If there was NO insurance, period...if it were outlawed, then health care providers and medical suppliers would have no choice but to moderate costs. Very few people would be able to pay medical costs as they are now (like 1-5%). The ONLY options would be lower costs or go out of business. They charge what they do because there's an infrastructure in place that can support it. In turn, that infrastructure makes bank and so supports the other side. It's almost collusion, though not necessarily premeditated.
If there was NO insurance, period...if it were outlawed, then health care providers and medical suppliers would have no choice but to moderate costs. Very few people would be able to pay medical costs as they are now (like 1-5%). The ONLY options would be lower costs or go out of business. They charge what they do because there's an infrastructure in place that can support it. In turn, that infrastructure makes bank and so supports the other side. It's almost collusion, though not necessarily premeditated.
Actually in my experience it'd be the opposite. Most of the doctor's I know only want enough to support themselves, pay their loans, and pay their malpractice. Most volunteer in third-world nations or disasters with most of their free time. I don't know a single one that got into medicine for prestige or money...it was a calling. Having worked in a hospital and with a number of friends and family involved in health care that seems to be true of most medical workers. Not all, but most.
JohnOfSheffield
Lifer
- Jun 26, 2007
- 11,925
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Even as a civilian OR at the government funds used we pay anywhere near what the US "fuck them up as bad as you can" system makes you pay.
Insurance makes your employer pay 20-30X what it actuall costs for the majority of people to be insured, out of that money, if you were actually to develop a serious disease the insurance company would do it's damndest, using whatever possible to make sure that they don't have to pay for it...
Yah, the EU nations really do have lousy healthcare...
What you idiots don't get is that you are involved in corporate socialism, you pay the insurance companies to give them money so others can be treated for your money and the rest (most) goes to people high up... "Why should i pay for my neighbours illness" is what you ask while you do just that, just with a premium so that profits can be made and people who need care won't get any, even those with insurance.
Out of the worst systems that can be thought up, you have the very worst of all kinds, you actually pay more for others that do not even get proper care.
Insurance makes your employer pay 20-30X what it actuall costs for the majority of people to be insured, out of that money, if you were actually to develop a serious disease the insurance company would do it's damndest, using whatever possible to make sure that they don't have to pay for it...
Yah, the EU nations really do have lousy healthcare...
What you idiots don't get is that you are involved in corporate socialism, you pay the insurance companies to give them money so others can be treated for your money and the rest (most) goes to people high up... "Why should i pay for my neighbours illness" is what you ask while you do just that, just with a premium so that profits can be made and people who need care won't get any, even those with insurance.
Out of the worst systems that can be thought up, you have the very worst of all kinds, you actually pay more for others that do not even get proper care.
JohnOfSheffield
Lifer
- Jun 26, 2007
- 11,925
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Having known a lot of Brit docs in my days, that is pretty much the way it works.
Let the twats who want for profit healthcare work in a business where lifes are not at stake, like plastic sugeoun offices.
Hayabusa Rider
Admin Emeritus & Elite Member
- Jan 26, 2000
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Holy crap you think we pay 50 bucks for a bottle of Oxycontin 80 mg tablets?
I was talking about OUR (pharmacy) cost, and you think make that much profit? Shit, I should be a millionaire many times over.
Read up. Independent pharmacies are going out of business because the reimbursements aren't going up to cover the cost of meds. If you really worked for billing you should be familiar with MAC. That means if we billed a million dollars a pill, we get reimbursed a maximum amount, and it's no where near as much as you suggest. Tell me this- If we're taking in so much money, why don't I make 7 figures or more a year?
rudder
Lifer
- Nov 9, 2000
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How many patients will the doctor need to have to earn a decent living? How many people could afford the $10,000/year for a general practitioner. Sure many would not need full service... but that would mean the doctor would need quite a few patients to pay off his medical school bills.
And does that money I pay include medical supplies?
I think this system would work fine if everyone in the U.S. made over $200,000/year.
- Feb 22, 2007
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The doctors pay has not changed. And he isn't charging $10,000 a year, he is charging about $1200 a year.
I don't understand how people think that if everyone has insurance it will be okay because it will only be $1 a day , that makes no economic sense. You cannot have every member on an insurance program pulling out money unless they are putting more money in .
