But is it “gaming the system” if you don’t have any other access to medical care?
Only to some extent. In France, the public healthcare system isn’t ran by the government, but by an entity headed by half elected representative of the unions and half elected representatives of the employers (for historical reasons : the french public healthcare system was build upon the existing systems put in place by collective agreements in various industrial branches and originally covered only workers and retired workers).
However, essentially any significant decision has to be accepted (if not imposed)by the government because it requires some sort of legislation to be enforceable. And when people, or doctors, etc… are unhappy with something related to the healthcare system, it’s the government that gets the flak, and legitimately so, because when all is said and done, it’s still up to it to decide. An unelected body would hardly have the legitimacy to make decisions that impact directly people’s life (or even death), people’s paychecks, etc…
For one thing, it’s not run by people who have a financial motivation to screw you.
If they have no other means of getting the medicine, then yes. Survival trumps property rights, and a society that doesn’t bother to provide health care to those who need it has already announced it’s time for the law of the jungle anyway.
IMHO, yes, but it’s justified gaming.
I don’t know if it will work, but yes, a number of reforms have been implemented.
For instance, a number of drugs with an “unsufficient medical benefit” aren’t reimbursed anymore, or only partially reimbursed (don’t worry, homeopathy is still partially reimbursed due probably to its well proven efficiency).
Also, there’s 1€ co-pay for each visit to a doctor that isn’t reimbursed nor by the healthcare ysem, nor by the mutual insurances(*).
You won’t be able to see a specialist without being refered to him by a generalist first and be fully reimbursed anymore.
And finally we’ll have to pick a generalist and to “register” with him to be fully reimbursed. You can switch to another if you want to and I understand that’s it’s intended to prevent people from seing half a dozen different doctors for the same issue but I still don’t like the concept of not being able to see whoever I want whenever I want. It makes perfect sense when your medical expenses are covered by the collectivity, but I’ve not been accustomed to that. Besides, I had actually two doctors, who are twin brothers working in the same cabinet, and having to choose one put me in a diplomatically delicate situation.
(*) There are complementary insurances in France, and many of them, rather than for-profit companies owned by stockholders are “mutual insurances”, non-profit organizations ran by the elected representants of the insured people. They’re also very influential in healthcare policies since they’re federated and generally mostly in agreement and represent a huge number of people. I’ve always been surprised that these are apparently mostly non-existent in the USA. I just received the documents for the election of the board of directors of my insurer, for instance, and I certainly think it beats being dependant on the decisions made to please stockholders.
Problem is : since in the USA, you don’t leave people with unhealthy habbits die in the streets, when fire comes to stove, you also end up footing the bill for these people.
Which is the right thing to do, anyway, IMO. Especially since it’s difficult to assess who has unhealthy habbits. For instance I don’t own a car, and cars are notoriously dangerous. Should I pay when a car-owner needs medical care because he was involved in an accident?
It’s just more obvious when it’s a tax aided system. Someone still has to pay. In the States if the couch potato has insurance then they pay and the price of insurance will cover this cost. Even if the employee doesn’t pay the company he works for does and so the employees job may not be as secure due to medical costs for the company.
At the end of the day you still are paying directly or indirectly for the medical of others. One advantage a socialized system delivers is that it generally helps the poor to stay healthier than they would in a US type system. I’ve read lots of examples on the SDMB of people not seeking out medical help because of the costs. Something that may cost a few hundred bucks to fix is let become something that eventually costs thousands to a ER because of the patients inability to pay.
If I’m pissing everyone off, I must be on to something 
And I mostly agree with you - laws aren’t the best way to go about fixing problems. I think getting the major players in the healthcare industries and the insurance industries to sit down together and start evaluating treatments based on expected returns might do alot for the situation. Maybe legislate some incentives to instigate the changes… Though, since this is where the bulk of their income is, they might be hesitant to change. And I’d be more than happy to run on an unpopular platform (I think it’d be fun to spin this into something more palletable for the general population), are you going to fund me? Senator Spaz… I like the sound of that
At the end of the above article:
I know the definition of “medicare” there is different than it is here, but they are comparable I think. Isn’t it a trend here that doctors are seeing fewer or no Medicare patients?
Not all that comparable. Canadian Medicare is universal. Canadian doctors seeing no Medicare patients would see few patients indeed.
OK I call bullshit on this. How can you possibly reach this conclusion? Government has just as much, if not more motive to screw you. Elected officials are only there for a limited time. Get in - exploit the system personal gain - get out. There’s no one to answer to after that. Companies atleast have to look after their own reputation.
I disagree. The couch-potato-diabetic could have just as easily changed his diet and started excersizing as he robbed his neighbor. By arguing at the extremities (life/death situations) you’re not doing justice to the average folks who just have allergy problems, or just need a doctor once in a while when they get sick. You can’t create a system tailored to the minority. It will, by definition, be an unfair system. You should treat the terminal like what they are - the exception.
My very good private insurance works this way. I’m registered with a large group. I have a primary doctor, but in a pinch others from the group can see me also. The group also has specialists, but I can go outside it when necessary. Does the proposed system require you to see one doctor, or allow you to see others in an office?
