Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[rconnor]

Cranky, to your comment on the long wait times, here’s some numbers to put things in perspective:

% of Responses stating they could see a doctor the same/next day – Canada 41% (worst amongst OECD), US 43% (second worst), Germany 74% (best) (source)

Wait time for emergency case was 2 hours or more – Canada 48% (worst, 11th), US 28% (7th), UK 16% (2nd best) New Zealand 14% (best) (source)

% of people that did not get adequate care due to costs (fill prescription, visit doctor, get test, etc.) – US 37% (worst), Netherlands 22% (2nd worst), Canada 13%, UK 4% (best) (Source)

Number of annual deaths due to lack of insurance in the US – (2005 estimate, working age only) 44,789 (estimate according to this 2009 Harvard study)

2011 Health Expenditures/Capita – US $8,508 (worst, 11th), Canada $4,522 (6th), UK $3,405 (2nd) New Zealand $3,182 (best) (Source)

To claim that the solution to the current US healthcare issues is to move further away from what works in other countries (universal/socialized healthcare) flies in the face of facts and reason. Moving to a “free-market” healthcare system certainly does not address, and likely will make worse, the most crucial issue in the US medical system, equity. And if you don’t care about the fact that millions of disenfranchised people don’t have proper access to healthcare (and tens of thousands die as a result of that) in the “richest and most powerful” country in the world, well, that’s just sad (to put it as lightly as I can).

 

[JohnRBaker]

The irony of course is that the same people who oppose abortion are also the ones who want to remove sex education from the schools as well as make contraceptives impossible to get, at least for those age-groups where the issue of unwanted pregnancies is most prevalent. I'm sorry, but you can't have it both ways. Now don't get me wrong, I also oppose abortion, when it's being used simply as a form of birth-control, but if, after private consultation between a women and her doctor, it's determined that this is the best medical treatment going forward, who am I to say that it should be denied. After all, what other medical procedure does society think that the average 'joe on the street' (and I do mean 'JOE') should have the right to protest and demand that it be denied when it has no personal impact on HIMSELF?

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[KENAT]

OK, I grew up in one of the countries that has single payer, govt run healthcare but have lived in the US now for over 10 years.

I'm not a high consumer of healthcare either but based on my limited experience I've got to say considering how much more I seem to spend in the US, I don't get more for it - maybe less.

It's harder to find a primary care doctor here in the US, and a lot more time consuming to actually get to see them e.g. waiting several days or weeks to see 'your' primary care physician.

When I get to the office waiting for my scheduled appt, waiting times in the US are generally comparable to or maybe worse than in the UK. They game the system by having the nurse weigh you and stick you in an exam room fairly promptly (though I've been stuck waiting for this for a long time before now) but then you get stuck waiting in that room for 30+ minutes for the actual doctor to come see you.

When I have needed a non emergency X ray the service in the US was quicker - within the hour after being told I needed it V waiting a week or two for an appointment. However, I had to spend infinitely longer filling out extra paperwork each time (i.e. none in the UK, reams of it in the US).

My perception is that if you have the right insurance (and/or money) and live in a location with good clinics/hospitals etc. then you do get slightly better overall quality of care in the US. However, the value is not as good.

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[cranky108]

I just think that having food police and not have sex police when both can be bad behavor, is wrong. So who decided this? It was a control and desire issue, not a moral thought.

Sex education is only valuable if morality is also tought. The (many) public schools don't teach morality, and some how believe free condoms is a subistute.

So is bad behavor of one type better than bad behavor of another? That's what I am hearing.

So if I have to pay for your medical care if you over eat, why is that a concern, when some one else is doing something risky, and you don't seem to care?

And if medical care is intended to be equal, why can't I have the presedent's plan? It's better than mine, and much better than what the homeless people's plan.
However it's not being offered under the Obama care options.

And if care is to be equal, how exactly do you intend to move doctors to where they don't want to live?

 

[IRstuff]

Cranky,

Given all your complaining about the current system, why to you wish to continue what clearly isn't working for you?

TTFN
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[moltenmetal]

No cranky, I don't live under the myth that government is the solution to all problems- it absolutely isn't. I do live in an example of the FACT that the public sector is more efficient at delivering essential public services than the private sector could ever be. rconnor has given you the facts and figures, and other jurisdictions do some of it way better than Canada does. I'm not holding Canada out as an example of best practice in health care- I'm only using it as the closest and most direct comparison to the disaster of private/public that you people in the US put up with.

