I don't know what the solution to this would be- universal health care, possibly- but it needs to be fixed! Medical bills are too high for any individual to carry sole responsibility for their payment. I have insurance, and the bills are still sometimes difficult to meet, often taking months of a payment plan in order to be rid of. This should be one of the primary concerns our government addresses in order to better medical care in our great country.
Seriously! Whats so wrong with saying everyone in America deserves Health Care!
An interesting story about health care: My wife and I had our 1st child before we were married, so my wife didn't have any insurance. Medicaid paid for everything. Perscriptions were under $5 if not free. Hospital stay was free.
Our second child was born in the same hospital, with the same group of doctors. It cost us more then $1,500. It took us 6 months to pay off.
I think greed is the only reason we haven't switched to a privatized health care system. Why provide for free what you can charge thru the nose for?
There is no such thing as "free" health care. If you are getting free care, it's because someone else has paid taxes through the nose to make that possible. The problem with universal health care is it requires the government to get into the business of decided what care will, and will not, being provided to various patients. It takes medical judgment out of the hands of physicians and puts it in the hands of federal regulatory agencies.
The problem isn't entirely greed, we have to remember that we are investing a lot in diseases that are not common and therefore cost a lot to treat and it seems to me that that is a tough thing to be against - perhaps dismantling the pharmacy lobby or the medical lobby would help but it is not a simple solution
I think people like to use the number $45M because it actually represents a small percentage. People wouldn't respond as emotionally if they used the percentage, which I think it about 15%. This number is also misleading as it counts anyone who did not have health insurance at some time during the year, as opposed to the perennially uninsured.
While I agree with the poster who states that 15% of the population sounds like much much less than 45 million. I challenge all of us to realize that having so many among us who are uninsured contributes directly to the cost burden that we all must share. I am a family nurse practitioner working in rural primary care. I had a patient who was without insurance for many years and we "made do" in the short run. By the time he was old enough to take part in the medicare system his chronic health problems (diabetes, hypertension, hyperlipidemia) were far more advanced than they would have been with more comprehensive management earlier in his life. Now the medicare system will cover much of his medical costs however they will be more expensive as his multiple co-morbidities are more progressed. The referral person in the office made a joke about sending this guy to every specialist in the area...we were waiting until he had coverage. This doesn't even acknowledge the physical and emotional cost to this person.
15% doesn't sound like much but 45 million people does? When you put that into perspective: if you are sitting in an elementary class with thirty 7 yr old children, and then you realize that 4 - 5 of them may not get immunized, or dental work, or glasses...then multiply that by every person in the USA? It's 45 million people.
And that's WITHOUT insurance. That's not counting all the people on Medicare and Medicaid. So we're paying for 15% of the population to use an Emergency room at the hospital to treat a case of tonsillitis or the flu. Plus, the insurance coverage needs to be taken into consideration of the population that is covered by PRIVATE health coverage.
For a modest income family with 3 children and one employed parent at a $15/hr job, full coverage will run him over $700/month. Sometimes more than a housing payment. So the gamble? Pay the $300/month plan where I have a $10,000 deductible. But that deductible isn't just for heart surgery or other things that could go wrong: it's for routine medical care that prevents many illnesses in children and adults. So what happens? You pay the lower rates, pray you never need long term treatment, and do everything you can to NOT take your child to the ER or to a family physician.
The numbers are deceiving. It's not just 15% you pay for in ER care through tax dollars. It's everyone on Medicaid and Medicare as well (no income, low income, seniors)
I am a physician and I want my bias to be up front. I think the health care system needs fixing but the heart of this sticky debate is "Are we responsible for those who do not or cannot take responsibility for themselves?" I see many patients who work hard and do not make enough money to cover all of their medical expenses; they usually find some way (charitable organizations, medicare/medicaid, hospital "free care") to get the care they need. I have never personally turned away a patient nor have I seen the hospital I work for turn away a patient because of inability to pay, and I am proud of that. HOWEVER, I cannot tell you how many people I see abuse the system. Patients coming in on medicaid (you and I pay for their treatment) with clothes, cars, and cell phones nicer than mine. I also see well-to-do suburban yuppies driving BMWs who do not have health insurance because "they don't need it." Until something happens, but when they DO need healhtcare a public cry goes up that "It's too expensive!"
There ARE places to trim the fat in healthcare. Defensive medicine due to malpractice concerns would be my number one choice (again, I admit my bias). Second would be aggressively promoting living wills/advanced directives so that those who do not desire to have their lives prolonged with desparate measures are saved the suffering and indignity in the intensive care unit. Third would be REDUCING (not INCREASING) the administrative costs of healthcare. Every year, more and more government regulations on healthcare delivery require more and more documentation. The hospital I work for has nurses who are hired to do nothing but check charts. They look at the progress notes I write every day to correct them. And when I say correct I do not mean correct a medical error, but an administrative one. If I say a patient has a low hematocrit and I am ordering a unit of blood for transfusion, they flag it and ask me to correct it to say the patient has "anemia." You see, medicare reimburses for blood transfused for "anemia" but not for "low hematocrit." (They're different words for the same thing.) So, when you complain how expensive healthcare is realize that part of your healthcare dollar (insurance premium, taxes, etc) goes to pay these administrators WHO HAVE NOTHING TO DO WITH HELPING PATIENTS. The ONLY thing they do is help the hospital and doctors jump through the hoops medicare sets up to get paid. Realize this: Universal healthcare = more hoops = more money spent on healthcare NOT ACTUALLY RELATED TO PATIENT CARE.
