For the most part, people who cost the insurance company more pay more. Covering people with preexisting conditions, offering subsidies to people with chronic issues, and mandating healthy people enroll to ease costs for the unhealthy are all results of the ACA. So, maybe it’s vaguely like the lottery now, but not in the pre-Obamacare health insurance world.
Maybe I am misunderstanding the point of this thread, but most attempts at healthcare reform are made with the goal of alleviating the bankruptcies, crushing debt, ER overuse, substandard care and even death associated with being poor in our healthcare market. If this is about how people without those problems can shave a little more off their premiums, I’m sorry to intrude on that discussion. As far as I know, the NHS wasn’t established so that middle and upper class people could save a little on their healthcare bills.
You’re wrong about this. Employer-provided health care (which is far more common than individual coverage) allowed for pre-ex etc. prior to ACA.
But even beyond that, the assertion that people pay full cost for medical treatment would not be true even if what you assert was correct.
I would look to the title and the OP for ideas on what the thread is about. The title is: Health insurance suggestion from a lay-person to cut down on unnecessary care, and the OP is also on that theme.
Nothing against discussing poor people dealing with the health care market - or how people can shave a little off their premiums, for that matter. But those don’t happen to be the topic of this thread, and it can get confusing when you make or interpret comments out of context of this discussion.
A side-question on unnecessary care, F-P – how much of it is due solely to extra-cautious doctors playing CYA, and how much is due at least in part to make more money?
There are no neutral third parties. Whoever is paying for it want to spend as little as possible. Patients want as much medical service as they think can benefit them. Doctors want to do everything in their power to dot every I and cross every T, both to deliver the best possible care, and to avoid getting sued.
Any cost-benefit analysis is going to make findings that is going to make somebody unhappy. And everybody has a different definition of “benefit”.
Should mass mammograms for women under 50 be provided? Suppose we decide No, they aren’t worth it. Sure as you’re born, some 40 year old will die of breast cancer that could have been caught with early screening. A few years back, it was found that, by and large, women could be discharged from the hospital after 24 hours instead of 48, and the difference in outcome was not statistically significant. There was a huge hullaballoo and the media found some doctors to say, “No, we can’t discharge them early because they need to recover.” Statin drugs, on average, increase life expectancy about three months, and they sometimes cause memory loss, muscle weakness, and liver damage. Should we not cover those?
Some drug is discovered that reduces mortality by 10% over what is currently available. It also costs three times as much. Should we save the money, or save the lives? You know somebody is going to say that covering it will only raise the average bill by $.02. What about PSA screenings for prostate cancer? Medicare covers those for men over 50. Should it?
This is a good way to assure that those interpreting scans and tests will more frequently find something “wrong”, since you’ve now established a strong incentive to over-interpret findings.*
No doubt an impartial panel :dubious: would readily come up with definitions of what is completely normal and what is even a little bit “wrong”.
*such a system would also penalize physicians (i.e. radiologists and pathologists) who must struggle to interpret borderline findings. What (for example) if I spend much more time than usual on a breast biopsy that may or may not contain atypical ductal hyperplasia? Suppose it takes three times as long to screen the case, plus additional time (and money for lab expenses, internal or extradepartmental consults etc.) and the diagnosis winds up being “normal”. Sorry Charlie, you only get compensated at the typical low reimbursement rate for normal results, never mind the extra work you put in.
I’m not personally familiar with the active duty military health care, but in a certain sense you can say that the losers are the people who aren’t allowed to participate in the system. The military generally doesn’t recruit unhealthy people with large numbers of pre existing conditions, which limits the costs to the system.
The issue posed by the OP is actually a bit of a red herring.
From my experiences, doctors in the US order a flurry of tests and perform procedures for all patients knowing full well that a good chunk of their bills will not be paid.
Insurance companies will object, doctors and secretaries will have to make calls and send threatening letters, and there’s a lot of back and forth.
This is why about 25% of the U.S. medical budget is spent on administration.
Last time I checked that’s higher than anywhere else in the Western World. It’s about twice what is paid in Canada.
Another way to reduce costs is going to cause heart attacks to many Americans: restrict access to specialists.
It’s pretty standard in single-payer countries (and with HMOs) for a GP to be the first point of entry into the medical system, and thereby determining if a patient needs to go to a specialists.
But I know Americans who had a preferred cardiologist that they’d visit every time they had heartburn. That’s a waste of cash if I ever saw one.
*I’m a non-American who lived in the US for several years.
**I am married to a doctor.
I feel like I can speak to this, since I had a parent who died from colon cancer, and am therefore considered “high risk” for colon cancer and have regularly scheduled colonoscopies.
This is the worst idea in the history of medicine.
My first colonoscopy found polyps. Not malignant, but considered worrisome enough that they were removed right then and there. The next colonoscopy was completely clean, earning me a gold star from my doctor and the good news that I could wait an extra year before my next followup.
Under the OP’s plan, my doctor would have had no incentive to order a follow-up colonoscopy. After all, all the polyps had already been removed, right? Forget that the second colonoscopy was to verify that there was* still *nothing there. The alternative would be to wait until I showed symptoms like blood in my stool. Then the doctors would need to run a series of tests to determine what was causing the bleeding, and whether it was simply an anomoly (angiodysplasia) or something serious.
You can substitute almost any cancer – breast, prostate, lung – for colon. Instead of doctors ordering too many tests, now they’re ordering too few.
The thing I’ve never understood about hospital stays is how do they get away with marking up Tylenol and over-the-counter items up by 1000% and the like. I mean is there some rationale they have to even try to justify those prices, because it seems like extortion. When my son was born, a little bit premature he had to be kept in the NICU for a few days, I understand that would drive the bill up substantially, but the amount of charges before insurance was like $100,000 I mean I can’t fathom how it could cost that much.
