We don't need over-priced insurance - we need Guaranteed Healthcare. - page 2

We don't need over-priced insurance - we need Guaranteed Healthcare. Our healthcare system is frail - and making our patients sick. Even people with expensive insurance are denied health care, and... Read More

  1. by   VivaLasViejas
    No---but it's a step in the right direction.
  2. by   ZASHAGALKA
    If you want affordable insurance than we need to turn health insurance into an actual insurance program. The current systems amount to little more than prepaid care.

    Catastrophic health insurance that covers hospitalization, outpt surgery, and major DME/Meds only would be very cheap by comparison.

    Once consumers start actually paying for office visits and routine care, then you can bet that the market will make things competitive and as top notch in comparison to lowest price as possible.

    The market always works, if the gov't gets out of the way. The problem with healthcare today is NOT the market, but the gov't interference that already exists. More gov't involvement will just make things worse, not better.

    Your fatcat insurance people get rich because the gov't discourages the market from being competitive. Insurance execs with no need to be competitive can just vote themselves lavish salaries. Why wouldn't they, what with the gov't protecting their slice of the marketplace? That's a gov't problem, not a market problem.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on May 23, '07
  3. by   pickledpepperRN
    Quote from ZASHAGALKA
    If you want afforadable insurance than we need to turn health insurance into an actual insurance program. The current systems amount to little more than prepaid care.

    Catastrophic health insurance that covers hospitalization, outpt surgery, and major DME/Meds only would be very cheap by comparison.

    Once consumers start actually paying for office visits and routine care, then you can bet that the market will make things competitive and as top notch in comparison to lowest price as possible.

    The market always works, if the gov't gets out of the way. The problem with healthcare today is NOT the market, but the gov't interference that already exists. More gov't involvement will just make things worse, not better.

    Your fatcat insurance people get rich because the gov't discourages the market from being competitive. Insurance execs with no need to be competitive can just vote themselves lavish salaries. Why wouldn't they, what with the gov't protecting their slice of the marketplace? That's a gov't problem, not a market problem.

    ~faith,
    Timothy.
    OK I have a $20.00 co pay and about $35.00 for the lab when I see my doctor.
    Insurance pays about $110.00.
    Do you if insurance didn't pay anything think the cost would go down on these so the person making less than a nurse with a young family wouldn't have to pay 165.00 or more for a visit to the doctor?

    Maybe because the physician practice wouldn't have to pay someone to bill the insurance company?
  4. by   ZASHAGALKA
    Quote from spacenurse
    OK I have a $20.00 co pay and about $35.00 for the lab when I see my doctor.
    Insurance pays about $110.00.
    Do you if insurance didn't pay anything think the cost would go down on these so the person making less than a nurse with a young family wouldn't have to pay 165.00 or more for a visit to the doctor?

    Maybe because the physician practice wouldn't have to pay someone to bill the insurance company?
    Of course the price would come down. I would be willing to bet that, straight up visit, no paperwork, no insurance, would be something on the order of 40-50 bucks. But, ONLY if the docs had a reason to be competitive with each other. This is already happening in some places.

    Think about it: 40 bucks for a 10 min visit is STILL 240/hr. Not bad money, if you can get it. Of course, that means you have to keep your overhead low, and do OTHER things that actually make you competitive. Go figure.

    Not just office visits, though. A CBC that cost less than 5 dollars to run would NOT cost 300 bucks if the market dictated its cost. It would cost, maybe 15-20.

    A CT scan would be a hundred bucks, or less, if the market dictated its price, and that is complete with interpretation.

    Meds prices would fall. Do you think the new ARBs would really cost 200 bucks for a month's supply if consumers, now paying for what things really cost, opted for a 20 dollar generic ACE Inhibitor instead?

