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  #201  
Old 07-11-2018, 08:00 AM
survinga survinga is offline
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Originally Posted by wonky View Post
Why do you say so? There have been several studies on people's Medicare decision-making, and their ability to find and enroll in the least costly option is suspect, at best. And once enrolled, they often stick with the same plan even when that plan has a steep increase in price. People have too many options, not enough information and resources, and have generally low health insurance literacy. What they have lots and lots of is advertising.
Yes, at the individual level, you find confused customers in any area of life, whether it be buying cars, buying a house, or selecting from health insurance options. But the law of large numbers tends to indicate if something is a good deal or not. And currently about 1 in 3 are taking Medicare Advantage:

https://www.kff.org/medicare/issue-b...market-update/

The kaiser link mentions that they expect it to be about 40% in 2027. The Advantage plans, available through these "evil" private insurers, must be a decent deal.
  #202  
Old 07-11-2018, 08:06 AM
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It must be a pretty good deal though, or many wouldn't be taking it.
Without commenting about MA (which I know exactly nothing about), this seems like a really bad argument. You could make the same argument about things like payment acceleration or student loan reconsolidation services.
  #203  
Old 07-11-2018, 08:24 AM
wonky wonky is offline
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Originally Posted by gtyj View Post
Yes, at the individual level, you find confused customers in any area of life, whether it be buying cars, buying a house, or selecting from health insurance options. But the law of large numbers tends to indicate if something is a good deal or not. And currently about 1 in 3 are taking Medicare Advantage:

https://www.kff.org/medicare/issue-b...market-update/

The kaiser link mentions that they expect it to be about 40% in 2027. The Advantage plans, available through these "evil" private insurers, must be a decent deal.
I didn't use the word "evil." I have no objection to the existence of MA.

I do not agree that popularity means it is a decent deal. I think if an item is advertised extensively and another item is not, the one that's advertised extensively is likely to gain market share and the other item is likely to lose it. This is why advertising exists. FFS Medicare is likely to continue to lose market share as people becoming eligible for Medicare have greater familiarity and comfort with managed care, seek OOP maximums that are not available with FFS Medicare without Medigap, seek the limited supplemental benefits (that are going to be extended next year) that are not available in FFS, and get a barrage of targeted advertising for MA plans.

Whether these items add up to a good deal for any given individual is not my decision to make. Whether people actually understand for themselves if it is a good deal is very much in question. Whether people have awareness of or access to the resources they need to make the decision is not in question--they don't. Medicare Plan Finder is laughably bad. SHIPs are amazing resources but underfunded. Medicare FFS does not advertise (though Medigaps do) and recent changes in Medicare literature has skewed toward MA; last year, CMS didn't even mention FFS in some of the literature about open enrollment.

FTR, I work in health care policy, specifically Medicare, so I tend to view threads like this as more work--and therefore unappealing--unless someone is asking interesting questions. This will likely be my last post on the topic of MA (which is good as it is off topic for the thread).

Last edited by wonky; 07-11-2018 at 08:25 AM.
  #204  
Old 07-11-2018, 08:38 AM
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Magiver, how long did you have to wait when you came down with cancer? How long did you have to wait when you got hit by a car and paralyzed from the neck down? How long did you have to wait when your kid developed a rare and incurable autoimmune disorder? What's that, you don't know, because none of those things have happened to you? Be thankful for that, but what if they do? Catastrophes like that are the very reason why insurance exists, but the vast majority of people, those who haven't yet had such a catastrophe, don't know how well their insurance will react to it.
  #205  
Old 07-11-2018, 10:00 AM
survinga survinga is offline
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Originally Posted by wonky View Post
I didn't use the word "evil." I have no objection to the existence of MA.

I do not agree that popularity means it is a decent deal. I think if an item is advertised extensively and another item is not, the one that's advertised extensively is likely to gain market share and the other item is likely to lose it. This is why advertising exists. FFS Medicare is likely to continue to lose market share as people becoming eligible for Medicare have greater familiarity and comfort with managed care, seek OOP maximums that are not available with FFS Medicare without Medigap, seek the limited supplemental benefits (that are going to be extended next year) that are not available in FFS, and get a barrage of targeted advertising for MA plans.

Whether these items add up to a good deal for any given individual is not my decision to make. Whether people actually understand for themselves if it is a good deal is very much in question. Whether people have awareness of or access to the resources they need to make the decision is not in question--they don't. Medicare Plan Finder is laughably bad. SHIPs are amazing resources but underfunded. Medicare FFS does not advertise (though Medigaps do) and recent changes in Medicare literature has skewed toward MA; last year, CMS didn't even mention FFS in some of the literature about open enrollment.

FTR, I work in health care policy, specifically Medicare, so I tend to view threads like this as more work--and therefore unappealing--unless someone is asking interesting questions. This will likely be my last post on the topic of MA (which is good as it is off topic for the thread).
You make some good points. I used the "evil" kind of as a joke, since some others on the thread really don't like private insurance at all, best I can tell. I didn't mean to come across as a jerk.

My view on Medicare is that it's a good program that should be maintained and well-funded. Most doctors accept it, and people who are on it seem to like it. There are a fair number of Medicare enrollees who also get supplemental plans, and a growing and large % who get advantage. This makes me think that basic medicare has some holes where the private players can come in and help. You're right that advertising influences the %'s, and that people can become confused, as healthcare isn't exactly an easy topic. But I just have to think that with 1/3 of enrollees now taking Advantage, there must be something there that's good. Some advantage plans offer extra benefits that basic medicare doesn't cover, such as dental & vision. This might tip the scales a little. I don't know.

Since you work in healthcare policy, what's your view on the ACA? I think the ACA, though it was kludgy, was mostly well-written, and had a good logic behind it. If the states would all accept the Medicaid expansion, and congress would make the subsidy formulas better for lower-middle to middle class, I think we would get to almost full UHC.
  #206  
Old 07-11-2018, 11:47 AM
Northern Piper Northern Piper is offline
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I'm curious. Does anyone know someone who had brain surgery to cure intractable epilepsy in any Medicare system? Because I was given a choice: brain surgery or barbiturates for life.



Would any single-payer system pay for a very expensive surgery that is not guaranteed to work when a pharmaceutical solution, even though far from ideal, is available?
wolfpup's already dealt with this, but it bears repeating: in the UHC system he and I are both familiar with, the Canadian system, bureaucrats aren't involved in making those decisions on a case-by-case basis, unlike the apparent powers of private insurance agencies in the US.

The government and the doctors negotiate the compensation list for all procedures, and if a procedure is recommended by the doctors as meeting their professional judgment, useful in appropriate cases, it goes on the list. The dickering is about the compensation for that item.

But once it's on the list, the decision whether to use it is left to the doctor and the patient; the doctor's professional judgment and the patient's decision whether to undergo the surgery. The Medicare officials don't have to be consulted and can't override the doctor's recommendation. The doctor does the surgery, puts in the claim, and gets paid.

Is that how it works with private insurance in the US? Or does the insurance company have the power to reject the claim because it disagrees with the doctor's recommendation?

Quote:
And would you want brain surgery in a system that doesn't reward the best doctors more than the less effective ones?

You seem to assume that it's like a flat hourly rate for all surgeries, regardless of complexity.

The compensation list for procedures is very detailed. The more complex the procedure, the higher the fee. And, it's not like the government can just set the fee by diktat. It has to negotiate with the doctors, knowing that there are 12 other provincial/territorial systems setting the fees for that procedure in their jurisdictions. They have to keep competitive. And then there's the US, just to the south; and Australia, and New Zealand...

Canadian healthcare systems have to pay fees that keep doctors working in Canada.

Plus, it's not the Medicare officials who grade the doctors. Again, that's left to the professional judgment of the doctors themselves. The College of Physicians and Surgeons in each province is responsible for regulating doctors. If a doctor wants to perform certain types of surgeries, the doctor has to get certified for that surgery. The more complex the surgery, the harder it is to get certified, after going through training. So yes, I'm pretty confident in the skills of brain surgeons in Canada.

And that level of confidence has nothing to do with out single-payer system, but with the regulatory requirements of the College, to ensure doctors are competent.
  #207  
Old 07-11-2018, 02:16 PM
survinga survinga is offline
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BTW, here's the latest estimate of uninsured %'s in the USA. It comes from the CDC:

https://www.cdc.gov/nchs/data/nhis/e...nsur201805.pdf

We have 9.1% uninsured over the entire population as of the end of 2017, which is about the same as the prior year. That includes 5% for ages under 18, 12.8% for ages 18-64, and then ages 65+ it's essentially zero. I predict that will increase in 2018, as the Trump attacks on the ACA & Medicaid continue.
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Last edited by survinga; 07-11-2018 at 02:17 PM.
  #208  
Old 07-11-2018, 04:41 PM
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So now poster gtyj has changed his name to survinga. Yeah, that's sure to add clarity to all the complicated back-and-forths in this thread.
  #209  
Old 07-11-2018, 04:42 PM
Northern Piper Northern Piper is offline
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At least I can pronounce "survinga".

