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The great Health Care debate!

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trillionaire

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Sound off ladies and gents!

What is the best direction for our country right now in terms of health care? People WITH insurance can''t get their health needs covered (denied claims!) and people with employee based health care are in a bad position in this horrid economy. My SO''s brother was diagnosed with thyroid cancer 2 weeks after losing his job. He is expecting his first daughter in June. Millions are uninsured. How do we fix our broken system? Why is a single payer system demonized?
 

Maria D

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Date: 3/11/2009 8:39:07 PM
Author:trillionaire
Sound off ladies and gents!


What is the best direction for our country right now in terms of health care? People WITH insurance can''t get their health needs covered (denied claims!) and people with employee based health care are in a bad position in this horrid economy. My SO''s brother was diagnosed with thyroid cancer 2 weeks after losing his job. He is expecting his first daughter in June. Millions are uninsured. How do we fix our broken system? Why is a single payer system demonized?
Because people who are insured and in no danger of losing their insurance feel that a single payer system would be "socialism" and socialism is bad. People who are uninsured or worried about losing their insurance don''t have enough clout to change things. Also, insurance companies enjoy huge profits and are a powerful lobbying force.
 

icekid

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I continue to believe that we do need to head toward some form of universal healthcare, but wonder if we can accomplish everything that needs to be done all at the same time. Tort reform, end of life issues, care rationing. This is not a simple task. Here’s my view from the semi-inside.


Even though Americans are calling for universal healthcare, I wonder if they are truly ready for the consequences. For example, there are many patients who are for all purposes essentially dead, whose families insist on keeping them alive for years in some nursing facility with a trach (breathing tube permanently into the neck) and peg (feeding tube directly into the stomach). Often times, the care of these patients who will never recover reaches millions before they finally get an infection from these invasive tubes and die. So many families insist on this level of care. Is this, too, a right? Today, they are allowed to make that decision. When we nationalize healthcare, will we continue to waste taxpayer’s millions on a person who is, unfortunately, a lost cause. I would estimate that 75% of my ICU patients (and believe me, being in the ICU is expensive!) have no chance of ever leaving a hospital with any meaningful recovery. IMO, these end-of-life issues are reasons that we spend so much more on healthcare than other countries. It is wasteful and I do believe this money could be better utilized to take care of the living.


Americans insist on the newest and best drugs (read: expensive). This will have to change. Patients come in asking for CT scans and MRIs. This will also change. In Canada and the UK, you’ll wait a year for a non-emergent MRI. Sorry if your knee needs to replaced today; you’ll have to wait a year and deal with your limited mobility. However, the emergently ill will certainly receive prompt care. Still, I see these patients everyday. They are demanding and entitled. Are we ready for this change? Well, maybe we needed this economic downturn to make people ready.


Speaking of the latest and greatest drugs, big pharma will stop doing the research that is needed to develop these medications. Why? The compensation and ability to make money will not be there. The US is the country who funds this research by paying the exorbitant high costs of new medications. Other countries already refuse to pay these prices. Universal healthcare cannot afford these new designer drugs across the board.


Socializing healthcare will inevitably mean decreased compensation for physicians. Oh boo hoo poor doctors, right? Well, we’ve gone through college, four difficult years of medical school, followed by three to ten years of grueling additional training. Of course, all of this is while being paid a pittance which is not in line with our educational level nor hours worked. Not to mention wracking up a solid $200,000 in school loans ($250,000 for me!) if you’re not lucky enough to have parents with the ability to pay for your schooling. If compensation drops precipitously, I believe the government will have to take on some of these physician school loans. We were only able to take on this kind of debt with the knowledge that one day (far in the future!), we would have a well-paying job.


What else needs to change? Malpractice! The government has been absolutely unable to accomplish real tort reform. Can this happen yet? Malpractice attorneys still have a heavy lobby with the Democrats. Are Americans going to give up their right to sue, in exchange for free healthcare? In the UK and Canada, law suits against physicians are far, far less common than in the States. Ob/Gyn doctors in many states have stopped practicing, or given up their Ob practice because the malpractice insurance makes taking care of pregnant women a losing proposition.


