I understand the insurance companies do not pay this high amount as they can negotiate lower rates. Individuals can not. My brother is an ER doc and they only collect about 10% of uninsured bills.
Most of my friends are uninsured (goes with the industry)… one paid $17,000 for a fractured arm not too long ago and another $9000 for 5 minutes in the ER and 2 pills. So some people ARE paying these astronomical rates.
Best of both? Ever been to the CR or UAE? The medical care is great for a low cost, but there quality of life and climate are not the best.
“We” being the USA (I’m American). I would much rather live in the close to my family, but can’t risk being uninsured.
Sure. That is why I am saying that a single payer system will reduce the uncertainty. The average may be $1500 which you might say is bad enough, but it sucks to be the 1% guy who pays $10,000. More than 1% might be billed $10,000 but how many actually pay it.
When I read the OP, I see him/her asking if having a UHC would make health care cheaper for the average person in the US, either by lower premiums or cheaper costs for medical care and supplies. In what you quoted, my opinion on the latter is no.
I don’t know if they are getting the quality of care that we are. I also don’t know if they are paying more overall in taxes than we are, resulting in their UHC being supported by non specific taxes. I don’t know if the fact that those countries have had UHCs for decades makes a difference, or if the fact that those countries are smaller in size and/or population makes a difference. I do know that just looking at one statistic doesn’t tend to tell the whole story, particularly if the stat comes from someone that wants a UHC (or whatever the subject).
Interesting take on what I said, however untrue. What I am actually concerned with being able to hold onto at least some of our money so when my husband retires we will still be able to live a decent life. We are already paying a large percentage of our income into taxes that pay for health care for the poor (and in my state, the illegal), schools that cannot even teach the children to speak or write correctly nevermind decent math skills, to bail out people who had no business buying homes, etc. I don’t care if anyone is “punished” or not, I just don’t want to have to pay out even more of what could go into our retirement supporting the irresponsible who are unable to plan ahead. Of course, I don’t know that everyone or even a majority of the people who cannot get/afford insurance fall under that description, but since there are so many folks who are irresponsible with their finances, I’m afraid I tend to assume it.
I’ll gladly tell you why I don’t have insurance.[ul][li]I’m an independent contractor. I don’t qualify for any sort of group plan.[/ul][/li][/QUOTE]
OK, did you know that you would have to pay for your own insurance when you decided to go into this line of work?
[QUOTE]
[li]I have been diagnosed with a chronic and incurable condition that right now has no actual effect on my health. It’s an annoyance, but it doesn’t debilitate me, I don’t need medication, it has no daily impact on my life at all - it was diagnosed secondary to something acute and easily curable. This chronic condition, however, can cause and/or be linked to all sorts of not so pleasant issues including hypertension, diabetes and heart disease, my risk is marked (but not specifically quantified) as higher because of the underlying ailment, thereby deeming me a “bad/high” risk.[]I weigh more than is deemed acceptable according to the arbitrary charts and lists.][]I am female, and still within my childbearing years.[/li][/QUOTE]
None of this will keep you from getting coverage with a group policy when you finish your training.
[QUOTE]
[li]Years of tenuous employment and iffy income, as well as outstanding medical debt from an unpredictable/unpreventable illness several years ago (which affected my employment) have damaged my credit rating[/li][/QUOTE]
Damaged as in you have no credit at all? No credit cards?
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[li]It has been a number of years since I had insurance coverage, so the HIPAA protection regarding my pre-existing condition is long expired.[/LIST][/li][/QUOTE]
Again, this won’t affect you when you get a job with group coverage. You may have a period of up to 18 months where they won’t cover your pre-existing, but that is it.
Group policy insurers are not longer allowed to deny coverage (except for up to 18 months) based on pre-exist and I don’t think they were ever allowed to look at your credit history.
How did you get to this point? Did you not know that you would be unable to get insurance?
But after that, you would have full coverage and until then you would be covered for injuries and anything they didn’t deny due to pre exist.
I’m still not getting this. I was poor when I was young and first out on my own, as in I lived in a house with no heat, in a town on the Canadian border, living on less than a dollar a day for food and all that. So I went without healthcare, which I am paying for now in my old age, but that’s just the way it goes when one is young and broke. Eventually, I got a decent job that offered group coverage when I was about 25 and have held on to that privilege ever since.
