Single Payer Universal Health Care

Dahmd · May 25, 2004

"Jonathan Smith" <[email protected]> wrote in message
news:[email protected]...
> mike gray <[email protected]> wrote in message
news:<tLIsc.26690$fF3.685017@bgtnsc05-
news.ops.worldnet.att.net>...
> > matt weber wrote:
> >
> > > Because in the USA, someone other than the patient
> > > usually pays, and patient is almost entirely isolated
> > > from the cost issue, as is the physician, when a
> > > patient walks in and says my shoulder is bothering me,
> > > can you write me a prescription for Celebrex or Viox?
> > > The physician will happily do so.
>
> Why is this necessarily a bad thing? Under the assumption
> that there is a doctor-patient relationship and the
> physician does an exam to look for something other than
> muscle or joint pain due to exertion or perhaps a touch of
> arthritis, thuis makes a lot of sense. What would you do
> in this case?
>
> > That is, indeed, a major problem with the US system and
> > I'll give you another example. I sprained my wrist, went
> > to the corner dugstore and bought an Ace bandage. $3 and
> > it was fine in five weeks. My Medicare friend sprained
> > his wrist, went to the ER, X-rays, orthopedic
> > specialist, and seven weeks of physical therapy even
> > though it was fine in five weeks.
>
> And Medicare would be that huge efficient single payer
> model that we all want and need?
>
> > But "rationing" has become a buzzword in the US roughly
> > as evil as "holocaust". An insured patient who goes to a
> > doctor with a sprained wrist and gets only an Ace
> > bandage will certainly sue and just as certainly win.
>
> If the sprain wasn't a sprain and the failure to diagnose
> results in a permanent disability - yes, that is what
> would happen. Explain to me why it shouldn't.
>
> > This has created another problem: US doctors are scared
> > to death of their own patients. Very unhealthy
> > situation.
>
> I don't believe they are - they may be a bit apprehensive
> over their patients lawyers - so lets fix that.
>
> js
>

I have enjoyed reading your comments. It's much more
pleasant debating issues without vitriol. Unfortunately, as
on obstetrician I see dozens of examples every day where
physicians are so afraid of litigation that they either
refuse to see pregnant patients or, if they practice ob/gyn,
refuse to see "high risk" pregnant patients. In the last 2
years the number of ob/gyn physicians in our metropolitan
area (Orlando; about 2 million in surrounding communities)
who are willing to see high risk pregnant patients has
dwindled dramatically. Several of our top ob/gyns have left
the area rather than risk becoming part of the liability
crisis, and many others have given up obstetrics. In Dade
County (Miami) the median liability premium for those
practicing obstetrics is about $200,000 a year. Physicians
in other specialties just don't want to be exposed to those
kind of premiums.

I spoke with several physicians from various specialties in
the OR lounge today who made it clear that they will do
anything rather than treat a pregnant patient. The statute
of limitations for a newborn can be up to 21 years in
Florida, and there are several hundred ads on TV and the
radio in our area each week advising locals to sue their
physician. One series of ads suggested that ob/gyns don't
perform c/sections in a timely manner, leading to brain
damage. I would love to study the c/section rate before and
after that series of ads. I am awaiting the results of a
recent mail-in survey to read hard data, but in the
meantime, at least in Florida, fear of litigation has had a
negative impact on the availability of services and quality
of care for pregnant patients. Pregnant patients can provide
a lottery win for trial lawyers. It's to the stage where
physicians feel their careers are at risk when they care for
pregnant women. Best wishes,

Ashley

Muscleman · May 25, 2004

On Mon, 24 May 2004 22:40:45 GMT, JonK <[email protected]>
wrote:

>Skeptic wrote:
>
>> > Pre-existing illnesses are being used to deny coverage.
>>
>> Yes. Will a singler payer change that?

That's against Federal law, btw.

>>
>
>With single payer, you've always had the coverage, so how
>can there be a pre-existing condition?
>

Exaclty.

Lee Iacocca said in the late 1980's that he could build an
American car 500$ cheaper in Canada, due to lower health
care costs alone.

Let's keep the jobs here and make the hMO's outsource
for unding.

Muscleman · May 25, 2004

On 24 May 2004 19:23:07 -0700, [email protected] (Jonathan
Smith) wrote:

>People select insurance providers and are free to switch to
>plans with access provisions more in line with their needs.

no they don't, they take what they can get and afford. The
majority of Americans do not get choices except offers they
can not refuse...take it or leave it.

One of the wonders
>of competition is that providers need to meet the needs of
>their customer - if not, the customer goes somewhere else.
>Under single payer, all you get is a vote and then only
>every four years.

Actually, you actually get it. Our system doesn't give it to
1 of 6 people in the population, many of them children.

What about the children?

>
>The World Health Organization has rated the US health care
>system as the most responsive in the world. Wonder why?

I just searched their site. Where is the statement you are
talking about?

http://www.who.int/research/en/

>
>You want to see rationing - try the NHS in the UK.
>

Got rationing here already. Want less, go to universal
system. Best doctors get most work done, get moe money. No
work, no money. Just like real life.

Wes Groleau · May 25, 2004

Jonathan Smith wrote:
> The system works well BECAUSE it is NOT single payer. In
> the US, the poor are not excluded. The unemployed are not
> excluded either - there is COBRA.

COBRA ?!? Yes, when I was laid off, I was offered the chance
to maintain substantially the same coverage for about
thirteen hundred dollars a month. What an offer! For a
little bit less than the income I _no_longer_have_ I can
keep a plan that pays 80% of my medical bills. And I get to
keep it for eighteen months. (Meaning that IF I had been
able to afford it, it would be ending two months from now.)