With all of these potential changes coming, I do wonder if many physicians will remain in medicine. It is extremely stressful, demanding. The hours are too early, too long, and cut into time with my family. Who likes working weekends? Holidays? None of us, I promise! If the money is not there, I will find another way to use my brain that does not involve as much risk, stress, and time away from my family. I enjoy my job (sometimes!), but not enough to make all of these sacrifices without reward. This will need to be addressed, as well.


So for me… it comes down to a couple questions. Are Americans truly ready to do what is necessary to accomplish universal healthcare? Can all of these changes possibly happen at the same time?
 

swimmer

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Thank you for the very thoughtful post icekid.
(and again, love your sapphire!)
 

tlh

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Icekid, I agree. I think we have a lot of questions that need to be addressed before these reforms/changes happen.

Do I like the idea of the system. Not really. Only because I see public schooling going down the toilets... Where I live class room sizes are going up to 40, and they are trying to increase them to 50 because the overhead for the schools is too costly, so they are closing entire schools. laying off teachers, janitors, school ladies, etc. Everyone ALWAYS says, man, the teachers are sooo underpaid. My friends dad, a Dr and head of a hospital - had to retire because even though his salary was HUNDREDS OF THOUSANDS A YEAR... his malpractice insurance was just as high... and he said point blank... why work these hours, and be on call 24-7 --- for what would work out to be $30,000 a year. Not worth it, and he retired.

I don''t think a teacher should make the same as a Doctor. They don''t go through the same training, or require the same degree of care. They may be "shaping" the minds and lives of children, but they aren''t actually in the body, SAVING the life.

I''d love to see a system that would work. But I look at our system right now as broken. We''ve had public education for decades... and I am seeing it fail. I just don''t offer the same hope to a government with our health. That said, the benefits given out to our senators for THEIR healthcare is pretty sweet. I just want to see how this will be paid for... the US government seems to have the same mindset as most americans. Just charge it... we''ll pay for it later. What happens when countries like china (who owns a good portion of our debt) have issues and want to collect. What are we gonna do then... give them our territories? and outter states?

I am being ridiculous... I am just curious how this will pan out actually.
 

LtlFirecracker

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Here's my idea. Make the HMO's not for profit. Use the American Red Cross as a prototype. That organization works great, manages the countries blood, and doesn't benefit from saying no.

It will never happen, but it would be nice. I am too tired to comment on everything else, but I will later.

ETA: Very well said Icekid
 

JSM

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Our healthcare system is clearly broken, but universal healthcare isn''t the answer either.

I think the first big step is the medical malpractice issue. People have to understand that doctors are HUMAN, and therefore will make mistakes. I feel we need to drastically cut liability for these doctors. Who can afford to pay insurance with premiums at half a million dollars a year?


Something really does need to be done, though. My hard working fiance didn''t even have his x-rays for his broken wrist covered. He''s a full time employee paying $300 a month for health insurance!
 

strmrdr

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Date: 3/12/2009 10:43:59 AM
Author: icekid
IMO, these end-of-life issues are reasons that we spend so much more on healthcare than other countries. It is wasteful and I do believe this money could be better utilized to take care of the living.
That is real easy to say when it isn''t your loved one, been there and it is not easy.
Just talking about signing a dnr is heart breaking.
Made worse when the doc is a jerk about it.
I still to this day would punch him in the face if I ever see him again and it will be 11 years the 19th that she passed away and almost exactly 11 years to the hour that we had that discussion.
March 12 1998 1130am conference room 2, second floor, ward B.
Even the nursing supervisor was crying as soon as the jerk left the room and was apologizing for his words.
 

LtlFirecracker

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Date: 3/12/2009 12:04:32 PM
Author: strmrdr
Date: 3/12/2009 10:43:59 AM

Author: icekid

IMO, these end-of-life issues are reasons that we spend so much more on healthcare than other countries. It is wasteful and I do believe this money could be better utilized to take care of the living.
That is real easy to say when it isn''t your loved one, been there and it is not easy.

