Doctors fill only a single form, here, in almost all cases. I can’t see why it would have to be different in the USA.
I think it would be different based on the way every other US government agency is run, as well as how private insurance runs here already.
It’s certainly true that the Canadian system delivers far more cost efficient care. Always has, ever since it was created. Of course, every national system is different so who knows what might get set up, but it can be done.
Again, unless you want people to die from lack of treatment when they get sick without insurance, you and I will subsidize them anyway through higher doctor bills or taxes. If I’m going to pay for it anyway, why not do it in some sort of rational fashion, one that can help cut costs by earlier treatment and cut overhead out of the system.
There were an awful lot of things in there that don’t jive with my personal experiences in California, such as having to wait weeks to get an appt with a specialist, and a doctor having to spend 35 hours a week (!) talking to insurance companies. If nothing else, any time I’ve had an insurance company deny something, it has been my responsibility and not the doctor’s to deal with it.
She also really glossed over the issue of rural Canadians living rather far from anything other than basic medical care, and the differences between the provences.
Another thing that the article doesn’t address - Canada isn’t the US.
Yes. It’s cheaper in other places. Now if Republicans ran it, all bets are off. Medicare is actually very efficient.
Any evidence of that? Seems more likely to me that those who are ideologically opposed to the idea are against it. As I said, it is also more expensive than originally projected, so that might have something to do with it also.
What an elitist statement. So, someone working hard for 40 hours a week is avoiding a better paying job? Not everyone can be doctors or lawyers or even chefs. You clearly are a literate person who writes well. Did you choose to be that, or were you born that way and grew up that way? A lot of us got born on second base if not on third. Lets not look down our noses at those still trying to get on.
Interesting. Who did you talk to at the doctors’ offices then? My wife and I have both spoken directly to insurance people at the office. Not 100% do - a friend of ours opened her own dentist’s office, and I don’t think she could afford a full time insurance person. But all moderate sized practices (four doctors or more) I know of have one.
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Do you really believe that the US government, author of the income tax rules, could possibly have something that simple? If you are talking about a single form for the patient, I don’t fill out forms for my visits with the insurance I have now (and haven’t for years). If you mean for the doctors and their staffs, I really have to believe that the government would generate at least as much paper.
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Haven’t you ever gotten rejected for treatment for some obscure reason? We have, and it takes forever to resolve, and even more for the poor person at the doctor’s office who knows the obscure ways of insurance companies. Sure 99% go through fine, probably electronically now, but that 1% is the killer. If different insurance companies have different rules and different coding, don’t you think that adds to complexity?
So, you think people without insurance go for yearly checkups? Get standard tests done? Lets worry about that before we worry about expensive full body scans.
Are you really having trouble seeing the logic of a $100 test now making a $50K hospital stay later unnecessary?
Does it claim that Canada is somehow the US? Does it assume it? I think not.
Oh, wait, you say that Canada is unlike the US somehow. Well, that’s possibly another thread, so I’ve started one. In the Pit, so you don’t have to be polite about it.
You want less money spent on health care?
In what way do you think that Medicare is very efficient?
Those who are against (what do I call it now if socialized is the wrong word?) one US wide insurance plan run by the government tend to be those that have no need for it. Because they have insurance. Those who are for it tend to be those that don’t have insurance, and those who think that handing things to poor people is a good idea.
I was born on third base myself, if by that you mean in poverty and then given a less than stellar education. I have worked three jobs at once, lived near the Canadian border in a house without heat and etc. I learned to be responsible for myself, I learned to delay gratification until I could actually afford it. I am not and was never a doctor, lawyer, chef or held any other job that paid extremely well and came with great benefits. And yet, even with just a high school education I have always held jobs that had group health insurance since I was 20.
I am not looking down my nose on anyone that is actually trying to get on, I am looking down on those who think they “deserve” X, whether or not they can actually afford X. People who buy houses and cars they can’t really afford, who start families when they don’t have good jobs and decent health insurance, who run up big credit card bills, who have no savings and no plan should some disaster happen.
I worked hard for my semi-comfortable middle class life. I am not giving it up without a fight. I don’t see why my retirement years (which have actually turned into my disability years) should be threatened because people cannot be bothered to make things like health insurance more important than an SUV, a bigger house or three children.
Then perhaps it is a regional thing. I have not talked to the office my orthopedist is in since I’ve only been there twice, but I have talked to my rheumatologist’s people, the folks in my GP’s office, the dentist’s, my allergist when I still went there. Medical insurance (group) is what I did, so I talked to all of them.
I have had drugs rejected, PT rejected and non-mainstream treatment rejected.
