Single Payer Universal Health Care

Discussion in 'Health and medical' started by Sarah, May 23, 2004.

  1. "Proconsul" <[email protected]> wrote in message
    news:[email protected]...
    >
    > "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
    >
    >

    The average for an adult in the USA is over $500 a month.
    For a family, $700.
     


  2. "Proconsul" <[email protected]> wrote in message
    news:[email protected]...
    >
    > "George Conklin" <[email protected]> wrote in
    > message news:[email protected]
    > link.net...
    > |
    > | "Proconsul" <[email protected]> wrote in message
    > | news:[email protected]...
    > | >
    > | > "Jonathan Smith" <[email protected]> wrote in
    > | > message news:[email protected]
    > | > le.com...
    > | > | 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:<iess-
    > | > | > > [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
    >
    >
    I know the Ayn Rand rant.
     
  3. "Proconsul" <[email protected]> wrote in message news:<[email protected]>...
    > "George Conklin" <[email protected]> wrote in
    > message news:[email protected]
    > link.net...
    > |
    > | "Proconsul" <[email protected]> wrote in message
    > | news:[email protected]...
    > | >
    > | > "Jonathan Smith" <[email protected]> wrote in
    > | > message news:[email protected]
    > | > le.com...
    > | > | 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:<iess-
    > | > | > > [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

    PC: Georgy has been around for a while. He has never added
    anything of value.
    http://www.nccu.edu/artsci/social/conklin.htm I'm inclined
    to take Skeptics advice and just ignore him.

    js
     
  4. Mike Gray

    Mike Gray Guest

    George Conklin wrote:

    >> However, Federal accounting and private sector accounting
    >> are significantly different. But one does not have to be
    >> a CPA to analyze the data and see that gov't programs
    >> spend as much on administration as private sector
    >> companies do.
    >
    > Here you go again, claiming falsely that no one knows
    > how to compute costs but YOU. Shame.

    I see that English is not yer first language. When I say
    that "one does not have to be a CPA to analyze the data",
    that means that anyone with any understanding of charts of
    accounts can determine for himself what the costs are.

    Even you.

    And if you bother to do so, you will find that private
    sector administration costs are not seven times public
    sector administration costs, as was stated.
     
  5. Alan Mackenzie <[email protected]> wrote in message news:<[email protected]>...
    > 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?

    One payer - typically the central government - for all
    medical services.

    > > 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?

    There is a system of care financing provided to the elderly
    called Medicare. Tis is the closest model of 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.

    The premiums paid are based on income and age at enrollment.
    It is not a medical savings account.

    > > 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.

    And it isn't a single payer system.

    > >> 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?

    Not necessarily. In fact, it is quite rare though
    politically it is a big to do. There is a system of COBRA
    which provides for health care insurance continuation for 18
    months. Most people who switch jobs do so in a much shorter
    period. As long as you keep up with the premiums you are
    fully covered. Once you start in your new position, you
    become eligible for the plan there and there is a smooth
    transition.

    > > 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 positive part of the German system is not the funding -
    however, what is good is that the top end earners pay more,
    but not proportionately more. With a cap of 3500 Euro or so
    of income liable to the 7% tax, the costs are reasonable. In
    the absence of the cap, it would be a draconian
    redistribution of wealth.

    > The population of the USA is a good deal higher than 163
    > million, isn't it?

    Yes - 40 million are elderly and are covered under Medicare.
    Another 40 million or so have public sector insurances - VA,
    DoD, or Medicaid. And the last 40 million have no health
    care INSURANCE. That makes 283 million Americans.

    js
     
  6. Mike Gray

    Mike Gray Guest

    Jonathan Smith wrote:

    >> All proposals to date have permitted coinsurance,
    >
    > Which proposals are those? Kerry's? Kucinich?