Just talking about signing a dnr is heart breaking.

Made worse when the doc is a jerk about it.

I still to this day would punch him in the face if I ever see him again and it will be 11 years the 19th that she passed away and almost exactly 11 years to the hour that we had that discussion.

March 12 1998 1130am conference room 2, second floor, ward B.

Even the nursing supervisor was crying as soon as the jerk left the room and was apologizing for his words.
I am sorry you had to go through that. I can''t write the feelings I have for the resident who was taking care of my mother in her last days, I would get in trouble. She made a DNR well before this happened. It was out of our hands, which I thought was good. I took one look at her and realized there was no going back and that the end was coming. I am glad it was not prolonged.

I don''t mind keeping someone on support for a few days to allow the family to adjust to the situation emotionally, but keeping someone on support for weeks to years who has no chance of recovery is a lot of money for very little quality of life. Often the ICU doctors and say "what would our European friends say about this, there is no way they would let this go on"
 

basil

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People are entitled and want someone to blame when something goes wrong.

Child has CP? Sue the OB. Die of a heart attack? Must have been the Vioxx, couldn''t have been the years of being fat, having high cholesterol and high blood pressure. Get an infection after surgery? Must have been the surgeon''s fault, despite the fact that it''s a known risk and happens 1/1000 times, so sue him. Have a 95 year old relative who is suffering from severe dementia and pneumonia? By all means, keep them alive on a ventilator, spending thousands and thousands of the hospital''s dollars, so that you can still cash their social security check for a few more weeks. Have a minor health problem? Yes, please flood your doctors office with petitions for disability, free bus passes, social security, and whatever else you can think of.

I don''t know what is going to change until people stop expecting that everything will go perfectly, and if it doesn''t, they DESERVE something. Yeah, there are bad doctors and ones who make mistakes. But the vast majority of lawsuits are completely frivolous, and end up wasting a lot of time and money for all involved. I don''t know why people can''t understand that sh*t happens. Accidents happen. Bad things happen. You don''t deserve millions of dollars just because you''re unlucky.

And the really bad consequence is that it forces doctors to practice defensive medicine. Sure, that patient has a 1/100,000 chance of having a real problem, but you have to get the MRI anyway, because if you miss it, you''re screwed. This is where the real increases in health care spending comes from, not because doctors are being paid too much.

Icekid - intern year is almost done. July is close. It will get better. I promise. I felt the same way in IM, it made me hate medicine in general. I felt almost instantly better after finishing my TY...good luck!
 

fleur-de-lis

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Great points, Icekid.

Date: 3/12/2009 10:43:59 AM
Author: icekid

Socializing healthcare will inevitably mean decreased compensation for physicians. Oh boo hoo poor doctors, right? Well, we’ve gone through college, four difficult years of medical school, followed by three to ten years of grueling additional training. Of course, all of this is while being paid a pittance which is not in line with our educational level nor hours worked. Not to mention wracking up a solid $200,000 in school loans ($250,000 for me!) if you’re not lucky enough to have parents with the ability to pay for your schooling. If compensation drops precipitously, I believe the government will have to take on some of these physician school loans. We were only able to take on this kind of debt with the knowledge that one day (far in the future!), we would have a well-paying job.

Great point. Perhaps if this comes to be, student loans for medical school should be discharged on a 1/5 pro-rata share for each year working in the nationalized healthcare system (like the program for those teachers who work in high-risk areas). Give five years of service to the system, have student loans for med school wiped off.
 

trillionaire

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I hope to get lots of international voices to comment on Health care in their countries... even if it''s anecdotal, it helps to hear about different options and experiences.

 

vespergirl

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Honestly, I think that the healthcare system is as good as it can be to continue providing premium care for most of the country. If we socialize it, then it will become as difficult to see a specialist as I hear it is in Canada and Great Britain. We already have a form of social healthcare available for those who are poor enough to qualify - it''s called Medicaid. Also, plenty of people use emergency rooms, so it''s not like we turn people to the street if they''re sick.