I like the system, actually, since there is continuity of care. My late mother in law had constant issues with drug interactions, from seeing different doctors for different issues, and I think this kind of policy has benefits in reducing that kind of problem.
I hate to break this to you, but we’re all going to be terminal at some time or another. Some of us will conveniently die quickly, though.
What I’d like to know is how you’re going to distinguish this couch potato from someone with genetic problems, who sucks up health care for no fault of her own. I’m naturally healthy, and have chloresterol low enough that not even my doctor complains, but this is from the luck of the draw, not from any great moral edge I have. The whole point of insurance is to spread risk across as large a population as possible. That’s why a single payer system will always beat a multiple payer system using the same rules.
I haven’t seen the overhead the current system adds to doctors’ offices addressed either. Each doctor’s office, or even my small dentist’s office, has at least one person working full time to handle insurance and billing issues. I’m sure this overhead could be mostly eliminated with a single payer system. Those living in such a system - do your doctors have insurance specialists associated with them?
but with a single payer system… whats to stop one from strong-arming the other? Especially when one is The Law? How would you drive innovation in healthcare management? Instead of your office employee, you’d replace it with a local government office to handle payment and whatnot?
I would like to quit comparing things to what we have now (although I did it myself.) We obviously need reform. Consider this from The New York Times, 2/2006:
I recognize that they are working to remedy this problem, but what caused it? Is it because they didn’t have a mix of public and private like with other systems in Europe? Have European systems solved this problem?
Ok, I’m no longer for consumer-directed care being the sole solution. What if we had a mixure? I like HSAs because that’s how I paid for my elective eye surgery. Also, I would like health insurance policies to be more consumer-friendly.
If we went to mandatory insurance, paid for by employers but making it completely portable and individually-owned, consumers would choose their insurance plan. I can choose between plans now during open season, but I have a hard time understanding the brochures and comparing benefits.
I have not researched what is proposed for unemployed people, but first things first.
The government is strong arming people now. The Times yesterday reported that pharmacists in Texas came to the White House to complain to Rove that they were losing money on the new Medicare program, since they were forced by the plans to take less than their costs. This is the same plan, remember, that forbade negotiating with drug companies. The pharmacists are Republicans, and they’re pissed. Anyhow, what you call strong arming I call negotiation. The US is clearly getting ripped off.
As for savings - the insurance interfaces in the places I go seem to know the magic numbers to use to assign to procedures so the insurance companies will pay, get pre-approval of procedures, and understand the zillions of different plans their patients are covered by, with zillions of different forms. Don’t you think one standard plan will save lots of money?
What if the costs to include the uninsured in a single payer system equaled out to about the same as before – as in Taiwan’s case?
Considering the problems in other systems that they are having to tweak/reform and not knowing at this point if they will work, if they will solve budget problems, or avoid the coming crisis with long-term care for the huge number of seniors, and considering that there are proposals to address administrative costs/efficiency issues anyway, should we still choose socialized health care over mandatory insurance, etc?
The moral choice has to include a way for everyone to have insurance, IMO. Considering a population that is divided between conservatives, moderates and liberals, that overwhelmingly either chooses not to or has barriers to exercising regularly and making the wisest food choices, etc., and that is likely to continually fight over tax rates…
…given all that and supposing that we will have to make compromises before anything is changed nationwide, and stressing again the hypothetical “what if the costs were about the same,” would mandatory insurance, etc. be acceptable? Anyone?
It would be an excellent result. Thanks for the link - I just browsed it, but it is good data. It sounds like in Taiwan, at least partially, reduced transaction costs paid for the previously uninsured. I think we might do better, since more insurance could mean more prevention, and thus lower cost and earlier treatments. But even if this does not happen, care for all at the same price is a good thing.
Everyone is going to have the senior problem. I heard Lester Thurow say China is going to get hit worse than us because of their low birthrate. As for problems, anything we adopt will have problems, but they seem to be less than the ones we have today.
As for mandatory insurance, I have some questions. Does everyone get the same coverage? How many hours are required for coverage? My daughter knows people employed by retailers with good insurance who can only get a number of hours per week that is just below the minimum needed for the insurance to cut in. If there are loopholes that allow employers to cheap out to reduce their costs, they’ll often take them. Of course, keeping the same multipayer system won’t reduce paperwork as much, and thus not reduce costs. So, I’m not sure it is a good idea in practice.
I knew I messed this up! I meant what if the costs to move to a mandatory insurance, etc. system cost us about the same as now? It seems Taiwan didn’t save any money going National – is it unaceptable if we don’t save any money going Mandatory?
I looked at the National Center for Policy Analysis to see what’s being proposed, and it looks like PT would be covered, and that people would choose between different plans. I don’t know if that means that every 60-year-old could get the same coverage or not, but it makes sense that a 20-year-old and a 60-year old would have different needs. I’ll keep looking…
What is the root cause of the doctor shortage? A shortage of places in university medicine programs. It’s certainly not a shortage of people wanting to become doctors, as entry into medicine is ridiculously competitive. I have no clue why more positions aren’t made available, but I really can’t see how it is in any way related to our socialized medicine.