Sicko

[metta]

What are the Presidential Candidates Talking About? A Brief Dictionary of Health Policy Terms

As the presidential debates heat up and health issues assume a higher political profile, candidates are coming up with strategies to reform the current health care system. Some of these fundamentally redesign the way in which care is financed and paid for; most, however, tinker with the system, providing only partial solutions to lower the number of uninsured, control costs, and increase accountability. These proposals are likely to be subjected to much debate, and some phrases or concepts will be over-used and abused. We are therefore providing our readers with a basic dictionary of the current health policy vocabulary.

Choice: is as American as apple pie. In the health policy arena, however, the word is usually a code for the provision of a variety of options, some of which offer skimpy services or deceptively low premiums. Although appropriate and timely information is essential to true choice, many plans violate this basic tenet. They are confusing, complicated, and jargon-ridden; as a result, patients often have problems finding out what is covered and under what circumstances.

At the policy level, an insistence on "choice" often serves as the rationale for avoiding a uniform service package and universal coverage. It is also the entry point for strengthening health savings accounts.

Attempts to privatize Medicare also parade under the banner of "choice." This accounts for the creation of Medicare Advantage Private Fee-for-Services plans. These cover extra benefits and cost more than traditional Medicare. Indeed, Medicare pays an average of 12 percent more for those who enroll in Medicare Advantage plans than it pays for beneficiaries who are covered under traditional Medicare. These plans have been beset by aggressive, inappropriate marketing activities. After many senior advocates complained that some beneficiaries were inadvertently finding themselves in plans in which they did not want to enroll, whose coverage they did not understand, seven insurance companies agreed to stop marketing private Medicare plans temporarily. Nevertheless, there is still much confusion disguised as "choice."

Consumer "buy-in": This phrase, used to justify greater cost-sharing, assumes that paying out-of-pocket will make consumers more aware of the costs of health care, thereby making them more prudent consumers. Additionally, "buying in" is intended to reinforce their role as stakeholders in the delivery of care. The problem is that this makes consumers responsible for deciding their spending priorities (most often with limited information), distinguishing between needed and unneeded care, and unbundling complementary services that work only as a package.
Cost-sharing has more of an adverse effect on those in poor health. It promotes delays or decreases in health care, resulting in adverse health outcomes. A 1999 study on the burden of Medicaid drug copayments found that elderly and disabled Medicaid recipients who resided in states which required copays had significantly lower rates of drug use than their counterparts in states without copayments. The main effect of the copay was to reduce the likelihood that Medicaid recipients would fill any prescription during the year, and the burden fell disproportionately on the ill. A more recent compilation of studies on cost-sharing and use of prescription drugs found that cost-sharing is associated with lower rates of drug treatment, lower adherence rates, and more frequent discontinuation of therapy. Moreover, for patients with certain conditions (e.g., congestive heart failure, diabetes, schizophrenia), higher cost-sharing ultimately results in more use of medical services, thereby offsetting any savings accrued from lower drug expenditures.
Cost-sharing also affects providers who serve low-income patients. Providers are placed in the uncomfortable position of charging those they know cannot afford to pay, or assuming a financial loss for care to the poor.