    Neither Kerry nor Kucinich have made NHS proposals, though
    Kerry has promised one as soon as he takes office. His main
    point, that every American will have the same level of care
    that members of the US Senate have. Obviously, that is
    impossible, but he can blame its failure on someone else.

    There have been legitimate proposals, most recently by
    Hillary. Coinsurance has always been included to retain the
    support of those that would lose benefits in a NHS.

    > 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.

    Philosophically satisfying, but out of touch with
    reality. The problem
    in the US is that coverage has been split between gov't
    for the seniors
    and corporate for the employed, and it's difficult to
    change horses in
    midstream. Remember, countries which instituted
    universal systems did so
    at the same time that the US opted for the employer-
    based system.

    The mechanics of a tax credit system (in which there is, of
    course, a redistribution of income) are very unwieldy, major
    problems being the purchase of something now to be paid for
    with a rebate from the US Treasury next year, the pricing
    problem for young healthy groups (workers) vs high service
    groups (diabetics, elderly), and the perception of the
    elderly that they have already paid for the benefits they
    now receive.

    Mandating access is easy. Execution is a bitch. And the feds
    remain smack dab in the middle anyway.
     
  7. Mike Gray

    Mike Gray Guest

    Jonathan Smith wrote:

    > Germany is NOT a single payer system.

    Correct, but splitting hairs. The German system mandates
    that funding of coverage for all citizens come primarily
    from one source, the employers who represent only a fraction
    of citizens, as opposed to the US where funding comes from
    employer taxes, employee taxes, corporate premium payments,
    individual premium payments, and charities.

    > 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 allows an unemployed person to continue coverage if
    elected within a set period after being employed. First, you
    have to be employed, second, you have to come up with the
    funds, while unemployed, to pay the premiums.

    The poor are excluded to a far greater degree than you want
    to admit. Having spent most of my adult life in the for-
    profit health services biz, I assure you that if you have no
    cash and no coverage, your services are pretty damn limited.

    > 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.

    And that is the problem (if there is a problem). 163 million
    have, 120 million don't have.

    If some degree of access is a "right", we have a problem. If
    it is not a "right", there's no problem.
     
  8. Wes Groleau

    Wes Groleau Guest

    George Conklin wrote:
    > Cash customers pay list price. No one else does.

    And "list price" is inflated whenever [1] the doctor wants
    to make up for the lower fees the insurance plans say he has
    to accept to be allowed to treat their patients.

    [1] whenever, meaning "almost always"

    > 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 made it! Two pills a day and one of them is probably
    unnecessary.

    >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.

    --
    Wes Groleau
    -----------
    I've been framed! ...
    http://www.useit.com/alertbox/9612.html
     
  9. Mike Gray

    Mike Gray Guest

    MuscleMan wrote:

    >>>>And you have made a MAJOR mistake. Administrative costs
    >>>>are computed very differently for government and private
    >>>>entities. When they are figured on the same basis, they
    >>>>are very close.
    >>>
    >>>
    >>> Cite?
    >>
    >>Private company 10Ks and the federal budget.
    >
    >
    > show it. Show the amount and cite here.

    Interesting that you will accept a statement that gov't
    admin costs are
    1/7 of private admin costs, at face value, but won't bother
    to look for yourself.

    For a very reasonable fee, I will assemble the data and
    forward it to you. You will, of course, find some reason not
    to believe what is shown, so I require the fee in advance.

    Or go on believing the 1/7 without being shown the amount
    and cite for that ridiculous fraction.
     
  10. "mike gray" <[email protected]> wrote in message
    news:[email protected]...
    > Jonathan Smith wrote:
    >
    > >> All proposals to date have permitted coinsurance,
    > >
    > > Which proposals are those? Kerry's? Kucinich?
    >
    > Neither Kerry nor Kucinich have made NHS proposals, though
    > Kerry has promised one as soon as he takes office. His
    > main point, that every American will have the same level
    > of care that members of the US Senate have. Obviously,
    > that is impossible, but he can blame its failure on
    > someone else.
    >

    Impossible? You mean that already most of us have
    inferior care? I am surprised you admit it.
     
