Until that fateful November night, I never concerned myself with the politics of healthcare. I took my health for granted; I always exercised and ate a fairly balanced diet. My friends and I biked everywhere, and nothing ever happened. A few cuts and scrapes, but no major injuries.
Luckily, at the time of the accident I was still 21 years old and covered by my family's plan. But when I turned 22, I was dropped from my parents' healthcare coverage. Though I do have a required university healthcare package, it covers little more than my prescriptions and mental health needs. If I was ever in need of serious treatment, I am not sure what I could do. As a student I do not have the time to secure a job with benefits, and my parents do not have the means to support me beyond what they are already doing. I am mired in medical debt; my mailbox is full of second, third and last notices. I have no way of paying any of it off.
I actually see that as people know they can get care at doctor's offices and clinics they are going to avoid ERs for simple symptoms.
Or perhaps ERs can get away with what happens at military hospitals "this is not an emergency and here is your appointment time at the clinic accross the the street, or with Dr. so and so, goodbye."
Also, if the laws of supply and demand and private enterprise hold true, investors are going to see an opportunity as more people seek and get health care. It can continue to be the growth industry it is.
I just can't see advocating that health care remain the same just so I don't have to wait in line somewhere.
I actually see that as people know they can get care at doctor's offices and clinics they are going to avoid ERs for simple symptoms.
Or perhaps ERs can get away with what happens at military hospitals "this is not an emergency and here is your appointment time at the clinic accross the the street, or with Dr. so and so, goodbye."
Also, if the laws of supply and demand and private enterprise hold true, investors are going to see an opportunity as more people seek and get health care. It can continue to be the growth industry it is.
I just can't see advocating that health care remain the same just so I don't have to wait in line somewhere.
1. I think you will see 'pay as you go' (no insurance) clinics in Walmarts, etc., be a standard of care within 10 yrs. It's already starting. Just as $4 generic prescriptions didn't need a huge gov't bureaucracy to become a standard with lots of big-name pharmacies. The free market does the best job of mitigating price while expanding quality and cutting edge.
2. Who wants things to remain the same? I advocate for the government to become LESS intrusive in health care. Gov't restricted health care advocates for MORE restrictive gov't interference. I don't know anybody that wants more of the same.
3. What I specifically advocate is that the gov't end tax breaks for businesses to provide for health care and instead provide those breaks directly to consumers. That would break the back of gov't supported (with lobbiest infested rules for care) tax breaks to businesses and put health care back in the hands of individuals. Combine that with health savings accounts and catastrophic insurance, and you would have a model that would control pricing and bring health care to the masses.
I don't depend on my employer for my car insurance, and I shouldn't need to for my health care. Nobody should be forced to keep a job in order to keep health insurance.
THEN, after the gov't gets out of the business of interfering with care, THEN, the gov't could set up a catch all plan to insure that everybody is covered.
4. Universal health care isn't about universal coverage, at all. There are far cheaper -and less intrusive - ways to accomplish that. It's about controlling YOUR health care. It's about the money - why let YOU decide how to spend YOUR money best, when some bureaucrat in Washington knows YOUR health needs better than you do - and has the actuarial tables to prove it!
5. The only reason why a CT scan costs a thousand dollars is because, get this - YOU DON'T ACTUALLY PAY FOR IT. Remove the middle man and it would be far less. In order to have a market for a product, that market MUST be created at a price that will sustain it.
Nobody advocates leaving things status quo. I advocate a better system that keeps Washington out of your lives and provides par excellent care to everybody - with no rationing lines. Gov't restricted health care advocates want a fair share in a dismal gov't outcome for all.
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I advocate that we all have the ability/opportunity to have blackberry cell phones. Gov't restricted advocates argue that, out of fairness to everybody, we must all have black box rotary-dial phones. Would you want to bring back Ma Bell and that black rotary-dial box phone for all? For goodness' sakes, then, WHY ON EARTH would you want to do the same to health care?
If you advocate trusting the gov't with your care, then, having put your faith in a bureaucracy for such a personal and important aspect of your life, you cannot then complain that such a bureaucracy ACTS like a - BUREAUCRACY.
