Health Care Thread

[wdfifteen]

Another thread got off on the topic of health care/the social safety net and I don't want to hijack it, but I do think this is one of the most serious problems we face and an adult discussion of it would be helpful. So from the other thread:

Originally Posted by Noah930

wd, there's some incongruity in your posts. You claim that you're a realist. And several of your posts in this thread support that. But at the same time, you see nothing wrong with the system when it applies to your own parents. On one hand, you say the system is broken. People should not be guaranteed to anything and everything in their old(er) age. But by your own admission, you and your parents have benefitted from this broken system. And when someone (perhaps a little brusquely) suggested that your parents' situation is an example of why the system is broken, you bristled at that, claiming the other poster was cold and heartless.

I think everyone agrees that our economy can't support unlimited health care for everyone no matter how we pay for it. Porsche-O-phile said that you should only get health care if you can afford it. Rationing health care based on your ability to pay is cruel and heartless and there are much more sensible ways to do it.

My parents are both in their early 80s and in very poor health and both have DNR orders if anything life threatening occurs. The rule doctors follow is that in the absence of orders to the contrary (a DNR for example), every life saving effort will be made regardless of the patient's overall condition. There was a provision in the new health care law that reimbursed the doctor for discussing this with the patient's family so plans for DNRs etc could be made, but conservatives raise such a hue and cry that it was removed. So now we are back at unlimited care unless the patient's family intervenes (and ironically the same people who say we're spending too much are responsible for it). There is no real rationing of care when your care is paid for by taxpayers. So we need a real conversation about rationing.

Originally Posted by Noah930

You say the system is broken because it's poorly managed. So what's your solution? People pay in a pittiance, but then seem to reap a lot more in the end. That's the crux of the problem, IMO. What's the solution? Rationing? Your parents might be dead were we to have rationed their care.

My parents would definitely be dead if health care were doled out strictly on the basis of their ability to pay. You are absolutely right, we pay in a pittance, yet people who haven't yet encountered the other end of the system think they're being robbed.

American taxpayers ARE being screwed. Health insurance companies get a government subsidy to profit from selling insurance to the healthiest group of Americans - those in their working years who are healthy enough to work - while taxpayers get stuck with insuring the sickest groups - the indigent and the elderly. As I see it we can either fix that iniquity, or raise more money, or do as Porsche-O-File suggests and let the wealthy live while the poor suffer and die.

[Shaun @ Tru6]

sub'd

[porsche4life]

This will be fun to watch.... WD you do realize you are going to get to tangle with all the Drs now....

[Hugh R]

I would welcome a rational, non-inflammatory discussion of this subject (all subjects for that matter). You have to understand the concept of insurance. You bet you are going to get sick, have a car accident, your house is going to burn down (whatever type of insurance). The insurance co. is betting that won't happen. The idea of insurance is pooled risk. Let's take homeowners insurance, the insurance company is spreading the risk between thousands of homeowners, if one house burns, they pay, in the mean time, they take the premiums and invest them in whatever and make a profit on that investment. That is how they make money. They don't create their insurance company to help protect the public, they do it to make money, plain and simple. You don't like it, don't buy insurance.

You don't see regulators saying that 85% or 90% of homeowners premiums must go back to the insured do you? But in healthcare that is exactly what you see. If I can buy homeowners insurance after my house burns down, how long do you think those insurance carriers are going to survive? The same with health insurance; they won't be around if they have to offer the sick, those with illnesses (pre-existing conditions) the exact same premium as a young health, non-smoking, non-drinking heath and exercise nut.

I pay more for my fire insurance than the average Joe, why? I live in brush fire country. I should pay more, because I present more risk of a claim. Those with DUI's pay more in car insurance than those with a clean record.

The legislators tend to forget these things, and see "affordable" H/C as a "right".

BTW, for the 30 million or so that the dems point out as not having health insurance, they could have extended medicare/medicaid to them for free for a fraction of the cost that Obamacare is going to cost the country. Something like 75% of Americans were "OK" with their healthcare coverage, not delighted, but "OK". Name me one other subject were 75% of Americans were "OK", as in agreement, with any other issue.

[Dantilla]

While free health care for all is a nice idea, two main things trouble me.

1- The free market system we have encourages innovation. The incredible strides in medicine we have been priviledged to see over the last few decades is primarily the result of innovation here in America, bolstered by the ability for one to earn a profit for one's implementation of ideas. A government system would inherently stick to known methodology. Advancements in medicine would slow to a crawl.

2- We NEED to get this country's financial house in order. Get rid of the deficit, and once the incredible amount of cash currently being paid in interest is no longer neccessary, then, and only then, is it the time to consider the government covering health care expenses.

