Election 2008: Healthcare

[psophia17]

I know where I stand politically, and I'm reasonably sure that we're all somewhat aware of who's on the red team and who's on the blue team. Can we be purple for a minute or two?

There are several issues this election that are incredibly important to me. I'd like to discuss them a bit on a thread by thread basis, without any conservative/liberal, red/blue, republican/democrat arguments.

Healthcare is the first, and IMHO, the biggest one.

I think we can all agree it's broken - I'd like to discuss what aspects of it are broken, and what ideas you have for fixing it.

[brittone2]

I'll bite with a suggestion...

I"d like to see more funding devoted to prevention. In my pre-mommy physical therapy days, I found it frustrating that there wasn't more done to prevent falls in the elderly, for example. I know many PTs that would be willing to volunteer their time to do fall screenings, etc. (which is far cheaper than replacing someone's hip after a fall for example). When I was in college/grad school, as students we went out and did some volunteer work like running chair aerobics for the elderly, fall screenings, some classmates did work w/ a professor on using tai chi for fall prevention, etc.

I'd like to see reimbursements for gym memberships (some private health insurers do this, most do not).

I'd like to see more smoking cessation encouragement (the woman that taught my Hypnobirthing classes in PA ran smoking cessation programs using hypnosis and the county contracted her to do some programs for them).

I'd like to see more availability of affordable, fresh produce to city dwellers and children in schools through community garden programs, etc. I'd like to see sodas out of schools entirely, and the cessation of advertising/sponsorship arrangements in schools for products like soda, etc.

[srhs]

I do think the healthcare system needs more oversight, specifically the insurance companies. I do want healthcare available to more and affordable to more.

I do not think universal healthcare is a good idea by any stretch. I think many on here could point to Jack Newman, the Canadian who's respected as such a BFing guru. MANY point to his expertise, yet his clinic receives no gov't funding since it's not considered important by the powers that be. So, he has to do fundraising. That makes little sense to me.

I'd be interested in hearing from our Canadian members. Am I misunderstanding this?

[gatorsmom]

I know where I stand politically, and I'm reasonably sure that we're all somewhat aware of who's on the red team and who's on the blue team. Can we be purple for a minute or two?

There are several issues this election that are incredibly important to me. I'd like to discuss them a bit on a thread by thread basis, without any conservative/liberal, red/blue, republican/democrat arguments.

Healthcare is the first, and IMHO, the biggest one.

I think we can all agree it's broken - I'd like to discuss what aspects of it are broken, and what ideas you have for fixing it.


I'm not exactly sure where each of the candidates stand on this issue. But after living in France for 2 years where healthcare is free for everyone, I hope that their system is NOT considered as an example. I consider it an example of how to kill an economy. Essentially, employers are responsible for paying specific taxes for each employee they hire which would go directly to funding their healthcare system. When the program was initially started it was wonderful and made healthcare free for everyone. But over the years, it has insured that employers hirer fewer employees and overwork the ones they do hire. It has caused higher and higher rates of umemployment as well as allowed doctors and patients to abuse the system. For example, many of the elderly people I knew would spend a week at the sea because their doctors prescribed a week at the spa. Guess who paid for it? The healthcare system.

Hopefully, our candidates can come up with an acceptable system and soon.

[JBaxter]

I agree healthcare needs some work but I do NOT want universal heathcare. I cant see that ever happening in the US. There needs to be a low cost plan available for everyone but I want the ability to keep my very good healthcare plan. DH works his butt of at a company and one of the perks is the plan. I want to keep that option available to pick and choose who I want to go to and when.

[MontrealMum]

I do not think universal healthcare is a good idea by any stretch. I think many on here could point to Jack Newman, the Canadian who's respected as such a BFing guru. MANY point to his expertise, yet his clinic receives no gov't funding since it's not considered important by the powers that be. So, he has to do fundraising. That makes little sense to me.

I'd be interested in hearing from our Canadian members. Am I misunderstanding this?

Yes, you are...allow me to be the annoying, almost-Canadian with a love-hate relationship for both systems... ;)

As per Newman's own website, a good chunk (the physician's part - so the expensive part) is covered by OHIP, so, they are government-funded. See here: http://www.drjacknewman.com/about-funding.asp

I do not live in Ontario (which is the province of OHIP) so I can't say this example will be one-to-one, but my own doctor's practice charges for some services. Such as flu or other shots, blood draws, etc. That's because here in Quebec those things ARE offered free of charge at other places, under our provincial health plan. So, if you make the choice of convenience (which I have made often - I won't pretend that the Can. system isn't more time-consuming at times) to have your blood test done in the office rather than at the hospital or the CLSC, you pay a fee of $20. That fee can be submitted along with other medical fees with your taxes if it amounts to enough. I would imagine that ON has many other forms of b/fing help for mothers, as Canada is very pro-b/fing. We certainly have quite a few different, and free, services here in QC.

There is also a two-tier system here in Canada, where you have private clinics and public clinics. It has grown because the public system is overtapped in many provinces. Part of the reason the public system is overtapped here in Quebec is that those who are trained here, in English, don't want to stay. Also, they prefer to move to the US where they can make more $$. But that's just the tip of the iceberg...

Many disagree as to whether it should grow further, or be abolished. This isn't the place to discuss that...so here is a very sweeping and general, as healthcare is provincial, not federal, synopsis...private clinics do receive some government funding, but they tap into the manpower resources of the public system. They often duplicate the services of the public system. I would guess that Newman's clinic is private. However, it does not follow to assume that just because he is not fully funded, that there are not similar services available to women here in Canada. They may not be as posh, but they do exist. I think if you do a search you'll find that Canada has higher rates of b/fing, and higher rates of b/fing longer than the US. I expect that that is due to a combination to a number of things: pro-b/fing hospitals, staff, and physicians. Lactation specialists that come to your house for free days after giving birth. And much longer, and better compensated, parental leave.

As someone who has lived under both systems, albeit in the US under VERY good insurance, I can say --- the US system is not working, but neither is the Canadian one. It's too complicated to go into it more than that, but I agree that lawmakers and politicians have to work harder to make things better for everyone.

[brittone2]

I'd also like to add that we need to do something to help those with pre-existing conditions. The current system is absolutely horrible for those w/ a pre-existing condition.

[MelissaTC]

I think that everyone should have access to heatlhcare. But I agree with Jeana in that my husband works off his tail in part because his company has benefits and we don't want to lose those. But I don't think it is right that there are people that don't have that access, especially in the richest country in the world. It just doesn't seem right or fair.

I don't know what the answer is. I don't agree with those that say the federal government should create a program. It doesn't exactly have a great track record. I think it should happen on a state level.

[brittone2]

whoops, double post.

[brittone2]

I think that everyone should have access to heatlhcare. But I agree with Jeana in that my husband works off his tail in part because his company has benefits and we don't want to lose those. But I don't think it is right that there are people that don't have that access, especially in the richest country in the world. It just doesn't seem right or fair.



Same here. We've always had pretty incredible insurance (having things like IF treatments covered for example), and I'd like to maintain that choice. However, for those that aren't as fortunate, I think the current system is a disgrace. Those that need insurance the most often end up going without it.

[srhs]

MontrealMum--Thank you for the clarification. I apologize for any error and was definitely open to correction. I emailed Dr. Newman in July. In his response, he had a footer indicating they did not receive any federal funding and were always in danger of closure, going on to ask for donations. I really want to quote but the footer also says no reprinting without permission. Sooo, I went to the same site as you sited where he says "(Again, there is no government funding whatsoever for our clinic)," so I assumed OHIP wasn't gov't. My bad!

Anyway, I was struck that someone so highly esteemed felt fundraising necessary.

All the same, I really appreciate the response. Bummer that both systems have so many issues.

[JBaxter]

I know here in Maryland if you dont have healthcare coverage for your children but done qualify for a medical card they have insruance available for lower income parents to buy I want to say its less than $50 a month. I think Pennsylvania also has the same type of option. I know that isnt for adults but they at least have that for the children.

[Sillygirl]

The two things that make NO sense to me in our current system:
1) That we continue to tie insurance to employment. (I'm aware of the historical reasons why it started like this.) When you get really sick, say, with leukemia, and need insurance the most? It's awfully hard to hold down a job. Also, most people changes jobs frequently. Insurance companies know lots of people aren't going to stay on their rolls for decades. So they do less in the way of long-term preventative health.
2) That we funnel all this money into a system run by for-profit companies, who make a profit by not paying out claims. The insurance companies aren't responsible for keeping you in optimal health. They are responsible for keeping as many premium dollars in their pokcets as possible.

I understand conservatives want the forces of the market to make health care more efficient. But the existing incentives are incredibly skewed.

[MontrealMum]

Sorry srhs if I was abrupt before, I am battling a cold, and a teething DS...I've gone back to my original post to try to make it more jovial :)

Healthcare in Canada is provincial, not federal, so no federal funding doesn't mean no funding at all. However, it's all extremely confusing - and frustrating. I will admit that I love not having to pay for anything, ever --- but having my US experience to compare it to - oooo, that's hard, but again, I had top-of-the-line coverage, that most Americans don't have - so it's not much of a comparison. Level of service, wait times, distance to services, lack of choice, having to bring a fan to the hospital for DS' birth (OK, that was because I gave birth in a super-old hospital, but still).....both systems need work, certainly. I don't think I could even begin to list what I think needs to happen. But I also don't like it when Americans just look at the Canadian system and say that it should be copied - because it need shoring up desperately - and that's just such a simplisitic view of an extremely complex situation. I also have lots of friends in the medical field so I hear about this alot from both sides and it's just a sea of hard choices and imperfect situations. Still, I stand behind the Canadian system, even though it needs a bit of fixing.

[CAM7]

After having first hand experience with American healthcare I can say one thing for sure: everyone wants 100% coverage (for themselves and everyone else) but nobody wants to pay for it.

[maestramommy]

I think the part of healthcare that is tied to Medicare is too confusing. My parents are partially retired (mom is, dad about to be), and my mom just went through radiation for breast cancer. Her insurance company refused to pay for the assistant surgeon for her lumpectomy. Reason? According to the code number the doc used, this assistant was not deemed necessary by the insurance company. So we had to call the doc and ask about that, get the doc's office to decide which code number would qualify, all this through a third party, the company that is buying the insurance. WTF?? I'm a native English speaker, and I was barely hanging on to all the explanations. This was back in June, and I'm still not sure if it has been cleared up.

Besides that, even with insurance my parents have paid almost $10k to date for the surgery and radiation. How they are affording this I don't know. :32:

[HannaAddict]

We have universal coverage in this country, but only for seniors. And they seem to like it fine. No system is perfect, even when you have coverage you have to fight with insurance companies for the benefits you pay for, but I find it ironic (or shocking?) that so many in America who profess family values or religious values (or enjoy Medicare) don't want to risk giving up their personal insurance benefits to even consider all of us contributing for universal coverage so that a child can have good health care. I don't think just children should be covered either. There are hard working people who work their tails off who don't have benefits or have crummy ones. It isn't a moral or personal failing or that they aren't savy enough to work for a company that provides good benefits. Our neighbor is a small business owner who doesn't have enough employees to get a "group" plan and can't get insurance even if she pays due to a pre-existing condition. Once her COBRA ran out post-divorce, she was out of luck and literally in tears. I tried to help her and it was the most demoralizing situation I could imagine. She was on the waiting list for our state's uninsured pool that was closed because too many people needed it (and she was willing and able to pay the $2,400 a month premium for her and her teen daughter).

My husband and his two partners work their tails off too and spend big, big bucks to provide their entire office, part-time staff included, with full, 100% paid for coverage for employees, their spouses, children, and domestic partners. "Full coverage" meaning a pick your own provider plan, vision, and dental. They also pay maternity benefits of 100% pay for one month and 75% pay for two additional months (not a disability plan with reduced benefits) and they pay the health premiums (the parents doesn't pay COBRA) while the parent is on leave. Crazy, sometimes I think so, but health care seems like such a fundamental thing that everyone deserves it. I would probably not have as wonderful of benefits if we had universal coverage but we should at least try. FWIW, we have friends who are French and Swiss citizens (married to Americans) and they love their system compared to what they know of ours. They find it bizarre that our country has the "me first" mentality in health care and both get their health care from their home countries and their husbands are on those policies!! My Swiss friend was complaining because her premiums went up from under $100 a month to over $100. When I told her what it cost a month for our family (let alone our 1/3 of partner distributions for a staff of 20 plus their dependents!), she gasped.

Okay, done now. I guess you know how I feel.
Kimberly
Believer in a Rawlsian theory of justice, pick a system that you would like if you didn't know if you were born with health care or could get it . . .

[bubbaray]

I do think the healthcare system needs more oversight, specifically the insurance companies. I do want healthcare available to more and affordable to more.

I do not think universal healthcare is a good idea by any stretch. I think many on here could point to Jack Newman, the Canadian who's respected as such a BFing guru. MANY point to his expertise, yet his clinic receives no gov't funding since it's not considered important by the powers that be. So, he has to do fundraising. That makes little sense to me.

I'd be interested in hearing from our Canadian members. Am I misunderstanding this?


Yes, you are misunderstanding it.

His clinic DOES receive gov't funding and he explicitly states that on his site:

http://www.drjacknewman.com/about-funding.asp

He gets funding, like other doctors registered to practice medicine & who have a gov't billing number, for the dr portion of a visit. The clinic, like most other medical practices in the country, does not receive funding as a clinic. The payments are made on a fee-for-service basis to the physician.

Obviously, he is wording his website so that he receives funding -- hey, great for him. He has a niche and is finding a way to make it work.

But, please, do not misrepresent the situation and say that the Canadian healthcare system does not support BFg. Quite the contrary. There are many many resources (public health nurses, LCs, BFg doctors) all available as part of the universal health care system here. And, BTW, Canada has a much higher BFg rate than the US.

