Talking Heads - Healthcare Reform

[Babi]

Talking Heads #6

"It occurred to me that nothing is more interesting than opinion when opinion is interesting..."
Herbert Bayard Swope, creator of the Op-Ed page.

A two week  forum for opinions on anything in print: magazines, newspaper articles, online: bring your ideas and let's discuss.

Our Sixth  Selection is:     
Health Care  Reform~! Are We on the Fast Track?

7 Ways Health Reform Is Going to Affect You
Newsweek June 10, 2009

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To some degree, Bellemarie, doctors are accountable to their peers for their
treatment decisions. Hospital physicians may have to explain their decisions to
a hospital review board. The AMA hears complaints/charges brought against doctors, and is able to revoke their licenses if serious charges are confirmed.
  When it comes to billing, however, any doctor may charge whatever he wishes. The more affluent his patients, the higher the charges.

 Thank you for bringing up other systems, JANE. The British/Canadian models are the only ones I'd heard about. Quite likely the reason for that is, as you point out, the insurance companies and drug companies make sure we hear about them.

  Exactly, STEPH.  This is one of the richest countries on earth, and we should
be better able to help those in dire need, through no fault of their own.

[bellemere]

We have to keep in mind that the President is not Tr;ying to pass "National Health Care;, e.g. a 'single payer' system.  He advocates ONE health plan run by the governemtn as one of the many choices people can make when selecting a health care plan. Medicare Part B is an example of such a plan. Available to everyone, forced on no one.
I laughed at the senator who said"If you like the servce at the post office, you will love national health care"
Scare tactics again. But John Stewart pointed out that "a person comes to your house, picks up a piece of ;junk that you have written, puts it on a plane to Hawaii, and it gets there., for 44 cents. "  How can you beat that?

[Steph]

The post office.. well if they would stop the cheap rates for mass mailers that send stuff noone wants and the catlogues, that keep coming when I have never ever ordered anything from them, life would get a good deal cheaper.I cannot remember the last first class letter that I have gotten. I think Thank you notes for some gifts were about it.

[nlhome]

Steph, I do agree with you. We do need a form of universal health care that addresses those who cannot afford insurance and also those who cannot get it individually because of their health conditions. I think we all know people who would be uninsurable if it weren't for the fact that they or their spouse worked and had employer group coverage or they have Medicare. Often those people without insurance or who can't afford it don't talk about it.

I think that a single payer plan that the US developed could be much different from that in Canada or England - but the insurance companies want to scare us with the myths of waiting lists and rationing. I have a son who has no insurance and no ability to get it under the present system in our country - I'm sure he wouldn't mind waiting lists for optional treatments if he could get in to see a doctor for regular health care issues.

[Steph]

Health Insurance companies make obscene amounts of money. Insurance in general makes obscene amounts of money.. They are lobbying so hard now that I am sure our more aggressive congress people are swimming in campaign money. It is so sad. I am quite sure our founding fathers never considered lobbiers.

[serenesheila]

I want to see an option for National Health Care.  I have been upset with Medicare, since Newt Gingrich and his team took annual physicals off of what Medicare will pay.  For years I have heard and read, that preventive health care, including an annual physical, save money.  Not being able to have a yearly physical, results in people not knowing they have something until symptoms show up.  In many cases by the time they show up, it can be too late.  Then Medicare ends up with a much larger bill, than they would have had if they had an annual physical.

I am a military widow.  We had 3 military bases in this area.  All of them have been deactivated.  If I could get an appointment with a doctor, it would require a 100 mile trip for each visit.  I am no longer able to drive 100 miles in one day, as the result of numerous health problems.  I do order my prescriptions, by mail, from a military source.  It charges me $9.00 for a 3 month prescription for most medicines.  C~ertain med cost me $30.00+

I am very happy about the push  for a better health plan. 

Sheila   

[Steph]

I have a friend who is also a military wife. She feels like you do. There is simply not a base anywhere close.

[bellemere]

The latest NYT poll shows the American public overwhelmingly in favor of a government plan as one option for health insurance.  So the scare mongers have come upwith:
You may not be able to keep the health plan you have, even if you are satisfied with it. "
The reasoning goes that the govenment plan will be so competitive that everyone will want it, and drive the private insureres out of business.  they are saying very plainly that it is our money they want.
But if you have your insurance throught your employer, there is not guarantee that you will be able to keep it anyway.  More and more businesse, especially the smaller one, are reducing what they will pay for the plans, or stopping to pay health insurance altogether.  And fierce competition between private insurers is sure to drive some of them completelu out of business.  A government run plan is not obligated to pay dividends to stockholders; does not have to pay huge marketing costs; does not have to pay obscene salaries to their executives, and is not going to go awya in tough times.
That is awful about the military widow stranded without doctors.  she is required to go to a base for health care?  I thought they could go anyplace and their insurance would pay.

