I was watching a bit of the politicians talking about the "paying" part and there seems to be an idea that the sick people should pay for their costs. But isn't that the opposite of having insurance? The very nature of insurance is to spread the cost or risk around a large group where it is not known who will incur an expense. So splitting people into groups with premiums corresponding to risk defeats the purpose of insurance and certainly won't end up providing healthcare for more people than the ACA did.
It has been obvious to me that the only effective way to provide universal healthcare is to provide universal healthcare, as in a single payer system. That may be socialistic, but it is the only healthcare system that will work in that context.
It's called medical tourism. I almost went that router in 2007 when I had to deal with an uninsured prostatectomy. I have various options (Singapore, India, Mexico, etc). All provided an initial estimate of about 10% of the cost of having it done locally in California. That seems like a great deal, until I did the math. Well, actually what I did was hire an "expediter" to do the grunt work and arranging.
The cost grew rather quickly. I would need to pay for someone to go with me that spoke Spanish, carried my money and paper, and handled all the minor arrangements. That immediately doubled the non-medical costs. In the USA, hospital billing is done on the dinner plan, where everything is included in one bill. For medical tourism, everything is ala carte, where each part of the puzzle is billed separately. If you want nursing, that's extra. Food? Also extra, and so on. By time I added up all the incidental, personal, medical, and gratuity costs, the price was rapidly approaching the cost of doing the surgery locally. Note that the local price was for cash, not insurance. The cash price is 50% of asking price, because that's what the hospital would receive if they took me to collections, which is what usually happens with self paying patients. In the end, I decided to avoid the car ride back from Mexico after surgery, pay the extra costs, and have it done locally.
Incidentally, the reason I picked Mexico was a potential problem with the airlines. I could have saved quite a bit of money if I had flown to Singapore or India. However, the airlines have a policy of requiring a doctors signature before allowing a recent surgical patient on their airline. They don't want to risk a medical emergency while in flight. Usually, that means doing anywhere from 1 to 8 weeks of "recovery" before being allowed on the airliner. There are expensive ways around this, but I didn't want to chance it.
I have a few friends that live in Canada. They're all disgustingly healthy, but their aging parents are not in such good shape. When they have a problem that requires medical attention, they have to wait, often for long periods of time. I know of one that dies waiting. I don't know if it's the lack of medical facilities, lack of doctors, or lack of funding. Those that went to the USA for surgery went because they didn't want to risk waiting any longer, not to save money.
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Jeff Liebermann jeffl@cruzio.com
150 Felker St #D http://www.LearnByDestroying.com
Santa Cruz CA 95060 http://802.11junk.com
Skype: JeffLiebermann AE6KS 831-336-2558
The thing about US health care is that you can buy what you want, even it i sn't what you need.
Canadian health care takes medical ethics more seriously than it's US equiv alents. The poster child for this distinction was some Canadian politician who wanted his aortic valve replaced without open hearth surgery - you can use catheters to get to the valve through the arterial system.
His Canadian doctors through that this was irresponsibly risky for somebody who was healthy enough to survive open heart surgery, but somebody in Amer ica was happy enough to take his money. He survived the surgery, so he was happy.
The aftermath of open heart surgery is a couple of months of recuperation f rom the damage to your chest - I've been through it - which is what the pol itician seems to have wanted to avoid.
There are so few of either that it doesn't take all that many tourists to c log them.
The UK government is the same. The public health statistics demonstrate that Americans don't get value for money.
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The ranking table is on page 18 of the 23-page .pdf
Canada - at 30th spot and Australia - at 32 both do better than the USA at 37. The UK at 18 - is quite a bit higher up. France is number 1, the Netherlands, at 17, is just a head of the UK, and Germany - at 25 - still beats Canada and Australia.
Yep. That's the problem. Every politician talks about the benefits, but few will even mention by whom and how those benefits are paid.
Yep. Incidentally the largest healthy group that pays into such a system are children and teenagers. Statistically, they have the lowest need of major medical attention, which is why their insurance premiums are lower. If universal health care assesses a uniform tax (yes, it's a tax) on everyone equally, the younger sector is likely to see the largest cost burden.
The problem with any such system is being fair about distributing the costs, and the benefits. The definition of "fair" varies. I'll define it as not being a financial burden on the payers, and not being a medical burden on the recipients.
On the benefits side, no system can afford to pay for multi-megabuck long term care for the extremely old. While this is socially and politically unacceptable to propose an Obama "Death Squad" style of cutting off medical care, it will need to be done or this expense alone will bankrupt the system. Therefore, there has to be a ceiling on benefits received per year per person. The same applies to medical billing by doctors and hospitals. There has to be a ceiling on payments, as there is in Medicare, or it will invariably go out of control.
