Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I read the ACA twice before it was passed. My request is that whatever replaces it be about 3 pages long, not over 3000, and that it be written in clear and concise language. It should be easily understood by the average citizen with an average education should they want or need to read it. The ACA was intentionally written (by lobbyists, not even by Congress members) to be confusing so that anything that government regulators could do anything they wanted once it was passed.
Susan Collins - one of the 2 Republican senators directly responsible for the passing of the ACA in the first place .. no wonder that the plan she and her Louisiana cohort are suggesting start out sounding amazingly like ... gee whiz .. the ACA .. including the dreaded individual mandate. Why is she still in Congress?
I do commiserate with those dealing with 'pre-existing conditions' especially since over time I would bet the net there will widen and widen till almost everyone is included - since life is a pre-existing condition and a prelude to death. The issue there with a 2 year period is what if there are no insurance companies who will cover them at all?
HSAs - good
Coverage till age 26 - don't really have an opinion one way or the other but in most cases I am not sure this is a good thing for 'launching' a child at an appropriate age .. would maybe prefer we make it easier and/or cheaper for kids to begin to purchase their own coverage well before 26 so they learn the issues involved much earlier
What I am for is universal catastrophic insurance at a fair cost to the consumer and the ability to purchase across state lines additional coverage for things like doctor visits (or go cash only for this aspect) and prescriptions and outside/specialist tests, etc. if desired. I can see that the 'purchase across state lines' thing will be a problem though but if that can't be implemented to the advantage of the consumer to lower costs then perhaps we need to set limits on the amounts that insurance companies can charge various categories of the insured. But of course that will also lead to problems .. max price regulations inevitably do - all companies will charge the max, never less so there will be no competition in the end.
It would be nice to take insurance companies completely out of the health insurance equation because they are responsible for increasing costs exponentially. When I go to a doctor and say I have no insurance, I am charged a fair and fairly low price, even for blood tests and minor procedures conducted in house. When I go to the doctor and say I have insurance, the doctor bills the insurance company a MUCH larger amount, the insurance company tries to delay payments any way they can (which therefore almost justifies what the doctor is trying to charge) but eventually pays something which is far more than I paid with no insurance so the doctor is happy I guess (along with someone collecting the copays, etc.) and may even bill the patient for the extra.
Doctors incur so much overhead to deal with the insurance companies - and increasingly spend more and more of his/her time figuring out how to code the claim so that payment will be easier to collect (not necessarily to reflect the actual diagnosis or treatment). At any rate, I think we should all go on an 'actual cost' basis - everything is so badly inflated these days one can't even tell what those are.
If we do reduce the burden on the system of those who are illegal, etc. perhaps that will help reduce costs but with insurance companies involved I suspect not much of that will be realized. At least if everyone has to pay cash on the barrelhead for office visits and minor tests, that end could be straightened out a bit.
As someone who is also a Canadian (and I also did a fair bit of work in the US healthcare system as well during the Y2K era), I can say that I have never seen how a truly universal health care system could be instituted in the US even though there are 'some' advantages to that kind of system as far as 'the people' go. I say some because it is NOT the panacea everything seems to think it is - there are major drawbacks and costs are paid from taxes which can then go sky high .. not all is utopia, believe me. The issues are many - the population base is huge compared to what it was in Canada over 40 years ago when Canada's universal health system was instituted, doctors are very used to high salaries/income and won't take kindly to receiving MUCH less per patient/operation, etc. because the government is paying them - and even if they accept that they will start shovelling patients through faster, believe me, there won't be enough funding for research and specialized care facilities, insurance companies will have a major FIT when they are completely cut out (and they are not the only ones but they will be the loudest objectors). There are just too many stakeholders so even if it was accomplished it would take many many years and most of us will die off before it is in effect. Just isn't as easy as people would like to think it is. I think we are much better off in the US with trying to work on ways for the patient to pay directly for everything except major problems on their own and covering everyone for hospitals, etc.
