healthcare reform: the latest developments

Before you assume that the government would do any better than private insurance, talk to a few vets about the VA system.

mrblanche is correct, if the government cannot even run the VA adequately what makes anyone think that they can run a health care system that will a hundred times as large?

I also have a problem with all of us peons having to pay for this except
if you are a union member. If you are union you get a pass. Nice way for Barack to pay back the union for helping him get elected isn't it? Right along with Barack stopping the union's secret ballot.

Utopia, the government will dictate if you can be treated and when you can be treated. From all indications the elderly will be denied care.
Due to the high cost of "end of life care" that will be cut drastically.

I have to wonder who will sit on the throne making the decisions of who is worth care and who is not.

When you allow the government to take care of all your needs then they will dictate how you live your life.

Why not compare apples and apples? The VA is a unique beast because it has its own hospitals and doctors. I suspect a big part of the problem is underfunding. Active duty soldiers generally get decent care (Walter Reed not withstanding), but retirees and disabled veterans get the short end of the stick.

Medicare is a larger system that's much closer to a traditional health care plan, so if we're going to look at government health care, let's look at that.

You already pay for it. Just go to the emergency room on a weeknight and look around you. Half the people in there probably have colds, sprained ankles, or something like that. They're there tying up the emergency room because they don't have health insurance and without that a regular doctor won't see them unless they pay cash. So they go to the ER, they rack up hundreds or even thousands of dollars of care (which is probably just a prescription, and x-ray, and a bandage) because the ER can't turn them away. You pay for that. When a guy comes in with a heart attack that could have been prevented fairly cheaply with annual checkups (that he didn't get because he didn't have health insurance) and racks up $1,000,000 in hospital bills you pay for that. Unless you're happy with just letting people die on the streets because they can't afford treatment, you're going to pay for it either in the form of a universal plan that lets everyone get treatment or else in the form of much higher health insurance premiums.


This is the boogieman that the health insurance companies have created to scare us. How many 'elderly' are on private insurance? Just for kicks, go to the Blue Cross or United Health Care website and get an insurance quote for a 75 year old man who smokes and has a previous heart attack and a stroke. IF they don't just say "sorry, you're uninsurable", they'll want $4000/month and they probably still won't cover anything related to the pre-existing conditions.

No, most of the elderly are already on medicare now and they would still be on medicare after the change.

Who sits on the throne right now? Corporate executives. The only thing you hear coming out of Republican politicians right now is "Do you really want a bureaucrat between you and your doctor?" But the thing is, he's already there. As far as the health care companies are concerned, you're just a commodity off of which they can make money. If it gets too expensive to insure you, they will drop you like a hot potato. HMO's are notorious for telling patients they can't have a particular surgery because it's not critical, the survival probability is too low, etc. That doctor isn't in our network? Not covered. You didn't notify the insurance company you were being taken to the emergency room after that traffic accident? Not covered! You need a new heart or you're going to die? Well, that's a really expensive procedure and you only have a 40% chance of survival, so we won't pay for it.

Private insurance is ridiculously expensive, especially if you're middle-aged or older and an employer can at any point choose to quit providing health insurance because it's too expensive. I'm not naive enough to think the government could do a great job at health insurance, but I think they would be hard pressed to do worse than our current system where the quality of care is almost directly related to the patient's income.

Now this is just as much of a boogieman argument as the elder-care. The elder-care argument was a proposal from the man who was supposed to be Director of Health & Human Services under Obama, Tom Daschle. He dropped out due to (surprise surprise) tax issues. I have no clue if that is still on the table or not.

