Glad you can join us, Americans. I think.

This is why county hospitals exist. To treat the patient who cannot otherwise afford to seek treatment at private hospitals. During my med school career I was involved in the treatment of hundreds of indigent or sub-insured patients. They would be evaluated and treated without regard to being able to pay. They also had the option to seek health insurance that was graded on a sliding scale based on their current level of income through the hospital system. Prescriptions were also included, granted you may not always get the major brand name pharmaceutical for every malady.

Even at private hospitals if you are seen for treatment you must be stabilized before they can even request a transfer to a county hospital if you have no ability to pay. On a typical night on call with a cardiologist that I was involved with, we stented on average 5 people a night and only 1-2 would have health insurance. The cost of procedure would be eaten by hospital and the physician would basically be donating his time since he was obviously not going to get paid.

The problem with this bill is the addition of millions of people to the coffers of medicare and medicaid that reimburse at a substantially lower tier than regular health insurance. There just simply is no incentive as a physician to even see these newly insured patients. Another key part of this bill is to create primary care doctors to increase preventative medicine. However the problem is that medicare won't pay for even half of the preventive care measures that are even remotely necessary to perform. One example of which is that medicare will not reimburse a physician for a physical exam post age 65. Ridiculous!, and yet the usage of CYA medicine will continue since tort reform was not addressed because surprise surprise most of the politicians are lawyers. Sigh.... the worst part is that those family docs and pediatricians stood up behind the president and sold the specialists up the river all while smiling and applauding like sheep.

 

Short answer: because when you get hurt, the bill for your medical treatment doesn't disappear. Someone has to pay that. And often, that someone is the rest of us.

 

I will be the 2908325th person to agree that insurance companies are seriously out of line and need serious change.

But, to me, it's simple: this is going to harm healthcare. I think people get caught up in the idealism of everyone having healthcare. It would be awesome if we could all have the same advantages and benefits, but we can't. Our world is far from perfect and always will be.

People seem to forget that healthcare is a business. If your business has fewer financial resources/less money coming in, something is going to suffer. The quality of care will decrease. Who knows how many people in healthcare will lose their jobs. State of the art facilities and equipment will be fewer and farther between. Anyone who works in this industry is familiar with how Medicare works and why MOST physicians/facilities don't accept it.

Main concerns: I don't want patients' quality of care to suffer. Also, I'm hesitant about how a broke insurer is going to dictate how physicians treat patients and what drugs to prescribe. I don't want the government to have access to my medical history. I don't want my government and country to sink even deeper in debt.

The sad part is this bill (now law) seems more about power and politicians' personal agendas instead of actually helping and caring for people. This will not go well for anyone involved.

Edit: In response to people who wonder what happens when you have these impossible hospital bills to pay: EVERY hospital/clinic/etc I'm familiar with is more than willing to set up a payment plan and give discounted prices to people who don't have insurance. You can go to Parkland, rake up thousands of dollars during an ER visit, and pay $5 every month on a discounted amount for the rest of your life. As long as you are paying SOMETHING, people are more than willing to work with you on fees. (This is where everyone WITH insurance bends over.)

 

This is something I've been wondering about but haven't seen a good analysis on. To what degree does the United States (which is home to most of the major pharmaceutical companies, a whole heap of medical device companies and advanced private and university research, as well as the population that pays for these things) subsidize the rest of the world by bearing the brunt of the cost of developing new drugs, devices and treatments?

 

What if I want to pay it out of my pocket? Yes some of us have enough money to do that. Or let me die. Either way, I should be able to opt out if I want to.

I'm still in shock that this thing will raise income taxes on those making over a million a year by 5%. That would be enough to make me move/hide my income/do something if I was that rich.

 

The problem is that we as a society don't let people die, and I don't think a society should reasonably be expected to. The only time I've ever heard of an authority explicitly say they'd let someone die was when Alaskan park rangers, after rescuing some numb nuts for the second time in the span of two weeks, told him that they wouldn't come after him a third time, and that was only because they were putting themselves at risk every time they went out to get him. The whole "pay or die" hardline is basically the repo-men trailer someone linked earlier.

 

Too true. I've had patients on indefinite life support post massive cerebral hemorrhage with absolutely no chance of ever coming off. All because the family refused to believe that he was indeed brain dead. They thought that we were all evil penny pinching doctors who were withholding life saving neurosurgery from the patient, when such a procedure would offer absolutely zero benefit. People need to realize when to just squeeze their loved ones hand, cry one last time, and accept at some point it is game over. Huge wastes of taxpayer money.

 

OK, maybe I'm missing something. Out of 5 people, 1-2 would have health insurance and the rest would not. So the hospital and the Dr. would basically eat the cost on the other 3-4 people.

