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Healthcare in the US(26 posts)

Healthcare in the USPdxMark
Apr 23, 2003 1:58 PM
So does anyone think the healthcare system in the US works as well as it can? For those who are employed (usually in middle class or better jobs) or those who are on public assistance, there's at least something in place. For some, it's arguably the best system in the world, but for others, there is essentially no medical coverage at all - other than the local emergency room.

This is not right. Shouldn't the working poor have access to medical care? They do in Cuba, why not here? There are certain to be shouts of socialism, panty wastes, etc., if anyone tries to provide universal healthcare to people who can't afford it (or whose employers can't afford it for them). If universal coverage, supported by taxes, is an outrage, let's hear the defense of why it's right for the United States to allow tens of millions of people to suffer from inadequate health coverage.
What is adequate?TJeanloz
Apr 23, 2003 2:13 PM
I'm all for providing comfort to those who are ill, and providing preventive medicine to help encourage people to not be ill. I believe that society should provide this MINIMAL level of health care.

I don't believe that all of the wonder of modern medicine should be free [paid for by taxes] for all [or actually, any] people. Modern medicine is amazing, and also amazingly expensive. But it hasn't done anything to change the basic fact, as Keynes so aptly pointed out, that in the long run, we are all dead. I see no reason for the taxpayer to fund a fifth bypass surgery for somebody so that he can die six months later. If you want the fifth bypass, or the first, pay for it yourself. We're all going to die - and if you really want to live as long as possible, pay for health insurance.

For the record, and in the interests of full disclosure, I do not have health insurance, and I am not concerned about it.
how about "adequate" includes "basic"...PdxMark
Apr 23, 2003 2:41 PM
which covers preventive medicine, and comfort for ill... I like the basic or minimal coverage. It's affordable (for society) and very cost-effective. It's one lunacy of our present system that the absence of preventive coverage incurs high subsequent public costs.

I guess that leaves the catastrophic situations. Like LA's cancer. It seems basic coverage should cover these situations too, but the line between reasonable catastrophic coverage and high-zoot crazy coverage gets messy...

What do uninsured people, other than LA, do about cancer?
Absolutely not. Lance dies from cancer...TJeanloz
Apr 23, 2003 2:47 PM
In my world, if Lance were uninsured (which, actually he was), he could pay for the treatment out of his own pocket, or he could die. I think society owes him some comfort in his final months - a pain killer prescription, nursing treatment, etc. I don't think we owe a man with a very small chance of survival numerous surgeries costing many tens of thousands of dollars. There's no question that it would be a loss for the world, but that's life.
Absolutely not. Lance dies from cancer...PdxMark
Apr 23, 2003 2:52 PM
Yes... and he should have died by all rights, according to his docs... so those $250,000 last gasps to save life at any cost would not be covered... I can live with that... no pun intended...
Preventive medical care?Spoke Wrench
Apr 23, 2003 3:20 PM
There's a joke!

The original concept behind Health maintenance Organizations (HMOs) was to provide preventive medical care. The idea was that preventive medicine, vaccines and the like, have improved health far better than waiting for someone to get sick then replace the defective organ with a transplant.

HMOs were supposed to operate their own clinics for routing regular check ups, and were supposed to encourage a healthy lifestyle to minimize medical problems. The theory was that living a healthy lifestyle and useing preventive medical care would minimize illness and medical costs would decline. It was a nobel idea.

Almost immediately, the original concept fell apart. There were no healthy lifestyle provisions so the patient pool wasn't any healthier than any other similar size group of people. Patients overused their medical benefits and the HMO's began losing money. To stay solvent, then implemented gatekeeper measures to prevent patients from obtaining medical specialist services. HMOs morphed into the polar opposite of what they were supposed to be.

The last time that I went to a doctor to get a check up, I had to explain to four different people that, to my knowledge, there was nothing wrong with me. I just wanted to get a routine medical check up. It appears to me that check ups have become a rare thing. So much for preventive care.

Meanwhile, the drug companies have taken to advertising specific, ever-more-expensive prescription drugs to the mass market on television. So today you diagnose yourself, then go to the doctor so that you can tell him what kind of prescription you want him to write for you. I think that's crazy.
no health insurance and not concerned?zeke
Apr 25, 2003 7:01 AM
then you must be very young and not own any property, or have any other responsibilities.
if you do encounter some health difficulty, those in charge, ie the medical establishment, will have no mercy towards you in acquiring their payment in kind (if you have it) eg your home, and other assets.
If I encounter some health difficulty...TJeanloz
Apr 25, 2003 7:07 AM
If I require some kind of healthcare whose costs exceed my assets, I would rather die of it and have my assets donated to charity than live. I have a living will that says as much (and a DNR on my drivers license). If I require some kind of care that is cheap and survivable, I'll pay for it out of my own pocket.
If I encounter some health difficulty...zeke
May 6, 2003 12:01 AM
That's my point. If you require healthcare that exceeds your assets, then when you die, the hospital takes those assets and there would be nothing left for charity.