--
Wes Groleau

Armchair Activism:
http://www.breakthechain.org/armchair.html

Muscleman · May 25, 2004

On Mon, 24 May 2004 17:25:20 -0700, "Proconsul" <[email protected]>
wrote:

>| who really pays?
>|
>| the uninsured.
>
>If you were an illegal alien, you would pay nothing - think
>about it.....
>
>PC
>

thanks to our current president too.

Proconsul · May 25, 2004

"George Conklin" <[email protected]> wrote in message
news:[email protected]...
|
| "Proconsul" <[email protected]> wrote in message
| news:4nQsc.32458$PU5.7279@fed1read06...
| >
| > "George Conklin" <[email protected]> wrote in
| > message news:[email protected]
| > thlink.net...
| > |
| > | "Proconsul" <[email protected]> wrote in message
| > | news:M7qsc.21974$PU5.9829@fed1read06...
| > | >
| > | > "George Conklin" <[email protected]>
| > | > wrote in message news:[email protected]
| > | > news.pas.earthlink.net...
| > | > |
| > | > | "Proconsul" <[email protected]> wrote in message
| > | > | news:Ercsc.19015$PU5.11968@fed1read06...
| > | > || > | Any thoughts as to why?
| > | > | >
| > | > | > It's not a fraction of prepaid health
| > | > | > plans.....Medicare, like
any
| > | > | > government bureaucracy, lives on excessive
| > | > | > paperwork managed by
| > hordes
| > | > of
| > | > | > overpaid civil servants. They just conveniently
| > | > | > report whatever
| part
| > | of
| > | > | the
| > | > | > cost they want to report....
| > | > |
| > | > | You are like the Sierra Club claiming that the
| > | > | true cost of
| > gasoline
| > | is
| > | > | $15 a gallon because true costs are not computed.
| > | > | What you are
| doing
| > is
| > | > | claiming that all government data is a lie, and
| > | > | you and only you
| know
| > | the
| > | > | truth.
| > | >
| > | > Others have already answered your claim - but
| > | > speaking as one who
has
| > | worked
| > | > with the Federal bureaucracy for more than forty
| > | > years, I can assert positively that NO Federal
| > | > program reports it's "costs" as it's
| "costs".
| > | You
| > | > have to review all the ancillary agencies, etc., and
| > | > add them all
| > | up....this
| > | > is not rocket science and it's nothing new.
| > | > Government data isn't a
| > "lie",
| > | > it's government data and you need to learn how to
| > | > read it and
| interpret
| > | it -
| > | > I'm only one of many thousands of people who know
| > | > how to do that.
| > Clearly,
| > | > you aren't among that number......

PC

|
|

Proconsul · May 25, 2004

PC

|
|

Proconsul · May 25, 2004

"George Conklin" <[email protected]> wrote in message
news:[email protected]...
|
| "Proconsul" <[email protected]> wrote in message
| news:uuQsc.32461$PU5.15043@fed1read06...
| >
| > "Jonathan Smith" <[email protected]> wrote in
| > message
| > news:[email protected]...
| > | Alan Mackenzie <[email protected]> wrote in message
| > news:<[email protected]>...
| > | > Jonathan Smith <[email protected]> wrote on
| > | > 24 May 2004
| 19:24:20
| > | > -0700:
| > | > > [email protected] wrote in message news:<iessc.-
| > | > > [email protected]>...
| > | > >> In alt.cancer.support Evelyn Ruut <mama-
| > | > >> [email protected]>
wrote:
| > | > >> > Make a single payer universal health care
| > | > >> > system and all the
| prices
| > | > >> > will go down.
| > | >
| > | > >> There is NO free lunch. Name a 'single payer'
| > | > >> system that
doesn't
| > | > >> have shortages and long delays for complex
| > | > >> treatments such as
| > surgery,
| > | > >> etc.
| > | >
| > | > > I'd even be impressed if she could name one where
| > | > > there isn't a
| > waiting
| > | > > list for simple things like diagnostic xrays and
| > | > > specialist
| referrals.
| > | >
| > | > Funny, that. Last Monday (8 days ago), I fell off my
| > | > bike and
landed
| > | > heavily on my ribs. Last Tuesday, on waking up, the
| > | > pain was still significantly above what wasn't
| > | > worrying, so I visited my Doc. He
| said,
| > | > better get those ribs (and left-hand middle finger)
| > | > X-rayed. I was
| back
| > | > in that Doc's surgery little more than an hour
| > | > later, carrying an enveloppe with the requisite X-
| > | > rays. Luckily, nothing was broken.
| > | >
| > | > I'm not sure what you people mean exactly by a
| > | > "single payer"
system.
| > | >
| > | > Here in Germany,
| > |
| > | Germany is NOT a single payer system.
| > |
| > | It is a employer mandated insurance system funded by
| > | employer contributions through a system of private (quasi-
| > | private) insurance carriers (Krankenkasse) and
| > | delivered through a primarily private delivery system
| > | on a fee for service or local budget (depending on
| > | provider type) basis.
| > |
| > | > health insurance through the "Krankenkassen" is
| > | > compulsory for people earning less that a fairly
| > | > high threshold
| (around
| > | > 4,000 Euros/month). The premium paid depends only on
| > | > one's income,
| and
| > | > is around 14% of salary (with a maximum
| > | > corresponding to that ~4,000
| > Euro
| > | > threshold), half of it being paid by the employer.
| > |
| > | It is an employment tax - on the employer. The 7%
| > | metric is one of convenience for accounting. There is
| > | an upper limit - the most you will pay is 250 Euro per
| > | month. If your earnings are under 1000 Euro or so a
| > | month, you get a subsidy.
| > |
| > | > The unemployed and poor are not excluded. This
| > | > system works very well, despite the recognised
| > | > inefficiencies and, to some extent, corruption.
| > |
| > | The system works well BECAUSE it is NOT single payer.
| > | In the US, the poor are not excluded. The unemployed
| > | are not excluded either - there is COBRA.
| > |
| > | > High earners may stay in the normal Krankenkassen
| > | > insurance scheme,
or
| > | > they may opt for private insurance, or even decide
| > | > to pay for
| treatment
| > | > as they need it. Having opted out of the
| > | > Krankenkassen, they may
not
| > | > later rejoin them, since the Krankenkassen operate
| > | > on the basis of
| > people
| > | > "overpaying" when young and healthy and "being
| > | > subsidised" later in
| life
| > | > when no longer so healthy.
| > |
| > | No, that is not exactly true. However, the
| > | equilibrator is, once you go private, your annual
| > | premium is determined by the age cohort premium for
| > | the age at which you entered the system. In other
| > | words, as long as there is continuity if coverage
| > | there's no change in premium (other than for
| > | inflation).
| > |
| > | > The system has recently been "reformed" (worsened, I
| > | > would say) in
| that
| > | > patients now have to pay a 10 Euro charge per
| > | > quarter on visiting a
| > doc.,
| > | > and have to pay fairly hefty prescription charges
| > | > (10% of the cost,
| min.
| > | > 5 Euros, max 10 Euros, but never more that the
| > | > retail cost itself). Sadly, the government didn't
| > | > have the resolve to tackle the inefficiencies and
| > | > corruption in the various medical and insurance
| > | > systems. Maybe that will come.
| > |
| > | In Germany you have one of the more functional and
| > | equitable systems of health care financing. You also
| > | have some of the best quality care and excellent
| > | access. You also have the same set of problems that
| > | other systems face - you are spending a lot of money
| > | for this and the amount you spend keeps going up.
| > |
| > | > I would not swap this system for anything the USA
| > | > currently offers,
| and
| > | > would be very wary of moving there, even were I
| > | > completely healthy.
| > |
| > | The system you describe IS the system that 163 million
| > | Americans have. Private insurance with premiums funded
| > | by contributions from employees and their employers
| > | with comprehensive cover, nominal cost sharing, and
| > | excellent access and outcomes.
| >
| > Excellent points, well made - I hope everyone takes it
| > all in.....