So the US should start up a huge UHC project so you would have coverage for the next five years, until you finish schooling and start in a field that will provide group coverage? Because you chose to go into a field that not only doesn’t provide group coverage, but also apparently doesn’t pay well?
But, that is your choice. You can become an employee and get group coverage, or you can remain self employed.
Which would not be an issue if you had not chosen to be self employed.
That isn’t what I meant - I was asking how common is it that there are people out there who are employed with decent incomes who cannot get insurance for whatever reason, such as you being self employed with a genetic issue that private policies won’t cover. In your case, wouldn’t it make more sense to extend Title I of HIPAA to private policies rather than trying to make a UHC work?
I’m not sure that second one is really possible, if you want the policy to cover everything. Cancer, for example, is extremely expensive to treat so the premiums have to reflect that, no matter whether it is a private company or a UHC that is covering it. Maternity is also very expensive to cover, as are babies/toddlers. Unfortunately, everyone has to pay the same premiums to cover these expensive things.
I am not of the opinion that would be true. I cannot think of one thing that the US government runs that is more efficient and less costly, while maintaining quality, than what is run by a private company.
I don’t know anything about the Czech system. Are the locals paying very high taxes to subsidize their UHC? How is it that someone from out of the country was able to get such cheap care there? I have trouble believing that the quality of care was the same given the difference in price - it’s not like hospitals here are wallowing in money, or that the average doctor is a millionaire. So if that $10,000 figure is realistic, there has to be a significant difference in care. I think it likely that the doctors there don’t make as much money as ours, but the difference between $450 and $10,000 doesn’t seem to cover that.
Another factor is our FDA. I don’t know (but doubt) if the Czech Republic is EU/ISO so it is entirely possible that they do not have to pay the millions of dollars to test and get approved any and all drugs and medical devices, as we do here. It’s pretty much impossible to compare here and any other country straight across like you have, without taking things like the FDA into consideration. Even HIPAA, as helpful as it is in some ways, added quite a bit to costs.
There are no free lunches, and there are no simple conclusions.
You can’t just compare different country’s health care programs and decide that the one that spends the smallest amount of GDP must be the best, even if they score highly in things like infant mortality and life expectancy and cancer survival rates.
America’s population is quite unhealthy in a lot of ways. Obesity is a big problem. America also spends a lot more on health care for people simply because the people demand it. Health care costs are skyrocketing because we can do more for people than we used to, and that costs money. People who, 30 years ago would have had a heart attack and died of a secondary a couple of years later, are now living 20-30 more years, often on high-cost medications and expensive surgeries like bypass operations. The U.S. has no problem giving an 80 year old a hip replacement if the person can pay for it. The U.S. attempts to save premature babies that other countries don’t. This increases costs and also increases the infant mortality rate.
And so it goes. The link above that describes the various systems glosses over the fact that governments tend to control costs through rationing and intentional shortages of certain devices and people to keep costs down. Interestingly, Britain has privatized some of this elective surgery to keep costs down in the public health care system. The elderly in general tend to be the ones discriminated against.
Are Americans ready for a system in which a doctor consults a government schedule and then declares, after feeding your personal parameters into a formula, that you don’t qualify for the treatment that could save your life, and instead orders palliative care to make you comfortable as you die? This happens in Britain under the NHS. And you can’t spend your own money to seek your own treatment. That wouldn’t be ‘fair’.
I did not choose to become self-employed. The company I was working for went under (so no COBRA option). Here in Nevada only about half the companies provide coverage at all. If they would issue without regard to pre-existing, I’d be ok with that, assuming reasonable costs.
The post office works pretty well for what it costs. 42 cents to send a letter from Maine to Honolulu is a bargain.
Locals pay about 35% tax overall. Anyone can go there for care - you do not have to be a citizen… but CR citizens or EU citizens can get free care… others have to pay.
Doctor’s make less, there is far less bureaucratic paperwork and they do not order useless tests just to cover their ass because they don’t have the malpractice lawsuit industry we have.
