Socialised Medicine the myths and the facts - page 30

The first and the most obvious concern is the cost to the patient and their family, we all know how devastating an illness can be for patients and their family many times I have witnessed the despair... Read More

  1. by   Jstand
    Quote from ballerinagirl
    A private company can always dictate their price. And that price will be HIGH because they can no longer deny anyone to keep their costs low.

    Of course, if there's no money to be made, why stay in that business? I think they will get out and offer a plan to cover what the govt won't cover. that would be the way to go. That way, they can call it something else -- supplemental insurance (not health insurance).

    And if competition is really what we're after to lower prices...we have just eliminated the competition. Smaller insurance companies will get out or be gobbled by bigger ones. (that's competition?)

    And there's always concierge doctors for the rich. no insurance needed.

    A private company can't ever dictate their price. Competition dictates the price. Your posts are very telling about your lack of business knowledge. You have no understanding of the insurance or the healthcare market.
  2. by   Ginger's Mom
    For me, the bill only means more taxes for me since my state has implemented all the features, so I will be paying more taxes and higher cost in healthcare. And now the federal government is controlling education.

    Ok, I am factually incorrect about GPS, in Australia you can choose your own, In Canada, you will be placed on a waiting list.

    In my state of MA, when universal health was enacted many people can not find a GP and the emergency room visits for non emergent issues has increased.


    For those of you in other countries, when one does not get the desired service who do you appeal to ? I have mentioned the VA since it is controlled by the government and to get any action you have to appeal to your local pol.
  3. by   Ginger's Mom
    Quote from ballerinagirl
    the old system is unsustainable, but the new one is also quite unsustainable. Of course, you can always sustain it with higher taxes, I suppose. The new bill doesn't address the reason for high costs. What you are doing is replacing a system w/ another one that isn't quite likely to work either. If we really wanted to cover everyone, then just cover everyone that doesn't have coverage and don't try to fix what isn't broken.

    Insurance companies have always been profitable. That's why they are in it. You think Blue Cross provides insurance so they can lose money? Obviously they are making money. They don't care how the cost rises. they already negotiated their lower rates. Next yr, they know they have to raise premiums to account for rising costs.
    As a businessman, if you can't make money off one business, you usually get out of it. So costs are rising, but they are raising their premiums to maintain profitability. either that or cut benefits, which is what some of them will do. Either way, someone will pay. This is what I mean.
    You are incorrect, in my state health insurance is non profit.
  4. by   elkpark
    Quote from MedSurg32RN
    You are incorrect, in my state health insurance is non profit.
    AFAIK, the insurance providers in MA are a mix of for-profit and not-for-profit providers. If I'm wrong about that, I'd be happy to look at some documentation that shows otherwise.
  5. by   talaxandra
    Quote from MedSurg32RN
    For those of you in other countries, when one does not get the desired service who do you appeal to ? I have mentioned the VA since it is controlled by the government and to get any action you have to appeal to your local pol.
    In Australia you can:
    - change GPs if you're not happy with the care;
    - ask for a second (or third) opinion;
    - inpatients and their families can contact patient liaison/representative (eg Alfred, RMH, Austin), who can negotiate on your behalf;
    - contact the health services commissioner, or make a complaint through the health services commissioner;
    - in significant cases, go to the relevent ombudsman;
    - or contact the state health minister.
    A fuller discussion of complain options is listed here.
    Our system is far from perfect, particularly for consumers outside high density areas (where there may only be one doctor servicing an area of several thousand square kilometers). However, as there is less (though certainly not no) emphasis on money, and because the system is funded by the public, there is a strong emphasis on disclosure and accountability.
  6. by   lamazeteacher
    Quote from medsurg32rn
    for me, the bill only means more taxes for me since my state has implemented all the features, so i will be paying more taxes and higher cost in healthcare. and now the federal government is controlling education.

    really!! you make more than $200,000/year as a nurse? those are the only people whose tax will increase as a result of reform of health care...........

