Time For National Health Care In US?

[kevmicsmi]

Consider how the cost of malpractice insurance is driving ob/gyns in Virginia out of business... and making it harder for women with high-risk pregnancies to find care even from those who stay in business because the doctor doesn't want to risk a law suit.

I absolutely agree.

 

[SoyLeche]

I agree. Anyone who has ever had a windshield replaced knows one of the first questions they ask is" is this going to be a claim on insurance?" When you answer yes, the bill triples!!!!Insanity!

Looking at the hospital bill from the birth of my son, Insurance covered a WHOLE LOT of it. There was no incentive for me to try and find another hospital that could have done an equally good job for cheeper, because I would have paid the same either way. I like my insurance covering costs like this, though, so I'm not sure what the answer is.

 

[kevmicsmi]

Looking at the hospital bill from the birth of my son, Insurance covered a WHOLE LOT of it. There was no incentive for me to try and find another hospital that could have done an equally good job for cheeper, because I would have paid the same either way. I like my insurance covering costs like this, though, so I'm not sure what the answer is.

Understandable, but I think most people think the problem is we need to socialize medicine. In my view, the problem is it is already too socialized.

 

[Ernesto]

A lot of people moan about our health service over here (in Britain), but I'm not sure why. I think it's a fantastic idea...not having to pay every time you have an operation? Great!

 

[jeffrey]

One thing that bothers me is, as stated before I believe by Phil, is the middle class will foot the bill for any government sponsored health care. With a wife and 3 kids, I cannot afford to pay for mine AND someone who does not work, which through taxes, you end up doing.

 

[SoyLeche]

One thing that bothers me is, as stated before I believe by Phil, is the middle class will foot the bill for any government sponsored health care. With a wife and 3 kids, I cannot afford to pay for mine AND someone who does not work, which through taxes, you end up doing.

I have a hard time jumping on either side of this one, mostly because I am fairly well off, with a good job that has good benefits. I don't know what it is like for those who are not as well off as me. I know there is definately a problem, but I have a feeling that I personally am better off now than I would be under a nationalized system. That is a selfish way of looking at it, though... so I mostly don't discuss it.

 

[jeffrey]

SL, not selfish, you must think of your family 1st. I make decent money. But without much benefits. I've seen family insurance go up 5 fold with bigger deductables in just the last few years.

 

[Booko]

I agree something needs to be done, but I think the problem stems from the enormous cost to become a doctor, along with the abuse of the insurance system by doctors and patients alike. I would like to see more medical savings accounts, or incentives from insurance companies to consumers on the cost of care purchased. I really feel that if people had incentive to find the best value of care from a doctor, the medical field would quickly become more competetive in pricing.

The medical field is already competitive in pricing, kev. They do so by cutting the amount of time they spend with the patient, which results in bad or no diagnoses, and bad treatment.

As for hospitals, you should see how they make competitive pricing decisions. I should know -- I wrote the bloody programs hospitals use to make them. They analyze how much money they can get out of a "bed" taking into account how much reimbursement they can get from insurance companies, how fast they move patients through. They look at doctors to see who orders tests how much, and they CUT the ones who don't order uneeded tests, because it's the lab work and tests that bring in the dough from the insurance companies. The cut areas of treament that don't bring in the money. Ob/gyn areas are considered loss leaders, but necessary to get other patients to show up in other areas.

Oh, I'm only getting started, as this is just the hospital pov...do you see how "competition" is making things *more* expensive and not less?

I worked for 20 years in the healthcare industry, seeing every angle short of cutting open patients myself. I've worked for pharmaceutical companies, individual docs, hospitals, equipment manufacturers, you name it. I got to watch 20 years of where the money circulates and how decisions are made. The patient has little to nothing to do with most healthcare "business" decisions.

imnsho our healthcare system is irretrievably broken, and any attempts to fix it thus far have been tantamount to cutting open a patient from neck to pubic bone, sticking a butterfly bandage on him, and then shoving him out the door and telling him to walk home.

We have no hope of fixing our system until we stop viewing healthcare as a "business" and a "product" and start thinking of what our goals are in terms of keeping humans healthy.

And to start with, we can't possibly do that while still throwing sops to moneyed interests.

 

[Booko]

Understandable, but I think most people think the problem is we need to socialize medicine. In my view, the problem is it is already too socialized.

I don't think it's possible for me to disagree more.

Whatever socialization we have is terribly inefficient, I grant you that. But were we to remove those elements, our system would still be dysfunctional and expensive.

I'm not convinced that just turning it over to government is the best answer either, especially given the state of governmental institutions at this time, but letting the free market rule hasn't exactly done us much good either.

 

[kevmicsmi]

The medical field is already competitive in pricing, kev. They do so by cutting the amount of time they spend with the patient, which results in bad or no diagnoses, and bad treatment.

As for hospitals, you should see how they make competitive pricing decisions. I should know -- I wrote the bloody programs hospitals use to make them. They analyze how much money they can get out of a "bed" taking into account how much reimbursement they can get from insurance companies, how fast they move patients through. They look at doctors to see who orders tests how much, and they CUT the ones who don't order uneeded tests, because it's the lab work and tests that bring in the dough from the insurance companies. The cut areas of treament that don't bring in the money. Ob/gyn areas are considered loss leaders, but necessary to get other patients to show up in other areas.