Consumer-driven health care: This term characterizes health schemes that give greater responsibility to patients for the costs of their health care. Usually, this takes the form of higher co-pays or deductibles, which are intended to make the consumer more cost-conscious. These high-deductible plans are often paired with health savings accounts.
High-deductible plans have a number of perverse effects. Because they pay for high-ticket items rather than for more basic services (e.g., amputations rather than visits to podiatrists), they distort the supply and demand of care. In addition, cost-sharing can raise barriers to care, which in turn lead to late or no services (see also Health savings accounts). Moreover, high deductibles tend to have a differential impact on women, who have a greater need for preventive services, not all of which may be covered. A recent study compared out-of-pocket expenditures for maternity care under five different plans, four of which had high deductibles. The researchers found "tremendous variation" in the financial burdens the plans impose, and concluded that "women and families could be left with thousands of dollars of expenses from maternity care even with an uncomplicated birth, resulting from the high deductibles and cost sharing requirements in these plans."
Cost containment: Because many politicians, researchers, and analysts agree that much medical care is ineffectual or inappropriate, cries for cost containment come from a variety of sectors and result in strange bedfellows. Conservatives favor cost-containment measures as a way of shrinking the public sector and unleashing market forces. More politically progressive segments of the population consider cost containment a tool to better monitor health care, avoid unnecessary services, and free up resources that can then be used to cover more persons or broaden the scope of services provided. Because many disparate and even conflicting measures fall under the rubric of "cost-containment," it is best to ask Cui bono? (To whose benefit?) when assessing these strategies.
Cost-containment strategies also differ in terms of their target: some are aimed at consumers, others at providers. Those that seek to seek to modify consumer behavior try to reduce consumption of services (see Consumer-driven care). Others address physician behavior by reimbursing them for certain outcomes rather than the number of services they provide. At present, for example, Medicare is carrying out an experiment which rewards doctors "for the quality of care they deliver rather than how many tests and procedures they perform." The idea is to provide financial incentives to encourage doctors to help patients avoid costly hospital stays or emergency care through more timely monitoring of conditions and better coordination of services. Of 10 physician groups taking part in the experiment, which is still in process, all improved care for patients during the first year, but only two earned bonus payments because of monies saved. It is therefore unclear if the financial incentives work or not. Remaining issues include the fact that physicians were uncertain as to what they had done to generate savings, and rewards went to organizations rather than to the individual doctors.
Disease management: Under most health systems, a small fraction of those covered account for a large share of all costs. Thus, for example, 4 percent of Medicaid enrollees consume half of all Medicaid expenditures. Similarly, a survey among a group of large employers found that 72 percent of workers and their families accounted for only 11 percent of employer health-care expenditures annually, while the top 4 percent of users represented 49 percent of total employer costs. Program administrators are therefore eager to make a dent in the demand from those "high users" in order to reduce their disproportionate expenditures on this fraction of their enrollees. "Disease management" has been proposed as a tool to do this, and many providers are experimenting with ways to manage those with specific diagnoses or who are frail or have multiple chronic conditions. The aim is to improve health and prevent disability as well as to keep costs in check.
Because of its potential, disease management has become somewhat of a growth industry, and established plans have incorporated disease-management efforts within their offerings. At the same time, for-profit companies have sprung up to sell their services to employers and health plans who want to keep their employees healthy and their medical costs down. As self-contained entities separate from health care, these companies promote patient education and more effective self-management through phone calls and the internet. In 2005, two-thirds of employers with staffs of 200 or more offered disease management as part of their job-based insurance plans; more than 20 states have some kind of disease management for their Medicaid enrollees.
There is growing interest in assessing the efficiency and efficacy of these programs, and several studies have focused on whether or not they improve health and lower costs. Studies looking at disease-management initiatives in the Group Health Cooperative in Seattle and in the Kaiser Permanente program in Northern California found that quality of care improved, but there were no cost savings. A current, ongoing study by Mathematica Policy Research is testing whether disease management can lower costs and improve patient outcomes and well-being in the Medicare fee-for-service population. To date, the researchers have found that, while both patients and physicians are very satisfied with the efforts, few programs have had any detectable effects on patients' behavior or the use of Medicare services. Only one program had statistically significant reductions in hospitalization, and none reduced costs. The available data therefore suggest that, whatever the benefits of disease management on patients' health, they do not necessarily translate into savings.
Electronic health records, other IT Technology: Digital patient records provide a way to store a person's medical history, including chronic conditions, test results, prescriptions, contraindications, diagnoses, procedures, and physicians' comments. Some "smart cards" can hold the equivalent of 30 pages of medical records. The Secretary of Health and Human Services has called this technology "the most important thing happening in health care." EHRs have also received the blessing of Senator Hillary Rodham Clinton, and former Republican leaders Bill Frist and Newt Gingrich. What is it about EHRs that unites otherwise political opponents? Undoubtedly, the promise of easily portable, complete information that can be shared, searched, and analyzed is appealing to researchers and decision-makers alike.
Nevertheless, the changing dynamics triggered by this technology could have unexpected costs. While a RAND Corporation study found that EHRs could reduce errors and save about $80 million a year, other experts caution against overstating the cost-saving aspects of the electronic record. As economist David Cutler has pointed out, "there is money to be saved, but it is not going to be cheap." Even cost-saving products require an upfront investment, and EHRs will achieve their payoff only over the long-term, if at all. Physicians in solo practice or in small groups may find it prohibitive to shift to EHRs without passing on the costs to consumers. While efficiency may be seen as socially desirable, many individual providers will lack the financial motivation to streamline and upgrade their practices. Another potential inflationary effect of the electronic technology is that better information may lead to more care for more people, and create a demand for given drugs in small markets.
Moreover, some experts feel that too much emphasis is being put on the "technological fix" that EHRs and other health-related IT represent, and that we should not be lulled into thinking that that is a substitute for real reform in how care is delivered and paid for. In short, while health information technology has the potential to improve quality; reduce the costs associated with inappropriate care and medical errors; and boost administrative efficiency, information-sharing, and decision support, it is not a panacea for the system overall.
Health savings accounts (HSAs): This mechanism, ostensibly aimed at encouraging the uninsured to acquire coverage, allows those who buy high-deductible plans to deposit money, tax-free, into savings accounts that can be used to pay medical bills. If you don't spend the money in the account, you get to keep it. This 'solution' has been touted by the Bush administration as a tool to address the dwindling number of persons who have employer-sponsored health coverage. This proposal was best described by Stephen Colbert on Comedy Central: "It's so simple. Most people who can't afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don't owe, they can use the money they're not getting back from what they haven't given to buy the health care they can't afford."
These accounts benefit mainly the more affluent segments of the population, who have more to gain from tax breaks. Moreover, HSAs encourage the healthy and the wealthy to drop out of company health plans, further undermining the weakened system of job-related coverage by depriving the insured pool of those who are at less risk for illness and high-cost care.
Incrementalism: This refers to any policy that proceeds gradually in stages, usually by covering a growing group of people or an expanding array of services.
Many national health plans began as incremental efforts: some covered only workers in certain occupations, gradually expanding coverage to cover the entire labor force and then the rest of the population. When the US enacted Medicare and Medicaid, some expected that this would be the first step in achieving universal coverage. And when Medicare was extended to cover those with end-stage renal disease in 1972, there was some discussion concerning whether the US would be the first country to provide universal coverage on a disease-by-disease basis.
Incremental change has been hailed as "the American way" of addressing health care. Some have proposed covering children first and having them age into an expanding system. Others have suggested that progress is more likely to proceed on a state-by-state basis. In addition to creating a patchwork of systems that stop at state boundaries, the latter option will exacerbate existing geographical disparities. Moreover, state programs are relatively impotent to make the changes that are necessary to cover everyone and control costs. Only a national program will have the leverage to do this, and only a national program will give meaning to the concepts of "one nation," equal opportunity, and equal protection.

