What are people supposed to be basing these predictions ON?
Just a thought or two for those who are touting Medicare as the model for UHC -
Regards,
Shodan
Um…is this a trick question? I assumed that people who want UHC have, well, you know, a plan. How much it will cost. How long it will take. What it will encompass. That kind of thing.
You know…a plan. Are you saying that no one HAS a real world plan with real world costs and real world time tables? With actual transition planning on how we would get from our current system to…whatever? On how much it would realistically cost to do so? I’m ASKING for that data so I can make an informed decision on where I stand on UHC. Our current system is a mess…granted. How do we get to ANOTHER system from here? What will it cost both in the initial implementation and yearly after that?
When politicians spout off about UHC they never give any actual details about the dirty parts…how do we actually get from where we are today to your bright shinny new system? How long will it take…and what will we do in the transition? What is it REALLY going to cost to make those changes…and what will it cost us a year after ward?
-XT
You mean plans based on real world data that you’ve rejected at the outset as being unusable? Why should anyone reinvent the wheel when you’ve rejected the wheels that are rolling along already?
I would assume you’d want some evidence, yet you’ve rejected the biggest portion of the evidence from the outset. Oh, then you patted me on the head and told me I could waste my time gathering evidence when it was pretty clear you’d reject it.
Bah.
I knew many people who were happy to be on medicaid. I also knew many people desprate to get it.
These were all people who had disabilities making them difficult to employee or insure.
I’m asking for real world data here. Are you saying that all real world data is dependent on how Europe did things? If your entire argument hinges on that…well, I already said you can do what you want. What more do you want? Convince me.
Me thinks you protest to much. If you don’t want to participate in the thread then don’t. I said (as if my opinion counts) that you can use external data if you like…but that I am skeptical (which is different than rejecting it out of hand) that there is a good parallel between the US’s current situation and the situation of nations when THEY went to UHC. Again…convince me there is a parallel. Or stop whining and leave the thread if you feel it is hopeless. Whatever floats your boat.
You might want to consider the fact that while you may think that I will reject your analogies out of hand that some folks out in the peanut gallery won’t, and may be interested in your arguments. As I already said to go for it (i.e. it wont be a hijack), I fail to see why you aren’t bringing out the big guns you think you have. Fire away.
-XT
I can’t speak to your other points, but I do remember the times before the Canadian province of Ontario went to UHC. It wasn’t that long ago–only, IIRC, 1968–and prior to that, we were pretty much on the US model of employer-supplied health insurance. No job, no health insurance. I don’t know what happened to those who were un- or under-employed and who had no health insurance. But yes, at least Ontario was on the US model. I’d assume other Canadian provinces were too.
Unfortunately, I was only a child in 1968, so I really don’t know how Ontario made the switch. But that time should still be within the memories of those older than me who did deal with the switch from employer-paid health insurance to provincial health insurance. So perhaps some older Canadian Dopers could help with that info, for Ontario, or the other provinces.
Just to let you know, Medicare reimburses very poorly. Many physicians “fire” their patients when they go on Medicare, as the payments are not worth it.
Cite? Not saying you’re wrong, but some support would be nice.
At any rate, the argument that Medicare has problems doesn’t explain why, in theory at least, we can’t open it up to everyone who wants and needs it.
This concept still makes sense in my head. Private insurance is profit-driven. It’s a business, and like all business, turning a proft (as opposed to just being solvent) is the end all, be all. This inherently means there will be exclusions and costs that wouldn’t exist if the execs didn’t require their 7 figure salaries.
Okay, so here is what I propose: The government implement a system that covers basics for everyone–we’re not talking about Cadillac Escalade services; Hyundai Civic care would be enough. Call it Medicare, or call it Doodoodada, or whatever. Make those who can afford it pay premiums and co-payments; those who are poor would remain premium-free.
Without the profit motive and the bells and whistles (and yes, this would mean people might have to sometimes settle for radiographs instead of MRIs and this would surely suck…but I’m still thinking some is better than none), I don’t see why a system like this couldn’t be solvent while ensuring primary care for the millions of people who don’t have it now.
I wish I was an economist who had time to study this in depth…
Here’s a November 2006 pdf from the AMA on the issue of reimbursement cuts: http://www.ama-assn.org/ama1/pub/upload/mm/399/nac_qa_medicare.pdf
Do you know the difference between Medicare and Medicaid?
When I worked for disabled people everyone I met on caid appreciated it deeply. They were uninsurable.
In Germany you can opt out of the government health care system. I know many very well off Germans-college prof’s and engineers. None of them have chosen to. My German mother in law got breast cancer recently, and broke her leg about 5 years ago. Her care was exemplar both times. In my judgment her care was superior to those I have known who were sick or injured in the US.
What kind of a stupid question is this if you don’t include other systems?
Someone beat me to the cite - and you are right, I should have cited. In some of the circles I run with, it is a known factor that Medicare pays poorly and is also a pain to deal with. Firing patients is common when the leave their regular insurance. Because to me it is “common knowledge,” I did not think to cite. That is, of course, a poor choice both here and in the real world.
As to opening Medicare to others, I guess we would have to come up with an appropriate premium. I personally have no issue with making a Federal payer OPTION. We could take Medicare, Medicaid AND Tricare and put them all under one umbrella. All government workers (including all Congressmen and Senators) would only be covered by that plan as well.
