A friend of mine fit you scenario exactly. He was a low paid worker with no health insurance.

He started complaining he had a pain in his shoulder. I recommended he see my primary care physician. He went to her and was immediately x-rayed and then sent to an oncologist. This is where his out of pocket costs basically stopped.

He was diagnosed with terminal lung cancer. At this point it really didn’t matter how much money he had he was going to die in 6-12 months. He elected to “fight” the cancer. In my opinion from there on out he got excellent care. Everything was either written off (and his chemotherapy was not cheap) by the hospitals, doctors or paid for my Medicare. He quit work as soon as he was diagnosed and social security immediately (he did have to make a few calls) kicked in and paid for his living expenses. He even moved to an on the beach lake Michigan rental.

I’m sure there are horror stories out there of poor care for the poor but I was amazed at what our current system supplied him with.

It isn't just VA that is a mess. CHAMPUS was absolutely horrific once you were outside a military installation. Healthcare on post/base was decent (that might be my perception because of my father's work), but once you left, all bets were off. The public just sees the VA, they don't see how broken parts of the rest of the system are.

I am much happier with my current healthcare than I ever was with CHAMPUS/Tricare. I don't think the government can run a healthcare program on a national scale, the military system gives evidence to that.

My argument was that I feel we would be better if doctors who are in it for the money were supplanted by people who were genuinely enthusiastic about practicing medicine. Your argument is that it's already weeding out the money-grubbers and that that's good, but, somehow, that weeding them out twice would be detrimental. I don't know how that makes sense.


We are not merely shifting money around. We are providing preventative care that people currently do not have. It's a cliché, but an ounce of prevention is worth a pound of cure. However, even if I didn't think it cost less, I still think it is positive to provide basic healthcare for everybody, both from a humanitarian basis, as well as a national infrastructure basis: a healthy population is more productive than a sick one, on average, if not necessarily on an individual level, and even for those lazy sods who will never do anything, I'd rather they be healthy to avoid them getting the rest of us sick.


First, organ donation is not based on ability to pay. For one thing, it is illegal to pay for donated organs, so they're free anyway. (This is actually not entirely true, as the wealthy have the ability to fly to a distant hospital at a moment's notice, so they can put themselves on multiple waiting lists.)

Second, I think it is reprehensible that you think the wealthy should have a greater right to live.

That's great.

But totally irrelevant to the health care reform that's been proposed. The government will not have any more control over doctors, hospitals, or any other healthcare providers than they do now. All they're talking about is having a marketplace for group health insurance for people who currently are ineligible for group health insurance, and subsidization of the premiums for those unable to pay for it.

The system will remain effectively the same, except more people will have access to it.

I'm sorry to hear about your friend.

To more completely answer Cris's question:

No healthcare provider is allowed to deny coverage for an emergency based on ability to pay. However, cancer does not qualify as an emergency.

Social Security Disability Insurance provides a base level of income to those who have a medical condition that effectively prevents them from working.

Medicare is a national health insurance provided to those over 65 and those who have significant illnesses. You have to have been on SSDI for two years before you qualify in that case, though.

Medicaid is a national health insurance program run by individual states that is intended to help those who are poor and have serious illnesses. (I think eligibility varies from state to state.) I imagine that this is where your friend got his coverage from, and quitting his job was probably a prerequisite for him to be eligible. (Not that I'd want to continue working, either.)

I don't mean to exploit your friend's illness, I merely use it as an example, and cancer is an insidious disease that can have no symptoms until it's too late, so this may not fit his situation, but if your friend had had health insurance and had regular checkups with the doctor, his cancer might have been detected when it was still treatable. It's this sort of thing that bothers me.

Few, if any, people are left to die on the streets, but people are left to become sick enough to die.

People would be up in arms if these programs were abolished, but the notion of extending them to more people sends them into apoplexy, and the proposal doesn't even go that far.

Yes, my friend did have the kind of cancer that basically had no symptoms until it’s too late. I believe it was referred to as “small cell lung” cancer. It was caused by 30 years of smoking.

Like, me (even though I have average insurance coverage) he was of a mind set to only go to the doctor when you see a bone sticking out. That’s probably another reason men don’t live as long. They seem reluctant to go to the doctor.

There will always be people who just won't go to the doctor. There's not much to be done about that. But the number of people who would go if they could afford it is not insignificant.

Thanks for the answer, it has added quite a lot of clarity to the actual levels of care available. There is more than I thought. But it would bother me too.