Also on the recipients side, there has to be a list of maladies and a point on that list, below which the healthcare plan simply does not cover the costs. For example, I don't want my tax, er... premium dollars to pay for someone's cosmetic surgery, hangnail, or common cold. Make a list, draw the line, and be done with it. It's better than running out of money before the end of budget cycle. I think (not sure) this is effectively what Canada has done.
On the recipients side, there has to be a priority based on the likelihood of successful treatment. This is the worst part of triage. If you have limited dollars, do you perform expensive heroics on someone with a very high likelihood of dropping dead anyway? Or do you give them the bad news and use the money to treat those with a better chance of recovery? Such decisions have been heavily discussed in the medical profession but show no sign of producing a consensus. Now, the same decisions will need to codified into a law by politicians unqualified to make medical, moral, ethical, and apparently economic decisions. This is going to be difficult and ugly.
As with all government services, it's money and its associated greed that makes things run. Without money, a national healthcare system is ummm.... bankrupt. Without greed, many of the important players would not be interested in participating. We demonstrated in California what can happen when the voters decide to take greed out of the equation in 1988 with Prop 103: The voters simply decided to lower their auto insurance rates by freezing rates and effectively requiring the insurers to operate at a loss. That didn't play very well with the insurance companies who immediately refused to write new policies in California. The same thing will happen if congress does that to the medical and insurance industries. They'll probably go on some kind of strike until congress comes around to their point of view. I wouldn't mind seeing that happen with the insurance companies, but it would a national disaster if the medical profession went on strike or even a slowdown. Bottom line is we probably can't write greed out of the system.
In a previous rant, I mentioned that the AHA added about 20 million new recipients who had never paid into the system. Now that they've tasted the free lunch, they're not going to go away. What should have happened is that since they hadn't paid into the system, they should not be allowed to extract full benefits from the system. Some kind of graduated benefits scale could have been contrived, based on the years of contributions and the age of the recipient. However, this wasn't done, putting a huge financial strain on the system. I think it's too late, but if the Republican's have the guts to reduce benefits for these recipients until the dollars can catch up, that's fine with me.
As for whether it's Socialist, Communist, Fascist, Utopian, or whatever, it doesn't matter. Instead of the Marxist "Greatest good for the greatest number", the AHA established the principle of the "Greatest good for everyone without limit" paradigm. In my never humble opinion, that won't fly. Modify the mantra so that it's financially self sustainable, and it will have a chance at surviving. Building a health care system that lasts for maybe 10 years, runs out of cash, and dies, is not a good idea.
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Jeff Liebermann jeffl@cruzio.com
150 Felker St #D http://www.LearnByDestroying.com
Santa Cruz CA 95060 http://802.11junk.com
Skype: JeffLiebermann AE6KS 831-336-2558
I think there is some applesauce here. First, I recently had my hip done and one of the options was to go to India to lower the costs. I spoke with one person who had it *all* paid for by insurance since it was so much cheaper than here in the states. They convalesced for two days before returning. So obviously the airline is not a problem.
As to the shortage of medical care in Canada, I don't believe for a minute that someone needing care to save their life isn't put at the head of the list. Yes, it may be that someone died while waiting, but did they die from the condition or were they run over by a bus? I have heard that you wait some months before a hip replacement, but hip replacements are often recommended long before they have major impact on your life. In Canada everyone waits six months before getting a hip replacement while in the US only some are able to get them and others go without because they can't pay for them. I know which healthcare plan I would choose.
You seem to be a bit long winded on this topic tonight. Your definition of "fair" seems to ignore realities by including contradictory requirements. By definition medical care is a burden on the payers. Medical care is expensive even if we get our costs in line with other countries. I'm not sure how it would be a "medical" burden unless care is denied which isn't "care".
That's a bit of applesauce. The present system is paying for care for the extremely old. Why can't all systems pay for that?
Yes, total applesauce! How are we paying for it now? Why hasn't it bankrupted us so far? Are you talking about the baby boom? How about we keep the care for the old people and end care for the very young? That sounds more fair to me. We can always make more young. We have a large investment in the old.
Of course I am being factious about this.
Ok, set a ceiling on the dollars spent on any individual, but not per year, per lifetime. That is like Logan's Run where the robot cops were hot on his tail until the funds ran out and they gave up the chase. So you could have had lots of expenses as a child and get a cold later in life and they let you die.
Setting an annual limit is worse. One major illness and reach your max. Another $5 shot of antibiotic, you reach your limit and they let you die.
You really aren't even trying to think clearly are you?
I literally don't know where you are getting any of this nonsense. Just look at other countries. They give away healthcare without changing the way they do the caring. The finances do *NOT* have to dictate how to administer the care. The *existing* system provides good care in the US for those who can pay for it. We just need to extend that to all and find a way to pay for it. That does *NOT* mean we have to change the very nature of how we give care.