The way insurance works now they divide the cost from everyone's health care between the number of members. So you will pay for others health care whether you use it or not. So if I am healthy for 5 years never needing a doctor , the insurance companies make up to $10K off me for something I never used, and during that time if premiums increase because of mismanagement or people that abuse the system , again I pay more when it had nothing to do with me. The other problem with insurance is you have no control over prices, the insurance company does. Are you sure they are giving you the best deal ? How do you know ? All you can do is compare insurance companies, if you are even allowed to pick, which a lot of employers do not allow.
Chaotic42
Lifer
- Jun 15, 2001
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That's essentially what you're saying every time you don't spend money on starving kids, sick people, and those who generally need help. Unless you only purchase exactly what you need to live, you're screwing someone else over for your own comfort. Everyone does it, we just all draw our lines in different places.
Well, this prove insurance company is not the one while made the raising cost but the greed of doctor and hospital. So stop demonizing the insurance company and demonize the doctor and hospital.
I don't think that the fact that the insurance companies will pay them whatever they want is evidence of "greed" on the part of doctors and hospitals. When payment structures reward certain things and ignore others, it's natural that people and organizations will drift to what is rewarded. The current financing model (private insurance) has built-in incentives for things that are in the short-term interest of the insurance companies and are harmful over the longterm for the society.
Look at diabetic care as an example. In countries with universal healthcare, there is no charge for testing supplies and co-pays for routine care are low or non-existent. In the US, testing supplies provide a niche market for some companies that service seniors because Medicare covers the cost. Diabetics under 65 though are at the mercy of insurance or charity. Podiatrists don't qualify for most insurance programs, so diabetics skip care until their feet have to be amputated -- the fee for which is reimbursed. The same is true for eye problems. Instead of reimbursing for routine opthamology exams, insurance companies wait for retinopathy (which can result in blindness) to develop. An individual insurance company doesn't care because the person who needs routine care today probably won't be on its rolls when the consequences non-treatment have to be dealt with. The result is higher costs overall.
These truths do not "demonize" anyone -- it's simply an illustration of the way our current, private insurance based, model directly contributes to escalating costs that cannot be sustained.
No it doesn't. You fail at the comprehension. It shows that the three sides of the industry (manufacturing/supply, insurance, providers) are all supporting cost increasing from each other. They have a lock of a good/service and they're exploiting it to line their pockets at all levels.
The doctor increased costs partially to cover litigation and partially to cover skyrocketing education expenses. Yes, his salary has increased as well, but you can't demonize the medical staff as solely or even largely culpable.
Most cost increases are largely on the shoulders of the people who run/administer the business. They are the ones that look to increase profits. Their employees see little of that money (though especially with the medical profession they do see some).
It's a growing problem of everyone thinking they should be making a ton of money, but no one wanting or able to pay a ton of money for the goods/services. Reality can't function that way. Workers, right up to the CEO, need to take a REASONABLE salary and boards need to set REASONABLE profit levels for the corporation and investors. That's the only way to keep costs down. If they won't do it on their own they need to either be forced, or we need a different option (public) available to us.
Athena where do you get your info?
I am a physician, I have seen numerous patients from Canadian and the UK..these are often used as the example of "excellent" universal healthcare.
They can keep it.
I saw a patient yesterday from canada..pt has a shoulder issue and requires surgery. He is currently 79. He was given an appt for an MRI. This was canceled and rescheduled for 6mo later..guess what, happened again. He is convinced once he hits 80, they will say he is too old for rotator cuff surgery.
I saw a diabetic from the UK for emergency eye exam for a vitreous hemorrhage. She was seen the same day she came in. The patient was followed up a week later. I receommended on her return to the UK to be seen by her retina specialist. She said she would be lucky to see anyone on her return. If she got to, it would not be a specialist and she would likely be given an appt in 4mo to see an Ophthalmologist who would then refer her to a retina specialist, which could take another few months.
BTW, if she wants to be seen sooner she can pay on the private side and get it done, but she said why should i have too. I already paid with my health taxes!!!!!
People who are sick in these countries with universal health care are not getting care as fast as they need.
The idea gov't is going to make things more efficient is absurd. You stated VA patients are the second most satisfied patients..WTF. Where do you get your info?
I doubt that...again I see VA patients, they routinely wait 4hrs for appt and have delays for almost all elective surgeries.
