By Last week’s Open Thread has turned into a debate about health care in America. Instead of just posting a comment there I figure I would go ahead and create a separate posting to debate health care in America complete with my two cents of course. I think a national health care system is needed in the US, but not a completely government run. A universal government run health care program would become extremely expensive and a huge debt burden with people taking more from the program than what they paid into it like so many other government programs.
That doesn’t mean that government doesn’t have a role in providing health care. I think there are certain catastrophic conditions that a national health care program should cover such as cancer, heart attack, stroke, etc. for everyone. As far as appointments to see a doctor because you have a sore throat, an upset stomach, or broken bone there should be a limit on the appointments that are covered by the government. Maybe five appointments a year that the patient pays $20 an appointment. Over 5 appointments than the person pays the full rate.
This needs to be done to avoid people making an appointment every time they have a headache and flooding the hospitals with appointments because it is “free”. If the patient has some skin in the game than maybe they will think to themselves that it may be better to wait a day and see if the headache clears up before spending $20 to see a doctor. I always wondered what would happen to Army sick call if the Soldier had to pay $20? I can guarantee there would be a whole lot less Soldiers missing PT because they feel sick. As far as the emergency room and using the ambulance patients should pay the full fee. These are finite assets that someone should not feel like they can just go and access at anytime because it is “free”. There are other things I think should not be covered by the government such as eye doctors, dentists, plastic surgeons, chiropractors, etc.
This is basically what will happen if people have the attitude that going to the doctor is "free".
With the government providing catastrophic and basic health coverage the insurance companies should then provide policies to cover everything else. A customer should be able to tailor a policy according to what they need. For example maybe somebody wants a policy to cover the $20 deductible for the first 5 appointments and the full cost of any appointments after that, ER and ambulance coverage as well as dental and chiropractic coverage. This person may not want eye doctor coverage because there is nothing wrong with their eyes. Each coverage should have a price and whatever the total price per coverage is will become the monthly premium for the customer. Customers should not be forced to purchase all or nothing premiums. Without having to insure what the government is already covering this will bring down insurance premiums tremendously and make them affordable for all Americans.
This will also get US businesses out of the health care business. Wouldn’t US business owners feel a whole lot better about creating jobs if they did not have to worry about providing health care and the expense that comes with that for everyone they hire? This program could reduce the amount of money the Pentagon spends on health care as well. The national health care program would pay for health expenses of servicemembers and then Tricare would cover everything else. So servicemembers wouldn’t see any change in services provided, there would only be a change in the funding mechanism. This I believe would save the Pentagon billions.
Now the big question is how do you pay for this? I am not a believer in the class warfare rhetoric that is so en vogue in America right now. I believe in people paying their fair share for this program and I think the best way to do this is through a national Goods & Services Tax (GST) that many countries use today. So a study would have to be done to determine what the expense of the health care program would be. So let’s just say that the study determines that a GST of 10% is needed to fund the program. This means every time someone buys a good, like a car for example a 10% tax is added to the cost that goes to fund the national health care program. If you go to a restaurant where they are providing a service than 10% is added to the bill. This tax is progressive because the rich in theory will be buying more expensive goods and services compared to the poor and middle class. However, the GST causes the rich to not feel like they are paying high taxes to fund a bunch of freeloaders because everyone is paying into the program.
(Picture)
This is of course a major tax increase but I believe that over the course of the year it would be less than what people and employers are paying in insurance premiums right now while providing more efficient health care that covers everyone. Plus I think it would have a positive economic effect due to a major burden lifted off the backs of employers. Unfortunately I don’t think such a pragmatic program like I described is realistic in America due to the lack of enlightened leadership in this country. When you have one side that thinks government has no place in health care and is adverse to any tax increase and than the other side that wants complete government controlled health care that is funded by the wealthy than you throw in the special interests influence over each party and that is how you end up with Obamacare that does little to nothing to solve the health care crisis enveloping this country.
Well that is my best idea, does anyone have anything better?
7:42 am on September 17th, 2011 1
American People are not inspired to take care of themselves. You can see it at every doctors office. They blindly go to the doctor for a magic pill. Then they don’t heed the doc’s advice about being more active or losing weight. They there are those that will not see a doc until it is too late. Those that don’t prepare for those times when something major might happen. They eat whatever they want and wonder why they are so sickly. They they expect the feds to tax the hell out of the so-called rich to provide free healthcare for them
They will not take any action for themselves but feel free to blame the government and the so called rice for their piss-poor physical condition.
What is needed is affordable health insurance. Notice the word “affordable”. Not “free” health care. The individual should be aware of their responsibility to keep themselves as healthy as possible.
Getting the government involved is asking for trouble. I hated going on sick call during my active military years. Long lines. Sit in the waiting room for hours to see a doctor that didn’t care anymore about you that he or she did about the other “uniform” before you or the “uniform” after you.
Story time: I had what the doc called a “bad cold”. After a week and a half and four visits to sick call, she informed me that it was a “really bad cold”. I would have to “tough it out”. On visit #5 I was told I would see the same female captain, I informed the desk nurse that I WOULD NOT see the same doctor. I told him I would go down to the Korean Pharmacy instead. I was informed that this action was illegal. To which I replied that dying needlessly should also be illegal. Well, I saw a different doctor. A female LT COL. The head I guess of the department. I told my story she told me to wait and she came back 20 min later telling me that the captain would not make that mistake again. I had a good case of phenomena. Got a shot and pills and bed rest for something like five days.
You best learn that your health is your own responsibility. You have had your body for however many YEARS. The doc has seen it for a few minutes. He or she can make an educated guess. You know your body.
You know what they call a doctor that graduated last in her/his class? Doctor. Who do you think the Government will hire? Not the girl/guy that graduated #1 I would bet. That the kind of healthcare you want?
American healthcare is not the problem. Access to healthcare is not the problem.
The problem is the cost of health INSURANCE. Figure it out already.
7:55 am on September 17th, 2011 2
From what I understand any sales tax is regressive. The more you make the more you tend to save.
One idea I had is government would have health insurance for only catastrophic, e.g. cancer. This is like how government currently insures all savings accounts up to $250,000 in case of bank failure. All other health insurance would be banned so we create a true free market system. Right now we don’t have a free market system. However I wonder if we really want a world where there are price tags for every medical service you receive.
8:35 am on September 17th, 2011 3
Retired GI, I guess you didn’t read my posting very carefully because my plan is focused on reducing lines and bringing down the cost of health insurance which is what you are complaining about.
9:07 am on September 17th, 2011 4
Cost is what I don’t understand.
example:
I was talking to a guy who made a routine appointment with a family Dr, actually a new DR because he had relocated. My friend is a diabetic and the DR did a blood glucose test during the visit.
My friend did his $20 copay and got his bill. What got his attention was the charge for the blood test strip…10$! A bottle of 100 strips costs $50 retail, so .50 cents per strip.
WHAT KIND OF MARKUP IS THAT!!! Bet the DR gets a bulk discount of course.
But, in this example, what justifies the markup for something that cost 50 cents to 10$.
AT least, the Goverment needs to regulate the cost of such things.
What caused this system? Medicare?? If this DR sees Medicare patienst regular, he is marking up all these services to what the Government will pay.
In my friend’s case his insurance company foots the bill, and I suspect they give somekind of kickback to the DR.
9:17 am on September 17th, 2011 5
Frank, I seriously doubt because there is a GST that wealthy people are going to quit buying cars and going to restaurants.
10:49 am on September 17th, 2011 6
GI Korea, I read it. I just added my own Healthcare rant. Plus my personel example of Sociialist health care in the Military. After all, active duty healthcare is free.
You know what they say about something that is free, don’t you? Worth exactly what you pay for it. Nothing!
10:58 am on September 17th, 2011 7
#2 Frank, the more you make the more you tend to save? Nope. You are wrong. The more you make the more you tend to spend. That is the way it is.
