not afford their medical bills without it. Cost was not the issue, finding someone to insure them was.

People in this country DO go w/o healthcare. I don't think you appreciate how "truly poor" you need to be to qualify for Medicaid. My grandmother is a widow on a fixed income and my mother had to do some financial maneuvering to get her to qualify. Gma isn't out catching rays on the Riviera, she shares a 2 bedroom home w/ 2 children and a grandchild. She prepaid her funeral costs so she was "poor" enough for adequate medical care! If you are old and have any savings or assets you do not meet the qualifications. $35 for an office visit and $4 for a prescription doesn't sound like too much to pay...........except that's not what it costs. People pay hundreds of dollars for prescriptions, even w/ insurance coverage, and old people having to chose between food and medicine is not some political hyperbole.

I am a healthy person whose only medical expenses/incidents are regular dental & medical checkups, birth control pills, and the occassional sports injury. I pay almost $200 a month for that basic care and also have to pay for my prescription out of pocket because it's not covered under my health care (ironically neither is pregnancy, though I can't think of a more basic female health issue.) The last time I went to the doctor for a follow up on an injury, I was seen by a PA for almost 10 whole minutes and the charge was $170. No x-rays, prescriptions etc. I consider myself a middle/upper middle class person w/ above average medical care.

My sympathies obviously does not lie w/ your doctor friends who do $80,000 boob jobs (those must be pretty impressive) or the pharmaceutical companies who I believe are ruining the health care system. I think malpractice insurance is a major problem and sympathize with doctors about that, but overregulation is not. Even w/ the FDA controls you feel are too strict, drugs are constantly being recalled and restricted for their side effects.

 

[Mango]

Well lets not go getting our panties in a wad here. I am sure Punzy knows what the Medicare schedule is and who qualifies. Even though Skunk is a doc and Punzy is in industry, I have always found them to be objective and Skunky always looking for the least expensive route to treat someone which I find admiral.

I can certainly understand the 15 minutes with a doc. Between what my plan pays and my co-payment I often wonder how some of the stay in business. My doctor did it for a long time and eventually has gone to not even accepting insurance anymore.

But Punzy, where can someone go to a doctor for $35 who doesn't have insurance? In New York you can not even see a vet for that price.