| >
| > PC
| >
| >
|
| Our outcomes make us about #38. That is a lot of money
| for so-so
medical
| outcomes.

Our "outcome", as you put it, puts us way ahead of anyone
else - and, to quote someone who said it first, you get what
you pay for......until the costs are escalated to pay for
things that are merely administrivia and/or that transfer
wealth from one group to another.....

| And don't start in that we have the world's worst
| patients, and refrain from racist comments too.

I've made no such comments - is that all you can add to the
discussion? Can you comment rationally on what I and others
have said and give us the benefit of your "take" on the
subject at hand?

PC

Ted Rosenberg · May 25, 2004

One of the problems of the health care system is that it is
not even vaguely a free market. Most health care providers
will not provide prices for comparison shopping, and, if
they do say anything, it is usually false. They are also not
consistent.

I helped my wife do research a few years ago for an article
about the difficulties of health care shopping. It was on
one simple test, most hospitals flatly refused to quote a
cost "it's covered by your insurance" "come in, have the
test, and THEN we will discuss payment".

Two hospitals just flatly lied "we can't quote because we
don't know how much dye the test will use for each
individual " (NONE, the test doesn't use dye). The
remainder quoted prices ranging from $200 to $1,800, of
course, for insurance companies, it would be about $120
from all of them !!!

When the article ran, she got indignant letters from
hospitals, but fan mail from doctors. They hadn't had a CLUE
that prices varied from place to place.

I am also battling a hospital at the moment, I need a
regular blood test to adjust dosage of some meds. The
hospital quoted me $37/visit, - fair enough price, even if
insurance companies would only pay $25. BUT, they BILLED
amounts ranging from $42.20 to $53.45, when asked why, I get
a different answer every time I call (on the SAME bill) and
they are annoyed that I won't pay them until they get the
bill straightened. And tell me to call the doctor - there IS
no doctor!. When I ask the pharmacologist at the lab, SHE
says "that isn't right, you should call billing"

Proconsul wrote:

> "Jonathan Smith" <[email protected]> wrote in
> message
> news:[email protected]...
> | mike gray <[email protected]> wrote in message
> news:<3WHsc.26553$fF3.682402@bgtnsc05-
> news.ops.worldnet.att.net>...
> | > Skeptic wrote:
> | >
> | > >>
> | > >> With single payer, you've always had the coverage,
> | > >> so how can there
> be a
> | > pre-existing
> | > >> condition?
> | > >
> | > > Will all coverage be equal? Will there be levels of
> | > > coverage? Will
> there
> | > > be coinsurance?
> | >
> | > One of the barriers to universal health care is the
> | > leveling of coverage. For the uninsured and
> | > underinsured, that's great news, but for union
> | > members, government employees, and employees of
> | > generous companies it will be a huge loss.
> | >
> | > All proposals to date have permitted coinsurance,
> |
> | Which proposals are those? Kerry's? Kucinich?
> |
> | > primarily to satisfy the groups that now have Cadillac
> | > plans: their employers could offer group "gap"
> | > coinsurance. The result is a two-tiered system, those
> | > with basic benefits and those with enhanced benefits,
> | > but more equitable that the current system.
> |
> | Hardly more equitable. Reminiscent of Orwell's Animal
> | Farm - all animals are equal, some are just more equal
> | than otehrs.
> |
> | Want to know what they call private supplemental
> | insurance in the UK? Queue jumping insurance.
> |
> | The only reasonable proposal is the PPI version -
> | allowing (mandating) access to private insurance for
> | anyone and everyone. Using tax credits and incentives,
> | not income redistribution. Making individuals
> | responsible, in partnership with their employers, to get
> | affordable coverage that meets THEIR needs.
>
> IF such a system as you propose were to be put into
> effect, it would certainly be infinitely better than the
> current socialist model and it wouldn't be "single payer"
> any longer.....