  #210  
Old 07-11-2018, 04:48 PM
survinga survinga is offline
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So now poster gtyj has changed his name to survinga. Yeah, that's sure to add clarity to all the complicated back-and-forths in this thread.
Sorry, although I think you'll get over it. I hated the first name, and figured it was better to change now, rather than wait until I had hundreds or even thousands of posts. Note that I did put it in my signature, so people would know I wasn't doing something sneaky (like changing my name, and pretending to be someone else).
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  #211  
Old 07-11-2018, 05:31 PM
Magiver Magiver is offline
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Magiver, how long did you have to wait when you came down with cancer? How long did you have to wait when you got hit by a car and paralyzed from the neck down? How long did you have to wait when your kid developed a rare and incurable autoimmune disorder? What's that, you don't know, because none of those things have happened to you? Be thankful for that, but what if they do? Catastrophes like that are the very reason why insurance exists, but the vast majority of people, those who haven't yet had such a catastrophe, don't know how well their insurance will react to it.
I almost lost my leg. Does that count? It was only repeated on-demand appointments with doctors, specialists, surgeons and diagnostic equipment that saved it.

For years, yes YEARS I had to listen to someone with Canadian parents tell me about the delays that destroyed their health. Imagine waiting so long for bypass surgery that your parent deteriorated to the point they were too weak for the surgery. this is a simple, easily available surgery in the US.

But we can talk about delays in cancer treatments in the UK. “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Everybody I know who had cancer treatment got immediate attention. So I'm not hugely interested in anymore arguments about diagnostic equipment sitting idle. It's a big deal to have to wait for stuff like this.

Oh, and one of those cancer patients I mentioned was on medicaid.
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  #212  
Old 07-11-2018, 05:43 PM
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FTR, I wasn't accusing you of doing anything "sneaky", but it does make the already-complicated dialog here much harder to follow, since all the responses to your original name still contain that name, that's all. The discussion is already hard enough to follow with all the obfuscations and digressions.
  #213  
Old 07-11-2018, 05:52 PM
survinga survinga is offline
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FTR, I wasn't accusing you of doing anything "sneaky", but it does make the already-complicated dialog here much harder to follow, since all the responses to your original name still contain that name, that's all. The discussion is already hard enough to follow with all the obfuscations and digressions.
Yeah, I know you weren't accusing me of being sneaky. I was just throwing that comment in there, because some people do that on message boards.
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  #214  
Old 07-11-2018, 11:50 PM
Budget Player Cadet Budget Player Cadet is online now
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Originally Posted by Magiver View Post
I almost lost my leg. Does that count? It was only repeated on-demand appointments with doctors, specialists, surgeons and diagnostic equipment that saved it.

For years, yes YEARS I had to listen to someone with Canadian parents tell me about the delays that destroyed their health. Imagine waiting so long for bypass surgery that your parent deteriorated to the point they were too weak for the surgery. this is a simple, easily available surgery in the US.

But we can talk about delays in cancer treatments in the UK. “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Everybody I know who had cancer treatment got immediate attention. So I'm not hugely interested in anymore arguments about diagnostic equipment sitting idle. It's a big deal to have to wait for stuff like this.

Oh, and one of those cancer patients I mentioned was on medicaid.
If I lived in the USA and wanted treatment for cancer my wait time would be infinite, because I don't have tens of thousands of dollars handy. Normally I'd go more in-depth into what you're talking about but right now I have neither the time nor the patience to do more than point out that the story behind wait times isn't nearly as simple or clear-cut as you'd point out, even after you factor in the fact that for someone who cannot pay for it, the wait time for treatment is effectively infinite.
  #215  
Old 07-12-2018, 02:00 AM
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Unsurprising. MA has some limited extra benefits and has an OOP cap. It also has millions of dollars spent every year on aggressive marketing.
That's for sure. When you even approach 65 your mailbox is filled with the things. And they are one stop shopping, often offering dental and vision plans also.
I investigated them, and rejected them because none included my current set of doctors. One does now, but I'm very happy with the Medigap plan I have.
  #216  
Old 07-12-2018, 02:13 AM
Voyager Voyager is offline
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My view on Medicare is that it's a good program that should be maintained and well-funded. Most doctors accept it, and people who are on it seem to like it. There are a fair number of Medicare enrollees who also get supplemental plans, and a growing and large % who get advantage. This makes me think that basic medicare has some holes where the private players can come in and help. You're right that advertising influences the %'s, and that people can become confused, as healthcare isn't exactly an easy topic. But I just have to think that with 1/3 of enrollees now taking Advantage, there must be something there that's good. Some advantage plans offer extra benefits that basic medicare doesn't cover, such as dental & vision. This might tip the scales a little. I don't know.
I don't work in healthcare, but almost felt that I did when I was figuring out Medicare. It is complicated, and I hate to think what people who don't have PhDs make of it. And I needed Medicare for Dummies.

I actually cane into the process thinking I would choose an MA plan. However the plans for my area had very skimpy provider networks, and there was a big issue about coverage when traveling.
But I can see why people do it - you pick one provider not one for Medigap and other for Part D and others if you want dental and vision insurance. I never got to a real price comparison because of the coverage issue.
You worry about doctors taking Medicare, but a hell of a lot more do than take any given MA plan. I guess if my doctor were in the network it might have come out differently.
  #217  
Old 07-12-2018, 08:21 AM
survinga survinga is offline
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I don't work in healthcare, but almost felt that I did when I was figuring out Medicare. It is complicated, and I hate to think what people who don't have PhDs make of it. And I needed Medicare for Dummies.

I actually cane into the process thinking I would choose an MA plan. However the plans for my area had very skimpy provider networks, and there was a big issue about coverage when traveling.
But I can see why people do it - you pick one provider not one for Medigap and other for Part D and others if you want dental and vision insurance. I never got to a real price comparison because of the coverage issue.
You worry about doctors taking Medicare, but a hell of a lot more do than take any given MA plan. I guess if my doctor were in the network it might have come out differently.
Yeah, having all of medical, rx, dental, vision, under one roof kinda makes sense, and that would seem to explain why so many do the MA plans. The networks probably make some MA options unattractive though. I could understand why you didn't pick an MA plan.
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  #218  
Old 07-12-2018, 05:57 PM
Magiver Magiver is offline
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If I lived in the USA and wanted treatment for cancer my wait time would be infinite, because I don't have tens of thousands of dollars handy.
I don't have tens of thousands of dollars handy either yet I had open heart surgery. What I didn't have were delays in appointments, diagnostics or surgery. I was able to choose the specialist and surgeon.

The cancer survivor on Medicare I mentioned didn't have tens of thousands of dollars either. Still alive because there were no delays in treatment.
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  #219  
Old 07-12-2018, 05:59 PM
CCitizen CCitizen is offline
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You will have to pay more taxes so poor people can get something for free.
On helping poor people I agree with Liberals 100%.

Imposing higher taxes on millionaires would save countless lives of poor people.
  #220  
Old 07-13-2018, 07:28 AM
k9bfriender k9bfriender is offline
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I don't have tens of thousands of dollars handy either yet I had open heart surgery. What I didn't have were delays in appointments, diagnostics or surgery. I was able to choose the specialist and surgeon.
Fortunate for you. There are many who do not have as good of insurance. Even many who do have insurance and are "happy" with it, would discover that they would not be able to get any surgery by and doctor paid for by their coverage.

BTW, when you say that you were able to choose your medical team, do you mean that you looked at all the specialists in the country, ranked them by your discriminating criteria, and made a decision based on that, or that they gave you a list of a few surgical practices in their network that you got to choose from?
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The cancer survivor on Medicare I mentioned didn't have tens of thousands of dollars either. Still alive because there were no delays in treatment.
Sounds like a great argument for a government administered healthcare system to me.

Though, slightly confused. In your previous post, you said Medicaid. Now you say Medicare. Both are govt run programs, so both make sense to reference, but there are differences, which is it that you are talking about?
  #221  
Old 07-13-2018, 03:57 PM
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For years, yes YEARS I had to listen to someone with Canadian parents tell me about the delays that destroyed their health. Imagine waiting so long for bypass surgery that your parent deteriorated to the point they were too weak for the surgery. this is a simple, easily available surgery in the US.
So, you know someone whose friend's uncle's father-in-law's second cousin claims to know a Canadian who says that the health care system there sucks? Can't argue with that!

Well, actually, yes I can. The factual reality of health care in Canada is what I and others who actually live here have been saying throughout this thread, in my case based on half a century of personal experience with my own health care, that of my kids, my parents, other family members, and as a patient advocate for the elderly. The factual reality is that Canadians have a very high degree of satisfaction with their health care system -- much higher than insured Americans, as already noted -- and are generally in better health and live longer than their American counterparts. The factual reality is that everything you've posted and appear to believe about the health care system in Canada is unmitigated bullshit. You don't seem to have a single solitary clue about how it really works.