Universal health care here isn't perfect, but its better than having millions of people (and, sadly, children) uninsured and without even basic health medical services.

[CAM7]

Universal health care here isn't perfect, but its better than having millions of people (and, sadly, children) uninsured and without even basic health medical services.

Like where?

[srhs]

But, please, do not misrepresent the situation and say that the Canadian healthcare system does not support BFg. Quite the contrary. There are many many resources (public health nurses, LCs, BFg doctors) all available as part of the universal health care system here. And, BTW, Canada has a much higher BFg rate than the US.



bubbaray--I definitely did not mean to make any implications about Canadians not valuing BFing. I only meant to say I was SO surprised that he, as such a respected expert, felt he had to solicit donations to keep operating.
Fundraising as part of medical practice is genuinely troubling to me.

[bubbaray]

Like where?


This looks like a gov't agency, not sure, from 2004: http://www.mchb.hrsa.gov/mchirc/chusa_04/pages/0605ucM.htm

This looks like a lobby group: http://www.familiesusa.org/assets/pdfs/still-too-many-uninsured-kids-2008.pdf

USA Today -- stats vary, article says uninsured children range from 5% in MI to 20% in TX: http://www.usatoday.com/news/health/2008-05-27-kids-health_N.htm

Even 5% is a lot of uninsured children. JMHO.

[bubbaray]

bubbaray--I definitely did not mean to make any implications about Canadians not valuing BFing. I only meant to say I was SO surprised that he, as such a respected expert, felt he had to solicit donations to keep operating.
Fundraising as part of medical practice is genuinely troubling to me.


I dunno about him being considered an expert, at least not for billing purposes. As far as I know, there is no recognized speciality in lactation for physicians, at least not here. I would assume that he bills OHIP as a GP (family doctor).

[CAM7]

Even 5% is a lot of uninsured children. JMHO.

"Uninsured" doesn't nec mean that they can get NO healthcare. If I lived in a state where my kids could not get coverage I'd certainly look into moving somewhere where we could get care.

[srhs]

I dunno about him being considered an expert, at least not for billing purposes. As far as I know, there is no recognized speciality in lactation for physicians, at least not here. I would assume that he bills OHIP as a GP (family doctor).

Okay, this is one of those examples that would be cleared up on 10 secs IRL, I think.
I didn't mean 'expert' as in billing, just as in commonly thought of highly. The LC in the hospital had me watch his videos; my nurse-midwife used his book; kellymom cites him repeatedly; ladies here point to his info; etc.
To be simplistic...many people think this dr. is ALL THAT in the field of breastfeeding, but he is fundraising to keep his clinic running. That blew my mind. That's all! That's all! That's all! If a physician is that good, he should be able to practice without concerns about financial backing IMO.

[bubbaray]

If a physician is that good, he should be able to practice without concerns about financial backing IMO.


That is not how the system works here. GPs, regardless of how popular they may or may not be, all receive the same fees for various services. The gov't doesn't rank them based upon popularity or "following". For example, there is a set fee for a 1w well baby visit, a fee for a prenatal check, a fee to attend a birth (the majority of babies are delivered by GPs), etc.

Specialists are paid on a different scale, which varies by specialty and procedure. An OB, for example, gets paid a set amount for a scheduled c/s.

There are other types of drs too (such as hospitalists), which don't get paid on a fee-for-service basis (they are in-hospital dr's who do "rounds" and take care of patients in hospitals and they are paid a salary & work set hours), but I rather doubt Newman is a hospitalist.

Don't get me wrong, I'm not saying the system here is perfect, but for the majority of people it works well.

[CAM7]

I'm not saying the system here is perfect, but for the majority of people it works well.

Same could be said for US healthcare. So... why the bashing of US healthcare?

I've lived in England... not that impressed with NHS. I don't think any country has the ideal healthcare system.

Always the US taking heat for not being perfect. Why?

[MontrealMum]

Okay, this is one of those examples that would be cleared up on 10 secs IRL, I think.
I didn't mean 'expert' as in billing, just as in commonly thought of highly. The LC in the hospital had me watch his videos; my nurse-midwife used his book; kellymom cites him repeatedly; ladies here point to his info; etc.
To be simplistic...many people think this dr. is ALL THAT in the field of breastfeeding, but he is fundraising to keep his clinic running. That blew my mind. That's all! That's all! That's all! If a physician is that good, he should be able to practice without concerns about financial backing IMO.

Please understand that I am saying this very gently and not in a correcting tone, but in an explanatory one..., the Canadian system is verrry different than the American one.

As I said before, it's not *likely* that the services at this doctor's clinic are not duplicated at other facilities - within the system. Especially since he's in TO. That's one of the key differences, paying for one, is cheaper than paying for two, or three, or four. Again, I'm not in ON, but medical practices aren't seen as free enterprise here. I am not stating that well, but basically, he DOES have backing - likely as a GP as Melissa said. It's some of his extra services that don't. But those same services will most certainly be offered elsewhere. It's just that those "elsewheres" aren't as posh, or centralized (as in, all in one place), or have websites!

I have a friend that recently gave birth in the GTO and had lots of lactation problems, and I guarantee that she didn't pay a cent for the help she received. Because she hadn't started her job yet and had next to no money. I won't post about my own birth experience because it's very complicated, but basically if I'd wanted lactation help I could have gone free to either the hospital I gave birth in, or to the Jewish (which is a bit of a hike for me) but DS' doc was willing to write me a script; also a CLSC (QC's clinic-system) nurse came to my home, and if I'd wanted more I could have gone into the CLSC itself, or the drop-in centre. I also could have contacted LLL or other, private services, paid, and submitted the receipt for a credit at tax-time.

It's truly a different world up here, and it's not done justice by American pundits and commentators. I agree, as someone coming from outside this system - it is hard to understand, and really wrap your mind around.

[MontrealMum]

Apologies to Petra who started this thread and as someone who lives in Canada must be pretty familiar with our system ;) ... we've spent way too much time discussing healthcare in the wrong country :) - I'm bowing out and going on to other things...

[Staraglimmer]

sorry wrong thread!

[megs4413]

I know where I stand politically, and I'm reasonably sure that we're all somewhat aware of who's on the red team and who's on the blue team. Can we be purple for a minute or two?

There are several issues this election that are incredibly important to me. I'd like to discuss them a bit on a thread by thread basis, without any conservative/liberal, red/blue, republican/democrat arguments.

Healthcare is the first, and IMHO, the biggest one.

I think we can all agree it's broken - I'd like to discuss what aspects of it are broken, and what ideas you have for fixing it.

I thought you were canadian now? Will you be voting in this election (no snark, just really wondering how that works when you have dual citizenship)?

I think our healthcare system needs to be revamped from the bottom up. Education and regulations on malpractice insurance/settlements play key roles, IMO.

First, it's too expensive to become a doctor. Second, it's too expensive to BE a doctor. Doctors struggle to pay off student loans AND cover their malpractice insurance. The old promise of becoming a wealthy M.D. is not realistic anymore. More and more people are turning to more profitable areas of medicine (plastic surgery is a good example) and certain specialities are experiencing shortages in staffing (not to even mention the nursing shortages that are only getting worse). Our court systems have been clogged up with frivolous lawsuits and judgments have skyrocketed to alarming heights. Healthcare is not an island. Its problems are related to other problems in the structure of our nation. I don't have answers, but I don't see ANYONE even attempting to address the serious underlying causes of some of these issues. (Ok Ron Paul would like to address some of these issues, but he doesn't have a snowball's chance in you-know-where of pushing his agenda anywhere, so it's a moot point).

Insurance companies are the devil.

Drug Companies are the devil's spawn.

I really could rant on about this forever. What we need is to start viewing our healthcare system as the consumers we are.

that's all from me for now...

[niccig]

What do people dislike about universal health care?
Is it paying more for health care than now?
Is it paying for someone else to get coverage too?
Is it a different system that people don't know about it?

I don't understand. I lived in Australia with universal coverage, no it's not perfect, but if you need treatment you get it. No system is perfect, but to have millions of people with no coverage or very poor coverage, means the current system is failing.

I've had this discussion a few times with friends recently. I see the problem not only with people having no coverage, but also with families that have insurance, but then still go into debt as insurance won't cover this or that. Eg. my very good friends who are self-insured, their 1 year old has Down Syndrome. They have high premium and high deductible, and owe the hospital $12,000 from his birth and her stay for the c-section. He's just been diagnosed with a rare epilepsy disorder,infantile spasms, and the medication is $90,000 for 30 days and he may need to be hospitalized for the entire time. If he doesn't have the treatment he will become severely retarded, he's 12 months old and signing for milk, laughing, interacting with everyone, and most of his delays seem so far to be physical. He is not covered by mediCal yet as they were mistakenly told they didn't qualify as made too much money, but he does qualify based on his Downs Syndrome, and the mediCal is still being processed. They're in this nightmare of trying to work out if insurance will cover the treatment, who will pay, how much they will have to pay, the ped. neurologist doesn't take mediCal even if they could use it, and neither does the hospital the Dr. is affiliated with. If they did have mediCal, they would have to find another doctor and hospital. All they want is for him to get the medication to stop the seizures NOW.

In Australia, in the case I described above, they would be none of the extra stress and concern about paying, finding the right doctor/hospital to get coverage. Their baby has a life-threatening condition. He would be admitted to the hospital and Australia's Medicare would cover the treatment the doctor prescribed.

Australia has a 2-tier system. Medicare covers all Australians from birth. You can see ANY doctor. Some treatments are subsidized, others are free.. Some doctors charge more than the Medicare amount, you know that and just pay the difference. To see a specialist, you need a referral from your GP, specialists are either Medicare covered or Private. If you want private health insurance you can buy it. Your private coverage will allow you to see a specialist sooner and have elective surgery sooner. But you can see ANY specialist, you don't have to find one that is in your network. Unfortunately, the Medicare system is over burdened, and there are waits for non-life threatening surgeries - it's not a perfect system. If you can afford private insurance, you get it, and it is much cheaper than what you pay here and there is no back and forth with the insurance company about what is or isn't covered. I just got a quote, for DH, DS and I, for the top plan from the biggest insurer in Australia, it would be $325 a MONTH. At DH's work, they take out $1000 a month and our plan used to be much better, many things aren't covered as well now. If you can't afford private insurance or don't want it (many people feel they don't need it), then the universal Medicare system covers you.

I know Australia's system won't work here, and as I said it isn't perfect, but it's so much simpler than what I've experienced here.

I think there needs to be some sort of universal coverage - how much it covers for everyone, I don't know - but people need to have access to medical care and with the current system, only those with jobs that have benefits or people with money to pay for self-insurance, can get the care they need - and then there's the paperwork hassle to make sure your insurance pays correctly. If my friends can't get the $90,000 medicine covered, I think they'll need to take out an equity loan on their house - they're already stressed financially, and I think this could break them. And they have private health insurance.

[kijip]

My issues are (like other posters):

-Tying insurance to employment. Seems to mean it is less likely to be there when you need it and CAN'T work.

-Not training enough doctors. I know a lot of qualified people that can't get a spot in medical or even nursing school because there are not enough schools.

-That in many states, my mother who has a host of medical issues including 2 types of stage IV cancer and is disabled but who is WELL under 65 would not have insurance. It is only through our state that she does. People in my mom's situation can't afford to move- she lives on a small disability check, support from family, a HUD voucher, food stamps and luck. And while her state insurance pays for most of her health costs, guess who buys her dentures, hearing aid, glasses etc? Family. Like she is supposed to have no way to chew, no use of her ears and no vision. That my dad, a father and a veteran with MS went uninsured for 2 years until he qualified for medicare. His "high" social security check is too high for the program that insures my mother. With a serious preexisting condition, buying insurance would have been his income, IF he could get it at all. I worry about the hundreds of thousands/millions of people out there like my parents.

-That I get superior health benefits for no and low cost (100% employer paid for my husband and child/ren, nearly all employer paid for me) and low co-pays just because of where my husband works. It seems unfair that while many go without glasses, dental work, medical treatment, preventative care they need that I can see a PT, a Chiro, an Acupuncturist etc for $15 co-pay on a self referral.

-That people don't understand health care costs $$$ to provide and does and will and MUST cost them $$. Regardless of if it is state, employer or individually based we all pay for health care and will pay for it. I frankly admit to seeing people refuse to buy into affordable health offerings at work while whining they can't afford it but spending big $$ on non health things. Yes, some can't afford it. But many could, if they made it a priority.

[niccig]

Same could be said for US healthcare. So... why the bashing of US healthcare?

I've lived in England... not that impressed with NHS. I don't think any country has the ideal healthcare system.

Always the US taking heat for not being perfect. Why?

I don't see it as bashing the US. There are problems with the current system, we can be critical of that and say how we would like things changed.

I know it's not the best source, wikipedia has some statistics on people covered with health insurance and those without. If someone has a better source, please post.

15.3% of the population or 45.7 million people had no health insurance coverage at some time in 2007.
http://en.wikipedia.org/wiki/Health_care_in_the_United_States

That's an awful lot of people, more than the population of many countries. Where do they go when they need to see a doctor, when it's not an emergency. If they have a chronic condition like diabetes, who do they see to check their levels and adjust their medication?

There is amazing medical care in this country, the best in the world, but millions of people can't access it. I think that's a problem that needs fixing.

[psophia17]

I thought you were canadian now? Will you be voting in this election (no snark, just really wondering how that works when you have dual citizenship)?

Still a US citizen, and will remain so. My children have dual citizenship, I do not. I have sent off for my absentee ballot, and am looking forward to its arrival.

[annasmom]

I am not certain whether universal health care is the answer - but people need to have access to affordable and GOOD health care.