It would be nice to take insurance companies completely out of the health insurance equation because they are responsible for increasing costs exponentially. When I go to a doctor and say I have no insurance, I am charged a fair and fairly low price, even for blood tests and minor procedures conducted in house. When I go to the doctor and say I have insurance, the doctor bills the insurance company a MUCH larger amount, the insurance company tries to delay payments any way they can (which therefore almost justifies what the doctor is trying to charge) but eventually pays something which is far more than I paid with no insurance so the doctor is happy I guess (along with someone collecting the copays, etc.) and may even bill the patient for the extra.
I'm intrigued by the above report of your experiences since most people seem to report the opposite - namely, that the power of an insurance company tends to keep the medical providers honest so as to avoid losing the business of a powerful consumer. In contrast, providers are commonly able to intimidate individual consumers into paying high costs because (a) the provider doesn't fear the loss of future business from that single customer; and (b) the customer may lack enough knowledge of the industry and have enough fear of the consequences of defying a vendor that the consumer simply ends up paying the bill to avoid trouble.
I have also heard of several occasions where hospitals will deliberately have an out-of-network hospital staff member provide a service, so that the hospital can charge the consumer a fee far in excess of what the insurance company would have allowed. (one such case involving an ACA patient was given considerable press coverage in early 2016).
Quote:
Originally Posted by Aery11
As someone who is also a Canadian (and I also did a fair bit of work in the US healthcare system as well during the Y2K era), I can say that I have never seen how** a truly universal health care system could be instituted in the US even though there are 'some' advantages to that kind of system as far as 'the people' go. I say some because it is NOT the panacea everything seems to think it is - there are major drawbacks and costs are paid from taxes which can then go sky high .. not all is utopia, believe me. The issues are many - the population base is huge compared to what it was in Canada over 40 years ago when Canada's universal health system was instituted, doctors are very used to high salaries/income and won't take kindly to receiving MUCH less per patient/operation, etc. because the government is paying them - and even if they accept that they will start shovelling patients through faster, believe me, there won't be enough funding for research and specialized care facilities, insurance companies will have a major FIT when they are completely cut out (and they are not the only ones but they will be the loudest objectors). There are just too many stakeholders so even if it was accomplished it would take many many years and most of us will die off before it is in effect. Just isn't as easy as people would like to think it is. I think we are much better off in the US with trying to work on ways for the patient to pay directly for everything except major problems on their own and covering everyone for hospitals, etc.
First, why couldn't a Canadian type single payer system be implemented in the U.S.? I understand that the scale of the country would require a longer lead time, but that relates to implementation delay, not impracticability. It seems relevant to mention that, according to the link below, in the U.S., govt already pays for 2/3 of all health care bills. Moreover, in absolute numbers, in the U.S., govt spends about $6K per person on health care, already the highest of all nations (as of 2013), even though we don't have a national health care plan. It seems like a good deal all around to adopt a single payer system, have the govt (federal and state govts included) pay less than we currently we do on health care, and have universal coverage to boot!
If the American people vote in a system that provides universal coverage with a lower govt spending burden than we have currently, and in the process eradicates the need for direct payments from consumers to health insurance companies and medical providers, I contend that the doctors will simply have to accept the payments that are offered. Here, I propose something radical: I contend that the medical system is supposed to involve health care providers doing what's medically best for patients, not the patients and govt entities doing what is financially best for doctors. I realize that this won't stand me in good stead with the AMA, but again, I'm approaching this from the unusual standpoint of what is good for the patients.
I don't expect this to happen any time soon. But, when single payer naysayers bring up the issue of costs and tax burden, it seems highly relevant to observe that the govt, in the U.S., already spends more per person on health care than the Canadian govt does, notwithstanding the facts that (a) U.S. consumers must add trillions more dollars to the mix of non-tax money from their own pockets, and (b) that 30 million people remain uninsured.
