Obama health care plan explained

[BobG]

So you're unwilling to take my word for it (or either of the sites I linked to), and unwilling to look it up yourself, but you're still going to continue to call it a frivolous lawsuit and use it as an example to show that the courts don't toss out meritless suits.

Then I refuse to continue the discussion with you. Since the case is not a medical malpractice case or a frivolous lawsuit, it has no bearing on the topic anyway.



A settlement is between the two parties and does not involve the courts. Yes, it's up to the insurance companies if in fact they are paying out big settlements for meritless cases.

I've stated in a prevous post that I stand corrected! What else should I say or do? Prostrate myself on the ground?

 

[JoeTheJuggler]

I understand what you're saying, but I would put in one word of caution for general consumption. Many people seem to equate the term "universal healthcare" with a state-run system such as the NHS which is funded from taxes and to which everyone has access. It seems as if the USA is not intending to go in this direction.

However, countries such as Germany and Switzerland also have "universal healthcare" in that healthcare is available to everyone at a price they can afford, but it is done by making sure that everyone has health insurance cover that they can afford. It seems to me that this is what Obama is working towards, even if he's not quite there yet on the first move.

"Universal healthcare" simply means that everyone in the population (defined elsewhere) has access to the healthcare they need at a price they can afford. The "how" is irrelevant, and there are lots of "hows".

I know you didn't make this mistake, but many people in the USA do. Many criticisms of Obama's plans seem to be assuming he's proposing a system he simply isn't proposing.

Yes. You're right. One of Obama's goals is to put us on the path to universal healthcare through insurance reform, and I believe most of the plans proposed to date do have the "individual mandate" (requirement that everyone get insurance). Most versions would also expand medicaid so that people like me (the working poor, but not poverty level, and childless) would qualify, or provide a subsidized public insurance plan to make it affordable.

At any rate, I'd still call these plans health insurance reform, since that's largely what they're focussed on. The government is not going to become the employer of all health care professionals, for example. The ones getting attention aren't proposing a single payer system. A big chunk of the money we spend on healthcare is still going to become profits to private insurance companies. At most, we might see a kind of regulation of these profits (the way the Public Service Commission regulates utility company profits)--but I haven't even seen anything like that in these proposals (though I'm still wading through them).

On another note, I think it was a mistake for Obama to pledge that this kind reform be deficit neutral. Universal access to healthcare is the right thing to do in a civilized nation--even if it results in a net cost. (Again, I think as long as we're keeping the for-profit insurance companies in it, it's going to be expensive.)

 

[JoeTheJuggler]

I've stated in a prevous post that I stand corrected! What else should I say or do? Prostrate myself on the ground?

Sorry--I'm catching up. Your comment that you refused to accept that it's not a frivolous case (and refused to accept my two citations to the facts), but you weren't willing to spend 30 seconds to google it yourself bugged me.

So. . . what is the cause of unnecessary and expensive testing--one of the causes of the high price of healthcare in the U.S.? I don't buy that it's "defensive medicine" because of meritless lawsuits. I think, as with the status quo in general, it's an insurance problem mostly.

I also think there's the public education and perception issue mentioned earlier.

Despite the fact that the U.S. ranks 72nd in level of health and 37 on the overall health performance in the WHO's analysis of the healthcare systems of its member states, there are people who still boast the the U.S. provides the best healthcare in the world. I think what they mean is that we have the most expensive hardware of any country in the world. That is, if you have enough money, you can get the best treatment here.

I think that perception needs to be changed. We need to ask what kind of basic level of healthcare we can provide to everyone rather than what is the best thing we can provide to those wealthy enough to afford it.

It seems we're stuck on an all-or-nothing mentality. If you're in the system, you need to get (or deserve or will demand) an MRI for every little ache and pain. If you're not in the system, you get nothing.

 

[Brown]

The system we use in Canada is one such system. Now it is far from perfect (We are ranked 30, USA is 37 http://www.photius.com/rankings/healthranks.html), but we do have guaranteed health care for EVERYONE. We are currently looking at a combination of private and public health care, but it is a slow and resistant road. Our wait lists are longer, for sure, but as a physician I can tell you, if I feel someone needs a test urgently, they can get it within a week or two, if an emergency they get the test and see a specialist THAT DAY!

As a US citizen living and working in Canada, I have to vent a little bit about the system as I experienced it last week. I had "a warning sign" of a heart condition. My preference (being a male) would be to ignore it and hope it would go away (which of course it did). But my new wife (a registered nurse) said that I should consult a doctor about the sign, and thus began my battle with the Canadian health care system.