'Cheap and survivable'? For example a broken leg? How about $30,000 for a ruptured appendix. Its cheap and survivable. And you will pay for this out of your own pocket?

I dont understand.
wow; what a can of wormsDougSloan
Apr 23, 2003 2:13 PM
Your basic premise is that no one should be denied health care, right?

That is a socially responsible, caring, well-intended position. Perfectly defensible.

However, it is expensive. Someone must pay for it. Who should that be? Why is it morally defensible to require one person to pay for anything another needs?

Also, if we do this, I want some assurance that the needy aren't unnecessarily increasing their health risks. So, no smoking, over eating, promiscuous sex, etc. It's only fair. I suspect that the argument would end there.

I wouldn't use Cuba as an example. Not only is it communist, and selling communist ideas in US is a nail in the coffin of any idea, but the practical effect of that is that everyone is covered, but the common denominator is dragged down tremendously. So, everyone is guaranteed poor health care.

What distinguishes health care from any other need or commodity? We need gas to put in the car to get to work, so should everyone get free gas (or guaranteed public transportation)?

oops, gotta go; more later

wow; what a can of worms - that's our specialty here!PdxMark
Apr 23, 2003 2:50 PM
OK - Cuba is a bad example...

While we're getting the uninsured poor to live healthy lives, we might as well get our smoking, lethargic, co-insureds to do the same... Private subsidies for unhealthy living don't feel any better than public ones...

I guess what distinguishes heathcare from other goods or services is the standard set by much of the rest of the major economic powers. It's funny, food seems to be covered, by food stamps and charitable organizations. So hunger seems to be almost covered.. though it's not completely...

Maybe the problem with heathcare is the number of people who do without. Limited basic coverage, including preventative measures, seems like a reasonable benefit that might even be cheaper than our current system. Co-pays need to be set just right so that people can pay them, but are expensive enough that there is a disincentive against abuse/waste.
Not sure Cuba is a bad example, just off a bit.OldEdScott
Apr 24, 2003 9:19 AM
Cuban health care is first rate, especially when (a) compared with what it was before Fidel, and (b)compared with other poor countries. They've really done a pretty good job.

If you grafted the Cuban model onto the U.S., you would indeed have a general lowering of the quality of care here, simply because those with means (insurance) get otherworldy care, and if you spread the expense across the entire population to include those without means, there would be a great leveling effect.

That's not the case in Cuba. They started at a very low baseline. So almost everyone is significantly better off.
And it ain't crappy minimalist care either. It's comparable to most of the First World.
wow; what a can of wormszeke
Apr 25, 2003 7:06 AM
However, it is expensive. Someone must pay for it. Who should that be? Why is it morally defensible to require one person to pay for anything another needs?

it is morally defensible as well as logical. we are not separate entities, but rather social animals who depend on each other for existence. in general we can call that dependence 'society'. if we paid for others, as you put it, we would also benefit by creating a better society, ie less troublesome, less adversarial, less brutal etc etc. society, life in general would be better in ways we could not even imagine.
At the rate healthcare costs are increasing...dasho
Apr 23, 2003 5:08 PM
I wonder how long it will be before the average working class can't afford it anymore. I paid $105 per month for coverage for a family of three 4 years ago and today it costs $200 and I get less. It went up $60 per month last year alone. I guess I wouldn't complain if we used it more often but we are definitely not getting our $2400 a years worth.

Maybe people will start gambling and refusing to carry benefits and save the money instead. The only problem is that if long term (or short term for that matter) care is needed such as an extended hospital stay, one could go bankrupt really fast.
Start your own insurance company...purplepaul
Apr 23, 2003 5:45 PM
That's what the Rockefellers did for themselves and their friends. I have wondered what's involved in getting extended family and friends together to insure oursleves. With no profit motive, it should be much cheaper with enough people. Don't have any idea what that number would be though.
Those are good ideas.czardonic
Apr 23, 2003 8:47 PM
Get rid of the profit motive. Get as many people as possible together as possible to drive down the per-user cost. 40 million would be a good start. 260 million would be even better.
If that were true...DJB
Apr 24, 2003 6:15 AM
Government agencies, since they lack the profit motive, would be models of efficiency and accountability...
If it isn't true. . .czardonic
Apr 24, 2003 10:05 AM
. . .it has nothing to do with the basic ideas I was reffering too.