And, as I described over here, I had a cardiac experience similar to yours which was handled promptly and expertly, in which I had complete freedom to choose any provider and to determine treatment options without any concern about coverage or approvals, and with the assurance that none of it would cost me a single dime. I asked you some questions in that post about how that compared to your experience, which you still haven't answered and I don't expect that you ever will.
  #222  
Old 07-13-2018, 05:38 PM
Magiver Magiver is offline
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I had a cardiac experience similar to yours which was handled promptly and expertly, in which I had complete freedom to choose any provider and to determine treatment options without any concern about coverage or approvals, and with the assurance that none of it would cost me a single dime.
First off, I can go online with the UK medical system and look up delay times. So there's no point in arguing they don't exist. Secondly, those delays are not free, they're tax funded.
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  #223  
Old 07-13-2018, 07:04 PM
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First off, I can go online with the UK medical system and look up delay times. So there's no point in arguing they don't exist. Secondly, those delays are not free, they're tax funded.
This is completely incoherent, much like your other health care critiques. I'm not in the UK, I'm in Canada. And I never claimed that wait times "don't exist". But the critical element in any health care system is triage, so that cases are prioritized according to urgency and care delivered in a timely fashion. Furthermore, if someone is already in hospital, there is pretty much no wait time for anything.

In the case of my own cardiac surgery, once the decision was made on the best way to proceed, it was scheduled for later the same day, and it wasn't even particularly urgent. So when you repeat some bullshit story you heard from the friend of a friend about someone not able to get bypass surgery for so long that they deteriorated beyond help, it's both amusing in its ignorance and irritating in its ridiculousness.

As for "those delays are not free, they're tax funded", I have absolutely no idea what you're talking about. But I can tell you that when you have private insurance, you're paying double or triple the costs of other countries for the privilege of having insurance bureaucrats coming between you and your doctors, limiting their options by dictating what they will and will not pay for, and sometimes denying coverage altogether. This would be totally unacceptable in any civilized country. And I notice that you're still avoiding answering my question about what your health care adventure cost you out of pocket.
  #224  
Old 07-14-2018, 12:17 AM
Magiver Magiver is offline
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This is completely incoherent, much like your other health care critiques. I'm not in the UK, I'm in Canada. And I never claimed that wait times "don't exist". But the critical element in any health care system is triage, so that cases are prioritized according to urgency and care delivered in a timely fashion. Furthermore, if someone is already in hospital, there is pretty much no wait time for anything.
Yes, but you have to get to the hospital. that means various levels of specialists and diagnostic equipment. I got all that on demand. The biggest decision I had to make was which diagnostic center to choose as in, which was was closest, Do I want to drive to the one near my job or the one near my house.
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So when you repeat some bullshit story you heard from the friend of a friend about someone not able to get bypass surgery for so long that they deteriorated beyond help, it's both amusing in its ignorance and irritating in its ridiculousness.
And yet it happened. A surgery that should be scheduled the week it's diagnosed was delayed. The bullshit was the wait time.
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Last edited by Magiver; 07-14-2018 at 12:18 AM.
  #225  
Old 07-14-2018, 03:19 AM
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So does anyone have any actual evidence regarding wait times in various systems? Magiver, you seem to be under the impression that wait times for even critical treatments tend to be worse in the British NHS than in the American system; do you have any evidence of this? (Note: one unverifiable anecdote of a friend of yours does not constitute evidence.) I'm seriously struggling to find decent figures (and of course, it's complicated because surveys of "wait times" often ignore people in the US who put off seeking medical care because they cannot afford it), but if you're so convinced that the USA has considerably faster wait times, can you please provide some evidence?

If we're going off anecdote, I live in Germany, and every time I've needed to see my GP during working hours, my wait time has been measured in hours (or minutes), not days. If I've needed to see a specialist, my wait time has almost never been more than a few days - rarely more than a week. The sole exception here is psychiatry, where wait times are in fact a big problem and you might end up waiting a month or two for your first appointment. That said, the USA isn't exactly setting people up with appointments in a matter of days either, with a median wait time of about 50 days according to this study.
  #226  
Old 07-14-2018, 06:24 AM
survinga survinga is offline
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So does anyone have any actual evidence regarding wait times in various systems? Magiver, you seem to be under the impression that wait times for even critical treatments tend to be worse in the British NHS than in the American system; do you have any evidence of this? (Note: one unverifiable anecdote of a friend of yours does not constitute evidence.) I'm seriously struggling to find decent figures (and of course, it's complicated because surveys of "wait times" often ignore people in the US who put off seeking medical care because they cannot afford it), but if you're so convinced that the USA has considerably faster wait times, can you please provide some evidence?

If we're going off anecdote, I live in Germany, and every time I've needed to see my GP during working hours, my wait time has been measured in hours (or minutes), not days. If I've needed to see a specialist, my wait time has almost never been more than a few days - rarely more than a week. The sole exception here is psychiatry, where wait times are in fact a big problem and you might end up waiting a month or two for your first appointment. That said, the USA isn't exactly setting people up with appointments in a matter of days either, with a median wait time of about 50 days according to this study.
Why are you only demanding study data from Magiver? I live in the US, and have no issues with wait times. I have short waits, costs are reasonable, good choice of doctors. I know the US has problems with the uninsured, and with costs. But that's not been my experience, and I have health insurance through my employer.

Here's a survey on wait times that pulls out data on elective surgeries and specialists. The US is decidedly faster in this survey than either the UK or Canada in these categories.

https://expathealth.org/healthcare-n...me-statistics/

Here's another link that compares many areas, via the Commonwealth Fund. Canada does well, but it's not as rosy of a picture as Wolfpup paints, for sure. They do appear to have wait time issues. And some portion of their population wants "fundamental change" in their healthcare system, whatever the hell that means. I tend to discount that, as most people always complain about "the system", but like what they themselves have, which is the case in the US. In any event, the US does better in some areas, and not so good in others.

https://www.commonwealthfund.org/sit...es_2015_v7.pdf

I think the US has some issues to work on. But maybe Canada does, too.
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  #227  
Old 07-14-2018, 09:54 AM
Magiver Magiver is offline
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Originally Posted by survinga View Post
I think the US has some issues to work on. But maybe Canada does, too.
This thread has been repeated many times with the same results. "my health care is better than yours".

There is no perfect system. In the US we socialize medical treatment for the the very poor, the elderly, and veterans. The middle ground is privately funded. The difficulty has been with the near poor and those with pre-existing conditions. That was supposed to be addressed with Obama care but that drove up the cost of private insurance for the obvious reasons. Young healthy adults didn't buy into the system.

The privately funded system is profit based and that drives down wait time. We have excess capacity for those willing to pay and people come from other countries to use that capacity to reduce their wait times.

I'm not sure what's so hard to understand about wishing to avoid the wait times seen in other countries. Things like hip replacements aren't seen as life threatening and therefore get delayed. Wait times to see specialists cause delays in treatments and exacerbate unknown problems that need to be addressed sooner than later.

I've given examples before with kidney and heart surgery but the one that screams immediate attention was a massive blood clot. It was mis-diagnosed and I could not afford any delays in correcting that. When my GP figured it out she by-passed the specialist and cued up a diagnostic test the same day which saved my leg. I was in the hospital the following day. It's accurate to say ANY medical system would have treated me if they knew how bad it was regardless of country or insurance (or lack of insurance). But it wasn't an emergency until it was diagnosed.

This is a big deal for people who have medical problems that aren't diagnosed in a timely manner. Survival is a function of time and time is a function of money. UHC systems are not slow by choice but by money. What it creates is a system that gives more preventative care for the poor and less for the middle class. The wealthy will just get it wherever it's available because they have the money to bypass a UHC system.

Private insurance gives people the care afforded the wealthy at a cost above UHC tax funding.
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  #228  
Old 07-14-2018, 09:58 AM
Budget Player Cadet Budget Player Cadet is online now
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Why are you only demanding study data from Magiver? I live in the US, and have no issues with wait times. I have short waits, costs are reasonable, good choice of doctors. I know the US has problems with the uninsured, and with costs. But that's not been my experience, and I have health insurance through my employer.
(Bolding mine.)

Employer-backed health insurance is pretty nice, yeah. It's part of why Obamacare raised unemployment - people finally had the choice to leave jobs where they felt trapped because of their health insurance. But it'll definitely skew your experience with the US health care system. That's why I went looking for data, but decent direct comparisons were hard to come by.

Quote:
Here's a survey on wait times that pulls out data on elective surgeries and specialists. The US is decidedly faster in this survey than either the UK or Canada in these categories.

https://expathealth.org/healthcare-n...me-statistics/
See, there's one. I'd be cautious using electives as a measure, because they're typically over-rewarded in a capitalistic medical system. But the timing for specialists is a good point, even if the data has problems such as not counting people who can't afford care as "waiting". (And in fairness, I need to point out that this definitely doesn't support my claims either, and isolated demands for rigor are bad bad bad bad.)