    Let me bring it home. My monthly supply of Brand name Lotrel (Ca channel blocker plus ACE Inhibitor) would cost (if I weren't just paying an insurance co-pay) 110/month. If I had to shell out that total cost out of my OWN pocket, you can BET that my doc and I would have a nice little conversation about GENERIC Ca channel blockers and ACEI. You can bet. As it is now, my prescription plan doesn't much discriminate between the two (name brand combo vs individual generics), and so, neither do I.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on May 22, '07
  5. by   pickledpepperRN
    How can we get the insurance companies out of routine care?
  6. by   HM2VikingRN
    Quote from zashagalka
    of course the price would come down. i would be willing to bet that, straight up visit, no paperwork, no insurance, would be something on the order of 40-50 bucks. but, only if the docs had a reason to be competitive with each other. this is already happening in some places.

    think about it: 40 bucks for a 10 min visit is still 240/hr. not bad money, if you can get it. of course, that means you have to keep your overhead low, and do other things that actually make you competitive. go figure.

    not just office visits, though. a cbc that cost less than 5 dollars to run would not cost 300 bucks if the market dictated its cost. it would cost, maybe 15-20.

    a ct scan would be a hundred bucks, or less, if the market dictated its price, and that is complete with interpretation.

    meds prices would fall. do you think the new arbs would really cost 200 bucks for a month's supply if consumers, now paying for what things really cost, opted for a 20 dollar generic ace inhibitor instead?

    let me bring it home. my monthly supply of brand name lotrel (ca channel blocker plus ace inhibitor) would cost (if i weren't just paying an insurance co-pay) 110/month. if i had to shell out that total cost out of my own pocket, you can bet that my doc and i would have a nice little conversation about generic ca channel blockers and acei. you can bet. as it is now, my prescription plan doesn't much discriminate between the two (name brand combo vs individual generics), and so, neither do i.

    ~faith,
    timothy.
    why not just adopt this plan instead:

    as jonathan cohn explains in his new book, sick:
    in order to prevent cost sharing from penalizing people with serious medical problems -- the way health savings accounts threaten to do -- the [french] government limits every individual's out-of-pocket expenses. in addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.
    the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate.
    http://www.prospect.org/cs/articles?...lth_of_nations
  7. by   HM2VikingRN
    Quote from DarrenWright
    Untrue.

    A single payer system in no-way whatsoever assures "that everyone is covered with one high standard of benefits and care," and in fact assures that everyone is guaranteed coverage at the lowest levels routinely available, while people wealthy enough to purchase additional insurance will receive care not available at the single-payor level.

    That is unless, you advocate completely eliminating private insurance and private payees and taking away people's right to do what they want with their bodies.
    We can achieve higher quality health care at a lower price: Emphasis added.

    France's has a high floor and no ceiling. The government provides basic insurance for all citizens, albeit with relatively robust co-pays, and then encourages the population to also purchase supplementary insurance -- which 86 percent do, most of them through employers, with the poor being subsidized by the state. This allows for as high a level of care as an individual is willing to pay for, and may help explain why waiting lines are nearly unknown in France.
    France's system is further prized for its high level of choice and responsiveness -- attributes that led the World Health Organization to rank it the finest in the world (America's system came in at No. 37, between Costa Rica and Slovenia). The French can see any doctor or specialist they want, at any time they want, as many times as they want, no referrals or permissions needed. The French hospital system is similarly open. About 65 percent of the nation's hospital beds are public, but individuals can seek care at any hospital they want, public or private, and receive the same reimbursement rate no matter its status. Given all this, the French utilize more care than Americans do, averaging six physician visits a year to our 2.8, and they spend more time in the hospital as well. Yet they still manage to spend half per capita than we do, largely due to lower prices and a focus on preventive care.
    http://www.prospect.org/cs/articles?...lth_of_nations
  8. by   DarrenWright
    Quote from HM2Viking
    We can achieve higher quality health care at a lower price: Emphasis added.


    http://www.prospect.org/cs/articles?...lth_of_nations
    And American nurses (and physicians), unionized or not, would never agree to the working conditions and salaries of the French.
  9. by   Ladybugleaqueen
    I lived in Canada so I have seen their universal healthcare up close and personal. I can't tell you how good it was to know that if I got sick I would be able to go to the doctor or the hospital and not have to worry about paying and you stayed until you were able to go home you weren't rushed out because someone without a medical degree said you had to go. I could focus on getting better it is different when you have a chronic health condition the worry is always there. Canada still has private insurance it comes through their employers it pays for the extras that the provincial healthcare system doesn't also prescriptions drugs are covered under private insurance however government has a hand in it that is why their drugs are so much cheaper. I know nothing is free Canada pays higher taxes for their healthcare system. Why couldn't we have some sort of monthly premium for all possibly based on income for basic healthcare on the lines of the Medicare system. We could still keep private insurance for those who could afford it through employers. There just has to be an answer what good is all the technology that we have if people can't afford it.
  10. by   pickledpepperRN
    Quote from DarrenWright
    And American nurses (and physicians), unionized or not, would never agree to the working conditions and salaries of the French.
    I couldn't find much in English.

