After posting the piece about Nurses traveling to Germany and reading the feedback. I would like to open up a debate on this BB about "Universal Health Care" or "Single Payor Systems"
In doing this I hope to learn more about each side of the issue. I do not want to turn this into a heated horrific debate that ends in belittling one another as some other charged topics have ended, but a genuine debate about the Pros and Cons of proposed "Universal Health Care or Single Payor systems" I believe we can all agree to debate and we can all learn things we might not otherwise have the time to research.
I am going to begin by placing an article that discusses the cons of Universal Health Care with some statistics, and if anyone is willing please come in and try to debate some of the key points this brings up. With stats not hyped up words or hot air. I am truly interested in seeing the different sides of this issue. This effects us all, and in order to make an informed decision we need to see "all" sides of the issue. Thanks in advance for participating.
Michele
I am going to have to post the article in several pieces because the bulletin board only will allow 3000 characters.So see the next posts.
I agree with Linda. Allowing individuals and compnies to buy into a Tricare style insurance program is good social policy. It achieves substantial administrative simplification and cost savings, establishes a plan with consistent appropriate benefits and forces private insurers to compete with each other to provide best care IAW evidence based standards.
The other part of this is to mandate participation in financing the health care system by employers and individuals. In other words "pay or play." Its not IF you are going to carry coverage its WHICH coverage you are carrying. Some companies and individuals may prefer purchasing insurance through a medicare for all plan others may choose to use a private insurer. The reality is that we as a nation must flatten the curve of health care inflation and the big dollars that we can attack are in the admnistrative area. Consistent benefit sets are an essential part of reining in the administrative cost monster. Also the private insurers must accept all comers. We can also specify that Administrative costs may not exceed 5% of health costs. I could support a role for private health care insurers AS LONG AS THEY OPERATE WITHIN THE SAME ADMINISTRATIVE COST RATIO AS TRADITIONAL MEDICARE. If they want to make a profit their profits come from cutting their administrative costs to 3%. (Medicare's actual administrative cost is 3%.) We would in effect allow them to make a profit only through aggressive administrative cost cutting. 1$ of health care should purhase 97 cents NOT 69 cents of care.
if the problem is the inability to get patients to pay at any level for their er visit, then i don't see that msas or subsidized health insurance coverage helps. it would still be cheaper to just get the *free* service.
but the service can't continue to be "free"! individuals must be required to contribute to their own healthcare costs, or we will never reign in costs.
the msa exists to give individuals an effective method to plan, budget and cover their expenses up to the deductible. if they spend it wisely, they can obtain more services.
now why can't hospitals recoup any of their costs from these patients who shirk their bills? why can't they garner wages or sue or do whatever else other bill collectors do?
frankly, i'm all for that. responsible people contact healthcare providers and work out discounts and payment plans. the irresponsible ones should be tracked down.
why aren't there 24/7 low-cost clinics right next door to ers? then at least if a patient shirks their bill at the clinic, it's only a $400 bill and not a $14,000 bill.
in my area, there are low cost clinics in every area of the city. they are under-utilized because some people expect (and get) free care by shirking er bills, or passing off expenses to taxpayers via medicare. why go to a clinic and pay $25 when you can go to the er for free? that is why it is fundamentally necessary to make individuals ultimately responsible for their own healthcare utilization and costs.
and is there any way to keep a simple office visit with a routine diagnostic and maybe a one-time prescription from costing up to $400?
by getting third party payors out of routine healthcare. my doc bills $60 for a physical with labwork if you pay out of pocket at the time of service. she gets the money immediately and her staff spends no time filing claims. she bills over $400 for the exact same service to insurance, since she has to send specimens to the lab of choice of the insurer, wait months for payment and pay her office staff to file claims.
my sister is an internist who was once offered a position in a "concierge" practice. patients paid several thousand dollars per year for all of their out-of-hospital healthcare needs, and had 24/7 access to a physician in the practice. she declined the offer, thinking that it seemed too "elitest". she now regrets that decision, as her friend in the practice is able to offer excellent 1:1 care to her patients without insurance interference, and has a number of hours each month to devote to pro-bono care. my sister's insurance-based practice does not have the time or financial resources to do either.
I fail to understand how paying for one man to make more than $120 million in one year is cost effective.
What am I missing?
HOW can the profit motive work so very well?
Good luck with the "Blues" if you actually suffer a disabling expensive illness.
Janet was an RN for years but after being diagnosed with several incurable diseases she went on disability and struggles to cover the cost of her healthcare. She's a talented pianist and an advocate for Single Payer healthcare reform in America
HSA can run out quickly when you can no longer work.
I fail to understand how paying for one man to make more than $120 million in one year is cost effective.
What am I missing?
HOW can the profit motive work so very well?
Good luck with the "Blues" if you actually suffer a disabling expensive illness.
HSA can run out quickly when you can no longer work.
That's not the 'profit motive', neither is it competition. The big insurance companies can only do these kinds of things because of the ANTI-FREE MARKET interference of gov't.
The gov't has protected their markets and allow them to act in what is an incredibly non-competitive way.
They don't need to compete. YOU aren't their customers. The government has seen to that. It did so in 2 ways.
First, it gives tax breaks to subsidize your employer to provide your insurance, thereby transferring choice away from you.
2nd, it loads up so many mandates into health care plans that most people cannot AFFORD to buy their own policies; they must buy into their gov't subsidized employer plans.
This was done on purpose. The result: the neo-mercantile lobbyists get to make 120 million a year, and your Congressman gets all the donations he could ever want.
You seem to suggest this is a failure of the free market. NO. NO. NO. This is a total failure of the REGULATION of the free market, by gov't.