But if you insure those same people, then the facility and the Dr. would still get something, even if it was at a lower tier, correct? Isn't the incentive to get something rather than nothing? I think there's something I'm not seeing, but it seems that it would be better to get something for the procedures rather than just eating the entire cost.

 

Tort reform would be the single most effective way to reduce health care costs without raising taxes.

But no, that would be too effective. So we'll remove pre-existing exclusions, a simple smoke and mirrors effect that will raise premiums for all. But why?

FUCK SPECIAL INTERESTS!!!!



And yes, Pelosi is still an agenda-seeking cunt.

 

My point was that we as physicians are already donating our time to patients without healthcare. The issue is that with an increased number of patients on Medicare and Medicaid physicians will slowly have our pay eroded from us. In the short term this insurance coverage for all may boost our pay... however long term it will only serve to decrease our compensation. Insurance takes it's cues from Medicare when it comes to reimbursement. With an expanded role of Medicare they will take point to continue to devalue reimbursement and insurance will follow suit in order to save on their bottom line as well. As an anesthesiologist this is a key point for me since Medicare literally reimburses 60% lower than even the stingiest of health insurance companies.

 

We literally made people glow from all the CT scans we performed at the county hospital ER. Even if a simple physical exam and history would tell you the diagnosis, we would CT them in order to not have some rare complication occur which would then be used in court against us. At $1000 dollars a pop for a mostly indigent patient population that was hugely expensive and a time waste.

 

It varies greatly, but from friends of mine anywhere between 40k to over 100k a year.

Figure a doctor averages 150-200k a year, that's a conservative 30% in overhead on insurance alone.

 

Like many others, I am a firm believer that the healthcare system in this country has been in need of reform for a long time. There are good things about this bill. I like that it essentially gets rid of companies being able to deny you coverage because of a pre-existing condition. I like that it removes the middle-man in the student loan process in this country (this bill will eliminate banks from the student loan equation, making it so that loans come directly from the US govt. and you pay them back directly to the US govt.). I like that it will give more Americans access to care that they otherwise might never have had access to before.

However, I do not agree with there being fines imposed on those who do not purchase a healthcare plan. It seems to me that there are people out there who do not have access to the kind of money to afford a plan for themselves (and any kids they may have). What then will we do? Repeatedly fine them until they run out of money? (NERD ALERT, I know I'm referencing "Star Trek" again, but it's the best example I can think of) If people become too poor to afford healthcare because of fines imposed upon them - what are we going to do with them? Set them up in Sanctuary Districts just to get them out of sight, out of mind?

I definitely hope the fines/penalties for those who cannot afford a healthcare plan are removed from this bill.

Now - even though I am a fan of taking banks out of the student loan equation, this could bring bad news for the student loan program. It's a fairly well-known fact that most people don't ever repay their student loans in full - especially with recently enacted repayment plans like the Income Contingent plan (which allows you to pay a monthly payment contingent upon your income - and, if you have not repaid the full debt after 25 years, the remainder is simply forgiven). If not everyone is repaying their student loans in full, how will the program remain viable? If it's not taking in what it's giving out, I don't see how it can survive indefinitely.

This bill is far from perfect. I'm going to be interested to see what happens with all the lawsuits pending against it.

 

So in your proposed system, what is stopping people from refraining from purchasing health insurance until they are gravely ill? You could walk around until you are 50, but then you find out you have stage 4 lymphoma so now you go out and buy insurance? Seems highly responsible to me. The purpose of insurance is to have people pay into a community pool in order to cover those unfortunates who suffer catastrophic losses. Pre-existing conditions for children I agree should always be covered regardless... Pre-existing for adults is a hazy line that I would not support past age 21. At some point you have to start rubbing your neurons together and start thinking like a responsible adult.

 

Unfortunately, nothing is stopping them from doing just that. I agree that it's despicable for people who suddenly develop a terrible illness to run out and purchase health insurance. I just do not agree with imposing a fine of nearly $700 on people who do not have health insurance, as there are people out there who legitimately cannot afford to purchase the insurance in the first place. I have not been able to find a copy of the bill, so I'm unfamiliar with how the government plans to enforce the penalties for not having insurance - so my reservations may be for naught, depending on the enforcement of the penalties.

I personally already have health insurance through my job, so thankfully I'm covered.

 

That wouldn't work. If insurance companies can't discriminate because of pre-existing conditions, and there's no individual mandate, then you'd see millions of people game the system by coasting along without insurance, only to jump into the pool when they get really sick. I'm no fan of insurance companies, but they'd definitely be getting screwed under this scenario.

For the most part, I'm pleased with the bill. I think it's a shame that so many people have to go without health insurance, and I believe we can cover everyone without going bankrupt. I would have liked to see some tort reform- although I think the effects of it have been overstated- but there's plenty of cost control in the bill as it is.

