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 work for this company Building Materials and Paving for North America - Oldcastle Materials Inc which is owned by this company CRH Home A regional national and international leader in building materials
Oldcastle is the largest asphalt paving company in the United States. My office employs about 90 employees and we produce about 21 million in revenue at our office. The company goal is 8% profit but I have not seen that since about 2006 or so. Usually we are around 5% profit with most of the work being done for government. The Corp of Engineers example was because they felt we should be making 12.5% profit but our price only had 7%. (you must show your labor, equipment, profit, materials etc... government if requested) I think that 5 to 8% is peanuts but when you multiply it by a company of this size then it turns into 845 million in profit for year end 2012. The last I read there were 65000 employees worldwide and all of them have the opportunity for insurance. Now let's do some math, 845,000,000 / 65000 employees equals $13,000 profit per employee. Now translate that into a Mom & Pop owned business and it would equal $26,000 profit for a two person owned business. Does this corporate monster (and I agree it is a monster) seem so evil now? Now let's move on to your topic of choosing and thank you for taking this path with me.
$845m is a lot of money . That is after everyone is paid , all expenses including salary and benefits. Where does that $845m go? One person, remain with the business, a group of people? Lol. That is a nice profit even if the margin is low. So I still don't get how this translates to healthcare? If that man or group is making $845m a year and is complaining that that isn't enough, is well kind of disgusting in my eyes.
What is more important here money or humanity? That's what it boils down to for me. Who cares if that dollar amount is 1% or 12%. It's still a lot of money!
Last edited by Proud2beAMom; 11-12-2013 at 05:51 AM..
Interesting debate (and one of the most civilised I've seen online about healthcare ).
I have a somewhat unique perspective on this: I'm English and lived there most of my life, then lived in Switzerland for 4 years, then moved to the US. I've therefore personally experienced all that is good and bad about the three systems: single payer/ government controlled; a not-for-profit marketplace; (until recently) a largely unregulated marketplace.
First up, the UK: the cost isn't 11% as someone mentioned earlier (that's the percentage for a thing called National Insurance, which also goes towards the equivalent of Social Security; in fact, the whole UK tax/ NI thing is a huge fudge of pointless naming, it's all taxes). It's funded on a sliding scale of income - earn around $28k, you'll pay about 2% of your income; someone on $45k is paying about 4%; someone on $150 is paying about 6%). Figures are from here: Revealed: how much you pay towards benefit bill - Telegraph (a dollar is approximately 1.5 pounds, for mental conversion).
Everything that most people are likely to get in their lives is covered, no questions asked, no copays, just get the treatment and walk out the door. The only extra cost is for prescriptions, and this is capped at about $10 per item (item=type of med, so if you get a scrip for 3 asthma inhalers, that's one charge).
The potential downsides are that you might need to wait for things that aren't urgent in the eyes of the system, even though they might be urgent in the eyes of you - if your knee injury is causing discomfort, or you're having to take time off work, that doesn't get you to the front of the queue. An old person requiring a hip replacement; again, they might have to make do and hobble around for a couple more months, but they'll get there eventually.
You might also not have total say over which hospital you get sent to, although I believe there is more choice than when I last lived there (I've seen online league tables encouraging patients to 'ask' for X hospital for their procedure). And yes, there will be some procedures or drugs that you won't get access to - the 'it's new and experimental, and costs $100,000 a year to prescribe, and it's not yet clear whether it actually works in more than 1% of cases'... sorry, it's bad luck you've got X condition, but unfortunately the rest of society isn't willing to pay out vast amounts more tax on a slim-to-nothing chance.
If the basic service isn't sufficient for someone, and they have the means to do so, they can take out private top-up insurance with a private company (you may have heard of BUPA, who I believe are the largest). This gets you much quicker access to your operation, and a hospital that's more like a hotel - lavish private room, excellent food, lots of attentive staff, fresh flowers and fish swimming in a tank in reception, etc. Or you can skip the private insurance, but then just pay for the individual treatment you require, again at a private hospital.
