Insurance and Healthcare

[DGTess]

I think everyone should be able to afford BASIC health care.

Those who want everyone to have extensive health care are trying to become a nanny state. "I pay for your insurance, and you're more likely to need care if you eat trans-fats, so I get to determine what you put in your mouth". That's scary.

I'm reminded of a news story I saw some time ago, and can't locate now, of a guy who broke his ankle (in UK). Like many of us, he waited a couple of days thinking it was sprained, then got treatment. A few years later when it wasn't healed properly and he needed surgery, his health plan wouldn't approve it because he smokes. UNRELATED, but allowing someone to dictate your very actions. This nanny-state mentality is what scares me most about the direction of our country.

[texas*princess]

Originally Posted by DGTess

I think everyone should be able to afford BASIC health care.

Those who want everyone to have extensive health care are trying to become a nanny state. "I pay for your insurance, and you're more likely to need care if you eat trans-fats, so I get to determine what you put in your mouth". That's scary.

While it is scary, and I agree that it has the whole "Big Brother" vibe to it, I'd have to agree with them.

I'm not in the medical field but I've read a lot about the way it works in other countries -- I believe it was Norway? or Finland or something like that, where everyone pays way higher taxes than we do here in the U.S., but their health-care is pretty much all-inclusive. They have the kind of service PhoenixAzul described. In a lot of ways, the stereotypical view of the U.S. is true. We want what we want, NOW, and lots of it. If that means a double Big Mac and some SuperSized Fries, then so be it.

I'm not a smoker. I try to watch what I put into my body because I know if I put on way too much weight, I will be at risk for diabetes, and heart failure. If I am doing all these things to try to ensure I stay healthy (and therefore probably won't use my insurance as much as others) why should I pay the same high rates as someone who smokes 4 packs a day and has a pretty high chance of developing lung cancer?

I think it's one thing if you are born with something like diabetes (because I believe people of different backgrounds/sizes/ages/etc can get it) or any other chronic illnesses and can't control it, but if you are doing things to your body to make yourself way more susceptical to things like lung cancer, then yea, I'd say you're also considered a "risk" in the health-insurer's eyes and it makes sense for you to pay a higher cost.

[PhoenixAzul]

Originally Posted by DGTess

I think everyone should be able to afford BASIC health care.

Those who want everyone to have extensive health care are trying to become a nanny state. "I pay for your insurance, and you're more likely to need care if you eat trans-fats, so I get to determine what you put in your mouth". That's scary.
UNRELATED, but allowing someone to dictate your very actions. This nanny-state mentality is what scares me most about the direction of our country.

But isn't that what insurance companies do? They dictate what care you can and can't have based on how harmful it is the their profit margins.

I think it's one thing if you are born with something like diabetes (because I believe people of different backgrounds/sizes/ages/etc can get it) or any other chronic illnesses and can't control it, but if you are doing things to your body to make yourself way more susceptical to things like lung cancer, then yea, I'd say you're also considered a "risk" in the health-insurer's eyes and it makes sense for you to pay a higher cost.

Diabetes has 2 types. Type 1 (the type I have) is less about genetic factors. Mine was caused by an auto-immune response to an illness I had as a child. Type 2 (previously called adult-onset, but now type 2 because more and more children are getting it), is influenced by genetic and lifestyle factors.

We're all at "risk" for one thing or another. Lift stuff all day? Back problems. Walk a lot? Hip problems. Computer work? Carpal Tunnel. Woman? Pregnancy. Some people are just genetically pre-disposed to certain cancers. Diseases are caused by thing we've really yet to uncover, and in some cases can't avoid. I wouldn't be able to look at someone with lung cancer and say, "no mate, sorry, you've done this to yourself because you didn't avoid enough". To me, it's not really on to chastize people about the choices we make (how many of us have had a drink? you're at risk for x number of diseases)...its good to encourage best practices (nutritional information, exercise information, etc)...but to just outright deny or have to determined who did enough to avoid their disease...I wouldn't want that job.

[bluefish81]

I have good health insurance IMO, but I know that the amount it costs every year is increasing. Co-pays are going up every year, etc.

I've been on medication to treat a pre-existing medical condition for almost 12 years. 12 years ago the cost out of pocket was $90, the out of pocket cost is now $172 for a thirty day supply - for a one/day tablet. My copay is $27.