I telephoned my doctor's office. "He's going on holiday next week," they said. (Many Canadians use the word "holiday" when they mean "vacation," although they also confusingly use the word "vacation" too.) "Can you stop by this afternoon?" I replied that I would drive there right away, and the office said that would be fine.

Unforgivably, I had to drive MYSELF to my doctor's office.

Once I got there, I had to wait in line, just like at the Department of Motor Vehicles. True, there was only one person ahead of me, but it's the principle of the thing.

To the disgrace of everyone, I did not have to pay any deductible or co-pay. My health card (previously on file) was all I needed... and the staff didn't even need to verify the card. Shoot, I could have been ANYONE. Couldn't they make me fill out a stack of forms to be sure I was who I said I was?

I was escorted to an examination room after waiting five minutes of MY VALUABLE TIME in the waiting room. I had to wait another five minutes before the doctor actually came waltzing in the door. (I passed the time reading a year-old article from Reader's Digest, since my doctor did not have the good sense to put eight-year-old copies of Field and Stream in the waiting room.)

I got examined and various tests were ordered, tests that my wife said seemed to be appropriate. A follow-up visit was arranged on the spot. The whole incident, from telephone call to return to my office, took about an hour, which was, of course, infuriating. What is the point of going to the doctor if you can't take a break from actually working?? And by NOT requiring a co-pay or other out-of-pocket outlay, I was left with more money in my wallet to buy junk food, which would damage my health EVEN MORE!

The horror stories never stop.

Now for anyone who has read the above and does not recognize the sarcasm, let me say that the events and time durations are indeed true. My experience was far from being horrible. It may be (and probably is) an atypical experience, in that the doctor had a convenient opening and I was able to take it. In no way does this single incident suggest that the Canadian system is superior to any other system; but by the same token, the horror stories being told in the US about the Canadian system are even more atypical (and besides, in a horror-story contest, the US easily beats Canada).

I watch the US health care discussions with interest. Personally, I'd like to see the US adopt a system that is NOT like Canada's but that is BETTER THAN Canada's. It can be done, and the US is in a position to do it; but the US has to get past the ignorance and fear that seems to grip a significant number of citizens.

Curiously, in Canada, people see access to basic health care as a human right. The curious part is that people in the US largely do not see any degree of health care in that light, and in an extreme case, the so-called "pro-life" people generally tend to be adamantly opposed to treating access to basic health care as a human right.

 

[Matthew Best]

Good luck with your health, Brown.

 

[boooeee]

I smell weasel words here. What percentage of income is spent on buying healthcare? In European systems where insurance companies deliver universal healthcare, the figure is about 95%. The figure I've heard for the USA is about 78%, which is held to be absolutely diabolical in global terms. So even if 83.6% is a real figure, it ain't so good. And when they say "expenses" rather than "buying healthcare" some warning bells go off.

Rolfe.

The preceding paragraph is a bit more clear:

"For every premium dollar that they take in, about 83 cents goes out in medical costs -- doctors, hospitals, and drugs," says Carl McDonald, health insurance analyst at Oppenheimer & Co. The rest is spent on overhead. Net income comes to just a few cents per dollar of premiums.

This is pretty consistent with my own experience with large health insurers. Do you have a cite for the 95% number?

Also, there are a lot of things contained in the reform bill that should reduce admin costs for insurers. For example:

If you buy an individual policy through a broker, in many cases 20 percent of your first year premiums go to the broker. And it only drops to 10 percent after the first year. Under the "Exchange" concept, the broker's role becomes redundant, assuming they reform the market so that comparisons of benefits and rates are easy to understand.

Also, when you buy an individual policy, the insurer has to spend money underwriting you to make sure you don't have expensive pre-existing conditions. They pull medical records, pharmacy history, call you at home. This all costs money. And it all goes away under the reform proposals.

I doubt private insurers will ever touch the 95% number, but I do think their ratio will rise under reform. Besides, that's the small piece of the pie. Even if all health insurers ran at a 100% ratio, our costs would still be far above all other OECD countries.

 

[DC]

after reading all those storys from the Canadian system i think ours (swiss) suck

well in Hospital they first fixed my broken hand, but then i had to fill in sefereal forms and stuff. Siwtzerland seems to love paperwork. we got for everything several forms.

 

[Rolfe]

This is pretty consistent with my own experience with large health insurers. Do you have a cite for the 95% number?

I should keep a list of references! I think this was part of an interesting documentary entitled "Sick Around the World" which is available to view online.

Rolfe.

 

[T.A.M.]

Don't worry, doctors in countries with proper, universal health care are still filthy rich.

really?