We have always had really good insurance, but we do pay a lot of money for it.

Ever since my dd was born I have been REALLY concerned about health care in this country. I had good insurance, and a healthy pregnancy, and then everything went wrong.

The cost for her room & board in the hospital alone (nothing for me, no medical procedure expenses) costs $300k+. It would have bankrupted us to have to pay this.

AND, even though we had insurance, our insurance company fought us for almost 2 years about every nickel and dime. It was a horror show.

[MarisaSF]

I would like to see a universal medical records database. IMO, it would eliminate a lot of waste, missed diagnoses, patient reporting errors, duplicate/triplicate/etc tests, maybe streamline some overhead. There would need to be tight security, of course.

From what I understand the VA/military has such a system (E to clarify: *an electronic medical records system*). I'm not too familiar with it, but have heard it is handy for docs at least.

Much of my public health work has focused on expanding access to care, especially among children. I think the SCHIP plan is a good one and would like to see it expanded AND to get all qualifying children enrolled in it.

[psophia17]

I don't know if I think Universal Healthcare is the issue. It's certainly something I was thrilled by when we moved from the US to Canada - I'd had great insurance right up until DH and I were both unemployed, and then it took months to get the state-subsidized insurance for our infant, while DH and I went uninsured. COBRA was a joke - we were unemployed, how could we pay for it?

I would like to see some sort of a system that tied in to your income taxes. If you met income requirements, you qualified for coverage, end of story.

I would also like to see some sort of cap on standard fees, potentially also tied in to income earned. To make healthcare accessible without jumping through hoops.

When DS2 was born, I was without medical coverage, but I knew I would have coverage retroactive to his birth, so we didn't have to pay out of pocket. Our income for that year was low - we started a business, and my income of $0 averaged in nicely. So based on our tax return alone, we qualified for a variety of free or extremely low cost benefits. It was that easy - one form to fill out, done. When in NY, we qualified, but we had forms, interviews, meetings, more forms, a notary, and it took months. That's not okay with an infant - he was 4mos when we lost coverage, and we didn't get coverage until a couple of weeks before we moved, when he was 8mos.

That, in addition to having tons of services just available - well-baby clinics are accessible, there are community nurses that will come to your house if you need them, just call, lactation consultants and really, any service I've needed, I've been able to find. There's enough stress in the world without adding healthcare to the mix.

[shilo]

won't come as any big surprise to anyone here that i am passionate about this issue and that i am in favor of universal coverage. i'll try to be succinct (haha) and answer only what you asked...

what aspects are broken:
- for me, the key areas are access, administrative costs, liability, comprehensive coverage, quality and a lack of evidence based practice and care, lack of preventative care, and poor management/care of patients with one or more chronic diseases.

what ideas do you have (or in my case support) for fixing it:

** access: i am in favor of a universal access program that provides opt-in coverage to every citizen. i do think that each of us has a responsibility to pay a _reasonable/affordable_, (sliding scale if applicable) fee for premiums, deductibles and co-pays into such a system, which for many who already have coverage, would continue to be partially or fully covered by an employer. this would apply to all citizens regardless of current health status/pre-existing conditions, etc. as we are paying or assigning our own dollars into such a system, i believe in a choice of programs where individuals and/or groups (ie. employers) can choose from a variety of plans and price points where all meet a basic/minimum standard of coverage and expand from there. while i am very lucky to have really great benefits thru my DH's employer as well, i know that the line between the haves and have-nots is just a car accident, divorce, corporate layoff, etc. away. many of us have or know someone who has a pre-existing condition that would prevent them from obtaining coverage (affordable or not) in the event that they lost their job-tied insurance. in my case, not only would i not have coverage for this pregnancy, but sam would be immediately declared to have a pre-existing condition should anything happen to my DH and we lost our health insurance tomorrow. his single prescription for his disorder alone would cost us more than $25,000 out of pocket this year. how many of us could easily afford my expected $5-10,000 hospital/L&D bill for this baby, let alone sam's prescription if we lost our insurance suddenly?

- while i personally believe that a single payer system is the MOST effective way to achieve the best care at the best price, i acknowledge that the odds of that kind of system ever coming about in this country is almost nil. here's why i favor it tho - after 15 years working in the healthcare industry, i can tell you that MOST of my patients would much rather have medicare (the 'general' single payer plan) than the 'choice' options provided thru private insurers. i cannot count the number of patient's i've had over the years who have dropped their private insurance plans (ie. healthnet senior, cigna, kaiser, secure horizons, etc) for plain old medicare when they actually got sick and needed to use their catastrophic benefits b/c of medically unsound restrictions in coverage. in 15 years, i have not had a single patient sign over their medicare benefits for one of these insurance company managed care plans while experiencing whatever medical incident landed them in my rehab gym. not one. while everyone wants to have a choice of plans and all the 'pretty' fringe benefits these private insurers offer while they are well, when they actually get sick and need their insurance, they are often dismayed to find out what the insurance provider will/won't cover, consider 'medically necessary', etc.

** administrative costs: i'm not naive enough to believe/admit that this isn't a free-market driven economy and getting rid of the current for-profit system is basically un-doable. but i do believe that the existing insurance providers/companies would need to be drastically reigned in in both their profits and especially their administrative overhead structures in any new program. our current 'broken' healthcare industry has an average of 25% administrative overhead costs. the medicare and medicaid system averages just 2-5% overhead. it doesn't take an economic genius to see that this is wasteful spending when we are dealing in HUMAN lives. it's not that i don't think these private insurance companies shouldn't make reasonable profits for their services, but only provided they charge reasonable administration fees and meet acceptable levels of return of premium/deductible/co-pay dollars back into direct patient care!

- another big issue for me is the indirect (hidden/shifted) costs the private insurers foist onto providers, hospitals, etc. most studies have shown an average of 25% of providers/hospitals resources are eaten up by unnecessary paperwork, haggling, justification, delayed payments, etc. it gets worse... it costs these providers/facilities FOUR times as much annually to deal with these indirect costs as the 25% squandered on direct administrative waste already going on inside the private insurers.

-and just in case anyone asks... the 'official' numbers are as follows -
- the 2003 NEJM study reported that the indirect costs of administering the US's healthcare system in 1999 was 300Bn (yes, thats billion). by 2003, that number rose to 400Bn.
- the GAO (general accounting office) and the medicare/medicaid actuary's office reported that for those same years the direct costs of administration of private insurance companies were 40Bn and 95Bn respectively.

-we need to make modernizing to computerized records, patient team management, quality assurance, and billing technologies a priority immediately.

** liability: while i agree whole heartedly that a change/regulation in the medical malpractice insurance industry and decrease in malpractice cases needs to be addressed, it's a minor problem by comparison. the congressional budget office report showed about 26Bn spent on medical liability suits in 2003. both sides (bi-partisan) estimates put the savings to be had from tort-reform somewhere in the 6 to 7Bn range. not anything to dismiss, but certainly not the hundreds of billions in savings to be had in reform of the direct and indirect cost of administration of the current system.

** comprehensive coverage: i would like to see a national plan that addresses the whole person. i believe that only thru a comprehensive coverage program that addresses preventative services, prescription, vision, dental, mental health as well as catastrophic coverage can we really care for our nation in a way that is worthy of our legacy and ideals. nuff said.

** quality/evidence based practice: i'd like to see centralized outcomes measures and tracking, only then can we really know what populations we're caring for well, and what populations we're failing. i'd like to see a real shift toward evidence based care within every discipline. but even more-so, i'd like to see a shift in the laws and regulations that allow direct access to providers that are PROVEN to provide equally effective and efficient care to patients. at the individual discipline level, we need more generalists, not specialists in this country. it's not that i don't see/understand how expensive medical education is in this country (BTDT), but we (as a country) need to provide more incentives to ALL health care providers to 'generalize' into the care of larger subsets of the population. between disciplines, frankly, i'm sick of the AMA PAC/lobby preventing direct access to allied health care professionals (from therapists like me, to nurse practitioners, physicians asst., etc). when often times, these providers can not only provide appropriate and effective care, but at a significant cost savings to MD's. if we actually had a program that allowed all providers to be reimbursed at a fair rate commensurate with the level of care they can provide, maybe there wouldn't be a need for so much territoriality.

** preventative care: pretty much self explanatory, other than to say study after study has shown how cost effective this strategy can be. prevention coverage should be compulsory in any plan put forward. and it should include everything from education to evidence based disease management programs that can provide real long-term savings when compared to the catastrophic and chronic disease states that are the alternative.
also, you can't really talk prevention without addressing the pharmaceutical bit. i could go on and on, but i think the single most important factors here are addressing unfair pricing structures by the manufacturers and collective bargaining. if the same drug is being sold overseas by a company for half of what it is charging here, we should allow it to be bought overseas. the current ban on negotiating drug prices for the medicare prescription drug program as well as any future universal coverage program needs to be repealed immediately. it makes no sense - we're all here b/c we bought a book about how to get the most for our money in baby-gear... why wouldn't we do the same for our prescription drugs?

** chronic disease management: 75% of our healthcare expenditures are spent on caring for patients with one or more chronic diseases. in addition to the preventative strategies above, we should be using our best evidence based research to manage the care of these individuals in the most comprehensive and cost-effective ways possible. we need to centralize their records so that everyone on the healthcare team can not only contribute effectively to their care, but also not duplicate unnecessary care as well. i do believe the 'generalist' (pediatrician, family practitioner/general practioner (i'll even go so far as to say internist), and or geriatrician) is the most effective/efficient choice to serve as the point leader to coordinate specialist, prescription drug and allied health interventions and preventative care. these providers should be given the time and resources, as well as compensation to effectively help provide better management and care while reducing the overall cost of care over time in these patients.

anyway, i'm sure there's more, but i've rambled long enough. ITA with you, it is broken, it is a BIG issue and it NEEDS to be addressed asap.

lori

[o_mom]

I have no idea how to fix it - I don't think the Canadian system is anything that great as it has its own problems.

Some of the things that make sense to me:

- Stop tying insurance to jobs - create large pools with standard coverage along the lines of the Medicare supplemental insurance. People need to know what they are paying for and be able access it. I'm not sure how to eliminate pre-exisiting conditions without requiring coverage, and I'm not sure about mandating health insurance. Working it all out is not easy.

- Train more doctors and lower the cost

- Eliminate for-profit insurance companies

- Make the billing more transparent and level - even with good insurance, I have no idea what I will pay anywhere other than an office visit. The exact same lab test can cost 10 times more at one lab, even after insurance discount, but there is no way to find that our ahead of time.

[bethie_73]

From what I understand the VA/military has such a system. I'm not too familiar with it, but have heard it is handy for docs at least.


I grew up in the military, and DH is still military (but works in the private sector too). If Universal Healthcare will be like that, I really could do without.... sorry. I don't have an issue with Tricare etc. But my Mom passed away from Cancer, the first bout was VERY fast moving (DX in Feb, by the time she had the lumpectomy a couple weeks later it was a full mastectomy etc because it was so fast and invasive).... Thank god my parents had Tricare and she could go to a private hospital. The wait at the Military hospital was such that she *probably* would not have made it until the appt. I, unfortunately, have not had many good experiences with a military hospital, and many of the Moms I know choose to birth in other places if possible. But that is just one side of the story.

I believe there needs to be coverage for people, but I do not have a good idea, I know this and so I don't have a lot to contribute at this point. That said my DH works his butt off for his company and part of the benefits is the Healthcare. That was part of the overall "package" for him accepting the job

[megs4413]

Still a US citizen, and will remain so. My children have dual citizenship, I do not. I have sent off for my absentee ballot, and am looking forward to its arrival.

please forgive my ignorance on this subject...

so do you have some sort of permanent resident status in canada? i thought i remembered you having to go through some kind of process to get access to the medical care...i guess i mistakenly thought it was citizenship. anyway, so when you send your absentee ballot in how do they count it? will it apply to the voting in the state you used to live in? i've never voted absentee....

[psophia17]

I have the Canadian equivalent of a green card, so yes, permanent residence.

My vote counts for the last place I was registered to vote in. If only I could make it count for a swing state. My vote will count for NYC. After this election, I'll likely change the address to my parents' in upstate NY.

I'm not sure exactly how it's counted, but I'm going to give it my best shot.

[JTsMom]

I have way too much I should be doing right now, but I'm going to take a quick stab at this.


When DS was born, we were fortunate enough to have unbelievably good health insurance. They covered his $25,000 helicopter transfer. They covered the tens of thousands of dollars in initial testing without denying a single cent. They paid for his $250K surgery. They paid for his cath. They paid for his $1500 monthly Syangis shots. I never had to make one phone call to fight for coverage. Our monthly premiums were very affordable, and our deductibles and co-pays were reasonable. The entire time we were going through treatment, I kept thinking how very lucky we were to have the coverage we did. Can you imagine knowing that b/c we didn't have that type of coverage, DS was getting less care than someone who had better coverage? I would have been devastated. But that's reality for a lot of people.

DH has worked for Toyota for more than 25 years. He is an excellent employee. He works very long hours, and he works very hard. His bosses love him. Nobody could say that he isn't a hard-working, fantastic employee. When we moved here (for a lot of reasons, but I'm not going into that), we had to switch to COBRA coverage for 6 months. It was so expensive, that we literally could not afford coverage for all of us, and believe me, we aren't living extravagantly here! For obvious reasons, DS's coverage can not lapse, so we covered DH and DS, and I went without and just hoped for the best.

Now we all have coverage. We pay just shy of $1000/month for decent coverage- dental is pathetic, but health is pretty good. My Rx meds aren't covered, and of course we still pay co-pays, etc. The amount we pay for health care is ruining us.

Nobody else will insure us, so we have no choice.

I worry what would happen if anything ever happened to DH as far as healthcare goes.