My insurance allows me to pick who I want to see, without referral, although most specialists generally require it.

I think the availability of healthcare for a lot of people is getting worse. In this I mean, I generally have no problem calling my current primary care physician and getting in that day to see him. This is probably because he's my age and hasn't been in the area much longer than me.

However, I've been seeing neurologists for almost 12 years, and have often found that I have to schedule appointments sometimes up to a year in advance in order to see a doctor. At least six months is preferable. That's a lot of planning - especially if something happens. The fastest I've ever been able to get into a neurologist was six weeks.

When I lived in Michigan, the neurologist recommended by my Iowa neurologist required a referral from a PCP in Michigan, despite the fact that my neurologist in Iowa was more than willing to provide one as well as all my history (requirement of the neurologist not my healthcare provider). I had to wait two months to get into a PCP - because I was a new patient and they were so booked up and then another six weeks for the neurologist. I guess I just don't see how the current system is working all that great for us in some respects.

[jubilance1922]

I'm not a fan of insurance companies.

Almost 6 years ago, my then 12 year old sister was in a near-drowning. Went 25 minutes without a heartbeat, was on life support for several day before she woke up. She had some pretty bad brain damage, but the doctors felt that given her young age, with extensive therapy she could get better.

Insurance company originally refused to pay, and instead wanted to put a 12 year old in a nursing home. They'd rather pay for her car in a nursing home for years than 3 months in a rehabilitation facility. My parents and her doctors finally convinced them to send her to rehab, and 3 months after her injury she was back at school, and now years later she is almost back to her old self. I cringe to think what her life would have been like if she had been sent to a nursing home instead of therapy.

I have pretty good coverage right now through my job, and we have several different choices. Yet by 2010, everyone in the company will only have one health plan to choose from, which doesn't seem very attractive right now. Basically you'll have a fund of $500, which you use to pay for all medical expenses, and then you have to cover anything between $501-$1000, and the company covers everything after $1000. And it has a $1 million coverage cap, so one major illness and you're pretty much done.

[Kevin]

What part in the cost of health care does the scarcity of M.D.'s play?

It seems that the extremely restrictive enrollment criteria from med schools has really limited the number of doctors.

Could some serious public investment in new med schools or larger med schools help to alleviate some of our cost problems?

[KSig RC]

Originally Posted by Kevin

What part in the cost of health care does the scarcity of M.D.'s play?

It seems that the extremely restrictive enrollment criteria from med schools has really limited the number of doctors.

Could some serious public investment in new med schools or larger med schools help to alleviate some of our cost problems?

While this is marginally likely, it seems like there is no "exchange" or any sort of market method for utilizing the increased competition.

I've toyed with the idea of starting a sort of "brokerage" for more common services, especially as more people move toward the "personal health savings account" model and will thus (hypothetically) have more control and interest in actual costs. This system would be incredibly useful to the consumer and to the doctor, but would really require a large break from current modes of interaction with payment devices (i.e. insurance) and doctors.

[bluefish81]

Originally Posted by Kevin

What part in the cost of health care does the scarcity of M.D.'s play?

How one plays a direct role with the other, I don't know. I was more trying to respond to the OP's question of my opinion of healthcare in the U.S. Whenever the idea of universal healthcare is brought up, opposition says we'll have to wait for hours and hours to get in to see our doctors because "that's what's happening in those countries with universal medicine." Um, clearly in some situations here, this is already the case. I imagine on both sides of the coin - here and in countries with universal healthcare it's all about where you live.

[bejazd]

[quote=Kevin;1593973]What part in the cost of health care does the scarcity of M.D.'s play?

The scarcity of MDs who want to work for minimal pay under crappy working conditions? A big part. Does the top med student out of our best medical school want to spend her career working in a clinic where they shuffle through patients every five minutes? I don't think so. We want our healthcare providers to be the best educated, best trained, most experienced professionals with access to all the best equipment, tests, and medications. We expect premium care from our health care providers, and we're going to have to pay them well and provide them with autonomy if we want a premium healthcare system.

[RACooper]

Originally Posted by Scandia

I am very skeptical about socialized healthcare. Cannot say I am opposed to it. But I like being able to choose my providers. I like being able to keep the endocrinologist who has been treating me for over 12 years without having to go to a primary care physician first.

... and what makes you think that those of us living with "socialized healthcare" can't choose our providers?

