Yes, at some point, some decisions have to be made, because there isn’t infinite money available. But there’s a fundamental difference between a decision made by an impartial observer, and one made by a person who stands to profit from one choice, and lose money on another.
The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.
That’s an average. So lots were decided faster than this.
It’s absolutely true that small copays prevent people from getting timely care. Many US HMOs eliminated them in an attempt to stop problems before they became serious.
But i do know a person who arguably dropped from overuse to appropriate use when a copay was applied. He had a kid with hemophilia. And when there was no copay, he took the kids to the emergency room every time he had a bump or a bleed. After a copay was instituted, he took the kid to a clinic, instead, where a nurse checked the kid out and gave him supplemental factor of he needed it.
In the US, those panels would be beholden to Congress, for good or for ill.
I just got a call from my cardiologist yesterday about some test results, and thinking about it prompted me to throw out a sort of oddball fact here in the interest of helping folks understand UHC in general and the Canadian system in particular.
After I was discharged from hospital some years ago following PCI (cardiac stenting) I was set up with regular annual cardiology appointments at their outpatient clinic. I didn’t like it. The facility was huge, crowded, and impersonal. I waited in a queue, first for a technician to run an EKG, then shuffled off for another wait for a stress test that I absolutely hated, then shuffled off again to wait for the cardiologist.
I bring this up because I can see the critics of UHC, especially those with access to concierge type medical care, having an “aha!” moment and using it to point to the impersonal evils of “socialized medicine”.
But the reality is different. The reality is that the quality of service you get depends entirely on who the service provider is, and under UHC (which lacks any concept of “networks” that providers are in or out of) you can pick whatever provider you prefer. I solved this particular problem by telling my GP that I was unhappy with this arrangement, and she referred me to a different cardiologist that she said I’d likely be happier with.
Well! On my first appointment I walked into a club-like luxurious waiting room with comfortable chairs and oil paintings on the walls. Off to the side I could see well-equipped medical testing rooms right on the premises. The doctor was prompt – there was almost no waiting – and his attention has been dedicated and strikes a good balance between tests that I feel are a pointless nuisance and those he feels are important. His approach to medicine is explicitly that of a doctor-patient partnership (and of course, there are no insurance company bureaucrats to come between us). He or one of his assistants always – without fail – calls me about test results and provides recommendations. It’s usually the doctor himself, often in evenings or on weekends. I feel very well looked after.
The point is, both of those experiences are part of the exact same health care system, or perhaps more accurately, both part of the same system of publicly funded health care. Citing any particular bad experience as “proof” that a particular health care funding model sucks is usually a false narrative.
That is not strictly true, as prescription drugs would qualify as “medically necessary health care.” The line is sometimes fine: both my dentist and eye doctor have some services they perform at no charge, as medically necessary, but regular tooth cleanings, which can have medically serious consequences if not performed, are not considered medically necessary (at the moment—I think NDP is working on it. Check back in 20 years).
Well, sure, but what I mean is that if a medical procedure is covered (which strictly medically necessary procedures are, though one might quibble about some exclusions) then no extra-billing or co-pay is allowed. Generally speaking, our UHC system tends to nickel-and-dime the patient on small stuff (like eyeglasses) but fully pays for the big stuff (like quadruple bypass heart surgery).
Dental care and prescription drugs are current gaps that are gradually being closed. Being of retirement age, neither are big concerns to me. Whether it’s slower metabolism or some other effect of age, I generally tend not to have tooth problems (notwithstanding the one I had to have pulled last week – biggest dental event in at least 30 years!). Similarly, at my age prescription drugs are covered, and for working folks, they’re generally covered (along with dental) by employer supplementary insurance.
I wasn’t trying to quibble, just provide more context for those to the south. My prescriptions, dental, and some of my glasses are covered by my employer-based insurance, as it would be in the US (minus co-pays). (And only “some” because my lenses wind up being too expensive for their allowance.) Everything else is free at the point of service.
Words and phrases can be defined as one wishes. But some countries that are generally agreed to have universal health care do have competing networks. Israel, for one.
If the U.S. gets UHC, it will not look like that in most other UHC countries, simply because there are a wide variety of UHC systems.
Here is an idea of what I think might be feasble in the U.S., to get us to UHC, without unlikely near-revolutionary changes:
I suspect one of the biggest opponents of UHC in the US is probably the food industry, which makes a lot of money selling people shit. They probably have concerns that the government, once healthcare costs become very important to it, will seek prophylaxis to reduce those costs (attempt to make the average person healthier out-of-the-gate), which would likely result in much stricter regulation of the food supply. Other industries, like weapons manufacturers, might also be targeted.
The Netherlands, along with Switzerland and Germany, have among the highest per-capita health care cost among OECD nations. Plus the US, of course, which is completely off the chart compared to all the others. What do you suppose they all have in common? The US, of course, manages to combine lack of universality with total relegation of health care insurance to the private sector without even a pretext of universal access.
Not likely. A bunch of activist nutters tried to make a similar case in Canada, arguing that smokers shouldn’t be covered for demonstrably smoking-related diseases like lung cancer. The government’s response was, essentially, “what don’t you understand about the meaning of the word ‘universal’?”. A fundamental premise of UHC is that the insured pool is the entire population and there is no risk-based discrimination.