[Laneco]

I have hoped for a serious discussion of the healtcare issue in this country. A discussion that does not involve throwing chairs or hurling of insults because this issue hits real close at our house.

My mother will have medicaid but my father who is a terminal COPD patient will have no insurance at all in the next few days.

We have asked their insurance company for five years to BUY an oxygen concentrator but they insisted on a $250 per month lease. As my parents can't pay for this out of pocket, my brother bought one, much nicer than the current leased one and BRAND NEW, for $800. So how does this add up? My math skills are pretty rudimentary but I'm coming up with 60 months x $250 = $15,000. But it only costs $800 to buy out right...

This is just an example of the horrifying waste that eats up the money available to pay for healthcare. The money saved in this one area alone would probably keep my father in medication for at least a year. Quite a bit longer than a year if he does mail order prescriptions, etc.

I do not know what the answer is, but I do know what part of the equation keeps me up at night...

angela

[Tobra]

Angela, whenever I think about the medical challenges your father is confronting it makes my heart ache a bit. I have never met you, and I guess technically don't really "know" you, but what I do know is that you are a right dame and you are dealing with some pretty heavy stuff with aplomb. Your everlovin' Steve being on the other side of the planet can't make things any easier, but you are a pretty tough chick. I only hope that when the time comes for me to start confronting that parental medical stuff, I do half as well.

I like what Dan says about getting the finances in order first, but the issues are interconnected. Such a huge chunk of the expenses that are eating our lunch are due to healthcare.

When employers were prohibited from raising wages after WW II, they put the benefit packages together, as these were not restricted like wages. When the person getting the service has one or two degrees of seperation from what the service costs, the spare no expense attitude is not even a little bit surprising. A huge percentage of the average person's spending on healthcare is in the last 30 days of their life, contributing little to their quality of life. We must make difficult choices regarding this piece of the puzzle.

If the healthcare expenses are going to be subsidized in some fashion, there must be a mechanism to reconnect people to what they are spending. Perhaps a cost share based on income. This might sort of chap Hugh's ass a little, but there is a cream for that. Of course, a 15 gm tube would cost him $1700, to make up for all the people who don't have much in the way of income, so he might just choose to live with the red ass. People who have skin in the game, are going to pay more attention than those that don't, human nature.

Shaun would disagree, but tort reform will have a huge impact on our healthcare costs. A tiny portion of this would be in reduced malpractice premiums for doctors; little to none of this is going to get passed along to the consumers, but that is not where the money is. It is difficult to say how much is spent on practicing defensive medicine, but it is a LOT. There has to be some way to hold physicians accountable for mistakes, I confess I don't really know what a good way to do this would be. Peer review boards to field complaints and sanction them as appropriate maybe.

There are a lot of tough decisions that will need to be made. I don't see how politicians will be able to accomplish what will need to be done, because job number one for those mugs is keeping their jobs. If everybody is mad at you, you are not getting re-elected, and if things go as I expect, nobody is going to be all that happy with whatever deal is struck. I guess we could do it like the California Redistricting Commission, but that looks to be pretty mobbed up too, so maybe not.

[ben parrish]

Angela,
COPD is a terrible disease. For many years, I worked for a company that specialized in taking care of patients with COPD. On the cost of the concentrator; part of the cost of the machine involves the supplies that must be changed at least every week or two to reduce the chance of infection. External filters need to be cleaned weekly. Additionally, the machine needs servicing about every 1000 hours, which involves disassembly and "flushing" or changing the siev beds. Also, part of the monthly rate should cover visits by a respiratory therapist to asses his condition and communicate with his pulmonoligist to make any changes in his treatments.
The costs for a vehicle, the therapist, the technician, the liability insurance, the billing person, the business licenses, the supplies etc. are what contributes to the monthly cost. Also, there are portable tanks that need to be on hand for power outages and travel. All that being said, $250 a month is a little more than the average that Medicare pays but it is not absurd.

One more thing, to properly help your father better manage his disease, fully explore his diet. Foods high in starch and fat should be avoided..as should milk and orange juice. These foods help create excess mucus that further constricts the bronchial tubes and inhibits proper gas exchange. Does he by chance have Emphysema also?

[GH85Carrera]

No doubt the incredible wast and outright fraud is a big part of the problem. I have always wondered why it is not more like car insurance. Every policy has a deductible. If car insurance had no deductible people would take their car in for a new paint job every time there is a scratch or dent.

Many cities have patients call 911 and get an ambulance ride to the emergency room so they can get aspirin for a headache. They don't have insurance or any money so it is "free" to them. So when a responsible patient goes in for a few stitches it will cost thousands of dollars. I don't know how to stop someone from calling 911 for stupid stuff except to put them on ignore or in prison on a work detail.