Examples, can be found in Hollywood and those that win a few million and then go broke a couple of years later. Easy come, esay go.
As for price tags, yeah, I want them. Anything that is free is worthless. Freedom is usually expensive. So is Love. Marriage has a price, as does divorce.
Why would anyone want something that is worth nothing. Perhaps YOU want that kind of world. I do not. Off my soap box now.
11:14 am on September 17th, 2011 8
Healthcare IS a business. No one becomes a doctor because of the great hours. They become a doctor because of the great PAY.
Take away the great pay and then you really will have a difficult time finding a doctor.
I like doctors myself. A team of them once not so long ago, saved my life.
Cost me 300,000K. Tricare covered it. Not that I remember much from those days. Being in a coma for six weeks tends to make things a bit blured.
I watch what I eat. Take no meds. BP is good and bench pressed 300lbs two days ago. Will do it again today. Then I will walk on the treadmill for an hour. Not bad for a 55 yo. Had a bit of chicken with a glass of tea for lunch. That was after an hour with a shovel working in the yard.
11:37 am on September 17th, 2011 9
GI Korea, a few of your ideas are already considered and being employed, both in the private sector and in Obamacare.
Health economics is a fascinating area of study because it shows how health care itself represents a “market failure” (i.e., failure to conform to regular market conditions of supply and demand) and can also include a lot of different innovations that run the gamut of ideological perspectives. It is possible to create a system that is guided by government rules but is mostly implemented through private-sector entities.
Co-pays are a basic cost control because, as you say, when things cost money, even as small as the 12K won cost of a doctor’s visit, people put the brakes on their own demand: a good copay will not be cost-prohibitive (lest we have the poor not going to the doctor when they really need it) but cost enough that they won’t go in for every minor little thing.
Retired GI is on to something big in that people need to take care of their own health instead of living unhealthy lives and then expecting others to pay for it. While some of this is lifestyle choices they would make no matter what, not all of it is. Making safe areas for walking and biking, eliminating “food deserts” with no affordable healthy foods (including fresh fruits and vegetables), getting people into regular healthcare checks, informing people of caloric content of the outside-the-home food they order so that they can be better informed about their own caloric intake and perhaps affect demand for healthier choices, aggressive drives against adult smoking or kids starting smoking, etc., etc., are ways that the public health sector is trying to push the general population toward that.
Prevention is far cheaper than correction, and so eliminating the aforementioned copays on things that you want them to use a lot is in order: free annual checkups (age-appropriate for various screenings) are a money saver.
But here’s one of the problems: why should I, as Insurance Provider A, put all this money into preventive care when my client may up and move to Insurance Provider B when he/she gets a new job or whatever, and thus Insurance Provider B reaps the benefits of my investment? If we leave this all up to the free market, there is precious little incentive for insurance providers to offer preventive services at a cost that will entice much of the lower health percentiles to use them regularly and effectively. That’s one cost component somewhat unique to the US that drives up our health costs but without better health results. Here is where government regulation, to require all insurance providers and healthcare programs provide such-and-such preventive care at no charge to the patient, can be effective without being too intrusive.
The Obamacare requirement that insurance providers end the “pre-existing condition” ineligibility rules works on a similar idea: It would be patently unfair and financially ruinous for an individual insurance provider to end their “pre-existing condition” ineligibility rules when none of the others did: all the sick people who can’t get insurance elsewhere would flock to that insurance provider and either financially destroy it or force them to raise premiums so high that they become unaffordable. If the government provides healthcare or merely insurance for those with pre-existing conditions, then the same ruinous effect falls on the government. The best solution that is the least intrusive is to make a blanket requirement of banning the pre-existing condition ineligibility rules for all companies.
Ole Tanker mentions the outrageous costs of various items, which is part of a huge mechanism driving prices out of control. Healthcare providers (e.g., doctors and hospitals) generally have an incentive to milk as much money out of a patient who walks in the door as possible; they also have an incentive to see as many patients as possible. The former is bad from a cost perspective, and the latter is bad if you’re the patient (and Retired GI is absolutely right that we as consumers need to take control of health information related to our own condition).
There are a number of ways to work against this particular free market tendency, but they also have the problem where it is very difficult for one insurance provider or healthcare provider to do it (though Kaiser operates on this principle, I believe), which is why it requires the government changing the rules so all will have to do it.
One way is to pay doctors for outcomes. If Patient X walks in with a condition, you are paid a predictable sum of money, based on DRGs (one of the nearly 500 diagnostic-related groups in which almost all health conditions can be classified) and the outcome you provide. This is price controls based on industry averages in specific locales, but it eliminates the practice of hospitals charge $10 for a 50¢ blood test strip (the aforementioned example) because the hospital has zero incentive to pretend it cost that much for the blood strip: They will be paid by Insurance Provider A the same amount to effectively resolve Patient X’s condition whether the blood strip costs 10¢ or $10.
Insurance mandates are a sound part of health economics, but they obviously represent the most (?) contentious part of Obamacare. If you have a system, as we do in the United States, where someone cannot be turned away at the emergency room, then we have a situation where those who cannot afford health insurance (e.g., those too poor, those with pre-existing conditions, etc.) and those who think they do not need it (e.g., the young, those feeling healthy) can get free care.
This drives up healthcare costs in a big way because these people do get sick. Instead of either (a) preventing the problem in the first place through preventive care or (b) dealing with it earlier and more cheaply, they end up waiting until the problem is big enough to warrant an ER visit. An expensive ER visit. This not only drives up costs for all of us (the hospital spreads their loss to paying patients and the government ends up picking up the tab for this anyway), but it also creates a health danger when those truly in need of emergency care (whether insured or not) are unable to get it. At some point, it becomes more cost effective to provide free medical insurance for those who are uninsured.
But hold on, in an effective program, we don’t want the young and the “healthy” to get free insurance so we won’t have to pay for them on the occasional situation when they do need health care. We want them to pay for health insurance like everyone else because they will provide a net flow of cash to the healthcare system. This is called pooling. Insurance works best when the pool of participants is large and represents as much of the general population as possible.
But that’s not fair, Kushibo, why should the young and healthy have to buy insurance and pay for those old and the less-healthy? That’s a Ponzi scheme! Well, not really, since the young and healthy are most definitely moving on a trajectory toward being older and less healthy. And since they do in fact get sick, it’s not charging them for a service they do not use.
And that goes to the idea of the mandate’s constitutionality. The argument being made is that it is forcing people to buy something when they are not in the health care market. But that is simply not true: if you live in the United States of America where you can benefit by laws that dictate hospitals must treat you if you are in the ER no matter what, you are in fact in the healthcare market, as much as you are using public infrastructure as soon as you walk outside your property.
Now, no mandate should be onerous, and in most countries and states with mandatory healthcare, there are options for those who cannot afford it or want a bare-bones approach. In the US, this would build on Medicaid or insurance exchanges. This does not even require a “public option,” although there are sound principles behind that as well.
The US healthcare problems are eminently fixable without ruining what is good about the American system (innovation, etc.). The problem is that there are special interests poised against certain provisions that they feel will make them either lose money or not make as much money, and so they dupe groups of people to do their bidding by opposing it. “Death panels” was about counseling for hospice care, something that has been around for decades. Cries of “rationing” utterly ignore the fact that insurance providers today already ration healthcare and good proposals would undermine their ability to do so.
Obamacare is not perfect, but like former Republican House Speaker Dennis Hastert says, it’s better to tweak it than to repeal it. It’s a very good start, but even if it works exactly as it is supposed to, it necessarily requires tweaking; times change, demand changes, technology changes. But it keeps in tact a mostly private-sector healthcare system while using minimally intrusive regulations and market mechanisms, not government fiat, to control costs and maintain high-quality care, at least based on states and countries where various aspects have been implemented.
11:44 am on September 17th, 2011 10
Celebrities and lottery winners aside, those that “earn” more tend to spend less (percentage wise) on consumer goods and services and more on investments (e.g., buying housing, stocks, mutual funds, etc.).