It was pretty ridiculous that the bill's opponents were citing polls to make their case. "The people have spoken!" they were yelling on C-SPAN. Yes, the people did speak...in November of 2008 when we had the presidential and congressional elections. We're a representative democracy, not a plebiscitary one. If think the people are on your side, then run against the bill and maybe you'll get a majority in November. That's why we have elections.

 

As a citizen of a country with 'free' universal health care (Australia), let me share the crap we have to deal with. Take from this what you will. I'm hazy on exact details as I'm apoplectic over current developments and refuse to pay attention to anything more than the concepts as I'll just get angry and raid my gun safe. So this is a generalised, broad strokes dissemination.

For a number of years we have had free healthcare provided to all citizens and permanent residents. It's called Medicare. All taxable incomes have a Medicare surcharge on them which goes to the pool to pay for this. It's 1.5%. Many general practitioners and some selected specialists (eg optometrists, x ray techs) "bulk bill" through Medicare, at their election. That is you go along, you show your Medicare card and they give you a free consultation. Whatever you need from there, ie drugs, glasses etc, you're on your own. It's arguable that the standard of service is less than providers that require you to pay them, and then recoup from Medicare. As with any person you see, your mileage may vary. But even if you have to pay out of your pocket when you see your selected provider, Medicare will pay you cash based on a schedule of what they think you should have paid. There's no mandated scale, and most providers charge well above what the government think they should.

In addition, going to a public hospital is by and large free. Free care, free bed, free operations and so on. If it's not life threatening, be prepared to wait your ass off and get bumped down the line. Cosmetic surgery, for example, is not covered so the government is never going to give you free tits.

It's not perfect, but it's generally workable. But here's the rub. Remember the 1.5% of taxable income? Obviously, the more you earn the more you contribute, whether you're sick or not. In addition to that, the government says that if your gross income is over a certain amount (differs for singles and couples, but starts around $70,000), you pay an extra 1% unless you have private insurance. So, in other words, not only don't you already pay more for the same service, if you earn over a certain amount you have to pay and pay for insurance. Our insurers aren't as bad as the US, but they're no angels, and they only generally cover a part of the cost. This didn't used to be so bad as the government would rebate you 30% of your insurance premium. They recently scrapped this. So you're forced into private insurance (which has its perks but for a young, healthy single it's not worth it), and you subsidise all the welfare recipients who pay nothing for their healthcare. That's not an argument for or against, it's just a fact.

But that's not all. If you're privately insured, you're expected to use it and not clog up the free private system. For example, a client of my brother had life threatening cancer. He was privately insured, so was required to use it. After his treatment, he was out of pocket about $50,000 all up. Not too bad a price to pay for your health, you might say. The thing is; if he didn't have private insurance he would have received the same care, from the exact same doctors, in a public hospital for absolutely nothing.

My caution to the US is, be very fucking careful how this practically pans out. And look to the overall picture. The free health care you may be crowing about today as a student, you might end up paying for a hundred times over when you start earning. If that works for you, good stuff.

The more you know.

Edit: It's also worth noting that we don't have insurance provided by employers here. It might be a relevant point of difference. Either way, someone always pays.

 

While I am by no means an expert, I have tried to keep informed on this overly drawn out debate. A couple points: first, with the idea of tort reform, unfortunately it won't help as much as people think. Texas, for instance, has laws making it far more difficult to sue for malpractice and their costs are no lower than for the rest of the country. The figure that I usually hear is from the CBO, which estimates that it could lower overall health care costs by around 2%. While I'm not saying that it shouldn't be addressed, I think portraying it as the main or even a major issue is disingenuous.

I think the main issue in the US is that people think this is a bigger reform than it is. With the required insurance, 3 points: 1) The reason you must have people like the youth buy insurance is to cover those with pre-existing conditions. It would be unfair to the insurance agencies to expect them to cover all people with pre-existing conditions without also increasing the pool of relatively healthy applicants. In the legislation, it also provides for subsidies to help those pay for insurance that they otherwise wouldn't be able to afford. This may make it a better or worse bill, depending on your views.

I think in general, this legislation is more a set of individual projects and ideas shoved together as opposed to a comprehensive plan. The most popular parts go into place first: allowing people to stay on their parents insurance until they are 26, giving seniors a $250 subsidy for their prescription drugs until they close the Medicare "donut hole", not allowing insurance companies to drop coverage if you get sick, or deny a child coverage based on a pre-existing condition. We still have several years before the other, less popular, parts of the reform go into place and I'm sure that tweaks will be made. Overall, I am glad that something was done and I think it will calm down relatively quickly as people don't see their premiums go up.