A solution is needed but I am not convinced that a single payer system is it. My two cents.
How very nice for you to have never had to turn away a patient.
I live in Puerto Rico and am on government health insurance that is called simply "The Reform". I have been suffering from chronic pain since I was a small child, as well as verifiable physical symptoms such as a turned-under ankle, a cervical compression, loss of mobility in my right arm, and a displaced meniscus in my jaw. The problem with my jaw started 5 years before it finally locked up permanently; I waited for a year and a half while my request for surgery was being evaluated. It was finally denied 6 months ago, right around the time that the left side of my jaw started showing the same symptoms. I have had pinched nerves in my lower back over the years, some which put me on a cane for years at a time and one which put me in a wheelchair for several months. I'm sure that you know pinched nerves are highly treatable and that a 22-year-old should not have had to wait until she was 24 to get her EMG approved, and then until she was nearly 25 for the results to be released and treatment to be applied. That spanned the period of time in which I graduated from college and received my teaching license, but I was listed as unemployable due to my poor health. (I don't have to point out the illegality of that to you, either, I'm sure, but I will anyway, considering the prejudices to which you freely admit.)
Now, think about me as a person for a moment, not just a patient. I was born in Massachusetts and was raised in Puerto Rico. I grew up on Welfare. I graduated high school with high honors. I studied to be a Music teacher. I was an Opera singer. Partway through college my physical problems prevented me from continuing my singing career, but I did finish school. I graduated Magna Cum Laude, and accepted my diploma with the hand that wasn't holding the cane. The government decided I was unemployable because I am ill, so I continued to live off of Welfare. My government health insurance would not treat, or even attempt to diagnose my condition, so I continued to be unemployable and a drain on taxpayers' money instead of being able to live my life and have the career I had sought and worked toward. When I was 28, a doctor finally stopped long enough to really consider my complete list of symptoms instead of just telling me to "take some aspirin and get over it". What everyone had designated "symptomatic of possible Fibromyalgia" turned out to be Osteoarthritis.
I am now 29. I wear a back brace. I walk with a cane most days. My mouth opens about an inch, but there's not much I can chew. I still can't use my right arm much. My doctor won't send me for a lumbar x-ray even though the pain is excruciating; x-rays cost money. My jaw surgery was shelved; it would cost $6,500, which I don't have and The Reform won't pay. I'm still living on Welfare. I have never used my teaching license. I can no longer turn my neck or use my arm well enough to drive a car. Unless Universal Health Care is implemented and covers Puerto Rico, this is how I will live out my life... or worse. Untreated Osteoarthritis certainly doesn't "get better". I am a fighter. Always have been. If I wasn't, I wouldn't have a college degree in spite of everything. Don't you think someone who has been fighting as hard as I have deserves the chance to have enough treatment to reach "comfortable" and maybe someday "employable"? Then I wouldn't be on Welfare anymore. Then I would be able to work and use my own money for my health care instead of yours.
Isn't that what you want? It's certainly what *I* want. I am the kind of person who has a hard time asking for help, never mind charity. Do you really think I want to be living off of you and every other employed person in America? It makes me feel as worthless as my $2 t-shirt.
First, as an RN I would like to say that my heart goes out to you. What a sad state of affairs that you have had to live with a very treatable condition but you keep running into problems with our healthcare system. These kinds of situations should never occur. I would like to ask you some simple questions using parts of your letter. First, you stated: "I live in Puerto Rico and am on government health insurance that is called simply "The Reform". " So by your own admission you are using government funded (not free) healthcare.
Second, you stated:
"The problem with my jaw started 5 years before it finally locked up permanently; I waited for a year and a half while my request for surgery was being evaluated. It was finally denied 6 months ago,"
and followed that up with more stories about how your government funded healthcare was dragging out and eventually denying you treatment:
"you know pinched nerves are highly treatable and that a 22-year-old should not have had to wait until she was 24 to get her EMG approved, and then until she was nearly 25 for the results to be released and treatment to be applied. That spanned the period of time in which I graduated from college and received my teaching license,"
followed by your clain that the government "illegally" declared you unemployable:
"but I was listed as unemployable due to my poor health. (I don't have to point out the illegality of that to you, "
You then argue that MORE government funded healthcare would solve the above mentioned problems:
"Unless Universal Health Care is implemented and covers Puerto Rico, this is how I will live out my life... or worse."
I fail to see how giving an already bloated government control over your health care needs will solve your problems. You seem to be arguing against the inefficiency of your government funded healthcare only to argue in favor of adding more inefficient government control. I would ask you to read about the horror stories of people living and dying with government funded healthcare in places like England. Those people are trying to move out of such systems. If you know any veterans please ask them what they think of their government funded healthcare at V.A. hospitals. Most of them will tell you it's horrible. I worked in the V.A. system for years and had to leave it because I got sick of the bureaucrats tying my hands when it came to providing care.