1. I think you will see 'pay as you go' (no insurance) clinics in Walmarts, etc., be a standard of care within 10 yrs. It's already starting. Just as $4 generic prescriptions didn't need a huge gov't bureaucracy to become a standard with lots of big-name pharmacies. The free market does the best job of mitigating price while expanding quality and cutting edge.
3. What I specifically advocate is that the gov't end tax breaks for businesses to provide for health care and instead provide those breaks directly to consumers. That would break the back of gov't supported (with lobbiest infested rules for care) tax breaks to businesses and put health care back in the hands of individuals. Combine that with health savings accounts and catastrophic insurance, and you would have a model that would control pricing and bring health care to the masses.
4. Universal health care isn't about universal coverage, at all. There are far cheaper -and less intrusive - ways to accomplish that. It's about controlling YOUR health care. It's about the money - why let YOU decide how to spend YOUR money best, when some bureaucrat in Washington knows YOUR health needs better than you do - and has the actuarial tables to prove it!
5. The only reason why a CT scan costs a thousand dollars is because, get this - YOU DON'T ACTUALLY PAY FOR IT. Remove the middle man and it would be far less. In order to have a market for a product, that market MUST be created at a price that will sustain it.
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~faith,
Timothy.
Tim, I quoted only a portion of your post ... I hope I haven't distorted your thoughts too much.
Don't let it come as a shock to you all, but I'm with Tim in his concern over gov't-run health care coverage. My reasons are a little different. Having worked in the public sector I can tell you that efficiency, cost controls and ethics are no better than in the private.
I'm just not convinced that it's such an either/or choice between "free" enterprise and government. It's "free" enterprise that gave us the medicare drug "benefit" - overpriced medications - procedures that cost thousands-to-millions - a tort system that compels us to do unnecessary care - middlemen up the wazoo - and publicly traded healthcare providers who are required by law to put their stockholders before their patients.
When I started nursing in 1972, healthcare was mostly non-profit ... costs were out of control then thanks to third party payors. Tim is right, costs were high partly because they were paid by someone else. Medicare instituted drgs in an attempt to control their costs by tying payment to a standard price for a given diagnosis. Private insurers followed the leader with their own reimbursement restrictions.
Then comes the HMO (Harvard was the first) and the for-profit healthcare companies, each, in it's own way, claiming it could control costs. The HMO would do so by concentrating on health maintenance at the level of primary care and restricting access to expensive treatments, tests and specialist care via a gatekeeper.
For-profit companies were going to control costs the old-fashioned way ... the profit motive. But that only works if costs are kept down and prices are kept high. Remember, any company that has stockholders has to put the good of the stockholders ... ie their profit ... above any other consideration.
We've had 25 years or so of these various cost-controlling measures ... they didn't work.
One definition of insanity is doing the same thing over and over again and expecting different results.
So ... I finally get to my point. I, personally can't see a way out of this mess. So, I'd like to hear more about Tim's ideas on the cheaper, less intrusive ways to provide health care/coverage. If it's through a tax break, it would have to be one honkin' break for me to afford even the level of coverage I have now. And how would we get around the fact that prices come down in response to falling demand ... and demand for health care isn't going down anytime soon?
So ... I finally get to my point. I, personally can't see a way out of this mess. So, I'd like to hear more about Tim's ideas on the cheaper, less intrusive ways to provide health care/coverage. If it's through a tax break, it would have to be one honkin' break for me to afford even the level of coverage I have now. And how would we get around the fact that prices come down in response to falling demand ... and demand for health care isn't going down anytime soon?
A free market will rise to meet demand. There are billions of cell phones on the market and in use - right now. Nobody had to ration them, and the competition to put them in YOUR hands have made them cheap: cheaper than that black rotary-dial phone was 30 yrs ago.
Here's a four-part plan to make health care affordable. The number one aspect of any such plan is that it must be primary-payor: the user must retain control of the dollars in order to maintain cost-conscience choice.
