Obama's Universal Health Plan.

[Joesitz (RIP)]

Oh, the horrors of socialized medicine even when you can still have capitalistic medicine.

but why should we be taxed for caring for the poor? Am I My Brother's Keeper?
The country is based on the Protestant Ethic (look it up, if you don't know it) and there is no need to help anyone. Is there? The poor must help themselves or go the way of all flesh.

 

[Ptichka]

To me, the problem with Obama's plan is that it does very little to address the main issue - the rising costs. There has been a very thought provoking article in the New Yorker recently looking at some of the reasons. Until that is fixed, it is rather irrelevant who the "payer" is - I don't believe that having the government pay for healthcare will magically reduce costs in more than a superficial way.

 

[Joesitz (RIP)]

To me, the problem with Obama's plan is that it does very little to address the main issue - the rising costs. There has been a very thought provoking article in the New Yorker recently looking at some of the reasons. Until that is fixed, it is rather irrelevant who the "payer" is - I don't believe that having the government pay for healthcare will magically reduce costs in more than a superficial way.

Is that the main issue? I thought it was to get everyone in some sort of health insurance coverage.

It will cost the tax payer money to get the poor into some sort of health scheme. Capitalist Insurance Plans do not give out freebees, and they will raise the premiums whenever. Maybe if Obama puts a hold on the amount of increases the insurance companies will definitely act on, then that would be something to be happy about. But the Government interferring with the profit makers is a NoNo

 

[Spun Silver]

I don't think the real issue is "the poor" at all. They are covered, and covered well, through Medicaid.

The real issues are the ones who don't qualify for Medicaid because they're not poor enough, but also don't get employer-provided insurance, like the growing number of freelancers and those who own and work for small companies that can't afford insurance.

Even undocumented immigrants qualify for free emergency room care. Pretty much all children, undocumented or not, qualify for free health insurance (at least in the two states where I've lived the past 30 years). But not that group in the middle.

 

[SeaniBu]

I don't think the real issue is "the poor" at all. They are covered, and covered well, through Medicaid.

The real issues are the ones who don't qualify for Medicaid because they're not poor enough, but also don't get employer-provided insurance, like the growing number of freelancers and those who own and work for small companies that can't afford insurance.

:agree::agree::agree:

From being on this boat and not Qualifying for some plans by $36.14 I would have to agree. The only thing I really have a problem with is that they counted the overtime I had on my paycheck. Not counting the reliable income was the factor that makes us think it is not support but rather for show. Business is getting smoother now and that extra time I spent away does cause need for extra care that the overtime will not supply compensation for but disqualifies us. And in the future it will not be there for the economy should stabilize - It already has with the company I work for and that income is no longer there and much less. 800+ dollars of overtime is not happening for us over the 3 month period they asked for income to verify.
??

As far as caring about you brother, it depends. Nothing I can control but when we go to food bank and see someone loading up there SUV Danali that has 850 dollar a piece wheels on it makes me wonder if income on a paycheck is really the best judging factor. Granted they may have stole the wheels, but there inlays the questions. Who are we funding. Are they really "my brother?" or a conniving little "cousin" that will snake whatever they can.

 

[Ptichka]

The problem is not really in how much doctors gets paid - I believe the reimbursement of American doctors is actually reasonable. Nor (contrary to popular belief) is it malpractice insurance. The problem is that the system encourages doctors to perform tests and procedures that are not necessary. As a result, patients get over-prescribed yet the quality of care does not actually increase. There are, of course, other approaches. One of the most successful ones has been pioneered by the Mayo clinic. The doctors there get paid a set salary (BTW, whereas it was first believed that this approach can only work in Minnesota, it has been shown to work as well in Florida, one of the most "expensive" medical areas of the country). Each complex case gets analyzed by a panel of doctors. In one example the New Yorker article sited, a cardiologist actually walked over the a surgeon's office so they could sit down together with the patient to figure out the best course of treatment. In the traditional American approach, this is a "waste" of the cardiologist's time - no insurance will reimburse it properly; however, in the end, it results in care that is both better and more efficient. By contrast, when my grandmother (here in Boston) was having some problems after a surgery, her surgeon sent her to an appointment with her oncologist, who then sent her to the nutritionist - basically, it took two weeks (and a lot of Mericare money) to solve something that should have been solved in about 20 minutes. The million $ question, of course, is how do we turn this around? Because if all hospitals spent as much per patient as Mayo does, we could move to a public system and save money at the same time. The only proposal that seems to make some sense is one related to what McCain offered - essentially paying doctors for results as opposed to for procedures performed. The question then becomes how to define "results" (it can be curing a minor illness or prolonging a cancer patient's life by 6 months) to make sure that the patients' care does not diminish.