Governments lack a profit motive in the strictest sense of the word. But they are driven by political and ideological motives that are often at odds with efficiency.

Accountability is another issue entirely.
At the rate healthcare costs are increasing...DJB
Apr 24, 2003 6:08 AM
Since I work in the health insurance industry, I'm aware of the some of the factors fueling the rise in costs that don't have all that much to do with providing health care.

For example, I've recently read a report that throughout the industry, billions have been spent complying with the HIPAA (Health Insurance Portability and Accountability Act) regulations (think Ted Kennedy). Now privacy might be a worthwhile goal, but those billions won't provide a single band-aid.

Someone mentioned the advertising and 'market generation' of specific drugs. People do go to their provider and request certain drugs based on advertising. It's effective. And very expensive.

There is the issue of tort law and the huge cost of malpractice awards. Again, it certainly isn't a bad thing to hold providers responsible for their errors, and people need to be compensated fairly, but things are out of hand.

Those are just 3. I'm sure I could come up with others.

One other thing I'd like to point out is that no one lacks for health care in this country. It's health insurance that people don't have. And the idea that it would be cheaper if everyone had socialized health insurance would only be true if you limit services. When something is paid for by someone else, people are inclined to use it more. Look at Canada or Great Britain. Everyone has health insurance, but access to health care actually decreases in some ways. It can take months on a waiting list get some services. This is because the total amount spent on health care is relatively fixed. It might be cheaper in terms of the amount spent per person, but some services will end up being rationed.
How truedasho
Apr 24, 2003 6:29 PM
Some doctors are quitting due to the high costs of malpractice insurance. I agree that doctors should be held accountable to a degree but some of the settlements are ridiculous. Of course the lawyers are the ones that are making a killing.

The drug companies are more and more greedy also. Glaxo Smith Kline is trying to prohibit Americans from buying drugs from Canada which are much cheaper there. They claim they aren't concerned about the cost but they are worried the drugs could be damaged in shipping. Do they really think the consumers are stupid enough to believe that?

As you pointed out, I've heard that socialized healthcare is cheap but if you have a terminal disease and need immediate care, it could be a long wait.
I don't think anyone ever said socialized healthcare was cheappurplepaul
Apr 24, 2003 7:44 PM
because it isn't. Most countries have had to scale back in one way or another to keep costs under control.

As I see it, there's only one way healthcare could be significantly cheaper than it is now: fly people to India for big ticket operations and long term care. Once the shockingly costly treatments are taken care of, small time procedures could adequately be done close to home.

Now, should India stop being a cheap place with lots of highly skilled doctors, we'd be right where we are now.
At the rate healthcare costs are increasing...zeke
Apr 25, 2003 7:12 AM
high insurance costs was one of the reasons I left the usa back in 1993. at that time for my wife and i for coverage under blue cross/shield, the premiums would have been $400 per month. i was just finishing grad school and had to leave the security of the student insurance system. couldnt find a position immediately in the usa, found one in japan, expected to stay for 2 years and am still here and pay about $300 per month for 70% coverage for myself and wife.

even if i did not have a full time position, the amount of the premium would not be much more than $300. we would be able to afford it and not in any danger of losing any of our assets.
What a tangled web we weave...moneyman
Apr 24, 2003 6:28 AM
Healthcare in the US is such a mess, and its problems so deep, that I am not at confident that the "crisis" can ever be worked out. Add to that the fact that so many people make so much money from delivering health care and there is very little incentive to actually do anything about it.

Health care is not health insurance. We use health insurance to pay for treatment of our illnesses. If you think about this, its a ridiculous, expensive method of paying your bills. If you get the flu and go to the doctor for treatment, you pay your bill by submitting a claim to your insurance company. The insurance company examines the bill, determines if you have purchased coverage for that particuar treatment, then sends a check to the doctor and a notice to you of what it did. How many people must get paid to complete this transaction? The doctor, of course. He provided the primary service. Then there's the billing clerk in the office. The insurance company has to pay its accounts payable clerk to process the claim. The insurance company has to make a profit above its costs. The company you work for has to pay someone to manage the insurance benefits. That's five entities directly involved in the payment. Then add in the benefits consultants who help establish the plan, the lawyers who oversee the plan, the costs for printing and shipping of documents to process the claims, the support staff in the medical office and the insurance company, and you can see how the costs keep adding up.

