Health Care Reform

Can I ask you something? Whats the max payout per occurrence on your plan? Whats the deductible? I'm only asking because people who have insurance are the majority of people getting medical bankruptcy. My friend got insurance through her work, and was paying about $80. Then she got cancer, and they told her the max payout per illness was $5,000. Thats not even one Chemo treatment.

Should we have universal care via a single payer system? I don't know, I just think we need to fix problems like this. To many decent taxpayers fall through the cracks because there is no oversight on the medical insurance company's. They can pretty much do whatever they want, which is usually screwing the common American. That just bothers me, and makes me a little sad.


I also think we need to figure out why we pay so much more money for the medical care we do get. Why is an ambulance in Japan $50 USD and one Here is $500? Why will an ER visit cost me $300 in Japan and several thousand here? (This was for the same thing in both places. SVT with an ambulance ride.)

 

I don't disagree with you in theory, but Japan may be the worst example considering they have the largest deficit in the world. Any reform has to be fiscally sustainable.

 

Within the last year I have been having problems with my legs. I'm in good shape and exercise regularly. I had gone to about 5 specialists before they figured out that I had a compression problem in my lower spine that was causing me pain in my legs. The doctor who diagnosed me put me on the path to become relatively pain free through physical therapy and other things. If the PT didn't work, a relatively inexpensive surgery would be in my future. I thought that was a good diagnosis and was looking forward to getting well.

The insurance company denied the claim. The company that I spend over 1000 dollars a month to insure myself and my youngest daughter said that I could not continue therapy because they claimed that the spinal injury was a result of a car crash I was in when I was 7 years old and that they were not required to pay for me getting better.

Note, I saw one single doctor from the insurance company for all of 5 minutes. The doctor asked me a bunch of questions and believed the injury was due to my occupation and the fact that I'm actively on my feet for 10 hours plus on a clip. Yet, when the people who reviewed my case looked further (another doctor whom I've never met or spoken to) believed because I was in a car crash (where I spent one night in a hospital with a head injury) 30 years prior was the reason why I have problems now. Not to mention that I didn't hurt my spine in the accident or the fact that I've lived about 28 years without any problems prior. Still, it sucks that a company I'm paying for a service is denying service because of a technicality.

I've literally spent thousands of dollars to get 2nd, 3rd, 4th and 5th opinions from some of the best bone doctors in the business. None of them believe for a moment that my accident had any causation to my current predicament. Still, the insurance company believed the word of somebody in their employment, who had never met me or really diagnosed my case and are still denying my claim.

The only reason I haven't switched insurance companies is that if I get sick soon after I go with another company I'm going to have to go through the exact same thing again. I am paying for my physical therapy out of pocket while some bureaucrat in an office can sit back and say "tough luck".

So fuck the insurance companies. I hope that whatever policy gets pushed forth by the government causes them as much pain as I feel in my legs every day.

 

I'm not sure about the max payout. If I remember correctly it was in the millions though. I think with the plan I signed up for I have something like a $1,000 deductible. And I'm responsible for 30% of the bill while insurance covers 70%. Other options I have available to me would have a 80/20 and 90/10 split. Going to the walk in costs a $20 copay.

I understand what you're getting at though and I realize how fucked up everything is. My brother hurt his knee in a drunken sumo wrestling tournament at a bar. He has insurance and after all the tests and everything it still cost him something like $1,500. And believe me, I am fully aware that if something terrible were to happen and I had a million dollar hospital bill and was responsible for $300,000 I would be royally fucked. That's my biggest problem with the current system of insurance. Someone can have decent coverage and still go bankrupt if something catastrophic happens.

But I'm not going to jump on the insurance company bashing bandwagon. Their profit margin seems reasonable to me. They might be making a lot of money in absolute terms, but they also spend a lot of money on their customers. They pay something like $10 for a single fucking Tylenol. So compared to what they spend, their profits aren't that egregious, in my opinion. I think politicians know the average American feels cheated by the insurance companies (yes, dealing with them can be a fucking disaster. But I don't think that dealing with a government bureaucrat would be any better) and it's easier to deflect the argument and debate by attacking their profits than to actually talk about the real issues. The debate then turns into a fucked up mess of stupid political games where the real issues are 3 or 4 levels of abstraction away from where the discussion should actually occur.