What I do know is that I have been with multiple insurance companies through the years, and not one of them had anything like the system you're describing. I have a chronic disease that is expensive to treat and according to the insurance companies is fatal (not the doctors, but who cares what they say?). I have gone to multiple specialists, I have had multiple MRIs (one billed insurance $10,000 for a 3-part scan) and started multiple different treatment plans, each with a price tag of over $30,000/year. Unfortunately, I haven't been able to tolerate any of them. But that's awful expensive for the insurance company to cover for the rest of my life, which is what the treatment plans are for. Not once have I even been questioned. Been to the ER twice with this condition, didn't get pre-auth. Not even questioned. The only insurances that have those kind of requirements aren't worth the paper they are written on, in my experience.

I do have decent coverage, and my employer pays 91% of the premium for me. One of the options that is on the table is to tax the amount of employer paid premiums as salary, so suddenly I get a $6000 pay raise that I don't see, but that I get taxed on. That kicks me into the next tax bracket too, so the gov't gets even more of my money and I see nothing change on my end. So why wouldn't my employer decide to opt out of paying for insurance if it saves their employees (and themselves - they are getting the same benefits as we do) a bundle in taxes, and they can give us a smaller pay increase to cover paying for the government "insurance" option, that probably is closer to the nightmare scenario that you described above? Reason? The government isn't in the healthcare business, they are in the business of keeping costs down. That's their stated goal with all of the proposals.

And as far as MediCare goes, that is a wreck of a system and on the verge of bankruptcy.

One other fallacy, though a widely believed one...hospitals do not have to take everyone without insurance. They cannot turn away a life-threatening situation with or without insurance, but more and more private hospitals (which most are) will turn away people without insurance because unless they change their way of doing business they are also on the verge of bankruptcy. They have no way to recoup their losses except to raise rates on everyone else, and there's only so far that can go.

I am more than ready for health care reform, but it has to be a plan that is in the best interest of the people who need care, not in the best interest of the insurance companies. ut0pia, I could care less what happens to these companies.

Right now my employer is only offering health savings accounts, and it's absolutely horrible!!!! This type of plan requires a high deductible insurance plan, so the patient has much more out of pocket expense than they would have with regular insurance. I have a medical condition that requires me to purchase very expensive drugs each month, and the insurance company pays absolutely nothing until the deductible has been meet. Hopefully, this will happen next month. So since the beginning of the year, I've had to basically forget about going to the doctor for anything because I can't afford both the medications and office visits!!!!!

I really can't take anymore of this, so bring on health care reform!!!!!!!

I do believe that reform is needed, just not this big old hulking behemoth of Barack's that will just be one big nightmare and a huge HMO

That is not all the Republicans are doing
http://blogs.abcnews.com/thenote/200...m-outline.html

I have a big problem with Barack trying to hurry this through like he has everything else. Something this major takes time and should be a bipartisan effort. But no, Barack wants it shoved through immediately.

I definitely feel that neither side has offered an ideal solution to healthcare. While I don't want a government only run system, at the same time, I don't like how out of hand the insurance is getting.

My husband had an emergency appendectomy a couple of years ago, the ER care, surgery, recovery, medications - everything, totaled over $85,000. Now, okay, I get that there is some cost to any operation, but I felt that charging me $900 for a plastic apparatus that my husband blew into twice was a bit ridiculous. At least we got to keep it - that's a $900 plastic piece of art on my bookcase now. Luckily we were insured and in the end only paid about $600 out of pocket expenses. But something has to be going on to have such a level of inflation on the price.

I do believe in a cap on how much a person can make from a medical malpractice suit. And there should be levels to how much a person can make. Personally, I think there is a difference from a person suing because they had reactions to an unnecessary medicine but are fine now to those who get the wrong limbs removed.

The whole system is corrupt but the government can't fix it.

I can sort of understand why he wants to shove it through. If he waits until everyone agrees he'll be an old man, maybe even passed on. Just reading threads on this subject on this site is a good indication that there will never be any kind of agreement regarding health care in the US. So if anything is ever to be done to fix the problems with the lack of health care there, someone has to stick their neck out, take the bull by the horns, and actually DO something. If it's Obama so be it. IMO, it's always going to be a damned if you do and damned if you don't situation anyway.

