I'm so frustrated. Usually my writing makes sense, and it's easy to understand, and gives some background and links.... but I just can't. I have no idea where to start. This freaking issue is huge and it's full of bullshit. I'm glad I don't have cable, because I would spend my days screaming at cable news and get nothing done.
I'm worried that the government is not going to change healthcare enough to make a differance. They may change some things, but it could make our lives worse, and make the insurence companies richer. Like making it mandatory that we get coverage, and mandatory that employers provide coverage, insurance companies would love that.
Insurance companies are just parasites, they add no value to healthcare whatsoever. It's not even insurance, there's a good chance that when you finally get sick or injured they won't even cover your ass. They'll claim you commited insurance fraud, then it's your lawyer versus theirs.
You know 60% of bankruptcys are due to healthcare bills? and 75% of those people had health insurance! Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
Socialized medicine.. Rationing care.. It's all scare tactics invented by pharmeceutical and insurance companies. You know we already ration care in this country, it's based on income. The working poor get nothing. Pay or Die.
They're trying to tell you that Obama's a socialist... he's not even a liberal! He's barely left of center, and all these conservatives are shaking in their boots that he'll turn us into Cuba. It makes me furious because all this fearmongering has nothing to do with policy, it's all politics. Some Republicans just want to see the president fail. and their happy to be on the side of insurance companies, because if they get tired of Washington they can always get more money working as a lobbyist anyway. They get rich, so fuck you, and your country.
Not sure, right.. nobody's that self centered.. here's just one case in point "one of the Blue Dog Coalition's founders: former Representative Billy Tauzin of Louisiana. Mr. Tauzin switched to the Republicans soon after the [Blue Dog] group's creation; eight years later he pushed through the 2003 Medicare Modernization Act, a deeply irresponsible bill that included huge giveaways to drug and insurance companies. And then he left Congress to become, yes, the lavishly paid president of PhRMA, the pharmaceutical industry lobby."
What's up with lobyists anyway? they're "so powerful", boo hoo, it's soo hard... even when 70% of the public is in favor of a Public option
Seriously, in this country? 70% in favor of anything is a freaking landslide. But it's still a battle to the finish because of the money being thrown around Washington. And the people who are stalling or compromising are the ones raking in the cash, like Finance Committee chairman Max Baucus, and the 'Blue Dog' coalition in the house. Ysterday news broke that the Senate Finance Committee version of Healthcare reform will not include a public option (mission accomplished health insurance pricks). Instead we'll be allowed to form health insurance co-ops that nobody has ever bothered to explain. Their plan also eliminates the employer mandate, which I think is a good thing, but within the narrow confines of washington Healthcare reform it actually raises costs for the government, especially if the individual mandate still exists.
Alright... that brings me to a really important point.
Why are employers responsible for the health of the American people?
Companies are just a bunch of people trying to make a living, why should they care where you go to the doctor? I don't think the burden of healthcare should be on employers at all. I understand offering benefits, to help you retain good employees, like paid vacations, cellphones, or whatever. But Healthcare? It's not a luxury, everybody will need healthcare at some point in their lives. Something that important should be guaranteed by the government. Like Fire, Police, Schools, Water, some things should not be left to chance. I think it's irresponsable for the government to expect business to cary the burden.
You know.. if my house is on fire, I call the fire department. If I've been robbed, I call the police. If I have a medical emergency...... Pay or Die. Something is wrong here.
I run a small business too, if I start hiring employees are they going to ask "where's my healthcare?", Really? I have enough to worry about, go ask Uncle Sam what the problem is.
Right now they're proposing taxing businesses that don't provide healthcare in order to pay for a new system. If you have over 20-30 employees you pay a fine of around $700 per person per year. Sure it makes sense if you expect to get healthcare from your employer, and we all want to get revenge on Wal-Mart for screwing their employees all these years..... But I don't think the employer based healthcare system makes sense, and I don't think coercing companies to provide healthcare coverage is a good idea, especially when we're losing jobs. Instead I think every individual should contribute, whether they employ people or not. I don't think employers should bear the burdin anymore.