As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.
 

tlh

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Date: 3/12/2009 5:44:33 PM
Author: vespergirl
Honestly, I think that the healthcare system is as good as it can be to continue providing premium care for most of the country. If we socialize it, then it will become as difficult to see a specialist as I hear it is in Canada and Great Britain. We already have a form of social healthcare available for those who are poor enough to qualify - it''s called Medicaid. Also, plenty of people use emergency rooms, so it''s not like we turn people to the street if they''re sick.

As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.
really?
wow! if that is true... i''d agree with you... I''d hate to see the children suffer. However, America has the world''s richest poor... perhaps due to our sense of entitlement. But then again, overwhelming health care costs are the highest reason for bankruptcy... I read that somewhere once... sorry I don''t have a linky.
 

vespergirl

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Here''s the link to the article about uninsured children with insured parents:

http://www.newswise.com/articles/view/546142/?sc=rsmn

I heard the same thing about bankruptcy - our system definitely isn''t perfect, but after hearing stories from friends abroad, I would rather have what we have.
 

Lynnie

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I am interested in hearing what others have to say, as well.

Something has to be done. I work at a large teaching hospital, and the economy is definitely starting to take its toll... no more overtime for me! They want to - and have - cut the nursing budget significantly for the foreseeable future. I am thinking this will last well into the summer. They also cut family leave for new moms (I am so angry about that, as I plan to get pregnant in the next year). Patient/nurse ratios are up, no one is getting hired, and since this all started (March 1st), I feel like a workhorse. My legs were literally throbbing the other day, from so much running!

Sorry for the mini-rant there, I''ll get back to the issue. Unneccessary tests need to be dealt with. I can''t tell you how many unneccessary things I''ve been witness to.
The drug companies need to get their sh!t straight, and need to stop being greedy (ala DMX). Ditto that for the insurance companies. A Z-pack (antibiotic of 5 pills) costs the uninsured $90. Ridiculous. But the CEOs don''t think so.
Icekid, props for your post. Malpractice is crazy in this country. And, in most times, unwarranted.
I have no idea how this issue - or when - will ever get resolved, but I sure hope it does. I love what I do, but this budget-cut thing is causing a lot of stress in the workplace. I would gladly take a 10% salary cut to be properly staffed, and have patients get the quality of care they deserve.
 

LtlFirecracker

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Date: 3/12/2009 5:44:33 PM
Author: vespergirl
Honestly, I think that the healthcare system is as good as it can be to continue providing premium care for most of the country. If we socialize it, then it will become as difficult to see a specialist as I hear it is in Canada and Great Britain. We already have a form of social healthcare available for those who are poor enough to qualify - it''s called Medicaid. Also, plenty of people use emergency rooms, so it''s not like we turn people to the street if they''re sick.


As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.
But we are paying for them. I can''t tell you how many parents use the ED as a primary care clinic. That is way more expensive than just going to a regular doctor. And the hospital cant get them to pay, so they adsorb the costs, the bills go up, and than the insurance premiums go up.

Also, I live on a border town. Do you know how many parents bring their kids from Mexico when they get sick? I mean, I understand where they are coming from as parents. They have a sick child and will do anything to make sure they are taken care of. But it is so taxing on our system. I am conflicted on how I feel about the issue because the compassionate side of me sees a sick child and the part of me aware of government sees the drain on our resources.
 

strmrdr

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A lot of low end jobs will often pay the same towards single or family coverage, usually half the single premium.
In my area it is around 600-700 a month for family coverage with no childbirth coverage.
An individual policy that covers little may be $200 so the employer only pays $100 a month towards insurance no matter what the policy is.