It remains true that the basic problem with our health care system is not the health care, but the payment. And the big problem there is that the person who receives the care is not the person who is paying for it. There's a basic economic disconnect there.

Does our current system have holes in it? You bet. The biggest one is that the healthiest people don't get insurance, and that skews the actuarial basis of the insurance.

But I can tell you a real horror story about the much vaunted French system, which resulted in the death of my wife's sister's baby.

And it is still true that there are more cat scan machines in the state of Connecticut than there are in the entire country of Canada.

And have you heard about the problem Canada is currently having with running out of radiological supplies, causing people not to get cancer treatments, etc?

I think honestly you can find instances even in the US where doctors have made mistakes that resulted in death so I don't see the French story as being terribly unusual. Doctors are human as well and do make mistakes regardless of what nationality they are.

You are so right about more cat scan machines in the US and some folks that don't feel they should wait in the queue for a cat scan will pay the extra and go to the US for their scan. If someone needs a scan urgently, they can and will get it here in Canada. Just as some people want invitro and have been rejected for good reasons here in Canada will go to India or another third world country to get what they want. Doesn't mean our health system is bad.

As for the radiological supplies, I believe you refer to isotopes. Canada is one of the major suppliers of these isotopes to the WORLD. If you do some research, there are several other countries that also supply world requirements for isotopes. From what I've read and heard, although Canada's supply is dry right now because of leak issues with the reactor, the other countries that supply isotopes have come to the table with extra so that people who honestly need the tests involving isotopes will not be denied.

Again, people who NEED medical treatment/scans/isotopes for cancer treatment will get what they need. Others who feel they should get what they want when they want it may just have to wait - pity!

I just feel that if you take a plan like Canada's which may be adequate for a country of 30 million people and put it play in a country like ours with 300 million people, I can see delays in scans and treatment that will kill people.

But Mrblanche has just said that the one state of Connecticut already has more MRI machines than all of Canada. Now you multiply that by all your states and that adds up to some mighty number of MRI machines. Connecticut is also a small state compared to some I believe so it's feasible that there are even more MRI machines in some states than there are in Connecticut. By those figures, I highly doubt people would be delayed in getting scans or treatment. It doesn't compute!

The broad-stroke plan, given to reporters as a three-and-a-half page summary, lacked details or a cost estimate. Um, so they want to give affordable health care to all? How exactly are they going to do that? If a guy only makes $8/hr, it has to be pretty darn affordable. How are they going to force private insurance companies to provide these guys health insurance, especially if they're in their 50's and have existing health problems? It's just not a realistic proposal and IMO the reason there were no details is because they know it's impossible without raising taxes. It reminds me of a sign I've seen that said "You can have your service good, fast, or cheap - pick two." This plan tries to claim it can offer all three.

"They're generally under-funded ... and I think the interest of the doctors suffers to some degree," he told FOXNews.com. "Generally speaking, the physicians that work at the VA work there because they have no interest in private health care, and in some situations are unable to find jobs in private industry."

Strickland said care and oversight would not improve until funding is increased and the leadership makes sweeping changes.

So, like I said, the problem is (at least in part) that the program is underfunded. People who have fought and bled for this country deserve better, so let's pitch in and give them better care.

By the way, what private option do you envision being able to take on VA / Medicare patients. The patients are almost exclusively older and sicker than the average person. No insurance company could possibly make money with a patient base like that unless they charged thousands of dollars per month for each patient.

Actually, you're already paying for their costs - it's rolled into your bill, and then into your insurance premium. If the hospitals were getting reimbursed for indigent care, then they could charge less for each procedure and their profits would remain the same. You'd just be paying some of the money through taxes rather than insurance premiums.

And you don't have to force anyone to get screenings, but many people would choose to do so because they'd like to be healthier. They'd have the option. Right now, they don't get a choice.