[Babi]

 Not to mention, Bellemere, that many large retailers hire people only on a
part-time basis, so they do not have to provide insurance coverage for them.
It's cheaper for them to hire two people working 20 hours a week then one
working 40.  Or hire one person but only allow them to work 35 hours a week.
The net profit line is what matters.

[Steph]

The under 35 hours a week is a trick of many stores like Sams and WalMart. Simply not fair to the employees. Some others do a much better deal. Darden ( restaurants like Red Lobster and Olive Gardens) used to let you work as little as one day a week if you wanted insurance. You never got pay, but you did get to buy insurance cheap. We used to know a lot of people that worked or small retailers and they did that. Dont know if they still will allow it or not.

[bellemere]

It seems like the big private insurance companies are determined to deny us the chance to choose a government program if we want it.  They may succeed.  They only want the govt. involved in business when they go broke, like AIG.  Then they want taxpayer money, and plenty of it.
No plan should be free to everybody.  That is crazy. Even a gvt. plan can charge premiums, as Medicare does for Part B.  Free plans should be for the destitute. 
If people want an option for a gvt. plan theywill have to push their senators and reps hard.  In my state , it would be preaching to the converted :  Senators Kennedy and Kerry.

[maryz]

bellmere, in my state, it would be like preaching to a rock - Senators Alexander and Corker (I'm sorry to have to say).

[jane]

Article in our morning paper which apparently goes back to Mayt 26... about the millions and millions of dollars those "trusted" insurance companies some find so wonderful have bilked their customers out of by overcharging patients for "out of network" docs.  Ah, yes...such trustworthy companies...no wonder they're advertising like mad about the "horrible gov't run" health plans.  Sounds to me like some squaking about making loosing the goose that's laying all those golden (big $$$) profit eggs.



http://www.lawyersandsettlements.com/case/medical-out-of-network-overcharge.html


updated on May-26-09

[Steph]

My state will be a split one. Martinez is a no and Nelson will be a yes.. Darn.
Ah yes insuranced companies do not want you to know the different ways they make sure to make lots and lots of money.. I cant understand the senators who talk about not having health plans when they get one that is spectacular.

[nlhome]

Wisconsin Senators have come out for single payer. My Congressman is "iffy" but is scheduling discussions on the issue.

Right now my husband and I have very good insurance and are very satisfied, so when that question is asked in surveys, that is the honest answer. However, that coverage is government based, so, we are among the lucky. If we had worked for private companies, or had been unable to work as long as we did, or, for that matter, had worked in the current type of economy - wow, we'd be in trouble based on our income and health histories.

And our children are very vulnerable. One cannot afford coverage, and we're hoping he will qualify for a new state program that will give him some basic coverage for a low fee.


For years I worked for an employer who kept me 1/2 hour below the limit for providing benefits. I know how unfair that can be. It was done deliberately, because it was a permanent job. I was lucky that my husband did have benefits with his job that covered me.

So, we support single payer and universal coverage. And I make sure to keep my federal and my state legislators so informed.

Nan

[Babi]

STEPH
 

I cant understand the senators who talk about not having health plans
when they get one that is spectacular.

  If you think their insurance is spectacular, are you aware of their retirement
program? They serve a couple of terms, and continue to draw a salary for the
rest of their lives. I think we could pay off the national debt if that were curbed.

[Steph]

Amazingly enough they even get raises when the rest of the legislature does.. Almost as bad asmy home state of Florida, who lets you retire from government and spend 30 days down, then go back to the same job.. plus retirement pay. Hows that for feeding off the publictrough.

[Babi]

 And since Congress holds the purse strings, there's no way in the world
we'll ever be able to persuade them to give up that trough.  And no President can afford to cut his own political throat by taking them on. No wonder people
are so eager to be elected to Congress, whether they are qualified or not. So
what if they never get re-elected.  They're in!

[Janet]

Comment removed.

[pedln]

Please don't fade away, Janet.  There has been much said and written lately about just what this reformed health plan will contain.  And what I've read and seen in the media is that the "government plan" would be an option.

Many of us of a certain age have been in a government plan -- Medicare, and I for one am grateful for it.  I compare my situation with other retired teachers from my district who do not have Medicare because they never or their spouses never paid into social security.  They have the private plan from the school district, but when retired, pay for it themselves. (I use that insurance as a secondary.)  They must pay deductibles and co-insurance for everything.  I don't pay anything.  My deductibles are picked up by my secondary ins.  The non-medicare retirees don't have a secondary, just a primary.