I support a national Single Payer system, call it "nationalized", "government run", "socialized" or whatever you want. It's the only thing that makes sense. Abolish Health Insurance Companies, give that money to the government because they can do it cheaper and better, and they can cover everybody.
I want to choose my doctor, my hospital, my surgeries, I don't want to waste my time reading fine print in insurance contracts. You know which insurance plan gives you the most choice? Medicare. You can go to any doctor. You don't have to choose from a list of acceptable providers and get stuck with somebody far from your house. Just go to anyone accepting new patients. It's true, medicare gives you the most choice. And the Republicans want to say that a government will take away your choices? Give me a break.
I support Medicare for All. There's actually a bill that does that HR 676
How to do it? Phaise it in, the first 5 years expand it to people over 55, next, people over 45. That gives the insurance companies time to shift their business to hurricane insurance or something else.
I'm supportive of a strong public option, but I'm worried that it won't work.
alright, that's all for now, I should write more often...
here's a humorous parting shot.
That was a good article. Makes me want to move away from US as soon as I can. heh. I need to locate that book now.
Yuck. Don't you hate those pesky little drug pushers?! My advisor (back home) used to have them thrown out of the clinic by security.
and dave, I am absolutely with you on knocking out big pharma. That direct-to-consumer advertising makes me crazy. "ask your doctor if they purple pill is right for you."
Um, no. How about "trust your doctor to know which medicines to use and when, and to give you the purple pill if you need it."
Or have the drug companies teach the doctors about their drugs and when to use them. Not over a $200 dinner- but a five minute chat in the hallway. But don't solicit patients to go pester their doctors and ask them for meds they probably don't need.
Here is the New Yorker article, and a teaser quote to make you actually want to bother to click the link-
:::link:::
"McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miamiâ€"which has much higher labor and living costsâ€"spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns."
Tiny, you might enjoy the book "Better" by Atul Gawande. It is amazingly insightful, and well-written. And he writes essays on things like 'how much should doctors be paid' and one on malpractice claims, and even one on trying to mop up a polio outbreak in india. Really great stuff. he also wrote a good article in the New Yorker a couple months ago analyzing health care costs.
As far as your visit to the ER- sadly I'd say $250 isn't bad. I honestly have no idea how much an xray costs, but I would guess a couple hundred dollars. But once the xray machine and all that is paid for- it really doesn't cost the hospital anything. But I will bet you, the resident didn't see one cent of that money, and the ER docs supervising him didn't get much of it.
However- while I think that charge is typical- I don't think you should have had to pay it. Usually student health centers are somehow subsidized by the university. I.e. even if you don't have formal insurance, you can usually be seen in the student health center for free/$20.
I had my tonsils out when I was 21, and saw the 'explanation of benefits' from the insurance company. My insurance covered it, so it just cost me a copay or deductible or whatever (and actually I was on my parents' at the time anyway)- but I just remember that the bill was thousands of dollars. A very large portion of that went to the anesthesiologists. Another very large portion went to the hospital for "fees" (operating room time, etc). And a modest portion went to the surgeon. But- the 'surgeon's fee' was listed as $1500 or something (I'm making that number up), and the "amount paid" was something like $600. So, the surgeon CHARGED 1500, and insurance paid him 600. And he no say in that- he just has to eat the difference.
My brother went to the ER a couple years ago with excruciating abdominal pain. They did some bloodwork and a CT to make sure it wasn't his appendix (which is unnecessary in my opinion, but this country is so litigious that ERs are notorious for overtesting, b/c they're afraid of missing something and being sued). In the end they said he had indigestion and sent him home with some pepcid. Which on the bill was $400. For the medication. $150 for phlebotomy. Etc.