We can't tell someone "sorry we can't stitch you up until you pay the deductible" but there has to be some financial sting to that patient, even if it is just picking up trash along the road.

[cairns]

I very much agree on the deductible.

My Uncle has gone to the emergency room four times in a month for a stomach ache (yes in an ambulance). Our family has had it. The hospital staff are so sick of him they've given him taxi fare to get home. He even complains about the food they offer him while he's there.

No one should have to pay for that POS and if he had to pay for it it wouldn't happen.

[vash]

i wouldnt mind a system in place where as children with aging parents..we could "flip" our insurance and have them as our dependents. we foot some of the bill, and the insurance takes care of the rest and provides some coverage for them. the profit margins in the insurance biz must be mind blowing. i know they have room to do this.

[Drisump]

As far as I'm aware, there are no health care systems in the world that are not in serious distress right now. The truth is, no matter what budget you could place for health care, it could easily balloon into infinity, and honestly, this could be for an ever smaller percentage of the population. (given the ever more exotic equipment, drugs and procedures available) In Canada, we have had universal health care for probably 40years.....but don't think it's free, I pay probably double in income taxes an average American pays for the equivalent income. I think it's apparent that a considerable segment of our population takes limited responsibility for their personal health, pay little or no taxes to sustain the system, and uses this heavily stressed system way too frequently. Every time some form of usage fee is discussed, (to discourage people from seeing Doctors for various "Bobos" or common colds, etc...) the howls calling "unfairness"starts up. I do see the writing on the wall, when no real effort is made to rationalize the system, and (as a percentage of GDP) the budget is increased yearly. Yep, utopia it isn't, but if a rational discussion can finally be engaged, the system can move toward a much more sustainable model.Cheers

[Seahawk]

I've been working through my father's (he's 81) long term health.

He has decided to "buy in" to an extended care facility in California, near Fairfield. His worry is becoming a burden on my sisters and myself. He will start living in a single unit house and then move into progressively higher levels of care as he requires it.

He moves next month. I did not pry into the financial's, but it is clear to me that there is a business case that works, at least for this particular facility. He traveled the country for six weeks looking at various facilities and settle on this one.

I'll post more when I learn more.

[wdfifteen]

The system we have is so complicated that I don't think anyone understands it. I tried to help my friend get medicaid and it was a nightmare of conflicting regulations and ignorant "customer service" people. With the help of a public advocate and my insurance agent we finally got what I think is the best deal, but still she pays some hundreds of dollars for an insurance premium every month while another friend on medicaid pays not a cent. I don't understand why and I've spent days studying it.

[cairns]

"I've been working through my father's (he's 81) long term health.

He has decided to "buy in" to an extended care facility in California, near Fairfield. His worry is becoming a burden on my sisters and myself. He will start living in a single unit house and then move into progressively higher levels of care as he requires it.

He moves next month. I did not pry into the financial's, but it is clear to me that there is a business case that works, at least for this particular facility. He traveled the country for six weeks looking at various facilities and settle on this one.

I'll post more when I learn more."

Went through this with my Father last year before he died. The nursing homes will take all his money before finally accepting Social Security. Fortunately or unfortunately, he died before they got the chance.

It's sad. When you've lost control of your brain; they basically feed you, wash and clothe you and stick you in front of a TV all day with others like you. And for that you pay a lot.

[wdfifteen]

Insurance would be made cheaper by spreading the risk out among the healthy and the not so healthy. That is the intent of the requirement in the new health care bill that everyone has to buy insurance. I doubt that it is constitutional, plus it is an invasion of your right to be stupid.
Perhaps a health insurance model that works like life insurance would work. If you start buying in at age 20 the premiums are low and guaranteed to stay low. If you don't start buying in until your 50 the premiums would be astronomical, but that's your choice. We could get rid of medicare completely.
Of course there would need to be a mechanism to keep people from scamming the system. A real problem is those stalwart individualists who swear they can take care of themselves - until they need help. Maybe every year you must file a form stating that you choose to opt out of the health care system. When you're out - you're out until next year. You show up at the ER without cash to pay and they say, "Look here. You said you didn't want to be part of the system. Go bleed in the parking lot." Like someone here said, life is brutal. At some point we have to accept that.

[wdfifteen]

Originally Posted by cairns

Went through this with my Father last year before he died. The nursing homes will take all his money before finally accepting Social Security. Fortunately or unfortunately, he died before they got the chance.
It's sad. When you've lost control of your brain; they basically feed you, wash and clothe you and stick you in front of a TV all day with others like you. And for that you pay a lot.