I worry about what Jason will do as an adult. What will happen if he wants to start his own business? He won't be able to, b/c nobody will insure him.


I know that no system is perfect, but good health care should be a right for every living human being. Period. Regardless of our political affiliations, I would hope that we can all agree that all people deserve the best chance at health possible. Nobody should be left to suffer or die b/c they don't have a job with good benefits- and believe me, fewer and fewer people have that! I know it will cost money, and that this money will need to come from somewhere. I still think it needs to be top priority. I think it is just as important as any other expense our country has.

Our system is a mess. Unsafe drugs are put on the market b/c of the huge profits they can bring in. There is corruption everywhere. Good doctors are barely able to pay the bills to keep their practices open. The US has one of the highest infant mortality rates in the developed world. I could go on and on. For those who think our system is so perfect right now, I challenge you to dig a little deeper.

I don't have all of the answers. No matter what we do, the system won't ever be perfect. My hope is that it will get better, and more fair.

[lovin2shop]

I actually just came here to post a question about individual health insurance because I've been looking into a policy that I can afford to provide for our nanny and her child and it is just so frustrating. Neither she or her child have been to the doctor in ... years!

It is so complex, I certainly don't have many answers. I work for a small business and have managed the insurance programs for 7 years. Our health insurance cost has increased by at least 20% *every* year. We have to change plans every two years just to keep the costs lower which is a major pain because then you have different in network doctors, hospitals, etc. Employees that have left the company get very upset when they see the cobra bill. What they don't understand is that this amount that the business pays monthly with only a small administrative fee of 2% added. Fortunately, my employer values good health insurance and provides it at an extremely low price to the employees making up the difference personally, but the costs are staggering.

What I don't understand in the current system is why groups are not allowed to pull together for group coverage outside of employment? Either in professions (like nannies as I stated above) or even just affiliations. It seems to me that this would be a fairly simple option that would work in the current system, even if just in the short term, to get more people covered. If a large company like Toyota can use its size to get a more cost effective policy, shouldn't other groups be able to form as well? I know that this is even a problem in my profession as a CPA. Individual practioners have a terrible time getting coverage for themselves and employees and are often forced into a larger firm based on health insurance options alone.

[psophia17]

Thank you for sharing that :hug5:

[psophia17]

There are some options where you can join an official group (I've looked into a couple that relate to freelance work) and get coverage through that group. The problem is that often the group has dues, and then there are premiums on top of that. Depending on what the coverage options are, it is often still way more expensive than you can afford, and there are hoops to jump through to get coverage.

One group I looked into joining when we were without coverage had a great plan, and it was affordable (comparatively), but the dues were exhorbitant. IIRC, it was a lifetime membership, which was great. But without scraping together the dues, I couldn't get the membership, and couldn't access the group coverage. Dh tried as well - there were options for reasonably priced medical coverage for the self-employed, and we were starting a business, but we couldn't get the coverage without proving we could pay the premiums, and we needed to use our income taxes to prove we had an income, and the income taxes didn't reflect the brand new business, so they didn't count. Essentially, we didn't qualify for the affordable coverage until we had turned a profit for a year. In theory this is okay, but the first two months the business was in operation, we bankrupted ourselves paying for COBRA.

At that point, we had no options. DH and I went without healthcare, and we continued to jump through hoops for DS.

[MarisaSF]

I grew up in the military, and DH is still military (but works in the private sector too). If Universal Healthcare will be like that, I really could do without.... sorry.

FTR, I brought up the benefits of a universal medical RECORDS (blood test results, x-rays, medical exams, patient histories), which I believe the military/VA has implemented well. Totally separate issue from any sort of health plan or insurance coverage!

[buddyleebaby]

I don't know what the answer is.
When I was first married, I was able to get insurance at a reasonable price through my job, but it was only offered for me, not DH.
He at that time was going to school and working two fulltime jobs, neither of which offered insurance. Together we were making just enough to barely pay our rent and afford groceries, but we made too much to qualify for the low cost state sponsored plan. At the same time, if we paid for insurance for him out of pocket, it would leave no money for anything else. He went for two years without insurance before he got a job with the city that provided good family insurance at no cost to us and thankfully in that time we only had one ER visit for which we had to pay out of pocket. I was able to become pregnant and stay home with DD1.
I never want to go back to having no insurance. It COULD have been disastrous.

[psophia17]

From what I understand, that's how the Cdn records system works, at least provincially.

Bring up your personal health number, and the doctor you're at, wherever you happen to be in the province, has your medical records. I think pharmacies and other providers (chiros, etc.) have access to those records as well.

[psophia17]

That's the bit that makes it so obviously broken - that anyone should have to fear the disaster is not right.

[MontrealMum]

What I don't understand in the current system is why groups are not allowed to pull together for group coverage outside of employment? Either in professions (like nannies as I stated above) or even just affiliations.
It is my understanding that groups can pull together in this type of situation, but I don't have a clue what the rules are. Whenever I renew my AHA (American Historical Association) membership there is an option to sign up for their group plan, so they've obviously negotiated something, but again, no idea what, or who qualifies.

Petra - I have been told that absentee ballots are counted up after the regular votes are, and sadly, if the election isn't close, they aren't counted at all. If that's true, I try not to think about it. I imagine that this might have changed after the whole Florida thing though.

Also, I think that they want to institute a recordskeeping system in Canada that can be accessed by multiple doctors/centres, but I don't think that they actually have done it yet. At least, not here in Quebec, maybe in other provinces. But it would be a great thing. I have my Carte soleil (health care card) which has a permanent number, which is the same number used for university that gives me QC tuition status, and lots of other things, but it doesn't seem that these are consistently tied to records within the system yet.

Great discussion!

[infocrazy]

I only have a little time so I didn't read everything. I am honestly not super educated on healthcare so I have a few comments and questions.

Comments:
1. I work for a major company as an Engineer with, at least in my current experience, excellent coverage. Other than some pregnancy/birth complications though we haven't had to test it (thank goodness), but some of my coworkers have had some pretty serious issues and are happy with it.

2. There are three different coverage plans that cost from $0 to about $300 a month for yourself or entire family. This is offered to ALL employees after 60 days, including PT, with no preexisting condition limitations (well as of 2 yrs ago when I looked). We obviously have many people who own their own businesses and work for just the benefits.

3. It is unbelievable to me the number of hourly employees that we go through that only work for 1 day or quit because they don't want to do it. It is certainly not a fun job, but you would have medical coverage for your entire family for a minimal cost.

4. I know that my company obviously cannot hire every person that is unemployed but I do feel that a lot of people could take jobs that would provide sufficient health care and are just not interested in the types of jobs that would provide them that care.

Now my questions:

I thought that Medicaid or Medicare provided healthcare for children, elderly, or people who cannot work. Is that not true?

I also thought that if you went to some hospitals/urgent cares/clinics, they HAD to treat regardless of lack of insurance. No?

I am not saying that the healthcare system does not need some repair, but I certainly don't think that a universal health care system is the right step to fix the issues. I am sure that my personal experiences have impacted my opinions.

[kijip]

Now my questions:

I thought that Medicaid or Medicare provided healthcare for children, elderly, or people who cannot work. Is that not true?

I also thought that if you went to some hospitals/urgent cares/clinics, they HAD to treat regardless of lack of insurance. No?


First question: it does, but not all, not in every state and not for many in a gap point between low income and having healthcare through work. For example- a family making $30,000 a year in some states could get insurance for their kids (in some states, even for themselves). But in some states that is over the income limit. And a family making say $500 or $50 a year over their state's income limit is out of luck- they can't kick in that extra $500 or $50 to the state plan and buy the lower cost insurance. Many states are taken kids off such programs due to budget cuts. It is not all paid for by the federal government, the state determines a huge portion of it.

Medicare is for the elderly and people on SSD (who must have enough work credits to qualify when they become disabled- so a homemaker like my mom was is out of luck). Medicaid has very low income limits and in some places only is used to cover kids, however in my state it can been used for low income disabled people like my mom. In addition there is SCHIP (State Children's Health Insurance Plan) which is a plan people usually can buy into if they are low-modest income for their kids. Finally a number of states have plans they offer to families and adults with income limits. Many of these have long waiting lists.

Question Two- Hospital Emergency rooms have to stabilize you, not provide the ongoing treatment you need to stay the heck out of the emergency room in the first place. :) In some states and counties/local gov't there are free or low cost, sliding scale clinics. Some of these are decent, some are not decent and in many communities they don't exist. Also, emergency room visits come with bills which if unresolved can and do cause financial strain to already low income families. And who is paying the hospitals for all the un-reimbursed care? Unless they are a non-profit and make it up in fund raising, no one...so it raises hospital costs for all of us...and the cost of insurance.

I don't know the solution at all.

[egoldber]

I have been told that absentee ballots are counted up after the regular votes are, and sadly, if the election isn't close, they aren't counted at all.

This is the norm in many if not all states. If the election is not close, then absentee votes are typically not counted. We are voting absentee this year because we will be on vacation during the election. So I get to vote in about 2 weeks. :)


I also thought that if you went to some hospitals/urgent cares/clinics, they HAD to treat regardless of lack of insurance. No?

Just because they have to treat, does NOT mean you get a free pass on the bill. Medical emergencies have ruined many families. A family without health insurance is typically only one major medical event away from the proverbial poorhouse.

When Amy was born at 34 weeks, the first thing they did was wheel her down to the NICU and before they would even ADMIT her into the NICU, DH had to sign papers agreeing to be responsible for her bills if insurance didn't cover it. Nice huh? On her second day in the NICU, we got a visit in my room from the neonatalogist about her care. The SECOND visit was from the hospital NICU insurance billing specialist letting us know that their neonatalogy group was NOT an in network provider. We were like WTF???? The HOSPITAL is in network, the NICU is in network but the doctors IN the NICU aren't???? And like we have any choice on these doctors. It's not like you can ask for your own private neo to come in and do NICU care for your child.

We are STILL fighting with BCBS nearly TWO YEARS later over some of her bills. Her 11 day stay for being a 34 weeker (an uncomplicated stay, she just needed to get bigger) was nearly $50,000 (including the NICU, the neos, radiology, blah, blah.....). If a pregnant woman who is too "rich" to qualify for assistance happens to have even a slightly early preemie, that literally can financially ruin their family. People who have very early preemies with special needs often have bills that top out at WELL over a million dollars. And that's JUST the hospital, not including the costs of ongoing care.

I could go on and on, but I won't. People who think that a medical catastrophe can't happen to them are sadly mistaken.

[torontomom]

deleted...

[CAM7]

Just a quick comment about universal healthcare for the US.. it hasn't been adequately defined as far as what it will be comprised of... it may even go so far as take away individual rights as to what sort of treatments you can get...and what sort of treatments you can refuse.

[kijip]

Just a quick comment about universal healthcare for the US.. it hasn't been adequately defined as far as what it will be comprised of... it may even go so far as take away individual rights as to what sort of treatments you can get...and what sort of treatments you can refuse.

It's pretty well established in our legal system that mentally competent patients can generally refuse treatment (I suppose there are cases of court orders to interfere where kids or babies are involved). My FIL refused anything that would have kept him alive at all. I think there are plenty of things to say against universal health care, but that people would not be able to refuse certain treatments is not one of them.

[CAM7]

I think there are plenty of things to say against universal health care, but that people would not be able to refuse certain treatments is not one of them.

It certainly is.

Vaxes for one thing.

"Universal healthcare" is undefined right now.... depends on what "they" decide will be covered.

[niccig]

Just a quick comment about universal healthcare for the US.. it hasn't been adequately defined as far as what it will be comprised of... it may even go so far as take away individual rights as to what sort of treatments you can get...and what sort of treatments you can refuse.

The countries with universal healthcare all have different systems. You're right that there has been no explanation of what a system for the US could look like. There are so many different ways it could be.

I don't understand what you mean by what sort of treatments you can refuse - medical treatment can't be forced upon you, I know there are cases where it goes to court, but having lived in a country with universal health care, no one ever made me have any type of treatments I didn't want. I don't see how they could make you have treatment?? Just scratching my head.

As for right to certain treatments, doesn't that happen with HMO - you're doctor might want to treat you a certain way, but the HMO company can say no, there is a different treatment they'll cover?? We have POS - so we can go either HMO or PPO. When I started to have trouble with thyroid nodule, we asked the Dr. if HMO would be better. He said he would be restricted in number of ultrasounds needed and other forms of treatment. We decided to pay more for the PPO option, so he could treat me as he thought was medically best.



In

[o_mom]

It's pretty well established in our legal system that mentally competent patients can generally refuse treatment (I suppose there are cases of court orders to interfere where kids or babies are involved). My FIL refused anything that would have kept him alive at all. I think there are plenty of things to say against universal health care, but that people would not be able to refuse certain treatments is not one of them.

Actually I have to agree with the PP - some of the proposed plans would require people to have screening or or other preventative health measures (such as vaccines) in order to be covered. I'm not saying that those would pass or that those were not in the minority, but there were statements by at least one primary candidate about this.

Right now, it is wide open as to what "universal heath care" would be. Unfortunately, I have a feeling that in the end we will get more of the same - randomly put together plans that are not uniform across states - instead of true reform. Just the nature of how the government is run - too many special interests on both sides, resistance to change and that it is easier to add a new plan than to scrap the old ones and start over (kind of like the IRS).

[JTsMom]

Not true. Many of us here refuse some/all vaxxes, including some that are on some form of government health care. Obama has addressed this point. No, it is not defined in stone, but it can't be at this point. Using other countries as an example though, it's not something I'm worried about. Canadians have an easier time refusing vaxxes than we do in the US.

ETA: I should have quoted- I was addressing CAM7's post.

[kijip]

It certainly is.

Vaxes for one thing.