  11. "mike gray" <[email protected]> wrote in message
    news:[email protected]...
    > George Conklin wrote:
    >
    > >> However, Federal accounting and private sector
    > >> accounting are significantly different. But one does
    > >> not have to be a CPA to analyze the data and see that
    > >> gov't programs spend as much on administration as
    > >> private sector companies do.
    > >
    > > Here you go again, claiming falsely that no one
    > > knows how to compute costs but YOU. Shame.
    >
    > I see that English is not yer first language. When I say
    > that "one does not have to be a CPA to analyze the data",
    > that means that anyone with any understanding of charts of
    > accounts can determine for himself what the costs are.
    >

    > Even you.
    >
    > And if you bother to do so, you will find that private
    > sector administration costs are not seven times public
    > sector administration costs, as was stated.
    >
    >

    Except you are the only one making this false claim.
     
  12. Mike Gray

    Mike Gray Guest

    Proconsul wrote:

    > 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.....

    Perhaps. But I can't imagine a health system offering access
    to all without substantial gov't involvement. Indeed, the
    present system of Medicare uses the private sector to
    administer benefits and provide services.
     
  13. Mike Gray

    Mike Gray Guest

    Jonathan Smith wrote:

    > You want me to buy your health care insurance for you? No,
    > I don't think so.

    Actually, that would be very kind and generous of you.

    > 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).

    But even in a pool (which any insurance is) the young,
    healthy, clean living Democrats that work as personal
    trainers will transfer their income to old, rum-
    swilling, diabetic, genetically inferior Republicans
    that work as roofers.

    It's still about (1) whether everyone should have some
    minimum standard of access, and (2) what is the mechanism
    for assuring that access.

    If the answer to (1) is "no", the answer to (2) is moot.

    I'm usually accused of being just to the right of Attilla,
    but I think the answer to (1) is "yes".

    Unfortunately, I can't find the answer to (2) without
    substantial gov't involvement and a helluva lot of transfer
    of wealth.

    I don't think this thread will solve the problem, but maybe
    it will make some folks aware of the fact that the solution
    is not as simple as politicians like to make it.
     
  14. Mike Gray

    Mike Gray Guest

    Skeptic wrote:

    >> 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.
    >
    > In order to advance the discussion to a more meaningful
    > point, what are the actual stats... once you exclude those
    > who have an income, could afford health insurance, but opt
    > out of it because they are young, have other bills, saving
    > for a house, etc etc etc? That is not a small group.

    That's a legitimate point. And it begs the question as to
    whether anyone should be allowed NOT to have coverage. When
    that young, healthy, saving-for-a-house, uninsured person
    falls out of a tree someone will have to pay for treating
    his compound fractures (even if we dump him once he is
    stabilized) and few folks have the assets to cover that. He
    escapes paying for it, the dirty bastard.

    If we require he have coverage (gov't intervention in our
    personal affairs and trampling the rights of the
    individual) those of us that have will pay for the coverage
    of the have nots.

    I am semi-retired, underemployed (by most standards), and
    uninsured. I choose to be uninsured because the premiums are
    so damned high relative to my health needs. If a medical
    disaster should happen to me (knock on wood) my assets are
    sufficiently sheltered that someone else will have to pay
    for me to be put back together.

    Maybe that's not fair. But what the hell, I pay for Medicare
    (double!), I pay for corporate benefits (in everything I
    buy), let them look out for me.

    There's also a cost inefficiency in such an arrangement.
    Right now I'm negotiating with eye docs for removal of a
    cataract in my right eye. I'll delay the left eye until
    Medicare kicks in. Timing should be just right. I spend very
    little on my diabetes care, I'm sure I can make it until
    Medicare coverage kicks in, then I'll catch up.