They can afford the $100 but no way can they afford $600...
Since the employed person has to work and do the best to stay healthy they get the insurance.
It is not that they don't want to insure their kids, they cant.
 

vespergirl

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Date: 3/12/2009 6:32:27 PM
Author: LtlFirecracker

Date: 3/12/2009 5:44:33 PM
Author: vespergirl
Honestly, I think that the healthcare system is as good as it can be to continue providing premium care for most of the country. If we socialize it, then it will become as difficult to see a specialist as I hear it is in Canada and Great Britain. We already have a form of social healthcare available for those who are poor enough to qualify - it''s called Medicaid. Also, plenty of people use emergency rooms, so it''s not like we turn people to the street if they''re sick.


As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.
But we are paying for them. I can''t tell you how many parents use the ED as a primary care clinic. That is way more expensive than just going to a regular doctor. And the hospital cant get them to pay, so they adsorb the costs, the bills go up, and than the insurance premiums go up.

Also, I live on a border town. Do you know how many parents bring their kids from Mexico when they get sick? I mean, I understand where they are coming from as parents. They have a sick child and will do anything to make sure they are taken care of. But it is so taxing on our system. I am conflicted on how I feel about the issue because the compassionate side of me sees a sick child and the part of me aware of government sees the drain on our resources.
You''re right about people misusing emergency services - I don''t think that should be people''s first choice at all - I honestly don''t know enough about the topic to offer alternatives. I have relatives living in countries with totally socialized medicine who think it''s awful, so I''m still against that, but like I said, this is not my area of expertise, so I can''t really say what would work ... I just mentioned the emergency rooms to show that we don''t turn sick people into the street, like they do in many third world countries.
 

vespergirl

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Date: 3/12/2009 6:35:39 PM
Author: strmrdr
A lot of low end jobs will often pay the same towards single or family coverage, usually half the single premium.
In my area it is around 600-700 a month for family coverage with no childbirth coverage.
An individual policy that covers little may be $200 so the employer only pays $100 a month towards insurance no matter what the policy is.

They can afford the $100 but no way can they afford $600...
Since the employed person has to work and do the best to stay healthy they get the insurance.
It is not that they don''t want to insure their kids, they cant.
Maybe part of the solution would be making insuring additional family members more affordable ...
 

zhuzhu

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Date: 3/12/2009 5:44:33 PM
Author: vespergirl
Honestly, I think that the healthcare system is as good as it can be to continue providing premium care for most of the country. If we socialize it, then it will become as difficult to see a specialist as I hear it is in Canada and Great Britain. We already have a form of social healthcare available for those who are poor enough to qualify - it''s called Medicaid. Also, plenty of people use emergency rooms, so it''s not like we turn people to the street if they''re sick.


As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.
This impression is coming from people who have insurance and GOOD insurance. If you ask honest doctors, they will tell you the truth about how they have to withhold recommending some effective drugs/treatments because a lot of insurance companies will not approve these procedures. If the doctor fights the insurance company for you, paperwork will cost the clinic money. Just because there are those of us who have good employment-based insurance does not mean majority of Americans are enjoying the same luxury.

I do not pretend to have the answer to "what is the most effective healthcare system for America". However one thing I do know and firmly believe in is that ALL PEOPLE, should have the fundamental right to be treated when they are sick. Of course there are problems associated with any systems, but that does not mean those of us who have it easy should just keep what works for us and ignore the big picture. If your neighbor is uninsured and could not afford to go to the doctor''s for antibiotics to treat a serious infection, the chances are good that you and your kids may catch it too. The cost for uninsured Americans go to EVERYONE, and in worst case it may even result in pandemic.
 

trillionaire

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People WITH insurance can''t get full and proper coverage. People without insurance are routinely charge many times more in costs than people with insurance, because the insurance companies can negotiate prices, but individuals can''t. (example, $7,000+ for a kidney biopsy for an individual, vs. $900 for an insurance company) link the overcharges cause defaults, which raise costs on ALL of us. People born with, or who develop health issues cannot get insurance because of pre-existing conditions. Is there any way to change ALL of these things without national medicine? I would wait to go to a specialist if that meant that EVERYONE had insurance coverage. I already pay for a lot of things for other people which I don''t consider worthwhile. I would rather my money go to health care for all than fattening the pockets of pharmaceutical companies and insurance companies. My dad was the VP of an HMO. He quit because he found them immoral/amoral. He now manages a community health center, as substantially less pay. Health care for everyone is better for everyone, and by any means necessary, as far as I am concerned. And the sooner, the better.
 