Quote:
Here's another link that compares many areas, via the Commonwealth Fund. Canada does well, but it's not as rosy of a picture as Wolfpup paints, for sure. They do appear to have wait time issues. And some portion of their population wants "fundamental change" in their healthcare system, whatever the hell that means. I tend to discount that, as most people always complain about "the system", but like what they themselves have, which is the case in the US. In any event, the US does better in some areas, and not so good in others.

https://www.commonwealthfund.org/sit...es_2015_v7.pdf

I think the US has some issues to work on. But maybe Canada does, too.
Oh, make no mistake, Canada and the UK have problems. All systems can be improved, and the NHS seriously has a problem of a shortage of doctors for a number of reasons.
  #229  
Old 07-14-2018, 10:37 AM
doreen doreen is offline
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Originally Posted by Magiver View Post
I'm not sure what's so hard to understand about wishing to avoid the wait times seen in other countries. Things like hip replacements aren't seen as life threatening and therefore get delayed. Wait times to see specialists cause delays in treatments and exacerbate unknown problems that need to be addressed sooner than later.
Everybody understands the desire to avoid wait times- but not everybody understands that avoiding wait times costs money and I'm sure that almost no one knows how much it costs them specifically. Every job I've had has offered multiple insurance options with different employee contributions for each. At one former job, the employer covered the entire cost of plan 1 and employees only contributed the difference between Plan 1 and the plan they chose- so if Plan 2 cost $200/month more than Plan 1 employees choosing Plan 2 paid $200/mo and if Plan 3 was $300/mo more, that's what the employee paid. Plan 1 was the sort of HMO where all the doctors worked for the HMO and there was basically no such thing as "going out of network". A very frequent complaint among those who had Plan 1 was the wait time for routine appointments.They had to make their yearly OB/GYN appointments six months in advance, they had to make the next well-baby appointment for their kids at the completion of the current one rather than calling a week before, they had to call two months in advance for camp or school physicals that were needed by a certain date. But they didn't ever complain about wait times for an appointment when they were having symptoms (in fact, some lied and said they suspected pregnancy to get an earlier OB/GYN appointment). And they knew that those of us with other plans had shorter wait times - apparently the shorter wait times weren't worth the $2-300 a month to them. But here's the thing- I don't know how much extra my healthcare (including the total insurance premiums paid by me and my employer) costs because I can schedule a routine screening mammogram tomorrow, or a screening colonoscopy for next Saturday. If it a longer wait would lower the total premium of $24K to $23K , of course I would not want a longer wait. But for all I know, it would lower it from $24K to $17K - which would be a different story.

Last edited by doreen; 07-14-2018 at 10:38 AM.
  #230  
Old 07-14-2018, 11:11 AM
survinga survinga is offline
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Originally Posted by Magiver View Post
This thread has been repeated many times with the same results. "my health care is better than yours".

There is no perfect system. In the US we socialize medical treatment for the the very poor, the elderly, and veterans. The middle ground is privately funded. The difficulty has been with the near poor and those with pre-existing conditions. That was supposed to be addressed with Obama care but that drove up the cost of private insurance for the obvious reasons. Young healthy adults didn't buy into the system.
I think the individual mandate wasn't strong enough, and the subsidies weren't generous enough for some groups (namely the lower-middle to middle class who didn't get employer-based insurance). Also, the Medicaid expansion needs to get into all 50 states. The ACA, as it was written, had good logic to it that would have gotten us to near UHC, close enough to say we did it. But it's never been given the chance to work, and it's still under attack from Trump.

The young adults you mentioned will always be an issue in a system where you're not required to buy insurance. The mandate penalty wasn't strong enough.
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  #231  
Old 07-14-2018, 11:45 AM
wolfpup wolfpup is online now
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Yes, but you have to get to the hospital. that means various levels of specialists and diagnostic equipment. I got all that on demand.
I don't see the issue. Take my recent experience as an example. I had been having chest pains on and off for most of a week. Finally on a Friday afternoon, I was having a glass of wine and making a snack and decided to hell with this, I'm going to get it checked out. It was too late to try to get a doctor's appointment so I left everything in the kitchen and got myself to the ER, expecting I'd be back in a couple of hours at most with a prescription and some innocuous diagnosis.

I've pretty much told the rest of the story before. I got admitted with high blood pressure and cardiac issues that were non-urgent but needed attention. Over the next few days I got lots of testing done, medications administered, an angiogram done, bypass surgery was recommended, spoke with a heart surgeon about options, a meeting was convened to see if I was a candidate for stenting as an alternative to bypass, the answer was "yes", the procedure was done later the same day, and I was home the next day.

So what was it about this that was lesser quality than your cardiac experience? What took longer? What value would you assign to guaranteed unconditional full coverage with no out-of-pocket costs -- and most importantly, no meddling insurance company to say "you must have bypass" or "we won't pay for this particular stenting procedure because it's a new procedure (as indeed this was) and we deem it 'experimental'" -- as Aetna did to this unfortunate girl? Or this even more unfortunate one?
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Originally Posted by Magiver View Post
And yet it happened. A surgery that should be scheduled the week it's diagnosed was delayed. The bullshit was the wait time.
No offense, and I'm not blaming you, but based on my experiences over half a century of living with the health care system in Canada I find your friend-of-a-friend story to be not credible and the result of the typical kind of distortions and omissions that happen when verbal stories are told and retold, exaggerated and embellished, until they become unrecognizable. It seems like no coincidence that it fits the right-wing propaganda narrative of "people wait so long to get health care in Canada that many of them are dying!". That's not what the health outcome statistics say. In fact they say the opposite, compared to the health of the average American. And that's not what my personal experiences say.
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Originally Posted by survinga View Post
Why are you only demanding study data from Magiver?
Because he's the one making outrageous unsubstantiated claims.
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Originally Posted by survinga View Post
https://www.commonwealthfund.org/sit...es_2015_v7.pdf

I think the US has some issues to work on. But maybe Canada does, too.
I've only skimmed that article but it looks like one of the more thorough analyses of major health care systems I've seen in recent years. I like the comprehensive discussion of each country's system in a separate chapter. I wish more people would read them and educate themselves.

But as you've suggested, some of the numeric stats in the earlier part need to be interpreted in context and with a grain of salt. One can cherry-pick a number like a big portion of Canadians have supposedly said that the health care system needs "fundamental reform", and you're right to be skeptical -- it's also odd how one would reconcile that with other surveys that show 85+% are satisfied or very satisfied with it. One could also note that only a slightly smaller percentage of Americans think their own system needs fundamental reform, and that percentage is smaller only because quite a large chunk of them are in the "needs to be completely rebuilt" category.

You're certainly correct that the Canadian health care system isn't perfect, and if I sound like I'm claiming that it is -- and sometimes I do tend to sound that way, I admit -- it's partly because I'm so sick of hearing it attacked with complete falsehoods by the American insurance lobby and those who've bought in to their propaganda, and also partly because it's served me and my family so well for so many years. But no, it's not perfect. And some of the problems are problems that we have in common. There aren't as many GPs in family practice as we need, for instance, and that's a problem in the US, too.

The problem of wait times is the most talked-about and also by far the most misunderstood. I've tried, over and over again, to explain the all-important distinction between waiting for some trivial appointment where the wait presents nothing but a minor inconvenience, and having access to timely medical attention when you need it -- even if it's not urgent, but when time does matter. I think the Canadian system generally handles this very well, while managing to control costs for the overall system and providing guaranteed universal coverage for everyone with little to no out of pocket costs.

The other obvious point that's often misunderstood is that "wait times" refer to procedures scheduled for outpatients. Once you're admitted to hospital, wait times are generally pretty much how long it takes them to wheel you over to where the procedure is done.
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Originally Posted by Magiver View Post
The privately funded system is profit based and that drives down wait time. We have excess capacity for those willing to pay and people come from other countries to use that capacity to reduce their wait times.
True, it does. It does that by allowing the health care provider system to be so enormously profitable that expensive resources sit idle and underutilized. That's not a smart or sustainable way to run a health care system when a single piece of equipment like a modern MRI machine can cost millions of dollars, plus the staff to run it.

