I don’t think that’s actually correct- aside from drop-in centres, or an out-of-hours GP, you can’t normally just show up at a doctor’s surgery and ask to be seen. Some may see you (especially if it’s urgent and they’re somewhere rural where there’s no emergency service close), but they don’t have to unless you officially register with them, which can take a few days, and they certainly can ask for ID.
Mine asked for ID, when I moved last, as well as getting me to fill in some other registration paperwork (mainly apparently designed to see if I was an addict, from what I could tell). They would not let me make an appointment until the forms had been processed. In fact, neither would the one before that, though they told me how to contact the out-of-hours GP.
Normal GPs get NHS funding according to the number (and stats) of their registered patients. If they’re not also down to do emergency cover (which is funded differently), you just show up, they don’t get paid to treat you, as you’re not on their books.
For emergency treatment. In my case, I needed a steroid cream due to a sudden eczema flare-up and was told that sorry, they couldn’t see me. I had to wait for the registration to go through or see the out-of-hours doctor. Possibly the existence of the local out-of-hours doctor means they have to apply that rule strictly- they were most apologetic about it, but that’s who I had to see.
It’s up to the surgery if they require ID to register, and they increasingly do (got to look like they’re tackling fraud, don’tcha know!). My last two have.
No, you are wrong. The numbers I was looking at from the chart that is in the link:
Medicare/Medicaid subgroup - 79% satisfaction with their care; 79% satisfaction with their coverage.
Privately insured subgroup - 85% satisfaction with their care; 70% satisfaction with their coverage.
National adults (all adults) - 80%; 69%.
What that tells me is that the uninsured are pulling down the overall averages. Privately insured are doing very outstanding in satisfaction with care and doing good with coverage, and are not pulling down the average below 70%. Med/Med folks are doing very well in satisfaction with care and with coverage. Uninsured…must not be doing so well.
The problem is not private insurance. The problem is uninsured people, which is a political problem. The problem in the US is politics. It’s not private insurance. People who have private insurance really really like their care, and they like their coverage. Med/Med likes their care and their coverage equally. Uninsured…a different story. Don’t blame Blue Cross. Blame Washington.
I’m sure your brother’s criticisms are sincere, and I have no issue with that. I’m extremely familiar with some healthcare systems in some Asian countries. And I’m pleased with what I have in relation to what I’d probably have in those countries. And people I know from those countries have not complained to me about US doctors or US health care/insurance, when they’ve lived in the US.
I think your targeting of private insurance in the US misses the point. It’s like focusing on treating a sprained ankle when the patient has heart disease. The problem we have in the US is too many people with no insurance at all, of any kind. That’s the problem we need to attack - and ACA with thicker subsidies & stiffer mandate penalties, and all states on the Medicaid expansion, if the prices points are set right, would just about do the job.
The only way that that works is to make the penalty equal to the premium, and then if someone does not buy an insurance policy, then you use those penalties to pay for them to have an insurance policy anyway.
A public option would be very useful, especially if everyone was automatically enrolled unless they had a private plan.
If it’s less, then many people will just do without, and be resentful that they are being penalized for something that they cannot afford.
The gap between subsidies being useful, and actually making enough for the premiums to be affordable is too large, and too many fall into a range where the penalties make them resent ACA, as they do not qualify for medicaid and do not make enough to float the premiums.
For those who are worried about private insurance going away, I don’t see why we would actually make private insurance illegal or anything. However, if we offer a better plan than private insurance offers, then who is going to be upset about private insurance going away*? You can still get it, it just costs more and covers less.
(*Other than those who make their money off of siphoning it out of dollars meant to go towards healthcare)
But the point is that there are ways to improve the ACA. In the old days, when bills like that were passed, congress would later circle back and do a technical mark-up to fix any holes or flaws. So, things you’re talking about, could be done. Penalties and subsidies could be set such that more people are trying to buy the insurance. The Medicaid expansion deal could be sweetened to induce more states to get into it. This isn’t impossible from a technical standpoint. But in our political climate, it seemingly is impossible.
So, I think we’re left with blue states leading the way. There are maybe up to a dozen or so states that could experiment with something like a public option, or a better deal for subsidies, etc. I think this is the next logical step in our political environment today.
You seem to be missing that your numbers combine Medicare and Medicaid, while the passage I quote is for Medicare only. I have no problem believing that the Medicaid numbers are much lower than the Medicare ones.
I agree that the uninsured pull down the numbers. But if we’re going to insure them, let’s do it uniformly, which increases the size of the risk pool and thus cuts costs. We definitely should not pay private insurers for them. And if we put them into Medicare, I suspect private employers will dump their coverage. Which is fine so long as they are taxed to get the revenue to pay for the new influx of publicly covered people. So we’ll wind up with Medicare for all eventually - let’s do it efficiently.