[Kevin]

The scarcity of MDs who want to work for minimal pay under crappy working conditions? A big part. Does the top med student out of our best medical school want to spend her career working in a clinic where they shuffle through patients every five minutes?

That's just the thing -- to get into pretty much any med school, you need excellent grades and a pretty good MCAT score. If you were a mediocre student who scored well on the MCAT? You *might* get into DO school.

The fierce competition for a limited amount of admissions slots should (and this is not based on fact, observation, or anything but conjecture) breed the sort of M.D. who will expect to have an elite job with elite compensation whether they graduate from John Hopkins or anywhere else. Can anyone name a med school which has 'easy' entrance requirements or one which will admit students on a probationary basis?

I don't think so. We want our healthcare providers to be the best educated, best trained, most experienced professionals with access to all the best equipment, tests, and medications.

Why should medicine have to have only the "best"? How determinative are undergraduate grades and MCAT scores as to how good someone will perform in a family practice environment? We don't need every single person in the profession to be elite.

We expect premium care from our health care providers, and we're going to have to pay them well and provide them with autonomy if we want a premium healthcare system.

Sometimes, mediocre will suffice.

[bejazd]

I think we've got plenty of mediocre and flat out terrible practictioners out there. I don't think I want anyone who is mediocre diagnosing my child or prescribing medications, performing surgery etc. But I'm totally okay with a PA or a nurse under the direct supervision of an MD performing many of the routine tasks MDs do during regular office visits.

But...if I take my kid to the dermatologist, and he never sees the MD, is it right for the MDs office to charge me the same fee for an office visit as if he'd seen the MD? Even though the PA makes far less money?

[Kevin]

Originally Posted by bejazd

I think we've got plenty of mediocre and flat out terrible practictioners out there.

Which just goes to show you that the connection between academic performance in undergraduate college and performance in the medical field is very tenuous.

Really, other than M.D's being able to charge outrageous rates, who would be harmed by an influx of highly trained individuals into the profession?

Look at the law profession -- the wide open doors of law schools nationwide has made a lawyer something that you don't have to be wealthy to be able to afford.

That's good, right?

[AKA_Monet]

Originally Posted by PhoenixAzul

I have to warn you that this is a rather sore subject for me. Please don't be offended.

1) if we are talking about the standard of care in the states, then from my perspective, it's stayed about the same. I've got a chronic illness that requires dr visits and the whole nine every 3 months, so I guess I'm a frequent consumer. If we are talking about the standards of health INSURANCE in the states, then it is abysmal. It isn't the very poorest and it isn't the very rich getting squeezed out, it's working class and middle class families getting blocked from quality care, being priced out.

And the system of "pre existing conditions" is absolute and complete bullocks. I've got to pay double what someone else pays because of something that I couldn't control? And then pay more for medications? My rates were $900/ month without prescriptions to keep my insurance. Medications were probably another $200+/- a month. And then rent. And food. And gas. If I hadn't gone to graduate school, I'd have been bent over the table...I don't know anyone who can make the $1700/month right out of school, and few who had health care right out of school.

2) Pharm reps. Oh how I hate them. I want to chuck eggs at their cars. Before I left for Glasgow, I had to go and get a TB test and a meningitis shot at my GP. So I go in, and the waiting room is PACKED. So I sign in, present my card. And I sit...and wait....and wait....and wait. Finally I got up to check and make sure my appointment was on the right day/time. And through the window, I see that all of the Dr's and nurses are enjoying sanwiches, coffee, cake and such with a drug rep sitting there with his case open....

The waiting room itself has an LCD monitor that just constantly flashes direct-to-consumer drug adds. We're one of only two countries in the world that allow direct to consumer advertising, and it costs the pharmaceutical companies BILLIONS of dollars a year. I'd really rather they kept that money for research or, *shock* reduced the price of the medication. I've got zero sympathy when they lose a patent and a generic comes available.

3) The absolute cluster-f*ck of red tape associated with health care does my head in. Why am I paying someone the above $900/ month to DENY ME CARE? And it isn't the Dr that makes that decision, it's some paper pusher in an office somewhere that says, "nope, can't have that procedure". I pay you to WORK FOR ME, not to put up barriers to my care. That's not the way this system works....you pay, you receive services. We wouldn't accept this type of abuse from any other industry, but health insurance gets away with it because we've got to have it.