The absence of a central authority to negotiate and standardize provider fees is one of the fundamental structural problems with private insurance. The other one, which is a direct consequence of the first, is that they have to try to control costs at the individual case level, so there's enormous paperwork and scrutiny associated with each claim, and each claim comes with the risk of being cut down or denied. Which is why my position has always been that private business is totally the wrong model for health insurance. At best, it's a force-fit of a square peg in a round hole that would have to be very tightly regulated. Switzerland manages to do this with reasonable results -- to an extent that American conservatives would never find acceptable -- but they still end up with the second-highest health care costs in the world.
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Originally Posted by Magiver View Post
I'm not sure what's so hard to understand about wishing to avoid the wait times seen in other countries. Things like hip replacements aren't seen as life threatening and therefore get delayed. Wait times to see specialists cause delays in treatments and exacerbate unknown problems that need to be addressed sooner than later.
If your argument is going to be "all health care must be immediate, because you never know what you might find", then you'd better have the statistics to back that up. You'd better also have an infinite amount of money to provide it. The real world just doesn't work that way. I know you provided the anecdote about your blood clot. IANAD and I can't say whether there were obvious red-flag indications of urgency. What I can say is that misdiagnoses happen from time to time on very rare occasions, and they can happen under any kind of health care system. If there was a systematic issue of people's health being at risk from lack of timely medical attention, it would be reflected in UHC statistics. It isn't. In fact, as I said before, people in Canada live longer, healthier lives than Americans on average, and infant mortality is lower as well.

Since you mention hip replacements, it's a good example of the importance of triage. It's often dredged up as an example of awful "wait times", and the fact that a broken hip can be very dangerous in an elderly person is often thrown in to highlight the problem. This is a bunch of convoluted nonsense. Joint replacements like hip and knee typically have fairly long wait times when they're needed simply as a result of gradual aging, but not if something gets broken as a result of a fall or an accident.
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Originally Posted by Magiver View Post
This is a big deal for people who have medical problems that aren't diagnosed in a timely manner. Survival is a function of time and time is a function of money. UHC systems are not slow by choice but by money. What it creates is a system that gives more preventative care for the poor and less for the middle class. The wealthy will just get it wherever it's available because they have the money to bypass a UHC system.
This is another example of "nice theory, but it doesn't happen". There are many wealthy people in Canada. They're mostly fine with the health care system. Paying money to bypass the UHC system isn't done because it generally isn't legal. Some Canadians have indeed traveled to the US for medical care, but a careful analyses of these cases generally turns up the fact that they've done it in order to get some form of new highly specialized treatment that's only available in one or two research centers, and not for mainstream health care.
  #232  
Old 07-14-2018, 12:12 PM
k9bfriender k9bfriender is offline
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Yes, but you have to get to the hospital. that means various levels of specialists and diagnostic equipment. I got all that on demand. The biggest decision I had to make was which diagnostic center to choose as in, which was was closest, Do I want to drive to the one near my job or the one near my house.
That is in your insurance provider's network, of course.
Quote:
And yet it happened. A surgery that should be scheduled the week it's diagnosed was delayed. The bullshit was the wait time.
I do wonder the story behind this. I heard a very similar story about medicare some time back, that they had delayed until they weren't good for surgery anymore, but when the details were actually explored, it turned out that the patient was not in good shape for surgery, and they waited in the hope that the patient would be able to improve their health enough to survive the surgery. Unfortunately, he did not improve, in fact, his condition worsened. His doctors had made the wrong call, and he would have had a better chance if they had done the surgery earlier. But, that could have happened in any system, it had nothing to do with funding. I do wonder if your third or fourth hand story is missing any of those details to focus instead on the outrage.
  #233  
Old 07-14-2018, 01:33 PM
Budget Player Cadet Budget Player Cadet is online now
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Originally Posted by Magiver View Post
This thread has been repeated many times with the same results. "my health care is better than yours".
Well... I mean... it is.

We can agree on this, right? Like, there may be some debate to be had about whether we can replicate the successes of the NHS or the German system in the US, or whether there are USA-specific factors that make that unworkable, but the question of whether or not the NHS or Germany or Canada is better than the USA really isn't up for debate. Y'know how Americans sometimes have a hearty debate about that fact? Forget "state of the art" - in those countries, we pretty much universally look at the American system as a cautionary tale that shows us just how bad things could be. One of my dad's favorite jokes is that the US isn't a first world country because of our shoddy healthcare - and he was born in and lives in the US!
  #234  
Old 07-14-2018, 02:54 PM
jasg jasg is offline
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One of my dad's favorite jokes is that the US isn't a first world country because of our shoddy healthcare - and he was born in and lives in the US!
I agree with your dad and think that the rest of our nation is catching up with our healthcare...

Healthcare debate threads seem endless if distilled down I believe that the answer to the question in the OP is:

"Ideology and politics"
  #235  
Old 07-14-2018, 03:33 PM
survinga survinga is offline
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You make some good points. I used the "evil" kind of as a joke, since some others on the thread really don't like private insurance at all, best I can tell. I didn't mean to come across as a jerk.

My view on Medicare is that it's a good program that should be maintained and well-funded. Most doctors accept it, and people who are on it seem to like it. There are a fair number of Medicare enrollees who also get supplemental plans, and a growing and large % who get advantage. This makes me think that basic medicare has some holes where the private players can come in and help. You're right that advertising influences the %'s, and that people can become confused, as healthcare isn't exactly an easy topic. But I just have to think that with 1/3 of enrollees now taking Advantage, there must be something there that's good. Some advantage plans offer extra benefits that basic medicare doesn't cover, such as dental & vision. This might tip the scales a little. I don't know.

Since you work in healthcare policy, what's your view on the ACA? I think the ACA, though it was kludgy, was mostly well-written, and had a good logic behind it. If the states would all accept the Medicaid expansion, and congress would make the subsidy formulas better for lower-middle to middle class, I think we would get to almost full UHC.
Well, I thought my parents were on traditional Medicare plus a supplemental policy. I was wrong. They're in a Medicare Advantage plan. I asked Dad about it today. He likes it. He wasn't overly impressed with their dental coverage within the plan. But the overall experience has been fine. Just throwing that out there as a positive anecdote for a Medicare Advantage plan (through Aetna).
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  #236  
Old 07-14-2018, 03:35 PM
survinga survinga is offline
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Well... I mean... it is.

We can agree on this, right? Like, there may be some debate to be had about whether we can replicate the successes of the NHS or the German system in the US, or whether there are USA-specific factors that make that unworkable, but the question of whether or not the NHS or Germany or Canada is better than the USA really isn't up for debate. Y'know how Americans sometimes have a hearty debate about that fact? Forget "state of the art" - in those countries, we pretty much universally look at the American system as a cautionary tale that shows us just how bad things could be. One of my dad's favorite jokes is that the US isn't a first world country because of our shoddy healthcare - and he was born in and lives in the US!
And yet, 3 out of 4 Americans like their own healthcare. As I've said repeatedly, that's a big consensus in almost any other issue. We've got problems in the US, but it's not as bad as people make it out to be in aggregate. I'd like to get the uninsured rate from 9% down to 0%, but politicallly that aint happening right now.
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  #237  
Old 07-14-2018, 03:43 PM
survinga survinga is offline
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I've only skimmed that article but it looks like one of the more thorough analyses of major health care systems I've seen in recent years. I like the comprehensive discussion of each country's system in a separate chapter. I wish more people would read them and educate themselves.

But as you've suggested, some of the numeric stats in the earlier part need to be interpreted in context and with a grain of salt. One can cherry-pick a number like a big portion of Canadians have supposedly said that the health care system needs "fundamental reform", and you're right to be skeptical -- it's also odd how one would reconcile that with other surveys that show 85+% are satisfied or very satisfied with it. One could also note that only a slightly smaller percentage of Americans think their own system needs fundamental reform, and that percentage is smaller only because quite a large chunk of them are in the "needs to be completely rebuilt" category.


I tend to believe the numbers of people's opinion of their own healthcare moreso than what they think of the overall system. I think people are very familiar with their own situation. But their view of macro-systems is biased by what they read, what they watch on TV, nightmare anecdotes they hear from others, what their favorite politician says, etc. But when I read that 3 out of 4 Americans like their own healthcare, that tells me we're not in as big a crisis as many have been pre-programmed to believe.

If I were "fix" our system, first I'd take what we already have and make the ACA work to where we're at approximately zero uninsured. Technically, that would be an easy fix with very little disruption. I think if we did that, our 3 out of 4 would become closer to 4 out of 5.
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  #238  
Old 07-14-2018, 03:53 PM
k9bfriender k9bfriender is offline
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And yet, 3 out of 4 Americans like their own healthcare. As I've said repeatedly, that's a big consensus in almost any other issue. We've got problems in the US, but it's not as bad as people make it out to be in aggregate. I'd like to get the uninsured rate from 9% down to 0%, but politicallly that aint happening right now.
That's a simple question, "Do you like your healthcare". It really doesn't get into whether or not they actually have good healthcare.

When they answer that question, the only thing that they can base it on is what they pay in premiums. All healthcare plans will deal with small issues that can be taken care of at a GP or urgent care, usually with a small co-pay. So, if you haven't had any claims that were not taken care of at your doctor, then you have no idea whether your healthcare plan covers you in a way that you would like to be covered. Given that the employer often covers a substantial portion of the premium, they don't even know what it is that they are paying.

So, if you were to ask, "The contributions that go in your name towards your healthcare insurance is $X, do you feel that that is a good value for what you receive?" I think you would get a different answer.