Another factor is our FDA. I don’t know (but doubt) if the Czech Republic is EU/ISO so it is entirely possible that they do not have to pay the millions of dollars to test and get approved any and all drugs and medical devices, as we do here. It’s pretty much impossible to compare here and any other country straight across like you have, without taking things like the FDA into consideration. Even HIPAA, as helpful as it is in some ways, added quite a bit to costs.
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Yes, the Czech republic is EU, and the quality of the care is the same as I have received in the US… or at least it was for me on this occasion. Some examples:
Blood test: $9
Pathology on a tumor: $30
1 hr out patient surgery with doc and nurse: $190
Sonogram: $30
For Czechs, this would all be free. Prices are similar in Thailand which has similar care and nicer, more modern facilities (but I don’t own an apartment in Thailand!)
You may not have chosen to become self-employed, but it is most likely your choice to stay that way since it’s been seven years more or less since that company went under.
The thing is, you want two conflicting things - an insurance policy that will cover you without regard to your pre-existing condition, and what you consider to be a reasonable premium/copay/deductible. Can’t be done without it being subsidized by someone and under a UHC that someone is the taxpayer. I’d much rather that employers subsidize it.
What private company out there moves one ounce mail around as a majority of their business?
Yow.
Our lawsuit problem isn’t going to disappear if we get a UHC in here. Or the cost of medical school, malpractice insurance. As for bureaucratic paperwork, the government lives for that!
Since I have been out of the US the whole time, it’s hard to say.
I currently have private health insurance from a UK firm. It is valid everywhere in the world except the USA. My deductible is about $1400 (it changes since it denominated in GBP), and the max policy limit is about $7 million. For my wife and I together, we pay about $200/month. How is it that they can offer these rates, and be profitable in every country in the world… EXCEPT the USA?
35% is not too high considering that covers the equivalent of social security. Actually the Czech republic has an income tax of a flat 15%
Someone still pays in this situation. If the employer pays, then the employer’s products cost more and it makes people’s job mobility lower since they’ll be reluctant to switch jobs making the labor market more inefficient. I think the best system is an opt-in government based plan (the same on my congressmen get) and people can choose an employer based system, government system or private system.
Because you are free-riding on the USA. That is where all the new drugs, devices and techniques are paid for. It is not right or wrong, maybe it is clever of you and stupid of us Americans, but let’s not pretend as if it is all free. If all advances in medicine in the last 40 years or so (since all major industrialized countries adopted what amounts to a marginal cost pricing of medical services) all medical research is being funded in the only relatively cont-uncontrolled market, the USA.
Look at how much chemotherapy has improved since the 1970’s, when people would literally choose to die rather than endure it. If the NHS or OHP was a global system, the drug companies would have no incentive to develop the drugs with lower toxicity, except the goodness of their hearts.
Financial incentives are not the end-all and be-all, but you ignore them at your peril.
The US system has its own problems. Huge problems. Basically we spend $1 making sure that the other $1 is well spent, because things are so “fragmented” (or “competitive”) on the insurance side. Even the same insurance company may have dozens of plans, even hundreds, each with different rules, exclusions, approval requirements and so on.
And doctors in the US are in general paid much more, both in absolute terms and relative to the average incomes of the county, than doctors in any other first world country. For example in Australia a doctor makes less than a mid-level government bureaucrat, or an experienced school teacher. Same thing it seems in Japan, where as the population ages there is severe shortage of doctors developing. It is hard to fix because they don’t allow any immigration, which is how most of the rest of the industrialized world is dealing with their lack of incentives for people becoming doctors. They are importing doctors from India, Pakistan, Bangladesh, Sri Lanka, the Philippines and anywhere else they can.
I have doctors in my family that practice in the US, Canada and Australia. I think conservatively speaking the US doctor makes at least double what the Canadian one does, and at least five times the Australian one. I do not think there is more than a 20% difference between the median wage in these three countries. And the US doctor takes very nice family vacations (I mean “attends educational conferences”) in exotic locales every year. Greece and Fiji in the last four years. Not to mention he has an interest in a lab where his practice sends all their MRI and CAT scan requests. His tax return is the thickness of a Tom Clancy novel, and probably has more intrigue in it.