Let's all try to figure out ways to solve these types of problems without putting our life-altering decisions in the hands of bureaucrats who know nothing about you and care nothing about you. Please find a medical provider who is willing to sit down with you and help figure out a way to get you the treatment you need.
My friend, Rick is 65 years of age. His wife is 60. Rick's healthcare is handled through medicare and a supplemental. His wife, Cindy has to pay over $700.00 monthly for health insurance. By the time Cindy gets to be 65 they will have paid $42,000 in premimums just for her. Isn't this a nice way to enjoy your retirement years?
Canada has a national health care system I think we should try. If you don't care for the service, you can buy health care. At least every american could have a better chance of staying out of debt.
How else can healthcare costs be constrained in the USA? Look at the reduced cost of prescriptions in Canada? This is the United States of America. There should be a way for americans to afford healthcare at a reasonable cost. God Bless this land.
I keep seeing this 45 million number or the 15% of population figure as those without health care.
I am somewhat skeptical of this number because I have yet to see a more detailed breakdown of its components.
For example are illegal aliens counted in this number?
How many of these people are already on medicaid or are able to be treated by free clinics etc.?
How many of those counted in this number are temporarily without health care as opposed to how long these people have been without care?
There are probably other questions that could be asked. But the point is that before statistics are bandied about so easily as one of the reasons we need health care reform, we should attempt to understand the reliability of this number. Knowing the sub-components of this population would also help identify where to direct reforms target at this population.
Uwe E. Reinhardt is an economics professor at Princeton.
In the previous two posts, I sought to explain why the public health insurance plan that Barack Obama had firmly promised during the presidential campaign appears to have become a deal-breaker in President Obama’s quest to sign a genuinely bipartisan health reform bill later this year.
What if that plan were sacrificed on the altar of bipartisanship? Would it be the end of meaningful health reform?
Not necessarily, if the health systems of the Netherlands, Germany and Switzerland are any guide.
None of these countries uses a government-run, Medicare-like health insurance plan. They all rely on purely private, nonprofit or for-profit insurers that are goaded by tight regulation to work toward socially desired ends. And they do so at average per-capita health-care costs far below those of the United States — costs in Germany and the Netherlands are less than half of those here.
To see how this can work, think of the basic functions that any health system must perform. To wit:
* 1. the financing of health care, that is, the extraction of the required funds from individuals and households who ultimately pay for 100 percent of all health care
* 2. the pooling of individual risks with the aim of protecting individuals and households from the high costs of medical care in case of illness
* 3. the purchasing of health care from its providers (doctors, hospitals, drug companies, etc.)
* 4. the production of health care goods and services
* 5. the regulation of the entire system so that it operates towards socially desired ends.
Who should perform these functions is powerfully driven by the distributive social ethic that nations wish to impose upon their health systems.
In Europe, as in Canada, that social ethic is based on the principle of social solidarity. It means that health care should be financed by individuals on the basis of their ability to pay, but should be available to all who need it on roughly equal terms. The regulations imposed on health care in these countries are rooted in this overarching principle.
First, these countries all mandate the individual to be insured for a basic package of health care benefits.
Many Americans oppose such a mandate as an infringement of their personal rights, all the while believing that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it. This immature, asocial mentality is rare in the rest of the world. An insurance sector that must insure all comers at premiums that are not contingent on the insured’s health status — a feature President Obama has promised — cannot function for long if people can go without insurance when they are healthy, but are entitled to premiums unrelated to their health status when they fall ill.
Second, these nations try to tailor the individual’s contribution to the financing of health care closely to the individual’s ability to pay — almost perfectly so in Germany, albeit less perfectly in the other two countries.
In Germany, statutory health insurance, which covers 90 percent of the population, is financed by a payroll tax. The individual’s premium is not a per-capita levy, as it is in the United States. It is purely income-based. Ostensibly, about 45 percent of the premium is contributed by employers, although economists are persuaded that ultimately all of it comes out of the employee’s take-home pay (See this and this).
An employee’s non-working spouse is automatically covered by the employee’s premium.
Unemployment insurance pays the premiums for unemployed individuals, and pension funds share with the elderly in financing their premiums, which are set below actuarial costs for the elderly.
Finally, premiums for children are covered by government out of general revenues, on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility.
The health insurance premiums paid by Germans are collected in a national, government-run central fund that effectively performs the risk-pooling function for the entire system. This fund redistributes the collected premiums to some 200 independent, nongovernmental, competing, nonprofit “sickness funds” among which Germans can choose.
For example, if individual A chooses sickness fund X, then the central fund will give to fund X a capitation payment that uses over 80 variables to identify individual A’s actuarial risk. The same payment would be made for this individual to any other fund.
Thus, the sickness funds in Germany only perform the third function mentioned above — acting as purchasing agents on behalf of the central fund and patients.
Space does not permit a detailed description of the Dutch and Swiss systems. But these countries, too, have married the financing and risk-pooling systems, which try to own up to the principle of social solidarity, with a delegation of the purchasing function to competing, private insurance carriers. In the Netherlands, the latter may be for profit or not for profit. In Switzerland, they are basically nonprofit, except for supplementary coverage for items not in the basic package.