There's a lot going on out there that I don't know about, and I don't doubt that when the big reform comes, it's probably going to cost us a bit more than it does now. I speak only for mysef when I say, "maybe it should.  At least today, I can't complain."

[Janet]

Comment removed.

[nlhome]

Janet:  "You know he would never stand for having a federally appointed commission making health care decisions for him and his family. Then why should we?..."

If you have Medicare, you already have a single payer option. While it's not mandatory, unless you have certain older retiree policies, you can't get any other coverage. It's not offered. (In fact, that's one of the reasons Medicare was started - insurers would not cover the elderly or if they did, the elderly couldn't afford the coverage.)

If you have private insurance, then you have a profit-driven entity making your health care decisions. Unless you are wealthy, you do not really make your own health care decisions.

I suspect if the job situation doesn't improve soon, more people will understand why universal coverage and single payer are the only way to effectively provide health care to everyone.

[Babi]

 There is no question that some form of affordable coverage is desperately needed by a large portion of our population. My own daughter is among
them.  There is also no doubt that any government program, with its bureaucratic management, is going to be more costly and usually less efficient.
There is a long history of goverment 'management' to back this up. And Janet
is right that a program once started is easily changed later down the road.
  Someone has mentioned other national insurance plans that have been more successful than the British or Canadian models.  Does anyone have more
information about those, about how they are set up?  This is a very weak area for me, and I'm not at all sure I would understand the technicalities if I tried
to research them.  I need a 'for Dummies' version.     

[maryz]

jane posted links to the Japanese medical system and, I think, the German system (I may be wrong about this one) earlier in this discussion. 

[nlhome]

Baabi, the Medicare system, and Social Security also, have administrative costs that are substantially lower than the administrative costs of private insurance. Think about it - each insurance plan has its own claim process, its own rules and coverages, its own deductibles, copays and coinsurance rates. Thus, each doctor must hire extra staff to maneuver these multiple systems. Each time a person's policy changes, often annually, the person and all his medical providers must learn the changes. A government plan like Medicare would be much more consistent.

[bellemere]

The President sees health care reform as inextricably linked to the economic recovery.. So now is the time. 
When I retired, i was offered the Medicare Part B insurance, for doctors and for expenses uncoverd by Part A.  I had the opportunity to join some other plan.. But I want with the "government plan" with additional private supplement, and although the premium goes up each year and is deducted from my SS check, it has been satifactory. My private suppliement also goes up.
I think a government plan should be an optionand all the wailing about "everhone will be forced to join" is purely speculation as to the future.  I think the private plans, may be forced to cut some of their nonmedical expenses like marketing, executive salaries, dividends to stockholders. etc. Even now, some insureres will go under as private companies compete more fierce. Every private company has one goal: "Increase market share"  meaning take business away from other companies and make it ours.

[Babi]

 I saw her posts about the systems,MARYZ, but if their were links I must not have
stopped to read them them. Perhaps I can go back and find them.
 
 I take your point, NL, but for paperwork you can hardly outdo the government. I
have worked for agencies under contract to the government, as well as for companies
that had to comply with all the paperwork demands,so I have been on both
sides of the picture. Those demands tended to increase rather than decrease,
and were generally geared to make things easier for the government reviewers
than for the providers. 

[Steph]

I am happy with my own medicare and the supplement, but they do go up each and every year. I see no problems with a single payer.. By the way,, weird health things.. Ifyou go to the emergency room in a hospital in Italy,, you dont pay. No idea why.. You pay for any prescriptions, etc, but the actual emergency room is free. I thought that was strange.

[bellemere]

Boy, that is strange.  Obviously, the difference in ideologh between America and Italy.  There, health care is considered a right; here it is considered a market commodity. But the underlying debate is
"What is the proper role of the government in a market oriented society?"  Because that is what we have, and it has many benefits.  No country on earth has our standard of living, a wider choice of options for everything you buy.  Just look at the toothpaste aisle in the CVS.  But the mistake is to treat health care as just another consumer good, that people are free to choose, or go without.   That amounts to "buy or die"  doesn
t it?       

[Babi]

I receive my medicare through a provider, with a very nominal co-pay. My
costs do not go up each year; in fact, last year they went down.  One of the
advantages, perhaps, of not being under direct govenment management?

[nlhome]

Babi, are you a Medicare person? Because if you are and you are in a Medicare Advantage plan, it is possible that the government, not you, is paying increased costs for you to have that plan. So be careful, if you are part of the Medicare Advantage program, because your own costs may increase in 2010 as Congress is working to change the way payment is made to Medicare Advantage plans.

If you are in an employer retiree plan, it may not happen. Yet. But retirees are having their plans changed, reduced or eliminated every year. Some Chrysler retirees are facing that right now.