That is the part I don't understand. Why does it cost $200 to give someone a liter of saline through an IV? $400 (or even 40, because I think there was a factor-of-ten math error on the bill) for something that would cost you $2 at walgreens? You know the nurse who started the IV and hung the saline isn't making that money. Where does it go?!
I still think that bad use of the ER is a LARGE part of health care waste. Some mom is either uninsured, or doesn't feel like waiting all day in the free clinic, or doesn't want to call her pediatrician to make an appt, so she takes her kid to the ER for sniffles. That is a waste of resources. It is called the EMERGENCY room. Not the "convenience department". People don't seem to get that.
And a tangent- listening to the radio today, heard all these ads for hospitals. Memorial Sloan Kettering, Columbia Presbyterian, etc.
And that makes me want to vomit.
HOSPITALS SHOULD NOT BE ADVERTISING TO TRY TO DRUM UP BUSINESS.
How much doctors should be paid I guess is debatable. But hospitals should ABSOLUTELY be non-profit as far as I'm concerned. But now they're like just another business, all competing with each other. PUKE.
Ok, enough ranting! Time to brave the rain and go find something to drink.
Wow, that is a freaking loan. Loans are another issue, and I've posted my outrage on that before too. Maybe I'll hijack my own thread here and say that there are three big changes this country needs: Society should act collectively to provide 1)Higher Education, 2)Retirement, and 3)Healthcare.
The cost savings in a new Healthcare system SHOULD come mainly from Insurance Companies, and Pharmaceutical Companies. That's my target, and I think those industries know that their proffits could be threatened, and that's why they are lobbying so hard in Washington.
Doctors provide care. It's hands-on stuff. They're the ones preforming surgery, and directly helping the patients, they're the ones who deserve to be paid. But I wonder if Doctors might find their profession easier if they were just paid a good salary, and got periodic raises. Instead of needing to file some paperwork for everything they do in order to get paid by some middleman insurance company.
We need to save money primarily by cutting out the insurance middleman. Medicare is much more efficient than private insurance because it is not for profit, and because they don't have to advertise like insurance companies. That's where we'll save the most money.
The other part is Pharmeceutical companies. Oh boy do they like to advertise. I posted about that too, I think 40-50% of their income goes straight into advertising. And most of the R&D for drugs is done by the government and the patents are just bought by insurance companies. And when the patent expires they just change one molecule and start the advertising bonanza all over again.
it seems to me that the best way to save money is to go to a single payer insurance system, like Medicare for all, and to tightly regulate the pharmaceutical industries. And in order to eliminate medicare fraud I think we need to abandon the Fee for Service model that most hospitals and doctors use. You've heard of the MAYO clinic, they don't use fee for service, that's part of the reason they're so efficient.
Can we get there? Can we go far enough? I think we need to. Or else we'll be bankrupt. so, it's now or never. This healthcare debate has been going on for 80 years.
Good point, ((e:jenks)) and I can't say I disagree at all. Your perspective on this issue might probably be more relevant to this debate than mine ever will be because I come from a completely different system altogether.
Healthcare doesn't just comprise the medical service in India and the other commonwealth nations. It also includes medical education. The government funds the complete healthcare system from the beginning to the end. My views are completely taken from that context. Even if some of the medical schools are expensive the best schools in India are government funded. Though you pay for the resources and the facilities, the salaries of the faculty are paid by the government.
I don't think I can even begin to imagine what medical education costs here.
Where I come from, doctor *are* almost like any other civil servants (with longer hours) because health is a basic need. If you get violently sick, you don't waste time looking for your health insurance card and wondering what doctor will see you, because you don't have to. It's your right to walk into a hospital and be treated. Obviously, this doesn't work as it should because we are abysmally ineffective when it comes to population control. Let me just say that I go to great lengths to NOT get sick here because I have learned that it is going to harm me in more ways than one. And that is really quite weird.
