There are so many threads on health-care reform that this question has probably been asked and answered, so if it has, please forgive my redundancy, but whenever this point gets raised I haven’t seen anybody address it.
This question focuses on a single argument against UHC. The government would decide what to pay for and what not to pay for. The people making this argument seem to imply that as it is now, the doctors decide.
Other people and I have had things that our doctors decided were necessary, but the insurance companies refused to pay for anyway. So to me this argument makes no sense and even sounds slightly disingenuous because right now insurance companies and not the doctors are the ones deciding what gets paid for.
So if you’re worried about the government deciding what gets paid for, why are you OK with the insurance companies deciding instead?
I’m not exactly sure how to answer this. But In Canada as a general rule the government doesn’t really decide what gets covered and what doesn’t. They have a remarkably hands-off approach to things, and I think that’s what most Americans are unaware of. The government isn’t your HMO or insurance provider. You don’t submit forms for reimbursement or request approval. I know with my health care provider in Minnesota I’m supposed to call a number if I’m getting imaging done, assuming I’m awake and able to get to a phone.
In Canada, the government collects taxes, and then dishes that money out to the hospitals and doctors (it’s a little more complicated but not needed here). So it’s the hospitals and doctors that make most, if not all of the decisions. If you need x-rays, you’ll get them, if you need to spend 3 weeks in the ICU, you will. There is no overall bureaucracy deciding your fate, other than your doctor and the hospital they work in.
The only time it becomes an issue is with newer or controversial drugs and procedures, where the government has to decide if it will pay for it or not. I know my mother was part of a drug trial for Avastin. It was initially meant for people with colon cancer, and initially was found to only extend life by less than 6 months. But the cost of the drug was immense, I think upwards of $3000 per treatment. So the government conducted a series of trials to try and determine if the drug was effective enough to make it worth while.
So the short answer is that there is this drug that could benefit you, but it cost a fortune and may not actually do very much.
Because if you don’t like what the insurer is telling you, they can’t stop you cancelling your contract with them and paying for the treatment yourself. The government has the power to force you to buy their insurance (i.e. whatever health insurance levy they claim in taxes), even if it’s completely worthless to you and actively harms your ability to pay for the treatment you do need.
Ok, so I guess the point of discussion here is, what’s the likelyhood of your nightmare scenerio actually happening, and the government health plan not covering medically necessary stuff? Maybe you can dig up some cites of this occuring?
Why would you need to cancel your insurance contract? When the pharmacy tells me insurance won’t pay for medicine for my wife I just pay out of pocket. And because she’s disabled she’s on Medicare and Medicaid which means that the government is paying for her medical care and prescriptions.
It’s math. You cancel the insurance contract to divert the $$$ in premiums paid to an alternative treatment that the insurance doesn’t cover.
Just “paying out of pocket” does not recover the dollars lost to insurance premiums. Sometimes, you can afford to pay both the insurance premiums and out-of-pocket costs. Sometimes, you can’t. In the situations that you can’t, you have the choice of canceling the insurance and redirecting that money towards whatever treatments the insurance does not cover.
When you pay tax $$$ towards UHC, you can’t get that money back because of government law. Once UHC is in place, you can’t just decide to stop paying taxes towards UHC to fund your own treatment that’s not covered by UHC. That’s one of the differences between mandatory $$$ paid into UHC vs voluntary $$$ paid into private insurance.
The government is paying for medical care that the government approves of.
It is true that a similar restriction is in place for private insurance. But I hope I’ve explained above that the key difference is that the consumer still has some power left in his own hands because he controls the $$$ paid in premiums. He still has some discretionary power over his money paid to insurance. He has zero discretionary power over his mandatory payment in taxes to UHC. That money is gone.
But when people really need the treatment, say for cancer or something, canceling a couple of hundres or a thousand in medical insurance does not go far in paying for the tens or hundreds of thousands treatments (and tests, and hospital stays) cost and leaves the problem of you are then not covered for any damn things else. Really, do people actually do that?
It sounds a lot like the argument that universal healthcare will flood the hospitals with people getting colonoscopys for fun cause they are free
Okay, I figured out what bothers me about this line of reasoning. Right now, the US government prevents people from buying Cuban cigars. On the other hand, financial constraints prevent people from buying Italian sports cars. In either case, you are prevented from getting something you want.
When people talk about paying for a prescription or a procedure out of pocket, it becomes clear to me they have no idea how much health care costs. Sure, a $10 pack of pills, no big deal. But as I posted above, what about a $3000 dose of chemo once a week for 6 months, do you have that kind of change laying around? Or a $100,000 operation at the Mayo clinic.
When I shadowed a cardiothoracic surgeon, at one point he was doing an aortic valve replacement on a 90 year old. He had worked in Canada for several years, and said that there, this procedure basically would not have happened. It would have been very hard to justify doing a complex procedure that at best could give her a few extra years of life.
I’m a little slow this morning. Is the argument saying that the taxes paid which fund UHC are equivalent to the amount paid now in premiums? For example, I’m paying around $600 a month to keep four people insured. Surely my taxes won’t be going up $600 a month for UHC?
I’m thinking it’s more likely that the argument is along these lines: a person must have a health insurance policy under the UHC plan, either the gov’t plan or a private plan. If they’re on the gov’t plan and it doesn’t pay for a certain treatment, they can’t just drop the insurance and direct the $$ to the treatment; whereas, if they now are under some private insurance and it won’t pay for a treatment, they could drop the insurance and divert the amount spent on premiums to that treatment.