>
> Total privatization and a competitive free market would
> accomplish all you propose and more at lower costs - and
> would deliver a higher quality of care for everyone.....
>
> PC
>
>
>
>
> |
> | js
>
>

--
"...in addition to being foreign territory the past is, as
history, a hall of mirrors that reflect the needs of souls
observing from the present" Glen Cook

Proconsul · May 25, 2004

"George Conklin" <[email protected]> wrote in message
news:[email protected]...
|
| "Jonathan Smith" <[email protected]> wrote in
| message
| news:[email protected]...
| > mike gray <[email protected]> wrote in message
| news:<tLIsc.26690$fF3.685017@bgtnsc05-
| news.ops.worldnet.att.net>...
| > > matt weber wrote:
| > >
| > > > Because in the USA, someone other than the patient
| > > > usually pays, and patient is almost entirely
| > > > isolated from the cost issue, as is the physician,
| > > > when a patient walks in and says my shoulder is
| > > > bothering me, can you write me a prescription for
| > > > Celebrex or Viox? The physician will happily do so.
| >
| > Why is this necessarily a bad thing? Under the
| > assumption that there is a doctor-patient relationship
| > and the physician does an exam to look for something
| > other than muscle or joint pain due to exertion or
| > perhaps a touch of arthritis, thuis makes a lot of
| > sense. What would you do in this case?
|
|
| And the answer is the same drug you asked for without
| spending the money.

Who do you think paid for the drug? Who should pay? And,
you might take a stab at the poster's question, i.e., why
is this necessarily a bad thing? What WOULD you do in
this case?

PC

Proconsul · May 25, 2004

"Jonathan Smith" <[email protected]> wrote in message
news:[email protected]...
| mike gray <[email protected]> wrote in message
news:<qoIsc.26623$fF3.683423@bgtnsc05-
news.ops.worldnet.att.net>...
| > Proconsul wrote:
| >
| > > Sorry, but you have it backwards. IF single payer is
| > > approved, prices,
i.e.,
| > > TAXES, will go way up and quality of service along
| > > with availability
of
| > > service will go way down as care is rationed to lower
costs......that's the
| > > way it's worked everywhere else in the world where
| > > it's been tried.
| >
| > No argument there.
| >
| > > Our system, with all it's faults, is infinitely
| > > superior to any other
system
| > > so far devised by anyone.....and we need to focus on
| > > what we KNOW works.....a free market with competition
| > > and no government
interference is
| > > the key to lower costs and higher quality care -
| > > that's the way it's
always
| > > worked whenever it's been tried.....
| >
| > But the current system leaves out a substantial (1/6)
| > portion of the population. The universal care argument
| > is that at least basic health services should be a
| > right, not a perq of the fortunate.
|
| When you start counting up the uninsured you get some
| pretty interesting numbers.
|
| Some self-select to be uninsured even in the absence of
| financial constraints. 8% of people earnming more than 75K
| per year are uninsured (7 million total)

Good point that most everyone ignores...

| Some do not avail themselves of government programs that
| would provide them with health care insurance - SCHIPS is
| under enrolled by 5 to 7 million kids.

Good point that most everyone ignores....

It's also true that "some" less scrupulous advocates of
single payer count children who are covered by their
parent's insurance as "uninsured"......

| Some do not avail themselves of employer provided health
| care insurance for various reasons. This could be as much
| as 7 or 8 million.

Good point that most everyone ignores....

| Some are illegal aliens and whether or not we should pay
| for their health care is an intersting question that is
| political, not medical. This is estimated to be in the 3
| million range.

Actually, the number is closer to 10 million. There are more
than 3 million in Southern California alone.....

| That is 24 million of the 42 million uninsured.

I think it's closer to 35 of the alleged 42 million....

| That leaves less than half with a bonafide gap. And this
| gap grows every year as the state Medicaid systems, in an
| effort to balnace their budgets, constrain the eligibility
| criteria. 14 million with household incomes under 25K are
| uninsured. That is 150% of the poverty line for a family
| of 4. Now - who's fault is that?

The answer to those folks isn't government tax-supported
programs. The solution is private charity - which took care
of all such folks up until 1943. Before that, nobody had
health insurance. People paid their bills themselves....

| > It is not just the indigent that lack coverage, btw. We
| > self employed folks have been priced out of the coverage
| > market (in part by legislation requiring coverage of
| > benefits that we'd be happy to forego), yet we still
| > have to pay for the elderly (double!), the government
| > workers, and (through the pricing mechanism) the
| > corporate employees.