What's that? Spend less, get more, and have everyone covered? Nah! Makes too much sense. Some of the people currently receiving all those extra trillions of dollars will surely object.
I'm intrigued by the above report of your experiences since most people seem to report the opposite - namely, that the power of an insurance company tends to keep the medical providers honest so as to avoid losing the business of a powerful consumer. In contrast, providers are commonly able to intimidate individual consumers into paying high costs because (a) the provider doesn't fear the loss of future business from that single customer; and (b) the customer may lack enough knowledge of the industry and have enough fear of the consequences of defying a vendor that the consumer simply ends up paying the bill to avoid trouble.
I have also heard of several occasions where hospitals will deliberately have an out-of-network hospital staff member provide a service, so that the hospital can charge the consumer a fee far in excess of what the insurance company would have allowed. (one such case involving an ACA patient was given considerable press coverage in early 2016).
First, why couldn't a Canadian type single payer system be implemented in the U.S.? I understand that the scale of the country would require a longer lead time, but that relates to implementation delay, not impracticability. It seems relevant to mention that, according to the link below, in the U.S., govt already pays for 2/3 of all health care bills. Moreover, in absolute numbers, in the U.S., govt spends about $6K per person on health care, already the highest of all nations (as of 2013), even though we don't have a national health care plan. It seems like a good deal all around to adopt a single payer system, have the govt (federal and state govts included) pay less than we currently we do on health care, and have universal coverage to boot!
If the American people vote in a system that provides universal coverage with a lower govt spending burden than we have currently, and in the process eradicates the need for direct payments from consumers to health insurance companies and medical providers, I contend that the doctors will simply have to accept the payments that are offered. Here, I propose something radical: I contend that the medical system is supposed to involve health care providers doing what's medically best for patients, not the patients and govt entities doing what is financially best for doctors. I realize that this won't stand me in good stead with the AMA, but again, I'm approaching this from the unusual standpoint of what is good for the patients.
I don't expect this to happen any time soon. But, when single payer naysayers bring up the issue of costs and tax burden, it seems highly relevant to observe that the govt, in the U.S., already spends more per person on health care than the Canadian govt does, notwithstanding the facts that (a) U.S. consumers must add trillions more dollars to the mix of non-tax money from their own pockets, and (b) that 30 million people remain uninsured.
What's that? Spend less, get more, and have everyone covered? Nah! Makes too much sense. Some of the people currently receiving all those extra trillions of dollars will surely object.
The only part of that statement that would happen is the "get everyone covered" part. It would NOT cost less and you would NOT get more. Sorry, but yes, you would be able to see a primary care doctor for your cold and not have to pay anything out of pocket outside of the very high taxes that come out of your paycheck to cover this, but then, for anything more substantial, how long are you willing to wait? What if you need a knee replacement, you get put on a waiting list, they have 100 knees that they will replace in 2017, there are 1275 people on the waiting list....that is how they keep costs down....
I'm intrigued by the above report of your experiences since most people seem to report the opposite - namely, that the power of an insurance company tends to keep the medical providers honest so as to avoid losing the business of a powerful consumer. In contrast, providers are commonly able to intimidate individual consumers into paying high costs because (a) the provider doesn't fear the loss of future business from that single customer; and (b) the customer may lack enough knowledge of the industry and have enough fear of the consequences of defying a vendor that the consumer simply ends up paying the bill to avoid trouble.
I have also heard of several occasions where hospitals will deliberately have an out-of-network hospital staff member provide a service, so that the hospital can charge the consumer a fee far in excess of what the insurance company would have allowed. (one such case involving an ACA patient was given considerable press coverage in early 2016).