What do you mean by filthy rich?

TAM

 

[T.A.M.]

But won't testing always fall on the "better safe than sorry" side? What was so disturbing to me about his post was that he was indicating that somehow fear of litigation motivated doctors to test more than concern over the patient's health.

In other words, it's weird to hear "we have to do excessive testing because if we missed something the patient would sue our pants off" when you'd think the desire to, you know, keep the patient healthy would be all the motivation they need to makes sure they didn't "miss something."

yup. Up north Everyone is covered, but I will confess (and can safely say most of my colleagues are the same) that a good percentage of tests are ordered either through physician caution and/or patient caution with the "better safe then sorry" approach.

That said, I HAVE NO DOUBT, that litigation in the USA is much more horrible in this area then here in Canada.

TAM

 

[T.A.M.]

As a US citizen living and working in Canada, I have to vent a little bit about the system as I experienced it last week. I had "a warning sign" of a heart condition. My preference (being a male) would be to ignore it and hope it would go away (which of course it did). But my new wife (a registered nurse) said that I should consult a doctor about the sign, and thus began my battle with the Canadian health care system.

I telephoned my doctor's office. "He's going on holiday next week," they said. (Many Canadians use the word "holiday" when they mean "vacation," although they also confusingly use the word "vacation" too.) "Can you stop by this afternoon?" I replied that I would drive there right away, and the office said that would be fine.

Unforgivably, I had to drive MYSELF to my doctor's office.

Once I got there, I had to wait in line, just like at the Department of Motor Vehicles. True, there was only one person ahead of me, but it's the principle of the thing.

To the disgrace of everyone, I did not have to pay any deductible or co-pay. My health card (previously on file) was all I needed... and the staff didn't even need to verify the card. Shoot, I could have been ANYONE. Couldn't they make me fill out a stack of forms to be sure I was who I said I was?

I was escorted to an examination room after waiting five minutes of MY VALUABLE TIME in the waiting room. I had to wait another five minutes before the doctor actually came waltzing in the door. (I passed the time reading a year-old article from Reader's Digest, since my doctor did not have the good sense to put eight-year-old copies of Field and Stream in the waiting room.)

I got examined and various tests were ordered, tests that my wife said seemed to be appropriate. A follow-up visit was arranged on the spot. The whole incident, from telephone call to return to my office, took about an hour, which was, of course, infuriating. What is the point of going to the doctor if you can't take a break from actually working?? And by NOT requiring a co-pay or other out-of-pocket outlay, I was left with more money in my wallet to buy junk food, which would damage my health EVEN MORE!

The horror stories never stop.

Now for anyone who has read the above and does not recognize the sarcasm, let me say that the events and time durations are indeed true. My experience was far from being horrible. It may be (and probably is) an atypical experience, in that the doctor had a convenient opening and I was able to take it. In no way does this single incident suggest that the Canadian system is superior to any other system; but by the same token, the horror stories being told in the US about the Canadian system are even more atypical (and besides, in a horror-story contest, the US easily beats Canada).

I watch the US health care discussions with interest. Personally, I'd like to see the US adopt a system that is NOT like Canada's but that is BETTER THAN Canada's. It can be done, and the US is in a position to do it; but the US has to get past the ignorance and fear that seems to grip a significant number of citizens.

Curiously, in Canada, people see access to basic health care as a human right. The curious part is that people in the US largely do not see any degree of health care in that light, and in an extreme case, the so-called "pro-life" people generally tend to be adamantly opposed to treating access to basic health care as a human right.

I don't know what was more entertaining, the story, or your wonderful sarcasm.

As I said, if YOU NEED something done, it is done. Of course there are always exceptions, but for the most part, wait lists that people refer to are for routine or non-urgent investigations and specialist appointments.

One thing I am unclear about, is access to specialists. One of the ways the Canadian system cuts costs, IMO, is that GPs are used as gatekeepers to specialists. I am under the (correct or incorrect?) assumption that down in the USA you can book your own appointments to see any specialist you like, without reference for a GP? correct?

TAM

 

[JoeTheJuggler]

I doubt private insurers will ever touch the 95% number, but I do think their ratio will rise under reform. Besides, that's the small piece of the pie. Even if all health insurers ran at a 100% ratio, our costs would still be far above all other OECD countries.

My understanding is that that percentage value changes too with return on investment changes. That is, when the stock market was paying a safe 10% return, insurance companies could make their profits off their investments (the money earned on the premiums they put into interest-paying accounts of one sort or another) and still cover their claims. Now, they've got to rely much more on the premiums (that is, they need to charge more).