I don’t know much about individual plans, so if that is what you have, this may not apply. However, thruout the years that I was involved in group insurance, particularly large groups, the plans were all essentially the same. If you were rejected for something by your insurance company, you would probably also have been rejected by all the others - they all use the same statistics. And this is another reason why I am against the government taking over - they will, I can guarantee, write a plan that will automatically pay for all well child, all maternity, all office visits for sniffles and other things that really are not going to seriously impact the health of the people. And, they will most likely limit cancer care, marginally elective surgeries such as that for sleep apnea, restrict access to tests beyond xrays and blood tests and severely cut back on drug coverage. Because this is what the lesser insurance companies do, the ones that are trying to cut costs such as the average HMO. Like Kaiser, which was and may still be a non-profit. And the punch line? We won’t have any choices unless it’s opt out.
I think you are having trouble seeing the logic of a $100 test multiplied by a couple of hundred thousand people who have no health problems. There is no financial reason to have preventative care visits available to healthy young people, except that it sells insurance policies. Yet you want me to pay to have this available to every person in the US?
It makes comparisons as if the two countries are equal. They aren’t.
My dentist has one person in his office just to handle insurance. He’s increased the amount of Medicare work he takes because it’s easier to bill one consistent set of procedures and billing than the rat’s nest of different ones for all the various insurance companies.
One set of codes, one payer. Single payer. As Joe Bob Brigg’s said “I’m surprised I have to explain these things.”
The coding is already standardized. I fail to see how only paying the government (as well as a few remaining private insurers) is going to reduce paperwork for doctors. Have you ever experienced the amount of paperwork the government generates?
What we have in the US is a rat’s nest of third-party payors, lawyers, Medicare, Medicaid, and a whole lot of people whose salaries depend on maintaining the status quo.
We have insurance companies who set aside $35,000 to defend against a claim that would cost them $17,000.
We have doctors who, 25 years ago, had one person to deal with the insurance, and now they have a whole department to deal with it.
I worked for lawyers who spent $6000 a year to keep up with Medicare/Medicaid legislation, in CLE and updates, so they could explain to their physician clients how not to commit Medicare fraud, and of course that cost is transmitted tenfold to the clients. Who then pass it along to their patients.
The hospital I worked for had a patient who came in every three weeks for an orphan drug. The patient was on Medicaid. Medicaid reimbursed the hospital $950, the drug cost $1500. In other words, we lost around $600 every time this patient walked through the door.
At the same time, Medicaid reimbursed more if a patient was diagnosed with viral pneumonia than with bacterial pneumonia (let’s say; it may have been the reverse) so no matter which kind of pneumonia the patient actually had, it was coded as the one that paid more. One way, it was enough to pay the doctor’s cost of treating the patient, the other way, it wasn’t.
One of my colleagues is a former RN whose salary is around $120,000 at the insurance company she works for, plus other bennies like a fairly nice company car, and her job is, basically, to look at claims and make sure they are actually covered. You can read between the lines on this–if she doesn’t catch at least $120,000 worth of claims that can be disallowed, she will probably be out of a job next year. If she catches a lot more than $120,000, maybe she’ll get a raise.
Meanwhile, a friend of mine and her husband were doing great 10 years ago. They both had good jobs, they had a couple of kids, they had two rental houses and one they lived in. Then he had a heart problem, which has resulted in a bypass, some kind of implant that has to be tested once a year, and severely cut back hours. He just can’t do what he used to do. And she had a brain tumor. They did have insurance, but nonetheless, after the heart problems and the brain tumor, they had to sell all their houses to pay the medical bills, one of them is now 100% disabled and the other 50% disabled, and they’re renting. No savings and nothing to fall back on and no vacations ever again.
And not only that, but health care costs are sneaky. You can’t ask, “How much is this going to cost?” because the only people who know are the insurance companies. For instance I went in and had a physical this year, because it had been a long time, and my doctor wanted to make sure I was healthy enough to take Fosamax. (Ha; they give this to people in nursing homes, how healthy do you have to be?) I asked how much it would cost, the receptionist looked at my insurance card and said, “Oh, just the copay.” $20. Okay, fine.
Weeks later I got the lab bills, which added up to almost $1000. If I had known that, I would have stayed the hell away. I know I’m healthy, and I could make that choice. (I could also afford to pay it, but that was luck.) There are people who aren’t healthy, though, and who can’t make that choice, and they get hit with the lab costs, etc., and end up getting calls from collection agencies.
I think the first thing I’d do to fix healthcare would be to get rid of all insurance companies, period. Of course this would throw a lot of people out of work. A hell of a lot of people. There would be opposition, and there would be lobbying. But I think we can’t even see what’s wrong with health care until we cut through some of the weeds, and by weeds, I mean insurance companies.
Why do there have to be codes? Why can’t a person be told the cost of an office visit with lab work, up front? Why do insurance companies pay more if it’s one kind of diagnosis and less if it’s another? It’s a total mess.
Do you happen to have a cite for that? Thanks.
I have no idea the credibility of this site, I just found it with a 30 second google search.:
http://www.uk-insurance-index.co.uk/article-8.html
It says that a discount private insurance would be £15 and a top of the pile single person policy for a 43 year old would be £145 a month.