My Mum has worked in the NHS most of her life, and has always said prevention is better than cure. It would be interesting to see if an NHS like system was introduced in the US that how much the overall cost to the country would change. I think there would be an argument for saying the cost could reduce as illness would be picked up much quicker and be much cheaper to treat.

Like Godfrey said earlier on, these days it's pretty easy to see your GP. I don't think the system is widely abused, of course there is some, I think there is something quite wrong to have to balance your own personal health with your own personal wealth. It doesn't feel very human to me.

Cheers

Cris.

What annoys me as well is that when an uninsured person does go to the doctor in many cases they must go to an emergency room in order to be treated in a timely manor.

Seems to me the cost of more free clinics could be balanced out by the savings of emergency visits. As well as the benefit of not plugging up the system with head cold patience’s that take resources away from real emergency patients. However I’m sure a lot of head cold patients would be screaming when they get turned away from the ER.

Many insurance companies here are pushing "wellness." They are offering 100% free checkup visits, weight loss programs and even in may cases free gym memberships.

Being a profit drive organization they see the light as well.

I assume you mean the ER is faster than a free clinic would be. Because a regular doctor won't see them at all without ability to pay. And it's not like the ER is fast.


I don't know what they're like elsewhere, but none of the free clinics here are run by hospitals. That cost would have to be passed through the government. Seems to me that doing it that way would be a waste of resources when you could use the same money to provide insurance to those people and they could see whatever doctor they wanted.


I don't think anyone prefers to go to the ER.

In addition, people are still triaged. The headcold patient will always be prioritized lower than the heart attack victim.

I haven't really followed this thread as closely as I should, mainly because I'm engaged in another healthcare debate on a mailing list I'm subscribed to. But I did want to address one portion of the discussion about the VA.



The canard that VA care is horrible is outdated. Read this article for the gory details, but here's an excerpt to chew on.



The article goes into the hows and whys, and I encourage you to read it to understand that the VA has gotten a lot better than it used to be.

The government doesn't have any control over the doctors, hospitals, or any other healcare providers once you leave base/post. That is the point of my post - it was fine when I was on a military installation, but once I left the medical coverage basically sucked ass. As I understand it, that is exactly what the national healthcare plan is looking at.

How about an opinion from an insider who's lived on the outside?

IMHO, as a Canadian living in the US, I'd rather live with the problems inherent in the Canadian system, than the problems inherent in the US system.

All the fear-mongering is a bit frustrating, and I think what it really boils down to is that the people stirring it up have learned how to avoid (or haven't encountered) the problems in with the US system. My father-in-law was visiting recently, and one of his biggest complaints was "the government is going to decide who gets cared for based on cost! People with kidney dialysis will be the first to go!" (Naturally, he listens to Rush Limbaugh religiously.) I cheerfully admit to not understanding that viewpoint -- under the current system, the insurance company decides based on cost (insurance companies are well known for dropping coverage for the expensive cases), based purely on realizing profit. I'd rather have the government saying "we can't afford that," than an insurance company saying "that doesn't bring us a profit." To me, the former is economic reality. The latter is... disgusting ethics.

Every time I talk about health care with an American, they inevitable ask "Don't you have to wait?" or "How long was it before you could get an appointment?" It's always interesting to watch their faces when I tell them I've waited longer to see a doctor, and get appointments in the US, than I have for similar care in Canada -- and my dad has had the same experience. Of course, that's not true for everyone.

Personally, I hope for success with the change -- with the unemployment rate as high as it is, people are starting to realize (unlike lectric's sentiment) that health care shouldn't be based on income (hi, here's your pink slip, and now that you have no income, here's an additional $1000/month bill for a health insurance policy), so the country has never been better primed.

However, despite my hopes, I have no expectation that this will ever succeed -- it's too politicized, by which I don't mean "there's a lot of highly charged debate over the value, or the solution," though there is plenty of that. Rather, it's too mired down in the existing US political process, which ignores the good of the people (you know, a government for the people, by the people?) in favour of lobbyists currying favour for their conglomerate backers. The political process needs to be fixed before anything else can be improved.

One of the guys on my hockey team is an ER doc. He once had a young woman come in because of some strange bumps on her tongue. They were her taste buds.

People go to ER because they know where it is, or it's late at night and it's the only thing open to treat their perceived emergency. edit: or they've let whatever it is fester so long it's become an emergency.