I'm not talking about this as a measure of efficiency, but rather as a measure of how much of the premiums paid in goes to pay claims.

Since private insurance companies exist to make a profit, they won't pay out 100% of the premiums unless they're making money on their investments. So Obama is correct that the health of the economy in general is firmly enmeshed with the health of the healthcare system (and vice versa).

 

[JoeTheJuggler]

One thing I am unclear about, is access to specialists. One of the ways the Canadian system cuts costs, IMO, is that GPs are used as gatekeepers to specialists. I am under the (correct or incorrect?) assumption that down in the USA you can book your own appointments to see any specialist you like, without reference for a GP? correct?

I don't think that's typically allowed in most insurance plans. Normally, you have to get a referral just as in Canada.

 

[The Painter]

It can be done, and the US is in a position to do it; but the US has to get past the ignorance and fear that seems to grip a significant number of citizens.

Nice!! So now if you disagree with the proposed reform bill you are ignorant and fearful. Yeah, No.

 

[Rolfe]

I don't think that's typically allowed in most insurance plans. Normally, you have to get a referral just as in Canada.

In France, on the other hand, the best-rated [universal] healthcare system in the world, you can go straight to a specialist if you want to.

Rolfe.

 

[Rolfe]

Nice!! So now if you disagree with the proposed reform bill you are ignorant and fearful. Yeah, No.

You know, I don't think I've yet seen an objection to Obama's proposed healthcare reforms that wasn't ultimately rooted in either ignorance or fear. Usually fear born of ignorance, actually.

OK, that's leaving aside the objections put forward by the people who are currently pocketing a large slice of the 7% or so of GDP which the USA is currently pouring into healthcare, over and above what other countries are currently paying for similar or better overall outcomes.

As someone else said, who is spreading all the lies going around about universal healthcare? Answer, the people with a vested financial interest in convincing stupid and gullible people to vote against their own best interests. And the rest of them are those stupid and gullible people.

Rolfe.

 

[boooeee]

My understanding is that that percentage value changes too with return on investment changes. That is, when the stock market was paying a safe 10% return, insurance companies could make their profits off their investments (the money earned on the premiums they put into interest-paying accounts of one sort or another) and still cover their claims. Now, they've got to rely much more on the premiums (that is, they need to charge more).

I'm not talking about this as a measure of efficiency, but rather as a measure of how much of the premiums paid in goes to pay claims.

Since private insurance companies exist to make a profit, they won't pay out 100% of the premiums unless they're making money on their investments. So Obama is correct that the health of the economy in general is firmly enmeshed with the health of the healthcare system (and vice versa).

I've heard this anecdotally as well, but it doesn't jive with my experience. Do you have a cite? Health insurance is of a very short term nature. Premiums are paid out in claims almost immediately (maybe a month or two delay). Health insurers can't sit on your premium dollars and let them grow in the market the way life insurers can. Or property insurers that build up big reserves over time to handle catastrophic natural events like hurricanes. Individuals and groups tend to pay premiums one month at a time for their current month of coverage.

 

[Brown]

One thing I am unclear about, is access to specialists. One of the ways the Canadian system cuts costs, IMO, is that GPs are used as gatekeepers to specialists. I am under the (correct or incorrect?) assumption that down in the USA you can book your own appointments to see any specialist you like, without reference for a GP? correct?

In the USA, access to specialists is a sticky thing. There have been times when I was able to see a specialist almost right away, and there was at least one time where it took me several years (inlcuding many months in intense agony) before I could see a specialist who would finally treat the condition successfully.

In both cases, I had to get a referral from my family doctor.

In the first case (where I got access to the specialist quickly), the specialist had people on staff to coordinate with the family doctors, work with the insurance companies, and perform the preliminary screenings to make sure the specialist's services were really needed.

In the second case, my family doctor(s) did not want to get a specialist involved for various reasons (in the end, I had to insist quite forcefully but politely), and the specialist did not have the staff people to make her services more accessible and thereby increase referrals.

As a general rule, in the USA, specialists have to be referred by the family doctor, or there has to be an emergency of some kind.

 

[Brown]

Nice!! So now if you disagree with the proposed reform bill you are ignorant and fearful. Yeah, No.

As you wish. Maybe it's just the loudmouths getting the attention who are the deadheads and the pussies. If you listen to their comments and questions, it is painfully clear that many of them are fear-motivated and as stupid as stones.

 

[DC]

Nice!! So now if you disagree with the proposed reform bill you are ignorant and fearful. Yeah, No.

look at your avatar and aks that again with a straight face, can you?