All three countries offer their citizens reliable, portable health insurance based on the principle of social solidarity, but without a government-run health insurance plan like Medicare. The $64,000 question is whether America’s private health insurers would be willing to countenance the tight regulation required for that approach.
Re: your comment "I also see well-to-do suburban yuppies driving BMWs who do not have health insurance because "they don't need it." Until something happens, but when they DO need healhtcare a public cry goes up that "It's too expensive!"
This is the reason there should be a universal mandate. Otherwise, we will continue to pay for the care of the uninsured. By uninsured, I mean not only those who cannot get health insurance (due to pre-existing conditions, etc.)but those who choose not to buy health insurance.
After 20 years as a medical practice administrator, I have seen the for profit insurers delay, deny and diminish care at every turn. I have seen hard working people who earned too little to afford private insurance lose everything they own to an unexpected illness. I've seen cancer patients reach the maximum payouts on their insurance plans and have to decide between continuing treatments that may save their lives and financially destroying their families. I know how difficult it is to find a private insurer for the self employed, those over 55 or those with pre-existing conditions to find an insurer at any cost. I've lived in Europe and applaud the countries that understand that equal access to health care is the right of all of their citizens, and I'm saddened that this great nation thinks corporate profits are more important than American's lives. Although I am in favor of nationalized single payer care, I know that isn't feasible in this nation that resists change so firmly, so a public health option is the best we can hope for to make health care more affordable and more accessible. It will create competition for the for-profit insurers and drive down costs.
It's very, very important to this discussion to bear in mind that the $45 million figure includes people who HAVE ACCESS to health insurance and DON'T WANT IT. Many people do have access to coverage through employers and waive coverage, because they do not feel they need it. I am an insurance broker and I see this all the time. Employers in professions that hire a high percentange of young, healthy people, especially males (construction, landscaping, iron-working companies) often cannot meet participation requirements because so many of their employees waive coverage, even though the employer is covering 65% to 99% of the cost. Until these people are removed from the figures, we don't have an accurate idea of what the "problem" looks like.
The administration cites 45.6 million "people" are uninsured, or simply "46 million uninsured", not 46 million "Americans". This is because 21%, or 9.7 million of that 45.6 million, were not US citizens in 2007. Further, a large proportion of the uninsured Americans (a) can afford health insurance but choose not to purchase it, (b) are young (18-34) and healthy and choose not to purchase insurance, and (c) are in transition, and only without insurance for a brief period. Only 19 million go without insurance for a full year (i.e., 6% of the US population). From IBD, "The Phantom Uninsured" http://www.investors.com/NewsAndAnalysis/Article.aspx?id=479724
Not all of the uninsured would be covered anyway by the $1.6 trillion plan(i.e., $1,600 billion), and House Democrats will not yet share how we are to pay for this. From the AP http://news.yahoo.com/s/ap/20090619/ap_on_go_co/us_health_overhaul (I think the House bill is now over 1,000 pages).
We already have a solution for poor Americans who want insurance but cannot afford it: it's called Medicaid. It's a failure of Medicaid that such people remain uninsured. Perhaps we should first focus on "reforming" Medicaid. We should also demand more "transparency" from elected officials before they move to vote on such sweeping policy.
I believe there are already current structures in place to provide healthcare for the 45 million uninsured Americans without retooling the entire system. For example, why can't the majority of hospitals -- which are not-for-profit and largely tax exempt -- be required to serve the uninsured in their market areas for free, or lose their tax exempt status? Secondly, let us not turn our noses up at the fact that healthcare was (until recently, I do not have the lost current data) one of just two sectors of the economy that is/was still generating new jobs. Some 50,000 healthcare jobs were added in December 2008 alone. And lastly, the majority of Americans actually like the healthcare they receive. So in closing, let me say that we need to look for ways to make the current delivery system work more effectively without creating a governmental competitor to the private insurance system. Ask yourself: when was the last time the government actually did a better job of providing a consumer service than the private sector did?
Rob,
You truly have no understanding of our healthcare crisis. Of course, all Americans would love for everybody to have full healthcare insurance. The problem is that your Medicaid baby cost the rest of us over $1500 as you later found out. Do you think the doctors, nurses, and hospital equipment are free? Which of the monitors your wife and baby were on do you think you could have done without to save money? The problem isn't that healthcare services cost too much. The problem is that they're overutilized. Americans don't want to take any responsibility for their own health (60% are overweight and over 30% are obese). We could pay for all your babies if we would just treat the obese like we do cigarette smokers, and TAX THEM.
Submitted by Anonymous M : June 10, 10:23am
I don't know what the solution to this would be- universal health care, possibly- but it needs to be fixed! Medical bills are too high for any individual to carry sole responsibility for their payment. I have insurance, and the bills are still sometimes difficult to meet, often taking months of a payment plan in order to be rid of. This should be one of the primary concerns our government addresses in order to better medical care in our great country.
Submitted by Rob M : June 10, 3:03pm
Seriously! Whats so wrong with saying everyone in America deserves Health Care!
An interesting story about health care: My wife and I had our 1st child before we were married, so my wife didn't have any insurance. Medicaid paid for everything. Perscriptions were under $5 if not free. Hospital stay was free.
