Health Service

forcing people to buy something is wrong, whether it's insurance or anything else. i think it's false to assume that everyone without insurance is trying to milk the system. i knew a guy at work for years who was simply never sick. it's amazing how many thousands of dollars he spent over the years and never received a benefit for it. obviously this guy isn't the normal situation. see this is how this gets all wrapped up. when it's coming from the government, you can easily say that everyone has to buy into it or our taxes are unfairly supporting those who don't. it's the government's way of getting you to do what they tell you.

and as far as the whole "you can keep your current insurance", we see now that there are problems with that. i don't believe this is going to be the case. i fully believe that some people will not be able to keep their own insurance.

i still would like an explanation of why the tax fine placed on corporations is actually cheaper than coverage for their employees. if i'm paying 10K a year for an employee to be on health insurance, and the fine for NOT offering that insurance is 8K per employee....well that is a no-brainer in the world of business. get rid of the health plan and let everyone join on to the government plan.

 

The issue is not whether they're trying to "milk the system" or not. The issue is that you can pay insurance premiums for decades, and then get hit by an uninsured motorist (it would be wrong to make them buy insurance, right). I guarantee it won't take many months of hospitalization and rehabilitation before you will have used up every dime you paid in. I'm not concerned with the taxes spent to take care of sick people. What I'm concerned with is the significant portion of my insurance premiums attributable to the voluntarily uninsured who end up in the emergency room.

And why is that?

There isn't a government plan. You will have to buy an individual plan from a regular insurance company. I didn't know that the fine wasn't going to be higher than the cost of coverage for their employees.

 

This was not a problem at the time and place of my household's transition from group to individual coverage. Provided any coverage lapse was sufficiently short, preexisting conditions could not be excluded.

Perhaps this was the result of an earlier siege between the insurers and the state legislature and insurance commissioner? During that siege, no new individual health plans were available in the entire state. By the time I was dumped onto COBRA and began planning for its end, three companies had reentered the market, including the provider of the group plan I was still on.

Those without prior coverage were still hosed.

 

And you dont think fraud happens anywhere else?

 

When it is your money, it is a lot harder to spend. I think that is the major reason. People that "have" money spend more than those that "worked" for an equal amount (generally).

I completely agree that there are multimillion dollar expenses to bring a drug to fruition. In my industry it is called NRE (Non-Recurring Engineering) cost. This is spread out over millions/billions of units, however we never sell a unit to a low end country at a loss. The part may cost a few pennies each + the spread of the NRE, and then you add a profit margin, and get the lowest price. We sell the same unit in the states or in Western Europe for a power of ten or more vs. the same part in Factory-Asia or Africa.

So the $5 inhaler probably costs less than $5 to make, market, and sell including NRE. The $120 is just markup because the insurance companies pay that much. If the insurance companies said 'no', then the would either pull out of the market or drop their price. But it is cozy where it is, and nobody cares.

I'm unsure of what you are referring to by "doctor-patient" healthcare? If a doctor feels you need a test, they can order it in government run or insurance run scenarios. Or private pay if you want. I dont really care if someone declines a service I want just because I want it with no medical reasoning. The doctors make the decisions on what tests should be done because they went to school for more than a decade. In a government run system, the doctors can get a test if you deserve it. In an insurance run system, the doctors can get a test if you can afford it. I would rather get what I needed when I needed it, then get what I can afford when I need it.

This is what I hoped the "town hall" meetings would be. Not just a bunch of people yelling and screaming not listening to anything.

 

Lots to consider here.

The patent system is enshrined in the Constitution. It is therefore an American ideal that inventors should have limited exclusive use of their inventions. I don't think this is changing anytime soon.

Limiting reimbursements to licensed/generics is an interesting question. The situation might also be solved by allowing the government to negotiate with drug companies, something that is currently not allowed by law under Medicare. But it is allowed under VA, and VA therefore only covers drugs where the manufacturers have agreed to a negotiated price. Therefore, some 3,000 drugs are not available under VA. I wouldn't be surprised to see the same result under a licensing scheme. Let's not forget that drug companies don't really care about our health, see Avandia, where GSK downplayed the risks going back about a decade. So I wouldn't be surprised to see a drug company say "F it", not license, and then the drug just wouldn't be available under government plans.

It's a tricky situation.. the drug companies have the upper hand because of the patent ideal. I don't see that ever changing, as it meshes so well with the whole "entrepreneurial spirit", "free market", etc.

However many people forget that there was a time when drug advertisements didn't exist on TV. Drug companies now spend $4-5 billion on these ads, and ~$30 billion on overall marketing (possibly as high as $50b). Some studies have concluded that this is actually more than is spent on R&D. Prescription drug use has also greatly increased. We talk a lot about how medical decisions should be between the patient and doctor, but we've allowed the drug companies to step into the middle of that. This runs into another American ideal of free speech, but in my opinion there is no commercial free speech (obviously some will disagree).

I'm interested in hearing if anyone else has had this experience. I have not, and it is not my understanding of how the system works. It is always about what the insurance company does or does not cover, and/or how much they reimburse for the procedure.