    ok, i am factually incorrect about gps, in australia you can choose your own, in canada, you will be placed on a waiting list.

    you're factually incorrect about canada, too. waiting lists are for common surgeries that are elective, only. the people there are very satisfied with their health care.

    it's the doctors who bad mouth it when they come to the u.s. for conferences with our physicians. the green jealousy monster gets into their eyes when they realize how much docs here make. well that is undergoing reconstruction here, and the game rules are changing, that's what the whining and crying is all about...... in the very near future we'll get doctors out of med schools who went there to learn how to take care of people, not make billions as a priority. (no matter how much their mothers think they're due that for getting into and through their schooling).

    in my state of ma, when universal health was enacted many people can not find a gp and the emergency room visits for non emergent issues has increased.

    there aren't many in most states, as most doctors want to specialize so they can make more money. the newly signed act to reform health care will reward doctors who choose to work as outliers.

    for those of you in other countries, when one does not get the desired service who do you appeal to ? i have mentioned the va since it is controlled by the government and to get any action you have to appeal to your local pol.
    that is the way our government assures fairness, no matter what the situation that is appealed, is. the appeal is heard by a committee od experts and the person who disgrees with the decision of the first level will be heard there. here, of you disagree with a decision made by your health care provider, you go to the board of medical licensure or medical association, which exists due to monies paid by doctors, and wherein there are colleagues of the person whose viewpoint is counter to your best interest.
  7. by   Ginger's Mom
    Quote from elkpark
    AFAIK, the insurance providers in MA are a mix of for-profit and not-for-profit providers. If I'm wrong about that, I'd be happy to look at some documentation that shows otherwise.
    Do a google search Ma Health Connector, it is not consumer friendly......I also a CCM, so am well aware of insurance products. United Health or Aneta are for profit. Rarely when a patient comes in with a commercial insurance management was happy since it meant a large paryment ( most of these patients worked out of state)......

    I have also taken a 240 hour insurance course.

    What are credentials? Are a CCM? Have you had extensive training? Do you live in MA?

    I would be happy to review you credential>
  8. by   Jstand
    Quote from MedSurg32RN
    Do a google search Ma Health Connector, it is not consumer friendly......I also a CCM, so am well aware of insurance products. United Health or Aneta are for profit. Rarely when a patient comes in with a commercial insurance management was happy since it meant a large paryment ( most of these patients worked out of state)......

    I have also taken a 240 hour insurance course.

    What are credentials? Are a CCM? Have you had extensive training? Do you live in MA?

    I would be happy to review you credential>

    I am trying to figure out exactly what this post means, but it sounds like you are agreeing with the fact that it is both for profit and not for profit and then trying to argue that you know because you took a six week course in something?
  9. by   Ginger's Mom
    Quote from Jstand
    I am trying to figure out exactly what this post means, but it sounds like you are agreeing with the fact that it is both for profit and not for profit and then trying to argue that you know because you took a six week course in something?
    Unlike most nurses, I have an expertise in understanding insurance issues. I was told I was wrong that I don't know what insurance products are available in my home state, Below is a list that I have copied from the state web site. But according to another member here, I have my facts wrong. I was just making a point, A. I have more understanding about insurance issues in my home state. I was asked to provide source that I listed below.

    Easy to tell me I am wrong without providing any back up, I do know that some families who's home company is out of state may have a for profit ( aetna, United Health, etc). But these policies are not based in my home state.


    Massachusetts Health Insurance Companies

    Blue Cross and Blue Shield of Massachusetts
    The Landmark Center
    401 Park Drive
    Boston, MA 02215-3326
    1-800-262-BLUE
    (617) 246-5000

    Number of Members: 2.4 million
    Website: www.bcbsma.com

    Service area: State of Massachusetts.


    Fallon Community Health Plan
    10 Chestnut St.
    Worcester, MA 01608
    (508) 799-2100
    1-800-333-2535
    Number of Members: 185,000
    Website: www.fchp.org

    Service area: Eastern and central Massachusetts.