Why are the dollars suddenly so limited??? Where are you getting this nonsense?
No, it does *not* need to be made part of law. They already use exactly that process for the aspects of medical care that *are* rationed such as transplants. But it isn't so much a financial issue as a medical one. Likelihood of medical care working is applied in all cases, but through science which is then applied by doctors. If it is an accepted means of care as proven by research and practice it will be paid for. There is no reason for laws regarding this.
You wore me down, I stopped reading the last few paragraphs. But I'm sure they are the same based on a mistaken assumption that somehow medical care has to be rationed differently than we are doing now. The people who oppose universal healthcare say our present system is fine. The only changes needed are extending it to all and paying for it. Nothing needs to change about the care itself other than perhaps finding ways to remove some of the profit taking. Currently it seems to be about making doctors rich first and giving care second.
You did well. The information on the airline problem came from my medical tourism advisor. I did not verify if it was true or not and whether it varied by country. I probably should have checked.
Canada healthcare wait times hit 20 weeks in 2016:
I was told the medical situation of the person who died waiting, but it was so long ago, I don't recall the details. I think, but am not sure, that it was directly related to their situation. I don't recall his age. I can ask if you're interested.
I'm not sure I did much better in the US. When I had the prostatectomy, I experienced 4 delays totaling about 3 months. Each time, it was because they had someone else that was more urgent than my operation. When my PSA score looked like it was going through the roof, and the hospital wanted a 5th delay, I put my foot down and demanded an end to the procrastination: Ignore the big peak in Feb 2007, which was caused by kidney stone. At PSA=10.0, it is likely that the cancer would break out of the capsule surrounding the prostate and spread to lymph nodes or the liver. As it happened, it did leak out sufficiently that I had to go through radiation treatment, but not chemo, a few months later when my PSA started climbing again.
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Jeff Liebermann jeffl@cruzio.com
150 Felker St #D http://www.LearnByDestroying.com
Santa Cruz CA 95060 http://802.11junk.com
Skype: JeffLiebermann AE6KS 831-336-2558
In 2007, when I had a prostatectomy done, having the insurance company pay for medical tourism was not an option. Although I didn't have any insurance at the time, I investigated the possibility. I spoke with
5(?) insurance agents who flatly indicated that their policies did not pay for medical tourism and there was nothing they could do for me.
Things may have changed, somewhat. From 2013: "US Insurance Companies Expanding Medical Tourism Coverage" A growing number of insurance providers are exploring medical tourism as part of coverage. Note the word "exploring". For example, some members of Blue Cross and Blue Shield who chose to access this international option will have a dedicated case manager, who will coordinate all medical arrangements, including scheduling and concierge travel service. All travel arrangements will be booked and paid for, for both the member and a travel companion. The case manager will also help make arrangements for any necessary post-operative care upon the member's return to the United States. In other words, the insurance company wants control of all the travel and medical arrangements, which could get expensive. I think I paid my "expediter" about $350 for making all the arrangements, which I cancelled when the costs went too high. Incidentally, he was based in India.
At the time (2007) I did find one company that would accept me with pre-existing conditions and would pay for medical tourism. I smelled a scam and investigated. They wanted 18 months of zero claims while I paid $800/month for nothing. At the end of the 18 month period, I would be faced with a huge increase in monthly charges. I would be left with the choice of walking away from $14,000 and getting nothing, or signing up for a VERY expensive insurance policy. No thanks.
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Jeff Liebermann jeffl@cruzio.com
150 Felker St #D http://www.LearnByDestroying.com
Santa Cruz CA 95060 http://802.11junk.com
Skype: JeffLiebermann AE6KS 831-336-2558
What would you say is the meaning of this report? The term ?medically necessary? is not the same thing as urgent. They just mean things that you need. Hell, that's not hugely different from here in the US and the big difference is that *everyone* will get the treatment. Here if you don't have a way to pay, you just plain don't get treated. So the average wait time in the US has no value since summing infinity into any average makes it incalculable.
I recall waiting four months to see a dermatologist. I had to wait three months to have my hip surgery and that would have been longer but they called me to postpone it and I got them to instead move it up.
Exactly. They don't really give a rat's ass about you. They have other more important issues.
I didn't explore the issue since I had insurance and there was an out of pocket max. Last year turned out to be my biggest income year of my life so I didn't really care about the costs to me. The real reason was that I decided to go with one of the best surgeons available to get past my medical phobia.
I'm not clear. What was wrong with having it done locally?
Of course they want control. But better they provide that service than you have to deal with figuring out the arcane restrictions they would impose. You know how difficult it is to deal with the medical expense issues, imagine how complex it would be to deal with all the arrangements to suit an insurance company.