If you were to ask, "Have you ever thought about starting your own business, or going to work for a small business, but chose not to because you are locked into your benefits at your current employer?" I think you'd get some interesting feedback.

If you were to differentiate the survey respondents into ones who have never made a claim, and those who have had claims denied, do you think that you may see a different level of satisfaction?
  #239  
Old 07-14-2018, 04:29 PM
survinga survinga is offline
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That's a simple question, "Do you like your healthcare". It really doesn't get into whether or not they actually have good healthcare.

When they answer that question, the only thing that they can base it on is what they pay in premiums. All healthcare plans will deal with small issues that can be taken care of at a GP or urgent care, usually with a small co-pay. So, if you haven't had any claims that were not taken care of at your doctor, then you have no idea whether your healthcare plan covers you in a way that you would like to be covered. Given that the employer often covers a substantial portion of the premium, they don't even know what it is that they are paying.

So, if you were to ask, "The contributions that go in your name towards your healthcare insurance is $X, do you feel that that is a good value for what you receive?" I think you would get a different answer.

If you were to ask, "Have you ever thought about starting your own business, or going to work for a small business, but chose not to because you are locked into your benefits at your current employer?" I think you'd get some interesting feedback.

If you were to differentiate the survey respondents into ones who have never made a claim, and those who have had claims denied, do you think that you may see a different level of satisfaction?
I'm sure many questions could be shaded to produce all kinds of answers. Here's the thing though. The US has about 320 million people, of which about 290 million get covered a variety of ways, all the way from the socialized VA down to people like me, who get it from my employer, and everything in between. When you ask someone about their own healthcare, their own situation, they're able to draw from their own experience and give you an answer that's probably accurate for them. I think that cuts through alot of the noise, because most people have had to receive healthcare during their adult life at some point, and certainly when they were children. So, "3 out of 4" is a real number that should be taken seriously.

When someone is asked about the overall healthcare system, like "Should the US health insurance system be redesigned?", I'll bet 95% of the people who answer that have no idea what they're even being asked about.

I don't mind asking my local butcher or local car mechanic if he likes his healthcare. He can answer that. He can't answer about the various schemes that maximize or minimize health care costs or that lower uninsured rates.

So, while I certainly think we need changes in the system, such as getting more states under the Medicaid expansion, I don't want to throw our current system away. Let's keep what we have, and just tweak it to make it better.
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  #240  
Old 07-14-2018, 04:59 PM
wolfpup wolfpup is online now
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... in those countries, we pretty much universally look at the American system as a cautionary tale that shows us just how bad things could be. One of my dad's favorite jokes is that the US isn't a first world country because of our shoddy healthcare - and he was born in and lives in the US!
No kidding. Cautionary tale indeed. In my view all that needs to be said about the barbarism of the US health care system is that it's in violation of Article 25 of the United Nations Universal Declaration of Human Rights and Article 24 of the United Nations Convention on the Rights of the Child. And it's not like the richest country in the world can't afford to provide UHC. Even Cuba has it. That the US doesn't is one of the anomalies and travesties of the modern era.
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If I were "fix" our system, first I'd take what we already have and make the ACA work to where we're at approximately zero uninsured. Technically, that would be an easy fix with very little disruption. I think if we did that, our 3 out of 4 would become closer to 4 out of 5.
Perhaps not that easy. As your illustrious leader once said, who knew health care was so complicated. And the problem of complexity has the same cause as all its other problems -- the intrusion of private business, with all its motivations that are directly counterproductive to the fundamental mandate of guaranteed universal coverage of all medically necessary health care. It creates a system where every claim is scrutinized instead of just being paid, creating massive administrative costs for the privilege of being able to deny or shortchange a claim and having an insurance bureaucrat tell a doctor what he may or may not do. It's just crazy to let a private business do this, but such is the system that evolved in the vacuum of government inaction.

If I was redesigning it, I'd make an effective and dominant ACA public option the centerpiece of reform, preferably managed by the states with federal subsidies. Many of the red states would of course refuse to participate, but the success of the program would gradually win most of them over. The continued co-existence with private insurance would be problematic, but I think co-existence is the best one can reasonably hope for in the foreseeable future. It would still be the most expensive system in the world with enormous waste and overcharging, but at least it would be universal, and costs at least somewhat contained.
  #241  
Old 07-14-2018, 05:02 PM
Budget Player Cadet Budget Player Cadet is online now
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And yet, 3 out of 4 Americans like their own healthcare. As I've said repeatedly, that's a big consensus in almost any other issue. We've got problems in the US, but it's not as bad as people make it out to be in aggregate. I'd like to get the uninsured rate from 9% down to 0%, but politicallly that aint happening right now.
I saw that! That's why I didn't make the claim that most Americans are unhappy with their healthcare. It is a surprising figure, given how incredibly cost-ineffective the American system is. I'm fundamentally suspicious of that figure, but I'm also not sure what better figure to use.
  #242  
Old 07-14-2018, 05:34 PM
survinga survinga is offline
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Originally Posted by wolfpup View Post
No kidding. Cautionary tale indeed. In my view all that needs to be said about the barbarism of the US health care system is that it's in violation of Article 25 of the United Nations Universal Declaration of Human Rights and Article 24 of the United Nations Convention on the Rights of the Child. And it's not like the richest country in the world can't afford to provide UHC. Even Cuba has it. That the US doesn't is one of the anomalies and travesties of the modern era.

Perhaps not that easy. As your illustrious leader once said, who knew health care was so complicated. And the problem of complexity has the same cause as all its other problems -- the intrusion of private business, with all its motivations that are directly counterproductive to the fundamental mandate of guaranteed universal coverage of all medically necessary health care. It creates a system where every claim is scrutinized instead of just being paid, creating massive administrative costs for the privilege of being able to deny or shortchange a claim and having an insurance bureaucrat tell a doctor what he may or may not do. It's just crazy to let a private business do this, but such is the system that evolved in the vacuum of government inaction.

If I was redesigning it, I'd make an effective and dominant ACA public option the centerpiece of reform, preferably managed by the states with federal subsidies. Many of the red states would of course refuse to participate, but the success of the program would gradually win most of them over. The continued co-existence with private insurance would be problematic, but I think co-existence is the best one can reasonably hope for in the foreseeable future. It would still be the most expensive system in the world with enormous waste and overcharging, but at least it would be universal, and costs at least somewhat contained.
If the subsidies were stronger - they cut off too early in the income levels - we wouldn't need a public option. The medicaid expansion is already good enough for increasing the "public" part of the ACA. Having said that, I'm not against giving some states the freedom to experiment with a public option. An idea that is being discussed is a "medicaid buy-in" option, that has a similar flavor to what you're talking about. Speaking of medicaid expansions, see the link. This is the type of political sabotage that is occurring by Republicans in America, and it's also why I don't think anything to improve & build on the ACA is going to happen soon.

https://www.pressherald.com/2018/06/...e-court-rules/

This Lepage guy is a nut. And he's still trying to stonewall the Medicaid expansion even though the voters passed a law requiring it in a referendum. And this is after the legislature passed the expansion, and he vetoed it numerous times.

This is what we're up against down here....and this is why single-payer is a pipe dream in the US.
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Last edited by survinga; 07-14-2018 at 05:35 PM.
  #243  
Old 07-15-2018, 09:22 AM
k9bfriender k9bfriender is offline
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If the subsidies were stronger - they cut off too early in the income levels - we wouldn't need a public option. The medicaid expansion is already good enough for increasing the "public" part of the ACA. Having said that, I'm not against giving some states the freedom to experiment with a public option. An idea that is being discussed is a "medicaid buy-in" option, that has a similar flavor to what you're talking about. Speaking of medicaid expansions, see the link. This is the type of political sabotage that is occurring by Republicans in America, and it's also why I don't think anything to improve & build on the ACA is going to happen soon.
The cut offs are very annoying. You literally cannot get out of poverty, if you are not allowed to get out of poverty.

I have had employees that I wanted to give raises and promotions and more hours, but couldn't, because they were at the limits of what they could make without losing benefits, and I couldn't give them enough of a raise to get them through that gap.

So, I have employees that have the skills and ability to make more money for themselves, make more money for me, and produce more services for the community, but cannot, due to the very stupid nature of our healthcare system.

As is, I only took the chance of starting my own business once I could buy an individual policy on the exchange. Prior to ACA, an individual policy cost nearly twice as what it did off the exchange, and would not cover anything to do with my joints or spine because I had had sciatica years earlier.

I'm very concerned about what will happen with the collapse of the exchange, and what I will do then. I really need to have insurance, as a medical bankruptcy on my part would destroy my business and ruin the careers of a dozen people.
  #244  
Old 07-15-2018, 10:25 AM
survinga survinga is offline
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Originally Posted by k9bfriender View Post
The cut offs are very annoying. You literally cannot get out of poverty, if you are not allowed to get out of poverty.