cara

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Date: 3/12/2009 5:44:33 PM
Author: vespergirl
As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.
Just because the parents can get insurance through their employer does not mean that the parent is able to insure their kid on that policy, or do so for a reasonable price. Two examples:

There is a reasonable student health insurance policy available from my university; students are required to be covered and the school usually covers half the cost of the insurance. But those pesky grad students kept having babies, and babies are expensive so they banned dependent coverage. You can not pay more to add your child on this policy - no kids are allowed period. And yes, they even emailed that out as the reason - too many knocked up people. One of my friends had a healthy baby and was able to purchase insurance on the open market for a reasonable amount of money. One of my friends was likely to have a premature baby, and was simply not going to be able to purchase ANY insurance at any price if that had happened. The kid actually went full term but had some minor, minor issue that needed to be watched (and did not end up costing anything) but that was enough that they couldn''t buy any coverage on the market until the kid was 7 months and this issue was officially done. So they got superlucky, but really had no method of insuring their brand-new, completely healthy baby that needed monitoring for a minor, preexisting condition.

Another case. Prior to grad school, I worked at a cheap school that would cover your health insurance but no dependents. In that case, they would allow you to add a dependent but you had to pay ALL the cost yourself and the employer would not subsidize any of the extra cost. The secretary was a single mom and she had insurance for herself, but to add her disabled son was an additional $900 per month. This job did not pay a lot, and she simply couldn''t buy food, rent and her son''s health insurance. Nor could she qualify for state help with insuring her son cause her income was too high and because *she* had insurance, they assumed she could add her son and her employer would pay. She went round and round trying to show that she couldn''t afford to insure her son on the school policy so she could qualify for help but it didn''t work. She was stuck in a no-man''s land and was actually advised to quit her job so her son would be eligible for state aid.
 

trillionaire

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Date: 3/12/2009 7:11:22 PM
Author: cara
Date: 3/12/2009 5:44:33 PM

Author: vespergirl

As far as children's healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.

Just because the parents can get insurance through their employer does not mean that the parent is able to insure their kid on that policy, or do so for a reasonable price. Two examples:


There is a reasonable student health insurance policy available from my university; students are required to be covered and the school usually covers half the cost of the insurance. But those pesky grad students kept having babies, and babies are expensive so they banned dependent coverage. You can not pay more to add your child on this policy - no kids are allowed period. And yes, they even emailed that out as the reason - too many knocked up people. One of my friends had a healthy baby and was able to purchase insurance on the open market for a reasonable amount of money. One of my friends was likely to have a premature baby, and was simply not going to be able to purchase ANY insurance at any price if that had happened. The kid actually went full term but had some minor, minor issue that needed to be watched (and did not end up costing anything) but that was enough that they couldn't buy any coverage on the market until the kid was 7 months and this issue was officially done. So they got superlucky, but really had no method of insuring their brand-new, completely healthy baby that needed monitoring for a minor, preexisting condition.


Another case. Prior to grad school, I worked at a cheap school that would cover your health insurance but no dependents. In that case, they would allow you to add a dependent but you had to pay ALL the cost yourself and the employer would not subsidize any of the extra cost. The secretary was a single mom and she had insurance for herself, but to add her disabled son was an additional $900 per month. This job did not pay a lot, and she simply couldn't buy food, rent and her son's health insurance. Nor could she qualify for state help with insuring her son cause her income was too high and because *she* had insurance, they assumed she could add her son and her employer would pay. She went round and round trying to show that she couldn't afford to insure her son on the school policy so she could qualify for help but it didn't work. She was stuck in a no-man's land and was actually advised to quit her job so her son would be eligible for state aid.
Excellent examples of our broken system, Cara!

'Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.' we pay more, and get less. Source

Safety net health care centers strain under increased demand.