    A significant portion of Medicare costs are the result of
    such delayed care. Not smart if you are the one paying for
    Medicare, and total lifetime per capita costs could be
    reduced if there were a continuum of coverage.
     
  15. Mike Gray

    Mike Gray Guest

    dahmd wrote:

    > 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.

    That's about $800/day, assuming you don't get sick or take
    any vacation.

    And assuming you work a twelve hour day, that's about
    $70 per hour.

    So how may exams can ya do in an hour? If ya run through a
    patient every ten minutes it's about the cost of a lunch
    at Arby's.

    But if you only work 220 days a year (the average for
    corporate types) and eight hours a day with an hour for
    paperwork, and spend a half hour with each patient, that's
    $65 per patient visit.

    Just to put it into perspective. $65 per patient visit.

    > 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.

    Yup, I also live in SoFla. Other than Kerry campaign ads,
    the lawyer ads are the most numerous and the most annoying.
    One law firm is soliciting clients that have ever had X-rays
    of any kind, including dental, another is soliciting clients
    that have ever been treated for cancer, either with
    radiation or chemo, yet another is soliciting clients that
    have ever done any welding. They all promise that, "We will
    get you the money you deserve". Makes me puke.

    But I have done a lot of welding, maybe my ship's come in.
     
  16. "mike gray" <[email protected]> wrote in message
    news:[email protected]...
    > Jonathan Smith wrote:
    >
    > > You want me to buy your health care insurance for you?
    > > No, I don't think so.
    >
    > Actually, that would be very kind and generous of you.
    >
    > > 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).
    >
    > But even in a pool (which any insurance is) the young,
    > healthy, clean living Democrats that work as personal
    > trainers will transfer their income to old, rum-swilling,
    > diabetic, genetically inferior Republicans that work as
    > roofers.
    >
    > It's still about (1) whether everyone should have some
    > minimum standard of access, and (2) what is the mechanism
    > for assuring that access.
    >
    > If the answer to (1) is "no", the answer to (2) is moot.
    >
    > I'm usually accused of being just to the right of Attilla,
    > but I think the answer to (1) is "yes".
    >
    > Unfortunately, I can't find the answer to (2) without
    > substantial gov't involvement and a helluva lot of
    > transfer of wealth.
    >
    > I don't think this thread will solve the problem, but
    > maybe it will make some folks aware of the fact that the
    > solution is not as simple as politicians like to make it.
    >

    Instead of wringing our hands and making beggars out of
    people, why not demand and insure that parents educate
    their children so they won't become dependant upon
    government handouts?

    As long as you support a beggar, a beggar will take the path
    of least resistance and that path will be you.

    --
    Brooks Gregory
     
  17. Mike Gray

    Mike Gray Guest

    MuscleMan wrote:

    >
    > thanks to our current president too.

    Other than giving a drug benefit to the elderly (for which
    they are extremely ungrateful!) our current president has
    had no impact, positive or negative, on the health delivery
    system. And the Democratic alternative is more of the same.
     
  18. Mike Gray

    Mike Gray Guest

    Ted Rosenberg wrote:

    > 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.

    Not really.

    The price lists that hospitals and doctors have (are
    required to have) are as meaningless as the MSRP pasted on
    the windows of cars (required to be pasted on the window).

    Different folks pay different prices.

    If ya walk in the door and offer to pay list price, they
    will love ya to death. But very few do.

    If ya ask what you can actually get it for, they will be a
    little evasive. Cash? Credit? Buy now or later? Just kicking
    the tires or are ya really gonna buy that surgery? Doing an
    expose on how some folks get a better deal than others?

    I'm currently shopping for cataract surgery. Locally, MSRP
    (out the door, tax, title, all the options) is about
    $3800/eye. I have the best shop in town down to about $2600
    and they have indicated that they might go lower. Cataract
    business is slow down here in the summertime, so you can get
    a better deal than in the winter, so, "Buy now" they tell
    me, "because that offer won't last for long".