Oh, no -- that was not hyperbole. Just simple logic. If somebody comes into a hospital dying without coverage or money, we can either let them die or somebody has to pay to give them medical care. Ultimately, that somebody is either going to be you. It may be you as an insurance holder or it may you as a taxpayer, but it will be you.

I bet that if I called my family doctor and told him I had a cold, he would tell me to come on in so he can take a look at me. Is that silly? maybe, but who are you to say. After all, that Republican Health Care "plan" you posted up listed this as one of their tenets: ensuring that medical decisions are made by patients and their doctors, not government bureaucrats; Everybody has their own standard for what requires a doctor's treatment. And if not colds and sprains, how about pneumonia and broken bones? How about an infection that requires antibiotics or a cut that requires stitches? The point remains that under the current system, the ER is the only place that many of these people can go to.

Actually, the President asked me to serve in the administration, but after he found out that I paid my taxes every year (on time even!) he withdrew the invitation.

You have been quite fortunate with your health care and I've very happy for you about that. Had you been unemployed or worked in a job that didn't provide health insurance or even a crappy carrier, then your condition would have gone untreated and/or you would have had to declare bankruptcy because you couldn't afford to pay for the bills.

I do know some people who have had to declare bankruptcy because they had the audacity to get sick when they were unemployed. I also know a person whose only recourse when they get a toothache is to go get it pulled because the free clinic won't do fillings.

Hmm, odd proposal, but it brings up an interesting point. They can drop the plan right now, let the peons go on the "pray you don't get sick" plan, and give the executives pay raises to offset the cost of the private insurance they now have to buy. I don't know of any legal reason they couldn't do that, so why do you suppose all companies don't do it? I bet it's the same reason they wouldn't all drop their coverage and swap to the government plan.

And a company is in business to make money. Period. At the end of the day, that's what the insurance companies care about - making money for the stockholders. My whole point, quite simply, is that your health care should not be a business decision.

You are correct, but... Should a hospital turn somebody away who then keels over from what they turned the patient away for, then they're looking at a massive malpractice suit. The ones in my area at least have have made a business decision that it's cheaper to triage everyone, make sure they're stable, and send them on their way with some minimal care than to risk the lawsuits.

There is another interesting effect that comes from this. In the town where I live, the hospitals in the poorer areas of town have a larger percentage of indigent patients, so they have been going bankrupt. So now the poor people have even less access to health care (many don't have cars). I'm sure it cuts down on some of the frivolous stuff, but I bet it has cost some lives too because people decided to "tough it out" rather than call an ambulance or spend their last $20 to take a taxi across town to one of the remaining hospitals. And, since the ambulance have to travel farther, it also puts a greater burden on the fire department.

What makes you think that a teen pregnancy "can be prevented" by taking a teenage girl to the doctor? How will going to the doctor prevent obesity? Color me confused.

I dont have the knowledge to make an educated response about what direction the US should go in.

I do know that with our system, people dont have to be put on a waiting list to be seen by a Dr. or be put on waiting list for serious health issues. If you need to be seen, you call and make an appt and go.

Healthcare is provided to everyone, there are just different plans on how it is paid.

So for those who think people in the US dont have medical care, thats not true. What they dont have is insurance and in those cases we have government programs to assist with that.

We have government programs based on incomes, all over this country. We have private organizations, public and government funded.

Do you think single mothers on welfare who have children foot the bill to have their children? They are on some form medical assistance.

I am not saying there doesnt need to be changes.

I've learned more about insurance since my diagnosis than most people ever know, so here's a little bit of knowledge passed on...free of charge.

The laws vary by state, but I know that Colorado enacted a law that went into affect this year that insurance companies cannot rank the risk of a company and base the premiums of the company on that risk. For instance, DH and I work(ed) (he's since been laid off) for small companies of approximately the same size. In the past, his company's premiums were much higher than mine because the median age and risk factors at his company were higher than at mine. When we compared plans again for this fiscal year, the costs were the same for the same plans (luckily we were able to compare apples to apples). Nice, huh? I don't know if other states are doing the same, but there is progress being made without Obama-Care.