Now Switzerland: this is closer to the forthcoming US model, where it's compulsory for everyone to have medical insurance, with subsidies for the poor. When you move to a new town/ area in Switzerland, you have to register with the town authorities within a week; within 3 months you have to provide them with proof of your medical insurance. If you don't, they will purchase a policy for you, and they don't worry overmuch if it's the cheapest.
Like in the UK, the Swiss medical insurance is designed to cover 98% of what regular people might encounter during their lives. There's a deductible that the person can choose based on their personal health needs, from $300 to $3k dollars, but everything after that is 100% funded. (Children have to have the $300 deductible, presumably to avoid sick kids not being taken to the hospital to save money.) I suppose this is similar to the point made above about how knowing you have diabetes or similar ongoing condition requiring medication and treatment is not for 'insurance' as such, more a budgeting issue. The premiums for the $300 deductible worked out at about $3k more than having the high deductible, so if you know you're going to be claiming, you sign up for that additional $3k and pay it monthly. Otherwise, like us, you hope you don't get sick or knocked down by a bus, have the $3k in the bank to cover it if you do, and cross your fingers.
You buy this basic cover from any of the several dozen or so providers, who all have to offer it on a non-profit basis. What they can then sell you for profit is a supplementary policy to cover being able to choose an out-of-network (area) hospital, or having a private room, or complementary therapies.
As a healthy couple in our late 30s with two kids, we were paying about $550 a month for policy with the kids covered after the first $300, and the adults covered after the first $3k. Payment is between you and the medical provider - the doctor would send you the bill, with enough time to then forward it on to the insurance company who'd send you the money early enough to have it in place before the doctor's bill was due. This all took days and perhaps weeks, rather than months.
There's a system in place where you can't have to pay out more than X percent of your income in medical costs, including premiums. I think it was about 10%, but didn't really pay that much attention at the time.
Here in the US, we're covered via hubby's work - the high deductible plan covers the 4 of us for a monthly contribution of about $500, including dental and vision. The deductible is $3k per person, $6k for the 4 of us; preventative is free, of course. The premium comes out pretax and we use a HSA to further offset the cost, but it probably equals out about the same as we paid in Switzerland in real 'money lost' terms, as the salary there was higher.
It amuses me no end when people in the US say they don't want 'socialised medicine' where they're funding other people's choices and misfortunes, and can't choose what treatments to have. I don't know if hubby's employer (a large multinational) is unique, but the scheme charges 3 different employee contribution levels based solely on salary (adjusted for family situation, of course). He's paying the top rate, so our very healthy family with a random kiddie doctor visit of about $1-200 a year and never once hitting the insurance, is clearly subsidising someone on a basic factory wage (and possibly with many more kids than us, or health issues caused solely by their lifestyle choices). Coming from the UK, I don't have a particular problem with this - it suits even higher earners to have society tick gently along, and not have people fuelled by desperation running rampant in the streets - but I don't see ANY difference between this being a large pool of employees and paying for other people's costs, and being in a large pool of everyone in the UK, and paying for their costs. And I also see no difference at all as an end user in having a government tell me they're not going to pay for X, and an insurance company telling me they're not going to pay for X.
As a user, there is no real difference in quality of care between the three systems. I think the US one has a nicer 'customer feel' to it - I'm more likely to be visiting a swishly decorated office with fresh paint and plants dotted about, and the staff apologise profusely if the appointment is running more than 5-10 mins late. But I had both my kids in the UK, with post c-section hospital stays in moderately pleasant surroundings with caring staff. One time I also needed a CT scan of my head. The process for this was swift and efficient, with an appointment within days and the results immediately. In Switzerland, my daughter needed day surgery to have some teeth issues sorted out under a GA; the hospital was a bit functional and painted throughout in 'institutional mushroom', but again, the medical care was excellent.
Pretty offices and knee jerk instant service aren't terribly important to me - if I had the option to use a basic, no-frills service that treated me but I had to wait a bit, or they might be running an hour late for my appointment, or I'd be sharing a room in the hospital... but it's half the cost - fine, I'd take that deal. The choice here though, seems to be between fully insured for lavish opulence along with your medical treatment, or not covered at all.