Our second child was born in the same hospital, with the same group of doctors. It cost us more then $1,500. It took us 6 months to pay off.
I think greed is the only reason we haven't switched to a privatized health care system. Why provide for free what you can charge thru the nose for?
Submitted by Logan P : June 10, 3:41pm
There is no such thing as "free" health care. If you are getting free care, it's because someone else has paid taxes through the nose to make that possible. The problem with universal health care is it requires the government to get into the business of decided what care will, and will not, being provided to various patients. It takes medical judgment out of the hands of physicians and puts it in the hands of federal regulatory agencies.
Submitted by Tarun S : June 10, 3:55pm
The problem isn't entirely greed, we have to remember that we are investing a lot in diseases that are not common and therefore cost a lot to treat and it seems to me that that is a tough thing to be against - perhaps dismantling the pharmacy lobby or the medical lobby would help but it is not a simple solution
Submitted by Jerry J : June 10, 6:53pm
That's a lot of people. Children don't vote. What if on this one issue we gave them the option.
Submitted by Anonymous C : June 11, 2:11pm
I think people like to use the number $45M because it actually represents a small percentage. People wouldn't respond as emotionally if they used the percentage, which I think it about 15%. This number is also misleading as it counts anyone who did not have health insurance at some time during the year, as opposed to the perennially uninsured.
Submitted by Emma A : June 12, 2:51pm
While I agree with the poster who states that 15% of the population sounds like much much less than 45 million. I challenge all of us to realize that having so many among us who are uninsured contributes directly to the cost burden that we all must share. I am a family nurse practitioner working in rural primary care. I had a patient who was without insurance for many years and we "made do" in the short run. By the time he was old enough to take part in the medicare system his chronic health problems (diabetes, hypertension, hyperlipidemia) were far more advanced than they would have been with more comprehensive management earlier in his life. Now the medicare system will cover much of his medical costs however they will be more expensive as his multiple co-morbidities are more progressed. The referral person in the office made a joke about sending this guy to every specialist in the area...we were waiting until he had coverage. This doesn't even acknowledge the physical and emotional cost to this person.
Submitted by Barb R : June 16, 2:48pm
15% doesn't sound like much but 45 million people does? When you put that into perspective: if you are sitting in an elementary class with thirty 7 yr old children, and then you realize that 4 - 5 of them may not get immunized, or dental work, or glasses...then multiply that by every person in the USA? It's 45 million people.
And that's WITHOUT insurance. That's not counting all the people on Medicare and Medicaid. So we're paying for 15% of the population to use an Emergency room at the hospital to treat a case of tonsillitis or the flu. Plus, the insurance coverage needs to be taken into consideration of the population that is covered by PRIVATE health coverage.
For a modest income family with 3 children and one employed parent at a $15/hr job, full coverage will run him over $700/month. Sometimes more than a housing payment. So the gamble? Pay the $300/month plan where I have a $10,000 deductible. But that deductible isn't just for heart surgery or other things that could go wrong: it's for routine medical care that prevents many illnesses in children and adults. So what happens? You pay the lower rates, pray you never need long term treatment, and do everything you can to NOT take your child to the ER or to a family physician.
The numbers are deceiving. It's not just 15% you pay for in ER care through tax dollars. It's everyone on Medicaid and Medicare as well (no income, low income, seniors)
Submitted by Dave F : June 18, 11:02am
I am a physician and I want my bias to be up front. I think the health care system needs fixing but the heart of this sticky debate is "Are we responsible for those who do not or cannot take responsibility for themselves?" I see many patients who work hard and do not make enough money to cover all of their medical expenses; they usually find some way (charitable organizations, medicare/medicaid, hospital "free care") to get the care they need. I have never personally turned away a patient nor have I seen the hospital I work for turn away a patient because of inability to pay, and I am proud of that. HOWEVER, I cannot tell you how many people I see abuse the system. Patients coming in on medicaid (you and I pay for their treatment) with clothes, cars, and cell phones nicer than mine. I also see well-to-do suburban yuppies driving BMWs who do not have health insurance because "they don't need it." Until something happens, but when they DO need healhtcare a public cry goes up that "It's too expensive!"
There ARE places to trim the fat in healthcare. Defensive medicine due to malpractice concerns would be my number one choice (again, I admit my bias). Second would be aggressively promoting living wills/advanced directives so that those who do not desire to have their lives prolonged with desparate measures are saved the suffering and indignity in the intensive care unit. Third would be REDUCING (not INCREASING) the administrative costs of healthcare. Every year, more and more government regulations on healthcare delivery require more and more documentation. The hospital I work for has nurses who are hired to do nothing but check charts. They look at the progress notes I write every day to correct them. And when I say correct I do not mean correct a medical error, but an administrative one. If I say a patient has a low hematocrit and I am ordering a unit of blood for transfusion, they flag it and ask me to correct it to say the patient has "anemia." You see, medicare reimburses for blood transfused for "anemia" but not for "low hematocrit." (They're different words for the same thing.) So, when you complain how expensive healthcare is realize that part of your healthcare dollar (insurance premium, taxes, etc) goes to pay these administrators WHO HAVE NOTHING TO DO WITH HELPING PATIENTS. The ONLY thing they do is help the hospital and doctors jump through the hoops medicare sets up to get paid. Realize this: Universal healthcare = more hoops = more money spent on healthcare NOT ACTUALLY RELATED TO PATIENT CARE.
