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That's part of the biggest problem with healthcare costs right now, the fact insurance (all of it) is state specific. If it wasn't that would control costs.
BS. You can't buy health insurance across state lines for the same reason you can't buy auto insurance across state lines: utilization, liability and settlement costs are drastically different from state to state.
Quote:
Originally Posted by coschristi
I was working in the hospitals when they were transitioning to HIPAA compliance & it was a mess.
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People have short memories or are too young to remember the mess caused by the Clinton Admin's re-vamp of healthcare financing. The HIPAA crap was only a small part of it.
Payments to hospitals were cut back so drastically that a full 1/3rd of all hospitals were forced to close. Rural and inner city hospitals bore the brunt of the closures. ...They really did us a favor??
If you want to know what single-payor system will look like, check out the VA. As long as all the blanks on the govt forms are filled in, then they think they're doing a good job. Actual medical outcomes or patient satisfaction are not important.
Medicare is not free. For full insurance, we pay $750 per month for our share of Medicare part B, supplimental plan to cover the uncovered portion, and a drug plan. Its a great deal, but its not free. See how the popularity of Harris goes when she tells the riffraff theyd have to fork over that much a month.
I know what you're saying. And I agree!
But Obama tried to pass a law making them pay their fair share and they refused. The challenge in court backed them up; they don't have to buy health insurance. That's why Medicare is not optional. Those of us who are retired are going to pay whether we want to or not. And we both know why.
M4A will have to be the same way. But there would be a sliding scale which would depend on income and number of dependents. Some people would pay dearly, others almost nothing. But worker Medicare, I think, will be very different from the stuff I have.
BS. You can't buy health insurance across state lines for the same reason you can't buy auto insurance across state lines: utilization, liability and settlement costs are drastically different from state to state.
People have short memories or are too young to remember the mess caused by the Clinton Admin's re-vamp of healthcare financing. The HIPAA crap was only a small part of it.
Payments to hospitals were cut back so drastically that a full 1/3rd of all hospitals were forced to close. Rural and inner city hospitals bore the brunt of the closures. ...They really did us a favor??
If you want to know what single-payor system will look like, check out the VA. As long as all the blanks on the govt forms are filled in, then they think they're doing a good job. Actual medical outcomes or patient satisfaction are not important.
Actually, while it may not be popular to say so in rural areas, closing rural hospitals is actually a good idea from a cost standpoint. Hospitals require a large capital investment. In order to stay in business, they must recoup their fixed costs (capital investment) as well as variable costs (day to day use). Recouping fixed costs is hard when you have a very limited number of people using the hospital. The only way hospitals in small rural areas can stay open is with some kind of a subsidy. On the other hand, the volume of traffic generated in large cities makes these hospitals very profitable if that is the objective.
Rural people need to understand that if they want to live in the hinterlands that part of what they are accepting is a lesser quality of medical care. The rest of us shouldn't be subsidizing it.
Closing these small hospitals is a positive thing for all but the small percentage of people who live in those areas.
Those who are against have never been real sick...
It works in other countries, The average age is slipping here in the USA.......
Go to Canada and ask somebody that has been "real sick" and needed quick health care how they like their health care system. And Canada's health care system is supposed to be the model system for the world.
Medicare is not free. For full insurance, we pay $750 per month for our share of Medicare part B, supplimental plan to cover the uncovered portion, and a drug plan. Its a great deal, but its not free. See how the popularity of Harris goes when she tells the riffraff theyd have to fork over that much a month.
While you pay $750 per month for that, imagine how much you would pay without subsidies deducted from those still working.
That's called an anecdote. There are a Million of them out there... I have some too.
And they're all worth just about the same: $0
Sometimes going with personal experiences on the matter which I have way more than the two I mentioned is better than listening to the talking heads from both parties or their devotees.
Quote:
Originally Posted by MrRational
You ready to put the blame for that on Bush Jr yet?
When you are come on back and explore practical remedies to the several problems.
You can start with #5
I put the blame on the past 2 POTUS and the current one for the debt situation as well as congress which reconciles the budget. But if you want to put all the blame on GWB if that makes you feel better, be my guest. I don't care for either party and I am disgusted by what they have done to this country.
The lines and wait times would be enormous. You will be waiting in line behind the senorita who wants to have a mole removed.
A friend of mine in Maine was diagnosed with gall stones. He was told not to eat or drink after midnight and come back in the morning to have his gall bladder removed. He did that. He was home for supper, just over 24 hours after being diagnosed.
I have another friend in Canada who was on the gall bladder list for 15 MONTHS! He finally had it removed after enduring several gall bladder attacks. I worked in Canada for seven years. They have a l0t of private clinics where Americans can have dental or medical work done at very low prices.
Our local hospital, Penobscot Valley Hospital filed for bankruptcy yesterday. It has been coming. They closed the delivery room last year.