The less money you earn (or receive from the government), the more likely you’re spending most or all of it on food, renting, gas, car, etc. In my own case, which I think is a reasonable example, when I was working full time in a reasonably well-paying job, I was able to save up to buy an apartment. Now as a grad student earning about $15K or less each year, I spend almost every penny on food, gas, rent, etc., with virtually nothing left over.
12:25 pm on September 17th, 2011 11
Does anyone else see a gap in thinking? Strangely enough, private health insurers strive to be profitable just like other private businesses. Offering affordable health insurance to people diagnosed with or at risk of chronic illnesses isn’t profitable. Some illnesses and conditions are easily linked to lifestyle choices while others are not.
Isn’t Tricare a government program? Wouldn’t it be better if the US government got rid of Tricare, increased soldiers’ pay by about $400 a month and let them arrange their own private health care?
I’m guessing you haven’t paid a visit to a public hospital emergency room in awhile. My last visit was four years ago to get a peritonsillar abscess lanced and drained. I had gone to an urgent care clinic first. They told me to get my butt to the emergency room ASAP and wanted to call an ambulance but I refused because I didn’t want to pay. The abscess was preventing me from eating and making it painful to swallow liquids. Thankfully I could still breathe unobstructed. In an emergency room that didn’t look particularly busy, I waited FOUR HOURS to see a physician. Sitting for hours in an emergency room IS “skin in the game.” Very sick people have keeled over and died in emergency rooms after waiting for up to 24 hours without being treated. I don’t know where you got the idea that most emergency room patients are hypochondriacs with the sniffles. It is true that UNINSURED people, especially people without valid Social Security numbers and valid state identification, do use the emergency room for treatment of minor illnesses because that is the only place they can receive “free” care. Nevertheless, co-pays are a necessary and fair means of getting people to accept some personal responsibility for using public health care services.
I do very much like the idea of funding health care with a GST because health care is a service everyone uses and everyone regardless of legal status buys things. Not everyone working illegally is poor. I was disabused of that notion after I started working in US public schools and observed the living standards and spending habits of families headed by fathers doing full-time construction work for $20 an hour, paid in cash, no pesky payroll taxes to pay or payroll stubs to submit when applying for benefits for US citizen children. A worker on payroll gets injured, he goes to a doctor and submits a claim to workmen’s comp. A worker paid in cash gets injured, he goes to the emergency room and the hospital applies for Emergency Medicaid to cover the cost of his care.
The only drawback to a GST is the growth of a black market. Earlier this year, notoriously corrupt Prince Georges County, MD, which borders Washington, DC, had a big liquor and cigarette smuggling operation busted, landing a few local officials and PGC police officers in jail. Adding another tax will add another form of tax fraud.
2:41 pm on September 17th, 2011 12
I am sure all these things were considered internally during the year long healthcare debate[?] Yet the only takeaways most of the public got were demagogic sound bites like the “death panels” as mentioned @9, and “we don’t need no socialized medicine” but “keep the government away from my Medicare.” All nonsense funded by special interests determined to maintain a status quo, driven by opportunist politicians, and abetted by sensationalist media.
Before we do the meaningful fixes to the healthcare system we have to fix the political system. Good luck with that.
3:36 pm on September 17th, 2011 13
And severely restricting the list of eligible foods covered by SNAP, the former food stamp program, to uphold its stated purpose of providing NUTRITION to poor people. Eliminating junk food from SNAP would reduce food deserts as stores in poor neighborhoods would need to stock eligible foods in order to stay in business.
3:41 pm on September 17th, 2011 14
Sonagi (#13), you are right. I’ve seen you trumpet that idea many, many times over the years and it’s something I was not particularly aware of (not having been on food assistance in the US) until I heard you discuss it. You’re a plus-alpha in the K-blogosphere, Sonagi.
I recently read an article I meant to post about, but I can’t find it right now, about how various local groups are trying to bring farmers market produce to those who are using WIC vouchers.
3:42 pm on September 17th, 2011 15
Sonagi, if you have something at the ready about your ideas for eliminating food deserts, I would be more than happy to post it at The Sonagi Consortium.
4:58 pm on September 17th, 2011 16
Dentistry?
Okay but them Dentists shouldn’t be able to sell teeth whitening products for what is it, 700 dollars?
5:34 pm on September 17th, 2011 17
Perfect example of people not taking care of themselves, yet expecting something:
“Even though we live in a supersized world, bigger is not always better. One devoted White Castle customer is suing the restaurant chain because he can’t fit into the restaurant’s booths. Martin Kessman, who weighs 290 pounds, complained to management for more than two years after repeatedly knocking his knee into the tables’ metal supports. After the 64-year-old New York stockbroker sent a series of letters of complaint to the chain, he received what he called condescending responses. White Castle sent him free hamburger coupons and promised that it would expand its booth sizes. But the booths were never changed and Kessman is now taking his case to federal court. He is suing for bigger chairs and unspecified damages because he says the eatery is violating the Americans with Disabilities Act. (He compares himself to pregnant women and the handicapped.) The lawsuit, however, has not put an end to Kessman’s love of mini burgers. Now, instead of going to White Castle himself, he sends his wife.”
http://news.yahoo.com/blogs/trending-now/man-sues-white-castle-because-over-booth-size-160126946.html
6:12 pm on September 17th, 2011 18
Nomad, respectfully, while that man does represent the abusive excesses of a segment of the population, the danger in anecdotes is that, on the national stage, they often get misused by rhetoricians as a distraction, a distortion, or an obfuscation. Think Representative Bachmann’s fan in Florida whose daughter became mentally retarded after getting an HPV vaccine. Even if true, the body of evidence and actual experience makes such a case so underwhelmingly minuscule compared to the hundreds of thousands of lives saved that it is a multi-layered embarrassment for Representative Bachmann to have mentioned with such credulity and urgency.
By mentioning The Fat Man at White Castle™,
opponents of reformdeep-pockedted proponents of the status quo can hold him up as an example of why those with health problems are really at fault and thus don’t deserve help. Never mind that some of those who actually need help Alzheimer’s patients, or teetotaling septuagenarians who never smoked, who eat well, and who run ten miles a week when they get that devastating stroke that cause them to need nursing home care or in-home care for the rest of their lives.Never mind them, because The Fat Man at White Castle™ has subconsciously given us permission to hold up our ears to the debate and go “Blah! Blah! Blah! I can’t hear you!” because we’ve decided that he is representative of those for whom our national patchwork (it’s a system) of healthcare has failed, and really, they failed themselves.
Sigh. Sadly, such people will realize when it’s too late how the pre-Obamacare system fails on so many levels. Illness or medical bills are causes or major contributors to most bankruptcies.
6:20 pm on September 17th, 2011 19
From the American Journal of Medicine:
Note that three-fourths of these people had health insurance. Obviously inadequate insurance, as insurance providers fight tooth and nail to pay out on things that the people with coverage thought were covered.
These bankruptcies may be a greater drag on the economy than the cost of shoring up insurance coverage so that they don’t happen.
7:34 pm on September 17th, 2011 20
GIKorea,
I find it quite ironic that after all the bashing on Canadian healthcare that’s been going on here you’re now pushing ideas for universal healthcare in the US that are essentially what we have in Canada.
7:42 pm on September 17th, 2011 21
I’m sick of you Canadians and you’re irony.
7:42 pm on September 17th, 2011 22
Damn Mac OSX auto spellchecker! your irony!
8:23 pm on September 17th, 2011 23
kushibo 22, spellcheckers have a sense of humor. Reread Retired GI 1 – he had a good case of phenomena.
8:26 pm on September 17th, 2011 24
Here’s my thought on this. I know I know, I am not welcome in giving advice here on American related issues. But I’ll chip in anyway because I’m in generous mood today.