These inequities require reform. You are also the victims of
one of the mechanisms used to transfer wealth from those who
produce everything to those who produce nothing....

| Like I said - give the right incentives and you'd be
| surprised. The fact that you are self-employed, though, is
| no defense for not buying into an insurance scheme.

With the proviso that fairness and justice come back into
the system through reform...

| > I have no problem with the free market restricting
| > Ferraris to the fortunate few. I'm not so sure that
| > healthcare falls into the same
category.
|
| You want me to buy your health care insurance for you? No,
| I don't think so. I would support incentives for you to
| pyurchase insurance, I would support a group buying pool
| arrangement for self employeds, and I would support
| minimalist coverage (catastrophic inpatient, for example).

Actually, I think he does want you to buy his healthcare
insurance for him - after all, "free medical" is a right for
those who advocate single payer and any other socialist
scheme.....

PC

Proconsul · May 25, 2004

"Wes Groleau" <[email protected]> wrote in message
news:[email protected]...
| Jonathan Smith wrote:
| > The system works well BECAUSE it is NOT single payer. In
| > the US, the poor are not excluded. The unemployed are
| > not excluded either - there is COBRA.
|
| COBRA ?!? Yes, when I was laid off, I was offered the
| chance to maintain substantially the same coverage for
| about thirteen hundred dollars a month. What an offer!
| For a little bit less than the income I _no_longer_have_
| I can keep a plan that pays 80% of my medical bills. And
| I get to keep it for eighteen months. (Meaning that IF I
| had been able to afford it, it would be ending two months
| from now.)

One wonders when/how that could be. I used COBRA between
jobs - cost about $125/month....pretty reasonable.....

PC

Muscleman · May 25, 2004

On Tue, 25 May 2004 13:18:42 GMT, mike gray <[email protected]> wrote:

>MuscleMan wrote:
>> On Sun, 23 May 2004 23:07:00 GMT, mike gray
>> <[email protected]> wrote:
>>
>>>Ted Rosenberg wrote:
>>>> It is not the cost, it is the administrative cost6
>>>>
>>>> Last I saw, it was 7 times as high for private plans
>>>> than for Medicare.
>>>
>>>Administrative costs are computed very differently for
>>>government and private entities.
>>
>> A buck is a buck. It's just less bucks with the gummint.
>>
>>
>> When they are figured on the same basis, they are very
>>>close.
>>
>> Cite?
>>
>>>
>>>Do it yerself. Go to the 10Ks for private insurors and
>>>figure the percentage of premium revenue that does not go
>>>to providers. Very simple. Now go the the federal budget
>>>and figure the percentage of Title
>>>XVIII/XIX funding that does not go to providers. Not so
>>> simple, but doable.
>>>
>>>Report the results here.
>>
>>
>> Burden of proof is on the asserter, prove it yourself.
>
> So it's up to Rosenburg who asserted, " It is not the
> cost, it is the administrative cost. Last I saw, it was 7
> times as high for private plans than for Medicare."
>
>Not real easy to believe, even if yer too lazy to find the
>facts for yerself.

Sure it is. That's why the Gummint under Bush is trying for
charities to take the poor and needy and uneducated, right?
Conservatives keep trumpeting that it's cheaper for them
since they have no profit motive. The same is true for
medicare/aid. That's why it would be better for a univeral
payer system....

But then again, Bu$h would lose all that donation money too.

Proconsul · May 25, 2004

"George Conklin" <[email protected]> wrote in message
news:[email protected]...
|
| "Proconsul" <[email protected]> wrote in message
| news:UqQsc.32459$PU5.10260@fed1read06...
| >
| > "George Conklin" <[email protected]> wrote in
| > message news:[email protected]
| > thlink.net...
| > |
| > | "W. Baker" <[email protected]> wrote in message
| > | news:[email protected]...
| > | > In alt.support.diabetes Proconsul
| > | > <[email protected]> wrote:
| > | >
| > | > : "Skeptic" <[email protected]> wrote in message
| > | > : news:9Jbsc.103231$iF6.9532547@attbi_s02...
| > | > : |
| > | > : | "Ted Rosenberg" <[email protected]> wrote
| > | > : | in message news:[email protected]...
| > | > : | >
| > | > : | >
| > | > : | > Skeptic wrote:
| > | > : | > > I don't disagree with much of your overall
| > | > : | > > point, but let me
| try
| > | to
| > | > : | > <snipped for brevity)
| > | > : | >
| > | > : | > You have one major mistake, and it is a MAJOR
| > | > : | > one. Medicare overhead is a very small
| > | > : | > fraction of overhead of
| prepaid
| > | > : | > health plans.
| > | > : |
| > | > : | Any thoughts as to why?
| > | >
| > | > : It's not a fraction of prepaid health
| > | > : plans.....Medicare, like any government
| > | > : bureaucracy, lives on excessive paperwork managed
| > | > : by
| hordes
| > | of
| > | > : overpaid civil servants. They just conveniently
| > | > : report whatever
part
| > of
| > | the
| > | > : cost they want to report....just as those who
| > | > : champion single
payer
| > | don't
| > | > : tell you that all too often care is rationed and
| > | > : unavailable to many....another way of keeping
| > | > : costs down. I prefer the private
| sector
| > | and
| > | > : open competition - whenever you have a free market
| > | > : and
competition,
| > | quality
| > | > : goes up and costs go down....that's an a priori
| > | > : truth.....
| > | >
| > | > : PC
| > | >
| > | > And HMO's don't ration healthcare unless they are
| > | > forced?
| > | >
| > | > Wendy
| > | >
| > | Mr. PC here ignores the fact that medicine here is
| > | twice as
| expensive
| > as
| > | average, and he blames it all on the the small part
| > | which provides
| > universal
| > | health insurance: Medicare. These shills for rapid
| > | rising costs
| forever
| > | are very shameful.
| >
| > Read past posts again, slowly, for comprehension.....
| >
| > Medicine is more expensive here because it is BETTER
|
| Ah, the big lie. Based on results, it is #38 in the
| world. But then again I guess you think WHO is just a
| bunch of commies.

