National Health Care, Your Thoughts

ZASHAGALKA, RN · Aug 6, 2007

Socialized medicine as done in Great Britain would not be my cup of tea. However, free market in health care also has inherent flaws and most if the industrialized world has come to this conclusion also. So somewhere in between our system and purely socialized system seems best. How to acheive that I have no idea. A first step though would be to take the profit out of financing the reimbursement system we now have.

Somewhere between a free market system and socialized medicine is what we have now. . .

It's not a matter of taking the profit out of the system as much as it is a matter of putting back into the system cost accountability. There is no free market competition in healthcare because the system is built on and by third party payors that don't care what the ultimate consumer thinks. Return to a free market and, with unfettered competition, profit falls to its smallest possible margin in order to sell you a product you want, at a price you are willing to pay.

The free market works, but only when the gov't butts out. When the gov't puts its hands on the scale, you get what we have now. The gov't placing an even larger hand on the scale is not the solution. The solution is to remove the hand already in place.

~faith,

Timothy.

ZASHAGALKA, RN · Aug 6, 2007

Single payer is not socialized medicine. The bureaucracy you despise is far more inefficient than you realize in the private sector.

Single payor IS socialized medicine. He who pays, decides. That has always been the case.

Your cartoon, which you use in lots of places, is a lie. It is not gov't or corporations. They are one and the same.

Your cartoon of big corporation denying your care is EXACTLY what will happen when the gov't takes over: your care, for sell to the highest corporate bidder (through lobbying).

You think it's bad now, wait until those corporations, through gov't contracts, have no concerns AT ALL about competing for your business. Think . . . . Haliburton, in control of your healthcare. . .

~faith,

Timothy.

jjjoy, LPN · Aug 6, 2007

Timothy, while I see your points about the drawbacks to a national health plan, I don't see your suggestions at how to create a better system. Removing ALL government interference isn't a realistic answer. I do think the third-party payer system we have is a problem but the majority of those ARE private. Thus, I don't see how decreasing the amount of government involvement would help resolve the problems of our massive third-party payer programs. I would think better regulation of health insurance could curb some of the worst problems. I don't know enough details to make specific suggestions, but advocating a total hands-off policy by the governments sounds unrealistic when you're talking about services that aren't optional, health care costs that could easily wipe someone out financially no matter how well they prepare, and that can cause greater societal costs if they are foregone due to their current expense.

ZASHAGALKA, RN · Aug 6, 2007

Timothy, while I see your points about the drawbacks to a national health plan, I don't see your suggestions at how to create a better system. Removing ALL government interference isn't a realistic answer. I do think the third-party payer system we have is a problem but the majority of those ARE private. Thus, I don't see how decreasing the amount of government involvement would help resolve the problems of our massive third-party payer programs. I would think better regulation of health insurance could curb some of the worst problems. I don't know enough details to make specific suggestions, but advocating a total hands-off policy by the governments sounds unrealistic when you're talking about services that aren't optional, health care costs that could easily wipe someone out financially no matter how well they prepare, and that can cause greater societal costs if they are foregone due to their current expense.

Remove the tax benefits for employers to provide your insurance and place those tax breaks directly in the hands of consumers. Combined with Health Savings Accounts (HSAs), and insurance only for catastrophic care, and you would return cost accountability to the consumer.

That cost accountability would drive prices down. Doctors can only charge 200 dollars for your visit because, get this, YOU DON'T PAY THAT BILL. IF you did, they wouldn't be able to charge nearly so much. Why not? Because you wouldn't go nearly as often.

The market needs consumers, and in order to get consumers, it needs to provide a product that consumers want, and can afford.

I've given this example before: I take a BP pill - lotrel. I started with a more expensive ARB, but it didn't work, so now I'm on the combo pill, Lotrel. NOWHERE did I ever take into account how much that cost. Nowhere. Why not? My co-pay for drugs is the same, regardless which drug I choose, or which drug is chosen for me.

If I'm paying the real costs, though: you'd better believe I'd be asking about generic ca blockers and acei!!!!!!! How much will this cost me? The result: prices will come down. If lotrel had to actually compete for older generation generics, they would have to price accordingly.

You think my example is bad, try antibiotics. How many of you have taken your kids to the doc and gotton hundred dollar antibiotic prescriptions without batting an eye? Hint: amoxicillin is cheap, but that only matters if you are paying for it.

Cost accountability would return sanity to the system. It would benefit those that are currently insured. More important, it would return the cost of routine care to a level where many that cannot afford it now could participate.

My solutions:

1. End tax breaks for businesses providing health insurance, effectively ending employee sponsored insurance. Give those breaks directly to consumers. That both bypasses the lobby driven regulations on insurance AND puts control of healthcare in the hands of consumers. You don't buy your car insurance from work; why should you buy health insurance.

2. Make health insurance actual insurance, only covering catastrophic illness (hospitalization or chronic illnesses). Routine costs are borne through HSAs. That means consumers actually price compare for services. Cost accountability means that those businesses that cater to you, must actually cater to YOU.

3. Provide gov't insurance, at the State level. Make it mandatory that if you don't have your own policy, you must buy the gov't policy, and it must be paid for through payroll deduction. Charge for those policys such that, by about 125% of the poverty level, it starts, on a sliding scale, to become cheaper to buy your own coverage. Then, let people choose to either stay in an increasingly expensive federal pool, or find their own.