America should not have the universal health care. Two reasons why:
1) You guys are broke. Your country is basically bankrupt. There is no more money in the coffers to spend another dime. Your priority as a country should be thinking of how to eliminate the annual deficit and start paying some of the money that you owe to your senior citizens and China. It is a joke, and an offense to even see you guys debating about health care at this time when your economy is about to collapse ala Greece. This is a sick joke.. tell me it must be a joke. But I guess not… which only tells me how much delusional Americans are at this moment. Sad but true.
2) You guys can never make the universal health care work – never ever. You ask why? Because the cost increases of health care are baked into the system. Surgeons are not going to stand around and see their salary increases stall or get cut, nor will the nurses, nor the lab care workers, nor any of the union members in the hospitals with their six figure pay checks with annual increases in cost of living adjustment plus bonuses and incentives, nor will the drug companies sit still while the cost increases of drugs are controlled. Basically, it’s the old individual American way of “I want my share of high pay and I want it now” attitude. And that’s why it will cost $6000 to get a broken arm set in cast this year (if you don’t have insurance). But next year that cost will be $7000, after everyone in the industry took their fair share of the cut that was extracted from either the poor *s.o.b* with no insurance, or the insurance company who must pay for this outrageous cost.
To have any kind of universal healthcare, you need some kind of cap on the costs. It works in Korea because Koreans are used to a system that balances out the needs of the entire group (or country in this case) and everyone understands this and despite some grumblings, most people are on board with this. But that ain’t going to work in America because of the cultural attitude of “me-first, I don’t care what the needy people nor the entire country needs, I want my share now” selfish cultural thinking that is the dominance force (which by the way is leading your country down to where it is today).
And that is why Tom thinks it’s better if you guys don’t have a national health care system at all. It will never work and all it will do is put your country in a bigger hole. It’s best to do nothing. That’s the best solution for the United States, believe it or not.
Unless the US is interested in experimenting with encouraging competition in the medical industry. The US should let Korean (or any other foreign) hospitals to set up in the US to provide American people with affordable healthcare. There would be none of this nonsense of $6000 to cast a broken arm. But that too will never happen due to nationalism and pride.
9:15 pm on September 17th, 2011 25
Thanks, Tom, especially for that last paragraph, but pretty much everything…
9:17 pm on September 17th, 2011 26
Tom, you’re an idiot. Despite the “baked-in” policies, some states and — so far — the national government are poised to resolve the problems you described.
And it’s actually cheaper in terms of national treasure and labor to put in place a culturally appropriate national health care system than doing nothing. You see, doing nothing is what got us into the expensive mess in the first place. So you’re wrong about that, too. (Obamacare, even if the Republicans win the White House in 2012, will likely survive in some form because the GOP president will be faced with presenting an opposing plan, which will meet with criticism no matter what it is, just as Obamacare did, and the path of least resistance will be sticking with what’s there).
You should worry more about your beloved China, where health care is abysmal and the demographic shift is going to be catastrophic. Offer a solution to that, then come and tell us how to run things.
9:39 pm on September 17th, 2011 27
Wow, did not think this one through did you? So when a military member has no money, how does he pay. Star card payment or sick call? Worst idea ever.
2:02 am on September 18th, 2011 28
#21,
If you had universal healthcare, you could get easily treated for that mental dysfunction of yours.
2:11 am on September 18th, 2011 29
#26,
I wonder how they’ll manage that. The administrative costs alone are ridiculous. I remember reading somewhere that managing the accounts of a few million customers of Blue Cross in Illinois (I think it’s Illinois, might have been Ohio) costs 4 times more than it costs to manage the whole Canadian healthcare systems (that’s 10 provinces and 3 territories, 13 different entities). The system appears to be bloated just so the insurance companies can justify the high premiums.
3:32 am on September 18th, 2011 30
Teadrinker 29, that can’t be! It conflicts with the dogma that “free enterprise” is always more efficient than “big government”.
5:12 am on September 18th, 2011 31
Nomad #17:
That anecdote about an overweight man suing a private business has zero relevance to the debate. All kinds of people sue for all kinds of reasons. If anything, a national health care system might reduce medical lawsuits as private companies have fewer protections against lawsuits.
Kushibo:
Thanks for the offer, but I do not have a solution to the problem of food deserts. I can tell you that some farmers’ markets DO allow EBT card holders to buy market money that can be used to purchase fresh produce. Some even exchange EBT dollars for market money dollars at a rate less than 1:1, thereby giving a discount. I can also tell you that there are enterprising produce trucks doiing a very successful business selling in poor neighborhoods.
Supply is only part of the problem. Demand is the other. Ever see Jamie Oliver’s visit to Huntingon, WV? It’s real, and it’s not a matter of cost, but convenience and taste. A pound of bone-in chicken thighs, a head of cabbage, and a bag of carrots all cost less than a large bag of chips or a package of Oreos, but the problem with raw chicken, cabbage, and carrots is that you can’t just open the package and throw the contents into the microwave for a few minutes, and the taste of real food doesn’t appeal to tongues warped from eating heavily processed junk jacked up with flavor additives. Not only the poor, but middle-class college grads, too, seem to feed their families a lot of industrialized foods. The only difference is that they can afford to buy ‘natural’ and organic cookies and mac-n-cheese.
My family was on food stamps for a couple years when I was a kid. My dad worked, but at that time, his business wasn’t bringing in much money because the franchise was raising wholesale prices of its products in response to increased sales by local owners like my dad, who were very successful in generating higher revenue when they got to keep some of that increased revenue as business owners. The company was trying to force franchise owners back into the fold as regular, salaried employees, so that the company alone could keep the extra profits from higher sales. My dad was one of the last holdouts. He finally gave in so he could feed his family on his own earnings. My farm-raised mom knew what real food was, and that’s what she bought whether it was paid for with food stamps or a personal check.
5:37 am on September 18th, 2011 32
@27 – I guess you missed the part where I said Tricare would pay for everything else? A US military member would pay nothing under this plan because they would be insured by Tricare.
5:53 am on September 18th, 2011 33
@20 – I haven’t been bashing the Canadian health care though others have.
I tailored my idea to address shortcomings with it such as wait times by limiting the number of appointments for general health issues per year the government would cover. This should cause people to be more prudent about when accessing health care.
Also Canadian health care is not funded by a GST but instead income taxes. I think a GST is better because than you are getting everyone to pay into it to include even the illegal immigrants who are using the system now.
5:56 am on September 18th, 2011 34
@13 – I totally agree with Sonagi’s idea of people receiving government food assistance being limited to eating healthy foods. However, I’m sure if you pull back the curtain the major processed food manufacturers are probably heavily influencing which products the government makes available for public food assistance.
6:32 am on September 18th, 2011 35
You are right, GI Korea. The Congressional Black Caucus voiced strong opposition to NYC Mayor Bloomberg’s proposal to limit foods eligible for EBT. Odds are that just about everyone in Congress gets money from ConAgra, General Mills, Dean Foods, and other major food companies, some more than others, depending on the support they show for legislation favorable to food companies, whom I expect will be giving generously to Bloomberg’s opponents if he runs again.
6:53 am on September 18th, 2011 36
#35 ^ in Korea it’s called corruption. But in America, it’s called something else to make it sound like it’s something better when it’s not.
8:17 am on September 18th, 2011 37
#35
quite disturbing considering studies show african americans are at higher risk for certain diseases including heart disease, high blood pressure, and diabetes. why does it seem that no one gets into public service with altruistic motives these days? i wonder if representatives set out to be corrupt from the get go, or if they are shaped into that mindset once they take office and start rubbing elbows with their colleagues.
9:21 am on September 18th, 2011 38
@35 Kinda maks me wonder what the Congressional Black Caucus has against African Americans.
2:59 pm on September 18th, 2011 39
Regarding the Blacks and the EBT, I think among some there’s a genuine worry that if foods are limited to a narrow range of healthy foods for EBT, those foods may not end up materializing in the stores and then the EBT recipients are left with little they can buy at all.