The one thing I would LOVE to change about here is knowing what my medical treatment was going to cost. I recently had to take my son to the children's hospital for an evaluation for a chest issue - I was told it would be an initial exam (look, prod, listen to heart) and chat with the doctor, lasting about 30-45 mins. 'And can you give me idea of how much that's going to cost - I'm still in my deductible, so will be paying this all out of pocket'. 'I'm afraid not', says the receptionist cheerily down the phone, 'the doctor will decide... it'll be somewhere between $100 and $500'. I can't even express how ridiculous this is - they can tell me exactly what the consult will involve and how long it will last, but can't tell me how much it will cost me upfront, within an accuracy ratio of 5:1? The notion of having people being interested parties to their own healthcare, paying out of the pocket of their deductible and questioning the need for XYZ test or treatment, is damned before it's even started if they can't find out costs in advance.
(Sorry it's so long - less debate, and more just a huge sounding off on my part! - but I thought others might be interested in personal experience of the 3 different systems that seem to be being compared.)
Wow thank you for this contribution. It's great to hear perspective of someone that actually experienced the different kinds of systems.
Good article - the Singaporean model sounds very sensible. I especially like the differentiated care element, which strips away the 'hotel experience' from the hospital's straightforward medical care. I personally enjoyed being on a 4-bed or 6-bed ward when I had my kids, as it was companionable and we helped out/ watched each others' babies during a quick shower, etc. I was actually placed in a private room at first, as my c-section was very late at night, and I was begging to be moved into the ward by mid-morning the next day out of sheer boredom (and because I wanted to go 'look at my lovely baby!' at lots of people).
Another element we'd need to take into account in our perfect system would be the cost of medical training. To my knowledge, UK doctors do a 5 year medical degree (standard UK degrees in less demanding subjects are 3 years, as UK kids specialise from the age of 16 so are more advanced in their preferred subject by age 18). Each year's tuition capped (like all UK degrees) at 9k GBP (about $15k). Double that to allow for fully paying for living costs, and the most debt they can graduate with is $150k (which still sounds extraordinarily, unbelievably high by European standards; most students will offset this by getting part time work/ bursaries/ living at home/ having their parents chip in). Student loans are repayable once kids are earning more than about $34k, at a fixed percentage of salary (I'm thinking 9% but not sure) and anything outstanding is written off at age 50. It's effectively a graduate tax by another name.
But it's only fair that if we're going to control costs at the delivery end, doctors can't have school debts in the half a mill range. If we're going to say that affordable universal healthcare is a good thing, then society should be prepared to cap the training costs that doctors personally have to fund, with the balance being government funded (i.e., shared out across the population who'll be benefitting from those doctors' training).
Excellent ideas on doctors and their education costs. Thank you!
I think it's a little too early to see what the necessary changes to the ACA may be, that said, we all need to understand the difficulty of going this far into a reformed system without realizing that this type of system will need constant tweaking for a few years. When the notion of health care reform went into the planning stages the insurance corps went berserk, they mustered all the help they needed to combat what they saw as a threat to their cash cow. It is these corporations that will resist any changes that aren't in their interest and that's where the American people must do all they can to see to it that we move FORWARD and not back.
Which is why I started this thread. Rather than bash it and throw it out entirely it's something to build on! Thank you for your thoughts.
I don't think its so much about the finances of making everyone cover it.
With something like pregnancy - I think its more about how women were charged more for coverage prior to the ACA and the ACA sets out to not discriminate based on sex and pre-exisitng conditions.
Some men have complained on the POC boards about it - but it does take 2 to get pregnant - so having the male sex have to contribute doesn't seem so bad.
Besides, its not like these are a la carte line items - more of a one size type thing for it to be balanced and again, not have to charge women more.
All the other stuff is basic general care items that everyone should have. It's intended to encourage preventative medicine - well visits to catch things before they become expensive problems. That is one area where the other countries with socialized medicine excel at. Because everyone has access they go for their regular check ups and often have a lot of preventative care more than after the fact care.
I'm not among those who complain about my premiums supporting services I won't use, whether it's pregnancy, pediatric care, newborn services, dependents, or practically any other. I recognize that in an employer-sponsored group plan, other people's premiums are supporting care I use and they don't.
However, in the individual market, I'd rather see more flexibility in coverage options than ACA offers.