As an aside, I’m a small business owner and my group policy is around $125 a person a month for bottom of the barrel, high deductible/copay coverage. Before I started my business I looked at single person insurance and it was three or four times what I’m paying at the group rate. [/Anecdote]
Takes a bit of looking, but through previously given links:
An anecdote that demonstrates the difference in private care between the UK & USA:
On US inefficiency, from a study. This seems to go to Martin Hyde’s point that we’d screw it up somehow, but I’m not convinced that’s a good reason to do nothing.
http://content.healthaffairs.org/cgi/content/full/23/3/10 :
From the other link in my OP (& since you didn’t go to the website with the nice quick abstract, I now send you straight to the PDF):
Here, this is worth quoting:
The only people benefiting from the system we have now are lobbyists, corporate insurance, executives, drug companies, and bribed lawmakers. Patients and health care providers are the losers. It doesn’t seem rational to fund a health care system that profits people who undermine its viability.
If the government nationalizes health care, it will remove profit. This will eliminate the administrative costs for screening, challenging claims and harassing providers. It also eliminates highly paid lobbyists and astronomical executive compensation. The government can negotiate drug prices –unlike Bush –and eliminate pharmaceutical advertising.
It will be a much more cost effective, efficient, and moral health care system that functions as a public service.
The “underclass” is a sweeping term that holds little meaning. Generally speaking the types of people who would be prone to abusing a single payer system are the chronically homeless (who already cost us from anywhere to $20,000-$150,000 a year per transient) and the urban poor who have a high incidence of drug addiction and a general feeling of entitlement.
Generally my personal opposition to socialized medicine is based on a few different concepts:
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As I said, single payer won’t create equality of result. Some hospitals will still be better than others. Generally these hospitals will give better treatment to wealthy benefactors than they will to street people. If you try to regulate this away then private hospitals will quickly eclipse public ones in quality of care. If you try to regulate it even further then quality of care in general goes down and the wealthy will start taking “health care vacations” to other countries. Right now it isn’t unheard of for the middle class to do this to save money–the wealthy on the other hand can get the best care in the world here in the United States (although I’m sure some scattered specialist programs around the world may be best in their field.)
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I’m not convinced that it will be cheaper. I agree we can certainly eliminate the profit margin of the insurance companies, but is that going to offset the massive increase in doctor’s visits? There are a lot of people now who don’t regularly go to a doctor for every little thing because they don’t feel like paying for it. I actually think this is a good thing, people shouldn’t go to a doctor over every little thing as a matter of national policy. Our current system gives us a pretty high life expectancy, quite high if you factor out the large numbers of urban poor who drag down the average (and who most likely will receive the least benefit from single payer health care.)
Generally speaking, as an American, I think there are few first world governments that are less efficient than that of the United States. I honestly guess we could speculate as to why that is (maybe it’s because of our strong Federal system, maybe it’s because of our large population of extremely mixed social and cultural backgrounds, maybe it’s something to do with how the Federal government itself works–we could talk about this in a thread of its own).
But given those truths someone pointing out that “ooh, ooh, look how efficient Canada’s system is compared to ours!” doesn’t really inspire much confidence. Most educated people understand a free market system will be more efficient than a socialized system. Usually the arguments for socialization ignore the matter of economic efficiency, for example if you feel that health care should be a public service and not a standard service that should be subject to the whims of a free market then you aren’t really too interested in economic efficiency in the first place. So the fact that our mixed-free market health care system (I say mixed because many of the best hospitals receive large influxes of funding from the State and Federal government every year as well as receiving hundreds of millions from private donors and such every year–this is why many major public hospitals employ people like Michelle Obama) is actually less efficient than socialized systems suggests to me that a fully socialized system done in the United States would quickly establish itself as the least efficient of any such system in the world.
As a conservative, I’m actually somewhat open to the suggestion that maybe health care should be a public service. So lack of efficiency wouldn’t instantly lead me to oppose a single payer health care system. But I’d honestly need more details. I think our health care system is in bad need of overhaul, if we just modify it by getting rid of the insurance companies and having the government pay all the bills I actually think our already ludicrously high national health care costs will skyrocket, because you’d be pumping more government money into a system that is already fairly chaotic.
I actually think the problems with our health care system are somewhat analogous to our public educational system. Generally primary and secondary education in this country varies widely from school district to school district. Let’s totally discount private schools here, some of the best High Schools in the country are public schools. There is an enormous variation in the quality of education from one public school to another, even within the same school districts. The wealthier families tend to have better neighborhoods, which lead to nicer schools, and attract better teachers. Most teachers do not want to work in an urban ghetto where they have to go through metal detectors on their way to work every day and where stabbings and shootings are par for the course.
We ostensibly have “single payer” primary and secondary education (State and Local governments, and to a lesser degree the Federal government) and it’s not created equality of result.
This is just wrong. My brother works for a company that makes practice management software for doctors and surgery centers. Its a pretty small practice if an office only has one person that does billing.