Individual mandate: This refers to a state requirement that all residents buy health coverage or face financial penalties, and is similar to the requirement that all licensed drivers have car insurance. In 2006 Massachusetts became the first state enacting legislation mandating such coverage. Other states, however, are considering similar legislation. Passed with surprising bipartisan support, the Massachusetts law requires all uninsured persons within the state to buy coverage by July 1, 2007. [All businesses with more than 10 employees that do not provide insurance are also mandated to contribute up to $295 per employee per year to the state (see Pay or play)]. The legislation stipulates that individuals who do not comply with the insurance requirement lose their personal tax exemption; furthermore, they face fines for each month that they are uninsured. There is one loophole, however: no one is compelled to buy insurance if he or she cannot find affordable coverage. Initially, the state did not define what "affordable" meant. But subsequent research has defined the upper bound of affordability at 8.5 percent of income, which is what middle-income people pay for health insurance, including cost sharing. This loophole in effect exempts a sizeable fraction of the uninsured – 20 percent – from the mandate, thereby excluding them from coverage. At present, enrollment of those previously uninsured has been lagging. Because almost half of the uninsured in Massachusetts are single males, the state has enlisted the Boston Red Sox in its publicity campaign, thereby stressing the need for Massachusetts' residents to "get in the game."

Market-driven solutions: These solutions seek to transfer to consumers the monies now spent on their behalf for the purchase of health care. Those who favor this approach argue that the health sector has much to learn from other sectors of the economy, and that following the lead of other manufacturing and service industries will produce the "quick, courteous, consistent, low-cost service" that has made the US globally competitive in other markets. Yet, even some who are pro-market concede that health care is the part of the public sector where market forces have had the most limited success, largely because of distorted incentives and information failures. In addition, most often it is doctors rather than patients that decide what care is needed, and how much of it. Indeed, it is estimated that physicians control over 80 percent of health care spending on hospital care, prescriptions, nursing home, testing, and their own services.
Paul Krugman has succinctly pointed out that the health care insurance market does not work because of three things: risk, selection, and social justice. "Risk" refers to the fact that, in any given year, only a small part of the population will incur major medical costs. Those who happen to be at high risk need good insurance if they are not to go bankrupt. But the insurance business is market-driven to cover only the healthy, pay out as little as possible for health care, and raise prices for the unhealthy. It therefore selects the "better risks" that will place fewer demands on the health system and cost less. "Social justice" refers to the widely held value that no one should be denied care because they can't afford it. So government subsidizes a growing proportion of health care, although the US does this imperfectly, in a far-from-transparent way, and, most often, grudgingly.
Donald L. Bartlett and James B. Steele describe the problem as follows:

The market functions wonderfully when we want to sell more cereals, cosmetics, cars, computers, or any other consumer product. Unfortunately, it does not work in health care, where the goal should hardly be selling more heart bypass operations. Instead, the goal should be to prevent disease and illness. But the money is in the treatment – not prevention – so the market and good care are at odds.
​

Medicare-for-all: describes a national health system which covers everyone through single-payer financing. This proposal builds on the foundations of the program enacted 42 years ago and therefore capitalizes on the familiarity and popularity of the current Medicare. Moreover, Medicare is run much more efficiently than private insurance plans: it operates with less than 5 percent overhead, compared with the 15-30 percent dedicated to administration and profits in commercial health insurance plans. This would fundamentally change the way in which care is provided and paid for by getting businesses out of health care altogether. As Ezekiel Emanuel and Victor Fuchs have stated in their support of this option, "Health care is not part of [businesses'] core competencies but something they use as part of their labor relations. It creates job lock and distorts employers' hiring and firing decisions."
Our hesitation about Medicare-for-all – and the reason we prefer a single-payer program (see Single payer) – is that Medicare has now started moving toward the inclusion of for-profit HMO's as one option for patients, diluting the single-payer effect.