Get USED to JUST this kind of action if nationalized health care passes (it won't). The lobbyists will get theirs, Congress will get theirs, and you will be an afterthought. Think Haliburton, in charge of your health care.
if the problem is the inability to get patients to pay at any level for their er visit, then i don't see that msas or subsidized health insurance coverage helps. it would still be cheaper to just get the *free* service.
but the service can't continue to be "free"! individuals must be required to contribute to their own healthcare costs, or we will never reign in costs.
the msa exists to give individuals an effective method to plan, budget and cover their expenses up to the deductible. if they spend it wisely, they can obtain more services.
when i said *free* i meant perceived as free to the person who doesn't pay for er visits. i realize that other people end up paying. my point was that if the choice is between $150/month to pay for subsidized health insurance which you pay whether you get sick or not and where you still have co-pays or deductibles versus going to an er and getting *free* service, it's understandable why someone would opt to take their chances.
it seems that a person can go to the er and leave without paying a dime but it also seems that that's not the case at low-cost clinics. how is that? because if they could get *free* care at either facility, why go to the er? do even low cost clinics refuse to give service if someone doesn't pay up front (unlike the er)? is the low-cost clinic even more crowded than the er? is it not open all hours so that working folks with odd hours can access any time?
by getting third party payors out of routine healthcare. my doc bills $60 for a physical with labwork if you pay out of pocket at the time of service. she gets the money immediately and her staff spends no time filing claims. she bills over $400 for the exact same service to insurance, since she has to send specimens to the lab of choice of the insurer, wait months for payment and pay her office staff to file claims.
i hear you there! but how to go about getting third party payors out? it's so entrenched it almost seems easier to garner support for a massive change like uhc than to try to untangle private health plans from private health care. i'm not saying it's impossible, i just don't see a clear way forward to make that happen. again, i understand the reasoning but i don't see how to make the change. any thoughts?
when i said *free* i meant perceived as free to the person who doesn't pay for er visits. i realize that other people end up paying. my point was that if the choice is between $150/month to pay for subsidized health insurance which you pay whether you get sick or not and where you still have co-pays or deductibles versus going to an er and getting *free* service, it's understandable why someone would opt to take their chances.
we can't continue to give people the choice not to pay for their healthcare. i realize you understand that healthcare is not free. my point is that we must hold recipients accountable for the services they utilize. we have to stop enabling deadbeats who take advantage of the er, walk away without paying, and stick the taxpayers with the bill. the way to do that is to provide coverage that requires them to pay for the services they utilize. if they go unnecessarily to the er, they pay big time. if they go to the clinic for more appropriate services, they pay a little. they don't get to walk away from either place without paying. they will either come to realize that services really aren't needed (for a cold), or that going to the clinic for a minor complaint is a better option than the er where their financial responsibility will be much higher.
we can't force people to do the right thing (utilize the er only when necessary), but we can and should take away the incentive that currently exists to do the wrong thing (utilize er and other expensive services unnecessarily)! we remove the incentive to do the wrong thing when we hold individuals accountable for their healthcare spending.
but how to go about getting third party payors out?
the first step in getting 3rd party payors out is exactly what i've outlined. couple higher-deductible plans with preventive care and medical savings accounts. that makes healthcare spending very predictible and easy to plan and facilitates budgeting. when patients plan their routine and preventive care in advance it is easy to negotiate discounts, just like my family doc and her $60 yearly visits. once providers see more individuals shopping for care, they will be forced to compete for cost and quality services, something they don't have to do now. insurance will still exist to cover emergency and catastrophic costs.
My reading of the literature just does not support MSA as a tool to achieve effective evidence based medical care and patient outcomes. Patients are just not very good at choosing which care can be economized. In other words they are just as likely to skip a BP pill as they are to skip a "worried well" medical appointment.
We can achieve far greater savings through tackling administrative costs.
I simply don't buy the notion that the vast majority of competent adult Americans are incapable of making sound decisions regarding their healthcare services. There will always be some who are penny-wise and pound foolish, skipping cost-effective care to save a buck. But that happens now, supposedly because people lack coverage and access to services. At least with the coverage I have suggested they would have the means to obtain services. If they choose not to do so, that is their perogative, not a fault of their coverage.
It is just too darn expensive to not design plans that encouage management of chronic disease....After the patient has a stroke who pays for rehab? It is the other people in the pool. It is far wiser to provide first dollar coverage for evidence based care for patients with chronic conditions....
This is probably enough to provide first dollar coverage for case management for the patients with chronic conditions including medications and medical management.
HM2VikingRN, RN
4,700 Posts
I agree with Linda. Allowing individuals and compnies to buy into a Tricare style insurance program is good social policy. It achieves substantial administrative simplification and cost savings, establishes a plan with consistent appropriate benefits and forces private insurers to compete with each other to provide best care IAW evidence based standards.
The other part of this is to mandate participation in financing the health care system by employers and individuals. In other words "pay or play." Its not IF you are going to carry coverage its WHICH coverage you are carrying. Some companies and individuals may prefer purchasing insurance through a medicare for all plan others may choose to use a private insurer. The reality is that we as a nation must flatten the curve of health care inflation and the big dollars that we can attack are in the admnistrative area. Consistent benefit sets are an essential part of reining in the administrative cost monster. Also the private insurers must accept all comers. We can also specify that Administrative costs may not exceed 5% of health costs. I could support a role for private health care insurers AS LONG AS THEY OPERATE WITHIN THE SAME ADMINISTRATIVE COST RATIO AS TRADITIONAL MEDICARE. If they want to make a profit their profits come from cutting their administrative costs to 3%. (Medicare's actual administrative cost is 3%.) We would in effect allow them to make a profit only through aggressive administrative cost cutting. 1$ of health care should purhase 97 cents NOT 69 cents of care.