As to your direct concerns:

1) Wait times for essential procedures and emergency care are quite modest here unless you live in a remote location. Most of the people waiting 2hrs or more for "emergency care" here aren't in need of emergency care- they are taking advantage of the free access to the emergency room we get here 24/7, either deliberately or as a precaution (for a sick child etc.). They're having their needs triaged against those of others who truly do need emergency care. When someone dies in an emergency room here because they were inappropriately triaged, it is a HUGE deal and national news- it happened to a First Nations man in Winnipeg recently and there was a hue and cry from sea to sea about it. Deaths while waiting for care here are truly rare.

2) Virtually nobody pays out of pocket for anything other than procedures or services that are not covered, or non-emergency, or are elective. Yes there are "medical tourists" here, most of them getting hip or knee replacements where wait times are still a problem, or precautionary MRIs etc.. There are plenty of medical tourists from the US too, going to hospitals in eastern Europe or India etc.

3) Yes, someone here who needs a hip or knee replacement and is on a wait list, or who is worried about a condition they won't know about until an MRI can be scheduled, is suffering. But so too is anyone in the US who is out of a job and lets their medical insurance lapse because they can't afford the premiums- and then discovers that their wife has cancer, and can't get insurance now for any money because it's a "pre-existing condition"...that NEVER happens here. No employer here has to make a decision between healthcare coverage for their employees or hiring new staff, and nobody has to worry about whether or not their job offers coverage- the essentials that you cannot live without are provided as a right of citizenship (in fact, even as a right of permanent residency). The one exception is basic dental care.

4) The proof of the comparative number of parasites is in the COST NUMBERS, not in your ideology. Your private/public mess costs you far more of your GDP than our purely public system does- and in other countries they do it even cheaper still. Your system costs more- very substantially more. It costs you more by a proportion of your GDP which is much greater than the ENTIRE cost of your "national defense". So you, and most Americans, need to give your heads a shake on that one, because your ideology is leading you to a conclusion which is demonstrably FALSE.

 

[tinfoil]

A little-publicized fact here in Canada is that there is a significant 'medical tourism' factor for rich folk coming TO Canada for specialized expert health care in hotel-like private rooms, for a REALLY hefty fee.

Typical clients are uber-wealthy folk from the middle east and South America

It is a dirty-little not-so secret that many hospitals, etc do this to subsidize their costs.

Domestic clients can't do this.

So, were the USA to adopt a Canada-like system completely, there will ALWAYS be a pay-for-use outlet SOMEWHERE for the wealthy to jump the queues or cherry-pick a superior doctor. It just may not be in your own country.

Meanwhile, the system will likely get better for most, in particular the lower income folk.

The only losers would be the accountants and lawyers charging 'rent' per Adam Smith on a process to which they add no real value.

 

[tinfoil]

A good analogy for this might be the US school system.

Americans have a two-tiered education system. Public schools are funded via taxes and paid for by everyone to pays taxes. The system does not care if you have kids or not, you pay for it.

However, there exists a private school system for those that want to send their kids there. They pay for using this system. But they still fund the public system too. Please leave out the 'voucher debate' on this as it is a red herring to the discussion.

Generally, the private school system is high quality. It HAS to be, or they would have no customers.

The quality of the public system is mixed. In areas where voter apathy permits it, the system can be poor. In other areas, voter concern has created a decent system. There are large portions of the country where private schools have little traction because the public system is good enough that there is no market for the privates.

So, by offering a good easy-to-understand universal health care system without the hype, hysteria, and outright disinformation to everyone, you would create an incentive (via voter attention) for politicians to support it (or perish in the NEXT election). The wealthy will always have a Plan B.

The same thing happened here in Canada back in the day when Universal Health Care was created. Conservatives initially opposed it, Pundits slammed it and lied about it, but they went away once the results were clear.

 

[TheTick]

Going in for health insurance revamp tomorrow. Thanks to the "Affordable" Care Act, my crappy insurance has tripled in price.

 

[cranky108]

As I have said, why not a dual system. And an example is the public school system. That's not what has been troughted. What is being proposed is only a public health system.
The bigest problem with the VA issue is that any of these people could have gone around the VA and paid for the treatment themselves. They choose not to do that because the VA was free to them.

A dual system will ensure public hospitals keep up with standards, as they do have a competetor.