I'm totally reposting that anecdote to my LJ friends list. LOL.

Okay, I misunderstood. Are you saying that the off-base healthcare coverage you had worked more-or-less like private health insurance? That you went to "any" doctor and the government reimbursed either them or you? Or did the government pay for Blue Cross or Aetna or some other private insurance plan?

What was wrong with the coverage? Not enough doctors in the network? Poor reimbursement levels?


Without understanding your complaint better, I can't comment well. However, I think you said you have private insurance now from your employer. You won't be affected.

That said, when you were off base, would you rather have had the healthcare plan the government provided you, or nothing at all?

It was cumbersome and almost non-existant. I had to go to the ER once because it felt like I destroyed my knee when I was at school - couldn't put any weight on it at all and you wouldn't believe how badly it hurt. The ER took my insurance (CHAMPUS), gave me x-rays and said they couldn't see anything wrong with it and that was the limit of what they could do. Nevermind the fact that there was obviously something wrong based on the swelling, bruising, etc. They couldn't even give me a prescription for pain killers or crutches. I think the bill was around $400 for what was basically just a set of useless x-rays.

It was easier to drive the 2+ hours down to Luke AFB for healthcare than it was to use the insurance outside a military installation.


I'm not sure you can say people won't be affected. At the very least the service has to be paid somehow (until it becomes self-sustaining like they claim). Does that mean higher taxes or other pots of money get raided? Will that system end up cannibalizing private insurance that can't compete based on cost alone? In a time when companies are raiding pension funds, freezing 401k contributions, etc are they going to start dropping private insurance for the national system to save more money? I think it has the potential to affect a lot of people that at first glance you wouldn't think it would.

However, based on my previous experience with government sponsored insurance, I don't have very high hopes for whatever it evolves into.

I am not a doctor, but I have worked in health care for a few of years. I can tell you once government steps in and takes control of the whole system you can be sure the reimbursment rates will take a nose dive. This means doctors will necessarily see their income go down over time and so yes you will find doctors leaving the profession to do something they can make a decent living at and many who will be discouraged from entering the profession at all. Let's not forget that the current administration has an ever expanding bloodlust for regulating "excessive" pay. You don't suppose that public health care would dovetail nicely with efforts to stick it to those "greedy" doctors just like financial regulation gave rise to taking care of those "money grubbing" Wall Street types do you? It's all by design.


Nope. I'd rather be seen by the best which in a free market would be encouraged to participate in health care.

Stu

That sounds to me more like a lousy ER than anything to do with your insurance. If you were indigent, you should have gotten more care than that.


Sadly, that sounds about right.


Did you ever go to a doctor for a physical exam or anything like that?


Fair enough. I meant that the coverage you currently have won't be directly affected by the proposed plan.


Keep in mind that the additional services to be provided are to be provided by private insurance companies, and they will be paid with premiums from individuals, just like everyone else's insurance. The only cost outlays from the government are for subsidies for the poor and from the semi-private "public plan", which is required to pay for its own expenditures through premiums just like any other enterprise. It is explicitly not supposed to be funded by the taxpayer. It does have the potential advantage of getting potentially cheaper loans due to its supposed backing as a GSE or GSE-like enterprise.

This actually points out a big difference between this system and CHAMPUS. Under the reform bill, if you're unhappy with your insurance, you can switch to a competing provider. CHAMPUS was a monopoly.


Any company with a payroll greater than $250,000 a year that doesn't provide healthcare insurance for its employees is required to pay into the subsidy fund.

So that does mean that smallish businesses that currently provide no healthcare have increased costs. But the insurance marketplace also works for them, as small businesses have generally been unable to get decent group plans. And the small businesses that do choose to provide insurance for their employees will get a tax break.

I guess my point is, assume for a second that there is no public option at all. The reform bill is still significant in the creation of a marketplace for group health insurance that can be bought by anyone, and in streamlining medical recordkeeping. I, for one, am sick of filling out the same 8-page form at every doctor's office I go to.

I assume you're referring to Medicare/Medicaid reimbursement rates. The public option is explicitly not modeled after that and is intended to work as a private company.

That said, again, if the public option were to go away completely, which is a possibility, you're still talking about creating a marketplace that currently does not exist.


That's exactly my point. People who are enthusiastic about medicine (or any field) are likely to be the best at it, and many of them are being driven away by the insurance companies.