    Harvard Pilgrim Healthcare
    93 Worcester Street
    Wellesley, MA 02481
    1-888-888-4742
    Number of Members: 808,000
    Website: www.harvardpilgrim.org

    Service area: Network of more than 22,000 providers and 130 hospitals in Massachusetts, New Hampshire and Maine.


    Health New England
    One Monarch Place STE 1500
    Springfield, MA 01144-1500
    1-800 842-4464
    Number of Members: 100,000
    Website: www.healthnewengland.com

    Service area: Western and central Massachusetts plus Hartford, CT.


    Tufts Health Plan
    333 Wyman Street
    P.O. Box 9112
    Waltham, MA 02454-9112
    1-800-462-0224 (HMO)
    Number of Members: 811,010
    Website: www.tuftshealthplan.com

    Service area: State of Massachusetts.
  10. by   elkpark
    Quote from MedSurg32RN
    Do a google search Ma Health Connector, it is not consumer friendly......I also a CCM, so am well aware of insurance products. United Health or Aneta are for profit. Rarely when a patient comes in with a commercial insurance management was happy since it meant a large paryment ( most of these patients worked out of state)......

    I have also taken a 240 hour insurance course.

    What are credentials? Are a CCM? Have you had extensive training? Do you live in MA?

    I would be happy to review you credential>
    Ooooooh, ya got me! I'm not a CCM, I wouldn't live in MA for love or money, and I haven't taken a "240 hour insurance course, " whatever the heck that is ...

    You made a broad, vague statement, "(Y)ou are incorrect, in my state health insurance is non profit," that implied there was no such thing as for-profit insurance in MA, and I questioned that since I'm not aware of any state in the US that has no for-profit health insurance providers (indeed, in some states, there are no non-profit options available). I was already aware that there are a number of well-respected non-profit programs available in MA, but thank you for providing the links.

    You have now responded with a statement that states there are at least two for-profit companies providing health insurance in MA, United Healthcare and Aetna, so it turns out my misgivings (or misunderstanding) about your initial statement were correct, so I don't see what you're kvetching at me about.

    Whatever --
  11. by   chani
    There are many interesting and thought provoking posts in this thread. As an ozzie I have lived with some aspects of socialised medicine plus private cover all of my life. Not sure if we have the right balance and ofcourse our current government is proposing the whole sale takeover of the hospital system (currently each state is given a 'share' of taxes to run most health services in each state. The system is definitely in trouble at the moment especially here in NSW where we have had at least five health ministers in the last 3years (and on our 3rd premier [=governor in US]) so there is almost complete inertia in our current system. As we pay for our own private health insurance we dont need to worry about our next job and the cover it includes. From my perspective this is one of the biggest problems in the US, and of course because of the need to make a profit by health insurance agencies and their strong political clout.

    Choice is available in Australia, but only if you are informed and can pay, which of course a number of people are not qualified on both accounts.

    It will take some major changes in societal norms before health is sorted. Firstly the profit imperative at mulitple levels of health, from private providers, insurance and doctors.

    Secondly the general public be willing to pay what its going to cost to support the type of health outcomes they want. At this point the public do not know or wish to know how much it costs.

    Lastly a huge reality check regarding what should be available. In Oz recently there was hugely devisive story about a young mother who had caught HEp C and developed liver failure. She had a transplant and then went out and took drugs again, so her liver failed. Her family successfully obtained a $600 000 interest free loan from the state government for her to have another transplant overseas. Their only argument was that her children deserved to have a mother. Now ofcourse her children do BUT what was the opportunity cost for other mothers, fathers and children now that that $600 000 has been wasted (she died by the way). Tragic though this story may be this girl had had her chance and threw it back into the faces of the health system and the original donor family.
    This what we must ask ourselves, if we say we can fund large sums of money to keep one person alive would we say the same thing if it was denying one of our family a strong chance at a healthy life? I dont think so. When public money is being used for health costs then we have to be real about it
  12. by   talaxandra
    You may all be interested in this - two cardiologist bloggers have taken a pair of hypothetical patients, one wealthy and one less so, and run through the treatment they'd get in the UK and the US for the same condition. The background is here, the UK case studies are here, the US versions here.
    No question there's more information missing that would be useful, but it's a start