And that is what my suggestion was. Not that individuals would be punished directly for making bad decisions but that businesses that promote bad decisions would be regulated heavily. And it is pretty easy for the industries promoting them to convince the people inclined to make bad decisions that the government is/will be infringing on your freedoms. Such rhetoric is very effective in US.
It wouldn’t be punishment for making bad decisions, it would be simply paying what those decisions cost society.
If you smoke, then you pay a tax that helps to treat smoking related illness. If you drink soft drinks, you pay a tax that helps treat obesity and diabetes. If you shoot, then you pay a tax that helps pay for gun shot victims.
A tax isn’t a punishment, too many people think of it that way.
Which, in the case of tobacco, is certainly happening here. It’s also true of liquor and cannabis, although the latter two are mostly just a cash grab. I mean, someone who has to pay $200 instead of $100 for a bottle of Chateau Lascombes Margaux is not someone at risk of becoming a raging alcoholic but is suddenly deterred by the cost! Yet the gubbermint, in its infinite wisdom,. applies the same markups across the board, with the same sanctimonious justification.
Those aren’t what the OP asked. Yes, there would certainly be an overall net savings.
But the OP was asking about Joe Sixpack, who gets Medical from his employer at a large discount, due to several factors.
As a retired fed, my Kaiser is about $150/mo or so for me and the wife.
So, yeah, I think Joe would save, but the data posted does not show that.
Also note that many of the Medical specialties, such as plastic surgery, would not be covered under most UHC, leading to rich doctors. Not to mention the rich would have specialized insurance and private care.
I do not think that just because a Doctor works under UHC, he can’t be liable for mal-practice?
Bernie, with his totally bogus mis-named “Medicare for all” (which had nothing whatsoever to do with Medicare), was totally wrong. Not only that but his crazy idea had no chance of ever passing. (A real “Medicare for all” could work, and could maybe pass)
Also, while indeed the overall net cost will go down, I have not seen anything that shows that the average wage earner with employer provided medical would have his net go down. The USA as a whole would pay far less, there would be some nice savings.
Well, let us take REAL “Medicare for all”. Everyone would get basic health insurance. But there is big bucks in selling Medicare Advantage plans. Not to mention the wealthy would want better medical coverage, faster appointments and care. The Brits are constantly complaining about their UHC plan- slow, hard to get an appt, long waits for certain procedures, etc.
Right, and there is “Part C and D” ie prescription plans and Advantage plans. I’d assume that REAL Medicare for all would make the charges for part B cheaper or gone. But still plenty of room for other services.
Yes, the numbers provided so far do not answer the Ops question.
It is to laugh. A big Corp, when faced with large savings from medical insurance will:
A- pass those savings along to line employees in the form of higher wages
B- pass those savings along to shareholders and bonuses to high level executives.
I’ve always wondered about this logic. We do, in fact, have such a tax. I drink diet soda exclusively, which may not be health tonic but doesn’t seem to contribute to obesity and diabetes in quite the same way as sugared soda, and yet I pay the tax, because the way the product is sold, there’s often no way to distinguish the “not healthy” from the “actively unhealthy” versions at the point of sale.
Rather than putting the burden on the consumer, wouldn’t it be more effective to increase the costs to make and sell such unhealthy products?
I mean, of course, if someone else is paying your insurance, then if it is paid for by your taxes rather than them, then you’d be paying more. It would be the same for anyone who is on their parent’s insurance as well.
But, it is a benefit the employer is paying. While you seem to think that the greedy corporations wouldn’t start paying the money that they pay in premiums directly to the employee, many would, as they would like to retain their employees.
And those are not covered under most insurance plans either, not sure the point you are making here.
No one said otherwise. However, what was actually said was that, since a large part of the reason that you sue is to cover the healthcare costs incurred by their mistake, such payouts would be substantially smaller, and malpractice insurance would either be less necessary or at least have substantially lower premiums.
Not really, they aren’t.
There are far too many factors involved to answer a simple yes or no. It would depend on what kind of UHC we have, it would depend on Joe’s income, job, and benefits. What has been given is information that would allow Joe to measure his situation and get a good idea of where he would come out, but anyone looking for a simple binary answer isn’t going to get one that is useful for anything.
I mean, that was money they were already allocating to the employees as part of their benefits. Sure, they could be greedy and keep that to themselves, but they also may want to keep employees.
Most of those greedy corporations have already decreased their contribution, and have the employee picking up most or all of it already.
If what you are saying is correct, then in any state that doesn’t reacquire employer contribution wouldn’t have any, and no company would be paying over the minimum. As neither of those conditions are met, then your premise is flawed.
It seems it shouldn’t be too hard to do so. It is a different product, so shouldn’t be too hard to distinguish. If diet drinks are considered to be healthier than non-diet, then it would be fairly simple to update the tax code to do so.
Where do you think that burden is going to end up?
It would actually be far easier to set up a tax system that taxes diet coke at one rate and regular coke at another than to set up a system that would get the Coca Cola company to sell them at different prices.
But we know that the answer is to raise taxes, which understanding, mysteriously, rarely translates into voting in a government that will do so. And although at the individual level a fair few people manage to go private to get round those difficulties, it never seems to add up to more than about 10% of total medical activity and certainly never leads to serious demands to abandon the basic principle of the NHS. So we soldier (or stumble) on.