3:01 pm on September 18th, 2011 40
As Sonagi mentioned, if the demand is there somebody will set up shop to sell the foods offered.
3:02 pm on September 18th, 2011 41
Tianjin Tom wrote:
Actually, it’s derisively called crony capitalism, and it’s a bit refreshing to see some of the Tea Party crowd warming up to the idea that there can be negative side effects of “capitalism” as it’s practiced in America.
But you shouldn’t be so smug, Tom. Back in your beloved China, crony capitalism is what “socialism with Chinese characteristics” has actually become, and it’s corroding Chinese society from within.
3:07 pm on September 18th, 2011 42
I misstated Bloomberg’s proposal. The only ‘food’ item he wanted to limit was soda, and it was 18 out of the 43 CBC members who spoke in opposition as a group. Whites, Hispanics, and Asians get diabetes and heart disease, too, but there is no Congressional White Caucus, Hispanic Caucus, or Asian Caucus to denounce Bloomberg’s modest proposal out of concern *cough* for their constituents.
3:08 pm on September 18th, 2011 43
Gi Korea wrote:
No, not necessarily. In classroom economics, we are led to believe that producers and sellers will come in to provide a good or service at an optimal price point that fits neatly on a supply-and-demand curve.
But the reality is that sometimes the price point ends up being too high or the difficulties associated with going in there too great, or some other problem associated with areas filled with the urban poor far removed from productive land, and there is no player to come and replace those that opt out of the market.
Sometimes, that is. So I would amend your sentence to read: If the demand is there somebody might set up shop to sell the foods offered and manage to stay in business there.
Back when we lived in Compton, I remember riding once a week in my dad’s Volkswagen to the “health food store,” a small mom-and-pop place where he got his vegetable juice and a few other things. My dad loved his raw milk and we sometimes went to a drive-through dairy in western Long Beach that served fresh offerings of all sorts of things (both pasteurized and non-pasteurized). But that’s the catch: my dad had a working car, but a good portion of our neighbors did not. The three miles to the health food store would have been onerous, while the ten miles to the dairy would have been near impossible, even on the bus.
3:10 pm on September 18th, 2011 44
Sonagi wrote:
That the soda manufacturers have the opportunity to influence such decisions by campaign contributions and other legal means is something we need to fix in our electoral system. Monied politics will be the downfall of our Republic.
3:13 pm on September 18th, 2011 45
Exactly. Poor Hispanic and other ethnic neighborhoods sell fresh produce and other minimally processed foodstuffs. My small city has no fewer than 10 stores catering to Latinos and each has a well-stocked produce section along with various cuts of fresh meat, fish, and dairy products, plus cheap, locally made authentic tortillas, tamales, and pupusas. Yum!
3:19 pm on September 18th, 2011 46
McCain and others have tried to fix the problem, but didn’t SCOTUS rule that corporate campaign donations were free speech? We citizens need to keep in mind that campaign donations are but a means to an end – getting enough votes to be re-elected. We encourage strings-attached campaign donations when we keep re-electing the candidate with the largest war chest. This election I am not thinking about individual issues but rather the big picture, and that is why I aim to cast most if not all of my votes for alternative party candidates, instead of the big two.
3:20 pm on September 18th, 2011 47
western Long Beach –> eastern Long Beach
Paul’s Dairy is still there, but their production has long since moved elsewhere, I think somewhere in the Inland Empire.
3:28 pm on September 18th, 2011 48
If 7-11 can sell heated hot dogs and taquitos, refrigerated pop and beer, and large bags of chips and cookies all priced about a third higher than in supermarkets, it can certainly stock cabbage and carrots, which have a decent shelf-life relative to other produce. Some currently do sell produce. I admire your ardor in playing devil’s advocate, Kushibo,k but we won’t know how SNAP restrictions will work until we try it. Malnutrition is sadly not uncommon for many reasons, but true starvation or chronic severe calorie restriction is virtually non-existent in the US. There is literally a huge difference in appearance between the poor in the US and the poor in developing countries like the Philippines, Indonesia, and China.
3:35 pm on September 18th, 2011 49
Sonagi wrote:
Yes, Citizens United was the SCOTUS decision that said corporations are people deserving of free speech, never mind that the individuals who supposedly make up the corporations already have free speech.
Corporations are not people, any more than highways or buildings are people, but that’s another topic for another time.
McCain had the right idea, but in the late 1990s and early 2000s he was perceived by some GOP operatives to be undermining the GOP’s fundraising advantage, so they went after him with everything they could throw at him, including insinuations that his Bangladesh-born adoptive daughter was a love child with a Black woman. I had great respect for McCain, but I couldn’t vote for him in 2008 because his healthcare plan had things in it that would have triggered a race to the bottom, à la credit card financing.
A SCOTUS-approvable way to prevent corporate entities from inundating the electoral and political processes in a grand game of quid pro quo must be found. I believe this may necessitate public funding of campaigns, which would probably be a moneysaver in terms of pork and what-not. But this would open the door to third parties getting at least matching funding, and that could upend the duopoly.
What needs to be done is for those who want third parties to be viable is to work to end win-by-plurality political contests, so those people won’t fear throwing away their vote or splitting the vote and letting a less popular candidate win. Or the multi-tiered first rank, second rank, third rank choice approach, if it is found constitutional.
But moreover, we must end the winner-take-all approach to the Electoral College. I believe in the Electoral College’s function of ensuring rural areas do not get ignored, but the winner-take-all aspect is not in the Constitution and it should be ended. It only insures that people will vote for the duopoly lest they throw away their vote.
But, I must admit, I don’t mind the duopoly. We have enough seats and enough branches of government so that myriad voices within the Democratic or Republican Parties can be heard and represented. No, the duopoly is not the problem: what’s wrong with America is the quid pro quo between politicos and their donors.
3:39 pm on September 18th, 2011 50
Sonagi wrote:
Oh, by all means try it. I’d love to see them try it.
But what I’m trying to say is that we shouldn’t be surprised if the “free market” approach ends up failing the residents of some of the food deserts and we see stores close and people have farther to go.
We may see that making SNAP work to bring healthy foods also causes stores to go out of business as their moneymakers can’t get buyers anymore. And then we’ll need something else, perhaps subsidies for opening up “healthy stores” in food deserts and/or innovations (like food grocery delivery services).
3:42 pm on September 18th, 2011 51
Here in Honolulu, if I want affordable fresh produce, I have to go to Chinatown, a six-mile drive. For those in some of the poorest neighborhoods, many miles out to the west, forget it.
3:53 pm on September 18th, 2011 52
The cost of living in Hawaii is probably the highest among the 50 states, or perhaps second after Alaska. A former colleague quit her job as a public school teacher there and moved elsewhere because she was embarrassed to rely on food stamps to feed her kids.
US Wal-mart customers are an international laughingstock.
4:06 pm on September 18th, 2011 53
I was actually going to mention WalMart in response to your first paragraph in #51. I’d say WalMart is doing a commendable job of trying to right some of its wrongs, including by offering fresh fruits and vegetables at affordable prices in places like Las Vegas (my aunt lives there, and she has started shopping there more lately).
I was disappointed that our local WalMart that was already a SuperCenter or whatever was not going to have the fresh produce available on the Mainland, but they have been stocking more healthy foods, including fresh packs of carrot sticks, etc., that are locally produced and (I suspect) offered at a low mark-up.
Hawaii is an agricultural state, but over the past century-plus, it has been engineered to mass produce certain foods for “export” while daily food items are “imported.”
Were it not for national chains trying to maintain nationally uniform prices, Hawaii might be too expensive to live in, given that the state no longer produces what it needs for local living.
5:04 pm on September 18th, 2011 54
The link ridicules Walmart customers,not Walmart products. It was sent to me by a Brazilian friend, who came across it in a Brazilian forum.
You are absolutely correct that agriculture in Hawaii has been transformed from subsistence to cash crop monocultures. There is something cruelly ironic about people in a state with fertile soil and a warm climate year-round having to buy imported fresh produce.