The Canadian and Australian doctors talk about practicing medicine. The American one talks about investments, taxes and the cost of liability insurance. I once pissed him off, by saying that “If you are going to make more money than God, you shouldn’t be surprised if people expect you to perform like God.”
I can see that new drugs and cutting edge procedures may cost more, but surely setting a broken arm is very basic and has not changed much in 50 years. Still, the cost in the US recently was $17,000 vs a couple hundred in Europe (non-EU citizen).
While I recognize that the US has quality health care, I firmly believe we have the worst “system” in the industrialized world.
PS: My brother makes more money than God and talks about investments, taxes and the cost of liability insurance. So there you go. Profit above everything.
I seem to remember reading that drug advertising is prohibited in much of the EU. Drug company marketing budgets far exceed their R&D budgets, so reducing that might reduce the cost of drugs there quite a bit. I assume that EU countries negotiate with the drug companies also, in the way Canada does. Bush’s Medicare drug bill specifically forbids the government from negotiating, a triumph of the lobbyists. So, we can see how much the right cares about reducing health costs. Not at all - profits for the business is far more important.
I agree. The post I was responding to was advocating one simple solution - essentially he waved away the idea that a socialistic system could have benefits.
As far as free lunches - yes, if we keep doing things the same way and simply add more people to the system, it probably* would increase costs.
(* I say probably because we as a society have decided we aren’t going to turn dying people away from emergency rooms for lack of inability to pay. So that money has to be made up somewhere - either by the government, or by overcharging everyone who pays for their medical services. If we’re going to incur those costs anyway, we might actually save money with preventative care. It’s sort of like if the governemnt guaranteed everyone that they’d fix their cars if they broke down catastrophically, but wouldn’t help with oil changes, which lead to more cars breaking down…)
But most people are advocating changing the system to make it more efficient. I haven’t seen anyone dispute the number that 30% of all medical costs are administrative in nature. 30%! Now even the most perfect system will have some administrative cost, but I can’t imagine it’d be more than a few percent. So right there, essentially 25% of the costs of the system go into propping up the complexities of that system.
I’ve heard 10-15% figures for malpractice insurance and unnecesary cover your ass tests. There will always be (and probably should be) a cost to malpractice, but moving health care into the public sector would provide a more practical way to limit the costs on the system - easier than a comprehensive reform of our civil courts.
There’s the value saved when preventative care that wouldn’t have otherwise been undertaken solves a problem early that would’ve been much more expensive later.
There are indirect economic bonuses such as a work force that can more freely move, not being limited or stuck at a job that doesn’t match their skillset or desires because they need certain things from their insurance. There’s a productivity benefit from having a healthy work force. There’s an economic benefit to people not being bankrupted by developing a problem at the wrong time in their life.
And of course there wouldn’t be the extra costs of a profit margin.
So we aren’t talking about a free lunch. We’re talking about logical, viable ways to reduce medical costs, such that even if everyone were added into the system, potentially we could still be saving money overall.
It’s strange - I would’ve never guessed I’d be advocating this one day - and I’m not, exactly - I’d like to see more data before I’ve made up my mind. Right now I’m just acknowledging that there could be benefits. I used to be against UHC for purely ideological reasons - being convinced that the government would screw it up and produce a worse system than private enterprise would. That - and UHC advocates I’ve encountered have used silly arguments like “everyone has a RIGHT to free health care!” as their main argument.
But when you look at the actual data comparing different medical systems, it doesn’t seem like the free market has served us so well in this instance. Not that I’m doubting the power of the market - but there are instances where it’s not ideal. The supply and demand of health care is nothing like it is for consumer goods - if I want a BMW but get a paycut, I can buy a Honda instead. If I can’t afford brain cancer treatment, I can’t substitute it with a cheaper hip replacement surgery.
Some libertarians squabble over whether or not the roads should be privatized - I wonder if we had a thousand different road-owning entities and a thousand different tolls to pay if we’d be better off. Maybe there are things government could end up doing better. Especially if you use a system with some sort of competition like they’re implementing in some countries now where medical providers compete for government funds based on quality of service, etc.
If a doctor prescribes me a medicine I’ve seen advertised it always makes me suspicious. Is che giving me this because it’s the best medicine for my case or for commercial reasons?
The medical care is great for a low cost, but there quality of life and climate are not the best.