I have had employees that I wanted to give raises and promotions and more hours, but couldn't, because they were at the limits of what they could make without losing benefits, and I couldn't give them enough of a raise to get them through that gap.

So, I have employees that have the skills and ability to make more money for themselves, make more money for me, and produce more services for the community, but cannot, due to the very stupid nature of our healthcare system.

As is, I only took the chance of starting my own business once I could buy an individual policy on the exchange. Prior to ACA, an individual policy cost nearly twice as what it did off the exchange, and would not cover anything to do with my joints or spine because I had had sciatica years earlier.

I'm very concerned about what will happen with the collapse of the exchange, and what I will do then. I really need to have insurance, as a medical bankruptcy on my part would destroy my business and ruin the careers of a dozen people.
They need to extend the subsidies to a higher income level, and then need to plug the holes caused by the states that don't expand medicaid. If you don't mind me asking, what state are you located in, and are you yourself a policyholder from the ACA exchange?
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  #245  
Old 07-15-2018, 11:51 AM
k9bfriender k9bfriender is offline
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They need to extend the subsidies to a higher income level, and then need to plug the holes caused by the states that don't expand medicaid. If you don't mind me asking, what state are you located in, and are you yourself a policyholder from the ACA exchange?
Ohio, and yes.

I used to buy it individually from insurance companies, and that was a pain in the ass. In order to get a quote, you had to call an agent, then wait for them to call you back a few days later, and if you didn't take their offer right there and then, then they "couldn't guarantee the same offer" if you wanted to wait to hear back from another agent before making a decision. They did not want you to be able to comparison shop based on service or price.

The exchanges changed that. Even without a subsidy (which I for the first year of the exchange qualified for a $5 a month subsidy), they were a massive improvement in the system. Actually being able to comparison shop on services and price was a totally new thing to the individual insurance purchaser. I also found a policy that had more coverage, cost a bit more than half of what I was paying, and didn't have dis-qualifiers to coverage due to pre-existing conditions.

That's where the real shore up on healthcare needs to be. Sure, there are lots of people with nice cushy jobs in big corporate environments who have great healthcare plans. They don't realize just how much those plans actually cost, as a large portion is covered by their employer, and they don't realize that their experience is not universal.

There are many companies out there, like my own, that are too small to effectively cover employees on a healthcare plan. I'd like to change that in the near future, but for now, it's just something that is not doable. I've had a number of jobs in my life, and the jobs that gave me the greatest sense of fulfillment of doing something useful were always for small businesses that didn't offer health insurance. The jobs I had at larger cooperate places that did have insurance were much less interesting, I was just another cog in the system.

And there are the places that offer medical coverage, but it was a terrible crappy coverage that really didn't do anything for you if you actually needed it, it was really just another revenue stream for the insurance companies.

So yeah, having employer based coverage is great for your employers. It means that employees are terrified of losing their jobs, not due to the pay, but due to the health insurance. It means that employees are not willing to find jobs that are more fulfilling and productive, as those jobs are almost always in growing businesses that are still too small to get an affordable healthcare plan for their employees. It means that individuals are not willing to quit their jobs to take care of ailing family members, new family members, start a business, or just because they want to have more time to enjoy their lives. Like I said, great for established large employers.

Not so great for the employee who hates their job and only stays because if they leave, their child's treatment for their diabetes will end and they will die.

Last edited by k9bfriender; 07-15-2018 at 11:53 AM.
  #246  
Old 07-15-2018, 12:47 PM
wolfpup wolfpup is online now
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If the subsidies were stronger - they cut off too early in the income levels - we wouldn't need a public option. The medicaid expansion is already good enough for increasing the "public" part of the ACA ...
The problem with relying on Medicaid as a public option is that it's completely the wrong model for it. First of all access to Medicaid is subject to a means test. It's not intended to be universal, yet everyone -- regardless of means -- should be entitled to affordable health coverage without being forced to rely on private insurance, with all its costs and arbitrary denials. Secondly, as if that wasn't problematic enough, Medicaid is subject to pretty barbaric estate recovery actions on the death of a beneficiary in order to get the money back, and in some cases the state may even place a lien on the home of a living beneficiary. This is the kind of bullshit that needs to be abolished, not expanded. But it exists in part because of soaring costs due to the incredible inefficiencies of the health care system it has to function in.
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Originally Posted by survinga View Post
https://www.pressherald.com/2018/06/...e-court-rules/

This Lepage guy is a nut. And he's still trying to stonewall the Medicaid expansion even though the voters passed a law requiring it in a referendum. And this is after the legislature passed the expansion, and he vetoed it numerous times.

This is what we're up against down here....and this is why single-payer is a pipe dream in the US.
Having just watched the Trumpists and Republican crackpots in Congress try to kill what little there is of the ACA -- and the rejection purely on ideological grounds of Medicaid expansion -- I think most of us are well aware of the political obstacles to single-payer. However, it's important not to conflate "politically difficult" with "can never work". Those are two different things.

Far too often I hear some argument along the lines of "it can never work in the US because ...". No, the issue is that single-payer can't realistically be implemented right now because there are too many far-right lunatics running around, and too many people have been misled by insurance industry propaganda. One should at least recognize that as being a different issue. The strength of single-payer is that it can and demonstrably does work, that it's arguably the most effective way of providing universality while managing costs, and it has thrived in other places precisely by gaining a foothold and proving its merits. I think the insurance industry saw the public option proposal as just such a potential foothold for single-payer, and that's why its demise was absolutely non-negotiable -- it had to be killed.
  #247  
Old 07-15-2018, 02:24 PM
survinga survinga is offline
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Originally Posted by wolfpup View Post
The problem with relying on Medicaid as a public option is that it's completely the wrong model for it. First of all access to Medicaid is subject to a means test. It's not intended to be universal, yet everyone -- regardless of means -- should be entitled to affordable health coverage without being forced to rely on private insurance, with all its costs and arbitrary denials. Secondly, as if that wasn't problematic enough, Medicaid is subject to pretty barbaric estate recovery actions on the death of a beneficiary in order to get the money back, and in some cases the state may even place a lien on the home of a living beneficiary. This is the kind of bullshit that needs to be abolished, not expanded. But it exists in part because of soaring costs due to the incredible inefficiencies of the health care system it has to function in.

Having just watched the Trumpists and Republican crackpots in Congress try to kill what little there is of the ACA -- and the rejection purely on ideological grounds of Medicaid expansion -- I think most of us are well aware of the political obstacles to single-payer. However, it's important not to conflate "politically difficult" with "can never work". Those are two different things.

Far too often I hear some argument along the lines of "it can never work in the US because ...". No, the issue is that single-payer can't realistically be implemented right now because there are too many far-right lunatics running around, and too many people have been misled by insurance industry propaganda. One should at least recognize that as being a different issue. The strength of single-payer is that it can and demonstrably does work, that it's arguably the most effective way of providing universality while managing costs, and it has thrived in other places precisely by gaining a foothold and proving its merits. I think the insurance industry saw the public option proposal as just such a potential foothold for single-payer, and that's why its demise was absolutely non-negotiable -- it had to be killed.
For your info, the "Medicaid buy-in" isn't just for low income people. That's why I mentioned it. Nevada actually voted on it, but their governor vetoed it. I think you will see some other states try it. This is a de facto public option that some states are looking at, and not just for poor people. I'm not against some states experimenting with it, to see how it works.

https://www.vox.com/policy-and-polit...dicaid-for-all

And I'm not conflating the politics of getting single-payer with the underlying theory of single-payer. At the same time, I don't think we can talk about single-payer in the US without talking about the politics. As I mentioned in an earlier post, it's like talking about being at the top of Mt Everest without discussing the dangers of high-altitude hiking. That's not the only reason I don't want single-payer. But it is a damn good one, and shouldn't be shrugged off by the hard-left single-payer advocates.

I've already mentioned that I like the private health insurance that I have, and don't want to replace it with something else. About half the country has something similar to what I have. And most who have it like their healthcare. We don't need to be "saved" from the evils of private health insurance.

And then there's the Trump factor. Once you get single-payer, then you have to hope you don't get a demagogue like Trump who would target it, the way he's targeting the ACA and Medicaid currently.

All of the above is why we don't need single-payer in the US. All we need is to strengthen the ACA, get to approximate UHC. Then, maybe all the social justice warriors will leave us alone.
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  #248  
Old 07-15-2018, 02:48 PM
k9bfriender k9bfriender is offline
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Originally Posted by survinga View Post
For your info, the "Medicaid buy-in" isn't just for low income people. That's why I mentioned it. Nevada actually voted on it, but their governor vetoed it. I think you will see some other states try it. This is a de facto public option that some states are looking at, and not just for poor people. I'm not against some states experimenting with it, to see how it works.

https://www.vox.com/policy-and-polit...dicaid-for-all

And I'm not conflating the politics of getting single-payer with the underlying theory of single-payer. At the same time, I don't think we can talk about single-payer in the US without talking about the politics. As I mentioned in an earlier post, it's like talking about being at the top of Mt Everest without discussing the dangers of high-altitude hiking. That's not the only reason I don't want single-payer. But it is a damn good one, and shouldn't be shrugged off by the hard-left single-payer advocates.