That being said, it's not right that someone with good health insurance is a car accident or a few tumor cells away from financial ruin. I would be more comfortable with the government somehow subsidizing these catastrophic expenses in a more organized and planned out way than having the government completely take over the business of health care. But even before that, I think we should look at free market solutions to these problems. And you touched on the major problem, as I see it anyway:

Now I'm not going to pretend to know a whole lot about the industry. But I have read about all of this quite a bit. And like I said earlier, I'm smart enough to know that I'm too stupid to understand all the complexities of the problem on anything deeper than a surface level. One way to look at it is an ambulance ride in a country with socialized medicine costs $50 because the government, by taxing citizens at a much higher rate, subsidizes the other $400, probably by paying $600. But the most convincing evidence for the higher price that I've seen is due to the fact that nobody knows what shit in a hospital costs. If you have insurance, it'll cost more than if you don't. If you have insurance then you get the brand name drug that costs $400. If you don't then you get the generic that costs $40. And since you have insurance, you don't care because you aren't paying shit for it. Like someone said earlier, the costs of medical care are so far removed from the consumer that it fucks with the basic principles of the free market. That's why I don't understand why it's so common for people to blame capitalism and free markets for the health care problems. I think Savage Henry (someone who works in the field and as far as I can tell is quite knowledgeable on the subject) already pointed out how the health care industry as we currently know it is a far cry from capitalism. And when the majority of people don't know, or more importantly, don't care what shit costs, then it fucks with the free market.

Before we jump head first into socializing medical care, I think it would be wise to at least attempt to find free market solutions to these problems. Major, sweeping change would be fine with me as long as it promoted real free market solutions. Say what you want about capitalism and free markets, but they have been essential in making America the economic leader of the world. I wouldn't fuck with that system too much. Maybe we need to detach insurance from employment. Maybe make health insurance more like car insurance or homeowner's insurance. With the decreased expenses to business, maybe employees could get paid more. Couple that with lower taxes, and maybe people could purchase their own insurance. With the government covering catastrophic care, maybe insurance companies could charge less because they wouldn't have to worry about payments over, say, a million dollars. Then maybe insurance companies would be able to cover closer to 100% of the bill instead of leaving customers with 20 or 30% of a huge bill. Again, I don't know how to solve this mess, but I do know what I don't want to see. For my money, I would rather see politicians identify and fix the problems with our current system than drastically overhauling the industry and transferring it to the public sector. It's fairly easy to undo free market solutions if they don't work, but once government takes control then there is no going back. That decision shouldn't be made in haste.

 

I don't disagree, but I also wonder why I rarely hear that about war. We can go into debt to kill people.

 

I agree somewhat. Does the fix need to be socialization? Maybe not. We wouldn't be jumping off a cliff in the dark either, we've got 50+ years of information too look over and figure out what works best from Europe. We could take the best parts from all the systems.

I can only say that it's their own fault for having to pay $10 a Tylenol. This shits expensive because the hospitals raise prices to cover the % of people who don't pay. If everyone had access to affordable care,(socialized or free market) the prices would shift. Or, so it seems to me. <my mom runs a surgical outpatient practice. So I've seen how they bill. Another thing, She spends well over $100,000 a year just to have people who know how to deal with the in and outs of each company.> That's a lot of money that could be used for other shit.


As someone on medicare, I've just gotta say, I've never had to talk to a government bureaucrat. I've only had trouble with it when the hospital bills incorrectly. That's an easy fix though, they just have to resubmit.

 

I'll leave a disclaimer on this post: I've been drinking and my arguments could be as coherent and productive as the guy on the bar stool next to you ranting and raving about the conspiracies of the Bilderbergs.

I have a degree in Criminal Justice. And the most interesting part of my classes was the punishment aspect. If you stick with me, I'll be able to relate this to the focus. If I fail at that, then the mods should delete this.