No, but the WHO is run by the UN - a gaggle of third
raters without a moral center. I wouldn't believe
anything they say.

Just for fun, how do they manage to rate us #38? What are
the criteria? Who are the 37 that are better?

PC

|
|

Wes Groleau · May 25, 2004

Proconsul wrote:

> "Wes Groleau" <[email protected]> wrote in
> message
> | COBRA ?!? Yes, when I was laid off, I was offered the
> | chance to maintain substantially the same coverage for
> | about thirteen hundred dollars a month. What an offer!
> | For a little bit less
>
> One wonders when/how that could be. I used COBRA between
> jobs - cost about $125/month....pretty reasonable.....

Maybe some idiot threw in an extra zero and didn't proof-
read.

--
Wes Groleau

A pessimist says the glass is half empty.

An optimist says the glass is half full.

An engineer says somebody made the glass twice as big as it
needed to be.

Alan Mackenzie · May 26, 2004

Jonathan Smith <[email protected]> wrote on 25 May 2004 13:26:16
-0700:
> Alan Mackenzie <[email protected]> wrote in message
> news:<[email protected]>...
>> Jonathan Smith <[email protected]> wrote on 24
>> May 2004
>> 19:24:20 -0700:
>> > [email protected] wrote in message
>> > news:<[email protected]>...
>> >> In alt.cancer.support Evelyn Ruut <mama-
>> >> [email protected]> wrote:
>> >> > Make a single payer universal health care system and
>> >> > all the prices will go down.

>> >> There is NO free lunch. Name a 'single payer' system
>> >> that doesn't have shortages and long delays for
>> >> complex treatments such as surgery, etc.

>> > I'd even be impressed if she could name one where there
>> > isn't a waiting list for simple things like diagnostic
>> > xrays and specialist referrals.

>> Funny, that. Last Monday (8 days ago), I fell off my bike
>> and landed heavily on my ribs. Last Tuesday, on waking
>> up, the pain was still significantly above what wasn't
>> worrying, so I visited my Doc. He said, better get those
>> ribs (and left-hand middle finger) X-rayed. I was back in
>> that Doc's surgery little more than an hour later,
>> carrying an enveloppe with the requisite X-rays. Luckily,
>> nothing was broken.

>> I'm not sure what you people mean exactly by a "single
>> payer" system.

>> Here in Germany,

> Germany is NOT a single payer system.

What does "single payer system" mean?

> It is a employer mandated insurance system funded by
> employer contributions through a system of private (quasi-
> private) insurance carriers (Krankenkasse) and
> delivered through a primarily private delivery system
> on a fee for service or local budget (depending on
> provider type) basis.

>> health insurance through the "Krankenkassen" is
>> compulsory for people earning less that a fairly high
>> threshold (around 4,000 Euros/month). The premium paid
>> depends only on one's income, and is around 14% of salary
>> (with a maximum corresponding to that ~4,000 Euro
>> threshold), half of it being paid by the employer.

> It is an employment tax - on the employer. The 7% metric
> is one of convenience for accounting. There is an upper
> limit - the most you will pay is 250 Euro per month. If
> your earnings are under 1000 Euro or so a month, you get a
> subsidy.

>> The unemployed and poor are not excluded. This system
>> works very well, despite the recognised inefficiencies
>> and, to some extent, corruption.

> The system works well BECAUSE it is NOT single payer. In
> the US, the poor are not excluded. The unemployed are not
> excluded either - there is COBRA.

Who is/would be the "single payer" in the US?

>> High earners may stay in the normal Krankenkassen
>> insurance scheme, or they may opt for private insurance,
>> or even decide to pay for treatment as they need it.
>> Having opted out of the Krankenkassen, they may not later
>> rejoin them, since the Krankenkassen operate on the basis
>> of people "overpaying" when young and healthy and "being
>> subsidised" later in life when no longer so healthy.

> No, that is not exactly true.

How not? Apart from people opting out, it is entirely true.

> However, the equilibrator is, once you go private, your
> annual premium is determined by the age cohort premium for
> the age at which you entered the system. In other words,
> as long as there is continuity of coverage there's no
> change in premium (other than for inflation).

>> The system has recently been "reformed" (worsened, I
>> would say) in that patients now have to pay a 10 Euro
>> charge per quarter on visiting a doc., and have to pay
>> fairly hefty prescription charges (10% of the cost, min.
>> 5 Euros, max 10 Euros, but never more that the retail
>> cost itself). Sadly, the government didn't have the
>> resolve to tackle the inefficiencies and corruption in
>> the various medical and insurance systems. Maybe that
>> will come.

> In Germany you have one of the more functional and
> equitable systems of health care financing. You also have
> some of the best quality care and excellent access. You
> also have the same set of problems that other systems face
> - you are spending a lot of money for this and the amount
> you spend keeps going up.

Very true.

>> I would not swap this system for anything the USA
>> currently offers, and would be very wary of moving there,
>> even were I completely healthy.

> The system you describe IS the system that 163 million
> Americans have.

Is it not the case that leaving a job in the USA typically
imperils one's medical insurance?