[quote=jazzarama;32194542]I'm not among those who complain about my premiums supporting services I won't use, whether it's pregnancy, pediatric care, newborn services, dependents, or practically any other. I recognize that in an employer-sponsored group plan, other people's premiums are supporting care I use and they don't.
However, in the individual market, I'd rather see more flexibility in coverage options than ACA offers.[/
Lets get more detailed. What mandatory things that are covered would you like to see as an option rather than mandated to be in every policy? Obviously maternity would be one, but what others?
I'm not among those who complain about my premiums supporting services I won't use, whether it's pregnancy, pediatric care, newborn services, dependents, or practically any other. I recognize that in an employer-sponsored group plan, other people's premiums are supporting care I use and they don't.
However, in the individual market, I'd rather see more flexibility in coverage options than ACA offers.
Lets get more detailed. What mandatory things that are covered would you like to see as an option rather than mandated to be in every policy? Obviously maternity would be one, but what others?
I think sometimes we look at this wrong. Men don't have babies, yet I think everyone ought to help pay for the cost of maternity care. Its in everyone's interest that babies receive prenatal care and be delivered by a competent professional. Supportive care should be available in case a baby is born with complications. All these things help guarantee that every child will enter this world in as healthy a condition as possible and will hopefully not need more care down the road because of problems that could have been avoided in the beginning. I sometimes have issues with people who choose to have large families, but ultimately we can't stop this and I still want those children to begin life as healthy as possible.
I think one thing that possibly should be considered is allowing young people (a group I'd maybe define as between 26 and 40) to purchase a "bare bones" policy. First, I want to see how the ACA plays out for a year or so. If we have trouble getting the millions of young people in this country to purchase coverage, we might want to consider letting them get coverage that pays for the least possible. Its better to have them in the system, than not have them in the system. Plus, this is the group that is having the hardest time establishing itself in the job market because of recent economic problems.
I think sometimes we look at this wrong. Men don't have babies, yet I think everyone ought to help pay for the cost of maternity care. Its in everyone's interest that babies receive prenatal care and be delivered by a competent professional. Supportive care should be available in case a baby is born with complications. All these things help guarantee that every child will enter this world in as healthy a condition as possible and will hopefully not need more care down the road because of problems that could have been avoided in the beginning. I sometimes have issues with people who choose to have large families, but ultimately we can't stop this and I still want those children to begin life as healthy as possible.
I think one thing that possibly should be considered is allowing young people (a group I'd maybe define as between 26 and 40) to purchase a "bare bones" policy. First, I want to see how the ACA plays out for a year or so. If we have trouble getting the millions of young people in this country to purchase coverage, we might want to consider letting them get coverage that pays for the least possible. Its better to have them in the system, than not have them in the system. Plus, this is the group that is having the hardest time establishing itself in the job market because of recent economic problems.
The ACA does this by allowing everyone under the age of 30 to purchase catastrophic plans that are really cheap.
I think sometimes we look at this wrong. Men don't have babies, yet I think everyone ought to help pay for the cost of maternity care. Its in everyone's interest that babies receive prenatal care and be delivered by a competent professional.
Agree with this - for me, it's one of those general 'good for society as a whole even if you don't have kids yourself' things, like education. Plus I think the men whining about having to pay for maternity are missing the point that although men don't HAVE babies, they do in fact CAUSE babies. When they can show me the first provable case of human parthenogenesis, I'll start to be sympathetic.
The trouble with the idea of being able to pick and choose in the 'individual market' is that there's no such thing as the individual market. The whole point of insurance is that you're grouped in with a whole ton of other people, whether they be work colleagues like in US group plans, the entire population like in the UK or Switzerland... there's no such thing as an 'individual plan' based just on you. That's called 'having the money in the bank and paying for everything yourself'.
But we're making progress. I'm getting the feeling from this thread that an underlying safety net of a compulsory basic, no-frills catastrophe plan is an acceptable idea to many, with the option to add concierge services on top for an increased cost. This is largely what exists in countries that get held up as examples of good healthcare.