I was one of those folks with a good insurance policy. I was happy with my doctors and occasional hospital visit, though the insurance company tried to complicate my life occasionally. But then I lost my job. COBRA was incredibly expensive and no other company would cover me due to trivial pre-existing conditions. Try coming up with $1,000 a month when you are out of work.
The problem is not that people are uninsured, it’s that we have insurance companies at all, and that healthcare is tied to your employer. We spend twice what every other developeday country does to cover fewer people and get worse resultsm
But for the purposes of the sort of discussions we are having in this thread, what we need to see is rating of both systems by people who have experienced both.
i.e. those on medicare (which is the quasi-UHC one yes?) should score their experiences on that system, paid for purely out of taxation versus their previous personal insurance system.
That sounds very familiar to us in the UK. The politicians can’t, as a matter of political reality, interfere with the core principles of the NHS or with system-wide clinical judgements (let alone what happens to individual patients), so they reorganise the structures for budget distribution instead. We’ve gone from local to regional and back to local two or three times over the decades (currently we’re in a hyper-local phase, on the argument that local GPs know best how to allocate funding to meet local clinical needs best, and to develop local integration across the medical/social care boundary).
I agree that once someone loses their job, there’s a problem in the US. You’re at risk of becoming uninsured unless you can quickly find another job or you pony up the cobra costs. I think that should be reformed. But that’s a political issue, not a problem related to the existence of insurance companies.
Also, how did your situation end up? Did you find new coverage? Did you go uninsured for a bit, etc?
OK, but they’re both types of government insurance. Medicaid covers 74 million people in the US, and there are proposals that have been brought out on the Left to go to a Medicaid for all system. Medicaid pays richer benefits than Medicare, but fewer doctors will see Medicaid patients, because of low reimbursement.
And your original point that private pulled the number below 70% was incorrect, as I pointed out, as you misread the link.
The issue on the insurance companies’ side is not their existence, but that they’re in charge of the medical system; the Swiss system is completely insurance-company based, but nobody loses their coverage when losing their job. The level of coverage the Swiss consider minimum would be ultra-super-duper-premium in the US, and the level of paperwork involved in a claim (for lack of a better word) goes from nothing to having to send in a one-page form and a copy of the invoice. If you see a doctor in Switzerland and are insured there you just need to hand your insurance card to the doctor’s receptionist; the doctor will process the payment with the company. You only need to do the form-and-invoice bit if you’re asking for reimbursement for an out-of-country payment. The one time I did it it cost me less than ten minutes and that’s because I was OCD about checking that I’d understood every verdamnt field description (for some reason the forms were available in bad Spanish but the instructions only in German).
The problem IS private insurance. Failing to recognize that central fact guarantees that the fundamental problems will never be solved. Ever.
I laid out some of those problems in #105. You even acknowledged them in #112. What you did not do was explain, either there or anywhere else, how those problems can be solved with private insurance. What you tried to do instead was explain why the US political system would not allow a public system like single-payer to be established. Now you seem to have switched tactics, as I read it, and are now claiming that private insurance was never the problem.
A few explanatory notes. “Private insurance” means private insurance as it operates in the US today, covering medically necessary health care for the majority of the population. Private insurance can still function if it only provides supplemental benefits. It can also function, as it does in many European countries, in a highly regulated mix of public and private coverage, where typically the vast majority are covered under a public system and a few can opt in to private coverage. For any of this to happen in the US requires a fundamental change in mindset and a rejection of conservative/libertarian fears of government, because government is an essential partner and regulator in all these systems, and is a central component in any model that seeks to have the private sector play a constructive role in health care coverage. And until it happens – and as long as the political right regards government as an enemy to be fought and suppressed – the central problems of costs, denials, complexities and mountains of paperwork will never be solved.
Some European countries have systems that superficially appear to be similar to the US one, such as Germany or Switzerland where everyone is insured by some nominally private non-governmental entity. The superficial similarities disappear as soon as one digs into the details, and discovers that the systems are as different as night and day. They would be virtually unrecognizable in a US context. Before the ACA, US health insurance was exactly like car insurance. After the ACA, it become just a little less like car insurance. But in these European countries, for medically necessary services their health insurance systems are all fundamentally patient-centric, tightly regulated, community rated, intrinsically universal, and really more similar to single-payer than to conventional insurance.
No, I didn’t respond directly to each point you made in #105. I do acknowledge that the US healthcare system has issues, as I’ve never said it was perfect by any means. But that’s not the same as acknowledging that private insurance is the issue. I will now go back and address your bullet points on #105 more directly. Give me a little time.
Yes, as I recall, the Swiss system is somewhat like the ACA exchanges for an entire country. I think the ACA was modeled, at least somewhat, along those lines. The idea is that companies must provide coverage, government must subsidize, and individuals are mandated to buy. This is the basic Swiss model, and it was the original ACA model (only too weak on a few fronts).
I would also note that I have very little hassle in paperwork or in claim payment with my insurance. We use it a lot. Little to no hassle. Reasonable co-pays, deductibles…“what a nightmare”!