"Pay or play": refers to proposals adopted or under consideration by states that require businesses to provide workers health insurance ('play'), or pay into a government fund that will do it for them. The latter is most often called a Fair Share Health Care Fund. In some states, the legislation has been limited to very large employers (e.g., those with 10,000 employees or more); but other states (e.g., Massachusetts) have cast a broader net in an attempt to cover more of the uninsured. The proposal has elicited a variety of responses from different interests, and there are conflicting opinions even within the business community. While some employers regard "pay or play" as an ideologically offensive mandate, others see it as a way to protect their own interests. The latter are those who cover their employees but are undercut by competitors who have lower labor costs because they do not provide health insurance to their workers.

Single payer: describes a financial system in which one entity acts as single administrator, collecting all health bills and paying out all health care costs. This would streamline administration, eliminating the complexity of having thousands of intermediaries with different billing systems, forms, and requirements. A single-non-profit plan is based on the original concept of insurance: creating a large buying pool to spread the financial risk of sickness so that no one faces a crisis when a health need strikes. The public agency would negotiate and pay the bills, exerting the leverage provided by being a powerful buyer to control costs and insure quality control. It would not employ providers or own health care facilities. At present, both traditional Medicare and the Veterans Health Administration operate as single payers, thereby cutting their administrative expenses. Single payer systems have been praised not only for their managerial simplicity but also for serving as "the ideal vehicle for implementing an egalitarian social ethic."

Universal coverage: means that everyone is covered. Few proposals accomplish this. But calling plans "near universal" or "quasi-universal" is a contradiction in terms.

http://www.worstpills.org

 

[PreTTy PeTe]

Here's a video that illustrates my points in earlier posts about the flaws in the Canadian health care system. My family has suffered similar problems with the decline in health care availability since they went to universal health care.
I want universal health care in the U.S., but we have to be sure to have a system that is better than what is in place in Canada. We need checks and balances to be sure the system is accountable for providing a high standard of care.

to everyone who complains about our system, i just have to tell you to relax because the canadian health care system works.

i just spent 15 days in the hospital because of a seizure, a brain bleed and a fall.
everything i needed was given to me including an MRI that i got in 5 days. and other tests that were needed. no charge

now that i'm home they sent me an occupational therapist everyday for 2 weeks. no charge.

the only bill i got was for the ambulance which is $240 but the i pay only $45 .

the second time the system was a life saver for me

 

[metta]

to everyone who complains about our system, i just have to tell you to relax because the canadian health care system works.

i just spent 15 days in the hospital because of a seizure, a brain bleed and a fall.
everything i needed was given to me including an MRI that i got in 5 days. and other tests that were needed. no charge

now that i'm home they sent me an occupational therapist everyday for 2 weeks. no charge.

the only bill i got was for the ambulance which is $240 but the i pay only $45 .

the second time the system was a life saver for me

I'm so glad that your ok PreTTy PeTe

 

[Kulindahr]

[begin]
First, no private insurance company is large enough or powerful enough to command a more reasonable cost for treatment. The only "insurance" that comes close to it is Medicare/Medicaid - government programs. They can and DO dictate to ALL providers what charges will be. And providers sqeal like a pig under a gate about it.

Sorry, but quite a number of private companies are large and powerful enough to command a "reasonable cost for treatment". Blue Cross is one, Aetna is one, and there are others. My recent accident that almost cost me a thumb ran up a hospital bill, from ER to follow-up, around $12,000. My insurance slashed that to just under $10,000, applying its "maximum allowable" figures to almost everything on the list.
Who's my insurance company? Concordia Health Plan. How can they have such clout? Easy: the plan is administered through Blue Cross, which applies its clout on behalf of all the smaller plans which choose to be administered through it.

Fourth, those opposed to the single-payer system say that if you take away the profit motive for development of new treatments, such developments will stop and new treatments won't be found. I don't agree. There are plenty of scientists and researchers who do their job for the thrill of the hunt and the sense of personal satisfaction that comes with discovery. I don't think Thomas Edison was sitting in his lab in New Jersey imagining how rich he'd be when he developed the light bulb, or the phonograph; nor Alexander Graham Bell when he developed the telephone, nor Louis Pasteur when he developed the process that bears his name. Besides, take all the researchers who work for private companies and put them to work at the NIH (National Institutes of Health) and public universities - which BTW is where MOST medical research is done now anyway.