I have a similar situation with my father except that they interact with the residents a lot - no parking them in front of the TV all day. And they have dogs running around the place.
For payment, taxpayers used his assets (including SS) to pay for his care until they were gone, then they pay 100%. They leave enough cash from my mother's SS check for her to exist on and won't take the house until she can no longer live alone. I bought and still own the car she drove until she was unable to use it any longer. I bought her lawnmower, pay for all the lawn care and repairs on the house, basically I pay for everything except food and insurance premiums because she is not allowed to have anything.

[Superman]

I appreciate this and other mature, respectful discussions about important public policy issues. Let's lobby for a lifetime ban for whoever 'blows this up' with divisive rhetoric.

Hugh eloquently outlined the principle of "pooled risk," which explains why I feel supportive of a public solution. Individuals rarely have the financial means to "self-insure," but together we do have the resources. Indeed, whether the pool is in the hands of a for-profit corporation or a public fund, we underwrite that pool. In the case of a public fund, we potentially have two advantages. Public control, and absence of the skimming of profits from the pool.

In my mind, we have two main disadvantages to a public pool. Dantilla hit the nail on the head regarding research and advances, and so a public option should still retain those incentives that spur technological advances. Yes, this can be done. The other disadvantage is that, sadly, the public does not seem to control public policy. Given full socialization of medical services, certain forces would still whisper into the ears of legislators and exert substantial control of decisions.

Down to Earth: Decisions must be made. Rationing on the basis of who can pay means health is something you buy. I'm okay with yachts and mansions falling into this category, but if health becomes essentially unachievable except for those with yachts and mansions, then America will have moved quite a bit closer to the "winner take all" society we should fear. To the winner should go the spoils. But there will also be losers, and we are forced to decide whether our impressive and robusts medical services community should be bothered with their situation.

Wildly expensive end-of-life medical heroics should certainly be critically examined. I prefer to keep these decisions out of the hands of legislators and corporate managers. Medical professionals and patients should make them. Indeed, it looks to me as if one of the main problems in our system is the hijacking of these decisions.

I'd be very interested, Tobra, in hearing more about employers being prohibited from raising wages after WWII. Very interested. Wages form the center of my professional career, and I am unaware of any such wage regulation, following WWII or any other time in American history.

[nineball]

when i started my own business 8 years ago i was paying $185 a month for 100% coverage, no deductible, scripts and eye/teeth included. fast forward to today (now 38 years old) and i am now paying $605 a month with an 80/20 plan, scripts and eye/teeth (now limited to $100 of coverage a year which is almost pointless). on top of that i had to join a local business organization to get this insurance at it's reduced rate. originally it cost $75 a year, now it is $300.

health care sucks.

[cairns]

Down to Earth: Decisions must be made. Rationing on the basis of who can pay means health is something you buy. I'm okay with yachts and mansions falling into this category, but if health becomes essentially unachievable except for those with yachts and mansions, then America will have moved quite a bit closer to the "winner take all" society we should fear. To the winner should go the spoils. But there will also be losers, and we are forced to decide whether our impressive and robusts medical services community should be bothered with their situation.

I think we're already there. The situation noted in "As Good as it Gets" describes it perfectly. With greater government control I think we'll move even further in that direction as costs will go up, we will support an entirely new bureacracy and lawsuits have not been limited in any way. Those with the means will pay; those without will get "government" or second tier, decidedly lower quality, care.

Does everyone have a right to healthcare? Not IMO. Do I, and I think the majority of citizens want the government to develop a "safety net" to provide health care for the less fortunate? For me the answer is yes and I suspect that would be true of the majority. But do they want it to be run by the government, require over 2,000 pages of legislation, be bartered by backroom deals and exempt cronies and other special interests (such as unions, the State of Louisiana, GM etc. that the current administration favors) from its mandate? I think the last election answered that question.

I sure don't know all the answers but I would rather see the government take a nominal amount of tax dollars from all of us to fund such a system and compete it to a bidder on a best value basis (and have it recompeted every five years). Users would have a means based deductible. While it would still be second tier healthcare I think it would be much better and far more efficient healthcare than the direct government control currently looming. I would also add one more thing- anyone availing themselves of that system would consent to exempt the provider from all liablility. Within or ancillary to the contract that is let, there would have to be a separately run arbitration board to act on behalf of the victim in the event of negligence or malfeasance. The decisions of that board would be final and binding on all parties.

I don't want to buy health care via a Government mandate and I don't think the Government has the right to make me do that. But they do have the right to tax me and I would support the government levying a tax to provide healthcare for the less fortunate (not everyone) via reasonable, cost effective methods. If we could do it with the present amount being taxed (let's face it the Government could spend our money a lot more effectively) I'd be even more supportive.