I never said that doctors don't deserve to get paid well but they certainly don't deserve to be overpaid at the expense of an ailing healthcare system. You make an excellent point when you point out the cost of pharmaceutical products and administrative fee of insurance companies. All these factors contribute blow by blow to the mess of healthcare in this country. (Yes, pharmacies and prescriptions at home are subsidized by the govt as well.)
Tell me something. How much does an X-Ray of a forearm really cost according to you? I fell off my bike in my first year here (I was learning how to ride, btw!). I severely sprained my wrist. I already had RSI and so the pain was unbearable to the point that I was close to fainting when they looked at my hand. It was swollen and ugly. Even then, I was fairly sure there were no broken bones but they decided to get an X-Ray anyway - and that was fine. The simple visit to the University health care system along with one x-ray of a single forearm and wrist cost me $250.
The resident saw me for 2 minutes. The nurse handed me an ace bandage and a strip of NSAID and it took 2 more minutes for the X-ray.
The break-up of the bill was:
$150 - X-Ray forearm
$100 - "UHS Medical Services"
Really? $100 for 2 minutes of the resident's and 30 seconds of the nurse's time? Does that sound logical as a serviee fee? At this rate, won't people earn several times of what they ever owed... and more in no time at all?
Again, this is just one isolated personal experience. I have no other first hand extensive personal dealings with healthcare here other than the patients and relative I occasionally talk to at Roswell. In the end, I can only be a spectator and comment on the scary dread of being a patient here and miss home where getting sick is never quite such a nightmare as it is here. :(
Ack, I have too much, and too little, to say about this.
but first of all- thank you jason.
To answer your question- according to SallieMae.com, my current outstanding balance is $186,666.60.
And I am fortunate enough to NOT have any undergrad loans.
Is the point of being a doctor to make money? No. If all I cared about was money, I'd go work on wall street or something.
But, doctors put a LOT of time/money/blood/sweat/tears into their training, and sacrifice a LOT.
Some financial planner guy came and spoke to us once, showed an earnings graph of doctors vs "average" jobs. and yes, the doctors' line is a lot steeper, but it starts about 20 years later, and in fact "average joe" is better off than a doctor until they are about 55.
And with that said- can you name anyone that works harder than a doctor?
If I don't "deserve" to be paid well, who does? Athletes? Actors? CEOs of insurance companies? At least what I do is of some benefit to society.
I know that is not the point of the post, and I don't mean to hijack. And obviously I am biased here and take it to heart.
I realize there is a problem, and I don't have a solution.
Healthcare in this country is good. But it's way too expensive. So how do we cut costs? it seems like "pay doctors less" is always the first solution.
But, I dunno, how about "tell pfizer their antibiotic can't cost $500/day" or "don't pay the insurance CEO millions for sitting on his ass and DENYING people the care that they need"?
tiny your point is well taken, but to say that doctors should be paid like any other civil servant, because they CHOSE to go into medicine and knew what they were getting into, and they should be in it for the patients and not the money is not entirely fair.
Says me.
But, as always, your opinions may vary.
Nobody has put forth any myths concerning waiting lists. They're a fact of life for everyone. The number of specialists won't increase in America by adopting one system over another. I would suggest that once government gets a hold of something, there is no reversal, which is why it's so important to discuss pros and cons honestly. Government is the only enterprise we know where failure is rewarded.
You know, I'm with you guys, and I think everyone is, when it comes to day-to-day administration of health care. There certainly is waste and fraud. That has to be remedied no matter what direction we go.
The CBO has already shown us that under the current bill there will be no cost savings. I have to ask again, where are these savings coming from? It's vaporware. The options to bridge those gaps are not very palatable. Here is a link to an excerpt of Kent Conrad interviewing the Director of the CBO:
:::link:::
For us, there really is no such thing as having more people enrolled, equal or better care than they get now, on less money overall. Do you know what that sounds like to me? A pipe dream. Partisan Democrats say the Non-Partisan CBO is ignoring savings, yet decline to tell us what those savings are. I think I know why. You know, I think the savings side of the argument really should be dropped at this point until a plan comes forward that actually does save us money.