Basically, there are 3 ways for the government to deal with criminals:

1) Social Isolation: Lock criminals up so they cannot commit any more crimes against the public.
2) Retribution: Lock criminals up because it's a fair and just punishment. The punishment fits the crime.
2) Reformation: Turn criminals into good citizens.

Now, without getting into the specifics, these three philosophies of punishment are in direct contradiction to each other. Yet we try to do all 3. If we're going to isolate criminals, then we need to lock them up for an insane amount of time (regardless of whether they will continue a criminal life or not, since it's essentially impossible to figure that out with any degree of confidence). When we do this, we end up punishing criminals much harsher than their crimes would allow (failing at retribution by exceeding 'the punishment fits the crime' model), and fail at turning criminals into decent citizens (reformation, since they never assimilate back into society). On the plus side, there are very little repeat offenders.

If we focus on retribution, then there is a public outcry for not isolating or reforming criminals. With pure retribution, a person would only be punished in accordance with the crime they commit. If they commit the same crime 10 times, the punishment never changes since the amount of harm they cause on the specific crime never changes. Once they pay their "just deserts" for the crime, the slate is wiped clean. Also, this philosophy says it immoral to try to "change" or "fix" the criminal. If a person chooses to break societies rules, then they should be punished in direct proportion to the amount of harm the crime caused. This usually results in a much lighter punishment than society would like. The public then becomes upset because we aren't isolating repeat offenders (social isolation) or turning them into decent citizens (reformation). On the plus side, we aren't punishing too harshly or softly since the punishment truly fits the crime, maximizing "fairness".

We could also focus on reforming criminals and turning them into decent citizens. This pisses off the public because they are routinely released into society (no social isolation). And the public is also pissed because the criminals don't pay for their crimes through an appropriate punishment (going to counseling and group therapy isn't harsh enough for a violent criminal, so there is no retribution). On the plus side, we are maximizing the extent to which criminals can be turned into productive members of society as opposed to being a drain on it.

Now that I got that out of the way, I'll repeat something a professor said: "If we can focus all our energy on doing 1 of the 3 right, then we'll at least succeed at being very effective at that one thing. But since we currently try to do all 3 at once, we fail at being effective at anything."

When it comes to health care, the government cannot possibly do 3 things effectively ("taking the best part of all the systems", because those parts are usually contradictory in nature). Their promises never match the results, no matter what arena of society they are talking about. To me, "Taking the best parts of all the systems", means that they will only succeed at failing at everything.*

That's not to say the private sector doesn't do this to some extent as well. But why transfer all that power to the government just to get similar results?

I'll say it again, when government tries to provide everyone with equal results, they only result in making everyone equally miserable.

*downndirty pointed this out earlier.

 

No, I get that and my argument wasn't just for single payer. That kind of sounds like "Nothing we can do will be perfect, so why try." I honestly don't see how they could get worse.


We can look at Europe to figure out what we can reform. Some Countries like Switzerland, have a really effective and cheap mix of private/ public. How do they do that? How can we do that?
Its just simple research.

 

Why do they need to try to make a profit? Why does this field need more people taking more money out of it? I've got a non-profit insurance plan, and it's fine, it has a solid reputation and good service. But once you change the motivation from "heal sick people" to "heal sick people and/or make a decent profit", you've given a very good chance for a conflict of interest to arise, and given a very good chance that a for-profit company will do something unethical to deny coverage (like, say, claim some bullshit that a car accident you had 20 years ago is what's hurting your legs, despite a complete lack of evidence for this hypothesis and a dissenting opinion from every doctore who has actually examined the patient).

 

I think a lot of us are missing the big issue here. Health care costs too damn much. Hospitals in the US charge insane amounts of money for the services the provide because they can get away with it. Basically, the customer is the insurance company and the insurance company has a large pot of money to draw from. This gives the hospital no incentive to look into cutting prices/costs because because they're dealing with the insurance company rather than an individual persons bank account. If the hospitals had to deal with your average joe's bank account, they'd have to slash prices overnight in order to stay in business.