A solution is needed but I am not convinced that a single payer system is it. My two cents.
Submitted by Maria S : June 18, 5:34pm
How very nice for you to have never had to turn away a patient.
I live in Puerto Rico and am on government health insurance that is called simply "The Reform". I have been suffering from chronic pain since I was a small child, as well as verifiable physical symptoms such as a turned-under ankle, a cervical compression, loss of mobility in my right arm, and a displaced meniscus in my jaw. The problem with my jaw started 5 years before it finally locked up permanently; I waited for a year and a half while my request for surgery was being evaluated. It was finally denied 6 months ago, right around the time that the left side of my jaw started showing the same symptoms. I have had pinched nerves in my lower back over the years, some which put me on a cane for years at a time and one which put me in a wheelchair for several months. I'm sure that you know pinched nerves are highly treatable and that a 22-year-old should not have had to wait until she was 24 to get her EMG approved, and then until she was nearly 25 for the results to be released and treatment to be applied. That spanned the period of time in which I graduated from college and received my teaching license, but I was listed as unemployable due to my poor health. (I don't have to point out the illegality of that to you, either, I'm sure, but I will anyway, considering the prejudices to which you freely admit.)
Now, think about me as a person for a moment, not just a patient. I was born in Massachusetts and was raised in Puerto Rico. I grew up on Welfare. I graduated high school with high honors. I studied to be a Music teacher. I was an Opera singer. Partway through college my physical problems prevented me from continuing my singing career, but I did finish school. I graduated Magna Cum Laude, and accepted my diploma with the hand that wasn't holding the cane. The government decided I was unemployable because I am ill, so I continued to live off of Welfare. My government health insurance would not treat, or even attempt to diagnose my condition, so I continued to be unemployable and a drain on taxpayers' money instead of being able to live my life and have the career I had sought and worked toward. When I was 28, a doctor finally stopped long enough to really consider my complete list of symptoms instead of just telling me to "take some aspirin and get over it". What everyone had designated "symptomatic of possible Fibromyalgia" turned out to be Osteoarthritis.
I am now 29. I wear a back brace. I walk with a cane most days. My mouth opens about an inch, but there's not much I can chew. I still can't use my right arm much. My doctor won't send me for a lumbar x-ray even though the pain is excruciating; x-rays cost money. My jaw surgery was shelved; it would cost $6,500, which I don't have and The Reform won't pay. I'm still living on Welfare. I have never used my teaching license. I can no longer turn my neck or use my arm well enough to drive a car. Unless Universal Health Care is implemented and covers Puerto Rico, this is how I will live out my life... or worse. Untreated Osteoarthritis certainly doesn't "get better". I am a fighter. Always have been. If I wasn't, I wouldn't have a college degree in spite of everything. Don't you think someone who has been fighting as hard as I have deserves the chance to have enough treatment to reach "comfortable" and maybe someday "employable"? Then I wouldn't be on Welfare anymore. Then I would be able to work and use my own money for my health care instead of yours.
Isn't that what you want? It's certainly what *I* want. I am the kind of person who has a hard time asking for help, never mind charity. Do you really think I want to be living off of you and every other employed person in America? It makes me feel as worthless as my $2 t-shirt.
Submitted by john k : June 19, 9:16am
Dear Maria S.
First, as an RN I would like to say that my heart goes out to you. What a sad state of affairs that you have had to live with a very treatable condition but you keep running into problems with our healthcare system. These kinds of situations should never occur. I would like to ask you some simple questions using parts of your letter. First, you stated: "I live in Puerto Rico and am on government health insurance that is called simply "The Reform". " So by your own admission you are using government funded (not free) healthcare.
Second, you stated:
"The problem with my jaw started 5 years before it finally locked up permanently; I waited for a year and a half while my request for surgery was being evaluated. It was finally denied 6 months ago,"
and followed that up with more stories about how your government funded healthcare was dragging out and eventually denying you treatment:
"you know pinched nerves are highly treatable and that a 22-year-old should not have had to wait until she was 24 to get her EMG approved, and then until she was nearly 25 for the results to be released and treatment to be applied. That spanned the period of time in which I graduated from college and received my teaching license,"
followed by your clain that the government "illegally" declared you unemployable:
"but I was listed as unemployable due to my poor health. (I don't have to point out the illegality of that to you, "
You then argue that MORE government funded healthcare would solve the above mentioned problems:
"Unless Universal Health Care is implemented and covers Puerto Rico, this is how I will live out my life... or worse."
I fail to see how giving an already bloated government control over your health care needs will solve your problems. You seem to be arguing against the inefficiency of your government funded healthcare only to argue in favor of adding more inefficient government control. I would ask you to read about the horror stories of people living and dying with government funded healthcare in places like England. Those people are trying to move out of such systems. If you know any veterans please ask them what they think of their government funded healthcare at V.A. hospitals. Most of them will tell you it's horrible. I worked in the V.A. system for years and had to leave it because I got sick of the bureaucrats tying my hands when it came to providing care.