Medicare is so poorly run it is estimated that 20% of its budget is waste or fraud. It is very easy to screw the gov't we see it all the time. The problem is it's too big to run smoothly.
Here's a good one for you. In june medicare approved use of a drug I adminster in a patients eye. They changed a code and dose associated with it.
In may I was paid my cost..$25 plus shipping.
Today I have to bill 5 units and I get paid $1.44/unit...I will get $7+ for a drug that costs me $25+ because I have to have it made especially for my use.
Medicare knows the nat'l average cost .....so guess what. I lose money on it now and they will likely fix this but it will cost the system money for the changes.
Why, we will have to re-submit all the claims.
I can give more examples. You would be wise to keep the gov't out of your healthcare.
I dont want them telling me who, what ,when, and where I take my wife or child. They will.
AND it will cost taxpayers a fortune in the process
From 10+ years of working in the UK, France, and Austria -- supplemented with extensive study after I returned to the US.
My experience in the UK was that, while the facilities were utilitarian, the care was quite good. For various reasons, I much preferred the French system where all my medical needs were covered in full with reimbursement typically paid within a week.
For the record, before I went to Europe, I was employed by two different Fortune 100 companies and had the best employer-paid coverage available (no co-pays for surgery, drugs fully covered, etc.). I now pay 100% of my own insurance premiums for skimpier coverage than anything I had in the Europe. I am very happy with the care I get from my providers...I think the way we organize and pay for care is awful.
You realize of course that there is nothing in your message that contradicts what I said about the effect insurance companies have in the escalation of health costs.
I'm sure your stories are anecdotes are factual as far as recounting what those patients have told youl I admit though, that I'm rather skeptical about the story from the UK having had direct experience with opthamology care there. In any case, patients in those the UK and Canada are consistently more satisified that patients here -- as are patients in France, Germany, the Netherlands, Switzerland and everywhere else that has some form of universal care. In survey after survey, doctors are more satisfied too. Most significantly, they have better overall outcomes than we do here. Something is just not right when the outliers determine what kind of care we all get.
Canada and the UK are not the only countries with universal health care. The waiting times in UK simply do not exist in other countries in Europe and they aren't nearly what they were 5 years ago (I wonder whether your UK patient has actually tried to see anyone).
The VA is an example of an excellent system that has been starved of resources by legislators for whom its success is an affront to their personal ideology. There are unfunded, vacant positions all over system. The Indian Health Service is in even worse shape; it's constituency is not nearly as powerful as veterans.
Since I am not a "Medicare for all" advocate, I'm not sure what this has to do with my comment. I will say though, that if Medicare had not been specifically designed to be compatible with the in place, supplier driven system, we probably wouldn't have the same sorts of problems.
Isn't that an argument for the ability to negotiate with pharmaceutical companies more than it is an argument against Medicare?
Why would you say something like that. There isn't a system in the industrialized world that dictates your provider. Why would you inject such a statement in a rational discussion?
In any case, I don't have a problem with the fact that you don't want any government involvement in health care. The problem I have is that you want to deprive me of my choice. Why does your preference trumph that of the majority of voters -- who want the option of a non-profit, public system? And once again, public does not necessarily mean "government-run".
- Mar 20, 2000
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and they compete to sign you up for the for-profit related businesses of auto, home, whatever, insurance. 'have your health insurance with us, we'll give you a discount on your motorcycle and boater's insurance.' they're not quite as non-profit as people might want.
of course, there's nothing to stop a non-profit from paying large CEO salaries and sponsoring the local sports team.
not to mention there's nothing at all in congress' abortion of a 'reform' bill that would accomplish something like the german or french system.
I am for a public option but against the "abortion" you speak of. In my opinion though, the reason it is so bad is due to compromising with repugs and corporate demo's that is necessary to get any bill through.
I don't think the reform bill actually does anything that would be even close to hurting the "for profit" system we have and this is all pandering.
The problem is in the US we don't have any competition between any of the for profits. Frankly, they don't give a fuck. Their profits are made solely on the fact that people "NEED" insurance and they get to write the terms. Basically they make money by fucking you over and "bait and switch"ing.