Example - my daughter had an accident at school where she received a small cut on her forehead and we took her to the doctor. The doctor put a butterfly bandage on the wound and sent her home. Total time in the office with the health care professional - two minutes. The bill was $165. Our insurance policy has a $5,000 deductible. Since I am self employed, I pay the entire cost of health insurance, which is around $400 a month. In the four years that I have had this policy, I have never received reimbursement from the insurance company: costs of nearly $20,000, benefits $0. We wrote a check to pay for the treatment. If I had been able to pay the doctor for her services and completely skipped the third party insurance company, her services might come to half the cost or less. If everyone paid for their own health care, not insurance, costs would be reduced dramatically.

Unfortunately, as long as health insurance is seen as the primary method for paying for health care, and as long as health insurance is seen as a primary benefit of employment and not a personal responsibility, it won't happen.

Health care paid for by "the government", i.e. the taxpayers of the US, could only be more complicated and more expensive.

Doug's "can of worms" statement doesn't even begin to scratch the surface of the problems with our health care delivery system. We continue to view health-care payment as someone else's responsibility. Until we view it as our own, it will continue to be the disaster that it is.

Four out of five actuaries disagree, and the 5th is a shill128
Apr 24, 2003 7:22 AM
Spreading risk through group insurance increases affordability. You have a high deductable, catastrophic plan not b/c heathcare is unavailable, but b/c it is unaffordable for you to have a low deductable plan.
I agree the system encourages waste and your example is a good one. But I would not go so far as to assert we all pay individually. I'm not sure that's the 'civilized' thing to 'do' to those less well off.

I have heard competing theories on why healthcare is unaffardable (medical equiptment, name brand drugs and doctors fees overpriced. And on the other hand administrative costs, over regulation and all those poor people getting paid for) Experts seem to agree some form of managed competition for this essential service is the best solution. I am somewhat reluctantly in support of the IDEA of universal coverage but the "can of worms" will need to be managed as well. Tough issue.

"Promote the general Welfare."
It's not "unaffordable"moneyman
Apr 24, 2003 7:48 AM
But rather a philosophical disagreement with the current concept of health insurance. I have health insurance for catastrophic illness, something that I could not pay for out of my own pocket, e.g., cancer treatment, organ transplants, etc. The concept of insurance, any kind of insurance, is to transfer risk from me to someone else for a price. I cannot accept the risk of a $250,000 medical bill, but I can accept the risk of a $165 office visit.

We all pay for our homeowners insurance individually. We all pay for our auto insurance individually. Why should we not pay for our health insurance individually? That way we could get the coverage we want at the price we want to pay. Instead, many are forced to accept the coverage and cost that their employers, not them, have chosen. Having health insurance delivered through the workplace is a major part of the problem. If delivery of health insurance was outside the workplace, and therefore able to be customized to the individual's needs and wants, the costs would go down. Hypothetical: Suppose that group auto insurance is available as an employee benefit. As the employer, I get to decide the schedule of benefits and how much I am willing to pay. I drive an $80,000 Mercedes, so I buy the group policy for that coverage. Is that at all fair to the person in the mailroom who drives a '91 Fiesta? And if the mailroom person goes outside his group policy, he will have to pay four times as much for his auto insurance.

We have essentially no individual options when it comes to paying for health insurance. If it was not linked to the workplace by expectation and tax benefit, we could each buy what we wanted and pay what we could afford. Instead, we are forced to buy something that someone else chose for benefits they perceived as important.

The law of large numbers128
Apr 24, 2003 8:35 AM
is why group is better (more affordable) than individual insurance.

Yes, there is a philosophical difference indeed. The risk is not tranferred as you say, it's spread more equally (theoretically). How can you price insurance on a persons needs and wants (and on 'what we want to pay', as you phrase it) if they don't know what those needs are or if they can't afford even the basic HMO coverage, such as what you carry? That's about the cheapest ind. plan right? I see your point about 'forced' premiums at work, but isn't that a stretch? I've never heard of a group plan at work being too expensive (although I have seen benefits cut and ERs who can't afford ins in the first place. Maybe, I just havn't heard of it.)

I disagree that employment is a major problem. That is how the majority of citizens afford any (life, health, disability etc)coverage at all; the law of large numbers. As for the comparison with auto and homowners, those risks are pooled as well by the carriers. They donn't just insure you, they insure a group of homeowners and that is why we can afford to uionsure homes and cars. (car insurance is a whole 'nuther can of worms)

Critically speaking of universal 'care', that's the issue. People talk about 'care' as contrasted to a schedule of benefits. There would have to be oversights just like our currnet HMO policies read; max. caps, usual and customary charges, co-pay, medically neccary, non-cosmetic etc...It's not just everbody gets what they want. And sure there is a social cost there, where again the less healthy and less well off benefit disproportiately. Again, the philosophiocal difference.