5:24 pm on September 18th, 2011 55
“Also Canadian health care is not funded by a GST but instead income taxes. I think a GST is better because than you are getting everyone to pay into it to include even the illegal immigrants who are using the system now.”
No, the problem isn’t illegal immigrants, who don’t have (legal) residency, which means they can’t get a health insurance card. The problem is Canadians with dual citizenship (American citizenship) who reside in the US but claim residency at a friend or relative’s home in Canada in order to acquire a health insurance card and defraud the government. We’re talking thousands upon thousands of people, more than 1% or so of the total number of insured people in my province alone based on my calculations. So, you could say that Canada has a vested interest in seeing universal healthcare in the US. As for the illegal immigrants and any American citizen who resides close enough to the border, they can go to the international clinic. It costs 30$ per visit. That’s what we do when we’re in Canada since we don’t have residency.
5:58 pm on September 18th, 2011 56
Don’t these dual citizens still have to pay provincial taxes to remain eligible? My Canadian friends overseas all paid in and went back to Canada every summer to maintain residency and access to public health care.
7:02 pm on September 18th, 2011 57
#55
Our sensational media sought every opportunity to present cases where Canadians had to turn to the USA to get treatment that was ‘denied’ in the Canadian health care system. But, I as suspect, they may be vastly outnumbered by the number of Americans seeking to gain access to Canadian health care.
We can actually become less informed by watching the news.
8:11 pm on September 18th, 2011 58
In regards to health care I am opposed to socialized medicine because I think we can do better than the North Korean level of health care. I would favor a catastrophic plan that where the government or private companies chips in if the total medical bill is above a certain percentage of someones total income. I don’t want the government running the whole shebang. This would prevent someone from going bankrupt from having to have a lifesaving procedure. Kushibo #49, You wrote “Yes, Citizens United was the SCOTUS decision that said that corporations are people deserving of free speech, never mind that the individuals who supposedly make up the corporation already have free speech.” I don’t know why you said “supposedly” since a corporation IS people working together. I agree with the SCOTUS that just as people can bind together as environmental groups, labor unions, and political parties to work for their common interest so corporations also can work for their interest. You compared corporations with highways & buildings which are physical structures. I think my comparison of corporations with labor unions, political parties, environmental groups, and pro or anti gun control groups since they are groups of PEOPLE is more apt.
8:28 pm on September 18th, 2011 59
Tom Langley wrote:
Of all the dozens upon dozens of examples of socialized medicine, why would you pick the North Koreans and suggest that that’s where the technology- and resource-rich US would end up if it were to go that route? Why not the Germans, who have been working on some sort of socialized medicine for about a century, or the Swedes, the Canadians, the Chileans, the Koreans, the Japanese, the Taiwanese, the French, or even the Brits? Your statement is demagoguery and nothing more.
A corporation is not just people. It is people working within a matrix whose aims are often outside the interests even of those inside the corporation.
The corporation, particularly one that is for-profit and beholden to stockholders to continue to make profit, is a structure put together by contracts and laws. If one disagrees with the aims of the corporation, one can try to change it or quit, or try to change it and then be fired. Now what if everyone at the corporation quits? Well, it still goes on, replacing those people perhaps with new people, or fewer people, etc. It can go on irrespective of the people who are in it; it is not a human, even though there are humans within its structure.
An extreme example illustrates this. Governments are a form of incorporated entity, even if they are not “commercial” in the traditional sense. The DPRK regime is a political corporation that exists irrespective of the needs, wants, and desires of the North Korean people. Even if the people within the regime decide to change it, they are likely ground up and spit out. If a faction within the DPRK regime decides they do not wish the government to be cruel and heartless, the corporation is structured such that another faction will destroy them.
Even Kim Jong-il himself cannot unilaterally change the behavior of the political corporation, because some faction will be poised to take him down. Ultimately, the DPRK regime, made up by people, exists independently of the people and is designed to perpetuate itself. This is what corporations are programmed to do. They are like Hal.
The highway and building comparison is apt: they, too, are systems designed by (and for) people to operate them and use them, and we sometimes give them power to take precedence over actual humans.
But if you prefer the comparison with labor unions and political parties or environmental groups, so be it. Those are also corporations, even if they are not supposed to make money. Ultimately, many exist for the sake of existing, because they are self-perpetuating entities irrespective of the people involved in them. Some of the greatest excesses of the labor unions stem from that.
8:58 pm on September 18th, 2011 60
@55 – I was referring to illegal immigrants using the US health care system now. With a GST at least they would be paying something towards their health care.
10:24 pm on September 18th, 2011 61
“Note that three-fourths of these people had health insurance. Obviously inadequate insurance, as insurance providers fight tooth and nail to pay out on things that the people with coverage thought were covered.
These bankruptcies may be a greater drag on the economy than the cost of shoring up insurance coverage so that they don’t happen.”
This is my issue with the current crop of insurance companies. You buy a service from them, yet when the service is no longer profitable for them they can unilaterally terminate the agreement through various loopholes they have pre-programmed in. Pre-existing conditions was just the most common “escape caluse” used as it is nigh impossible to prove that the headache you got when you were 17 didn’t cause the cancer that you got at 55. There are others, inappropriately filed paperwork is another clause that can cause the insurer to unilaterally terminate the agreement. And it’ll be paperwork you never knew about, did you know were you supposed to file a from 2281q-B4 with appendix V sub-form 29 whenever you did your yearly physical? Ohh you filed sub-form 28 instead? That’s misrepresenting your health history, *TERMINATED*, guess we’re not paying for that expensive surgery anymore. And btw, you might of filed the correct form, but can you prove it in a civil court while your dieing? The form was conveniently *lost* from your insurers file system and their now claiming you never filed it, your surgery is in a month and it’ll take at least a year to get this through the legal system, you’ll be dead before then. The insurance companies are not your friends, their out for themselves and the only way they can turn a profit is to provide you $500 worth of care for every $1000 you pay them. All the cards are stacked in their favor, when your facing a serious illness / disease you don’t have the tools to fight them and win, their way to lawyered up with too many pre-programmed escape hatch’s. Sometimes people get lucky, but usually the insurance companies will win against individuals. Who usually fights the companies is the health care providers themselves, hospitals and doctors offices. Their far better staffed and equipped to do that, but it costs money and that cost is passed onto the patients and insurance companies in those outrageous bills.
My mother worked as a RN for the last 30 years, she’s seen it all and the insurance companies WILL do these things whenever they think a patient is no longer profitable. And while she prefers working at VA hospitals (my father is a disabled vet) she did time at a private hospital and wow talk about shenanigans. Along with charging for an entire bottle of pills for a single dose, they were constantly in legal battles with various insurance providers.
Personally I’d love to see a Medical Savings Account system be put in place, a real one not a scam. You however much you want into this account, it counts as pre-tax dollars. You can never withdraw money from this account, but can instead use it to pay for medical services at “cash in hand” rate. For those who might not know, health care providers will often slash costs by as much as 50% if you agree to pay upfront cash and not go the insurance route. It saves them administration costs and legal hassles. When you die any remaining money can be passed on to the MSA’s of your family members, but again it can never be withdrawn as cash, only paid to health care providers.
And while I know the above system doesn’t help those who are currently old and ready for the $200K+ nightmare that is the 50+ block, if all the young children, starting as burger flipping teenagers and part-time college students did this, then they would have a significant fund setup. This wouldn’t replace insurance, as you could still get private insurance if you desires, but this would significantly reduce the costs that we see today.
And FYI this is what I’m already doing, but it’s with post-tax dollars to my own savings accounts. I pay the absolute minimum to my insurance company, I don’t expect them to actually do anything should I get seriously ill. I trust that I would find a better way to spend $1000 on my own healthcare then them to spend $500 and keep the other $500.