Regarding Doctors, I just don't approve of telling them how much they can earn. I have very, very dark words to describe that. How much PERSONAL debt has (e:Jenks) taken on to get to where she can actually get a paycheck? Nobody has a right to tell them, in essence, to do it out of the kindness of their own hearts. I don't care if doctors are wealthy - I expect them to be due to the length of education and training they receive, and the importance of their work. If the left starts to treat them like they treat the people who pay the country's bills?? Like YOU OWE ME THIS? Mmm. Not very flattering.
Lastly - about usage. Someone who goes to the doc every week and pays a copay is still costing every one of us for their own greed and thoughtlessness. They would never do so if they had to foot the entire $65 bill (what my doctor visit recently cost). I think we all can agree misuse of the system should be eradicated.
Bottom line - I want people to have health care, but I want a better plan. None of us should be afraid of questioning the proposals or the politicians. To think that politicians want to push this thing through without even reading the bill? And responding to the CBO by saying in essence they're lying? These people don't have our best interests at heart. Give me a better plan and I'll back it.
There are already waiting lists - do you know how long it takes to get an appt with a specialist? Last year I scheduled something in January for JUNE!
I know too many people who are uninsured. They don't go to the doctor when they should because they can't afford it so they have complications from stuff that is so easily taken care of. Broken bones, months of digestive difficulties, diabetes & dialysis... <sigh>
I just think it's a myth that in America we can get whatever medical treatment we need without a waiting list. And to say that it will be worse when managed by the government is pure speculation. This is a democracy, if we're not satisfied with the care we get we can use the phone and the voting booth to get it changed. I think we have more influence over the government than the Health Insurance Companies.
If you don't like the care you get from your insurance, what can you do? Most of us don't have a choice, you can't take your business elsewhere. Your employer provides one or two options, usually with the same insurance company. And insurance is exempt from anti-trust laws so they're already allowed to dominate the market.
And if somebody wants to go to the doctor every week they'll still have to pay, nobody said that the government would get rid of copays, it'll still cost you $10-$20, individuals will still have some 'skin in the game' there will be user fees.
If you know anyone who works in a hospital they will tell you how happy they are to deal with government health programs because there is so little 'red tape' compared to private insurance.
The potential for savings is huge too. Apparently we spend an average of $6000 more per person per year than the international average. The government alone already pays the same amount as other governments that cover everyone. And we citizens pay the other 40% of the total cost for.. what? to cover their administrative fees? If we kept the cost where it is, there would be no rationing whatsoever, there's plenty of cash to go around, but maybe it would be used to provide medical care instead.
The incentives in the healthcare system are totally backwards. Endless treatment is encouraged. "take two aspirin and call me in the morning" isn't profitable. The amount of paperwork and redundancy and inefficiency... there's so much bullshit that we need real structural changes.
Like I said, I don't think the current proposals go far enough.
Part of the waste comes from the fact that doctors bill for each service they preform. That's a lot of paperwork. Plus the more treatments they give, the more profit they make. Are we really encouraging doctors to look at patients and think, "how can I get most profit off of this person's problems" Why not put all doctors on a salary, so the only concern is making the patient comfortable and helping them stay well.
Eliminating the bureaucracy of hospital and dr ofc insurance billing staff is where the real savings comes in - universal health care is the only way to really achieve this. Electronic medical record systems may reduce billing costs some, but those are incredibly complex systems to build and integrate. At the moment there are several EMR systems available and they don't talk to each other.
"I think you have to dictate to doctors and hospitals exactly what they will be earning, which puts them in a tough position."
It doesn't. Medicine is not supposed to be a free-for-all "make-as-much-money-off-my-patients-as-I-can because I did some extra schooling and put in long hours I WANTED to put in" deal.