Healthcare is one of the few industries out there where technological improvements and increased efficiency actually increase the cost, it's fucking insane! Now let's take a look at something like Lasik surgery, which isn't covered by most health insurance plans. When Lasik first came out it cost a fortune, I think somewhere around 2k an eye. Now I've seen prices as low as $500 an eye. I don't think you'll find any hospital procedure that's ever gone through that kind of a price reduction because they were never forced to in order to continue doing business.

I don't think universal health care will solve the price issue because the government would essentially take the place of the insurance companies and once again, hospitals would have no incentive to lower prices. In a way it could get worse if the prices kept skyrocketing and we had to pay for it with extreme hikes in our taxes or increased deficit spending on the part of the government.

My view is, make the playing field level and let hospitals compete for business just like every other company out there has to. It seems pretty obvious to me that if your average American can't afford his 1 month hospital stay to cost him somewhere in the 6 figure range that the hospitals would figure out a way to reduce the price in a hurry or risk going out of business entirely.

 

Medicare already sets prices. THey say " Hey the fair market price on this procedure is $100.00 So that's all we'll pay. So The hospital charges the medicare patients $100.00 and the private insurance company pay $200.00 and people paying out of pocket get charged $150.00


I think one of the goals of the Obama plan is cost control.

 

From what I've heard, you're right. Obama's plan(did he write it?) has cost control as one of it's goals but I'm not a big fan of government price regulation in general.

My idea is pretty much a fantasy, if implemented, a lot of people would lose a shit ton of money, from the doctors on down to the hookers that the lobbyists paid to blow the Congressmen to keep this current shitty system in place.

 

I think this is where a lot of the debate is centered. I've talked about my opinions on this issue many times. There's no question that major improvements and changes need to be made to the way insurance companies operate. But when the motivation is purely "heal sick people" and "make money" is put on the back burner, you'll run into a whole new set of problems. We currently have a 12 TRILLION dollar debt. And I think I read that that number is going to grow by 1 trillion every year for the next 10 years. And that's a conservative estimate. The fact of the matter is that we cannot sustain that much debt unless we want to start a war with China and hope we kick their ass and make them forgive our debt. If a large government program that is driven by "heal sick people" is created, it's inevitable that it will not be a self sustaining system and will add to the deficit.

Between Medicare, Medicaid and Social Security, and the debt as of 2008 we have $53 trillion in unfunded obligations.

It doesn't take an economist to tell you that we cannot keep spending this much without 1) Significantly raising taxes, 2) borrowing money, which raises inflation, or 3)printing more money, which raises inflation, or 4) A combination of all 3. I don't think spending another trillion dollars a year is a very wise decision. Even if we spent a trillion dollars a year less than what we do now, we'd still be half fucked.

So what the fuck do we do then? I don't have a clue. But the answer lies somewhere between "let hospitals and insurance companies do whatever the fuck they want" and "Let government control it all". I hope we can all agree on that at least.

Also, if we don't make money on some level, advancements in technology and techniques will most likely suffer. Maybe that's what we need since everyone wants the newest and best technology in the hospital. It's like we're giving everybody a brand new Corvette every year and throwing away the old ones. It's no wonder the economics of the industry are fucked sideways. Maybe if new Corvettes weren't being produced, we'd hold onto our current ones longer and reduce costs. But that obviously opens up a whole new set of problems. No matter what you do, it seems like solving one problem will create 2 or 3 more. I guess we'll have to pick the best tasting piece of shit.

 

Free health care is driving up health care cost. Realize that for everyone that doesn't pay, someone has to make up the cost. And that happens to be people with private health insurance. Personally I pay for my health insurance. Last year I had shoulder problems and my wife had her gall bladder removed. The medical bills for both of us were close to $45,000 for the year. After our deductible and our 80/20 plan, we owed in the neighborhood of $7,000 dollars. So I feel my insurance covered enough on their part. Now why is the cost that high? Mainly because all you have to do is show up at an emergency and the hospital has to treat you and if that means admit you for a stay then they have too. Then they recieve no payment or if it happens to be someone on Medicare that is treated and uncle sam denies 1/2 of their claims then again they recieve no money. That is why cost is high for the people who are paying for it.