As a general concept, you're not going to find many people who disagree. But as with many general concepts, it falls apart when applied to real life.

The fundamental difference here is that we have said as a society that we will not let someone die due to lack of insurance. I don't think anyone is interested in changing that. IMO, then, if we're going to have such a system, those with the means should be required to pay something. If they don't want to deal with insurance, that's OK, but they should still have to pay something for what is essentially catastrophic coverage supported by the health care system (many of these costs are written off and/or built into what we pay). The proposed penalty is $700 (it starts at $95 in the first year or two, but will go up). This is about what a catastrophic plan costs today.

People will certainly be able to keep their own insurance. But the phrase "own insurance" is very misleading, since so many of our insurance decisions are actually made by our employers. I don't know about you, but I have a huge choice here... I get to choose from one provider. What decision am I really making?

First, there is no government plan.

Second, there is no government plan.

If an employer chooses to pay the tax, which some will certainly do (I believe the penalty will be $2,000, but it's a weird tax thing so the actual impact might be greater?), then those people would get put into the health exchange. While these exchanges are overseen by the government, the providers are still private insurance companies.

As to the question, was the penalty set deliberately low to encourage this? Probably. The whole idea behind the reforms is to generate larger risk pools. Right now we're all broken up into little pools of 10, 50, 500 based on how many co-workers we have (or 1, if you have individual coverage). The exchange concept is not new, and it has failed in the past because too few people were in the exchange. If the exchange is limited to companies with <50 employees, it would likely fail, as it did in Texas. If companies with 50-100 are encouraged to use the exchange rather than provide benefits themselves, that might be the critical mass needed to give the exchange real clout in the marketplace.

 

Very good read and explanation !!!!!

 

Difference is, in other places the people invovled go to jail

http://www.newschief.com/article/20101013/NEWS/101019981/1021/sellbuy

Medical Billing, and Practice Management Systems

Medicare fraud scheme, threats lead to prison - Miami-Dade - MiamiHerald.com

Here in Canada, you can have a billion dollar OHIP "ehealth" cost overrun, get fired, and still get several hundred thousand taxpayer dollars as a severance

Or, with Manitoba Health and the Winnipeg Regional Health Authority, you can accept tens of millions of dollars in suspicious gifts and cold hard cash, and keep all of it without even a slap on the wrist

That is the difference

That $1 billion dollars could have been better spent by OHIP to equip hospitals with better equipment, hire more doctors, etc. The $20 million estimated fraud for the Winnipeg Regional Health Authority could have been spent on better equipment for hospitals and hiring more doctors to help with the chronic doctor shortage here

 

Yeah and it is just as corrupt everywhere else. If you have power, you dont go to jail. I dont see Bush or Cheney going to prison even though they openly admitted to torture.

The cost of the Middle East Clusterf**k is more than any Ontario health scam.

$1billion may sound like a lot, but it really isnt all that much for a government.

 

Boy, that is says it all.

At least with a private corporation you can hold them accountable and perhaps get them to pay up (like BP's fund). But with a government entity you are essentially suing yourself if you pursue that path. At best you would have to wait for the next election cycle to boot out the dorks. No thanks. I work for a government agency and I know what goes on behind the scenes... scary. The smaller we keep government that better off we are IMHO. Or is that HMO?

 

A lot of good thoughts here. I was all for the pubic option, but what we got is health insurance "reform" written by the insurance companies.

Since we are the last industrial country to adopt universal health care,
shouldn't it be possible to look at all the other systems in place and choose what works and what does not work? Why do we pay twice as much per person as most other countries, but have worst results?

Some problems that I see:

-Tying health insurance to a job. This made sense 30 years ago when you got a job with a large corporation and stayed with them until retirement, but it does not work that way now. How many people are staying in jobs because of health concerns? How many people did not start their own businesses because of health insurance? We don't get our car insurance or our home insurance thru our employers.

-State lines. My daughter moves a lot and has to get new insurance when she does. Why does the same company have different policies and rates for differnet states? What would be the down side of standardizing insurance nationwide?

-Malpractice costs. Some say it is only 2-5% of our healthcare costs, but this does not cover all the extra tests, MRIs and Xrays done to cover the healthcare providers butt.

-Prescription drugs and costs. Why can't Medicare negotiate bulk purchases? This is just a big gift to big drug companies. Someone pointed out that the big drug companies are now spending up to $50B on advertising. Wth??? Prescription drug use has gone up with this increased advertising, not because we need the drugs but because there are huge profits to be made. My mom (90 years old) takes twelve prescription drugs a day! Can this possible be healthy?

-Because of my now ex-wife's employment, I was insured by 5 different insurance companies over 12 years. Not one of those companies sent me any information to encourage me to be or get healthy. Not one of them encourage me to go in for an annual check up. Seems their business model is: the more that is spent on healthcare, the more they can charge in premiums and the more profit they can make. A "healthier" business model would be to encourage the insured to live long, healthy lives.

