Conservatives, under what conditions would you allow universal coverage?

[aggle-rithm]

I don't think the problem with the US healthcare system is about insurance coverage. It's about the cost of healthcare.

IMHO, trying to solve an economic inflation problem by throwing money at it is like trying to put out a fire with gasoline.

Not that I have a better solution. I wish I did.

Not that anyone would listen to me...*sniff*

 

[lionking]

I don't think the problem with the US healthcare system is about insurance coverage. It's about the cost of healthcare.

IMHO, trying to solve an economic inflation problem by throwing money at it is like trying to put out a fire with gasoline.

Not that I have a better solution. I wish I did.

Not that anyone would listen to me...*sniff*

Nothing a touch of socialism won't cure.

 

[aggle-rithm]

And this is to everybody: I don't care how well insured you are, unless you're a millionaire, you're one cancer diagnosis away from poverty. You have no idea what the costs can be. People think "oh, my insurance covers 80%, that's good!" and then are very, very surprised to find that 20% of four million is $800,000 and they don't happen to have that lying around in the sofa cushions.

If you get such a bill, here is the conversation you have with the hospital:

Billing dept: So, can you pay the $800,000 dollars?
You: No. I'll pay you $100 a month.
Billing dept: Can't you put it on a credit card or something?
You: No. I don't have that much credit.
Billing dept: Well, how about liquidating all your assets, and sending the money to us?
You: Hmmm...no, I like my idea better. $100 a month.
Billing dept: *sigh* OK...

My wife had such a conversation with the hospital after we had a catastrophic medical event about ten years ago. After she paid $100 a month for about a year, the hospital wrote the balance off.

 

[Grizzly Bear]

A few things I don't like about UHC at the foundational level:

• A government system is essentially a monopoly. Ironic IMO considering the rhetoric I often see regarding large corporations. This is the reason why it's so often called a "removal of choice."
  
• With the inefficiency of government here, I'd rather they have a minimal role if any in a full blown UHC plan. The current proposals passed but it's a complete mess because the politics of this country will never allow for an emulation of a European or Canadian UHC system.

If they can somehow integrate a balance of government intervention and free market practices I might favor the idea. But one of my main concerns before any other criticism of the system is there should be a means in place so that if part of the industry fails for whatever reason, then there's redundancy in the system; in other words if I get bad service I want the ability to change to a more efficient provider. If my provider seriously screws up, I want the choice to select a different provider, etc etc...

One of Obama's major proposals was to introduce the government system as a competitor to the private insurance system we already have, which is another thing; lopsided competition pretty much ruins the value of competition in general.

To clarify my position. I don't want to put all of my eggs in one basket. Maybe the government can have a tangential role in laying out standards that insurance companies follow? Just my $.02

 

[TragicMonkey]

If you get such a bill, here is the conversation you have with the hospital:

Billing dept: So, can you pay the $800,000 dollars?
You: No. I'll pay you $100 a month.
Billing dept: Can't you put it on a credit card or something?
You: No. I don't have that much credit.
Billing dept: Well, how about liquidating all your assets, and sending the money to us?
You: Hmmm...no, I like my idea better. $100 a month.
Billing dept: *sigh* OK...

My wife had such a conversation with the hospital after we had a catastrophic medical event about ten years ago. After she paid $100 a month for about a year, the hospital wrote the balance off.

I know. That's what always happens. The richer providers can afford to write off stuff. The others can't afford it, so they have to pursue where they can and be more selective about who they treat and what they do. My employer makes enough money that we can afford to treat indigent patients, write off huge balances, work out "payment plans" that all parties know are polite fiction. We can do that because we're rich because we're raking in money from the other patients. We're making up that lost income somehow--does it mean the other patients are paying more than they need to? Is our profit margin excessively high?

 

[WildCat]

I* don't have need for perscription eyewear coverage, but it is likely that Tricare is superior to many other insurance carriers, especially for the traditionally under-covered items like glasses.




*I am a Tricare beneficiary.

It never ceases to amuse me when those with government health insurance rail against government health insurance...

 

[TragicMonkey]

Personally, I think "healthcare reform" is doomed to failure because everybody's using the wrong language. We don't need to "reform" the current system, we need to replace it. There are currently 3 parties involved in healthcare: the patients, the insurers, the providers. One of those two takes X amount of money from another, and pays out X - Y to the third in exchange for the third's services to the first. What, precisely, is the point of having a middleman in this? A middleman who makes profits by maximizing the amount the patients pays out and reducing the amount the provider receives?