Let's all try to figure out ways to solve these types of problems without putting our life-altering decisions in the hands of bureaucrats who know nothing about you and care nothing about you. Please find a medical provider who is willing to sit down with you and help figure out a way to get you the treatment you need.
Best wishes.
Submitted by Leo C : June 19, 4:41pm
My friend, Rick is 65 years of age. His wife is 60. Rick's healthcare is handled through medicare and a supplemental. His wife, Cindy has to pay over $700.00 monthly for health insurance. By the time Cindy gets to be 65 they will have paid $42,000 in premimums just for her. Isn't this a nice way to enjoy your retirement years?
Canada has a national health care system I think we should try. If you don't care for the service, you can buy health care. At least every american could have a better chance of staying out of debt.
How else can healthcare costs be constrained in the USA? Look at the reduced cost of prescriptions in Canada? This is the United States of America. There should be a way for americans to afford healthcare at a reasonable cost. God Bless this land.
Submitted by Tom P : June 22, 12:50pm
I keep seeing this 45 million number or the 15% of population figure as those without health care.
I am somewhat skeptical of this number because I have yet to see a more detailed breakdown of its components.
For example are illegal aliens counted in this number?
How many of these people are already on medicaid or are able to be treated by free clinics etc.?
How many of those counted in this number are temporarily without health care as opposed to how long these people have been without care?
There are probably other questions that could be asked. But the point is that before statistics are bandied about so easily as one of the reasons we need health care reform, we should attempt to understand the reliability of this number. Knowing the sub-components of this population would also help identify where to direct reforms target at this population.
Submitted by Bill B : June 26, 9:29am
This Reinhardt fella is pretty smart for a Professor at Princeton...
http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-pub...
April 17, 2009, 7:02 am
Health Reform Without a Public Plan: The German Model
By Uwe E. Reinhardt
Uwe E. Reinhardt is an economics professor at Princeton.
In the previous two posts, I sought to explain why the public health insurance plan that Barack Obama had firmly promised during the presidential campaign appears to have become a deal-breaker in President Obama’s quest to sign a genuinely bipartisan health reform bill later this year.
What if that plan were sacrificed on the altar of bipartisanship? Would it be the end of meaningful health reform?
Not necessarily, if the health systems of the Netherlands, Germany and Switzerland are any guide.
None of these countries uses a government-run, Medicare-like health insurance plan. They all rely on purely private, nonprofit or for-profit insurers that are goaded by tight regulation to work toward socially desired ends. And they do so at average per-capita health-care costs far below those of the United States — costs in Germany and the Netherlands are less than half of those here.
To see how this can work, think of the basic functions that any health system must perform. To wit:
* 1. the financing of health care, that is, the extraction of the required funds from individuals and households who ultimately pay for 100 percent of all health care
* 2. the pooling of individual risks with the aim of protecting individuals and households from the high costs of medical care in case of illness
* 3. the purchasing of health care from its providers (doctors, hospitals, drug companies, etc.)
* 4. the production of health care goods and services
* 5. the regulation of the entire system so that it operates towards socially desired ends.
Who should perform these functions is powerfully driven by the distributive social ethic that nations wish to impose upon their health systems.
In Europe, as in Canada, that social ethic is based on the principle of social solidarity. It means that health care should be financed by individuals on the basis of their ability to pay, but should be available to all who need it on roughly equal terms. The regulations imposed on health care in these countries are rooted in this overarching principle.
First, these countries all mandate the individual to be insured for a basic package of health care benefits.
Many Americans oppose such a mandate as an infringement of their personal rights, all the while believing that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it. This immature, asocial mentality is rare in the rest of the world. An insurance sector that must insure all comers at premiums that are not contingent on the insured’s health status — a feature President Obama has promised — cannot function for long if people can go without insurance when they are healthy, but are entitled to premiums unrelated to their health status when they fall ill.
Second, these nations try to tailor the individual’s contribution to the financing of health care closely to the individual’s ability to pay — almost perfectly so in Germany, albeit less perfectly in the other two countries.
In Germany, statutory health insurance, which covers 90 percent of the population, is financed by a payroll tax. The individual’s premium is not a per-capita levy, as it is in the United States. It is purely income-based. Ostensibly, about 45 percent of the premium is contributed by employers, although economists are persuaded that ultimately all of it comes out of the employee’s take-home pay (See this and this).
An employee’s non-working spouse is automatically covered by the employee’s premium.
Unemployment insurance pays the premiums for unemployed individuals, and pension funds share with the elderly in financing their premiums, which are set below actuarial costs for the elderly.
Finally, premiums for children are covered by government out of general revenues, on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility.
The health insurance premiums paid by Germans are collected in a national, government-run central fund that effectively performs the risk-pooling function for the entire system. This fund redistributes the collected premiums to some 200 independent, nongovernmental, competing, nonprofit “sickness funds” among which Germans can choose.
For example, if individual A chooses sickness fund X, then the central fund will give to fund X a capitation payment that uses over 80 variables to identify individual A’s actuarial risk. The same payment would be made for this individual to any other fund.
Thus, the sickness funds in Germany only perform the third function mentioned above — acting as purchasing agents on behalf of the central fund and patients.