This would, however, include a hefty amount of government control - how acceptable would that be culturally? In the UK it's easy to see that the government controls the healthcare offering - they are the only provider for 95% or more of the population (some use private hospitals), own all the hospitals, employ all the staff, etc. But even in Switzerland, although the medical services are accessed through private doctors and hospitals, paid for via private insurance companies, there's still a government mandate. The Swiss government determines what treatments are available within the basic plan (pretty much everything an average person is ever likely to need), and crucially sets the price list for these. Everything has a maximum price that the provider can charge, and that the insurer can reimburse; they're allowed to offer it cheaper by choice, of course. These prices are freely available in a huge paper directory, or online - anyone can see them. They're quite generous, allowing doctors to make a decent, professional living, but not outrageously so; this is ok, because as I mentioned earlier, the doctor isn't paying down a second mortgage-worth of student debt.
The trouble with trying to reform the health system is the old asking for directions 'oh, you don't want to be starting from here to get to there!' If I ruled the world and had a blank sheet of paper, I could craft a perfectly reasonable system of a communally-funded basic health safely net for all, operated and controlled by the government (either directly as in the UK, or indirectly as in Switzerland). On top of that, people could add modular health care as it suited them, for a more boutique experience or because speed was important to them. I would also make it that everyone had compulsory payroll deductions into a HSA from when they first started work, so that they were building an individual pot of personal insurance for their Future Selves, or for black swan life events. I think young people would feel better about the compulsion if it was at least going into a pot with their name on it, ring-fenced for them rather than being spent on other people making poor life decisions or having the temerity to age. You could tell them it's like a second pension fund that they can spend on anything post age 60 or 65, like the current HSA rules, because by then most people are much more inclined to hoard health funds anyway as they're no longer immortal like in their youth.
(Aside: Switzerland has a small basic state pension for all, and a second layer of pension funded through employment: contributions are compulsorily deducted through payroll at a percentage based on age - it was about 7% in our 30s, I think, with a compulsory employer contribution of maybe 11%. Many European countries have similar stipulations about how much the employer has to contribute to a pension/ 401(k) scheme on their employee's behalf, so the points about how linking US employment to healthcare is making the US uncompetitive are not strictly true - it's just that the employers here are forced to pay a large sum of money to health insurance companies to employ someone, whereas employers there are forced to pay a large sum of money to the Future Employee. I know which I prefer...)
Back to my blank sheet of paper... I would arrange tertiary education in such a way that things that were of benefit to society had funding from society, and other things weren't. A country should determine that over the next 20-30 years, it needs a certain number of doctors, dentists, civil engineers, computer scientists, marine biologists, heck, even a few PR consultants and computer game designers, and offer tuition bursaries accordingly to candidates on merit. Medical professionals would therefore not have to graduate with crushing debt which is then just passed onto the whole of society anyway in the form of high prices throughout their entire career.
But here's the rub - we're not starting from a blank sheet of paper. There are existing doctors with hundreds of thousands in student loans; there are existing old people who haven't been paying into a self-funded insurance pot for 30-40 years ready for their twilight years. And even leaving aside the rapacious and self-serving insurance companies trying to make a profit, you have a problem. In order to get to something resembling an ideal system, you'd have to ask one or two generations to pay twice: to fund their own future medical needs whilst also paying for the needs of the current batch of sick and elderly. It's exactly the same problem facing pensions/ Social Security.
I don't know an easy answer, other than shrugging 'sorry, sucks to be you', and getting the pain over with to solve the problem going forward for our grandchildren. Alongside a brutally frank end-of-life care discussion for current seniors, to make them understand that in exchange, society isn't spending $100k to extend their life by a month.
Agree with this - for me, it's one of those general 'good for society as a whole even if you don't have kids yourself' things, like education. Plus I think the men whining about having to pay for maternity are missing the point that although men don't HAVE babies, they do in fact CAUSE babies. When they can show me the first provable case of human parthenogenesis, I'll start to be sympathetic.
The trouble with the idea of being able to pick and choose in the 'individual market' is that there's no such thing as the individual market. The whole point of insurance is that you're grouped in with a whole ton of other people, whether they be work colleagues like in US group plans, the entire population like in the UK or Switzerland... there's no such thing as an 'individual plan' based just on you. That's called 'having the money in the bank and paying for everything yourself'.