Sure, insurance companies make good profit, but that's not where the main cost problem is. Look at Medicare - it pays doctors way less, yet still costs a bundle. Why? Once again, because procedures get performed that should never be. (Well, you also get into end-of-life care there, with most hospitals still not switching gears for good palliative care, but that's a whole different discussion altogether.) Public option will not change this. However, increasing the number of people on public coverage is THE perfect time to implement reforms that can begin to take steps toward this goal.

Oh, and as to your original point - yes, absolutely, I do believe that we should cover everyone. It actually makes sense not only from the moral but also from the practical point of view. Despite the horror stories you hear from the like of Michael Moore, a hospital cannot turn you down if you, say, have a heart attack even if you don't have insurance. It's far cheaper to provide cardio care for the person before he gets to that point. The problem, though, is that, once again, attitudes need to change. Massachusetts has had "universal coverage" for a while now, and yet emergency room visits do not diminish; people still hold off on going to the doctor before it's too late. Though in Mass one of the problems is that there just aren't enough general practitioners (which is actually a problem for American medicine as a whole because while there are usually great specialists to look at a particular problem, there is no one doctor to look at the patient's overall situation).

 

[Joesitz (RIP)]

Doctors, and all profit making organizations' main interest is in profit and they will do whatever it takes to make higher and higher profits every year.

Health costs are high and Medicaid doesn't cover everything and doctors jump for joy if Medicare will pay. Private insurance premiums will rise every year.

If Obama wanted to lower the health costs, the AMA would not allow it. It was a miracle to get medicare and medicaid passed. What can he do except make a proposal which profiteers will kill as socialized medicine.

 

[Particle Man]

Corporations ARE inherently corrupt, because of the unchecked power. So is government. Demonizing one and not the other is just naive. But you are right if you are saying that the underlying problem isn't who is paying for health care, but how much health care currently costs. Why must it cost $3000 for someone to get an MRI? For many people that's 3 entire months of wage after taxes. Work for 3 months to get one scan? Something is seriously wrong with that picture.

On the other hand, if you don't reward companies who research and develop and produce things like MRI machines, they wouldn't exist. To those who demonize the profit motive, I would ask: what would the computer industry look like if it were nonprofit? The automotive industry? (before the new great depression anyway.) It's clear that we'd be paying far more for far less. We don't even have to speculate about what socialized medicine would be like, because other countries are doing it. In Canada, everyone can get the health care they need, but they have to wait many months for anything to get done. Is that better? I don't think it's very clear cut. At best, it might be a poor improvement. Wouldn't it be a better solution to also address the costs somehow?

I currently have health problems and can't afford insurance. I've been to a few general MD visits at $50 a pop out of pocket, none of them could give any real diagnosis or treatment (i.e. general practitioners have always been totally useless to me.) They just refer me to a specialist "which will cost me $500 just to walk in the door." I can't afford that so I don't go. Every day my health gets worse and has been getting worse for several years. I would personally be a lot better off with a socialized health plan, since in those years I could have gotten treatment and may be healthy now. But I still don't know if overall it would be an improvement for the country.

...Anyone know of any affordable health insurance for the self-employed? I'd kinda like to live to see the Olympics. :think:

 

[dorispulaski]

You could move to Canada--if they'll take you. And the Olympics TV coverage will probably be better too.

There are several additional problems that I wish got more play. Rather than worrying about the amount of malpractice insurance, I'd like to see a heck of a lot less malpractice here in the US.

Here's an interesting article:
http://www.consumeraffairs.com/news04/2005/medical_errors.html

The US stood out for high error rates, inefficient coordination of care, and high out of pocket costs, resulting in forgone care.

I saw a recent study that said that patients who were active and understood their treatment had significantly better outcomes and significantly fewer medical errors here in the US. All in all, that's a heck of a thing - the patient has to coordinate his care here because no one else is going to do it very well.

Finally, there is the question of rescission, where a patient with an expensive disease (like breast cancer) who already has insurance will be cut off by the insurance company. Politicians of both parties all find this repugnant, but it is done by all the companies.

http://www.latimes.com/business/la-fi-rescind17-2009jun17,0,5870586.story

 

[skatingbc]

In Canada, everyone can get the health care they need, but they have to wait many months for anything to get done. Is that better?

That's not true in all cases. I'm sure that some people do end up waiting for non-emergent surgeries, but I haven't found that to be the case in my experience. My sister has knee problems and has had 3 non-emergent surgeries to correct this. Every surgery was performed within 6 weeks. Long wait? I don't think so!

 

[heyang]

People have cited the unneccessary tests, but this is partially the result of the # of lawsuits. Doctors are 'covering the bases' by going overboard on tests just to ensure that they can't be sued for not having done the test.