Of course make it free at or below the poverty level, and only incrementally increasing as salaries rise.

Everybody's covered that way. Everybody. And cost accountability shifts to consumers, thereby creating the free market conditions of affordable care.

The market can only charge what people can pay. Third party payor systems create a break in that concept, and it creates the corporations in that cartoon above that say NO. If you are not part of the equation, then, simply put, you are not part of the equation.

Take back your own choices.

~faith,

Timothy.

pickledpepperRN · Aug 6, 2007

Is there an example of free market healthcare making safe, therapeutic, effective care available to anyone working full time?

clee1 · Aug 7, 2007

Is there an example of free market healthcare making safe, therapeutic, effective care available to anyone working full time?

I can think of one.

A local Doctor; a very good, well respected one, (whom I know pretty well) takes uninsured patients three afternoons a week for the cost of $35 (cash) for the office visit. Any labs or other tests are extra, of course, but he tries to avoid those when he can - and when he can't he sends them to the lowest priced lab he can; a local storefront "Anylabs" kind of place. Meds he prescribes are most often well-established generics (from the $4 Walmart list when possible), and he gives samples out liberally.

The patients love this low-priced service, and he tells me that not having to fool with a pound of insurance paperwork and wait for up to three months for payment therefrom makes offering this service worthwhile to him. He is toying with the notion of rejecting insurance patients altogether and going strictly to this service model.

Another doctor (an EENT specialist) I know does what is termed "riding bareback". His patients sign a form every visit that explains that he a) carries NO malpractice insurance, and b) his "medical corporation" is a LLC and has very limited assets. He is a great Doc (he stays booked weeks in advance), but his prices allow working folks to see him without the need for a second mortgage.

Timothy's point is well taken. Here are two examples of where providers are taking advantage of current market conditions and providing valuable services at a reasonable price - all by cutting red tape and expenses. Get government interference and insurance company paper-pushing out of the way, and professionals CAN provide services at reasonable prices.

pickledpepperRN · Aug 7, 2007

Great! This is doable.

I know several physicians who do this.

One whose father is also a doctor. He charges $30.00 and arranges for those needing surgery to go to county.

He does take medicare only so his patients over 65 come to my hospital.

He says Medicare just pays the $30.00. All other physicians charge more than they will pay.

He wears jeans and Hawaiian shirts with a white coat. His Dad wears a suit and tie every day.

As you can imagine their patients love them.

A friend had a cancer surgery arranged by him years ago.

UKRNinUSA, RN · Aug 8, 2007

I like this idea but how does it translate into the hospital/healthcare facility setting when you need more care for a more serious illness?

A friend's mother recently received a $38,000 bill for a 6 hour ER visit that included a CT angiogram. If she had not been insured to the hilt, this would have been her responsibility. Needless to say, that kind of bill is crippling and besides I really don't understand how they can justify that kind of expense.

That prompts another question - before you undergo overpriced testing shouldn't you be informed of the risks vs benefit to your wallet ? I work with a lot of uninsured/underinsured patients in the ED and I don't ever see the price of services being discussed prior to the event. Most people are shocked to discover it costs $500 just to say hi to the doc. I can't think of any other instance that you purchase something blindly. Perhaps if people were informed up front the price of these services would go down.

pickledpepperRN · Aug 8, 2007

It is only good for the fortunate people who don't need to go to the hospital.

People with high deductable insurance couldn't use it because the doctor would have to pay someone to do the billing anyway.

Costs would have to go up to pay that person.

We really need single payer healthcare.

PHC · Aug 11, 2007

National health care or Universal health care does not equal socialized care. It is completely different. National health care allows every American citizen the right to affordable care without fluctuating costs that insurance or pharmaceutical companies control. If you consider any other public programs such as education, libraries, or even medicaid/medicare, all of these are government funded programs and they do an excellent job.

pickledpepperRN · Sep 17, 2007

Health reform failure

By Steffie Woolhandler and David U. Himmelstein | September 17, 2007

IN 1966 - just before Medicare and Medicaid were launched - 47 million Americans were uninsured. By 1975, the United States had reached an all time low of 21 million without coverage.

Now, according to the Census Bureau's latest figures, we're back where we started, with 47 million uninsured in 2006 - up 2.2 million since 2005. But this time, most of the uninsured are neither poor nor elderly.

The middle class is being priced out of healthcare. Virtually all of this year's increase was among families with incomes above $50,000; in fact, two-thirds of the newly uncovered were in the above-$75,000 group. And full-time workers accounted for 56 percent of the increase, with their children making up much of the rest.

The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth, 651,000 residents are uninsured, 65 percent more than the figure used by state leaders in planning for health reform....

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/09/17/health_reform_failure/?p1=email_to_a_friend

HM2VikingRN, RN · Sep 17, 2007

I read the BBC website's health section regularly. There is no paradise. Nurses are having a difficult time over there. Many nurses opt out of the National Health and go work for agencies. Doctors do too.
Americans have a different culture than the Europeans, and I do not think most people would tolerate rationed medical care.

We ration care in the US by ability to pay instead of real needs. That is amoral.

As to administrative costs for medicare. Medicare administrative costs are about 5% vs 15% for the private sector. To me its pretty clear that government often does deliver services to the public at a much lower cost than the private sector. Give me results over ideology anytime.