    I also came across this interesting article by two US physicians, discussing some non-patient-based reasons why the US health care system is so expensive.
  13. by   lamazeteacher
    the following information was taken from the website elk park recommended. blue cross is well known as an illegal monopoly business that has profits in the multi billions. they shuffle figures throughout theiur enormous holdings, to make points. the loss reported for 2009 of $95 million was from the dip in the stock market taken by their investments. non profits, by definition don't have investments, as there shouldn't be funds left over to buy "assets".

    at the end of the report, a kick in the reform of health care act assumes that "government regulation" will make them charge higher premiums because of higher medical costs. the author, tara murphy could not have read or doesn't understand the act, or she'd know that the costs of care will be reduced, so premiums needn't be higher.

    the fact that they claim an enrollment of 2,194,133 members of mcbsma + 500,000 members outside that state who are also members of that state's plan which gives them the majority of those covered in massachsetts bates the question of why they include out of state members in their plan for ma.

    after i worked for blue cross, i realised that it is an unconscionable, huge profit making organization with no interest in patient care, other than lowering their responsibility for its costs.



    blue cross blue shield of massachusetts files 2009 financial results

    contact: tara murray
    (617) 246-4851
    tara.murray@bcbsma.com
    boston-february 26, 2010 -- blue cross and blue shield of massachusetts, inc. (bcbsma) and blue cross and blue shield of massachusetts hmo blue, inc. (bcbsma hmo blue) announced its 2009 calendar year, statutory financial results today and is reporting a combined after-federal tax net loss of $149.2 million.
    "like most other businesses, blue cross blue shield of massachusetts has been affected by the worst economic downturn since the great depression," said allen maltz, bcbsma's chief financial officer. maltz said the company's 2009 results were the result of an adverse employment market which reduced membership; increased utilization of medical services due to the seasonal and h1n1 flu; a rise in elective procedures such as knee, hip and back surgeries, and in behavioral health utilization; as well as higher than anticipated costs associated with merging the individual and small group markets.
    maltz added, "nearly two thirds of our net loss or approximately $95 million is due to our adoption of a more conservative view of existing accounting rules which caused us to write off certain investment assets with a current market value that is below the price we initially paid." maltz said the decision was consistent with best practice accounting standards.
    bcbsma has already taken steps to improve its 2010 financial results. "before the downturn even began," said maltz, "we took action to reduce our administrative and medical costs which will help improve our financial position going forward." maltz specifically pointed to initiatives underway to reduce medical costs by eliminating the overuse, underuse and misuse of health care services that don't improve patient care but do add unnecessary costs that drive up premiums. maltz said he is concerned that future regulatory action by state government could negatively affect the company's 2010 results if premiums that reflect the cost of medical care are not approved.
    bcbsma continues to be the leading private health plan in massachusetts, with 2,924,133 members as of december 31, 2009.

    blue cross blue shield of massachusetts ( http://www.bluecrossma.com ) was founded more than 70 years ago by a group of community-minded business leaders. today, headquartered in boston, bcbsma provides coverage to more than 3 million members, 2.5 million in massachusetts. bcbsma believes in rewarding doctors and hospitals for delivering safe and effective care, and in empowering patients to take more responsibility, become educated health care consumers and become stronger partners with their doctors. blue cross blue shield of massachusetts is an independent licensee of the blue cross blue shield association.



    blue cross blue shield of massachusetts is an independent licensee of the blue cross and blue shield association.
    registered marks of the blue cross and blue shield association.
    2010 blue cross and blue shield of massachusetts, inc., and blue cross and blue shield of massachusetts hmo blue, inc.
    landmark center, 401 park drive, boston, ma 02215-3326 | 800-262-blue (2583) | tty# 800-522-1254

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