I've already mentioned that I like the private health insurance that I have, and don't want to replace it with something else. About half the country has something similar to what I have. And most who have it like their healthcare. We don't need to be "saved" from the evils of private health insurance.

And then there's the Trump factor. Once you get single-payer, then you have to hope you don't get a demagogue like Trump who would target it, the way he's targeting the ACA and Medicaid currently.

All of the above is why we don't need single-payer in the US. All we need is to strengthen the ACA, get to approximate UHC. Then, maybe all the social justice warriors will leave us alone.
Throw in a public option, and we could make it work.

Without a public option, without having a base level of service and coverage that can be had by anyone, the for profit industries will never control costs.

You talk about fearing trump messing with the ACA, then say that the ACA should just be tweaked, and it'll be just fine.

We do need to have a system that is not beholden to the whims of the executive, and that system is probably best administered at the state level, but by legislation that removes the executive's ability to meddle in it. Right now, trump is messing with the insurance by refusing to pay out the pool that insurance companies paid into, that the executive is only supposed to administer, not control.

Last edited by k9bfriender; 07-15-2018 at 02:52 PM.
  #249  
Old 07-15-2018, 03:10 PM
Magiver Magiver is offline
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I don't see the issue. Take my recent experience as an example. I had been having chest pains on and off for most of a week. Finally on a Friday afternoon, I was having a glass of wine and making a snack and decided to hell with this, I'm going to get it checked out. It was too late to try to get a doctor's appointment so I left everything in the kitchen and got myself to the ER, expecting I'd be back in a couple of hours at most with a prescription and some innocuous diagnosis.

I've pretty much told the rest of the story before. I got admitted with high blood pressure and cardiac issues that were non-urgent but needed attention. Over the next few days I got lots of testing done, medications administered, an angiogram done, bypass surgery was recommended, spoke with a heart surgeon about options, a meeting was convened to see if I was a candidate for stenting as an alternative to bypass, the answer was "yes", the procedure was done later the same day, and I was home the next day.

So what was it about this that was lesser quality than your cardiac experience? What took longer?
Link: From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year. This wait time is 177% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (6.7 weeks) while the longest occur in New Brunswick (26.6 weeks).

Where to start. If my doctor isn't available we have after hours medical facilities that you can walk into without an appointment. As for your surgery, you didn't have a choice of surgeons and you lucked out on the ER visit. You should have had that diagnosed ages ago. Instead you stumbled in with a serious condition. The issue of wait time for treatment is addressed in the same rticle:
From the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment increased from 10.6 weeks in 2016 to 10.9 weeks this year. This wait time is 95% longer than in 1993 when it was 5.6 weeks, and more than three weeks longer than what physicians consider to be clinically “reasonable” (7.2 weeks). The shortest specialist-to-treatment waits are found in Ontario (8.6 weeks), while the longest are in Manitoba (16.3 weeks).

I had open heart surgery which is a lot different than stents or bypass. They just did a stent on a friend of mine in a similar example to yours. Completely different comparison to what I had.

Going back to my blood clot issue it was the immediacy of diagnostics that saved my leg. I had already seen my doctor once, a specialist twice and had 2 diagnostic tests. All within weeks of each other. I didn't think the medical conclusions matched my symptoms so I voiced my concern with my doctor over the phone and had a 3rd diagnostic test that day. It was scheduled after work at an after-hours diagnostic facility. Any delay in this would have cost me my leg.

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Originally Posted by wolfpup View Post
No offense, and I'm not blaming you, but based on my experiences over half a century of living with the health care system in Canada I find your friend-of-a-friend story to be not credible and the result of the typical kind of distortions and omissions that happen when verbal stories are told and retold, exaggerated and embellished, until they become unrecognizable.
your anecdotal story doesn't match what Canadians are experiencing.

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Originally Posted by wolfpup View Post
You're certainly correct that the Canadian health care system isn't perfect,
It's not a function of perfection. It's a function of choice and time. You get what you pay for and it's not a linear ROI. It's like you're trying to justify the number of lifeboats on the Titanic.

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Originally Posted by wolfpup View Post
The problem of wait times is the most talked-about and also by far the most misunderstood. I've tried, over and over again, to explain the all-important distinction between waiting for some trivial appointment where the wait presents nothing but a minor inconvenience, and having access to timely medical attention when you need it -- even if it's not urgent, but when time does matter. I think the Canadian system generally handles this very well, while managing to control costs for the overall system and providing guaranteed universal coverage for everyone with little to no out of pocket costs
I've provided a cite showing the delays and have tried over and over again to explain that this is how serious conditions get overlooked. You don't know how serious a lot of conditions are until diagnosed.

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Originally Posted by wolfpup View Post
The other obvious point that's often misunderstood is that "wait times" refer to procedures scheduled for outpatients. Once you're admitted to hospital, wait times are generally pretty much how long it takes them to wheel you over to where the procedure is done.
No, wait times refer to the time waiting to see a doctor, specialist, diagnostic equipment, and treatment.
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  #250  
Old 07-15-2018, 03:27 PM
wolfpup wolfpup is online now
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For your info, the "Medicaid buy-in" isn't just for low income people. That's why I mentioned it. Nevada actually voted on it, but their governor vetoed it. I think you will see some other states try it. This is a de facto public option that some states are looking at, and not just for poor people. I'm not against some states experimenting with it, to see how it works.

https://www.vox.com/policy-and-polit...dicaid-for-all
This is a plan that I freely admit I don't know anything about, but I'd have some serious reservations about it. From a quick read, it appears that the "means test" would be eliminated. But doesn't that mean that already soaring costs would increase tremendously faster, and would become absolutely astronomical if "Medicaid buy-in" came close to being universal without changing anything else? And therefore wouldn't the barbaric aggressiveness of the Medicaid Estate Recovery Program have to get even worse? And how would people feel about being limited to only those providers willing to accept about two-thirds of their normal fees?
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Originally Posted by survinga View Post
And I'm not conflating the politics of getting single-payer with the underlying theory of single-payer.
You've mentioned both the political difficulties and also things like how different the US is from Saskatchewan (and, presumably, from the rest of Canada, where single-payer now thrives), which I perceive (perhaps unfairly) as talking about political difficulties and operational feasibility all in the same breath. The difference is crucial, especially when those political difficulties are largely based on ideologically motivated falsehoods being promoted in the service of special interests.
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Originally Posted by survinga View Post
And most who have it like their healthcare. We don't need to be "saved" from the evils of private health insurance.
With all respect, I don't think most Americans know enough about the difference between private insurance and single-payer or its close equivalents as practiced throughout the civilized world to be able to make that evaluation objectively. Why would anyone NOT want their insurance to cost half as much while having unconditionally guaranteed coverage for everything that was medically necessary? Unless they believe the bullshit that AHIP and the other lobbyists are constantly spewing.

Everyone loves their private health insurance until the first time a claim is denied or the first time they're hit with enormous out-of-pocket costs, like the various cites I've already provided. Some people die because of those factors. I wonder how much they liked their insurance? I'm reminded of lengthy discussions I had with someone on a different board a long time ago, who was a staunch defender of US private insurance. According to him, it could do no wrong, and served his needs with consummate perfection. Then I found a different thread in which this same person was complaining bitterly about the out-of-pocket costs that a hospital was charging him, and which required him to put down a huge deposit on his credit card before they would even treat his child, and asking if that was even legal.

And it's not just the big stories that make the news about claims denials that are relevant -- they happens thousands of times every day across America. My own brother who lives in the US and has an excellent executive-level health care plan has had claims denied. Nothing especially major, but frustrating as hell. One time the insurer refused to pay for a prescribed medication because there was a cheaper alternative, which made his doctor absolutely furious because while the other stuff was cheaper, alright, it was also less effective. And the insurer turned down home care when he was home with an injury, for reasons that were inconsistent the several times that he called them about it. Meantime my elderly mother here in Ontario has had the home services of a nurse, a personal care worker, a dietician, and a hospital technician providing oxygen devices including a portable mobile oxygen system -- all at no cost under the public insurance system. So yeah, I tend to be a cheerleader for single-payer, because experience is a powerful teacher.
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Originally Posted by survinga View Post
And then there's the Trump factor. Once you get single-payer, then you have to hope you don't get a demagogue like Trump who would target it, the way he's targeting the ACA and Medicaid currently.
And as I've said before, in a democracy you can't kill a system that has overwhelming popular support. That's why single-payer was never at risk in Canada, and the NHS was never at risk in the UK. Even the new ACA, with its many limitations and limited support, managed to mostly survive Trump and Republican lunatics anxious to kill it, because the impacts to those who depended on it were obvious even to some of the more dull-witted voters.
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