Health Service

I disagree. The system only works fine for those who make a good living and for those who choose to do nothing with their lives. For those people in between, the system is terrible. Subjects who fall between the cracks include people switching jobs and require re-training, older students, etc.. The system cannot be rated as fine when someone who works 1 part-time job, an internship, and goes to school full time cannot get state/federal assistance nor afford insurance yet the meth head around the corner receives full service for any of his/her medical needs. I concede to the fact that health care is a VERY complex issue and changes that are fair to everyone are not so easy to make. I'm typing this from Kaiser Permanente's oncology chemotherapy department....

 

Overhauling the American Health Care System has got to start with overhauling the fundamentally destructive economic motivations in place. There are two destructive incentives working. Destructive incentive one is there is NO REWARD for individuals living healthy and minimizing unnecessary medical services. Destructive incentive two is that medical providers MAXIMIZE income by maximizing BILLABLE health precriptions and procedures.

Solutions to these two different problems are hard, but not impossible. The first could be addressed with something like the following system:

1-Individuals must have a set part of their pay set aside in a health care account until a minimum buffer amount is reached. This is no different than collecting insurance premiums. The big difference here is that the money belongs to the individual, not given to the government or insurance company.

2-All medical expenses are paid for out of that fund. At the end of the period (1 year?) all money above the minimum needed for that period are returned to the individual as cash. (e.g. You remain healthy, you get money back. You have nominal medical expenses, you are covered.)

3-All medical expenses above the medical account are either covered by optional insurance or by government minimum standards. There must be a sliding co-pay associated that is not crippling, but provides incentive for a free market solution for those that can plan. Also for the govenment option, there are very restrictive limits to the care provided. (e.g. No brand name drugs if generic equivalents exsist.)


The second problem solution is only feasible with the first in place, but it could work as follows:

1-Instead of the Individual account above, a doctors organization could be the receipiant of the cash, in turn they have to provide all the medical services outlined in a contract. This contract would need to meet a minimum service standard established by the government. Obviously, there incentive is to keep their patients as healthy as possible.

2-Hard regulate the charges that medical providers have if they occur after the patients medical account is exceeded and they are government paid. Remove most (not all) charges if they are patient or insurance company paid. This provides a incentive to not get too greedy.

Are there holes and problems with this?---YES. Is it on the right track?---Yes. It puts the government back into the regulation business and out of the running of health care, It lets the free market figure out the most efficient health care economics. It puts the individual back in control of his money and health. It puts the insurance companies back into the insurance business and out of being defacto doctors. It motivates doctors to make people healthy.

 

Government does fine at healthcare, just people are too blind to see it. I dont see the world coming to end despite all the socialistic countries that provide basic neccessities to all humans no matter their financial background.

The "buffer" account you speak of is done to an extent in Canada where you must reside at least 180days a year in Canada to receive the healthcare. (At least last time I checked in the GTA). So 180days worth of taxes comprises your buffer.

 

First-Thanks for the good posts earlier. I'm going to disagree with your first paragraph, but that is to make sure my point is clear. What I'm talking about is the economic basis of the present US system. A lot of these problems are not present (to the same degree) in other countries. The core problem is the exploding cost of health care, not the lack of it. Where the government has problems is in ensuring that the cost can be paid for. When it comes to businesses, the government requirements are defacto putting a lot of businesses into the red or fueling moving manufacturing overseas. When it comes to Medicare and Medicaid, the government budget keeps coming up red. Those are both problems needing to be solved (and not the only ones either).

 

Could it not be argued then that having a single healthcare system (like Ontario) you can control costs better? It is a well known fact that companies (in general) charge different prices for different markets, and it is not just the equivalent amount in local currency. So taking this to health items like drugs and dispensers, why does it cost so much? If they (the manufacturers) can charge $5USD for an inhaler in Cuba that they routinely charge $120USD for in the states, then it obviously costs less than $5 to manufacturer and distribute. They can charge $120 here beause the insurance companies dont really care. They can blame the high cost of insurance premiums on the high costs of the medicine and supporting devices, which is somewhat true. Now, if we had a single government system, they can say "we will buy them from you at $60USD, or get the f*** out and we will go somwhere else. We know it is still a 1200% markup, so no whining."

Also the current costs of the US's government run health programs sort of stem from the same idea. They do get discounts, but not as much as they could or should be. Some of the major business ideas are volume discounts and price fixing. The government can set a price they want to pay, and who better to get a volume discount than an entire nation? It is like a giant group buy.

I realize this is not a very strong argument, but I believe it is equally as strong as saying the government has failed at medicare. A lot of those angry at the government takeover of healthcare that was never proposed yet somehow what people believed, really wanted to keep the government out of their healthcare plans, that just happened to be government run/assisted programs to begin with. It just shows that people have no idea what is going on, but if it sounds good and lots of people are shouting it, then they should shout too.

 

Why stop with the health care system? Why not privatize all roads in the U.S. and get the government out of the loop. That way free enterprise could work out which roads we need, and which are the most efficient to keep.

Tom

 

This preexisting conditions problem not an automatic consequence of losing a job. Rather, it is a consequence of allowing insurance to lapse for one or a few months.

Ex-employees can keep the employer's health plan for 18 months by paying the monthly premiums. They may acquire a different -- and likely more affordable -- plan at any time during that period or very shortly after it expires, without triggering the preexisting conditions clauses.

When I was laid off, I made damn sure COBRA was always paid on time. We eventually ended up with a high deductible (i.e. lower coverage) plan, which would trigger a preexisting conditions clause should we ever try to return to a full coverage individual plan, but not if switching to other high deductible plans.