That particular issue is one not exclusive or unique to universal systems- for example, there is one (more?) state where there are no religious or personal exemptions for vaccines. That is about public policy and school enrollment, not who pays for the vaccines. For the most part parents in this country can refuse vaccines.

[niccig]

It certainly is.

Vaxes for one thing.

"Universal healthcare" is undefined right now.... depends on what "they" decide will be covered.

Yes, taking your vaccine example, they can decide that all current childhood vaccines will be covered, that is, it will be paid for in some way if you CHOOSE to have them. But they can't make you give them to your child. Lots of things can be covered in universal health care, some of those will be needed by some people and not by others.

Scratching head to remember, but forcing medical treatment on someone without their permission, unless court case, is a form of assault.

[CAM7]

As for right to certain treatments, doesn't that happen with HMO - you're doctor might want to treat you a certain way, but the HMO company can say no, there is a different treatment they'll cover??

Depends on what sort of system would be set up. If a surgery is considered "elective" you may not be able to get it done at all... or be pushed back for months waiting for your chance to get into surgery.

Usually the HMO will only cover what your employer (if that is how you are insured) has contracted with the HMO. Some employers don't 'buy' a package for their employees that cover as much as maybe another companies coverage.

[o_mom]

That particular issue is one not exclusive or unique to universal systems- for example, there is one (more?) state where there are no religious or personal exemptions for vaccines. That is about public policy and school enrollment, not who pays for the vaccines. For the most part parents in this country can refuse vaccines.

Yes, but once you say that you must have vaccines to get into school or to have healthcare, it is removing the choice from people. A wealthy person can just say, fine, I'll homeschool or I'll pay for my own healthcare. The poor person who cannot afford to take off work to homeschool or pay for private medical care in that situation has no choice. Ironically, those are the people that universal healthcare is trying to provide coverage for.

[CAM7]

Yes, taking your vaccine example, they can decide that all current childhood vaccines will be covered, that is, it will be paid for in some way if you CHOOSE to have them. But they can't make you give them to your child.

It's mandatory right now in some states!

Like I said, there hasn't been a definition of what will be invovled in this "universal" system that everyone is talking about...so right now it's an open ended argument imho.

[JTsMom]

http://www.barackobama.com/pdf/Obama08_HealthcareFAQ.pdf

Pg 2, toward the bottom.

"Q. I don’t want the government telling me which doctors to see or what treatments

to get. Will the Obama plan force these kinds of decisions on me?

A. Senator Obama agrees with you. His plan will not tell you which doctors to see or
what treatments to get. Under the Obama health care plan, you will be able to keep your
doctor and your health insurance if you"

[o_mom]

Yes, taking your vaccine example, they can decide that all current childhood vaccines will be covered, that is, it will be paid for in some way if you CHOOSE to have them. But they can't make you give them to your child. Lots of things can be covered in universal health care, some of those will be needed by some people and not by others.

Scratching head to remember, but forcing medical treatment on someone without their permission, unless court case, is a form of assault.

No, they can't force them, but they can provide heavy coercion by telling people their coverage will be dropped if they don't comply.

[kijip]

Yes, but once you say that you must have vaccines to get into school or to have healthcare, it is removing the choice from people. A wealthy person can just say, fine, I'll homeschool or I'll pay for my own healthcare. The poor person who cannot afford to take off work to homeschool or pay for private medical care in that situation has no choice. Ironically, those are the people that universal healthcare is trying to provide coverage for.

Yes, but in reality most states offer exemptions for school. And if they do or not has nothing to do with how the vaccines are paid for (self pay, public or private insurance, free clinic, universal health insurance). Also, I am unaware of a universal health system in which refusing one treatment or drug excludes you from the other aspects of the available care. If someone knows of such a country, I'd be interested in learning more.

[kijip]

No, they can't force them, but they can provide heavy coercion by telling people their coverage will be dropped if they don't comply.

But unless a proposed Universal Health system has this provision, I don't see how it is relevant to discussing the merits of universal health care plans.

Like I have said before, I don't have the solution. Not at all. :)

[JTsMom]

o mom has a good point- in states with no exemption, vax's are required for school entry, and that puts some parents in a really tough position. I am the first person to say that I feel that is very wrong.

However, that has nothing to do with universal healthcare. That's how it is right now, with private healthcare.

As it stands today, vaccines are NOT required, by law, no matter what people might lead you to believe. They are required for school attendance ONLY, and religious and/or philosophical exemptions are offered in every state except WV and Mississippi. It's still not right imo.

[CAM7]

I guess my point is that since nothing is written in stone about how this universal coverage will be implemented we are opening a HUGE Pandora's box... what will be included/excluded/mandatory or forgotten about all together is anyone's guess right now.

[CAM7]

However, that has nothing to do with universal healthcare. That's how it is right now, with private healthcare.


Exactly.. the key phrase is "right now".

[niccig]

It's mandatory right now in some states!

Like I said, there hasn't been a definition of what will be involved in this "universal" system that everyone is talking about...so right now it's an open ended argument imho.

But isn't the mandatory vaccines to do with school enrollment and not universal health care from the federal government? The universal health care didn't cause the mandatory vaccines, that was a different policy.

In the universal health care system I have experienced there was NO requirement to do certain things to keep your coverage. You got it from being a resident of that country and then you got treatment depending on how you were sick, and you could fully decide your medical treatment. Vaccines for school was a education policy issue and it varied depending on the state, it was not a universal policy from the federal government.

I do see your point and O-Mom's point, that we don't know what the system will be, or what will be in it. Will it even be universal or an opt-in option for those that can't afford health insurance.

[o_mom]

Yes, but in reality most states offer exemptions for school. And if they do or not has nothing to do with how the vaccines are paid for (self pay, public or private insurance, free clinic, universal health insurance). Also, I am unaware of a universal health system in which refusing one treatment or drug excludes you from the other aspects of the available care. If someone knows of such a country, I'd be interested in learning more.

Most states, not all - notably, two of the poorest states are the ones that do not offer religious exemptions, so that leaves a huge number of people with no choice in the matter.

I don't think there is an exisiting state run healthcare that does require this. Again, I'm not saying it will happen, but John Edwards proposed requiring people to have preventive healthcare to have coverage. I think it is reasonable to be cautious with this as there are many people who think it is a good idea and ultimately it will not be just the president writing the bills.

[CAM7]

I do see your point and O-Mom's point, that we don't know what the system will be, or what will be in it. Will it even be universal or an opt-in option for those that can't afford health insurance.

Yep, and I don't have a lot of confidence that big pharma will keep out it ...

[MontrealMum]

Torontomom - thank you so much for sharing your story with us...and I am so sorry for your loss.

[lovin2shop]

There are some options where you can join an official group (I've looked into a couple that relate to freelance work) and get coverage through that group. The problem is that often the group has dues, and then there are premiums on top of that. Depending on what the coverage options are, it is often still way more expensive than you can afford, and there are hoops to jump through to get coverage.

One group I looked into joining when we were without coverage had a great plan, and it was affordable (comparatively), but the dues were exhorbitant. IIRC, it was a lifetime membership, which was great. But without scraping together the dues, I couldn't get the membership, and couldn't access the group coverage. Dh tried as well - there were options for reasonably priced medical coverage for the self-employed, and we were starting a business, but we couldn't get the coverage without proving we could pay the premiums, and we needed to use our income taxes to prove we had an income, and the income taxes didn't reflect the brand new business, so they didn't count. Essentially, we didn't qualify for the affordable coverage until we had turned a profit for a year. In theory this is okay, but the first two months the business was in operation, we bankrupted ourselves paying for COBRA.

At that point, we had no options. DH and I went without healthcare, and we continued to jump through hoops for DS.

Interesting, I wonder why it is not more popular for large groups to offer health coverage since it works well for large employers? In my CPA example above, the American Institute of CPA's offers many insurance programs like life, disability, general liability, etc. that are very popular for thousands of members (and in some cases the only reason that people even pay their dues). And I know that there is a huge demand for health insurance within this group. But, they don't or can't offer it for some reason. Maybe it is just too expensive however they try to structure a plan? I haven't looked in to specifically since I have coverage, but I just wish that I understood the hurdles better.

[niccig]

I guess my point is that since nothing is written in stone about how this universal coverage will be implemented we are opening a HUGE Pandora's box... what will be included/excluded/mandatory or forgotten about all together is anyone's guess right now.

I don't see it as a Pandora's box - yes there's lots to work out, but having those 45 million people able to get some health care wheres now they have none, it's worth it to work out a new way. I know my view is different, having experienced a system where everyone, regardless of job or wealth, had access to health care, so I see medical care as a right everyone should have. And that's not the case in the current system.

[niccig]

Torontomom - I too am sorry for your loss. Thank you for sharing your experience with the Canadian medical system.

[bubbaray]

From what I understand, that's how the Cdn records system works, at least provincially.

Bring up your personal health number, and the doctor you're at, wherever you happen to be in the province, has your medical records. I think pharmacies and other providers (chiros, etc.) have access to those records as well.

Not in BC, yet. That is the plan for some point down the road, but there are issues currently. The province wants to store the health records (or maybe some already are?) in the US. Which means that Homeland Security would (possibly) have access without a warrant to health records from Canadians. As I understand it, that controversy has not gone away. Drs here are quite resistant to this proposal.

[o_mom]

Interesting, I wonder why it is not more popular for large groups to offer health coverage since it works well for large employers? In my CPA example above, the American Institute of CPA's offers many insurance programs like life, disability, general liability, etc. that are very popular for thousands of members (and in some cases the only reason that people even pay their dues). And I know that there is a huge demand for health insurance within this group. But, they don't or can't offer it for some reason. Maybe it is just too expensive however they try to structure a plan? I haven't looked in to specifically since I have coverage, but I just wish that I understood the hurdles better.

One reason, I would guess, is that most large employers are self-insured. The way DH's company explained it to us is that they have money set aside for healthcare and the premiums paid are only for the administration of the plan. The company actually pays the insured portion of the bill. So if you work for Company XYZ and your EOB says "insurance paid $100", that $100 comes from Company XYZ, not from Blue Cross. I'm pretty sure there are minimum reserves ($$$) the company has to hold to do this and most trade organizations do not have that to offer.

Smaller companies that have group plans are buying the full coverage, where the insurer pays the bills. That is one reason it is more expensive.

Additionally, insuring a group of people who are working is going to be cheaper than opening it to everyone. If you are healthy enough to work, for the most part you aren't going to be a huge resource suck (on average). If you opened it to everyone that was a CPA, you would get people who were no longer healthy enough to work etc. That is one of the big problems with insurance pools. People don't buy into them if they are healthy. They tend to buy the coverage after the fact, when they start to get sick. The only way large group buying works is if everyone is required to have coverage. At my employer and DH's (two different ones as the company was bought out) employees were required to have coverage. The basic coverage was automatic and you could not decline it unless you proved that you had coverage elsewhere. Even if you declined it, that only meant you didn't pay your portion of the premium, not that you also got the employer's share.

[lovin2shop]

Torontomom - I too am sorry for your loss. Thank you for sharing your experience with the Canadian medical system.

I am also so very sorry. No one should have to endure what you have been through and I think that you are very strong for weighing in on this issue.

[bubbaray]

Just a quick comment about universal healthcare for the US.. it hasn't been adequately defined as far as what it will be comprised of... it may even go so far as take away individual rights as to what sort of treatments you can get...and what sort of treatments you can refuse.

In unaware of any medical treatment that a legally competent adult can *not* refuse for themselves in Canada. The situation is a bit trickier with respect to children. Typically, the issues arises with Jehovahs' Witnesses refusing blood products. There have been a number of cases about their rights as parents, and the rights of doctors to provide life-saving treatment notwithstanding a parent's, or child's, objections. To summarize some complicated case law, the younger the child and the more life-saving the treatment, the greater the dr's rights and the lower the parent's right to refuse medical treatment. The law on this matter really has little to do with the universal health care system. As I understand it, there are similar cases in the US.

With respect to vaccines, they are NOT mandatory here in BC at least. They are "required" for public school, but from what I have been told, if you don't want to vax your child, you just tell the school that you have refused vax's and the child still can attend school. Scheduled vax's for children are free and offered through their dr or public health clinics.

ETA -- fix obviously typo in 1st sentence.

[lovin2shop]

One reason, I would guess, is that most large employers are self-insured. The way DH's company explained it to us is that they have money set aside for healthcare and the premiums paid are only for the administration of the plan. The company actually pays the insured portion of the bill. So if you work for Company XYZ and your EOB says "insurance paid $100", that $100 comes from Company XYZ, not from Blue Cross. I'm pretty sure there are minimum reserves ($$$) the company has to hold to do this and most trade organizations do not have that to offer.

Smaller companies that have group plans are buying the full coverage, where the insurer pays the bills. That is one reason it is more expensive.

Additionally, insuring a group of people who are working is going to be cheaper than opening it to everyone. If you are healthy enough to work, for the most part you aren't going to be a huge resource suck (on average). If you opened it to everyone that was a CPA, you would get people who were no longer healthy enough to work etc. That is one of the big problems with insurance pools. People don't buy into them if they are healthy. They tend to buy the coverage after the fact, when they start to get sick. The only way large group buying works is if everyone is required to have coverage. At my employer and DH's (two different ones as the company was bought out) employees were required to have coverage. The basic coverage was automatic and you could not decline it unless you proved that you had coverage elsewhere. Even if you declined it, that only meant you didn't pay your portion of the premium, not that you also got the employer's share.

Thanks, this makes sense, I hadn't considered the self insurance aspect.

As much as I wish that the whole system could be scrapped, I agree that it probably will never happen. So, I would love for there to be a bipartisan plan that somehow works with what we already have, but opens the barriers to coverage for all americans. I guess if I had that answer, I'd be running for President.