Much of the cost of insurance is a result of the administrative costs involved. With all the things that require pre-authorization, there's a whole department at every insurance company just to handle the phone calls - and I've never not been granted approval even when I thought something was unneccessary (Dermatologist offered me Retin A Micro - since she offered, I said ok. When I went to pick it up and it wasnt' authorized, I would have had to pay $130 for a tube that lasts at least a year. I told her that it wasn't approved. She called and got it authorized. I really did not need it - if anything it the worst thing I could have used at the time.) I get cost summaries of every doctor's bill that I really don't need - at most, I need a year end summary - so dollars wasted on excessive mailings and printing,etc.

 

[Joesitz (RIP)]

Doctor's are human, and if they want to send their daughters to the best universities, they will do whatever it takes to make the money.

If they make mistakes in their profession, they should be penalize to the extent of the law as would negligent homicide accidents. The right to sue for malpractice is important.

Bush was able to get many disputes settled by Arbitration rather than by legal means. If you ever had a case go before Arbitration, you will lose that case. Arbitration favors the guilty over the victim. It keeps business in business.

 

[heyang]

There's definitely a need for the ability to file a malpractice suit where negligence is committed.

However, the US has become overly litigious. There are some people who have sued because they failed to follow the care instructions given to them by their doctors, as well as people who have sued even though they had no loss of income or any long term side effects of significance. Now, insurance companies are willing to give a settlement even if there's a slight chance of going to court [even if they will likely win] because the costs of defending are greater than awarding a minimal amount.

I was put on a jury for a motor vehicle accident a couple of years ago. The actual MVA had occurred at least a couple of years before. The woman claimed chronic back pain after the accident, but she had no visible signs of suffering and moved around unassisted. She also admitted that she did not attend all of the physical therapy recommended by her doctors. The only time she did not look healthy was on the day of her testimony because she was wearing colors that did not compliment her [unlike the day before and the day after]. She was also unable to demonstrate that her lifestyle was impacted beyond the initial days after the accident. We almost made the mistake of giving her an award as payment for initial suffering, but re-thought and granted her nothing.

When I had oral surgery last year, my surgeon made a point of telling me read and follow the directions given. I didn't understand why he would emphasize this until he explained to me that he has told several other patients to do the same, yet they show up for their surgery and haven't taken the prescribed antibiotics as instructed. Some didn't even open the envelope up. These patients got upset because he refused to do the surgery that day, thus, disrupting their days - not accepting that they also disrupted the doctor's day (as well as those of other people who could have used that appointment more wisely) due to their own negligence.

anyway, my point is that some people take no responsibility for their own care and rather blame someone else.

 

[dorispulaski]

Yes, but it is also a fact that the US has more medical errors per patient than other countries, too.

http://www.healthcareitnews.com/news/survey-us-patients-report-high-rate-medical-errors

WASHINGTON – The United States leads six countries in its rate of medical mistakes, an international survey released today found. The study, which looked at healthcare safety, access and care coordination in Australia, Canada, Germany, New Zealand and the United Kingdom, found that the United States also lacks care coordination and has high out-of-pocket costs for healthcare.

Medical errors are the eighth leading cause of death in this country

http://www.ahrq.gov/qual/errback.htm

Medical errors carry a high financial cost. The IOM report estimates that medical errors cost the Nation approximately $37.6 billion each year; about $17 billion of those costs are associated with preventable errors. About half of the expenditures for preventable medical errors are for direct health care costs.

Why does the US have such a high rate? The initial article cites lack of coordination of care. The second article says that the largest contributor is errors in medication.

My husband has for one reason or another clocked a very large number of days in a variety of hospitals. Here's some things I spotted in some that could be easily improved:

1. Very questionable cleanliness. This was in a hospital in a wealthy area that had a hard time getting cleaning staff.

2. Use of CNA's instead of RN's in a hospital with chronic money problems.

3. Not enough RN's, especially on weekends. If there was an emergency, nobody came. This is why people hire somebody to sit with them in the hospital. To make sure if there is an emergency, that the staff knows about it.

4. Hospital did not check for MRSA (my husband has it) We had to tell them after the rest of the interview.

5. Failure to do continuity between shifts in any good way (Yale New Haven has a nurse that is in charge of shift and weekend continuity for each patient, and a back up for the nurse for patients who will be in hospital for an extended stay. Costs nothing and avoids tons of screw ups on the weekend)

6. Inadequate checking of doctors for cancellation of licenses in other states. The doctor moved states, requalified, and no one checked that he had his license lifted for incompetence in another state.

7. Failure to check adequately that they have the right patient matched with the right surgery (there are more checks these days), which is why the error rate in 2002 was better than in 1999.

8. And the biggie, failure to get the medications right, including the patient's incoming medications.

So the medical community needs to take responsibility for their part of the problem, rather than blaming everything on patients not following directions and suing for malpractice.

Heck, mailing the patient directions is already a ridiculous thing. Not all patients can read. Not all patients can read English. And not all letters actually get delivered by the post office.