The hidden costs of health care
 

iluvcarats

Ideal_Rock
Joined
Apr 17, 2008
Messages
2,536
Date: 3/12/2009 7:16:42 PM
Author: trillionaire
Date: 3/12/2009 7:11:22 PM

Author: cara

Date: 3/12/2009 5:44:33 PM


Author: vespergirl


As far as children''s healthcare goes, a current statistic listed that over 2 million uninsured children have at least one insured parent. Which means that the parents are buying themselves insurance, without insuring their children. It is not my responsibility to buy their children healthcare - if you have the capacity to insure them through your employer, then you should be obligated to do it.


Just because the parents can get insurance through their employer does not mean that the parent is able to insure their kid on that policy, or do so for a reasonable price. Two examples:



There is a reasonable student health insurance policy available from my university; students are required to be covered and the school usually covers half the cost of the insurance. But those pesky grad students kept having babies, and babies are expensive so they banned dependent coverage. You can not pay more to add your child on this policy - no kids are allowed period. And yes, they even emailed that out as the reason - too many knocked up people. One of my friends had a healthy baby and was able to purchase insurance on the open market for a reasonable amount of money. One of my friends was likely to have a premature baby, and was simply not going to be able to purchase ANY insurance at any price if that had happened. The kid actually went full term but had some minor, minor issue that needed to be watched (and did not end up costing anything) but that was enough that they couldn''t buy any coverage on the market until the kid was 7 months and this issue was officially done. So they got superlucky, but really had no method of insuring their brand-new, completely healthy baby that needed monitoring for a minor, preexisting condition.



Another case. Prior to grad school, I worked at a cheap school that would cover your health insurance but no dependents. In that case, they would allow you to add a dependent but you had to pay ALL the cost yourself and the employer would not subsidize any of the extra cost. The secretary was a single mom and she had insurance for herself, but to add her disabled son was an additional $900 per month. This job did not pay a lot, and she simply couldn''t buy food, rent and her son''s health insurance. Nor could she qualify for state help with insuring her son cause her income was too high and because *she* had insurance, they assumed she could add her son and her employer would pay. She went round and round trying to show that she couldn''t afford to insure her son on the school policy so she could qualify for help but it didn''t work. She was stuck in a no-man''s land and was actually advised to quit her job so her son would be eligible for state aid.

Excellent examples of our broken system, Cara!


''Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.'' we pay more, and get less. Source
This is true, but things would change in other ways. Americans would need to accept the fact that we are mortal, and all lives eventually come to an end. There is a lot more hospice care utilized in other countries, but we always want every possible measure taken whether it is futile or not. With no expense spared. And Drs. do it because they are afraid of being sued. It is not realistic to want a healthcare system like we have here today under a national system. People are going to have to accept *no* for an answer sometimes. And while the quality of medicine will likely remain the same,actually being approved for that care is a different story. Do you really want a government official deciding what your Dr. can and cannot do? I agree that things need to change, but it will be a very different system.
 

basil

Brilliant_Rock
Joined
Jun 27, 2006
Messages
1,526
Date: 3/12/2009 6:19:35 PM
Author: Lynnie
I would gladly take a 10% salary cut to be properly staffed, and have patients get the quality of care they deserve.
The physicians in my department actually just voted to take a 5% pay cut in order to not have to lay off nurses and technicians.

The VA system is basically an example of socialized medicine. In my experience, the majority of people do get good care at the VA. But some also get poor care, and there''s no way to really predict or control what you get. They definitely wait longer to make appointments and to be seen when they have appointments. Doctors have less choice when prescribing medications. If you try drug A for your patient and he has an allergy/sensitivity/side effect and can''t take it, in a private system, you would just choose another drug. At the VA, there are multiple forms (govt bureaucracy), and whomever decides these things (not an MD) can either accept or deny it.