Nothing is free for everyone. If you work and pay taxes you are getting nothing free from the goverment.

Everyone should be responsible in contributing to their own health care no matter how little the amount. If you can't afford five dollars for an ER visit then you aren't trying hard enough. And if you don't care enough about your own health care then why should anyone else have sacrifice what they EARNED to make your life better.

 

Where can I go for an $5 ER visit, because holy shit, I'm there.

What I'm saying is If everyone has some sort of care socalized or private industry, cost will go down because EVERY BILL WILL BE PAID. IF the prices drop, we can treat more people for the SAME AMOUNT OF MONEY!

I've asked before, but why is my heart medication $5 in Japan or $6.50 in England, and $300 here? That's some fucked up shit, also BTW, Japan's System

 

$5 for a trip to the ER would be a hell of a deal. I somehow doubt it would cost that little, especially if the ambulance that brought the person there probably cost in the neighborhood of $500.

I got hit by a car back in 2003. I was only 20 at the time and I had no health insurance. At the time I tried refusing medical care but I was assured by some city official on the scene that the ambulance ride was free or some such crap. I was pretty much in a state of shock and I didn't have the faculties about me to put up much of a fight so I got carted up into the ambulance and hauled off the hospital where surprise, they found nothing seriously wrong with me. Even more surprising for me was finding that my little trip to the hospital, including the ambulance ride, cost me somewhere in the neighborhood of $1200. There is no fathomable way that any sane person could justify that cost. The doctor spent a total of 15 minutes on me and gave me no medication. The bottom line is, the insurance system allows hospitals to charge amounts that are way out of line and that no one can afford.

As for people complaining about paying for other peoples health care. When I was 21 I got a job working for an automotive website, with health insurance, and remained employed by them for 2 and a half years. At no point in time during that 2 and a half years did I need to go the hospital so I never went. Meanwhile my coworkers were working the shit out of it having kids and whatnot. We all pay for other people's shit eventually. I personally don't advocate a single payer system with the government being that single payer, but I sure as hell don't think there's much of a difference between a government payer and a private insurance company. I think they're both poor solutions to the problem.

 

Cost would not go down. Medicare as we have now is pretty close to socialized medicine, ie, the goverment paying for it. However that is what health care reform advocates are blaming for running up health care cost. My parents are on medicare and they have to have a supplemental insurance policy to cover what medicare doesn't cover. And alot of doctors won't take new patients without supplimental insurance because often times medicare denies paying their claim. So there again some recieves a service with an incurred cost and the provider is not paid or not paid in full, so the cost is made up from people who have private insurance and actually pay.

Right now with schip, children of families under a certain income level recieve free health care. My younger brothers children recieve care under this program. The doctors treat them no different than any other child. He recently had a baby boy that had a genetic disorder and had several holes in his heart. They had him scheduled for heart surgery and he recieved very good care from the hospital. And it was all free for him. Don't get me wrong, I believe this is a worth while use of my tax money, but someone had to pay for it.

Read the legisilation of the current health care reform bill. Most people will not get free health care. You will get goverment health insurance but you will still have to pay for your services. And to control cost for the goverment using our money to pay for care like my little nephew recieved, they will have to start DENYING services.

The $5.00 dollar emergency room visist is an amount for people who are covered free now and visit the ER because they have a runny nose. Maybe if it cost them five dollars they would stay home. Ask any ER attendant if it doesn't happen.

 

I currently pay $550 a month, through work, for "family coverage". Then you factor in the $25 co-pay for a regular visit, $40 for a specialist and $150 for an ER visit. I could get a cheaper plan but then it would be an 80/20 plan or one with a maximum lifetime benefit payout.

While I have no (real) complaints with the coverage we receive or wait times for procedures I think it's pretty ridiculous that I'm paying 1/5 of my yearly income on something I only use for routine childcare visits and random sickness visits. But I'm afraid to lower my coverage in case something serious were to happen/ be found.

I'll admit I don't know the ins and outs of the proposed new plan, but if it's going to lower my monthly costs and afford me the same coverage then sign me up.