11:15 pm on September 18th, 2011 62
In Hawaii, insurance providers for some time now have not been able to get you for pre-existing conditions. But again, it only works when applied to every insurer at the same time, and that means government regulation. $o¢iali$m!!!
Someotherguy, ever since Bush43 started pushing the idea, I’ve been intrigued by the medical savings account concept, but I never hear much talk about what happens when people’s medical expenses end up going beyond what they have in the account. What’s your take?
As for insurance non-payment, I spend a great deal of my time helping out with two close relatives in nursing homes since 2006 and 2007 respectively. One being my uncle who died a few weeks ago in an Alzheimer’s care facility, after my aunt went bankrupt (both in the literal and legal sense) and still had to give all his Social Security and pension to the nursing home each month before Medicaid would kick in the rest, forcing her to keep working at 72.
The other had a devastating stroke (even though he was not overweight, didn’t smoke, didn’t drink, and ate healthy) and is paralyzed on the left side and requires nursing home care, which is about $5000 per month. Medicaid pays for the care now, though we must file piles of paperwork each year to prove need, and this is only after $200K of savings was depleted in the first three years. Now this is the relevant part: this person had insurance that supposedly covered long-term care that is illness related. But nope, the insurance company insists that the paralysis and the stroke are not connected according to their insurance contract. You thought you were covered, but too bad.
Still, we must keep the insurance companies happy because this is America and they’re part of the free market that magically makes everything right.
12:44 am on September 19th, 2011 63
Kushibo,
There is much government over-regulation and interference in many areas of the economy.
While some is necessary, a good deal of this regulation and interference is encouraged by big companies to keep small companies from competing and to insure there needs to be less competition among big companies.
When the system fails due to the burdens of artificial government regulation and interference, everybody points their finger at capitalism and the free market…
…not fully grasping that many of the problems are due to a very controlled and artificial market which has little to do with capitalism.
Misrepresenting capitalism and the free market may be an honest mistake… or it may be a pattern of clever social engineering which seeks to demonize anything that can’t be easily controlled and manipulated by the political and business leaders which make up the ruling elite.
1:01 am on September 19th, 2011 64
“But nope, the insurance company insists that the paralysis and the stroke are not connected according to their insurance contract. You thought you were covered, but too bad. ”
This is really my point, this person paid into the system, his work place’s paid, there was a legal agreement to provide money for services rendered. And when it was a good deal for the insurance company they happily took your money, but when the deal turned sour they had their experts go over everything imaginable to find a way to not have to pay. The people being shammed are too old, or too ill to fight back, so they get screwed over unless their rich and have strong legal allies, in which case they probably don’t need insurance to begin with.
My personal belief is that health care costs have inflated too much, compared to every other civilized nation in the world our costs are astronomical, for the exact same things. Me going to the doctor to treat a sprained wrist here in SK is no different then me going to the doctor in the USA, except the price tag is 2~4x higher ($100 USD for treatment here, and I pay full price). It’s so cheap here that I don’t even bother using my company paid health insurance The less I involve them the less chance of them screwing me over later.
I do believe MSA’s are the way of the future, it’s a way of getting your money under your control. Think about it, what is the job of a health insurance company? The theory is that their supposed to protect in disaster scenarios, worst case situations. Instead their trying to cover 100% of costs, something insurance by default can’t do. In order for the Insurance company to make a profit, you must pay them $1000 and they pay the hospital / doctor $500 and pocket the other $500 as profit. Their basically acting as the middleman between myself and my care providers, except I’m still physically going to my care provider and paying %200+ premium for it. Just cut the middleman out and pay the care providers cash, you’d be amazed at how much they’ll lower their rates once you say your paying in cash and not dicking around with an insurance company.
Which leads to the purpose of insurance companies to begin with, medical disasters. I do believe someone should have insurance to cover the worst stuff, and you have to weave through tons of paper work when you opt for your benefits / insurance plan. I took the highest deductible I could, but with short term / long term workplace injury compensation and a few other options but trying to be as frugal as possible. Every $$ I don’t pay them is one I can put in savings to use when I do get hurt. As long as I live a healthy life I should avoid most of the nickle and dime stuff that happens.
And NOTHING is free, ever. Just because your insurance company is paying something ~now~, doesn’t mean their math wiz’s and computer models are not calculating your financial worth and profitability. If they had to pay $2000 for something, they’ll remember that and “adjust” your premiums appropriately to get it back. Another reason I like to pay for things on my own, the less they pay the less I have to pay them back later. I prefer the insurance company as uninvolved with my health as possible.
1:13 am on September 19th, 2011 65
GI can you dig my comment out of the filter. I think I ran up against something..
1:18 am on September 19th, 2011 66
@CH,
While I’m a fan of free markets for all, I hate government over regulation in general, this is one area that the traditional concept of supply vs demand doesn’t work. It’s people’s lives we’re talking about, how much is your life worth? How much would you pay for your good health?
Usually free markets function in that a provider will charge what the market is willing to bear, if they charge too much then people will not buy their product. This serves as a natural balance to prevent companies from charging more then their product is worth. Companies will ~ALWAYS~ charge as much as possible, their after profits not charity, and this is usually a good thing. Except the value of human life and good health doesn’t have a cap, there is no amount of money that someone will not pay for their continued good health. Thus there is do downward balancing factor to keep the cost’s in check, and without that the costs will spiral up and up and up without limit. Insurance companies are recording nice profits these days, there’s no end to the amount of money people will pay for a guarantee of their continued good health.
2:17 am on September 19th, 2011 67
someotherguy,
The debate in a previous post instigated this post on health care.
If you refer to that conversation, you may agree with my statements that some things, such as a military or health care, are best socialized.
3:13 am on September 19th, 2011 68
“Don’t these dual citizens still have to pay provincial taxes to remain eligible? My Canadian friends overseas all paid in and went back to Canada every summer to maintain residency and access to public health care.”
Only Quebec has provincial income tax, the rest is all federal. Being deemed a Canadian resident and a resident of a province are two separate things. You can be a Canadian resident (for tax purposes) and still be a non-resident of a province (must reside in a province for at least 6 months out of the year in order to receive healthcare coverage). Your friends were defrauding the provincial government. They most probably but down their parents’ home down as their residence. That’s exactly the kind of fraud Atwork was describing.
4:23 am on September 19th, 2011 69
#67, what’s there to defraud? Canadian hospitals suck and the medical system is horrible. No wonder it’s free. And top of that, the system is a ponzi scheme.
4:57 am on September 19th, 2011 70
Canada’s health care is like Cuba’s.
Run down, dilapidated, but free.
7:33 am on September 19th, 2011 71
Your comment is the 69th…
How fitting.
1:37 pm on September 19th, 2011 72
Teadrinker #71, Sometimes many years ago my wife & I would sometimes go to play bingo. Whenever the number 69 was called I would always yell out “69, my favorite number” which of course would embarrass my wife. I’m surprised that you didn’t tell Tom that if he didn’t care for the Canadian health care system that he was free to move somewhere else. I’ve never had any dealings with the Canadian health care system but I do know that I believe it was prime minister of Newfoundland decided to come to the US to get some cardiac test or something. For a POLITICIAN who obviously relies on votes to get & keep his job to have to go to another country for some health care problem has to say SOMETHING about the quality of care, don’t you think?
2:40 pm on September 19th, 2011 73
#72
This article might answer some of your questions on that issue.
I think this was a case where he had the resources to go to a doctor that was a pioneer in a procedure he performed often. Something not that may not have been available to even most Americans, without the same resources. Would an American health insurance company approve sending a patient in California to that Miami doctor? Not very likely, but if that California patient was a millionaire he might be able to get in for a faster, non-bone-breaking, under the armpit heart surgeries.
If I cared to try, I could come up with anecdotal stories of Americans of means traveling to others countries to get pioneering specialized treatment not yet available in the USA. That information is hard to come by since most people’s health care is private. There have even been stories of wealthy people traveling to other countries to get organ transplants because they don’t want to wait in line and there are more means to entice people to ‘donate’ organs.