[bubbaray]

Torontomom, I am so sorry for your loss. Your family is in my thoughts and prayers.

[CAM7]

...again... what we have going now may completely change under some new "universal" plan...depends on who is organizing the changes and what their agenda's are.

..and just because they do it 'this way in xyz country' doesn't mean that it will happen (or not happen) here under a new system that might be implemented.

[o_mom]

As much as I wish that the whole system could be scrapped, I agree that it probably will never happen. So, I would love for there to be a bipartisan plan that somehow works with what we already have, but opens the barriers to coverage for all americans. I guess if I had that answer, I'd be running for President.

:thumbsup: I'd vote for you! :D

[JTsMom]

Torontomom- I am so very sorry for your loss. Thank you for sharing your story.

CAM7- Again, that's how it is now UNDER PRIVATE INSURANCE. Even if universal coverage required vaxes (and again, Obama disagrees with that idea) it wouldn't be any worse than it is right now, so I don't see your point.

Seniors and others in this country already have government insurance, and treatments are not forced on them. Why would you assume it would be any different for the rest of us? Also, in my mind, saying they might muck up the plan is not a good reason to scrap it all together. They might make a perfect plan! I might get in a car accident on my way to the store- doesn't mean I'm not going to try to make it there. Why assume the worst when we have no reason to? Most of us seem to agree it's bad now- likely, things will get better.


O mom- that's one of the reasons I would not vote for Edwards.

[niccig]

..and just because they do it 'this way in xyz country' doesn't mean that it will happen (or not happen) here under a new system that might be implemented.

I agree. I was sharing my experiences in a different country as in my experience with friends here in the US, many people don't know much about universal health care or what it means on a day-to-day seeing your doctor level. Friends have said "I don't want universal health care" and when asked why, they couldn't tell me what they disagreed with, they just knew they didn't want it. I would explain how it worked in my experience, which is different from other countries, and many were surprised that I had such easy access to medical care.

I really don't think the US will go universal, as it is in countries like Canada or Australia. Something needs to be done to cover those that can't afford or get coverage because of pre-existing conditions, extending current programs probably. But for the rest, private health insurance will stay.

ETA
Reading Obama's website on health care, I don't see where he's saying there will be universal health care, like what I described in Australia. I read it as extending an affordable plan similar to the plan for Congress to all people, so they can buy it if they WANT TO. For people needing financial assistance, they'll be subsidies to buy into the new plan or to buy a private health care plan. To me that's not universal - universal as I know it is where everyone is automatically enrolled based on residency in that country. Instead, this will be another plan that is open to all, not based on employment, but you don't have to buy it if you don't want to. You can look at what it offers, and if you don't like it, you don't buy it. You can still purchase another option, either privately or through your employer if they offer it.

[CAM7]

Something needs to be done to cover those that can't afford or get coverage because of pre-existing conditions, extending current programs probably.

Agreed.

Here in Minnesota we seem to have a fairly good non-profit system in place... would probably be a good template for other states to follow.

[mamicka]

CAM7- Again, that's how it is now UNDER PRIVATE INSURANCE. Even if universal coverage required vaxes (and again, Obama disagrees with that idea) it wouldn't be any worse than it is right now, so I don't see your point.


I'm not CAM7, so I might not get this right, but I think I hear what she's saying. I'm not agreeing or disagreeing with anybody here, I'm just trying to explain what I think she's saying.

Right now, with private insurance, vaxes are required most of the time for schools, daycare, etc & all but a couple states have exemptions. But I'm not aware of private insurance that would require the vaxes or would drop coverage if any preventative medical treatments (for example, vaxes) were refused. If the government has anything to do with medical coverage, it isn't out of the realm of possibilities that the government would say, "if you don't accept all preventative medical treatments, you forfeit all coverage". I've even heard this kind of thing advocated for on this board, not regarding vaxes, but healthy lifestyle. So, yes, right now, for some people they don't have a choice to refuse some medical treatment in a sense. Might it not be even worse if the government had more control?

[CAM7]

Exactly Allison, thank you.

[JTsMom]

I'm not CAM7, so I might not get this right, but I think I hear what she's saying. I'm not agreeing or disagreeing with anybody here, I'm just trying to explain what I think she's saying.

Right now, with private insurance, vaxes are required most of the time for schools, daycare, etc & all but a couple states have exemptions. But I'm not aware of private insurance that would require the vaxes or would drop coverage if any preventative medical treatments (for example, vaxes) were refused. If the government has anything to do with medical coverage, it isn't out of the realm of possibilities that the government would say, "if you don't accept all preventative medical treatments, you forfeit all coverage". I've even heard this kind of thing advocated for on this board, not regarding vaxes, but healthy lifestyle. So, yes, right now, for some people they don't have a choice to refuse some medical treatment in a sense. Might it not be even worse if the government had more control?

Anything is possible-it could be worse, or it could be better. But judging by what we see so far (Medicare/Medicaid and state programs, and the plan Obama has laid out), it just doesn't seem likely to me that anything would be required. If anything, I'd be more concerned with a private company dropping me for something like that. Plus, it's not like there is going to be one proposal for united healthcare and it's going to fly through and be approved regardless of what others think. It's going to have to be approved.

Honestly, I can see why someone might worry about that- we don't vax, I'm planning a VBAC, etc- I do get the fear, really- I just don't think it's going to happen.

[CAM7]

Plus, it's not like there is going to be one proposal for united healthcare and it's going to fly through and be approved regardless of what others think. It's going to have to be approved.



By whom? What agenda (personal or otherwise) will they have? What will be in small print...or slipped in at the last minute?

Should make you nervous...just a tad...

[JTsMom]

Congress. If you read my original post, you can see why I am nervous about things as they stand now.

ETA: Have you read Obama's plan?

[mamicka]

I'm so sorry for your loss.

[MelissaTC]

Torontomom, I am so sorry for your daughter.

[egoldber]

By whom? What agenda (personal or otherwise) will they have? What will be in small print...or slipped in at the last minute?

But this is true for every single bill that goes through Congress. By that argument we should never make legislation.

And Torontomom, I am so very sorry for your loss.

[CAM7]

Congress. If you read my original post, you can see why I am nervous about things as they stand now.

ETA: Have you read Obama's plan?

What is promised during campaign time doesn't nec mean it will be fact after election.

[CAM7]

But this is true for every single bill that goes through Congress. By that argument we should never make legislation.



In mho healthcare and big pharma have their own 'momentum'... different than your usual 'hairy political beast'....

Just mho though... ;-)

[JTsMom]

But this is true for every single bill that goes through Congress. By that argument we should never make legislation.

And Torontomom, I am so very sorry for your loss.

:yeahthat: Exactly. "It might turn out badly, so we shouldn't try." doesn't sit well with me, especially when we have no reason to believe that will be the case.

[niccig]

By whom? What agenda (personal or otherwise) will they have? What will be in small print...or slipped in at the last minute?

Should make you nervous...just a tad...

We can say this about ANY legislation and not just health care. Look at all those lobby groups in Washington D.C. trying to slip what they want into pieces of current legislation. It's not a reason to do nothing about an issue.

[niccig]

What is promised during campaign time doesn't nec mean it will be fact after election.

Again, this is the same of ALL political campaigns. We get the chance to vote them out in 4 years if we disagree with what they do when in office. Yep, not the best answer as you have to wait 4 years, but better than their life-time as in a monarchy.

[CAM7]

Never claimed we should not make changes. Just saying that we shouldn't go too gung ho on a huge issue like tackling some undefined universal healthcare policy... our system seems to work for most...like many other nations' healthcare systems.

We definitely need some 'tweaking'... just not a major overhaul like some think.

[JTsMom]

But by your definition, how could it possibly be defined? Not by spelling it out in a plan like Obama's. Not by writing it up and sending it through Congress.

[niccig]

.. our system seems to work for most...like many other nations' healthcare systems.


I'm going to disagree with you on the system working for most - 15% no coverage and how many others with poor coverage or having to make medical decisions based on financial concerns.

Tweaking may be enough to fix what we have, or it might not be. We do need to find an answer.

[o_mom]

Never claimed we should not make changes. Just saying that we shouldn't go too gung ho on a huge issue like tackling some undefined universal healthcare policy... our system seems to work for most...like many other nations' healthcare systems.

We definitely need some 'tweaking'... just not a major overhaul like some think.

'tweaking' is what got us the IRS mess that we have today. Add a bit here, whoops, there's a loophole, just patch that right up, oh no, now we have someone else to cover let's make a special plan for them.... and so on and so forth.

The patchwork that we have now is good in some states, really crappy in others. Just increasing the patchwork isn't going to make meaningful reform, IMO. If we wanted to go toward a universal insurance plan (which I believe is what Canada has, not univeral healthcare), it really only works if we cover everyone. Any time you have optional pools, etc, the sick people buy in and the healthy people take the gamble which drives up costs from both sides.

That's just covering reform from the insurance side - the other side with too few doctors being trained at way too high of a cost which drives them to specialties and increases costs, the non-use of lesser credentialed (sp?) providers (NPs, PAs, Nurse educators), the proliferation of specialty hospitals and facilities to siphon off lucrative procedures, etc. isn't even touched by many of these arguements.

[CAM7]

I agree niccig... we do need to find an answer.


Gotta sign off for the day... thanks all for the lively discussion!

[psophia17]

Not in BC, yet. That is the plan for some point down the road, but there are issues currently.

Are you sure? When the boys had their vax, it was all in the computer at the well baby clinic, and when we went to the clinic for an ear infection a few weeks later, there was record of the recent vax there, and our family doctor had nothing to do with it...

[bubbaray]

Are you sure? When the boys had their vax, it was all in the computer at the well baby clinic, and when we went to the clinic for an ear infection a few weeks later, there was record of the recent vax there, and our family doctor had nothing to do with it...


Yeah, the comprehensive program isn't implemented yet. Maybe there are certain pilot projects going on. I don't think all dr's are even required to keep electonic records yet. A dr I work with told me that is coming, but I can't remember the date he said.

There was talk of a chip being embedded in the CareCards. I think that's been scrapped. What they are talking about is all medical records (GPs, labs, walk-in clinics, public health offices) all being linked up in one database. Right now, there is a lot of electronic communication (labs in particular can electronically send results to some dr's).

I know for a fact that my GP, who has an electronic office is not linked up to the public health unit where my girls get their shots.

[psophia17]

I'm not CAM7, so I might not get this right, but I think I hear what she's saying. I'm not agreeing or disagreeing with anybody here, I'm just trying to explain what I think she's saying.

Right now, with private insurance, vaxes are required most of the time for schools, daycare, etc & all but a couple states have exemptions. But I'm not aware of private insurance that would require the vaxes or would drop coverage if any preventative medical treatments (for example, vaxes) were refused. If the government has anything to do with medical coverage, it isn't out of the realm of possibilities that the government would say, "if you don't accept all preventative medical treatments, you forfeit all coverage". I've even heard this kind of thing advocated for on this board, not regarding vaxes, but healthy lifestyle. So, yes, right now, for some people they don't have a choice to refuse some medical treatment in a sense. Might it not be even worse if the government had more control?

It all depends on the way that the elected officials write it up. Either they will be supportive of letting individuals choose what action is right for them and their families, or they will not, and having the option to choose won't be there.

[ohiomom]

Never claimed we should not make changes. Just saying that we shouldn't go too gung ho on a huge issue like tackling some undefined universal healthcare policy... our system seems to work for most...like many other nations' healthcare systems.

We definitely need some 'tweaking'... just not a major overhaul like some think.

I disagree re: tweaking being enough to fix.

Have you seen this documentary series? http://www.unnaturalcauses.org/

Do the 'take the quiz' section. Given the $ we spend on healthcare in our country, this is embarrassing: http://www.unnaturalcauses.org/assets/uploads/file/olympics.pdf

The most powerful analogy in the series for me personally:
Former U.S. Surgeon General Dr. David Satcher and colleagues calculated that in 2002, 83,570 African Americans died who would not have if Black and white mortality rates were equal. That’s 229 “excess deaths” per day: the equivalent of an airplane loaded with Black passengers being shot out of the sky and killing everyone on board every single day of the year. (found w/many other health equity facts at http://www.unnaturalcauses.org/assets/uploads/file/AmazingFacts_small.pdf)

If you are a person/family of means, the current system works. Otherwise, that is often not the case.

Going back into my closet...

[HannaAddict]

After having first hand experience with American healthcare I can say one thing for sure: everyone wants 100% coverage (for themselves and everyone else) but nobody wants to pay for it.

I am happy to pay for it, I would much prefer paying for it for everyone versus just seniors. And we are paying for it, it is factored into wages, etc.

[HannaAddict]

I just wanted to say thank you for sharing your deeply personal experience with the health care system. I am so sorry for the loss of your daughter.

Kimberly

[mamicka]

I've seen a couple of posts about certain programs (medicare, military, etc) that are supposedly working & implying that the people who use these programs being happy with them. I would beg to differ & also say that I'm pretty sure that the programs aren't working for the providers, either. There are several physicians in my family, all different specialties. Each one of them takes patients on medicare or the state-run children's program (different states). They just know that they won't get paid for those patients. Sometimes they never get paid, sometimes several months/years after they "should have". I don't think those programs are working for them. I used to work for a subsidiary of the VA. I guarantee you that most of the people using that program weren't satisfied - & I didn't work in the complaints department.

I don't know what the solution is. I'm not in favor of the government running... anything, just about. They don't have a really good track record. I don't think anyone is saying not to fix the current system, but I think we have different expectations of whose job it is to fix it & whose capable of fixing it so that it actually works.