First, why couldn't a Canadian type single payer system be implemented in the U.S.? I understand that the scale of the country would require a longer lead time, but that relates to implementation delay, not impracticability. It seems relevant to mention that, according to the link below, in the U.S., govt already pays for 2/3 of all health care bills. Moreover, in absolute numbers, in the U.S., govt spends about $6K per person on health care, already the highest of all nations (as of 2013), even though we don't have a national health care plan. It seems like a good deal all around to adopt a single payer system, have the govt (federal and state govts included) pay less than we currently we do on health care, and have universal coverage to boot!
If the American people vote in a system that provides universal coverage with a lower govt spending burden than we have currently, and in the process eradicates the need for direct payments from consumers to health insurance companies and medical providers, I contend that the doctors will simply have to accept the payments that are offered. Here, I propose something radical: I contend that the medical system is supposed to involve health care providers doing what's medically best for patients, not the patients and govt entities doing what is financially best for doctors. I realize that this won't stand me in good stead with the AMA, but again, I'm approaching this from the unusual standpoint of what is good for the patients.
I don't expect this to happen any time soon. But, when single payer naysayers bring up the issue of costs and tax burden, it seems highly relevant to observe that the govt, in the U.S., already spends more per person on health care than the Canadian govt does, notwithstanding the facts that (a) U.S. consumers must add trillions more dollars to the mix of non-tax money from their own pockets, and (b) that 30 million people remain uninsured.
What's that? Spend less, get more, and have everyone covered? Nah! Makes too much sense. Some of the people currently receiving all those extra trillions of dollars will surely object.
I agree with you that universal healthcare in the US sounds ideal from the socialist system perspective. I wrote a whole long post (longer than this) trying to explain to you why it is not but I have deleted it because a) I doubt you will listen and b) it is all very complicated anyway.
I DO understand your viewpoint and why you think it could and should work (I would love if it could too) - but mine is different when it comes to whether, ideal or not, it is viable and implementable in the US .. and I have experienced more than just the system and culture in the US so I do understand some of the issues, drawbacks and advantages either way. Suffice it to say that for instance those who espouse a universal system in the US too often compare apples to oranges in terms of the society in which it will be required to work but say if it works there, it can work here without further thinking about how different the cultures, political system, population, values and realities are in their country versus that in the country they are referencing or looking at the problems that affect the whole of those societies when such a system is implemented. (Aside from all this, even if a 2 tiered system were theoretically cut out for a while, it would return soon I am certain and then there would be more screams.)
Utopia, as I said, it is not. Possible, it may be but the far reaching effects are likely to be much greater and will come from more unexpected places than you can imagine. This is just not something that anyone can legislate in the US in a few weeks and expect it not to have major ramifications for everyone here. You have to change a whole culture and way of life to do this .. it is just not as easy or simple as you think.
I would love to tell you as I said that it is workable .. I just don't think it is right now, right here, much as it would be nice. Also while I would like to think it could work in the future here, the culture is very ingrained here and that makes me think the chances were better here (as they were in Canada) 40 or more years ago than now or in the future unless you manage to truly make this a socialist country and put a true dictator in power (for at least a while) .. which I hope not to see happen.
It is a dilemma but nothing is free in this life. At the very least, even if it could be done, if today you are paying 30% taxes tomorrow you would be paying 50% (they will NOT go down no matter what you think and over time an insurance premium may begin to look good to you). People all over the place would be squawking - not to mention that soon you will probably wait weeks for even a simple doctor's appointment and forget about any upgrades on medical equipment as time goes on. Doctors, many of them specialists, will retire en masse. Ultimately you will pay more and get less, and not only less, but poorer quality.
The legal system will also be an issue - very different controls on that in the US than in Canada - doctors who are not being paid much cannot pay for malpractice insurance which is astronomical in the US and people are sue happy here. Yes there will be savings once you iron out that mess but your protections will be less too. There are ALWAYS trade offs and believe me, the average person doesn't win in the end .. sadly.
The AMA does not represent all the doctors in the US by a long shot. Most, I am told, won't join and do not regard that group as being representative of them. They simply are a political arm of the medical industry really. I take little heed of anything they talk about to be honest since I learned that.