I am honestly only for Obama's original proposal because it introduced an actual competition for them to go against. They would have to lower fees and expand care to continue to rope in the dopes that pay for "do nothing" insurance. On top of that, they'd also have to fight amongst themselves more. It could be like playing Golden Eye with 2 friends and the "Computer". Sure it might be set to "easy" but it at least adds another variable that you have to take in account and play against.
Were you by any chance thinking of the Blue Cross executives cited in Vanity Fair?
"Even C.E.O.?s at ?not-for-profit? insurance companies (like most state Blue Cross and Blue Shields) collect multi-million-dollar compensation packages, even as their companies pay little in the way of taxes. Blue Cross of Massachusetts?s C.E.O., Cleve Killingsworth, got a 26 percent raise in 2008, to $3.5 million, and Blue Cross of North Carolina?s C.E.O., Bob Greczyn, pulled down nearly $4 million after a 19 percent raise. Gail Boudreaux left Blue Cross of Illinois in December 2007 with $15.3 million. The not-for-profits can be just as freewheeling with expense accounts. In early September, a state audit found that Blue Cross of North Dakota used premiums to pay for a $238,000 sales managers? retreat in the Cayman Islands and a $34,814 retirement party for an executive."
I dont care whether you believe my experience with my patient from the UK. It is fact and reality. Geez, now you are suggesting this poor lady who has had several procedures over the last several yrs was lying about seeing anyone just because you think it could not be possible.
Just as you say above, why should I believe your experience elsewhere was the norm and not the exception. Did you have a major medical illness?
Please show me your medical data showing their outcomes are better for the same disease and population types as in the US. I am sick of this comment without basis. I find it funny because I have pt that travel to see me from out of the country for care. It's not just the big universities, they seek out.
Funny how many pts and families, we doctors see from other countries....while my sample is small, I have not had a single example where they wanted their system over ours..does this means ours is perfect..Not a chance.
VA patients are not happy with th system in so many ways its amazing..yes they get free care so toospeak..but these guys earned. They have delay in treatment and wait untold hours to get stuff. Is it better than paying, for most yes. I was a medical student and resident and I took pride in treating veterans and I saw the system firsthand..it sucks. The waste is awful and many staff at the VA hospitals could careless.
Why did I talk about Medicare above its because it is a gov't run system, that has wonderful benefits and is terrific insurance BUT the cost we pay for it is huge since it is gov't run. They do not neg. with drug companies and if anyone noticed the Senate Democrats decided late last week..not to squeeze more out of them. Yea!
Hmm...lets see it took medicare 3 yrs to pay for that $25 drug...they would pay for the $2000 drug only. Why, because it went through a national trial.(these drugs are Avastin and Lucentis). Retina guys like me have been using it for 3yrs plus and there was more than enough clinical data to show it worked. In fact, ophthalmology went to CMS to get the mto sponsor a study comparing both drugs, which will save medicare $30million during the study. A non-gov't setup would have reassessed this after a year.
Why do I bring this up...because our congress is hell bent on redoing the whole system....at huge expense. It can be fixed cheaper. The more the gov't is involved the more waste and cost....
and YES they will ultimately dictate who, what, when and where....I am sorry but if you listen carefully the liberal congress that is pushing so hard for "reform" does want a single payer system..the govt.
The majority of of voter do not seem to want a "public option"..or have you missed the recent polls showing the popularity for these things are dropping below 50%
Remember, what was promised was to provide insurance for those without..not to revamp the whole the system. I have no issues helping those who need insurance. I can bet you, no one here gives away as much as I do in reduced and free care. I proudly do it because it is the right thing to do.
A portion of the uninsured do so by choice...I see plenty of people who are employed that choose no insurance. They do not want ot pay for it. I do not want them supplemented. This is different from those employed but can afford the insurance from the employer.
There is no doubt we need to FIX the system, the cost is too high. Many need and deserve care but congressional leaders are making a mess of this process trying to rush and get something out. There is no time frame that requires this, if they really want it they could through out all the bills. They keep saying it needs to be done fast or it will fail..why?
Go to the parties involved and start by looking for the problems and wayt s ot fix them. IMHO it is like building a skyscrapper without plans and then later decide we need sprinklers, windows, exits etc.
I have no faith that anyone in congress sat down and looked first at what is broken, then worked on solutions.