[JTsMom]

I can see where you're coming from. Those systems definitely need work, no doubt about it. Medicaid/Medicare are confusing at best. I've used military healthcare and was pretty happy with it, but I know there are problems there as well. My grandfather had VA care, and it could be a hassle. I can't speeak from a physician's pov. Having said that, these systems are better than what most of those people would have without them, by a long shot!


Michael Moore (I can hear the groans, but hear me out) was saying last night on Larry King, (loosely paraphrased) that "We are the government! The government is of the people, by the people, and for the people." and I thought that was an excellent point. If we don't like the way the government runs things, we're putting the wrong people into it.

I asked up-thread, but nobody responded- have those of you so uncomfortable with the idea of universal healthcare actually read what Obama is proposing? I think a lot of people are picturing something very different than what the Dems have in mind. As a patient, you probably wouldn't notice much of a difference in care- except, of course, some extra cash in your pocket at the end of the year.

[kusumat]

The two things that make NO sense to me in our current system:
1) That we continue to tie insurance to employment. (I'm aware of the historical reasons why it started like this.) When you get really sick, say, with leukemia, and need insurance the most? It's awfully hard to hold down a job. Also, most people changes jobs frequently. Insurance companies know lots of people aren't going to stay on their rolls for decades. So they do less in the way of long-term preventative health.



I think it is fair on the tie to employment. You work. Then you get paid plus benefit. With the universal system, everyone gets the same coverage even he/she is not working or not. Am I right? I don't know much in detail. Why do we need to pay for people who do not work?

Canada provides the universal hc system but the tax rate is very high there. I know many people do not like the old old system - pay per service, no health insurance company involved, you pay directly to doctor/hospital. I think you get better service and overall cost is actually lower.

Even now, hospitals can't really refuse treatments to uninsured individuals if it is emergency. We have already paid higher tax to cover those.

[mamicka]

I'm far from a fan of Michael Moore but don't think that quote says anything about him. Of course I agree that we are the government, I don't think that's exactly an original thought. I do vote for the people that I think will do the right things for the country.

If we don't like the way the government runs things, we're putting the wrong people into it.
I agree - but we don't all agree on who the right people are.

I have read what Obama is proposing. However, I don't trust him at all (He has surrounded himself with some pretty shady characters, among other things) so it doesn't really matter what his proposal is. IMO, all he's shown is that he's got style & charisma & feels as if he's the "chosen one" with one of the biggest egos in government. I haven't seen any real substance from him at all.

[o_mom]

I think it is fair on the tie to employment. You work. Then you get paid plus benefit. With the universal system, everyone gets the same coverage even he/she is not working or not. Am I right? I don't know much in detail. Why do we need to pay for people who do not work?



If you are healthy enough to work, it must seem like a fine system. If you get cancer and need time off for chemo or cannot work afterwards, you may face the double hit of losing your job AND your health insurance at the very time you need it most.

It is also not just "people who do not work" that we are talking about. Small business owners many times cannot afford coverage. It is hard for people to go out and start a business knowing that everything could be wiped out with a trip to the ER.

[JTsMom]

I'm far from a fan of Michael Moore but don't think that quote says anything about him. Of course I agree that we are the government, I don't think that's exactly an original thought. I do vote for the people that I think will do the right things for the country.

I agree - but we don't all agree on who the right people are.

I have read what Obama is proposing. However, I don't trust him at all (He has surrounded himself with some pretty shady characters, among other things) so it doesn't really matter what his proposal is. IMO, all he's shown is that he's got style & charisma & feels as if he's the "chosen one" with one of the biggest egos in government. I haven't seen any real substance from him at all.

In that case, I'll just have to bow out of this discussion, b/c I can't rationally discuss universal healthcare without discussing what is being proposed!

[Sillygirl]

I think it is fair on the tie to employment. You work. Then you get paid plus benefit. With the universal system, everyone gets the same coverage even he/she is not working or not. Am I right? I don't know much in detail. Why do we need to pay for people who do not work?

<snip>


You DO pay for people that aren't covered, and you're not getting very much for your money.
High blood pressure goes undiagnosed or untreated until it causes a stroke or heart attack or kidney failure. Now that person can't work, so, less tax revenue coming in. Also, they're disabled, so they get SSI payments and Medicaid. More of our tax dollars being spent. And Medicaid will now have to pay for bypass surgery, kidney transplant, expensive medications, specialst care, etc. for those people. When a few thousand a year in preventitive care would have saved literally millions.

I mean, if you're going to completely ignore the human suffering that's going on, at least realize how much of your taxes are wasted in the current system.

[kijip]

I think it is fair on the tie to employment. You work. Then you get paid plus benefit. With the universal system, everyone gets the same coverage even he/she is not working or not. Am I right? I don't know much in detail. Why do we need to pay for people who do not work?

What about:

-a mom who needs to care for a disabled child full-time whose husband up and leaves her, never paying child support or health costs again? In some states, only her child could get coverage.

-A small business owner who works their tail off and can't afford or find insurance (perhaps they have a preexisting condition?) In that case, they do work, but can't be insured.

-Someone laid off in a bad economy that spends months or more looking for work, any work with benefits. I have seen this happen to qualified people with degrees and/or excellent resumes...the economy just can't employ everyone. Should you or your child be plum out of luck if you or they need surgery or ongoing treatment? (Stabilizing someone int he emergency room does not include operating on a brain tumor or similar life threatening thing- people can be and have been sent home to die or work out a complicated charity care scenario). Or by the time someone goes to the Emergency room, they are going to die regardless...there is nothing to be done.

-A disabled person who absolutely can not work. This is my mother. Should she be SOL with her cancer treatments because of her inability to work?

-Anyone that has worked all their lives and gets laid off close to but not all the way to 65. This happened to my dad. He tried worker retraining at 61, he looked for work for months before realizing no one was hiring a 62+ year old man with MS and he took his reduced SS benefit (medicare did not kick in for him till 65). So he was pretty much SOL until 65.

-SAHMs and SAHDs whose partners work ft but whose insurance plan at work only covers employee or employee and kids and not spouse. I know a lot of people in this situation. Are the parents not working? Certainly that would not sit well with those on this board. My husband has an excellent plan at work that covers us all. In many types of jobs, spouse coverage is becoming less and less common.

I understand the general principal of valuing work. But the scenarios above (and other situations) do not account for a smidgen of the population- they account for a lot of people.


As a note, unless it is a county or public hospital our tax dollars do not necessarily pay for un-reimbursed emergency care.

[SnuggleBuggles]

Torontomom, I am so, so sorry for your loss.

~Beth

[psophia17]

In that case, I'll just have to bow out of this discussion, b/c I can't rationally discuss universal healthcare without discussing what is being proposed!

Please don't! I've enjoyed reading, and have learned a great deal from, everyones' contributions to this thread.

[psophia17]

I am so, so very sorry for your loss. And thank you for sharing your story.

[brittone2]

You DO pay for people that aren't covered, and you're not getting very much for your money.
High blood pressure goes undiagnosed or untreated until it causes a stroke or heart attack or kidney failure. Now that person can't work, so, less tax revenue coming in. Also, they're disabled, so they get SSI payments and Medicaid. More of our tax dollars being spent. And Medicaid will now have to pay for bypass surgery, kidney transplant, expensive medications, specialst care, etc. for those people. When a few thousand a year in preventitive care would have saved literally millions.

I mean, if you're going to completely ignore the human suffering that's going on, at least realize how much of your taxes are wasted in the current system.
:yeahthat: 100%.

And also agreeing with Katie (kjip) that it doesn't make sense to tie employment to health insurance. I've worked with many families as a health care provider where the child had major medical needs and one parent had to quit work to effectively care for that child. I've worked with families with children with special needs and the father walked out because he couldn't handle it anymore, leaving single moms to care for multiple kids, including one with special needs (I've seen this more times than I even want to think about).

How about those baby boomers that end up layed off by their employers, especially in this economy. COBRA is insanely expensive for most people to pay out of pocket. It isn't all that easy to land a new job when you are in your 60s, particularly for those individuals that work blue collar jobs in factories, etc. No one wants to hire them. (eta: I see that Katie included this scenario now as I reread, but my father had several friends that ended up in this position).

It isn't as simple as hard work and pulling yourself up by your bootstraps (like John McCain implied in his speech the other night). I am a huge believer in working hard, saving aggressively, and making wise financial decisions in one's personal life, but absolutely none of those can guarantee we won't be faced with a major tragedy that leaves us without healthcare.

[MontrealMum]

How about those baby boomers that end up layed off by their employers, especially in this economy. COBRA is insanely expensive for most people to pay out of pocket. It isn't all that easy to land a new job when you are in your 60s, particularly for those individuals that work blue collar jobs in factories, etc. No one wants to hire them. (eta: I see that Katie included this scenario now as I reread, but my father had several friends that ended up in this position).
.
My uncle is presently in this situation. He has worked hard all his life. Short story - was laid off (downsized) by the multinational corporation that he worked for shortly after being moved clear across the country by them in order to keep his job amidst huge layoffs. Looked and looked and finally found a job in a warehouse, not managing it as he'd done before, but actually lifting boxes. Had a severe heart attack (wonder why?) this spring and had to be life flighted to the proper hospital. Yes, he does have insurance, and they aren't paying anywhere near the total bill, or even half. He and my aunt (who also works) now owe somewhere in the vicinity of $30,000 as the remainder of this bill. He's 60. Nice little personalization of the event ...EMT's in the helicopter asked him if he's ever been in one before, he said yes, in Vietnam. They experssed their appreciation for his service to our country. And my uncle's take on this, too bad they're not appreciative enough to waive the bill. Not being serious, just a little irony. His goal? To hang in there with this job until he turns 62. Oh, the doctor's recommendations for his recovery upon release from the hospital - no heavy lifting. This means he's not even allowed to work in his garden, I have no idea how he's supposed to do his job.

On the flipside, my BIL lives in Canada and is only slightly younger than my uncle. He has been laid off multiple times over the past decade because of the industry he works in. SIL had trouble going back to work (as in, finding a job) because she'd been a SAHM for years and her skills were outdated. They have a young child with some health problems. Throughout the whole thing, they've had all their medical needs met, free of charge. Losing your job in your late 50s is stressful enough, figuring out how to keep your family safe health-wise on top of it???

All I know is that the present system doesn't work. I don't know how to fix it. But it needs fixing, soon. It's all well and good to say that people who work hard should be insured, as if good health is some sort of *reward* for working hard . But there are plenty of people that work hard who are uninsured or underinsured. Are they less deserving? Morally, I have a real hard time with that sort of judgement.

[mamicka]

Please, don't imply that I'm being irrational.

[Sillygirl]

Also, not that *I* think this should be a basis for national policy, but many people do. . . I'm pretty sure that Jesus didn't take an employment history before healing the blind and the sick. Just sayin'.

[bubbaray]

Also, not that *I* think this should be a basis for national policy, but many people do. . . I'm pretty sure that Jesus didn't take an employment history before healing the blind and the sick. Just sayin'.


Amen to that.

[Wife_and_mommy]

I'm pretty sure that Jesus didn't take an employment history before healing the blind and the sick. Just sayin'.

Nope, he didn't. He did require faith that he *could* heal, though. ;)

That would be far harder to do than working, for myself included, I think. Just sayin'. ;)

[mamicka]

Also, not that *I* think this should be a basis for national policy, but many people do. . . I'm pretty sure that Jesus didn't take an employment history before healing the blind and the sick. Just sayin'.

Are you replying to something I said? Because, if so, I'm not following.

[shilo]

I've seen a couple of posts about certain programs (medicare, military, etc) that are supposedly working & implying that the people who use these programs being happy with them. I would beg to differ & also say that I'm pretty sure that the programs aren't working for the providers, either.


my average reimbursement rate from medicare my last full year (2004) as a director of rehabilitation at a large sub-acute rehab facility in a major metropolitan area: 97% payout by 90 days

my average reimbursement rate from contracted insurance providers: 52% at 365 days. is it any wonder that my company chose to dis-enroll from accepting over half of the insurance contracts it once had in the last 5 years?

and this included the billing for not only the therapy services, but often the facility stay as well (the only clients this did not apply to was medicare part B outpatients).

now that doesn't mean that we as providers don't kick up a stink about it when the fed govt. tried to cut the reimbursement schedule or in the case of therapists bundle our re-evaluation billing codes into our treatment codes. but on the whole, if i'm talking strictly money in my pocket and leaving out the human element (which is HUGE, imho), i'll take a medicare patient over an insurance patient _any day of the week_! the reimbursement rates structure is far superior, as is the ease of billing/submittal and actual reimbursement. again, from a strictly lucrative standpoint the only client that is more desirable to my industry is a pay-at-the-time-of-service client (be they private pay, or one who had a PPO from an ins. co. we no longer accepted who payed out of pocket and then filed for reimbursement from their ins. co. themselves).

it's been almost 9 years since i've worked in the VA system, but i did spend a year there early in my career. it is a far more complicated system in terms of it's sliding fee structure and %disability coverage, etc. the studies show it is very efficient from a record keeping and billing standpoint at this point, but does not rank very well in it's client satisfaction studies. but you would have to spend some time working with this population to truly understand what a difficult dynamic there is in dealing with issues of the emotions (rightfully so) invested in service/entitlement to benefits/disability coverage, etc. having worked with these (mostly) men, i can tell you, you will never see a truly positive client satisfaction survey coming out of ANY VA until we cover all service personnel at 100% regardless of their time in service or their disabilities received as a result.

just my 2 pennies having spent the lat 15 years working exclusively with these systems and client populations...

[MontrealMum]

Allison, I can't figure out the hybrid or threaded modes, so maybe your post has nothing to do with mine even though it's directly below, but I was not referring to anything that you said in my post. If you thought I was calling you irrational, I'm really sorry, that was not my intention. And if I read that wrong, sorry to everyone else for making this even longer. I *will* figure out the other displays eventually!