And a free market in health care currently doesn't exist. No one has anything approaching perfect information. Group health insurance is effectively a series of employer-sponsored monopolies. And it's not a simple commodity anyway, as insurance providers clearly deny their product to those they feel they can't make any money from.


I don't think that anyone thinks that doctors are, on average, exceptionally avaricious. Change that to insurance companies and you might have a case. A case that no one will defend.

And by "money-grubbing Wall Street types", are you referring to the people who took taxpayer money intended to bail out their institutions that they ran into the ground by defrauding each other and the populace and then paid for performance bonuses and parties with it? And then afterwards were told that if they wanted their companies to benefit off of the taxpayer that they were required to have a salary cap?

Why is it that you're all for companies getting taxpayer money and having them being able to squander it however they wish without restriction, but if that taxpayer money instead goes to individuals to try and make sure they don't get sick, you get all up in arms?

Not outside of the military installation. Routine stuff could wait until I got back home. My dad was (eventually) the NCOIC of Aerospace Medicine, so we got to deal with the Doctors that dealt with the pilots instead of the general practicioners. I think that is part of why my view of the care we received on base is so skewed - we got sort of preferential treatment.

I keep meaning to link to this four-page summary of the healthcare bill. It seems to be a good summary, if light on details here and there. Unsurprising given a 250:1 ratio. So there you go.

Yeah... I recently paid a $250 bill for three stitches. Three. Insurance covered the local anesthetic, though.

Given it's still government (more so) and it's bargaining power, I don't see why the public plan reimbursement would be any more generous.



Actually I was referring to the job market and the looming caps on pay for providers as well as the unavoidable reduction of their income if gov. health care becomes entrenched.



I don't have anything against it in principle. I don't believe the government should have used public money for the companies in the first place (hello Adam Smith?). The control over pay of executives of bailed out companies pay will make it that much easier for government to make the leap to private, non-TARP companies. Which is undoubtedly part of why the companies were "bought" in the first place.

Stu

Because it is intended to compete with private insurance companies. It is intended to negotiate rates with providers just like every other insurance plan. Sadly, the current text of the bill does not reflect that, and if that doesn't change, I definitely do not support that provision.


I can't attribute that to anything but pure paranoia.

Actually congress is pushing for non-negotiated reimbursment rates based on Medicare.




Tell that to Venezuela!

I just can't understand how anyone could be for a government running something that is as important as health care when everything else it touches goes to shit. I guess I'm too stupid to wrap my head around it. Medicare, Social Security, FEMA, USPS-why they're just such a model of efficiency and solvency. Yes please give me more government; it's done so much for us already.

Stu

I just can't understand how anyone could be for corporations running something that is as important as health care when everything else they touch is done with their own self-interest placed above those of the customer.

It doesn't have to turn to shit, just because the government touches it, but I agree, the odds aren't in our favour. Even so, I'm in favour of letting them try -- the current system is so broken, I'd consider nearly anything progress.

You have got to be kidding me. Yeah, there have been some notable problems of late, but life without those organizations would be far worse.

Social Security has come under fire for insolvency, but it has enough funds to pay full benefits through 2037, and after that something like 75% in virtual perpetuity. Only very minor changes need to be made to solve this problem.

Medicare is under a very real financial crisis, but it's because of the skyrocketing cost of medical care, which is growing far faster than inflation. Notably, the cost of Medicare is growing at a slower rate than healthcare in general, though still faster than inflation. A large portion of the healthcare reform is to bring those costs under control, and much of that has to do not with regulation, but with streamlining.

FEMA has been through some hard times, but that's what you get when you nepotistically hire a horse registrar to run an emergency management organization. But you don't decide to get rid of the fire department because it's not doing well enough.

And the postal service has hit on some hard times, too. They should have kept up with technology more than they did in order to remain competitive in package shipment in light of the reduction in first-class mail due to the internet. Still, you can send a letter across the country for 44¢ and have it get there in a couple of days. Fedex and UPS would charge you $15.

Anyway, if you don't want the government providing services for you, you can also fight your own fires, stop driving on our roads, deal with burglars and the other vigilantes yourself, and when China invades, you're on your own.

That's just the problem. There are some services for which the government is uniquely qualified to provide, some of which you've named, but we've long since gone beyond such services. And about China, not to worry, Obama is in charge now! We can all feel safe. In fact he is already promising the Chinese we will get rid of our nukes just so they'll like us more.

Stu