Thomas Edison didn't needed hundreds of millions in funding to develop his inventions. Sure, there are scientists who will do the research -- but who will fund them?

Finally, there is a moral contradiction, IMO, with considering healthcare as a marketable commodity. Isn't withholding treatment from a sick or dying person somewhere up there with battery and murder? Instead of sins of COmmission, these are sins of Omission. Our system turns its back on the sick and suffering every day for no sin greater than being poor. Instead we choose to throw good money after bad into frivolous and despicably wasteful things like "The Bridge to Nowhere" and Iraq.

There's another moral contradiction: when does it become morally acceptable to point a gun at someone and require them to pay for someone else's care? That's what's going on when the system is funded by taxes.
I don't deny the faults of a system that penalizes the poor for being poor -- I suffer for being poor on a regular basis. But coercion is immoral whether by a meth addict in an alley or a man in a government office.

all it's going to take to defeat that, or any other bill like it in this country, is to make a few commercials about how "illegal aliens" are going to jump across the border to take advantage of the new system.

Well, that's a valid complaint. It's too bad we can't bill the Mexican government for services to their citizens invading us.

Yes things are as bad as they seem. It is time to overhaul the system.

Things both are and aren't as bad. A lot of it depends on who's running the hospital. A friend here had a work injury, and no insurance, and discovered that anyone with an income under 150% of the federal poverty level can basically get free care. How? Because it's a church-run hospital.

 

[Boogerqueesha]

Hey guys.

Some of us here use facts to support our opinions... that's not the right way to do things, though. Please, make an effort to construct your opinions AFTER you look at the facts, rather than finding facts to bolster your opinion. The former will lead you to truth, whereas even the most petty of simpletons can do the latter.

Patriotism in its pure form is debatably acceptable, but blind patriotism is just plain sad. Here's a lovely free documentaries site, with sicko in it. Watch some, and if you appreciate what they're doing, donate!

http://freedocumentaries.org/film.php?id=133

Sometimes, you have to be wrong in order to be right

 

[andysayshi]

Thomas Edison didn't needed hundreds of millions in funding to develop his inventions. Sure, there are scientists who will do the research -- but who will fund them?

Universal Health Care doesn't negate the incentive for R&D by private companies. Pharmaceutical companies still develop and sell their drugs, the payment just travels a different route. Instead of

Sick Person -> Insurance Co. -> Pharmaceutical Co,

it's Sick Person -> Government NHS -> Pharmaceutical Co.

One way or the other, the community still pays for the medicine, and companies will continue to make those medicines.

There's another moral contradiction: when does it become morally acceptable to point a gun at someone and require them to pay for someone else's care? That's what's going on when the system is funded by taxes.
I don't deny the faults of a system that penalizes the poor for being poor -- I suffer for being poor on a regular basis. But coercion is immoral whether by a meth addict in an alley or a man in a government office.

What you call "pointing a gun" I call social responsibility. We are all human beings. We all have an ethical and moral responsibility to ensure ALL human beings are treated with the same dignity and respect that we would hope for ourselves. In Australia, a flat percentage of everyone's wage is taken to fund our health system, and I don't resent it in the slightest.

Well, that's a valid complaint. It's too bad we can't bill the Mexican government for services to their citizens invading us.

Perhaps Canada could just bill Mexico, to compensate them for the US citizens who travel to Canada for healthcare.

Things both are and aren't as bad. A lot of it depends on who's running the hospital. A friend here had a work injury, and no insurance, and discovered that anyone with an income under 150% of the federal poverty level can basically get free care. How? Because it's a church-run hospital.

And, of course, churches are funded by their own communities. Why not expand the system to a National community-funded Health Service?

 

[Kulindahr]

I know someone who had a premature baby and had she not had good insurance she would have had to pay nearly a million dollars by the time she was able to take her baby home.

I was a member of Lutherans for Life once upon a time. A gal in the neighborhood was facing a premature delivery and leaning toward abortion 'cause she couldn't afford it.
Between our dollars and the pastor's persuasion, she got to have her kid and the hospital settled for a good deal less than the billed amounts.

I totally agree with you. That is one of the critical parts of the issue. The profit must be taken out of the equation. It is unethical for it to be there.

Unfortunately, profit is a motive that gets hospitals built. It's a motive that gets medical research, and medical equipment research, done.
You'd do better to require 1/3 of profits to go into an endowment fund, with proceeds used to cover people who can't pay.

health care is a right.
people should not die because they can''t afford heath care.

I'd be willing to grant that health care is a right if your affliction is something you couldn't possibly have avoided -- say, genetic.
It's too bad insurance coverage doesn't take responsibility into account, asking if a person took all sensible precautions.