The problem here is any hospital, public, or privite, must take all patents no matter there ability to pay. But doctors don't, so if you don't have any money, you wait until it is an emergency to see the hospital for there basic needs.
So the emergency rooms are full of not so urgent people.

And the mandate states we must all pay for abortion and berth control, which I believe should be optional. The cost have been incerased, because of things we don't really need, due to goverment requirments.

Does Canada provide free abortions, and burth control? Tuba lessons for cruked teeth? Message theropy? etc. That's what passes for medical insurance costs here.

 

[davefitz]

cranky108,
so , it is now proven that mechanical engs can spell better than electrical engs. Lets take that question off the list.

"Whom the gods would destroy, they first make mad "

 

[beej67]

"is the $300,000/yr treatment the root of the problem?"

How is that the problem? Is compassion "the problem?" Do you wish an early death to all those that suffer from this illness? Or are you suggesting that we abort any fetus that lacks a working CFTR gene? That would save lots of money. Should we likewise put out all the frail, aged, etc., into the wild and let them die? Where do you want to draw the line? Or do you want someone else to draw that line?

In my lifetime, medical researchers are going to achieve immortality, at a price.

A very expensive price.

So ... immortality for everyone? Who pays for that? Everyone else?

It's not argument-ad-absurdum when we're well on our way to having exactly that.

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[beej67]

cranky, the numbers don't lie. 11% vs 17-18% of GDP, for similar health outcomes between Canada and the US. You've been given plenty of reasons why this is the case earlier in this thread. Obviously the myth that the private sector can always do things more efficiently than government is a hard one for you to accept, but it's a MYTH and you need to get over it

And both you guys need to get over this idea that you can fix the problem by changing who shares the cost. "Single Payer" is just everyone buys Blue Cross Blue Shield, or everyone pays extra taxes and gets Medicare. It does not solve the problem. The problem is cost. See my numerous posts above.

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[cranky108]

The problem is not just cost, it's adminstration, and regulations. What exactly is medical, and what is optional?

Who gets rationed, in there perspective? The poor, or the hard to justify?

If you can't pay doctors enough to attrect more into the profession, then those are the choices around single payer.

It's not all bad or all good, it's just not perfect.

 

[rconnor]

TheTick, your rates went up because now health insurance companies actually have to pay for proper treatment of people whom pay to be insured when they get sick (I know, what an absurd concept!), which is eating into their revenues. Shrinking revenues are unacceptable to the board of directors, so now you have to pay more to cover the difference. So ya, the problem is the Affordable Care Act (well, Obama personally), not at all with the health insurance companies!

Another fine example of how the “free market” sounds like a wonderful solution to your health care problems…let’s give these corporations MORE power and LESS regulations! That will solve the problem! I mean, thank goodness you didn’t get some commie-universal healthcare system, then your rates would have been…ahhh….well I don’t know but it would have been bad!

a dual system will ensure public hospitals keep up with standards

This implies that “public” hospitals (i.e. all hospitals in a universal health care system) offer poor quality care compared to private hospitals. That is false as demonstrated by the rank of quality of care in countries with universal healthcare.

The problem here is any hospital, public, or privite, must take all patents no matter there ability to pay. But doctors don't, so if you don't have any money, you wait until it is an emergency to see the hospital for there basic needs.

This problem is NOT solved in a “free-market” system (and likely exacerbated) and is inherently solved in a universal healthcare system because going to the doctor is just as free as going to the hospital. This is one reason why costs are lower in universal healthcare systems – preventative and routine care are free and easily accessible, thus reducing the amount of emergencies required.

"Single Payer" is just everyone buys Blue Cross Blue Shield, or everyone pays extra taxes and gets Medicare. It does not solve the problem. The problem is cost.