As others have said, I’m not sure that amount of money would pay for much, but there is a little window in there where some people might choose to do that. Example: I’m prescribed a cholesterol med which costs $168 a month. It’s not easy paying for that and my insurance premium too. Theoretically I could drop the insurance and spend my money on the med. I would be loathe to make that choice for a few reasons, two being: my money spent on the med would no longer be tax deductible, and if something catastrophic happens I could be financially ruined. I can, however, see somebody making that choice.
At the risk of sounding harsh, I don’t think I’d want an aortic valve replacement when I’m 90, and I wouldn’t advise any relative of mine to go through the pain and suffering of such a significant operation at that age. It would be hard to justify.
I think what bothers people is that their choice would be limited - that they couldn’t choose to get the surgery for Grandma; they might agree with me that it’s not justified, but they would want the choice to still be there.
Point one: health care is rationed in America; it is just rationed irrationally.
Employers decide what plans to buy and can only afford so much. What gets left out of coverage is often even hard decipher when one wades through the actually insurance policy statement. But no plan covers everything and many do not cover many very basic services or define some well established care as “experimental” and subject to extra high deductibles in the thousands and a larger co-pay after that (Growth Hormone for established growth hormone deficiency for example).
Don’t have a job with a company large enough to afford offering health insurance? The pay more for less of a product and god help you afford it if you can find it if you or yours have anything that the insurance companies consider a pre-existing condition - no matter how long ago it was or how trivial. Care to you is rationed as you are economically excluded. Irrational as that may be.
Point two: Just like now, if you want someting not covered by your plan - an extra well care check up, an early mammogram outside of guidelines but one that you and your doctor think makes sense for you, some goofy test, whatever … you can have it - you just got to pay out of pocket for it. And no rational person would go without insurance for everything else in order to divert money to that extra bit.
Point three: speaking as a doctor I can tell you - when we doctors have problems with payors refusing to cover care we feel is required it does not come from any government funded system but from the privates. The government systems (Medicare, Medicaid, whatever) pay for things we order. Maybe not well enough, maybe kiting out the payment cycle, but they’ll cover it.
UHC is a pipedream not worth considering right now and has a host of other potential pitfalls. But the argument that it would lead to rationing care worse than we have right now is the opposite of the truh. It would result in less rationing of care and the rationing that would persist would at least be more rational than the irrationing of care we currently suffer under.
Colonoscopies, maybe not. But if you were sick, and you didn’t have to pay for your own treatment, wouldn’t you take the latest, most high-tech solution possible, even if people only think it’s slightly more effective? Certainly there would be no reason for you to skimp. You seem to think that higher cost = more uncomfortable, which is clearly not always the case.
If a particular person with AIDS wants to try an experimental drug that’s not covered by private insurance, it is “rational” to sacrifice insurance to help pay for treatment that might keep him alive.
Yes, the standard insurance will pay for hospital costs if the AIDS victim gets into a car accident but what’s the point of that peace-of-mind if that AIDS person is dead?
Isn’t worrying about the insanity of not having insurance for non-AIDS related medical issues a luxury for those still alive?
Yes. A rational system would refuse to cover a procedure that would cost many tens of thousands of dollars that had very little potential upside in either quality of life improvement or years of life saved and substantial risk of immediate mortality andof increased morbidity.
The fact that our system and the systems proposed currently by Congress would not address that irrational expenditure while not having the money for many interventions that are proven to have huge returns on the dollar in terms of years of life saved, quality of life improvements, and future costs averted, is a problem. The specter of having a system that can say no to some waste in order to yes to more important things would not be a problem.
No it is not. It is not rational for a person with AIDS to give up the proven effective medicines that keep his or her disease at bay, the coverage for antibiotics and hospitalizations for pneumonias, etc, in order to try an unproven snake oil. Those things provide him or her potentially hundreds of thousands of dollars of care per year and both prolong his or her life and improve the quality of that life. Giving that up to pay for ten thousand dollars worth of an unproven approach is irrational.
The thing is, when you don’t pay for the treatment you don’t think, or generally even know, about the cost. You go with what your Doctor recommends as he’s the expert and in comparison you know bugger all.
The idea of telling a Doctor to not do that test but do this other one instead is utterly alien to me.
For the record I grew up under the UK’s NHS and now live in Sweden.
You have very valid points – but they are valid points for a different debate – the debate about effectiveness of treatments a person-by-person basis.
You have not eliminated the logic behind why a person would prefer to keep his choice of how to spend his health car $$$ towards insurance vs treatment. The “unproven” aspect of the treatment is irrelevant.
Again, waiting for years of clinical trials to see what is “proven” is a luxury for those that are still alive.
Your hypothetical individual with AIDS has a choice: pay maybe $10K/yr for insurance that is providing a variety of very expensive (hundreds of thousands potentially) services that (s)he needs or will be at high risk of needing in the near future and either go without this uncovered benefit or pay for it out of pocket; or go without coverage for those services and divert that money to the uncovered benefit. Which choice is rational?
Why would you need to cancel your insurance contract? When the pharmacy tells me insurance won’t pay for medicine for my wife I just pay out of pocket. And because she’s disabled she’s on Medicare and Medicaid which means that the government is paying for her medical care and prescriptions.