1. End employer tax breaks for coverage. Employer provided coverage would fall to nothing inside of 3 yrs. Good. You shouldn't be forced to keep a job to keep insurance.
2. Give citizens a 2-fold tax break.
A. - a $5,000/person Health Savings Account (HSA) tax deduction that allows a pool of money to grow tax free for use in health care. Similar to the cafeteria/flex plans many employers use now, but able to "rollover" year to year. When the average person is healthy - in their 20's, this account will build as it's not used much so that, when you're 50-ish, and more prone to chronic problems, you have a relatively big account to pay for care.
B. - Make a catastrophic plan tax deductible as well.
3. Catastrophic Insurance. - Covers only big expenses. Your car insurance doesn't pay for gas and tune-ups, and neither should health INSURANCE. Today's Health Insurance isn't insurance at all; it's pre-paid health care. Make it Insurance: 5k/yr deductible (conveniently the size of your HSA) - when your HSA is depleted, catastrophic coverage kicks in. But. Not before.
4. Gov't pro-rated coverage for anybody in the gap - make it a % of income so that, at about 50k for a family of four, it becomes cheaper to get your own, using the methods above.
That gov't asst would extend to the chronically ill. For example: It's cheaper for society to ensure that a diabetic has access to the right primary care than it is to treat them for non-compliance.
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Right now, Geico, State Farm, Farmer's, All State - they all market heavily to YOU for their business. Why is that? They must compete TO you for YOUR dollars. Why doesn't Blue Cross have a gecko hawking health care to you? You don't count; your employer provides your insurance and YOU have no say. THAT could change.
Give people control over their own dollars and watch health care change. With most routine care being paid "out of pocket", there will be competition for those dollars. "Come to OUR ER, and any CT scans will be free!" LOL.
There are better methods than gov't run care. There are even better methods to universality than gov't run care. Gov't run care isn't about being fair - or universal. It's about lobbyists having more of a say in what kind of care you get than YOU do. Money is power and gov't restricted care is about a few in gov't having access to the power that is 1/7th of the economy. AND. NOT. YOU.
and i will wager a bet that at least half of those billing clerks are needed to obtain payment from government health care programs.
don't even get me started on that aspect for our little rural hospital . . . . . .
i'm with tim and jolie and even heron in some aspects. " having worked in the public sector i can tell you that efficiency, cost controls and ethics are no better than in the private."
i do not understand why people think the government is the panacea, (the goddess of healing).
I do not understand WHY people think the government is the panacea, (the Goddess of Healing).
steph
I'll just quote you but it also addresses Timothy's and Heron's concerns that we're asking the government to take over health care. What some of us are saying is not turning the entire health care system into a system of government run hospitals and clinics, but keep it private. Just have a fair and equal funding source that embraces all of our citizens. Medicare and medicaide make billions of dollars in payments to private hospitals, clinics, and nursing homes throughout the country here and now. Is it such a stretch of the imagination that when all people are covered this can't continue, or is suddenly all capitalist health care going to collapse? I actually see more growth in the industry, this at a time of rising unemployment and other economic concerns, and it might actually be not be doomstay to have all people covered.
And I will wager a bet that at least half of those billing clerks are needed to obtain payment from government health care programs.
True. But government programs are pretty cut and dry with their criteria, you either meet the criteria to get paid or you don't. In some ways I appreciate it because it's not a free for all with our money. I appreciate they are pretty tightfisted. Unfortunately in these days and times they are pretty low paying in the reimbursement.
Insurance companies do the same thing to the billing clerks. "The person's IV rate was only 100 cc/hr and we only pay if they are at 125 cc/hr....DENIED PAYMENT".
Thanks, Tim ... I like a lot about your ideas, but I still have reservations.
First, if I don't like my cellphone, I don't have to buy one ... my life does not depend on having a cellphone, although you wouldn't know that from the advertising. Fact is, I don't need a phone at all. So, the dynamics of the demand side of the equation are skewed from the get-go. I like the notion of buying my own insurance rather than going with whatever my employer happens to want to offer ... I have no PCP now because there are no providers accepting my insurance taking new patients at this time. Luckily, I'm reasonably healthy and can afford to pay out of pocket.