> Private insurance with premiums funded by contributions
> from employees and their employers with comprehensive
> cover, nominal cost sharing, and excellent access and
> outcomes.

The essence of the system in Germany is that it is
comprehensive, encompassing everybody. Also that what one
pays is dependent only on one's means, not on one's health.
The population of the USA is a good deal higher than 163
million, isn't it?

> So - now what.

> js

--
Alan Mackenzie (Munich, Germany) Email: [email protected]; to
decode, wherever there is a repeated letter (like "aa"),
remove half of them (leaving, say, "a").

George Conklin · May 26, 2004

"dahmd" <[email protected]> wrote in message
news:[email protected]...
>
> "Jonathan Smith" <[email protected]> wrote in
> message
> news:[email protected]...
> > mike gray <[email protected]> wrote in message
> news:<tLIsc.26690$fF3.685017@bgtnsc05-
> news.ops.worldnet.att.net>...
> > > matt weber wrote:
> > >
> > > > Because in the USA, someone other than the patient
> > > > usually pays, and patient is almost entirely
> > > > isolated from the cost issue, as is the physician,
> > > > when a patient walks in and says my shoulder is
> > > > bothering me, can you write me a prescription for
> > > > Celebrex or Viox? The physician will happily do so.
> >
> > Why is this necessarily a bad thing? Under the
> > assumption that there is a doctor-patient relationship
> > and the physician does an exam to look for something
> > other than muscle or joint pain due to exertion or
> > perhaps a touch of arthritis, thuis makes a lot of
> > sense. What would you do in this case?
> >
> > > That is, indeed, a major problem with the US system
> > > and I'll give you another example. I sprained my
> > > wrist, went to the corner dugstore and bought an Ace
> > > bandage. $3 and it was fine in five weeks. My Medicare
> > > friend sprained his wrist, went to the ER, X-rays,
> > > orthopedic specialist, and seven weeks of physical
> > > therapy even though it was
fine
> > > in five weeks.
> >
> > And Medicare would be that huge efficient single payer
> > model that we all want and need?
> >
> > > But "rationing" has become a buzzword in the US
> > > roughly as evil as "holocaust". An insured patient who
> > > goes to a doctor with a sprained wrist and gets only
> > > an Ace bandage will certainly sue and just as
> > > certainly win.
> >
> > If the sprain wasn't a sprain and the failure to
> > diagnose results in a permanent disability - yes, that
> > is what would happen. Explain to me why it shouldn't.
> >
> > > This has created another problem: US doctors are
> > > scared to death of their own patients. Very unhealthy
> > > situation.
> >
> > I don't believe they are - they may be a bit
> > apprehensive over their patients lawyers - so lets
> > fix that.
> >
> > js
> >
>
> I have enjoyed reading your comments. It's much more
> pleasant debating issues without vitriol. Unfortunately,
> as on obstetrician I see dozens of examples every day
> where physicians are so afraid of litigation that they
> either refuse to see pregnant patients or, if they
> practice ob/gyn, refuse to see "high risk" pregnant
> patients. In the last 2 years the number of ob/gyn
> physicians in our metropolitan area (Orlando; about 2
> million in surrounding communities) who are willing to see
> high risk pregnant
patients
> has dwindled dramatically. Several of our top ob/gyns have
> left the area rather than risk becoming part of the
> liability crisis, and many others
have
> given up obstetrics. In Dade County (Miami) the median
> liability premium for those practicing obstetrics is about
> $200,000 a year. Physicians in other specialties just
> don't want to be exposed to those kind of premiums.
>
> I spoke with several physicians from various specialties
> in the OR lounge today who made it clear that they will do
> anything rather than treat a pregnant patient. The statute
> of limitations for a newborn can be up to
21
> years in Florida, and there are several hundred ads on TV
> and the radio in our area each week advising locals to sue
> their physician. One series of ads suggested that ob/gyns
> don't perform c/sections in a timely manner, leading to
> brain damage. I would love to study the c/section rate
> before and after that series of ads. I am awaiting the
> results of a recent
mail-in
> survey to read hard data, but in the meantime, at least in
> Florida, fear
of
> litigation has had a negative impact on the availability
> of services and quality of care for pregnant patients.
> Pregnant patients can provide a lottery win for trial
> lawyers. It's to the stage where physicians feel their
> careers are at risk when they care for pregnant women.
> Best wishes,
>
> Ashley
>
>
>
Overall the cost of insurance in the medical business is
about the same as for any other industry. However, it
falls on different areas of the system in very different
ways. Since physicians still follow the small business
model where physicians purchase insurance one person at a
time, you end up with high fees for some areas. You are
in one of them Ashley.

The solution is very simple: get rid of the small
business model of 1900. That is the fee-for-service
model, which hits both patients and physicians. The costs
of malpractice need to be in large pools, perhaps whole
states, so insurance companies cannot cherry pick. But at
the same time patients need to be members of large pools
of customers, so insurance companies cannot cherry pick
among customers too. Continued use of outdated business
models is the problem.

George Conklin · May 26, 2004

"Ted Rosenberg" <[email protected]> wrote in message
news:[email protected]...
> One of the problems of the health care system is that it
> is not even vaguely a free market. Most health care
> providers will not provide prices for comparison shopping,
> and, if they do say anything, it is usually false. They
> are also not consistent.
>

When I have asked about prices, here are the two most
common answers:

1. What's the matter? Don't you have insurance?

2. Ask the nurse. (She does not know or won't say either).

> I helped my wife do research a few years ago for an
> article about the difficulties of health care shopping. It
> was on one simple test, most hospitals flatly refused to
> quote a cost "it's covered by your insurance" "come in,
> have the test, and THEN we will discuss payment".
>

Correct. They do that. No one will talk price, and we
customers are not even supposed to know DRGs exist.

