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The current private insurance market is driven by profit alone; patient short or longterm health never enters the equation. With denial of coverage for pre-existing conditions or dropping subscribers when the actuaries decide that "Joe" may actualy cost more than his premium. It should more justly be considered white collar crime.
ps I do have healthcare through my place of employement
Why not let the people choose between an array of private options and one public option? Nobody has to give up their current plan if they like it. Nobody is forced into any one option. We believe in choice from among a variety of plans that follow certain rules so people can know what they're getting.
An entirely deregulated system like you propose would make it very difficult for health care "consumers" to pick an effective plan unless they spent a significant portion of their day-to-day lives studying all the options. How would anyone know if the plan were on the up and up? We've seen similar results from our largely deregulated financial and banking systems. Fraudulent players rise to the top of the heap and Americans are duped without much recourse.
I have health insurance through my wife's employer. Thank you!
Another talking point is that a universal health plan would make the United States more globally competitive. Corporations moved their businesses out of the United States and into countries that have health care plans funded by their government due to the high cost of health insurance here. Insurance companies are into making money and profits which are determined by Wall Street. I don't think health care should be run by either one of these entities because they have no concern for human beings and its cheaper to bury people than to keep them healthy.
But I was an unwitting player in this game. I thought I was doing it because I was a good nurse and a good teacher and it was stemming the flow of patients to the emergency room.
I would like to see these interventions come from the physician. After all, the MD is the one treating the patient and the MD should get the profit, not the insurance company.
As a patient, I am sick and tired of insurance companies interferring between me and my doctor. Let the doctor run the show. I agree with Kelly above as well. Keeping patients healthy starts early. My doctor is "allowed" 15 mins to see me. How much interaction goes on in that time. Again, insurance driven.
The past two years my husband's employer offered a less-than-user friendly and now out-of-state insurance option. We still pay out the same to the employer but get less coverage. What's with that? We've got to get the insurance companies to stop interfering. And now I understand that the employer is getting paid to provide insurance to employees?
Medical coverage IS broken and has been for a long time. We cannot fix it overnight. It may be painful to fix, like a broken leg. Why does the president think we can fix it this summer? Please, please, please, study this issue longer. Don't put a bandaid on it. Oh, lordy, I'm scared.
Vincent Las Cruces, NM
"Our neighbor had to have surgery for temporomandibular joint disorder. AFTER the surgery, Blue Cross/Blue Shield CHANGED to declaring this as dental surgery and refused to cover it. The couple have been forced to sell their house to pay the extra $50,000."
Karen Carlsbad, NM
"I am a Family Nurse Practitioner providing primary care to patients in rural New Mexico. I see patients with and without insurance everyday who suffer from chronic diseases that are not treated due to the high cost of health care and health insurance. Insurance in this country does not guarantee health care due to high co-pays, deductibles and pre-existing condition exclusions.
I am burdened daily with at least 3 or more hours a day of mine and my staffs time spent with paperwork for gatekeeping and denials. We need health care for ALL Americans that is preventive, affordable and accessible to EVERYONE."
I will try to post a couple more each day of the forum.
True, buying health care is not necessarily as simple as buying hamburgers, but that is even more the reason that consumers need to be empowered with pricing information that they currently lack and that some are trying to eliminate entirely.
Lastly, if we used insurance for what it was intended (emergencies, not day-to-day treatments) and we, not our employers, paid the bills and were therefore the customers, many of the issues with insurance would disappear.
There must be more than the 41 mil to 45 mil people without insurance that number has not moved substantially for years and years...maybe year 2000 or before. The uninsured must be at twice that by now....80 mil.?? and not even counting the underinsured. I wish there was real current data on that number. If anyone has any please share.
Funny I have never ever worried that a doctor was going to prescribe too many tests, I worry the opposite the right test willnot be ordered due to costs.
Imagine if we treated our citizens healthcare needs as our security needs. The billions that go to defense. The 2 bil a week still going to Iraq and Afganistan. Meanwhile the enemy is within the borders a sick work force hanging on by a thread. If the swine flu did take off I can only imagine.
We are the (or were the) richest country in the world. I can not imagine what will be the result if we do nothing or if this fails. Walking over people dying in the streets? third world?? fourth world??
Can you be more specific as to who "certain groups whether they be geographically or demographically determined have been particularly prone to over-using the health care system, thus driving up costs," might be?