[Steph]

I like being able to choose my own doctors. I belonged before Medicare toa plan where you had a listof doctors.. I had a lot of problems with the fact, they listed like one specialist for various things. The gastro they insisted I use, spoke very little english and insisted on a variety of things they simply are not done any more. I vowed when Medicare started, I would use he one where you picked and I have.

[bellemere]

Steph
How do you go about choosing your own specialist?  Say, a gynecologist?  Do you consult the state Board of Registration of Physicians to see if there have been complaints filed? OR do you have friends whose advice you trust?  I heard the best way was if you are a friend of a veteran nurse at a local hospital. That is how I learned that one popular local doctor was referred to by nurses as Dr. K.O.D., for "Kiss of Death"  Around here, the consensus is that a Boston physician would be the best choice, especially one affiliated with Harvard Medical School.  What do you do?

[Babi]

Medicare is my only insurance source, NL. My costs may indeed go up, but look what the Japanese are paying under their national health insurance program.
Under the Japanese plan, 68.5% of costs are paid through premiums/payroll taxes and by out-of-pocket payments. (The out-of-pocket payments come to 12.2% of that total.) 
  Is this really affordable for those people who are presently uncovered here,
because they can't afford insurance?
  Of course, if our Senators and Congressmen would take a cut in their huge salaries, we would have the money to offer health coverage to the indigent.  Fat chance of that happening. 

[Steph]

Choosing doctors. If you know a long time nurse , that is a perfect way to judge doctors, but nowadays where we live. They mostly have hospitalists, so the nurses dont know the internists etc. I got really lucky in that when we moved to where we are, I got sick within two weeks.. Food poisoning,, I asked a pharmacist and he recommended a local family practitioner. She and I met and it was instant karma.. I trust her and like her. She is down to earth, likes alternative medicine and generics. She lets me choose all sorts of vitamins, etc as long as I tell her what I am doing.. All in all, I am happy. When I was diagnosed with an aneurysm atwo years ago, I had a horrid time finding a specialist who would see me after the hospital. I finally got a recommendation from my husbands radiologist.. Saw a wonderful man , who reassured me that my aneurysm is small and harmless. Thank heaven.

[nlhome]

Babi, if you only have Medicare, but have it through a private plan rather than original Medicare, then your coverage can change every year. The standard Medicare premium for Part B is $96.40, which is about 25% of what the "premium" would be.

I don't know what Japan's total health costs are, but most countries that have single payer and/or universal coverage have a much lower cost per person for total medical costs. So 67% of the US medical costs may be higher than 67% of Japan's. As I said, I don't know that particular country's.

It is said that every family that has insurance pays about $1000 of their premiums toward the uninsured - in other words, their premiums are increased because of the cost to providers, who then must charge higher fees, which result in insurance companies paying more.

I don't know what the answer is, but it seems logical that having fewer insurance companies and more people in the plans would spread the costs out more fairly.

Kaiser Foundation and FamiliesUSA have good information on the insurance situation in this country.

[Steph]

When I check our medical bills as they come from medicare and medigap, I am struck by the difference in what they say they charge andwhat medicare, etc pays.. My husband has had a lot of radiation for skin cancer and it is amazing the cost of one treatment.. They pay only a fraction of this..Insurances are quite interesting if you try and figure out what they pay. I realized the other day that in our travels, we have not passed a hospital in years that was not adding on.. Maybe if they would stop playing "Can you top this" with all of the equipment and actually sit down and cooperate in what sort of specialty each one should have.. I know in Orlando that two of the major hospitals are both starting heart transplants. There is no way that we have enough hearts to do that sort of thing. Sad..

[bellemere]

The danger of two hospitals starting heart transplants is that unless the skills of the transplant team; surgeions, nurses, anesthesiologists, technicians, etc.  are fully utilized in constant practice, they are not retained well.  The incentive is on the docs to perform more heart transplants, in some cases maybe marginally necessary in order to achieve a higher rate in essentially the same population.   

[bellemere]

Steph
Getting sick in a new town is tough.  But you found your general practitioner through a combination of word-of mouth (a knowledgeable pharmacist, not a common occurence) and sheer luck.  And you found a cardiologist through the recommendation of a doctor.  Not bad. \I belong to a Medicare Advantage plan and pick from a list of specialists who accept our insurance.  My primary care doctor always recommends someone and so far, that has worked out fine.  Only once have I been tempted to go outside network for a consultation on macular degeneration.  My retina specialist gave me the name of his professor at Mass. General Hospital, again that old Harvard Medical School reputation..  I called first and lo and behold, they said they would take my insurance!  I never followed up; I am doing okay with the retina specialist here.

[Janet]

Comment removed.