So you had *no* insurance? That's a totally different animal. But it's an animal that the ACA tries to address by making insurance available if you want it. Unlike what detractors try to say, it doesn't let you sign up when you get a condition that needs treatment. You can only get insurance during open enrollment.
No, I want the freedom to not have you involved in it. If I don't trust you in my house maybe someday you'll decide you have the right to come in anyway. Progressive ideas are like that. Who knows what you'll think tomorrow.
Sadly, health care is one of those situations where everybody is involved.
If you don't get vaccinated against infectious diseases you are a potential threat to everybody you run into, and if you get an infectious disease, an d decide to tough it out, you are an actual threat to everybody you run int o.
As has been said, universal healthcare isn't some socialist mantra motivate d by affection for the rest of the population, but a simple epidemic preven tion strategy that only the USA has been too dumb to adopt.
You may feel that you are entitled to a different opinion, but forget it. A ny country that has embraced conscription has put already public safety ahe ad of the convenience of individual citizens, and the US unwillingness to e mbrace universal health care isn't principled, but simply stupid.
No, children and young adults pay no taxes. Taxes are paid by workers and the way the it's set up now, only by the upper middle class. Ask them to pay for health insurance, on top of everything else they're paying, and the entire economy crashes.
That's the problem. Democrats are constantly talking about "fairness". Everyone sees that as "the other guy pays". Great marketing but it doesn't work.
Just watch for the "Death Panels" to be politicized, as has every other department of the government.
So there are no more "experimental" treatments? Yesterday's experimental treatments are today's SOP. You're proposing that medical science stops here. Essentially, the rest of the world is in that situation now, though they have the US to subsidize their technology.
That's exactly why capitalism works. It aligns the wants of the individuals with the needs of society. Socialism does exactly the opposite.
It certainly *does* matter. Humans don't change based on the government. They will operate in their own best interest. If that works against their neighbor, that's the way it is.
The purpose of passing legislation like the AHCA that its supporters in Congress didn't even read (even though it's 1/10th the size of the ACA) is because they know it's going to be a shit program that will leave millions of people uninsured, and when people realize that it's shit the legislators will say "Well, the first one was going to be really good, but the reason this one is bad is because liberals wouldn't let us make it exactly the way we wanted it. Their fault, really."
I can confirm that people needing immediate life saving medical care get it on the bounce here in BC. My family and friends have had various problems that required emergency room visits and they were attended to immediately on arrival if the problem was life threatening. I have gone to emergency a few times in my life (mostly broken bones when I was a kid from falling off things) and the response was graded depending on the risk factors. Triage. All health centers practice it, same in the USA, but here insurance isn't a factor.
Childbirth? Complications? Fully covered and you can upgrade to a private room (from a dual patient room) if you want to pay extra for that. Coverage otherwise was under the public system. Childbirth and childhood diseases are all covered, so children are possibly healthier here in Canada.
There are problems. We are human. The system lets some people down. And sometimes it has been racist in how well people were responded to but we are getting over that.
For the most part people have an expectation that they will receive competent unbiased medical care here. And we generally get it.
Lots of problems, shortages of doctors and nurses in some more rural areas for example, creative solutions are coming to try and help deal with it (online diagnosing, computer aided diagnosing, etc.).
That's why kids don't wait on line. They have more "value" as future tax payers.
And others are free to use the coverage they require me to pay for. That's you're f***ed up idea of what freedom is. While I'm not free to have the insurance policy I want with no maternity or drug addiction coverage.
Then care for them with your money when *they want* you to. My friend had a great insurance plan that he paid for with money he earned, and it was cancelled because of Obamacare. But you people don't think people are entitled to what they earned. You think they are entitled to what other people earned. That is not the meaning of charity. You talk about charity and don't even understand what it is. Nor do you understand what civil society is. It's where people do the right thing as voluntary individuals.
Civil society was destroyed in socialist countries where today people ignore people lying on the street after an accident.
The free market would also work better than the system we had since WWII where people are compelled by the government to get insurance through their employers, so they have to change insurance when they change jobs. Defense contractors wanted to attract workers with higher wages and FDR's progressive assholes said they couldn't, so the employers offered insurance as an incentive. Then those same assholes loved the idea so they mandated it.
And it would be better than having regulations that drive up costs. When Clinton tried to get this passed in the 90's they succeeded in getting regulations expanded so doctors in the US who used to have offices in their homes now have to work out of "medical buildings" (a concept that never existed before) which have lots of extra staff to comply with regulations. It's more expensive for them to practice that way, and it's one of the most recent measures by which the government raises costs, so you dimwits who wouldn't know what a free market is if it fell on you could complain that the free market raised prices.
Neither I nor those who think like me ever denied the progressives the right to have the kind of government they want. That's why Massachusetts is able to have socialized medicine if they want. But you progressives are perfectly happy to deny me the kind of government I want. Get the f*ck off my life.
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