 

hah! sure! america's healthcare system is fantastic. and if you slip through the cracks, it's always your own fault. you deserve the $60,000 bill hanging over your head for your lack of personal responsibility. bootstraps, people! pull em up!

or maybe you got hurt and your employer kicked you to the curb. or your insurance decided to deny or drop your coverage for illegitimate reasons. or any other constellation of things that can happen when you have been responsible and done absolutely nothing wrong except require a bit of medical attention.

 

After the death of my father-in-law, I had two seriously tardy bills that were rejected for cause.

One was submitted on time without any description of service. I rejected it and asked for itemized detail. Lacking a response, I disclosed this in a Probate Court filing, which was accepted by the judge as she closed the estate. Much later, without ever replying to me, the provider sent the debt to collection. I made it very clear to the collector that the debt was rejected for cause, their client didn't reply to my inquires or the court's legal notice, missed multiple court deadlines, and the court accepted my rejection of the unsupported claim. It was now their client's responsibility to appeal to the court to reopen the estate -- which of course no longer had any assets.

I also left it to them to figure which court handled the probate. (It wasn't the provider's home district, but any competent billing department would have figured it out on the next guess.) They dropped it.

The other bill was from one of the many specialist businesses that makes sure their agents drop in to say 'Hi' to each hospital patient every day so the billing departments can harvest lots of money. This agency forgot to bill one day, so they tried again -- same day of the same month, but three years later. Busted! Neither I nor Medicare pay for services rendered years after the patient died.

I feel for the many patients who are too foggy from dealing with their illnesses to chart out and match up all the EOBs and Medicare summaries and bills. Several of the bills were erroneous and technically illegal to even send to the customer.

 

Here is another reason why U.S. health care is so expensive:

How to brand a disease -- and sell a cure -- CNN Opinion

 

More specifically, it is the result of not being in an insurance group. By law, anyone receiving group medical insurance is eligible to join another insurance group regardless of existing conditions. Those with individual insurance policies or no insurance enjoy no such protection. This is an easy trap to fall into after losing a job and exhausting COBRA. The new insurance reforms have helped in this area, but there is still much room for improvement.

People act as if COBRA solves all of the insurance problems for the unemployed. It works for short term unemployment, where some hope exists for getting another job with benefits. It isn't much help in a state like Michigan, where crushing unemployment has been the norm for the last decade. People here lose good jobs, and then face little chance of ever finding another job with benefits.

Tom

 

The reform legislation is regulation, not "running health care". It regulates insurance plans, and requires that they not reject for pre-existing, not have lifetime caps, cover children to age 26, not drop people when they get sick, sets a maximum limit on administrative spending, etc. The reform expands the current system of private health insurers, and seeks to use the free market magic power through the health care exchanges that I referenced in my previous post.

The only piece of the reform that is "government running health care" are the temporary high-risk pools. Those will go away once the exchanges are online.

 

Like the $1 billion dollar ehealth scandal?

 

what about the part where you have to have insurance or the government fines you and could send you to jail?

 

What about it? Doesn't change the fact that insurance will still be provided by private companies, pursuant to certain government regulations.

 

I believe that anyone who chooses not to buy health insurance should be thrown in jail so I can pay for their health care through my taxes. Otherwise they will be in the emergency room so I can pay for their health care through my premiums.

What happened to conservatives/Republicans and their "individual responsibility?"

 

I already pointed out in my previous response that this is similar to the same sort of idiotic expendetures of private insurance companies in the states. But they not only have to foot the bill of idiocity, but that of outrageous medical prices.

 

There is a lot of evidence over the years that individuals can control cost a whole lot better than government buearucrats if given the ability and motivation. There is also a lot of evidence that corporations (insurance and drug companies) will do everything possible to maximize revenue, regardless of the adverse impact on the population. Obviously that requires government to be involved with the regulations and enforcement to restrain corporations and empower individuals. Your situation above is an excellent example to follow through with, so let's discuss it some.

Cuba probably did not provide any of the money for clinical trials and testing, which can be in the mega-million dollar range. This results in the drug companies having to set prices depending on affordability, since price uniformity would eliminate many low income countries. Presently, the bad situation is that our government/laws allows every new drug to be a total monopoly for quite some time. This is the real root of the outlandish costs. If the government were to make the simple (but powerful change) of reimbursing only drugs that have multiple vendors, then a far different situation would occur. Regulated correctly it allows new drugs to be sold and allows a company to make an overall profit, but not an obscene amount on market manipulation. Lots of critical details missing in this short example, but it should be clear that government, the individuals, and the competitive market have critical roles in any national health care system.

The real problem that drives me nuts is that the only two solutions discussed are government controlled healthcare vs. insurance company run healthcare. Obviously, doctor-patient controlled healthcare is dismissed as not worth discussing. The government and corporations have critcal roles, but the role of either of them determining one inflexible standard of what is paid for on every individual drug and medical procedure in the country is not a sustainable system. I will re-emphasis that I'm not stating that the government is failing on medicare. I'm stating that it is failing to balance the budget, with medicare being one of the things requiring more money than being collected.

Thanks for responding. I am fully aware that there are holes and major issues with my viewpoint, that's why I read and listen to good comments and criticisms.

 

You are right that the government does not directly run health care. However........

When the cost of the vast majority of procedures is determined by Medicare, this in turn determines what many doctors/clinics will or will not perform. The ripple effect reaches much farther than just Medicare patients. I find my doctors are very much part of this cycle. I have to work like crazy to convince them that their medical decisions can be based on what is optimum for me, not the government boards that set what will and will not be paid for.

 

I'm not talking about paying too much for an intubator or an infuser. I'm talking about FRAUD

Like the common practise in RHA's to accept cash in brown paper bags to award tenders

Tories call for investigation into WRHA tendering - Winnipeg Free Press

not based on price vs quality, but on how much the appointed, non-elected RHA Admin person can expect in cold, hard cash