Yes there is a price...he is right...despite how much health care costs in America...there is this idea that the more you pay the better care you get...we all know thats bullshit. Just because you pay more doesn't mean you get a better, more quality outcome.

In Hospital Deaths from Medical Errors at 195,000 per Year USA

http://www.medicalnewstoday.com/articles/11856.php

Good point -- the doctors who treated me when I almost lost my thumb didn't know whether I was a 'paying customer' or a charity case... and didn't care.

That medical error death rate just keeps climbing!
Worth noting: you're more likely to die of a medical error once you go to a hospital than you are from a gun shot if you encounter someone who's armed.

 

[Kulindahr]

No healthcare system is perfect, including the Canadian system. However, the results of the American system (life expectancy, infant mortality and other measures of health outcomes) are really not that great for how much we pay. Canadians or Britons may be on waiting lists for certain kinds of surgeries, but they live longer and pay less for healthcare.

I think the key there is that everyone can get basic healthcare without a problem. A friend who's a doctor and my doc also says that if everyone could just get basic care without worrying about cost, most of what comes into the office... wouldn't. And I know that if everyone got an annual physical, health care costs would plummet, since problems would be caught earlier.

My experiences with health care in the United States:

(1) For the first time, I've scheduled a colonoscopy. It's next week, but I began the effort to schedule it back in JUNE! Whoever says there's no waiting time in the U.S. is "full of it."

(2) More than likely the health insurance, which I am paying about $6000 per year for, will not pay for this test. The ONLY way that the insurance will pay for this test, is IF the colonoscopy discloses something which requires hospitalization or surgery. In other words, if it doesn't disclose something LIKE cancer, etc., I'll have to cover the cost on my own, and I believe it's around $2000 or more.

(3) If anything results in a prescription drug, it is not covered unless it's administered in a hospital.

(4) In 2003, when I had surgery, the total was around $25,000 and I had to pay far more than $10,000 of it by myself DESPITE my expensive insurance.

(5) As far as I can tell, no clinic visits are covered, for any reason. Not EVER.

What a totally fucked-up system! I can't believe how many people still think that our system beats the pants off the rest of the world. I would feel safer and more secure with healthcare in Cuba, Costa Rica, Argentina, Colombia, just about any European country (even Macedonia and Belarus?), etc.

Whoa.
My insurance doesn't cost that much, and my coverage is a LOT better!

 

[Kulindahr]

^ This shit pisses me off all to hell.

Dropping people because they're sick should be totally illegal, with hard prison time for all the people involved.

In my mind, this is tantamount to premeditated MURDER (or conspiracy to commit murder or grievous bodily harm, if the person survives).

I have a suggestion for situations like this:

The indemnity against the company in a case like this should go into a National Healthcare Endowment; principal would just sit there, income would go to provide basic healthcare to those of low incomes.

And bar the individuals involved from ever working in any career even resembling the position they held... ever. If they're convicted of crimes, make them register just like sex offenders.

http://blog.myspace.com/index.cfm?fuseaction=blog.view&friendID=144312962&blogID=340269412

It amazes me how many people don't check to see what they're covered for -- and not just for, but how long. My actual insurance company farms things out, and every time they change provider companies I check all over again. Right now I hope they don't change again, because they're contracting to Blue Cross for the best level of coverage, and since I'm with them and not Blue Cross directly, I can't be cut.

The reality is that most people without health insurance can afford it, but choose not to buy it. Sure they complain they can't afford it, but drive new cars and keep Starbucks in business. I pay less than $5 per day for health insurance. About the cost of a cup of coffee at Starbucks. Given that most people who don't have health care are far younger then me, they would pay even less. For people in their 20's, it would probably be around $3 per day. This assumes that they take out insurance while they are healthy. If they wait until they have a major problem, the rates will be much higher and the major problem probably won't be covered at all.

I read a piece that said that most people without health care smoke. Between giving up smoking -- a smart thing, anyway -- and drinking water instead of pop or beer, I believe that most of those people could afford health insurance -- so you're probably right: they can afford it.

And, of course, churches are funded by their own communities. Why not expand the system to a National community-funded Health Service?

Sure -- if it's a choice.
See, in a free country, people get to choose to support such things. So if you want to make a flat-rate system to cover everyone who joins, go for it.

But your claim that "churches are funded by their own communities" is misleading: churches are funded by those who choose to fund them. I was going to say, "by their members", but not all members give, and sometimes those who aren't members give.

 

[Kulindahr]

One of the biggest problems with plans to provide health care is that people want to cover every thing at once.

It would be simple enough to provide one free physical and two free doctors visits per year to everyone. That alone would cut care costs immensely by catching things ealry, and covering small things before they become big things.

Yet there's a problem: if everyone could go to the doctor twice a year free, where are the doctors going to come from? We don't have that many!