It's not without basis. I think the most recently published on was An International Update on the Comparative Performance of American Health Care. The World Health Organization publishes surveys all the time...and universal health countries consistently outrank us. Small populations may do better in some areas but overall, we are just not getting our money's worth.
Umm...you don't think that the fact they were in your office was the result of self selection? There are probably a few former patients of yours who are now happier being treated by someone else. Does that mean their opinions are in any way representative of the majority of your patients?[*]Canada actually tracks how many of its citizens get care in the United States and the total turns out to be infintesimal. Phantoms In The Snow: Canadians? Use Of Health Care Services In The United States. It's a pity that we in the US do not track how many people are getting drugs in Canada or treatment in Costa Rica or India. [*] When other countries decide to revamp their systems, -- both Taiwan and Switzerland went though the process in the 90s-- one conclusion they quickly arrive at is that they don't want anything like the US.[*]In 2004, Tommy Douglas, the founder of Canada's Medicare, was voted "The Greatest Canadian of All Time" in a contest run by the CBC. Whatever you think of such things, it's clear that most Canadians do not share the views of your self-selected sample.
If I understand what you are saying, you are critical of the VA because a) you see too many eligible veterans who have not been able to get adequate care in the VA system and b) your own experience as a medical student some years ago in the VA was not good. As Phillip Longman, who has invested quite a bit in studying the VA, noted in The Best Care Anywhere, the popular notion of the VA as a dysfunctional, "government-run" system is simply wrong. Many think that the VA is an example of just how good medicine can be in the US. It's patient load doubled between 1995 and 2005 while it's costs were cut in half. We're in the middle of a war and Congress is still trying to starve it.
VA has been at the forefront of electronic medical records and comparative effectiveness studies. Could it do better, yes -- so tell your congressman to fund those vacant specialist physicians.
The "liberal" congress is too cowardly to deliver the only solution that will make a difference in the long run. And once again, Single-payer does not mean that it's "government run" and there is no government-run program in any of Western Europe or Asia that dictates where patients get care. In fact, most patients in most universal care countries have more choice than the average American.
I don't think that is true. The New York Times poll published last week indicated that 2/3 of those surveyed were in favor of a strong public option. That may be down from the 3/4 who favored it a couple of months ago but that's still the majority.
.
Um no, many insured people actually do want reform. In fact, some of the rising disatisfaction is due to the fact they they don't think Congress is reform minded enough.
All I can say, is on this we agree. We probably wouldn't agree on what the solution should look like though.
I think the current bills are like building extra stories on a building with a sinking foundation. The way they plan to extend coverage to the uninsured (and I do not agree that's the primary problem) is through MedicAid (which is 10 times more broken than Medicare) to subsidize the private insurance model that has put us in such a hole.
IMHO, reformers should have had long listening sessions with doctors, nurses, and patients before ever going off to meetings with the lobbyists from the industry. They would have done better too, if they had talked to HR executives from multi-national companies.
Recommended reading: Money Drive Medicine by Maggie Mahar.
Mythbusting Canadian Health Care -- Part I
Mythbusting Canadian Health Care, Part II: Debunking the Free Marketeers
Do you have a source for that? I'm not contesting it, I'd just like to see the context. In many specialties, self-referral for imaging and other tests has contributed markedly rising incomes. Gwande illustrated just how dramatic the difference was in McAllen.
There are a lot of other variables too -- average vs. median, specialty vs. primary care, geography, etc.
Phokus
Lifer
- Nov 20, 1999
- 22,994
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You're not one of those conservatives who uses anecdotal evidence to 'prove' the VA is a bad system, are you?
We had this debate before and you guys looked pretty stupid afterwards
It's not perfect, but the amazing thing is, the VA system has the sickest and oldest patients compared to your average private healthcare patient (and their system is being strained by 2 ongoing wars), yet they are able to hold costs down so low while increasing quality. If vets were forced into private care? I highly doubt they'd even receive care (or it would bankrupt the nation to pay for private care).
Again, older and sicker patients in the VA, yet they cost less than the national average (of mostly private care patients)
Pathetic
Some of these studies were done by the annals of internal medicine, rand corporation, and new england journal of medicine.
http://forums.anandtech.com/me...AR_FORUMVIEWTMP=Linear
America is quite LITERALLY the dumbest nation on the planet that we see success like this but we PERSIST in preserving private care at all costs.
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