    Or I can fly to the midwest in midwinter and get a really
    great price.

    Free enterprise at work. Love it.

    Now if I could only get someone else to pay for it. . . .
     
  19. Mike Gray

    Mike Gray Guest

    MuscleMan wrote:

    >
    > 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.

    No, we keep trumpeting that it's cheaper for the taxpayer
    because it's funded with charitable donations.

    The gov't's offer of all my wants and needs from cradle to
    grave is tempting, though. And all those gov't employees get
    great health benefits. Terrible to put them out of work.
     
  20. mike gray <[email protected]> wrote in message news:<[email protected]>...
    > Jonathan Smith wrote:
    >
    > >> All proposals to date have permitted coinsurance,
    > >
    > > Which proposals are those? Kerry's? Kucinich?
    >
    > Neither Kerry

    He did as a Senator though currently he has elected to go
    the universal coverage private insurance pay for it with
    taxes on the rich route.

    > nor Kucinich have made NHS proposals,

    Kucinich? You bet he does, every chance he gets.

    "My plan is called Enhanced Medicare for All -- a universal,
    single-payer system of national health insurance,..."
    http://www.kucinich.us/issues/universalhealth.php

    > though Kerry has promised one as soon as he takes office.
    > His main point, that every American will have the same
    > level of care that members of the US Senate have.
    > Obviously, that is impossible, but he can blame its
    > failure on someone else.

    If the other good senator from Massachusettes (you know, the
    one challenged by driving) is willing to take a cut in his
    access to care....

    > There have been legitimate proposals, most recently by
    > Hillary.

    Hardly legitimate and hardly recent (10 years ago and
    designed by lawyers)

    > Coinsurance has always been included to retain the support
    > of those that would lose benefits in a NHS.

    Which makes it a bit different in that it is no longer a
    single payer system but rather a government safety net with
    private top ups.

    > > 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.
    >
    > Philosophically satisfying, but out of touch with reality.

    Why? It's working for 163 million working class folks and
    an additional 10 million or so seniors under Medicare
    Plus programs.

    > The problem in the US is that coverage has been split
    > between gov't for the seniors and corporate for the
    > employed,

    Not true - seniors have access to Medicare Plus Choice (or
    its more recent derivations) PLUS most already subscribe to
    private supplemental, and many have private employer
    retirement health insurance. All the federal employees have
    this as well - top ups and privated, through FEHB.

    > and it's difficult to change horses in midstream.

    Hardly. It only impacts on a small number of folks.

    > Remember, countries which instituted universal systems did
    > so at the same time that the US opted for the employer-
    > based system.

    Do NOT confuse single payer with universal systems and do
    NOT confuse employer-based with public based. Your
    dichotomies are not accurate.

    Germany, as an example, is a universal coverage (by law)
    with a mixture of true private, quasi-private, and
    public funded.

    > The mechanics of a tax credit system (in which there is,
    > of course, a redistribution of income) are very unwieldy,

    And only the IRS is to blame for that.

    > major problems being the purchase of something now to be
    > paid for with a rebate from the US Treasury next year,

    So how does the earned income tax credit work or the
    childcare tax credit, or....

    > the pricing problem for young healthy groups (workers)

    This isn't a problem now, is it?

    > vs high service groups (diabetics, elderly),

    And what is the problem?

    > and the perception of the elderly that they have already
    > paid for the benefits they now receive.

    The benefits they now receive are basically inpatient
    catastrophic coverage. The rest they pay for every month in
    part B premiums and cost sharing. Medicare is hardly a
    significant entitlement UNTIL you get really sick.

    > Mandating access is easy. Execution is a bitch. And the
    > feds remain smack dab in the middle anyway.

    No - take the feds out of the money loop.

    What is it about extending the market for private health
    insurance to the remaining 100 million US residents from the
    180 or so already in it?

    js
     
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