Honestly, I don''t think Americans would tolerate socialized medicine. It''s very American to be able to say "well, if I pay more I should get something better/be first in line/get the latest technology". It''s not very American to say "well, Joe Homeless needs an MRI too, so I guess I''ll wait a few more days". Can you imagine the black market for some drugs? Can you imagine Ted Kennedy not going to Duke for his neurosurgery, and going to a community hospital and waiting in the waiting room instead? There''ll be black market clinics!

I''d like to blame the drug companies too, but the fact is that we pay the R&D for the whole world. Most of the pharmaceutical advances have come from the US, and are funded by drug companies. Then they charge the US market whatever they want, and the rest of the world negotiates for a lower price. Now, the extravagances of taking physicians to pro football games, on vacation, out to dinner, etc., has largely fallen by the wayside. I can''t even take a pen from a drug rep, and we can''t even give out medication samples to patients anymore (not that that''s a good thing).

Cara - I don''t really know that we get less. Sure there are individuals who get less. But some people get a lot more than they would in another country. I have never seen a breakdown of where those differences in costs come from. Do our drugs cost more? Hospital visits longer? More end-of-life expenses? Order more tests? It is hard to know.

Obviously, there''s no easy solution.
 

LtlFirecracker

Ideal_Rock
Joined
Feb 29, 2008
Messages
4,837
Dido to Basils statements. All of them are what I wanted to say.

I want to add about the drug companies. The rest of the world does need to share the cost of R&D, we are funding most of that and our costs are sky hi. I think that drug companies need to be restricted on how much advertising they do as well. That is another reason costs are so high. And while patents are good, they are abused. I don't see why a drug company should get a whole new patient for making an extended release version a med that went off patent, and than advertise it to doctor's and patients as the next great thing so that that becomes the number one prescribed drug instead of the cheep generic. The extended release version should have been released first if that is what works best. They are totally milking the system.
 

cara

Ideal_Rock
Joined
Mar 21, 2006
Messages
2,202
basil, I think that trillionaire said we get less for our money, not me.

But I agree that in some ways we get less for our money because the money is not distributed according to need but rather flows in great, wasteful excess to some people for certain types of care while others are denied lifesaving, and cost effective treatments. I mean, if you could wave a magic wand and redistribute some of our health care provisions, wouldn''t you save a few millions of dollars by cutting off hopeless ICU patients a little earlier and providing cost-effective screening to uninsured people? Maybe I have my examples wrong, but with ~50 million uninsured, surely there would be a way to reroute some of the health care to them to improve our overall outcomes? Of course, rationing and ''to each according to their need'' sounds very socialist and unAmerican, but I''m not sure that the capitalist system is really appropriate for allocating health care.

Vesper- where I agree with you is that parents should be required to insure their kids. All people should be required to have insurance, so long as we as humans are not going to like letting people die in the street because they don''t have health care. At the same time, we as a society have to figure out a way to make affordable health care available to people. One way is to require companies to insure everyone for the same fee, and not allow them to deny coverage for preexisting conditions. Thus forcing a broad pool where healthy people do end up subsidizing sicker people. But again, until we are willing to let people die in the streets for lack of care, I think that there is a social obligation to figure out how to provide health care for our fellow citizens.
 

basil

Brilliant_Rock
Joined
Jun 27, 2006
Messages
1,526
Oops, sorry Cara! I read it wrong.

Yup, I would totally redistribute resources if I could. A lot of money is wasted on treatment that the physician knows is futile. But it''s almost anti-American to give up. And as long as there are stories about people waking up from comas, and as long as there are people who think Terry Schiavo''s husband was wrong to let her die, there are going to be people who think they were terribly horribly wronged if it is not their decision about when to withdraw support for their loved one.

What I worry more about, though, is access to cutting-edge care. I remember reading an article recently, I forget if it came from here or not, about a breast cancer drug in Australia, Herceptin, which for a while wasn''t approved by the Australian government. So no one could take it. Then they approved it for people with advanced cancer, i.e. the sickest. But many of them were too sick already to benefit from it. In the meantime, people in the US with early cancer were given the drug, and more of them survived. Sure, we spent a lot of $$$ on Herceptin, but tell that to the people that took it and are cancer-free.
 
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