-How to pay for it? We already are paying for a seriously bloated healthcare system that does not distribute the product efficiently.
We are already paying for the uninsured either thru increased premiums or increased taxes. We could add healthcare taxes to those products that are sold that increase healthcare costs to cover the "true costs" of those products. Examples: cigarettes, alcohol, booze, high fruitose corn syrup, bullets, etc etc.

One question I would like to ask. Does anyone think that our healthcare system (insurance, delivery and results) works fine and des not need change/reform?

Just my 2 cents,

 

The problem isn't with the transition from group to individual coverage. The problem is going the other way around. Insurance companies don't have to take you if you are coming from individual, but they do if you have group. Perhaps this is a state law related only to Michigan.

Tom

 

I have worked in both pharmaceutical R&D and medical equipment R&D. From experience, I can attest that insurance approval is key for both drugs and devices. No matter how nifty your new medical scanner, it won't be brought to market if you can't convince the insurance companies to pay for using it. In this respect, medical insurance companies wield a lot of control in the medical world.

People worry about the government making medical decisions. As it is now, we have pimply faced insurance staffers making the decisions instead.

This bothers me a lot. Back when I worked for The Upjohn Company, we called prescription pharmaceuticals "ethical" drugs. Doctors didn't advertise, and neither did the pharmaceutical companies, except for over-the-counter stuff. We worked very hard to separate our ethical drugs from over-the-counter products.

Now we have a full court press from the drug companies. You can't turn on the TV or open a magazine without seeing their advertisements. It bothers me for two reasons:

1) A very large amount of money is spent on advertising. This money must be recovered in the cost of the drugs.

2) These are prescription drugs. Only doctors can prescribe medication. The advertisements should go to the doctors, not the end users. Instead, what we have is drug companies building demand for a drug, hoping people will go to their doctors and demand it. This is just wrong.

If our medical system worked properly, your doctor would learn about a new drug, think that it might help you, and call you in for a consultation. Unfortunately, we are a long way from that these days.

Tom

 

It is all perspective...

$1billion is chump change to a government. $1billion to me is an aweful lot of money.


$100 is nothing to me. $100 is the difference between surviving for the month or being evicted for a few of my friends.

When you take in money, it is easier to spend money. I routinely buy crap I dont need or make bad buying decisions because it is easier and not worth my time. One of the same friends from above will walk to her work with a gas can and fill it up on her way home instead of driving just to go to the gas station because she just can't afford it.

So it is easy for everyone to get upset about this million dollar scandals. But in most of your worlds it is equivalent to totaling your car and losing a few thousand bucks. Yeah it was stupid, hopefully you wont do it again, it hurts your pocket, but it really isnt a big deal.

 

It works both ways. Some people will make bad decision, but even more will make good decisions. Most will definitely pick up on being defrauded and go to a different doctor, clinic, or treatment when they have their money being taken from them. Not the case when the "government" or "company" is picking up the tab. For example, it is essential that I be able to pick the doctor I desire, not be forced to use only doctors from an insurance company list or a government list.

True to a degree now. But if the inflated cost were to come down due to true cost competitiveness, then the regional pricing makes a huge difference in very poor countries. In Africa, the difference between a 50 cent drug and a $1 drug are immense in terms of affordability, much like the difference between a $20k car and $40k is to us.

I would also like to point out that the "nobody cares" is exactly what I'm trying to address by getting the right system in place.

"Doctor-patient" healthcare is what my first post on this thread refered to. It was basically, that within a cost ceiling, the doctor and patient would work out what they wanted to have done without regard to government or insurance company restrictions. After the ceiling is exceeded, then government/company restrictions come into play since these cost are no longer being paid for by the patient, but someone else. When kept under the ceiling, the patient gets to keep unspent money (his/her incentive) and the doctor gets to bill at their rate and gets paid directly with no outside involvement (her/his incentive).

I keep hoping the FHOPolitics would be the same. Oh well.

 

I was not insisting on that. There is nothing preventing a company drug from getting multiple manufacturers with licensing agreements. This has happened a lot in industry where the big money market is only available if other competitors are allowed. Where big changes need to be made are the things (e.g. DNA sequences) that should not be patentable to begin with.

This works both ways. I expect a lot of drugs are being developed on the basis of manipulating consumers and doctors. (A whole lot of what I see on TV has shockingly scary side effects for some marginal benefit.) These drugs we would want to go away. Notice that virtually everything that is advertised is a "lifetime" drug.

A partial solution would be economically incentivizing the companies to make it affordable. Ford became big since the market for competitive cars was vastly bigger than overpriced cars. Changing the legal rules is unlikely, but changing the end market is quite possible.

Mostly agree.

The most painful one is the low reimburstment rates for primary care doctors and the extremely high rates for many rather conventional procedures. That's why most primary care doctors have to handle a large volume to make ends meet.

 

It's sad how many Americans think their doctor decides what they need. Your insurer makes the decisions- most of the time by a bureaucrat who has little if any medical care and certainly no medical doctorate.

The spending on prescription drugs is really just a legal bribe to the media to cover up the highway robbery going on with every prescription.

 

I misunderstood your prior posting as protecting only those entering group plans. But the U.S. probably has more variations on this than it has states.