MOST doctors already do what is best for their patients as much as they can within the confines of 'the way things are' .. but if you drastically cut what they get paid for visits/procedures etc. they will be less inclined to do so despite what you think - they will spend LESS time per patient and cease caring as much even if they don't want to do that. If they can't live with that, they will retire or change professions. They hate dealing with insurance companies too .. and the costs to administer an office with only one insurer will go down but other costs will stay the same or rise (as they tend to do over time) and depending on how much they receive from the government (which, if it is doing its job for the people, will definitely pay as little as possible) they may not be able to keep their offices open. Fewer doctors, less availability of service .. longer wait times.
Currently doctors can often afford to take less from the government because they balance that out by taking more from insurance companies if they can. Most doctors who take Medicare/Medicaid patients do not treat ONLY those 'subsidized' patients because they can't afford to. If you make them take less for ALL patients they won't replace equipment, they will reduce staff (sounds great but that affects the economy as a whole too), they will reduce the time spent on each patient, and they will still have high overhead costs (because of insurance, building costs, etc.) - probably higher than they can afford on the lowered payments. It has happened in Canada much as many Canadians hate to admit it. Outlying areas will be less serviced too but in the cities longer wait times will ensue anyway.
If government listens to people (doctors and/or patients) squawk about that, taxes will go up for everyone to pay for a higher premium. On and on it goes. The impacts for everyone are just far greater than you realize. And we have not even talked about research and large specialized medical care centers and how those will definitely go downhill too in no short order.
I don't like the way the system in the US is right now, believe me. But, something of a hybridized system .. which is fair to all and considers all impacts to society in the US .. is probably where things should go. But even figuring out what that system should look like is going to take time - and political cycles are notoriously short and filled with many other issues to deal with too which is a big problem as well because the winds change often but the project is bigger than one administration can really handle (take a look at what happens with mega-acquisition projects in the military to see what I mean ... if they take longer than 4 years to design and build a plane for instance, they are subject to radical changes in contracts and cancellation before they get far in and we all pay the price for that).
So many competing interests need to be considered - it just isn't as simple or cheap as you/we would like to be. Sorry .. I am a realist. I hope you are right though and it can be done in our lifetimes.
The only part of that statement that would happen is the "get everyone covered" part. It would NOT cost less and you would NOT get more. Sorry, but yes, you would be able to see a primary care doctor for your cold and not have to pay anything out of pocket outside of the very high taxes that come out of your paycheck to cover this, but then, for anything more substantial, how long are you willing to wait? What if you need a knee replacement, you get put on a waiting list, they have 100 knees that they will replace in 2017, there are 1275 people on the waiting list....that is how they keep costs down....
You seem to be saying that Canada pays less and gets less. If the U.S. wants a system that charges and delivers more, that would be fine with me, even if the system were multi-tiered: a basic plan for the poor, and more comprehensive plans for people willing to pay more. However, that's hardly the case today. The U.S. currently spends about $10K per person to Canada's $5K and according the oft-cited study linked to below, performs worse. If the Canadian situation is as bad as you indicate (I'm not able to verify or contradict your claim), one would think that Canada's political campaigns would be dominated by a health care debate driven by Canadian Medicare's shortcomings. However, to my knowledge, they are not. More anecdotally, in a lifetime of visiting Canada (I was born in Canada but have lived in the U.S. for almost 40 years), I've never met anyone who wanted to substitute the U.S. system for what they have there.
While no system is perfect, the ability to modify the system, either minimally or significantly, is likely greater in Canada than in the U.S. If for example the facilities for knee replacement operations are lacking, Canada could temporarily pay to have its people got elsewhere for such procedures, elsewhere being any place that can do the work, be it the U.S., Mexico, India, or Thailand. In contrast, with the U.S. system, there is continuous agitation to fundamentally reorganize the system every ten years or so.