And that points to an aspect of the problem almost never mentioned: healthcare in the United States is effectively a government-sponsored monopoly. Don't believe me? Think about this: how does one become a doctor? Well, a person goes to medical school. Which medical school? The answer to that is simple: one certified by the American Medical Association.
See, if you want to be a doctor in the U.S., you have to go to a school with the imprimatur of the American Medical Association, and earn your own imprimatur. What that means at root is that the AMA decides how many doctors we'll have, because not only do they approve only so many medical schools, they tell those schools how many students they can take.
If we're going to overhaul the healthcare system, busting that monopoly would be a good place to start.

 

[Boogerqueesha]

My dad has to turn off the television set every time health care debates show up on American television. Doctors can only take so much of this horrible dynamic, you know- the ugliness of business infecting one of the most caring, giving professions in existence.

My grandfather, also a doctor, lives in Canada. He, thankfully, doesn't have that insanity to deal with. With their health failing, my grandparents don't DARE visit us here in the USA. Not because they can't afford health care here, but because they're rightfully fearful of our ailing system.

Governments should provide two things, and two things only.

LIFE through health care, first and foremost.
and Liberty, by stopping bigots from harming you (and you from harming them).

It's shocking, how we Americans, previously the most independent of peoples, have fallen to having the tiniest aspects our lives dictated by government... a government that fails in its duty to PRESERVE OUR LIVES.

Kulindahr, sometimes it seems to me as if you develop your opinions with the sole purpose of being contrary to those of us latte liberals. Issue after issue, sheesh! So outspoken, too. Out of the most benevolent of curiosities, might you be one of them log cabin republicans?

 

[metta]

My dad has to turn off the television set every time health care debates show up on American television. Doctors can only take so much of this horrible dynamic, you know- the ugliness of business infecting one of the most caring, giving professions in existence.

Yes, I come from a long line of doctors in my family and my father did not encourage me to become one for this very reason. He has been gone for more than 20 years now, but he told me when I was a teenager, that he saw things changing and the focus was not on quality care. It was more about the money. And, at least to my family, that is not what makes health care a rewarding career. I find it very sad to hear how some doctors today, even if it is a minority of them, go into it just because of the money.

 

[metta]

An Open Letter To The Candidates
On Single Payer Health Reform

America's health care system is failing. It denies care to many in need and is expensive, error-prone, and increasingly bureaucratic. The misfortune of illness is often amplified by financial ruin. Despite abundant medical resources, care is often inadequate because of the irrationality of our insurance system. Yet our political leaders seem intent on reprising failed schemes from the past, rejecting the single payer national health insurance model that is the sole hope for affordable, comprehensive coverage.

Leading Republicans propose tax incentives to encourage the uninsured to buy coverage, but these subsidies fall far short of the cost of adequate insurance. For cost control, they suggest high co-payments and deductibles. Yet these selectively burden the sick and poor, discourage preventive and primary care, and have little effect on costs, since seriously ill patients - who account for most health spending - quickly exceed their deductibles and are in no position to forego expensive care.
The incremental changes suggested by most Democrats cannot solve our problems; further pursuit of market-based strategies, as advocated by Republicans, will exacerbate them. What needs to be changed is the system itself.

Most leading Democrats offer a mandate model for reform. Under this model, the government would require people (or their employers) to buy private coverage, while offering an expanded Medicaid-like program for the poor and near-poor.

Variants of the mandate model, first proposed by Richard Nixon, were passed with great fanfare in Massachusetts (1988), Oregon (1989) and Washington State (1993). All died quiet deaths. As costs soared, legislators backed off from enforcing the mandates or funding new coverage for the poor. Massachusetts' recent reform, which largely excuses employers from the mandate but imposes steep fines on the uninsured, appears poised to follow a similar path. Of the middle-income uninsured who are required to pay the full premium for coverage, few have signed up. Meanwhile, the state has already announced a $147 million shortfall in funding for subsidies for the poor.

Mandates and tax incentives can add coverage only by increasing costs. They augment the role (and profits) of private insurers, whose overhead is four times Medicare's, and whose efforts to avoid payment impose a costly paperwork burden on doctors and hospitals. The cost cutting measures often appended to such reforms - computerization, care management and medical prevention - have repeatedly failed to yield savings.

In contrast, single payer reform could realize administrative savings of more than $300 billion annually - enough to cover the uninsured, and to eliminate co-payments and deductibles for all Americans. It would also slow cost increases by fostering coordination and planning.

Political calculus favors mandates or tax incentives, which accommodate insurers, drug firms and other medical entrepreneurs. But such reforms are economically wasteful and medically dangerous. The incremental changes suggested by most Democrats cannot solve our problems; further pursuit of market-based strategies, as advocated by Republicans, will exacerbate them. What needs to be changed is the system itself.