And where do these costs come from? All universal healthcare systems COST LESS PER CAPTIA than the US system. A sampling of the problem with costs in the US system, all of which are inherently solved by a universal healthcare system, are the following:
[ul][li]Preventative and Routine care cost too much for the uninsured or underinsured, so they don’t do it. Then little (and inexpensive) problems, become big (and expensive) problems.[/li]
[li]Hospitals, insurance companies, etc. get to run as for-profit organizations. Their objective is to increase profits, pure and simple. If low cost, quality care is a by-product of that, great, but it doesn’t have to be and usually isn’t in the real world. In other words, they will keep costs as high as they can possibly get away with. (Even if there is some “fair” trade-off between quality care and inexpensive care, then are you suggesting that poor people should get bad care because that’s all they can afford?) Every step along the way is trying to skim profits off the customer and this will increase costs.[/li]
[li]A for-profit system has a negative incentive to promote healthy life-styles. They benefit off sick people. However, insurance companies lose profits on sick people and are therefore encouraged to deny coverage to unhealthy people (and they do whenever possible…the ACA tries to combat this slightly though). So when you have one half of the system that profits off sick people (hospitals) and the other half that wants to deny coverage to sick people (insurance companies), you get this messy inequitable, costly system. Whereas a non-profit system is intrinsically benefited by a healthy population.[/li]
[li]Because you have to deal with insurance companies, there is a lot of time spent dealing with paper work and disputes related to coverage which adds unnecessary overhead. Much of the doctors time is spent dealing with this paper work or themselves fighting the insurance companies so that patients can get needed medication/treatment blocked by coverage restrictions. Furthermore, the insurance company itself is an added cost to the system.[/li]
[li]Lawsuits due to malpractice are a huge issue in the US. It takes a lot of money to protect yourself against them, fight them when they arise and payout if you are found guilty. Like with any for-profit organization, this cost and risk is eventually passed onto the customer through higher rates.[/li][/ul]

None of these issues are solved by going to a “free-market”, insurance based system. If anything, they put more emphasis on the for-profit model and less control over providing proper care. All of these are solved by going to a universal, non-insurance based system. This is the reason why the real-life numbers demonstrate that universal healthcare systems are, across the board, less expensive than non-universal healthcare systems. So if cost is your only concern, then I think we have our winner.

And this doesn’t even begin to touch on the issue of an equitable system, which is apparently a non-issue to “free-market” enthusiasts….

 

[JohnRBaker]

The ONLY thing that President Obama can be blamed for is conceding to so many of the demands made by the Republicans when they were crafting the ACA. In the end not a single Republican voted for the bill. What he should have done was blow-them-off right from the get go and we would have had a much simpler and easier to implement law today. And lets not forget the role that the Robert's Court has played in this, gutting the Medicaid supplement provisions which was a fundamental part of the law (and which was part of what the GOP wanted based on the work done by the Right-wing Heritage Foundation in the 90's). And then to make matters worse, the Court continued their idiotic insistence that public corporations have the same rights as individuals including the right to practice religion in the Hobby Lobby case, something that will have far reaching consequences in this country for years to come. What's next, giving corporations 2nd and 5th Amendment rights as well? And it's not over yet; the Court is on the verge of gutting the law even more, all over what was basically a 'typo' when a single word was left out of the description of who qualified for subsides based on what type of exchange that they got their insurance through, be it a state versus a federally run program. Again, the idea of subsides was part of that original Heritage Foundation proposal which the Republicans insisted should the 'model' for any sort of comprehensive insurance program being considered. And let's not forget that this is also where the so-called 'personal mandate', that the Right loves to harp on all the time, originally came from as well.

Sorry, but if you're going to condemn the ACA for not being what it could have been, just keep in mind that there were a lot more actors in this play than just the President and his people.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
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To an Engineer, the glass is twice as big as it needs to be.

 

[swall]

Funny, JohnRBaker, I don't recall the debate the way you do. I don't recall any Republican input--there was no need for it, as the Dems had majorities in both the house and senate. I DO recall the insurance companies having a voice in the debate in order to protect their interests. AND, I blame Obama for not managing the process--he just threw the whole thing over the wall to Congress and let them write it.

 

[tinfoil]

Y'all do know how your separations of powers is supposed to work, right?

Congress is SUPPOSED to draft the bills/laws

The Executive is SUPPOSED to bless or reject it.


Obama does NOT write the dang laws.
He also did not cause the BP oil spill or Hurricane Sandy.

Stop blaming him for these things.

 

[Dievant]

It wasn't Hurricane Obama or the Obama oil spill. If you put your name on something you better expect the majority of criticism to be directed to you, so you better stay in the loop and have significant input. Not saying that happened, but it is greatly in part to why he gets the criticism and would have gotten the praise if things would have worked out differently.

 

[KENAT]

tinfoil, I'm afraid your understanding of education system in the US doesn't seem to match what I've seen. Many of the private schools are actually religious based and at least in our town the level of education provided by most of them is well below that the public schools provide. So perhaps the dual system would be a choice between public healthcare and a faith healer?

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