Doctors are not superhumans who are above the criticism of everyone else. They just got an extra degree. So what if they work 50 hour shifts? Its what they signed up to do. Its a profession and money is not the main motivation.
Doctors know exactly what they will be earning in a state funded healthcare system. They don't have a free passport to riches because they are doctors. I think its wrong and snotty for the medical profession to act as if they were doing some un-repayable favours to the rest of the population. That is not the spirit of medicine at all. Doctors and hospitals should ALWAYS be non-profit. Anyone who thinks they are going to be rich and untouchable in the profession earns my disgust. :/
"Government has to exert more control because we sure as hell can't, going to the emergency room for bullshit, misusing hospital resources, or going to the doc for every little sniffle."
Very right. The only way to police this is setting limits to what the state will fund and what you need to spend out of your pocket. For this to happen you need a corruption-free health ministry and that is, I am afraid, such an impossibly lofty ideal, I might easily believe I am in heaven when I see it as a reality.
Rationing under a government system is a guarantee, not a scare tactic, and the experience of other nations bears that out. There are only X number of health care dollars. We would be going from "rationing" under insurance companies to the same thing, only it's a government starched shirt that is going to tell you no. What happens then? Who are you going to sue? Good luck? I see it as a wash.
In terms of the levels of red tape and bureaucrats, again I see it as a wash. These things are hallmarks of government operations. Have no doubts, you are going to be still dealing with bureaucrats under a government system. There is no "me and my doctor are going to take care of me and nobody is going to get involved in my care decisions" when someone in DC makes decisions about what medicines and procedures are covered. It isn't a holy grail solution.
What is intriguing is the potential for savings. If you take away the profit motive, what does that get you? Where are the savings? What nobody has shown me is how in the USA adopting a single payer plan is going to turn a $32,000 hospital stay into a $20,000 hospital stay. What do you do? I think you have to dictate to doctors and hospitals exactly what they will be earning, which puts them in a tough position. Government has to exert more control because we sure as hell can't, going to the emergency room for bullshit, misusing hospital resources, or going to the doc for every little sniffle.
In any event, I do agree our current system is unsustainable. It breaks my heart for someone to go bankrupt because of catastrophic costs. But the CBO has been clear, the current bill on offer does not save money and in fact drives us deeper off the cliff financially. To Obama's credit, he went back to them and asked "How can we save more money?" but if we can't afford it, we can't afford it.
Speaking of Conyers, why is it that he can say more or less that it's unreasonable to read the god damned bill? They don't want to read it, they don't care what's in it, they just want to rush things through with little thought or debate. They have contempt for the rest of us. If that were Brian Higgins, I would be calling for his head, although you can be sure he's not going to be bothered to read the bill either.
Tiny, you said it perfectly "How could you let some third party money making insurance company control whether you get treated for your illness?" so true. Doctors in other countries are free to practice medicine, and do what they think is best for the patient. Here we have a useless middleman trying to squeeze a profit out of someones misery.
I don't understand why employers, doctors or patients should have to worry about an insurance bureaucrat. Health Insurance companies are an artificial economy. A waste of money that we have accepted for years because we had money to waste. Now we just can't afford them.
If Obama was liberal he would at least talk about Single Payer. and he would have opposed that sham environmental legislation instead of trying to posture behind it like it was a victory.
India has a universal state funded healthcare system but the government does not want to take any responsibility or even look at the population problem in a sensible way. Even with an efficient healthcare system, we are doomed by apathy.
d:
You've suggested that Obama is barely a liberal - you've finally rendered me speechless.
Health is a basic right. I couldn't agree more. The health insurance system here completely baffles me. How could you let some third party money making insurance company control whether you get treated for your illness? How could you do that?
I was shocked when I heard that my university would cover my "health insurance" - everything about that statement was and is still alien to me. Maintaining a healthy population should be a priority for a country of people. Health is the true wealth of any people.
Ever wonder why Japan is dead bottom of that list and still has the healthiest living centenarians?