Space does not permit a detailed description of the Dutch and Swiss systems. But these countries, too, have married the financing and risk-pooling systems, which try to own up to the principle of social solidarity, with a delegation of the purchasing function to competing, private insurance carriers. In the Netherlands, the latter may be for profit or not for profit. In Switzerland, they are basically nonprofit, except for supplementary coverage for items not in the basic package.
All three countries offer their citizens reliable, portable health insurance based on the principle of social solidarity, but without a government-run health insurance plan like Medicare. The $64,000 question is whether America’s private health insurers would be willing to countenance the tight regulation required for that approach.
Submitted by Jan M : June 27, 12:15am
Re: your comment "I also see well-to-do suburban yuppies driving BMWs who do not have health insurance because "they don't need it." Until something happens, but when they DO need healhtcare a public cry goes up that "It's too expensive!"
This is the reason there should be a universal mandate. Otherwise, we will continue to pay for the care of the uninsured. By uninsured, I mean not only those who cannot get health insurance (due to pre-existing conditions, etc.)but those who choose not to buy health insurance.
Submitted by annie s : June 28, 11:37am
After 20 years as a medical practice administrator, I have seen the for profit insurers delay, deny and diminish care at every turn. I have seen hard working people who earned too little to afford private insurance lose everything they own to an unexpected illness. I've seen cancer patients reach the maximum payouts on their insurance plans and have to decide between continuing treatments that may save their lives and financially destroying their families. I know how difficult it is to find a private insurer for the self employed, those over 55 or those with pre-existing conditions to find an insurer at any cost. I've lived in Europe and applaud the countries that understand that equal access to health care is the right of all of their citizens, and I'm saddened that this great nation thinks corporate profits are more important than American's lives. Although I am in favor of nationalized single payer care, I know that isn't feasible in this nation that resists change so firmly, so a public health option is the best we can hope for to make health care more affordable and more accessible. It will create competition for the for-profit insurers and drive down costs.
Submitted by Anonymous L : June 30, 12:24pm
It's very, very important to this discussion to bear in mind that the $45 million figure includes people who HAVE ACCESS to health insurance and DON'T WANT IT. Many people do have access to coverage through employers and waive coverage, because they do not feel they need it. I am an insurance broker and I see this all the time. Employers in professions that hire a high percentange of young, healthy people, especially males (construction, landscaping, iron-working companies) often cannot meet participation requirements because so many of their employees waive coverage, even though the employer is covering 65% to 99% of the cost. Until these people are removed from the figures, we don't have an accurate idea of what the "problem" looks like.
Submitted by Jason H : July 1, 1:07pm
The administration cites 45.6 million "people" are uninsured, or simply "46 million uninsured", not 46 million "Americans". This is because 21%, or 9.7 million of that 45.6 million, were not US citizens in 2007. Further, a large proportion of the uninsured Americans (a) can afford health insurance but choose not to purchase it, (b) are young (18-34) and healthy and choose not to purchase insurance, and (c) are in transition, and only without insurance for a brief period. Only 19 million go without insurance for a full year (i.e., 6% of the US population). From IBD, "The Phantom Uninsured" http://www.investors.com/NewsAndAnalysis/Article.aspx?id=479724
Not all of the uninsured would be covered anyway by the $1.6 trillion plan(i.e., $1,600 billion), and House Democrats will not yet share how we are to pay for this. From the AP http://news.yahoo.com/s/ap/20090619/ap_on_go_co/us_health_overhaul (I think the House bill is now over 1,000 pages).
We already have a solution for poor Americans who want insurance but cannot afford it: it's called Medicaid. It's a failure of Medicaid that such people remain uninsured. Perhaps we should first focus on "reforming" Medicaid. We should also demand more "transparency" from elected officials before they move to vote on such sweeping policy.
Submitted by Anonymous T : July 1, 4:54pm
I believe there are already current structures in place to provide healthcare for the 45 million uninsured Americans without retooling the entire system. For example, why can't the majority of hospitals -- which are not-for-profit and largely tax exempt -- be required to serve the uninsured in their market areas for free, or lose their tax exempt status? Secondly, let us not turn our noses up at the fact that healthcare was (until recently, I do not have the lost current data) one of just two sectors of the economy that is/was still generating new jobs. Some 50,000 healthcare jobs were added in December 2008 alone. And lastly, the majority of Americans actually like the healthcare they receive. So in closing, let me say that we need to look for ways to make the current delivery system work more effectively without creating a governmental competitor to the private insurance system. Ask yourself: when was the last time the government actually did a better job of providing a consumer service than the private sector did?
Submitted by Anonymous F : July 6, 1:14am
Rob,
You truly have no understanding of our healthcare crisis. Of course, all Americans would love for everybody to have full healthcare insurance. The problem is that your Medicaid baby cost the rest of us over $1500 as you later found out. Do you think the doctors, nurses, and hospital equipment are free? Which of the monitors your wife and baby were on do you think you could have done without to save money? The problem isn't that healthcare services cost too much. The problem is that they're overutilized. Americans don't want to take any responsibility for their own health (60% are overweight and over 30% are obese). We could pay for all your babies if we would just treat the obese like we do cigarette smokers, and TAX THEM.
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