As an RN who has worked in long term care for over 15 years in New Mexico, I find that statement rather odd. My most costly, most intensive patients, with the poorest outcomes, tend to be people who could not or did not access health care before a catastrophic event--untreated hypertension leading to stokes, osteoporosis leading to fractures, untreated diabetic or circulatory ulcers requiring amputation, for a few examples. Conditions that can be diagnosed and in many cases monitored, by primary care providers. This is under use of medical services, not over use.
Thank you,
Kelly
A much more detailed description of the problem from the Congressional Budget Office can be found here: http://www.cbo.gov/ftpdocs/95xx/doc9567/07-17-H...
BTW: I would point out that in a health care system in which individuals bear the costs for their own decisions, "overuse" is a nebulous term and the negative impacts are negligible. In a system where others pay the bills, overuse is a far more significant problem due to the incentive structure.
After reading the CBO report, I gather the problem is not hordes of hypochondriacs demanding monthly MRI's, but heath care providers either knowingly gaming the system for profit or operating in localized cultures of expensive care. An eye opener for me, because as an RN married to a PT, there are accepted standards of practice that we have to operate by, and I didn't realize things are much less standardized for physicians.
However, individuals don't have much of a say in these matters. If the doctor says a test, medication, or procedure is need, the patient, fearing for their health and trusting their doctor, will go along with it. I am amazed at how few of my patients even ask for second opinions.
As for "bearing the costs for their own decisions," patients do, if not financially, then physically, when that stroke or heart attack finally arrives after years of being overweight or smoking. I do agree that everyone should be required to buy health insurance, otherwise the cost is going to overwhelm us.
Thanks again for the information and discussion,
Kelly
In my experience with healthcare, I have never been too worried I have been getting too many tests. Maybe the opposite.
It is a litigious society we have here in the US, all professions are held to a new and different level of care and standards. My sympathy for Doctors and the litigation is marginal, you are not alone in this legal battle time. If you love your profession you do it! You take an oath, you have a license, practice medicine as your plaque on your wall says.
Lastly, a suggestion is to have everyone who comments here state if they have healthcare coverage. I find the ones who have it speak much differently then the ones who do not.
ps....i do have healthcare coverage
I agree with Democrats in Congress who argue that everyone should have the same kind of insurance that they have. And help in dollars to those who can't afford it would be the simplest least expensive way of giving it to them.
But litigation ceilings, and perhaps a tax incentive for physician insurance costs would help. The government ought absolutely not get into the insurance business. The government has never run anything cost-effectively --- not Amtrak, Post Office, Driver Licensing, nothing. Furthermore, there is a huge difficulty of bureaucratic log-jams in countries that do have government run health care.
Government incentives for private sector is the only cost-effective way to improve the system.
For example, let's say you are a 35 year old married healthy male and are the sole bread winner for your family of four (wife and two kids). A medical misdiagnosis, or mistake, is made in a surgical procedure you have that leaves you permanently disabled. You can no longer work and have to depend on SSI for your income. What is this catastrophic loss going to cost you and your family? At bare minimum it will cost you your annual salary through age 65, your current and future medical bills, and your cost of living adjustments. You can no longer save money for vacations, special events, home improvements or college for your kids. Most tort reform advocates would like to see a cap placed on verdicts in the range of $200,000 - $400,000. Caps like these are ridiculous. They don't compensate the victims. High verdicts aren't the sole driving force behind high premiums. Bad investments by the health insurance companies and sky-high CEO bonuses are.
Medicare will be bankrupt long before many of us who have paid into the system will be able to take advantage of the plan. Medicaid is not successful in enrolling all those eligible because they are ineffective in communicating and marketing the available coverage.
And to take from some non-healthcare examples the government run post office is broke and we now see annual increases in postage. Our government run school systems are a disaster and fail to educate our children to be globally competitive. We now have private companies who administer MVD and charge a premium which most of us are willing to pay because we don't want to put up with a government bureaucracy.
With all of these examples that government is not effective at running things why would we entrust the most important and personal service we use to a government run entity?
a. Does Congress have a grant of power to enact health care legislation?
Answer: No it does not (see Article I, Sect. VIII, U.S. Constitution). Period.
b. Read the 'penalties' (that is what I call it) section of hr 3200, sec. 401 - 418.
Here is a link (printer friendly version): http://thomas.loc.gov/cgi-bin/qu...emp/ ~c111EuJ8aX
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