Here is some article about the crazy prices in the hospital for stuff you can buy at Walmart:
While I’m convinced that my idea is problematic at best, the idea wouldn’t be no incentive for doctors to order tests – just no financial incentive for extra tests (as well as no financial incentive to avoid tests). So your doctor would have the normal motivation to order a test to check that the polyps were still gone or whatever, and no financial incentive to avoid the test, he/she just wouldn’t have an additional financial incentive to order it.
But my plan is still probably silly, due to the many other points raised.
Not the case. A typical middle class person in the UK would have the NHS *as well as *private health care insurance (which in itself is usually cheaper than in the USA). That’s your free choice of course. If you choose not to pay extra for private healthcare you still get the full benefit of the NHS. There may be a longer wait for elective or non-urgent treatment but there you go, it is free at the point of delivery. (no co-pays, no yearly or lifetime limits, no insurance company negotiations) with capped prescription costs.
All people in the UK have full access to the NHS regardless of employment status, income amount or health history.
All treatment is based on purely medical needs. If your doctor or specialist thinks you need it, you get it. And the more urgently you need it the further up the queue you start.
There is no such thing as a middle-class or poor persons NHS.
I don’t think that’s correct. From this source, only about 10% of people in England have private medical insurance, which does not cover your “typical middle class person”. And it’s unsurprising, since in England the typical middle class person needs to pay taxes to support the NHS, and any payments for private insurance would be on top of that. In addition, employers would not feel the same pressure to provide employer-sponsored coverage.
Right. But my point was that the vast majority of poor people in the US are getting some form of healthcare, in the form of Medicaid and/or ER. Medicaid doctors are typically not the highest top tier doctors and using ER as primary is also sub-optimal, but considering the wait times for HNS services, it’s hard to know how this compares.
There are very few doctors who do only private medicine in the UK. All the major teaching and research hospitals, and therefore the leading specialists, are within the NHS (once you reach a certain level of seniority, your contract allows you to spend a certain amount of your time in other activities, like private medicine, or research, or other sorts of professional leadership).
There will of course be variability of quality within hospitals, and within those that local NHS organisations have contracts with for the normal range of treatments (very specialised services for rare conditions are centralised on relatively few national centres). The current system is that your local NHS organisation (run by the GPs) has to offer you four choices of hospital for non-emergency treatment, and the range of information you have for making your choice is a matter of constant debate (it’s a long hard slog getting surgeons to decide on the best way to present their success and failure rates).
Yes, we too have people turning up at A&E (ER to you) for minor conditions they could and should have gone to their GP with (or even just a pharmacy), but not usually because they have nowhere else to go (apart from the truly homeless and vagrant), or because they want to jump the queue for a waiting-list (because that won’t happen - A&E is for emergencies).
I guess we don’t have a good definition of what a “typical middle class” person in the UK actually is. I’d draw a middle class line around the £75k household income and I’d imagine anyone pulling a wage like that would more than likely be provided with private healthcare from their employer or choose to purchase it themselves.
Depends where you draw the line of course.
It compares terribly in terms of both access and cost. Take a fairly routine hip replacement operation. The poorest person in the UK gets that as soon as their medical needs dictates and it will cost them nothing. How would that be handled in the USA?
I’m not looking at this in terms of earnings. But I know that the “typical middle class” person is a group that covers a lot more than 10% of the population. So unless you dispute that number, then your statement is clearly incorrect.
A lot would depend on whether they have Medicaid (not all low-income people are eligible), although a typical person needing a hip replacement is probably eligible for Medicare (which covers people over 65).
But on what basis are you declaring that US coverage “compares terribly in terms of both access and cost”? What are you asserting to be the situation in the US (and on what basis)?
My employer has paid my insurance premiums for almost 13 years, but I have only used it after having to go through either the emergency room or urgent care at the hospital. There are no doctors in the urgent care, only a nurse practitioner, and the emergency room visit (blown knee - torn ACL/MCL and meniscus) was filled by a doctor who gave me two Advil and a a pair of $200 crutches, after paying $100 cash to get admitted. I have a variety of issues I’d like to get looked at, but there are no doctors at the regional hospital and no GPs who will see new patients. There are doctors at the hospital, but you can’t get in to see one unless it’s through the emergency room or nurse practitioner in urgent care. It’s crazy, I remember having a “family doctor” growing up, but then harping on about “the good old days” is something that’s frowned upon.
You have tens of millions that have no insurance and no access to the full range of medical care they need and who get charged at the point of use. You have tens of millions more that pay large insurance costs on top of the taxes they already contribute (for medicare etc.) and yet still have to battle insurance companies to get treatment and run the risk of being bankrupt by their medical bills. Your expenditure per capita on purely public healthcare (that covers only a fraction) is greater that the total per capita expenditure (of private and public healthcare that covers EVERYONE) in the UK,
Class and private medical insurance in the UK: I suspect the range of employers who offer private insurance as part of remuneration is relatively limited, as are the classes of employee involved - basically senior managers. I worked to quite a senior level in university management and no-one would have thought of it, nor I suspect in any sort of public service: but that was before the days of widespread privatisation and commercialisation of public services (and rent-seeking top bosses, but don’t get me started).
What we were discussing was the comparison between the level of care that a poor person in the US would get from the Medicaid (or Medicare) and ER combination versus the level of care that a poor person in the UK would get from NHS services.
Your cites attack the US healthcare system on various fronts, but none of them address the issue we’ve been discussing.
[Though truth be told, that that issue itself is something of a hijack for purposes of this thread anyway …]