BTW, car insurance, at least in my home state of Massachusetts, is regulated ... rates are set by the insurance commission, companies have to justify increases and account for the quality of their coverage.
I'm afraid I just don't trust that a so-called free market will operate to my benefit. If vendors/providers operated according to theory, we would probably see lower prices and at least some kind of competition in terms of quality. However, private companies manipulate markets all the time, collecting large profits for lousy quality.
If we cap profits at a reasonable rate of return and regulate marketplace behavior ... that puts us back at square one with government, with all it's ethical pitfalls, back in the picture.
A free market approach does not address the inherent conflict of interest involved in companies that earn a profit out of providing healthcare services or supplies. We already have a free market in the pharmaceutical and biomedical industries and costs have continued to climb. Affordable insurance does me no good if benefit caps do not cover what I need. 5K a year would probably cover most of my basic health care ... but my only chronic condition is high blood pressure which has been easily controlled with diet and exercise. For some people, $5000 would barely cover meds, especially if it has to stretch to cover a family rather than one person.
On the whole, though, I like your proposal.
I just don't think it's the whole answer to keeping costs under control.
True. But government programs are pretty cut and dry with their criteria, you either meet the criteria to get paid or you don't. In some ways I appreciate it because it's not a free for all with our money. I appreciate they are pretty tightfisted. Unfortunately in these days and times they are pretty low paying in the reimbursement.
Insurance companies do the same thing to the billing clerks. "The person's IV rate was only 100 cc/hr and we only pay if they are at 125 cc/hr....DENIED PAYMENT".
I understand you point Tweety, but I would like to remark on the irony of it. Proponents of government mandated, taxpayer funded health care plans often hype the "efficiency" of existing government plans as a means of cost savings over private insurance. Bunk. The paperwork and personnel required for Medicaid and Medicare reimbursement is at least equal to, if not more than that of private insurance. Hence the number of billing clerks at Duke exceeds the number of nurses.
The cost savings of current government plans stems from the pitiful reimbursement they provide and now the denial of payment for sometimes unavoidable, legitimate complications of hospitalization. (See the thread on the end of c-diff testing hospitals.) Hospitals will stay afloat only if they are able to transfer these legitimate costs onto private paying and privately insured patients. That's not government efficiency.
Gov't rationed care is a horrible idea. These guys tanked the economy, social security is on the brink of failure and is only dwarfed by the coming financial wipeout of Medicare. And, we want to trust these people with MORE control over our lives?
I think they've proven themselves to be stunning failures without giving them more to ruin.
And don't even compare the gov't with Big Health, Inc. They are one and the same. Big Health, Inc. acts the way it does because its lobbiests ensure gov't protection for what they do. Did YOU pick your health care company? Or, did your employer, at the end of a gov't tax break? Hmmmmmmmm.
I don't trust a politician more than I can throw them. They are all bought and paid for and I don't have the price for admission. They will make decisions, not in MY best interest, but in the best interest of the highest bidder/donor.
So, what are we to do? Where's the accountability? It's at the voting booth. It's our government, our health care, and most of us are fighting to regain control of it. We had an election, remember, and threw most of "those guys" out of office. Unfortunately, one of their "spokes-holes," who remains in office, Rep. Senator Mitch McConnell has said, of the auto-bailout imparticular, "Republicans won't allow the taxpayers to subsidize failure." Aw, shucks, Senator Grinch, and as you've noted, ZASHAGALKA, that's exactly what "those guys" have been asking us to do for the last eight years! We can remove the barriers to health care reform that "those guys" have left behind and move forward.
I agree that there's dirty money in politics...so have you joined the fight for public accountability and clean elections? Until then, hopefully, Obama and the new Congress will repeal Medicare part D and restore government's right to use its bulk purchasing power to negotiate lower drug prices. It's a travesty and disingenous to deprive the public sector of resources and then call it a failure. SiCKO!
We've got to end corporate "I've got a Golden Ticket" control of Congress.