Booko, this is my point though. I dont expect the hospitals etc to do anything less than the cost-benefit analysis you mentioned about purchasing beds. The problem arises when pricing is not set by demand, which is the case right now.

As far as the highlighted section, if consumers had more at stake in the deal, it would be in their best interest to investigate whether Doctors are giving them unnecessary tests. Once this happens, the smart hospitals will cease such behavior as it could affect their future business.

 

[kevmicsmi]

I don't think it's possible for me to disagree more.

Whatever socialization we have is terribly inefficient, I grant you that. But were we to remove those elements, our system would still be dysfunctional and expensive.

I'm not convinced that just turning it over to government is the best answer either, especially given the state of governmental institutions at this time, but letting the free market rule hasn't exactly done us much good either.

As of now though, the free market does not determine pricing of medical operations, because there is no incentive to provide less expensive care.

 

[Booko]

I agree something needs to be done, but I think the problem stems from the enormous cost to become a doctor, along with the abuse of the insurance system by doctors and patients alike. I would like to see more medical savings accounts, or incentives from insurance companies to consumers on the cost of care purchased. I really feel that if people had incentive to find the best value of care from a doctor, the medical field would quickly become more competetive in pricing.

My insurance company's idea of forcing competitiveness is to contract with doctors for an amount so low that I get inadequate healthcare. In addition, the "choices" that are left to me consist of doctors who are at best marginal, since anyone who's any good will get patients on a cash basis and not file insurance. What this means is healthcare even for the insured is often "rationed." I can choose to spend my money on someone who knows his eggs, or I can let the insurance company pay and go to some incompetent who can't tell the difference between a sinus problem and a food allergy.

The other issue that has not come up here in regard to competitiveness is *geography.* You can't get on Amazon.com and order healthcare. You have to consume it whereever you are. It's all fine and well for the insurance company to find someone in rural GA who can work cheaper, but why should they expect me to drive 60 highway miles with my sick kid, in logjam traffic, to see such a doc, when there's one 5 minutes away? People will not do that ... nor should they be asked to.

But this is exactly what they expect me to do, if God forbid anyone should get sick after normal working hours.

And when the kids and I are away for a month in the summer, then I get lousy coverage because they don't have any contracts with anyone in Michigan. But I still pay the same premiums, natch.

Sorry, kev. There is some abuse by doctors, but imv very little of it. What you call abuse I call, "trying to make a living." There is abuse on the part of some patients who are always running to the doctor every time they get a fart crosswise. And there is abuse by the insurance companies as well. They know darned well that if they stonewall patients long enough, some of them will just give up and eat the cost, and they won't have to pay.

And what exactly is the "best value of care" to an insurance company, kev? I'll tell you what it is: WHAT COSTS THEM LESS.

That isn't about value as you or I would think of it -- but it's exactly how *they* view it. Bottom line thinking. Good ol' free trade and all...whatta wonderful thing, solves all problems.

Yeah...tell me another fairy story...

 

[Booko]

As of now though, the free market does not determine pricing of medical operations, because there is no incentive to provide less expensive care.

Please see my other post on the issue of geography.

And yes, the free market does decide...oh...I mean the insurance companies decide. They decide what they will pay, and the hospitals then decide whether they will axe that area of their business.

Back in the 90s the up and coming thing was mental health care. Hospitals did all sorts of things trying to bring in patients, especially kids, for mental health issues.

Did they do this because there was a greater need? Hell, no! They did it, because their nifty computer program showed them that they could make more money on these patients than anything else.

The reason was, it was an emerging part of healthcare in the insurance industry, and the insurance companies hadn't figured out a way to drive the cost down yet. It took them a few years, the *insurance companies* software showed them the problems on their end, and then mental health went off the radar screen for hospital marketing personnel. And something else showed itself more profitable for the hospital so they emphasized that, and then the insurance company clamped down on it, and so it goes, ad infinitum.

This is no way to decide what kinds of services a hospital should be offering.

Here's the decision left to patients. You can pay for healthcare or not (nod to Jeffrey), but if you do, you won't really get what you need or deserve anyway.

Some choice.

 

[SoyLeche]

So, let me see if I've got this right.

You don't think that insurance companies are able to get the services at a good price, but the government could do the same job more efficiently? Since when has our government been more efficient than an insurance company at anything?

Actually, that may not be what you are saying at all. How would you fix the current system?

 

[Booko]

Booko, this is my point though. I dont expect the hospitals etc to do anything less than the cost-benefit analysis you mentioned about purchasing beds. The problem arises when pricing is not set by demand, which is the case right now.

Which is why I made my point about geography. Why should I investigate pricing? When I'm sick, I want to be close to home. I want my husband to be able to come in an be my guard dog, because I sure know the nurses won't be able to do it.

As far as the highlighted section, if consumers had more at stake in the deal, it would be in their best interest to investigate whether Doctors are giving them unnecessary tests. Once this happens, the smart hospitals will cease such behavior as it could affect their future business.