[Lolabee]

I think it is fair on the tie to employment. You work. Then you get paid plus benefit. With the universal system, everyone gets the same coverage even he/she is not working or not. Am I right? I don't know much in detail. Why do we need to pay for people who do not work?

Canada provides the universal hc system but the tax rate is very high there. I know many people do not like the old old system - pay per service, no health insurance company involved, you pay directly to doctor/hospital. I think you get better service and overall cost is actually lower.

Even now, hospitals can't really refuse treatments to uninsured individuals if it is emergency. We have already paid higher tax to cover those.

As a mother I would expect that you would understand that plenty of us work terribly hard every day as SAHMs despite the fact that we aren't legally "employed." My husband does work for a fairly large family business (with somewhere around 50 employees) but like plenty of other employers they don't provide health insurance benefits. So like so many families in our situation we've had to source a private health insurance policy.

As is often the case, private insurance usually provides fewer benefits than group policies and regularly excludes coverage for conditions deemed to be pre-existing. Because we are unable to pay over $1,200/month for better coverage we had to opt for a policy (for which we pay almost $600/month) that does not cover things like my very necessary asthma medications, and I now go without because we can't afford the additional $120/month for them. Under a group plan I would not have to go without my medications because these types of policies regularly provide coverage for medications after charging a copayment of $20-$30.

Health insurance has become an issue about which I am passionate because I have witnessed first hand the drawbacks of the multi-tiered system we currently have in place. Especially when one is fortunate enough to have employer sponsored coverage, I fear it may be easy to not fully understand the difficulties facing those who do not have access to that kind of coverage. Private insurance is often cost-prohibitively expensive, riddled with exceptions and unreasonably large coinsurance rates that sometimes render it's benefits useless, and most importantly is not even available to those who are deemed to have a pre-existing condition (I was denied coverage by one insurance company because of my IVF treatments.) Many people go without health insurance not out of laziness or cheapness, but because it simply isn't available to them.

I personally welcome Obama's plan for health insurance reform because it would provide access to insurance coverage to those who need it, and it would provide that coverage to all applicants regardless of their medical history. It does not make coverage mandatory for anyone, but opens the door to affordable care for millions of people who otherwise would have to go without any coverage at all. To me that is a huge improvement to the system that we currently have in place.

[mamicka]

my average reimbursement rate from medicare my last full year (2004) as a director of rehabilitation at a large sub-acute rehab facility in a major metropolitan area: 97% payout by 90 days

my average reimbursement rate from contracted insurance providers: 52% at 365 days. is it any wonder that my company chose to dis-enroll from accepting over half of the insurance contracts it once had in the last 5 years?

and this included the billing for not only the therapy services, but often the facility stay as well (the only clients this did not apply to was medicare part B outpatients).

now that doesn't mean that we as providers don't kick up a stink about it when the fed govt. tried to cut the reimbursement schedule or in the case of therapists bundle our re-evaluation billing codes into our treatment codes. but on the whole, if i'm talking strictly money in my pocket and leaving out the human element (which is HUGE, imho), i'll take a medicare patient over an insurance patient _any day of the week_! the reimbursement rates structure is far superior, as is the ease of billing/submittal and actual reimbursement. again, from a strictly lucrative standpoint the only client that is more desirable to my industry is a pay-at-the-time-of-service client (be they private pay, or one who had a PPO from an ins. co. we no longer accepted who payed out of pocket and then filed for reimbursement from their ins. co. themselves).

it's been almost 9 years since i've worked in the VA system, but i did spend a year there early in my career. it is a far more complicated system in terms of it's sliding fee structure and %disability coverage, etc. the studies show it is very efficient from a record keeping and billing standpoint at this point, but does not rank very well in it's client satisfaction studies. but you would have to spend some time working with this population to truly understand what a difficult dynamic there is in dealing with issues of the emotions (rightfully so) invested in service/entitlement to benefits/disability coverage, etc. having worked with these (mostly) men, i can tell you, you will never see a truly positive client satisfaction survey coming out of ANY VA until we cover all service personnel at 100% regardless of their time in service or their disabilities received as a result.

just my 2 pennies having spent the lat 15 years working exclusively with these systems and client populations...

I'm glad your experience with medicare payout has been good. That isn't always the case & hasn't been the case for any of my family members. I actually have spent time working with this population & I feel I truly *do* understand the difficult dynamic. I understand where all of their frustration comes from & I think the government has done a shamefull job in providing for their care.

[mamicka]

No worries, Molly. :) I was replying to Lori (JTsMom) - I should have done a better job quoting. I have similar difficulties with the displays, I seem to get less confused with the Hybrid Mode.

[JTsMom]

I didn't imply anything. I said directly that I can't have a rational discussion with you about the proposal if your feeling is "it doesn't really matter what his proposal is". How could I possibly defend the proposed plan if everything I say is going to go back to, "it doesn't matter, I don't trust him.", kwim? (paraphrased, not a direct quote) We'd both be wasting our time. It doesn't mean that you aren't rational- your feelings are your feelings. If you substitute McCain for Obama in your sentence, I fell pretty much the same!

My use of the word "rational" referred to the discussion, not to you. Circular arguments are not rational, imo, and that's what the discussion would be. I try to leave name-calling and judgements about people out of my posts here.

[JTsMom]

Please don't! I've enjoyed reading, and have learned a great deal from, everyones' contributions to this thread.

Aww, thanks Petra! That made my day. :love-retry:

And right back at you btw. I'm not going to leave the thread alltogether, just that particular discussion. I think the discussion overall has been really interesting, and I enjoy seeing everyone's input.

[JTsMom]

Also, not that *I* think this should be a basis for national policy, but many people do. . . I'm pretty sure that Jesus didn't take an employment history before healing the blind and the sick. Just sayin'.


:applause:

[shilo]

I'm glad your experience with medicare payout has been good. That isn't always the case & hasn't been the case for any of my family members.

sorry, didn't mean to imply that it was or should be. the original post i was replying to talked about the programs not working for providers. i am a provider and i am happy with it, that's all i was trying to say - not that every provider is or should be.

if you or anyone else is curious, providers are asked for our opinions and satisfaction thru the Medicare Contractor Provider Satisfaction Survey every year (MCPSS). i still get all the professional journals and mailing listserves for healthcare mgmt. professionals even tho i'm not still working FT... the 2008 overall provider satisfaction number was somewhere greater than a 4.5 on a 6 point scale, iirc. the years i've participated in the survey a 1 was something like "completely unsatisfied" and a 6 was "completely satisfied" kind of thing. so while the average score certainly does not indicate glowing enthusiasm, nor does it indicate that most providers are significantly unsatisfied with the reimbursement aspects of the program.

as far as patient satisfaction goes, i'm not personally aware of any recent studies (<5-7 years) or surveys that have looked directly at the medicare population in its entirety (lots of smaller patient satisfaction and outcomes measures of specific patient populations - ie. those with a chronic conditions, or those needing a specific surgical intervention - exist). i hope my previous posts did not imply that all of my patients over the years are satisfied with the medicare program and their benefits, because that's certainly not true. but a majority are, and FAR more (like an order of magnitude) of them have expressed satisfaction with the traditional fee-for-service medicare program than those who have signed their medicare benefits over to an HMO/private insurance company. so when i'm comparing theoretic apples to apples, my anecdotal experience with what has worked best for thousands of my patients and the companies and organizations i've worked for over the last 15 years has been a single-payer, centralized government run, universal 'type' program. petra's original question asked what we thought was broken and what our ideas were for fixing it. i feel like all i can do (and have done) is try to answer that based on my experience, which by virtue of my profession and passion happens to have paralleled many of the issues in this particular topic for most all of it.

lori

[NewfieNat]

I've only read the first half of this thread so far but wanted to chime in with my experience in Canada. So far, so good -for my family and those we know.

About 6 weeks ago we took DD to the emergency room at 3 am and by 7 pm that day she had 2 x-rays, an ultrasound, a bone scan, and a procedure under general anesthetic. Three days later it was decided she needed a MRI and it was scheduled for the next morning. Her total stay was 6 days and we paid not a penny. Currently she sees a pediatrician, family doctor, ophthalmologist, orthopedic surgeon, rheumatologist, plus non-MD services like occupational therapy, physical therapy, and dietician services. This is all covered by Alberta Health. She is on 5 medications and these are covered 100% by DH's supplemental work insurance if we pick them up at company pharmacies, 60% elsewhere.

Besides DD's recent issues, DS was born premature and spent a month in the special care nursery. Right now he is seeing just a family doctor, opthalmologist, and speech therapist.

We've been really happy with our (Canadian) health care system. ALL of these health care workers have been wonderful, and the only waiting involved is to get in with our family doc. The only bill I ever received was $80 for a two-night stay in a private room when each child was born. Really, what more could I ask for?

[mommy111]

I'm not exactly sure where each of the candidates stand on this issue. But after living in France for 2 years where healthcare is free for everyone, I hope that their system is NOT considered as an example. I consider it an example of how to kill an economy. Essentially, employers are responsible for paying specific taxes for each employee they hire which would go directly to funding their healthcare system. When the program was initially started it was wonderful and made healthcare free for everyone. But over the years, it has insured that employers hirer fewer employees and overwork the ones they do hire. It has caused higher and higher rates of umemployment as well as allowed doctors and patients to abuse the system. For example, many of the elderly people I knew would spend a week at the sea because their doctors prescribed a week at the spa. Guess who paid for it? The healthcare system.

Hopefully, our candidates can come up with an acceptable system and soon.
I just got time to browse this thread and so I haven't read any of the other responses, but, wow, a week at the spa prescribed by the doc??? I'd like to see any of our docs get away with that!!!!!

[Octobermommy]

I hope my post is not a repeat b/c I have not read all the responses but I needed a surgery for infertility that my "friends" on the web in Canada needed also. I waited 1.5 weeks to get the surgery, they waited over 2 years. Government healthcare will not solve our healthcare problems which imo has a lot to do with the insurance industry...

[gatorsmom]

I just got time to browse this thread and so I haven't read any of the other responses, but, wow, a week at the spa prescribed by the doc??? I'd like to see any of our docs get away with that!!!!!

My host mom was a medical doctor. One time I had a 2 day bout of gastroenteritis. She prescribed me 6 different medicines. One for ibuprofen, one for cramping, another to stop the diarrhea, another to stop the nausea, etc. I can't remember them all I just remember that there were quite a few medications for something that lasted 2 days. And of course, why not prescribe everything under the sun? They were all paid for by their health system. I paid nothing.

edite for spelling.

[Mirthful]

Torontomom, thank you for taking the time to share your heartbreaking story - I too am so sorry for your loss.


Right now, it is wide open as to what "universal heath care" would be. Unfortunately, I have a feeling that in the end we will get more of the same - randomly put together plans that are not uniform across states - instead of true reform. Just the nature of how the government is run - too many special interests on both sides, resistance to change and that it is easier to add a new plan than to scrap the old ones and start over (kind of like the IRS).

I have to say that this is one of my biggest concerns with the whole healthcare debate. I unequivocally agree that the system is broken. I also agree that there will never be a government with enough political capital to scrap the current system and build a new one from scratch. As a result, every time new legislation is passed, it has to "interact" (for lack of a better word) with the current broken system and that's where the problems come in. I feel like everytime there is a "fix" to the system, the unintended consequences end up swallowing up whatever good it was supposed to accomplish. Like Medicare Plan D. I work in a healthcare setting and we see SO many examples of patient who are stuck in the "doughnut hole" and are just jumping through hoops to work around it. Not to mention that pretty much nobody understands it.

For those that aren't familiar with it, Medicare Part D is a program that Medicare started to help seniors pay for their meds. After a small deductible, they pay only a percentage (around 25%) of the cost of their meds for the first $xx (it depends on their plan) and then they have to pay all of their drug costs (the period known as the doughnut hole) until they hit another level (usually about $2000-$3000 later) where the plan picks up most of the cost again. Well, in theory this is great because, before this, many seniors on Medicare didn't have any pharmacy coverage at all. BUT, since this is overlaid on top of the existing Medicare system (specifically Parts A and B), what we see is patients who are in the doughnut hole coming in DAILY to get medications that they could give themselves at home. This is because provider visits are covered under Medicare Parts A & B and anything that is given during a visit is covered by the copay. Truly, in the end, Medicare has lost huge sums of $$ and seniors quality of life with this work-around. But at least these patients have a work-around. Others just stop taking their medications. Before Part D came into existence, many had supplemental medication plans that weren't that expensive - especially compared to the thousands of dollars that they have to pay when they're in the doughnut hole. But, Medicare stopped offering those policies when Part D started.

Ugh, sorry for the novel. But, I'm sure each and every one of you can name an example of a program that got implemented that didn't work the way it was supposed to.

So, with that preface, I would love to see a version of universal healthcare but would settle for mandated healthcare coupled with serious insurance company regulation. Unfortunately, the reality is that there is no way that everyone could be given universal coverage with no limits - healthcare is just too expensive. However, affordable, basic catastrophic coverage tied together with aggressive preventative health care would go a long way towards reducing the disproportionate loads on our emergency rooms and uninsured/underinsured. (That 25% for administrative costs that Lori (lorien_ca) posted is just staggering) The only way I can see to make it affordable is to increase the pool of patients to include the healthy, thus the mandated part. While this might seem unfair to a 21-year old who has no medical problems - that 21 year old will likely one day be a 60 year old with diabetes or high blood pressure. Not to mention that he might get into a motorcycle accident tomorrow. (And ironically, he rides a motorcycle because of the great mileage it gets because of the high cost of gas - but that's a different debate...)

In fact, in looking for her statistic, I realize that I agree pretty much 100% with Lori's post (#38) back on page 4 and she put it much better than I did.