But we're making progress. I'm getting the feeling from this thread that an underlying safety net of a compulsory basic, no-frills catastrophe plan is an acceptable idea to many, with the option to add concierge services on top for an increased cost. This is largely what exists in countries that get held up as examples of good healthcare.
This would, however, include a hefty amount of government control - how acceptable would that be culturally? In the UK it's easy to see that the government controls the healthcare offering - they are the only provider for 95% or more of the population (some use private hospitals), own all the hospitals, employ all the staff, etc. But even in Switzerland, although the medical services are accessed through private doctors and hospitals, paid for via private insurance companies, there's still a government mandate. The Swiss government determines what treatments are available within the basic plan (pretty much everything an average person is ever likely to need), and crucially sets the price list for these. Everything has a maximum price that the provider can charge, and that the insurer can reimburse; they're allowed to offer it cheaper by choice, of course. These prices are freely available in a huge paper directory, or online - anyone can see them. They're quite generous, allowing doctors to make a decent, professional living, but not outrageously so; this is ok, because as I mentioned earlier, the doctor isn't paying down a second mortgage-worth of student debt.
The trouble with trying to reform the health system is the old asking for directions 'oh, you don't want to be starting from here to get to there!' If I ruled the world and had a blank sheet of paper, I could craft a perfectly reasonable system of a communally-funded basic health safely net for all, operated and controlled by the government (either directly as in the UK, or indirectly as in Switzerland). On top of that, people could add modular health care as it suited them, for a more boutique experience or because speed was important to them. I would also make it that everyone had compulsory payroll deductions into a HSA from when they first started work, so that they were building an individual pot of personal insurance for their Future Selves, or for black swan life events. I think young people would feel better about the compulsion if it was at least going into a pot with their name on it, ring-fenced for them rather than being spent on other people making poor life decisions or having the temerity to age. You could tell them it's like a second pension fund that they can spend on anything post age 60 or 65, like the current HSA rules, because by then most people are much more inclined to hoard health funds anyway as they're no longer immortal like in their youth.
(Aside: Switzerland has a small basic state pension for all, and a second layer of pension funded through employment: contributions are compulsorily deducted through payroll at a percentage based on age - it was about 7% in our 30s, I think, with a compulsory employer contribution of maybe 11%. Many European countries have similar stipulations about how much the employer has to contribute to a pension/ 401(k) scheme on their employee's behalf, so the points about how linking US employment to healthcare is making the US uncompetitive are not strictly true - it's just that the employers here are forced to pay a large sum of money to health insurance companies to employ someone, whereas employers there are forced to pay a large sum of money to the Future Employee. I know which I prefer...)
Back to my blank sheet of paper... I would arrange tertiary education in such a way that things that were of benefit to society had funding from society, and other things weren't. A country should determine that over the next 20-30 years, it needs a certain number of doctors, dentists, civil engineers, computer scientists, marine biologists, heck, even a few PR consultants and computer game designers, and offer tuition bursaries accordingly to candidates on merit. Medical professionals would therefore not have to graduate with crushing debt which is then just passed onto the whole of society anyway in the form of high prices throughout their entire career.
But here's the rub - we're not starting from a blank sheet of paper. There are existing doctors with hundreds of thousands in student loans; there are existing old people who haven't been paying into a self-funded insurance pot for 30-40 years ready for their twilight years. And even leaving aside the rapacious and self-serving insurance companies trying to make a profit, you have a problem. In order to get to something resembling an ideal system, you'd have to ask one or two generations to pay twice: to fund their own future medical needs whilst also paying for the needs of the current batch of sick and elderly. It's exactly the same problem facing pensions/ Social Security.
I don't know an easy answer, other than shrugging 'sorry, sucks to be you', and getting the pain over with to solve the problem going forward for our grandchildren. Alongside a brutally frank end-of-life care discussion for current seniors, to make them understand that in exchange, society isn't spending $100k to extend their life by a month.
Wow.. thanks for that.. I really do like the ideas you have in here..
I think that while the ACA isn't perfect, it may be a springboard to the place you have envisioned. Not clear and not without it's rocky edges.. but we are at least slightly closer than we were before (there is mandates, there is min coverage needed).. now we can work on , change and mold the system from there.
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.
).