We urge our political leaders to stand up for the health of the American people and implement a non-profit, single payer national health insurance system.

Yours truly,
Quentin Young, M.D.
PNHP National Coordinator

http://blog.myspace.com/index.cfm?fuseaction=blog.view&friendID=144312962&blogID=362512617

 

[metta]

I think that this explains why the US health care system is the way that it is...

http://cosmos.bcst.yahoo.com/ver/256.0/popup/index.php?cl=7112628

 

[frankfrank]

When the medical system rations diagnostic tests: (altered to reflect gay content LOL)

The phone rings and a man answers, "Hello."

"Mr. Mason, please."

"Speaking."

"This is Doctor Jones at the Medical Testing Laboratory.
When your doctor sent your mate's biopsy to the lab yesterday, a biopsy
from another Mr. Ward arrived as well, and we are now uncertain which one is
your mate's. Frankly the results are either bad or terrible."

"What do you mean?" the man asks nervously.

"Well, one of the specimens tested positive for Alzheimer's and the other
one tested positive for AIDS. We can't tell which are your mate's."
"That's dreadful! Can't you do the test again?" questioned Mr. Mason.

"Normally we can, but Medicare will only pay for these expensive tests one
time. The people at Medicare recommend that you drop your mate off
somewhere in the middle of town. If he finds his way home, don't sleep with
him."

 

[metta]

Lifeline

Forty-seven million Americans have no health insurance. Millions more are underinsured, unable to pay their deductibles or get access to dental care. Here's the story of Remote Area Medical, a charity founded by Stan Brock that was originally designed to bring doctors and medicine into the jungles of the Amazon. But these days RAM finds itself doing much of its business in the U.S. Scott Pelley spent a weekend in Knoxville, Tennessee taking a look at RAM in action.


http://60minutes.yahoo.com/segment/163/lifeline

 

[frankfrank]

BUMP, as promised.

Similarly, the thread What's the point of a 'free' health system... is worth reading...

 

[metta]

Survey Shows Nearly 1 in 4 Gay Americans Lack Health Insurance

The study also revealed that gays and lesbians are almost twice as likely to have no health insurance coverage as their heterosexual counterparts.

http://www.realjock.com/article/1120

 

[metta]

Paying More, Getting Less

How much is the sick U.S. health care system costing you?

By Joel A. Harrison
http://dollarsandsense.org/archives/2008/0508harrison.html

By any measure, the United States spends an enormous amount of money on health care. Here are a few of those measures. Last year, U.S. health care spending exceeded 16% of the nation's GDP. To put U.S. spending into perspective: the United States spent 15.3% of GDP on health care in 2004, while Canada spent 9.9%, France 10.7%, Germany 10.9%, Sweden 9.1%, and the United Kingdom 8.7%. Or consider per capita spending: the United States spent $6,037 per person in 2004, compared to Canada at $3,161, France at $3,191, Germany at $3,169, and the U.K. at $2,560.

more than 60% of the $2 trillion annual U.S. health care bill is paid through taxes

All told, then, tax dollars already pay for at least $1.2 trillion in annual U.S. health care expenses. Since federal, state, and local governments collect about $3.48 trillion annually in taxes of all kinds—income, sales, property, corporate—that means that more than one third (34.4%) of the aggregate tax revenues collected in the United States go to pay for health care.

a family with an annual income of $50,000 that has no health insurance nonetheless contributes nearly 10% of its income to health care merely by paying typical income, payroll, sales, excise, and other taxes. A person who earns about $25,000 a year and has no health coverage already contributes over $2,400 a year to the system—enough for a healthy young adult to purchase a year's worth of health insurance.

Americans spend more than anyone else in the world on health care. Each health insurer adds its bureaucracy, profits, high corporate salaries, advertising, and sales commissions to the actual cost of providing care. Not only is this money lost to health care, but it pays for a system that often makes it more difficult and complicated to receive the care we've already paid for. Shareholders are the primary clients of for-profit insurance companies, not patients. Moreover, households' actual costs as a percentage of their incomes are far higher today than most imagine. Even families with no health insurance contribute substantially to our health care system through taxes. Recognizing these hidden costs that U.S. households pay for health care today makes it far easier to see how a universal single-payer system—with all of its obvious advantages—can cost most Americans less than the one we have today.

 

[drhladnjak]

A few years ago, I saw a talk where the speaker noted that the amount of money spent in California by the health insurance industry on advertising equaled the cost of the premiums for people in California who were currently uninsured.

Similarly, Medicare shoulders a surprisingly large chunk of the cost of healthcare in this country, mainly because the elderly need a lot more care than everybody else already. It's kind of ridiculous how shrill the debate about a single payer government backed healthcare system is considering how we're quite close to that already with Medicare and Medicaid.