If you join into a group plan, i.e. through your employer, they don't do the pre-screening. You're accepted, period. One of the benefits of joining insurance coverage through an employer.

This is also true of disability and life insurance. I absolutely could not get a single policy for disability or life insurance regardless of how much I am willing to pay with my disease (it's multiple sclerosis, in case anyone doesn't know...it's no secret ), but I can through an employer. Even if I switch employers I can because it's a group policy. Once you have a policy, you can opt to continue it as well without being screened. If I wanted to increase the coverage they would have the right to screen me, but not if I wanted to keep it at the same level.

I don't know how many of you have ever needed CT or MRI scans when you weren't admitted to a hospital. I have a 1 to 1 comparison here because I need them for the MS (non-emergency basis) and a good friend of mine in Canada (her DH actually) was in an accident and also needed the scans (more of an urgent basis, but still a non-emergency basis). I have had 4 separate MRI scans over the past year and a few months. I can get in to get a scan within a week or so. Two weeks tops to make it work with my schedule. When I needed a CT scan on a semi-emergency basis, I was able to get in the evening I had the appointment with my doctor. My friend's DH? He had to wait a month and a half for a CT scan (the scan itself only takes a few minutes), and over 2 months for the MRI (which can take up to an hour, depending on the strength of the machine). The worst part? He couldn't work until the issues were diagnosed or at least assessed.

I also want to note that in many of the countries that have public care, there are still options to purchase insurance above and beyond the standard public health care and there are private doctors and clinics that are available to those who have the insurance or money to access them.

Last year I fell and hit my head. This next morning I called my Dr., within a few hours I was having a CT scan.

Are you saying countries or counties?
My BiL is high up in his position with the Canadian National Railway and when my nephew was sick, they had to come to the US for treatment.

In Canada a young woman can go to a doctor for any reason and that doctor is not allowed to tell her parents - I believe the age is 14. I mentioned to my doctor one day that our daughter Jen had said she had been in to see him and he told me he was not allowed to discuss it.

I work for a US company and when I was hired on I was required to take a complete medical which they arranged with a Canadian company. They also scheduled drug testing for me which my boss had to explain to their HR that it is illegal in Canada to do drug testing for hiring. Passing that medical was contingent on me being hired on permanently so you are lucky to be with a company that didn't require it. As another poster said, you have been extremely lucky with your health insurance. I don't believe your story would indicate the majority.

As for CT or MRI - if they are considered by the physician to be urgent or the patient is in a life-threatening situation, you can bet they will get the MRI or CT without waiting weeks or months. Naturally there are folks who believe their illness is more important that others and want everything done for them immediately, if not sooner. I trust that most doctors will make the right decision regarding each case.

When I was admitted in January for my COPD, I had a CT from the emergency room before I even got admitted. I also had 4 ECG's and a heart ultrasound done within the 9 days.

Here again I would be interested to know what the nephew was sick with. It may well have been something where the experts on that particular illness are housed in the US just as there were women who came to Toronto General Hospital from the US to see my cancer specialist because he was the known North American expert at that time.

I think it's important to know all the details of a situation before "generalizing".

This sounds great on the surface, but do you really think the insurance companies are just going to throw up their hands and say, "Oh, well, guess we can't make as much money"? Now they'll just base everybody's rates off of the statewide average age and health of the workforce. So if you had a fairly young and healthy company, your rates will go up. If you have a company that employs lots of young and healthy people, that may be an incentive to cancel the insurance (since they can get private insurance fairly cheap) which of course raises the median age and lowers the average health of the covered population, raising the rates even more.

Exactly! That's how auto insurance works as well. We all pay for other people's idiocy but that's the price of driving a car which we accept.