The most recent alteration of the U.S. system will entail scaling back health coverage to some degree, based on about three weeks (!) of study by some Senate staffers. It's hard to imagine that that will lead to anything but a backlash that will yet again push the system in the reverse direction four or eight years from now. Hardly a formula for a successful outcome.
You seem to be saying that Canada pays less and gets less. If the U.S. wants a system that charges and delivers more, that would be fine with me, even if the system were multi-tiered: a basic plan for the poor, and more comprehensive plans for people willing to pay more. However, that's hardly the case today. The U.S. currently spends about $10K per person to Canada's $5K and according the oft-cited study linked to below, performs worse. If the Canadian situation is as bad as you indicate (I'm not able to verify or contradict your claim), one would think that Canada's political campaigns would be dominated by a health care debate driven by Canadian Medicare's shortcomings. However, to my knowledge, they are not. More anecdotally, in a lifetime of visiting Canada (I was born in Canada but have lived in the U.S. for almost 40 years), I've never met anyone who wanted to substitute the U.S. system for what they have there.
While no system is perfect, the ability to modify the system, either minimally or significantly, is likely greater in Canada than in the U.S. If for example the facilities for knee replacement operations are lacking, Canada could temporarily pay to have its people got elsewhere for such procedures, elsewhere being any place that can do the work, be it the U.S., Mexico, India, or Thailand. In contrast, with the U.S. system, there is continuous agitation to fundamentally reorganize the system every ten years or so.
The most recent alteration of the U.S. system will entail scaling back health coverage to some degree, based on about three weeks (!) of study by some Senate staffers. It's hard to imagine that that will lead to anything but a backlash that will yet again push the system in the reverse direction four or eight years from now. Hardly a formula for a successful outcome.
No, the NOT in capitals means we would pay MORE and get less...sorry, but everyone equates good with "cheep" when it comes to health insurance and they don't look at total cost, access or care.
Did you read that article you posted? We rank last in dealing with health insurance companies--you don't HAVE health insurance companies in Canada except for the select few that buy private insurance to get better care than what they get for "free" in Canada, the UK, etc., not to mention that the article is old and focuses only on low income people, who, at the time of the article, DID have access to FREE care everywhere in the US, if they chose to take advantage of that care.
In your example of temporarily paying for a knee replacement elsewhere, that is the issue, they COULD do all of the knee replacements they want, but they chose NOT to to control costs. It isn't about lack of facilities--which there are, but that is by design. That is what people don't get about Universal health care and since that is all most people in Canada know, they don't care or don't know any better. Another post I saw the other day, a woman had a surgery in the UK, there should have been a follow-up appointment for some additional procedures at 4 weeks post surgery. Her surgery center STILL doesn't have a date for her follow-up, 12 weeks later and has told her that she probably won't get in for another 6 MONTHS. REALLY? And the US ranks LAST???? HOW????
An easy solution to all of this would be to allow those that truly do not have access to a health insurance plan to join the federal employee plan paying the employee rate plus a percentage to cover admin fees, etc. and then allow a proportional amount of taxes to be funneled back into that plan to cover costs, require companies with 2 or more employees to carry health insurance after establishing a small employer group plan pool by zip codes. Since group plans are deductible business expenses already, they would have the same tax treatment as every other business.
For those that would need the Federal plan, it would be sole proprietor for the most part, but even then, if they had access to a plan through their spouse's job, they would be required to take that.
Fine those that DON'T sign up instead of punishing those that do carry coverage to pay for those that want to save money and not take a plan. Put some teeth into the penalties so it would cost more NOT to be on a health plan vs these current slap on the wrist fines. If you chose not to sign up for a health insurance plan, your fine is now $6000 vs $128.
Do you support taxing people for going without insurance because they can't afford it due to the individual mandate?
You do realize that penalties are waived for people with very low incomes, don't you?
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