I think this is more than a little naive, kev, sorry. Most people do not have the knowledge to guess which tests may or may not be necessary, and they aren't going to spend the time to learn that level of medicine to understand it. They are quite content to just do "what doctor tells me to."

It's like going to your mechanic -- there are plenty of people who just bring the car in, and when the man is done, they write him a check. They wouldn't know a fuel injector from lunch, and don't care to.

If you expect consumers of healthcare to educate themselves better in this regard, then I suggest you hang around people from backgrounds much different than yourself. You will quickly find that there are lots of people who haven't the time and/or capacity to understand what tests are reasonable. They, after all, have not been trained in medicine. Why should they be expected to know?

You know, there was a time when most people paid out of pocket for their healthcare. They still didn't know which tests were reasonable or not. That history should tell you something.

 

[Booko]

So, let me see if I've got this right.

You don't think that insurance companies are able to get the services at a good price, but the government could do the same job more efficiently? Since when has our government been more efficient than an insurance company at anything?

Actually, that may not be what you are saying at all. How would you fix the current system?

Hi SL.. I'm not sure if you were asking me or not, but I think you were.

I said in a post to kev that I'm not sure the gov't is capable at this point of doing any better.

And if I knew how to fix the system, I would be making millions in consulting fees.

Personally, I think the problems are so deep, running right down to our society's priorities of what's important, that our system will remain broken until we change ourselves.

So...I don't expect major improvements any time soon.

Hopefully this is a little clearer?

 

[Ryan2065]

National health care is a great idea for the US.

Economically it will help increase productivity cause now people will be able to go to the doctor, get good drugs, do everything they need to do to get better when they are sick.

People shouldn't have to worry about how to pay for this. There would be no need to pay for health care through an insurance company anymore, so businesses could pay their employees a little more each month. Plus if you buy your health care yourself, you would not need to pay the monthly fee anymore.

Doctors get screwed by the insurance companies lots of times. Illinois has a hard time with this and doctors leave the state to get away from the insurance companies here. (well at least this used to happen, I'm pretty sure the bad insurance company went under)

People say illegal immigrants would be a drain on the system, but actually they wouldn't be. For one, many illegal immigrants do pay taxes. They have illegal SS numbers and our government doesn't exactly tell people they can't pay taxes. So they do not get caught. Also, the illegal immigrants who do not have SS numbers usually work for real cheap, which lowers the prices of items all around the country. So the money the immigrants do not pay in taxes, they pay in lowering prices on things we buy.

The problems seem to be in switching from the one system to the other system, not which system is better...

 

[SoyLeche]

Doctors get screwed by the insurance companies lots of times. Illinois has a hard time with this and doctors leave the state to get away from the insurance companies here. (well at least this used to happen, I'm pretty sure the bad insurance company went under)

Replace "insurance companies" with "government" in that paragraph. Again, is there any evidence that our government would be better at this than the insurance companies?

Oh, and whaddayaknow - the market worked to get a bad company out. What do you do about a bad government system?
one system to the other system, not which system is better...[/quote]

 

[Ryan2065]

Replace "insurance companies" with "government" in that paragraph. Again, is there any evidence that our government would be better at this than the insurance companies?

So stick with a system that is bad because of fear of the unknown? gotcha

Oh, and whaddayaknow - the market worked to get a bad company out.

Right, lots of people lost their jobs, many good doctors left the state, many patients got screwed over by their own insurance company in the process... But the bad insurance company is gone.

What do you do about a bad government system?

We, uhh... change it? The insurance company was allowed to do business in Illinois for years and years, its not like they did shady business then the next day they were out of business. More than likely, it took as long to put them out of business as it would to change a government program. Or are you suggesting it is impossible to change government systems?

one system to the other system, not which system is better...

The government system would be better for everyone as a whole, in my opinion. Currently, if I do not get a good job with health insurance, I will not be able to get any health insurance with all the problems I have. If I get a job at a small business, I would have to worry about losing my job because the insurance rates of that small company would skyrocket due to the fun problems I have. There are tons of people in my position...

 

[kevmicsmi]

I think this is more than a little naive, kev, sorry. Most people do not have the knowledge to guess which tests may or may not be necessary, and they aren't going to spend the time to learn that level of medicine to understand it. They are quite content to just do "what doctor tells me to."

It's like going to your mechanic -- there are plenty of people who just bring the car in, and when the man is done, they write him a check. They wouldn't know a fuel injector from lunch, and don't care to.

If you expect consumers of healthcare to educate themselves better in this regard, then I suggest you hang around people from backgrounds much different than yourself. You will quickly find that there are lots of people who haven't the time and/or capacity to understand what tests are reasonable. They, after all, have not been trained in medicine. Why should they be expected to know?

You know, there was a time when most people paid out of pocket for their healthcare. They still didn't know which tests were reasonable or not. That history should tell you something.

Im not suggesting everyone get a medical degree, Im suggesting that people get different opinions on something just like a smart consumer would do with their car. Nothing is a perfect system, but putting the purchasing power in the hands of the consumer is a much better alternative to what is reality at this point.