However, I am not sure how applicable any of these stories are to our health care debate.
4:48 pm on September 19th, 2011 74
Buffalo Bills Football star player in Korea to save his knees, which could not be fixed in the States.
http://news.hankooki.com/lpage/culture/201109/h2011091921460386330.htm
I wasn’t exaggerating when I said the Canadian system is terrible. Remember, this opinion is coming from a third party person like me.
The waits at the doctor’s office is at least an hour, usually more. The waits at the emergency rooms is horrendous, with minimum 4 hours, even up to 5, 6 hours are not unheard of. You can die from pain while they make you wait. The staffs at the hospitals are unfriendly and grouchy. The hospitals themselves smell of urine, as most of the facilities are run down – at least 30, 40, 100 years old. Sometimes there are not enough beds, so sometimes you see old delirious patients that don’t have rooms, being wheeled into halls where they are left to wait it out.
I know of one person (a sister of one person I know) who was diagnosed with cancer last November, and died two weeks ago. She had gone to two doctors and two hospitals for a back pain, and both missed the diagnosis early which would have saved her life. She was told to diet and exercise and told to go home. They failed to do the Cat scan. When they did, it was too late, as the cancer had gotten bigger. The doctor at the hospital told her this offhandedly: “we’re going to have to operate on you, and oh.. by the way.. you have cancer”. Boy talk about sensitivity.
They opened her up, removed one of the growth, but the surgeon failed to remove all the cancer because get this, he said he wasn’t experienced enough. (WTF)? After the surgery, the cancer spread like wild fire in just matter of couple of weeks – all over the organs and the body. The patient was in extreme pain and could not move. She was in diapers for couple of weeks and died just recently. I am quite sure that the hospital’s poor care had much to do with spreading the cancer faster, it would have been better and she would have lived longer if she didn’t get the care from the hospital.
Another person I know, a 55 year old Korean immigrant who got a perfect physical from a Canadian doctor, was recently diagnosed with intestine cancer in Korea after another physical at a Korean medical facility. She was visiting her family in Korea and her family insisted on her getting a physical in Korea. Lucky for her, they found the cancer at initial stages, and the prognosis is good. I’m sure it would have been worse, if she had not visited Korea.
It seems Canada has poor preventative treatment. Getting an annual physical is crap. The doctors ask you questions, take blood tests, measure the blood pressure, and take urine samples. Then they declare you fit and healthy! That’s it. And they call that a “annual physical”. The health care itself, is very low tech and basic, and even if it’s free, it still doesn’t cover everything, you still need to pay for some critical drugs yourself. And top of all that, the system itself is going broke. So like I said, I call it the ponzi scheme that cannot be sustained.
At least in the US, if you can afford it, you don’t have to deal with poor quality of care. The problem with the US is the runaway cost, not the poor quality of the health care or the facilities.
I would not recommend this poor quality of care to the Americans, they probably would not stand it.
Whenever you hear Canadians like Teadrinker going on and on about the glorious Canadian healthcare, just take it with the grain of salt. It’s just their smug nationalism talking, not the facts.
9:11 pm on September 19th, 2011 75
I don’t like how people expect a system to be a 100% solution, it’s not financially feasible. And what you quickly find out is that last 10% accounts for %50+ of the costs, especially when were talking cancer and the last 5 years of life care.
There needs to be a system that keeps costs down for the 90%, for the common things, broken bones, common sickness’s and such. You will find that if you can take care of those at an economical rate, then the cost’s will lower and the rest will follow.
And yes regardless of the system, nothing should be purely “free”, a small $10 ~ $20 co-pay per visit is enough to deter people from abusing the system.
10:02 pm on September 19th, 2011 76
Here’s a market-based solution to the Medicare problem. It would be like Paul Ryan’s plan, with a little improvement: the level of the premium-support payment each year would be based on bids submitted by providers in each region. So this plan is even more market-friendly than Ryan’s. Even liberal blogger Kevin Drum discusses it favorably, with a link to National Review’s Reihan Salam, who presents it as the Confident Market Solution by Yuval Levin of the Weekly Standard. Now we just need a Republican to champion this conservative, free-enterprise approach.
10:03 pm on September 19th, 2011 77
My link to Kevin Drum needed a little work.
11:22 pm on September 19th, 2011 78
Well the GOP isn’t interested in conservative “free market” anything when it comes to health care. The current crop of health insurance companies have done well for themselves setting up a state approved monopoly, or near monopoly. Insurance companies don’t compete across state lines, and have zero interest with actually competing with each other. Instead they all agree on a few ground rules and just sit back and enjoy the profits come in.
If you were to force them to compete with each other with some form of regulatory oversight then it would eat into profits. And so they stuff large amounts of cash into various campaign coffers with promise’s of more to follow should the elected officials prevent any change to the status-quo.
1:11 pm on September 20th, 2011 79
Free Market baby!
The government didn’t help us a hundred years ago. We didn’t need it or health care then and we don’t need them now.
http://www.youtube.com/watch?v=3E29LD98ruo
Watch that video. There are two areas of health care that are almost entirely free market, plastic surgery and lasik. Because the consumer must pay out of pocket, doctors must compete. Quality improves and prices come down.
Sometimes a person still wants/needs insurance, but against catastrophic events. We don’t buy home insurance for minor repairs, we buy it for home destroying events.
As for pre-existing conditions or children in great need, well, I’m sorry. I’ll give voluntarily to a charity or my church. Your condition does not give you the moral right to take my money through taxes. I want to help, just don’t force me.
2:05 pm on September 20th, 2011 80
Floridaegu, #79, must have overlooked the important point made that health care, unlike most consumer goods, is a need, not a want. A moral right is a judgment. You judge that that government should not tax your income or purchases to provide health care to people of low income or with pre-existing conditions. Others like me judge differently. I am, however, deeply moved that you “want to help.” I’m sure you would give a large chunk of your income to benefit the poor if the government didn’t pick your pocket. Unfortunately, most human beings aren’t nearly as compassionate and generous as you appear to be, so a safety net is necessary to help ensure a healthy, productive population.
2:14 pm on September 20th, 2011 81
You’re absolutely right that the government had no real public health care 100 years ago. You are dead wrong that it wasn’t needed. The school lunch program was introduced in 1946 to combat malnutrition and stunted growth, which rendered many military draftees unfit to fight in WWII. Historical records of Civil War vets indicate a wide range of preventable health problems afflicting young soldiers and causing early disability. Public health and nutrition programs, for better or worse, evolved in response to population needs.
2:15 pm on September 20th, 2011 82
Floridaegu, a hundred years ago the life expectancy was about fifty.
Cosmetic surgery and LASIK are so different from non-elective healthcare that they barely warrant being in the same discussion.
Healthcare is not a widget. It represents a market failure because of asymmetric information and the inelasticity of demand (you will pay for it regardless of the price because you don’t want to die). It also relates to externalities and productivity outside its costs that benefit society as a whole.
Simply, it’s different. Any economist, right or left, will tell you this.
Here’s the problem with that: You deciding to go it alone with only catastrophic coverage may be fine, but everyone else having regular policies that dominated in the pre-2010 era will be driving up the prices you pay, even if you get that cash discount of up to 50%, and it becomes unsustainable. It only works to keep prices down if it’s universal.
Careful, karma is listening.
Look, we build roads, schools, and a whole bunch of other stuff I will never use, so why should I pay for it? Well, I know the answer to why I should, and you might very well think we shouldn’t, but in the end, we as Americans are better off — not just collectively but individually — if we have the infrastructure, and a healthcare safety net is among those things.
Charity and donations paying for healthcare bills is grossly inefficient and typically inadequate. Like massive bankruptcy (nearly two-thirds of which were health-related prior to the the economic collapse) it is a drag on the economy. I dare say we get back more in the long run by paying for those you’d brush aside with “Well, I’m sorry,” than by not paying.