I would like to allow to still purchase my own plan as well, and doctors could choose if they wanted to take the government plan.
My folks, both seniors, had a Blue Cross PPO and Medicare. Thank goodness, too, because they would have been screwed without Medicare, which paid for my dying dad’s hospital bed, some in-home nurse visits, his time in a nursing home/rehab home after 3 days of hospitalization (it would have paid for the first 100 days but he died before that time period was up); and it also pays for my asthmatic mom’s nebulizer.
I’m not saying that nobody has had problems, but I’m glad Medicare exists.
My folks, both seniors, had a Blue Cross PPO and Medicare. Thank goodness, too, because they would have been screwed without Medicare, which paid for my dying dad’s hospital bed, some in-home nurse visits, his time in a nursing home/rehab home after 3 days of hospitalization (it would have paid for the first 100 days but he died before that time period was up); and it also pays for my asthmatic mom’s nebulizer.
I’m not saying that nobody has had problems, but I’m glad Medicare exists.
As Spiny Norman said, why is that a given? Isn’t it possible that we’re paying more because our system is different?
The extra overhead, AIUI, isn’t on the insurance companies’ end. It’s on the doctors’ end: they have to spend more time and hire more staff to handle billing than their counterparts in UHC countries, thanks to the wide variety of plans and providers we have to choose from. No amount of pressure from insurance companies is going to lower that, unless all the insurers decide to work together to standardize their billing and coverage.
Obviously it’s to stupid a question to be answered thus far…since no one has taken a shot at answering it. As I’ve already said that if you feel you must, go ahead and use examples from other countries, I must assume you are bitching here simply for the sake of bitching…or because you don’t have an actual answer to the OP.
Why did I not want to use examples from other countries? Well, since several people have asked so nicely I’ll explain. It may be lost on people, but the US doesn’t have UHC. Why? Well, because thus far in our history we haven’t wanted it…as a nation. Another fact that is obviously lost on people…other countries DO have it. So…there is a bit of a difference there, no? Additionally I didn’t really want to debate UHC per se…and I certainly didn’t want this thread to degenerate into yet another ‘Europe rulez!’ no ‘European socialist medicine is the suxor!’ type shouting match. We’ve HAD that debate…many times. What I wanted to debate was how UHC might work HERE…and to try and ferret out some of the details on how it might work and what it might cost.
Thus far no one has even taken a shot at the core questions…just sniped at the stupid stuff. And bitched that I didn’t allow other examples. Even after I DID allow thing (as if I could stop ya’ll from posting whatever the hell you wanted to in any case…sheesh). Seriously…people have hijacked the thread into personal anecdotal experiences that have zero to do with the OP.
So…anyone who actually wants to take a shot at answering the questions I asked, feel free to use whatever the hell examples you want. If they are irrelevant…well, at least maybe people will stop bitching about the small stuff and give something.
-XT
Um… are you suggesting that every other country with UHC has always had it, since the dawn of time? Or did they, perhaps, have transitional experiences that we can learn from when pondering what our own transitional experience might be like?
This assertion begs for some kind of substantiation. Between the millions of people who don’t have health insurance and the millions more who have it but are dissatisfied with it, I suspect way too many people are desirous of some form of government-subsidized healthcare for you to make such an absolute statement.
Well, I’ve proposed something. Since it apparently doesn’t satisfy your questions, can I ask why my idea is unreasonable?
Some more data about Medicare from here:
In 2005, the total number of people enrolled in Medicare was 44,067,816. That is Part A or Parts A and B. It is before Part D went into effect.
So, the total enrollment in 2005 was fairly close to the number of uninsured people we currently have. If every uninsured person were added to the Medicare rolls, Medicare would double in size. If every underinsured or too-expensively-insured person were also added, I do not know how big Medicare would be.
In 2002, Medicare spent $6,271 per enrollee, $6823 per person served, for a total of $213,737,000.
It’s important to note that the population Medicare serves should be the most expensive as a whole since it includes the old and the disabled.
Okay, let’s compare!
From here:
So, Medicare might be keeping costs down some since, as I said, the population on Medicare should be way more expensive than average. Included in that 6401 per capita for the US are a ton of people who aren’t getting any care at all, and a ton who are getting expensive care for minor problems (going to the emergency room with an ear infection).
So if a relatively young, relatively healthy population were added to Medicare, what would happen to Medicare spending per enrollee? I do not know.
Yes, that’s what I’m wondering too!
If a boatload of people like me (young, peak health, make enough money to pay a hundred dollar some-odd monthly premium, averages <1 doctor visit per year and requires little or no prescriptions) came into Medicare, seems like that would be a great thing for the system. As it is, a disproportionate number of people covered under Medicare are sick or disabled and are not paying anything for their care. So it leaves me thinking that if we were to expand the service so that we’re bringing in healthier and more affluent enrollees who pay more than what they’re taking out, not only would that make Medicare more solvent but it would also give folks the healthcare they need. I only see win win here.
If we were to implement this, the US government would have a bottom line incentive to emphasize the importance of preventive medicine. They should be doing that anyway, but the importance would become even more obvious. And this would be great for everybody.