Screw insurance. We don't need government acting like an insurance company. We need to forget the insurance model entirely. Instead of some people paying an insurance company on the chance they will need healthcare services, why not simply pay the providers for the actual treatments they perform? Remove the middleman. Instead of a few hundred bucks of my paycheck going to an insurance company that may (or may not) pay out to a doctor on the chance I get sick, why not have that money go to taxes in exchange for the guarantee that if/when I do get sick, whatever I need will be paid for?

No more pre-auths. No more contracts. No more fee schedules, negotiations, claims, appeals, denials, capitations, reversals. No more gigantic corporations making billions of dollars out of collecting as much as possible from the patients while paying out as little as possible to the doctors. The paperwork savings alone would fund the treatments of hundreds of thousands, if not millions, of patients per year.

 

[WildCat]

Let's take the Mayo Clinic as an example: Are you asking for a program that covers Mayo Clinic visits for everyone?

Also, please clarify something for me: Are you talking about entitlement, or affordability?

I mean, are you saying everybody is entitled to the Mayo Clinic (for example), or are you saying everybody should be able to afford the Mayo Clinic?

The Mayo Clinic, despite its reputation as one of the best places in the country to get health care, is also a low-cost provider. You can spend 3 times as much elesewhere and not get better care.

How is this possible? The Mayo Clinic's doctors are all on salary, they have no financial incentive to order unnecessary tests and procedures. They're not going to order unnecessary MRIs because they have a financial interest in the MRI clinic across the street. Care is coordinated so everyone is working on the same page, and tests are not repeated unless necessary, not just because a different doctor is on duty that day and he doesn't trust the tests the last doctor gave. Etc etc.

US health care costs would be a lot lower if every hospital was run like the Mayo Clinic.

 

[WildCat]

Your post is assinine, and perfectly captures the problem with these threads.

I not only didn't post that I oppose universal heath care, I actually posted condititions under which I would favor a universal heath care system - and the conditions I posted that I would find objectional are actual, unavoidable, and negative under most of the current proposed schemes.

Right, you don't oppose UHC, it just has to be a perfect system in every way...

Well enjoy your government health care sarge, keep making sure nobody else can get it!

 

[TragicMonkey]

Snort. I was a Tricare beneficiary for years, being a Navy brat. The quality of care...well, let's just say there are some serious deficiencies.

 

[Darat]

...snip...

It's much more complex that that. You really think there's a just one list of procedures with dollar figures next to them? Medicine is every bit as complex as the human body, and so is the business set up to deal with it. ICD-9, HCPCs, visit levels, credentialing, appeals...Jesus Christ, it's never going to work because people outside the system believe they understand how the system works. It's Dunning-Kruger in action.

Wow - no wonder health care costs so much in the USA if all that non-medical stuff has to be paid from the fees. From your list the only one that applies to getting medical treatment in the UK is the appeals.

 

[TragicMonkey]

Wow - no wonder health care costs so much in the USA if all that non-medical stuff has to be paid from the fees. From your list the only one that applies to getting medical treatment in the UK is the appeals.

Not entirely. ICD-9 is the coding for diagnoses. We'd need that regardless of who was billing, there just wouldn't be so many fights about deciding exactly which one qualifies for which treatments. HCPCs is the coding for treatments. For example, a patient could have a 174.8 dx and receive a 99213 procedure code--that means a patient with breast cancer got an evaluation visit. The problems arise when insurer X says there's not documentation enough to justify a 99213, it should be the cheaper 99212, or when insurer Y says those lab tests last week aren't necessary for a 174.8, only people with 150-160.9 ought to be getting those, so payment's being retracted. You can never know if they're honest and trying to abide by the strict letters of their contracts, or if they're just fighting to delay payment in the hopes of getting out of paying the whole thing (also, insurers don't pay interest, so the longer they drag it out the better for them).

 

[Darat]

A few things I don't like about UHC at the foundational level:

• A government system is essentially a monopoly. Ironic IMO considering the rhetoric I often see regarding large corporations. This is the reason why it's so often called a "removal of choice."

Doesn't have to be, for instance take the UK model, our GP practices are usually private companies (owned usually by the GPs), they have a contract with the NHS, but that doesn't stop them also having private patients, charging for non medical services and so on. Apparently £1 in every £20 spent on healthcare by the English NHS is paid to private businesses.

• With the inefficiency of government here, I'd rather they have a minimal role if any in a full blown UHC plan. The current proposals passed but it's a complete mess because the politics of this country will never allow for an emulation of a European or Canadian UHC system.