> Two hospitals just flatly lied "we can't quote because we
> don't know how much dye the test will use for each
> individual " (NONE, the test doesn't use dye). The
> remainder quoted prices ranging from $200 to $1,800, of
> course, for insurance companies, it would be about $120
> from all of them
!!!
>

Cash customers pay list price. No one else does.

> When the article ran, she got indignant letters from
> hospitals, but fan mail from doctors. They hadn't had a
> CLUE that prices varied from place to place.
>

You hear of elderly people losing their homes because of
bills for drugs, for example. No one over 50 is going to
escape being heavily medicated anymore.

> I am also battling a hospital at the moment, I need a
> regular blood test to adjust dosage of some meds. The
> hospital quoted me $37/visit, - fair enough price, even if
> insurance companies would only pay $25. BUT, they BILLED
> amounts ranging from $42.20 to $53.45, when asked why, I
> get a different answer every time I call (on the SAME
> bill) and they are annoyed that I won't pay them until
> they get the bill straightened. And tell me to call the
> doctor - there IS no doctor!. When I ask the
> pharmacologist at the lab, SHE says "that isn't right, you
> should call billing"
>
>
I asked a doctor once what something would cost. His answer
was that I
was responsible for the entire amount, but insurance paid
what it felt like.

However, another physician I see from time to time is cost-
wise. He accepts payment from BCBS and does not make you
pay in advance. I commented to the nurse how nice that
was and she commented it is unsual too. The $100 office
visit was paid for at $60 by BCBS.

George Conklin · May 26, 2004

"Proconsul" <[email protected]> wrote in message
news:uJUsc.33204$PU5.1745@fed1read06...
>
> "George Conklin" <[email protected]> wrote in
> message news:[email protected]
> link.net...
> |
> | "Proconsul" <[email protected]> wrote in message
> | news:UqQsc.32459$PU5.10260@fed1read06...
> | >
> | > "George Conklin" <[email protected]> wrote
> | > in message news:[email protected]
> | > s.earthlink.net...
> | > |
> | > | "W. Baker" <[email protected]> wrote in message
> | > | news:[email protected]...
> | > | > In alt.support.diabetes Proconsul
> | > | > <[email protected]> wrote:
> | > | >
> | > | > : "Skeptic" <[email protected]> wrote in message
> | > | > : news:9Jbsc.103231$iF6.9532547@attbi_s02...
> | > | > : |
> | > | > : | "Ted Rosenberg" <[email protected]> wrote
> | > | > : | in message news:2hc3bpFb2krnU1@uni-
> | > | > : | berlin.de...
> | > | > : | >
> | > | > : | >
> | > | > : | > Skeptic wrote:
> | > | > : | > > I don't disagree with much of your overall
> | > | > : | > > point, but let
me
> | try
> | > | to
> | > | > : | > <snipped for brevity)
> | > | > : | >
> | > | > : | > You have one major mistake, and it is a
> | > | > : | > MAJOR one. Medicare overhead is a very small
> | > | > : | > fraction of overhead of
> | prepaid
> | > | > : | > health plans.
> | > | > : |
> | > | > : | Any thoughts as to why?
> | > | >
> | > | > : It's not a fraction of prepaid health
> | > | > : plans.....Medicare, like
any
> | > | > : government bureaucracy, lives on excessive
> | > | > : paperwork managed by
> | hordes
> | > | of
> | > | > : overpaid civil servants. They just conveniently
> | > | > : report whatever
> part
> | > of
> | > | the
> | > | > : cost they want to report....just as those who
> | > | > : champion single
> payer
> | > | don't
> | > | > : tell you that all too often care is rationed and
> | > | > : unavailable to many....another way of keeping
> | > | > : costs down. I prefer the private
> | sector
> | > | and
> | > | > : open competition - whenever you have a free
> | > | > : market and
> competition,
> | > | quality
> | > | > : goes up and costs go down....that's an a priori
> | > | > : truth.....
> | > | >
> | > | > : PC
> | > | >
> | > | > And HMO's don't ration healthcare unless they are
> | > | > forced?
> | > | >
> | > | > Wendy
> | > | >
> | > | Mr. PC here ignores the fact that medicine here
> | > | is twice as
> | expensive
> | > as
> | > | average, and he blames it all on the the small part
> | > | which provides
> | > universal
> | > | health insurance: Medicare. These shills for rapid
> | > | rising costs
> | forever
> | > | are very shameful.
> | >
> | > Read past posts again, slowly, for comprehension.....
> | >
> | > Medicine is more expensive here because it is BETTER
> |
> | Ah, the big lie. Based on results, it is #38 in the
> | world. But then again I guess you think WHO is just a
> | bunch of commies.
>
> No, but the WHO is run by the UN - a gaggle of third
> raters without a
moral
> center. I wouldn't believe anything they say.
>
> Just for fun, how do they manage to rate us #38? What are
> the criteria?
Who
> are the 37 that are better?
>
> PC
>

I knew you were going to reject anything but your own
opinions, based on moral centers, not medical outcomes.
Ayn Rand was the most harmful pseudo-intellectual who
every lived here.

George Conklin · May 26, 2004

"Alan Mackenzie" <[email protected]> wrote in message news:[email protected]...
> Who is/would be the "single payer" in the US?
>

Medicare for All Ages.

Single Payer Universal Health Care

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