When I was getting ready to leave for Glasgow, we were trying to get the insurance company to give me a year's dispensation of my medication at one time. This was a nearly 4 MONTH process of phone calls, faxes, letters, complaints, threatening legal action (I owe my lawyer friend a nice bottle of Scotch for that one), in order for them to say, "oh! ok." (I should note that this is the only time that I have dealt with one person on a consistent basis and she was fantastic...it was a pharm services person in my health insurer, who said to me, "yea this system is shit, we'll get you that med one way or another")

4) The fear-mongering surrounding countries with national insurance is ridiculous. I've lived in the UK for a while now, and I've got a phenomenal GP who is literally 100 yards from my front door. I was immediately given an appointment, physical, podiatrist (which my old insurer wouldn't cover even though I'm diabetic), diabetes specialist, and a prescription waver form. The standard rate of prescriptions in the UK is 6.18 GBP...about $12 USD with exchange rate. But if you've got a condition that requires constant medication/monitoring, or if you're in a couple of other situations, the prescriptions are absolutely, positively, free. I don't pay a pence for them. And it isn't just insulin, it's flu shots (weren't covered under my old insurance), biohazard bins, they'll pay a good portion of orthotics should I need them....

And I've never waited to see a Dr. here. I've always gotten prompt appointments and treatments. My flatmate (also american) had a stroke (she's 22) the third week of us being here, and she was given treatment at no cost, and she continues to recieve treatment for the blood thinners and other things she takes, again at no cost. She might even be able to apply for transport funds, because the neurology clinic she has to attend is cross town from our flat.

But I guess my point is that treatment is no good if it is only for the rich. It would make more sense to me to given EVERYONE access, especially the working class. If you've got a healthy person who isn't having to scrape and decide between medicine and food or medicine and rent, then surely they'll be a better employee. Surely if they've just got a GP to go to for a blood test, that can prevent them from being disabled later. I don't know, to me it seems that if we make an investment in the health of EVERYONE then we should see the economic gains in productivity.

PhoenixAzul-- PM me... I can teach how to "work" this system and get what you need... It might take me some time, but I can do it...

(((((Hugs))))) for you though your dealing with this BS...

[AKA_Monet]

Originally Posted by Kevin

What part in the cost of health care does the scarcity of M.D.'s play?

It seems that the extremely restrictive enrollment criteria from med schools has really limited the number of doctors.

Could some serious public investment in new med schools or larger med schools help to alleviate some of our cost problems?

Kevin, VERY AWESOME QUESTION!!! Given I just got back from my State Legislature and some info on healthcare...

Physicians who have limited training cannot best treat their patients. It is different from other countries like China, where what they call MD's there are really PA-C here... They KNOW some aspects of medicine, but not all the aspects that are expected to pass the USMLE--all parts.

The enrollment is restrictive because there are so many people who want to be MDs. The other issue is there is something like ~300 med schools in the US--the one's that are accredited. Moreover, it is very expensive to fund certain specialties--like surgical wings-- pricey--and NO ONE will pay for students to screw up that on anyone... So most med students take on the "higher paying, easier (loosely used) pass" specialties, like family med, internal med, pediatrics, a few others. The hard ones, like cardiothoracic surgery... Wow, the school I worked for, cannot find many students interested... I'd do it if I could tie knots, but I cannot do it.

There is only one med school in my state. And it serves 4 other states with the pre-requisite of those students going back to their home states... That rarely occurs. Reasons are after one finishes med school, they go to do residency elsewhere in another location, that includes clinic duty. And if they like research, well they do that, too.

Who does the healthcare, ER surgeons do... But most of those doctors are triage folks. Many of ex-military or currently serve... A JAMA article just came out about their duties in Iraq and how to train for triage. But EVERYONE KNOWS that ER healthcare is NOT preventative--especially for chronic conditions... Good for blown limbs, BAD for chronic conditions du jour--unless there is a heart problem, priaprism or huristism...

And the sad part is, most of the American public uses ER care as their primary health care due to anger toward their primary care physicians. One has to be dead in their butts to get optimal care from an HMO, non-specialist... Even I had to do that. What's interesting about my HMO, is I write them emails and that crap gets into my medical record... So, if they deny me treatment, they might get put up under AMA board review... (hint, hint)