This goes back to something that has come up in these threads time and time again and it is the apparent belief (from the Americans I hasten to add) that the USA government is somehow uniquely incompetent and cannot manage what dozens of other countries manage. However there are examples of the UK NHSs wasting millions because of incompetence or inefficiency yet they still manage to provide good levels of healthcare at a much lower cost than the USA does.

Out of interest anyone know how do the current government run health services such as VA health care system stack up against the private services e.g. what are the admin costs and so on?

If they can somehow integrate a balance of government intervention and free market practices I might favor the idea. But one of my main concerns before any other criticism of the system is there should be a means in place so that if part of the industry fails for whatever reason, then there's redundancy in the system; in other words if I get bad service I want the ability to change to a more efficient provider. If my provider seriously screws up, I want the choice to select a different provider, etc etc...

Again the UK system allows for this for example I can move to any other GP practice that will take me on.

...snip...

To clarify my position. I don't want to put all of my eggs in one basket. Maybe the government can have a tangential role in laying out standards that insurance companies follow? Just my $.02

There are quite a few UHCs around the world that pretty much operate in that way with a safety net provision for those on low incomes - they seem to work.

 

[Darat]

Not entirely. ICD-9 is the coding for diagnoses. We'd need that regardless of who was billing, there just wouldn't be so many fights about deciding exactly which one qualifies for which treatments. HCPCs is the coding for treatments. For example, a patient could have a 174.8 dx and receive a 99213 procedure code--that means a patient with breast cancer got an evaluation visit. The problems arise when insurer X says there's not documentation enough to justify a 99213, it should be the cheaper 99212, or when insurer Y says those lab tests last week aren't necessary for a 174.8, only people with 150-160.9 ought to be getting those, so payment's being retracted. You can never know if they're honest and trying to abide by the strict letters of their contracts, or if they're just fighting to delay payment in the hopes of getting out of paying the whole thing (also, insurers don't pay interest, so the longer they drag it out the better for them).

Well you could take the concept of billing out of the system and hey presto the above costs disappear!

 

[Thunder]

Conservatives, under what conditions would you allow universal coverage?

I assume they would allow universal coverage if all Americans were Conservatives.

for example: all Congressmen and Senators have govt. funded healthcare...even the Conservative ones. None of the Conservatives in Congress have rejected their govt.-funded health insurance. Nor do they EVER reject their LIFETIME pension plan earned after just two-terms, regardless of age.

 

[Travis]

And so would I. Mightily so. But I don't think I'm entitled to such a system. Nor do I ask you to pay for such a system.


This is laughably vague. Covers everyone to what extent? Everyone has access to how much health care?

Let's take the Mayo Clinic as an example: Are you asking for a program that covers Mayo Clinic visits for everyone?

Also, please clarify something for me: Are you talking about entitlement, or affordability?

I mean, are you saying everybody is entitled to the Mayo Clinic (for example), or are you saying everybody should be able to afford the Mayo Clinic?

I see no reason that every public hospital can't have the same level service as the Mayo Clinic and be available to everyone.

 

[TragicMonkey]

Well you could take the concept of billing out of the system and hey presto the above costs disappear!

To an extent. There will always be a need for paperwork, just to keep track of treatments and arrange scheduling and ordering drugs and stuff like that. But definitely if the fights over claims went away a good deal of resources would be freed up for more actual healthcare-related work. We could hire three nurses for what they pay the woman whose sole job is to negotiate contracts with insurers.

 

[Grizzly Adams]

Why is an amendment so important to you.

Well, the Constitution explicitly states the federal government has only the powers delegated to it by the Constitution. There is no power to provide health care in the Constitution.

That is why the amendment is so important to me. Because without it, UHC would be unconstitutional.

Unless, of course, you're into that perversion known as a "living Constitution."

 

[TragicMonkey]

Well, the Constitution explicitly states the federal government has only the powers delegated to it by the Constitution. There is no power to provide health care in the Constitution.

That is why the amendment is so important to me. Because without it, UHC would be unconstitutional.

Unless, of course, you're into that perversion known as a "living Constitution."

I'm just glad the Founding Fathers anticipated the need for the FAA, there'd be a lot of problems if they hadn't stuck that in there.

 

[Nursedan]

In the meantime the uninsured, like myself, are kind of left waving in the wind. You talk about wanting choices for procedures when I would be happy to just be able to have any procedure.

Then get a job that provides insurance or make enough money to insure yourself privately. Have you not considered this as an option?