It sounds to me like the main reason for your lack of support for single-payer is political fear: you agree that there needs to be change, but you apparently believe that private insurers are too powerful to cut out of the loop, and so you demonize a single-payer solution, and align yourself with the the business interests. The same political calculations and ruminations led Bill Clinton to reject a single-payer system in 1993, even though his advisers understood that a single-payer system would be the least expensive way to provide universal coverage. Instead, he proposed a complex plan designed to preserve a role for private health insurers, and yet his plan backfired. The insurers opposed it anyway, and doomed meaningful reform with their "Harry and Louise" ads. The insurers ability to make a profit depends on their ability to control the system.
So, what's your solution, throw up your hands and surrender? Or, join the fight for freedom from the terrorist insurers, who delay and withhold payment for health care to make a profit. They heartlessly deny therapeutic treatments leaving patients to die; insurance companies rescind policies at whim, leaving patients bankrupt.
Let's talk about fundamental change and an end to "market-based" medicine...that's the "stunning failure" you need to be speaking out against: it's failed to control cost or increase access to care. We don't need mandates to buy defective insurance company product. We need to get to work and expand and improve the single payer system we already have: Medicare.
Nobel prize winning economist, Paul Krugman, has made the case and supports Universal health care.
Steffie Woolhandler, MD, co-founder of Physicians for a National Health Plan(PNHP) has a degree in economics, and her organization has also made the case for single payer.
The 85,000 members of America's RN union, the National Nurses Organizing Committee (NNOC), and the Institute for Health and Socio-Economic Policy has made the case that a single payer national health plan will stimulate the economy, put people back to work, and provide access to all preventative and restorative medically necessary health care. Read all about it.
Your apparent opposition and lack of trust, (and maybe it's not opposition), stems from the fact that you've been beat up by the current system so much that you've come to accept the status quo. You have a right to your opinions, but I still have hope and believe we can, and must fundamentally change healthcare. I'll take the facts from Krugman, Reinhardt, PNHP, IHSP, NNOC, and Conyers/HR 676, and the facts speak for themselves. Give it some thought and examine the evidence. We've accomplished many social reform despite the overwhelming opposition of powerful special interests. As nurses, patients are our special interest. I have no interest in seeing for-profit medicine continue in this country. What's yours? If Canada can institute a single payer system, we certainly can. Yes, we can!
I understand you point Tweety, but I would like to remark on the irony of it. Proponents of government mandated, taxpayer funded health care plans often hype the "efficiency" of existing government plans as a means of cost savings over private insurance. Bunk. The paperwork and personnel required for Medicaid and Medicare reimbursement is at least equal to, if not more than that of private insurance. Hence the number of billing clerks at Duke exceeds the number of nurses.
The cost savings of current government plans stems from the pitiful reimbursement they provide and now the denial of payment for sometimes unavoidable, legitimate complications of hospitalization. (See the thread on the end of c-diff testing hospitals.) Hospitals will stay afloat only if they are able to transfer these legitimate costs onto private paying and privately insured patients. That's not government efficiency.
Excellent points all. I guess I missed it where people are advocating and saying that the government is more efficient than private enterprise. It's well known and understood that government bureaucracy sucks. I know the irony is that I'm asking for more government payments, which will increase the number of claimants, but that's one of the many things that needs to be worked out. I believe that we have the potential and ability to make it happen, it's going to be tough and hard work, and with the depression going on now might now be the time, but we can do it. We're Americans.
Although, I'm wondering the accuracy of the statement about Duke. When I worked there, we had about 2000 nurses. I'm finding it hard to believe there are over 2000 billing clerks.
Tweety, BSN, RN
36,267 Posts
I actually see that as people know they can get care at doctor's offices and clinics they are going to avoid ERs for simple symptoms.
Or perhaps ERs can get away with what happens at military hospitals "this is not an emergency and here is your appointment time at the clinic accross the the street, or with Dr. so and so, goodbye."
Also, if the laws of supply and demand and private enterprise hold true, investors are going to see an opportunity as more people seek and get health care. It can continue to be the growth industry it is.
I just can't see advocating that health care remain the same just so I don't have to wait in line somewhere.