What it would look like is a screwed up mess. If the government is involved it will be screwed up. Don't get me started on how much the "Affordable Care Act" screwed up my health insurance and made it unaffordable as a self-employed business owner.
The key phrase here for me is "as a self employed business owner".
I don't want to read things into this that don't belong here. You are free to correct any misstatement that I might make. However, I'm imagining something like this:
1. You expect a very high quality of care.
2. You think everyone should be able to afford to pay for that care just like you do.
3. If people can't afford to pay for it than that is their problem.
4. Other people going without medical care doesn't particularly bother you.
Just a comment. I think America is evolving to a system where we are going to treat health care as a right, rather than simply a privilege for those who can afford it. People who think it should be a privilege for those who can afford it are likely to be unhappy at the direction we are moving.
Do you realize how much "government" is already in health care? Medicare and medicaid account for over 40% of the total payments made to medical providers. Most employer health plans are regulated by a federal law known as the ERISA. Those few plans offered by employers that are not ERISA plans are regulated by the state governments.
My point is that government is already heavily involved in health care and I don't see things not being that way through your lifetime or mine.
The Comstock laws,50 years before, are what the AMA efforts were leveraged on.
These were centered on SEX and midwives and early abortion methods.
The quality of medical care really had almost ZERO to do with any of it.
Whatever the rationale was for originally regulating the practice of medicine and pharmaceuticals, the rationale today is what I said in my post. Its to prevent unlicensed medical practitioners and unapproved medicines from killing and harming large numbers of the public.
Quote:
Originally Posted by dijkstra
Go to Canada and ask somebody that has been "real sick" and needed quick health care how they like their health care system. And Canada's health care system is supposed to be the model system for the world.
Interesting you bring that up. I've listened on the Canadian Forum here on city data to discussions about Canadian Medicare. The Canadians who post about it are about 80-85% pro. Only 15-20% are con. In public opinion surveys, Canadians are overwhelmingly in favor of their system. Canada is a democracy and if the people didn't like this system it would be voted down and a system like we have in America would replace it. It hasn't happened and its not going to happen.
Quote:
Originally Posted by Northern Maine Land Man
"What would "Medicare for All" look like?"
The lines and wait times would be enormous. You will be waiting in line behind the senorita who wants to have a mole removed.
A friend of mine in Maine was diagnosed with gall stones. He was told not to eat or drink after midnight and come back in the morning to have his gall bladder removed. He did that. He was home for supper, just over 24 hours after being diagnosed.
I have another friend in Canada who was on the gall bladder list for 15 MONTHS! He finally had it removed after enduring several gall bladder attacks. I worked in Canada for seven years. They have a l0t of private clinics where Americans can have dental or medical work done at very low prices.
Our local hospital, Penobscot Valley Hospital filed for bankruptcy yesterday. It has been coming. They closed the delivery room last year.
I mentioned in an earlier post that our wait time was zero when our son became sick during a trip to Canada. They got him right into the hospital and got him the scans and diagnostic tests he needed immediately. I suspect though that there is some truth to the notion that people who do not have a medical emergency wait longer for care in Canada. I don't see that as particularly bad and it has to be compared to wait times that already exist in our system. I know people who have waited months for a surgery right here in the good ole USA.
Hospitals would close as Medicare payments don't cover the the total cost incurred by the hospitals for providing the Medicare services today. Hospitals rely on higher commercial insurance payments to cover Medicare and Medicaid losses today. As it is, if you have commercial insurance through an employer or otherwise, a large portion of your premiums are effectively a tax to covered Medicare and Medicaid program losses. With Medicare for all, you would have "insurance" without access to care, or rationed care, that would leave you feeling like you have no insurance coverage at all. Many feel that way already because the physicians don't want to take Medicare today because of low Medicare payments.
This would happen, albeit it would only be wave 1.
Wave 2 is the bottom 10-20% of doctors that really aren't very good will hire very cheap, likely barely qualified staffs and they will put together sham places that will "service" Medicare patients. Whether a patient is cared for will not really matter. They will have equipment to do a narrow range of procedures and they will prescribe that for all of their patients. If a service normally costs $500, They'll likely need to bill $1500 of services that may or may not be needed in order to get the same payout. Who cares if the patients die...they're all patients.
Wave 3 would be like Cook County Hospital in Chicago. I went once when I was unfortunate enough to have broken my arm and not have insurance. The places that could treat kept saying the same thing. It's not life threatening...you have to go there if you don't have insurance. Checked in at 10:00am....with begging and pleading that I wasn't able to stay awake I was admit around 4:00am the following day. College kid came it, spent more time fixing a casting machine that had been plugged, through a cast on (no x-ray) and I was out. Fast and efficient, and completely reactive care. They did a great job, I'm not knocking them, but if you can get medical care more focused on helping people avoid problems and not just addressing issues...it's going to save money in the long run.