    Experiencing Nursing in France - http://www.nursezone.com/include/Pri...le=Main%20page

    http://www.edufrance.net/adm/docs/fi...irmier2-GB.pdf
  11. by   HM2VikingRN
    http://www.payscale.com/research/FR/...se_(RN)/Salary


    33,780.00 EUR

    =

    45,344.72 USD




    The numbers
    Here's the lowdown on how many vacation days the rest of the world enjoys. According to Hewitt Associates, the country with the most vacation days is Denmark with 31, followed closely by Austria and Finland at 30 days. France and Norway are at 25 days, Germany at 24 days, Belgium, Ireland, the U.K., the Netherlands and Switzerland each at 20 days. Non-European countries measured include Brazil at 22 days, Australia at 20 days and Colombia and New Zealand each at 15 days. The U.S. is second from the bottom with 10 days, tied with both Canada and Japan. Only Mexico, with a piddly six days, offers employees less vacation time.

    http://www.vault.com/nr/printable.js...810101&print=1

    Pay is not everything. 5 weeks guaranteed vacation each year plus the other social benefit of not having to worry about losing your job=lost health insurance is a huge benefit. If french workers worked the same number of days as US workers the salaries would be roughly equal. This salary report is based on a very limited number of employees.
    Last edit by HM2VikingRN on May 24, '07
  12. by   DarrenWright
    An American working as an RN in France.

    An RN with 15 years experience makes about $2500 per month. This RN makes $1600 per month working in an ICU with a 1:13 patient ratio!

    http://aboutmyjob.com/main.php3?acti...cle&artid=2489

    The entries on this site are only 2 years old.

    In addition, unemployment is remarkably higher in France, and French nurses have gone on strike at least three times in the past 10 years because of working conditions, primarly understaffing. I suppose one could speculate why hospitals are so understaffed in France that they are going on strike NATIONALLY...not just institutionally.

    Here's a link from NIH.

    http://www.pubmedcentral.nih.gov/art...i?artid=419378

    "The first strategy is to use the variation in wages across destination countries. For each source country, the wage premium for nurses is largest in the USA and smallest in France and the United Kingdom."

    6% of French nurses left the public sector in 2001. http://www.icn.ch/sewjan-march03.htm

    Just want to clarify, are you suggesting that working conditions are better in France? Keep in mind that I only work a 36 hour week, and have far more opportunities in practice.
  13. by   pickledpepperRN
    Not much in English but I did find some information on line. A nurse who works with us worked in a Paris ICU for six years. She told us that acuities are more variable. A fresh open hear stays until discharge. Usually until able to climb two flights of stairs and walk at least 200 meters before discharged.
    Doctors work alongside nurses. At the hospital where she worked nurses did not start IVs. I don’t know if that is customary for France or whether it was a hospital policy.
    I can’t find actual staffing for nurses and doctors in English. Maybe it is not available. None of what I found gave me an idea on whether staffing is safe or not. My colleague thought it was OK.

    Physicians staff hospital units. They work shifts, start IVs, suction, change dressings, and administer medications. - http://thorax.bmj.com/cgi/content/abstract/57/1/77

    The nurse to patient ratio in the Paris critical care units participating in this study ranged from 1:1 to 1:3. It is implies but not explicit that the staffing is based on acuity - http://ajrccm.atsjournals.org/cgi/co...ract/163/1/135

    French physicians, intensivists, who have a good working relationship with nurses are less likely to experience burn out. - http://ajrccm.atsjournals.org/cgi/co...ract/175/7/686

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