I believe it's similar here in the US as well. If a girl can't afford to see her regular doctor, she can always go to a lower cost clinic or Planned Parenthood or something similar. And anyone can go to the drug store or grocery store or Wal Mart and buy condoms, and I believe they are free at Planned Parenthood (they were a million years ago when I was a teen). If a girl wants to be on birth control or anyone wants to practice safe(r) sex, there's no reason why they can't, even in the US.

Linda, going by what you've said it sounds like passing the physical was a contingency for employment, which any private employer is allowed to do. I mean, there are employers that require their employees to be smoke free and can test for that too. That's not a requirement of the insurance industry. Depending on where they are based out of, they could have formed that policy in order to keep their insurance costs lower, but it's not a requirement to get insurance.

Yeah, it does sound great, and frankly it is great even if it means that some will pay a little more and some will pay a little less. In our small company, it means that we don't have to worry about our premiums skyrocketing because one employee was diagnosed with a chronic disease or because they hired a new engineer who has diabetes, or any other scenario that happens to come up.

It sounds like you've had very bad experiences with insurance companies and definitely want a full-on government run health-care system or insurance system implimented in the US. But not everything you believe about insurance companies holds true in all or even most cases.

Linda, you are correct that generally we will only hear the horror stories about the government-run healthcare systems and not the overall good things. That's also true of what is generally said about the US system. There are good things about our system as well, but what you hear about are the people who can't afford insurance, get crappy insurance, can't afford treatment, etc.

I don't know how many of you know this, but Medicare does require you to pay 20% out of pocket, which is the same as my insurance currently, until you reach a certain dollar amount of what they consider "out of pocket" expenses. I still haven't figured out exactly what that means. If this is what is the basis of the co-op insurance that may (or may not) be proposed, then it would still be outrageously expensive for some conditions. I know it is for mine, but I still have to manage. It's still outrageously expensive for many elderly people on fixed incomes.

It's not an ideal plan by any means, but I suppose it would be better than nothing Whch, btw, is what my husband has right now. Don't think that because I have been "lucky" (apparently being employed by good companies has something to do with luck?) I don't know what the uninsured are going though, or how difficult it is to find decent insurance for a non-group individual.

However, the Democrat plan needs some refinement. I'm not sure why including some sort of tort reform should be out of the question. Insurance against lawsuits is a huge reason why healthcare costs so darn much here in the states, why doctors require so many tests, and why some procedures are so difficult to get doctors to perform without a huge payment. That's definitely on my wish list. John McCain proposed an amendment for bringing cheaper drugs in through Canada, which was struck down in committee. Why?

It does need to be a bi-partisan plan, and not one that is just shoved through by Obama or the Congressional Democrats (who are more and more parting with Obama's requests, which is the biggest reason why I think he's so adamant about getting it done this year). Neither party has a corner on the market of good or bad or even workable ideas, and both need to open their minds what works not just who proposes the idea.

Yeah, yeah, it's from Fox. But Neil Cavuto is definitely not one of those hard-core right guys. This column definitely sums up why some of us are so very apprehensive about the health care proposals - because as Mariya said in the first post there are no specifics available. Just they they have to get it done and get it done NOW. Kinda like the Stimulus, and there's a lot about that was not done well. Even if you support it, you have to admit that the rush to get it passed made for a poorly thought out bill overall.

http://www.foxnews.com/story/0,2933,529108,00.html

I just have to wonder if the big rush to get this passed isn't so much about this "crisis" but about the mid-term elections next November. Obama knows that historically the momentum does shift when a party has complete control of the government at the mid-terms, and many of those who support him will be fighting for their re-elections next year. I just think that if it's important enough to get done, it's important enough to do well. The health care of the entire country isn't something to be rushed through just to be able to say "Hey, look what we accomplished in just one year!" That's how it feels to me. They want it done while they have this majority so they don't have to actually listen to anyone else. That bothers me, just as it would bother the other side if the tables were turned.

He had strep and had to fly into Michigan to be treated. They wouldnt even test him after repeated requests. Something similar happened with My Sis, too.