Of course, some advocate for the government hospital route. We've got a few examples to go from. The first were the mental institutions run by the government....most of which were shut down. The second is the VA system. Or we could look at China's free hospital care. I lived with a former doctor at the only oncology ward in the Fujian province of China. At first she said she was sad to be sent there, thinking it akin to failure, because people went to cancer hospitals to die, but then she realized how great her fortune was. She had the only hospital that could offer these people hope. No competition whatsoever. Your first question upon coming in wasn't what was wrong, but what do you do for a living. Only the rich that gave healthy favors were admit, and she recalled there being fistfights over an open bed between the doctors to sell. How much influence? She was responsible for making sure the doctors picked up their paychecks...and they had to do it at least once every 6 months. The pay was so little that most wouldn't bother.
The problem with this problem is what wouldn't you pay to have a chance at not dying? Now, if someone else is paying that, what won't you demand to be paid on your behalf?
Offering carte blanche services through medicaid is a sure way of making sure you get many providers that simply forgo the expensive and risky procedures and convert the entire supply chain into what is easy to provide. With little incentive for improvement, forget forward advances in medicine. If they come, it will be as a handmedown developed for other markets.
The lines and wait times would be enormous. You will be waiting in line behind the senorita who wants to have a mole removed.
A friend of mine in Maine was diagnosed with gall stones. He was told not to eat or drink after midnight and come back in the morning to have his gall bladder removed. He did that. He was home for supper, just over 24 hours after being diagnosed.
I have another friend in Canada who was on the gall bladder list for 15 MONTHS! He finally had it removed after enduring several gall bladder attacks. I worked in Canada for seven years. They have a l0t of private clinics where Americans can have dental or medical work done at very low prices.
Our local hospital, Penobscot Valley Hospital filed for bankruptcy yesterday. It has been coming. They closed the delivery room last year.
I experienced this in California. The emergency rooms are (or were) required to treat everyone who comes in, regardless of insurance or ability to pay. As a result the emergency rooms were always chock full of poor people (primarily immigrants) with kids who had a cold or sneezed once yesterday. I went to ER with a bleeding gash in my head. They told me to wait. I sat in a room full of coughing children and their parents for three and a half hours. the good thing was it stopped bleeding by the time they finally saw me,so they just stitched it up and gave me some antibiotics to kill whatever the kids had coughed into my blood. There was a guy with a broken arm who laid there on a stretcher for two hours and a guy with a knife wound who laid there bleeding fo over half an hour. It was a complete madhouse. They did not have the resources or the management skills to handle it all.
I think California changed that law later, because most of the hospitals that had ERs were getting put out of business and closing the ER (or in some cases closing the entire hospital). It got really hard to find a hospital with an ER. the ER I went to eventually set up a triage system so the people who needed immediate care got in right away and the kids with colds literally sat there all night waiting for someone to see them. Still not a good solution.
When medicine is free, people flock to the doctor's office for any reason and for no reason. There is no more: if your kid has a cold, give them some Robitussin and put them to bed. Now you race to the doctor or if you do not have insurance to the ER. At least having a cost factor causes people to think about whether they really need a doctor before they go.
We simply do not have the resources to allow everyone to run to the doctor every time they do not feel well or want a note for a day off work. there are not enough doctors, nurses, hospitals, clinics offices etc to service such a need for 360 million people.
Some potential solutions are in the works. You can now visit a doctor over the internet and get prescriptions for basic concerns. This could be expanded and some form of private internet connection made available. They will still need to find a way to deal with the paranoid parents and hypochondriacs.
Nurse Practitioners are becoming more common and can do a lot of the basic things a doctor can do. Midwives are making a comeback as well.
A big part of the problem is liability hysteria and excessive regulation. HIPPA rules go too far. They need to strike a balance between protecting privacy and practicality. Liability also must be controlled. Why do you have three or more medical professionals in the room for a procedure that requires one person? the other two are there as witnesses in case something goes wrong. Nice to have, but we cannot afford this. Why do they have so many redundant systems to confirm identity, prescriptions, etc? Liability. It is nice to be super duper extra incredibly careful. It is also a luxury that we cannot afford. The cost is too great for the .02% of times someone suffers some horrible malaise because of a mistake. Many of these redundancy are not likely to prevent a mistake (some are) they are just to minimize liability if a mistake happens.
We need to accept the fact that if everyone is going to get medical care, there will be some mistakes and those mistakes will result in permanent horrible impairment or deaths. We do not get to have both treat everyone and never have any mistakes in treatment. We will have to limit liability so doctors can treat people as best they know how and we have to accept their best will have to be good enough, even when it isn't.
At the same time we need to work on controlling profits. Especially big pharma profits. However they are so well entrenched, we are unlikely to see any progress there in the lifetime of anyone who is on CD today. If we keep poking at it there may be some progress one day. Until then, buy your medications in Canada or Mexico unless you have insurance to pay insane prices for it (also get a GoodRx card.).
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