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Tags health care issues , health insurance issues

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Old 19th September 2019, 09:09 PM   #1
Meadmaker
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The American Health Care System is Stupid

See the title.

But, specifically, the thing that is so awful about it is employer provided health insurance. That is just the dumbest thing in the world. Is there any other nation where that's considered normal?

People, especially conservatives, complain that they don't want government to choose their doctors. I can understand that. However, these same people seem to think it makes perfect sense for their boss to choose their doctors.

How dumb is that?

I was generally supportive of Obamacare when it was introduced. I thought the basic principle was fine....except. It strengthened the ties between employment and health care. That was very, very, unfortunate.

So, why is it that this thought is occurring to me now, and I feel compelled to rant on the internet about it. I want to assure you that I've thought this way for a long time, but there is, in fact, something about present circumstances that bring home just how stupid this connection is.

In June, I lost a job. Unceremoniously dumped, in the middle of the month (that will be significant later). Well, the truth is that I'm pretty financially secure, and I really hated that workplace. Therefore, inconvenient, but not catastrophic. Unfortunately, it means I also had to start paying for health insurance. Well, this is a problem. As I said, I am financially secure, but that doesn't mean I enjoyed the prospect of shelling out my own money for health care.

So, in the US, we have COBRA. Named for an act of Congress that established the law, but whose acronym has nothing to do with health care, it requires that employers allow recently former employees to continue health care coverage, as long as the employees are willing to foot the entire bill. As it turns out, that entire bill is usually quite large. It turns out that most people don't really understand how much their health care costs. But, even without the individual mandate, I am the sort of person who insists on having health insurance, and it not lapsing even for one day. If that's the day you happen to be in a car crash, you're screwed. So, no matter what, I'm going to be covered every single day. And, I'm financially secure, so I can do that. A lot of people can't, but that's not the subject of this thread (until someone makes it that, because it really can't be avoided.)

Since COBRA is expensive, it would be better to have some other alternative. There are "marketplace", i.e. Obamacare, plans. They are not cheap, but more importantly, they have very high deductibles. They have to, because they cover preexisting conditions. The insurance companies know that there will be people who wait until they need care to sign up. Those high deductibles help mitigate that problem.

What else is available? Well, I'm 56 years old and diabetic. The answer is that nothing else is available. Literally. It's COBRA or Obamacare.

There's another interesting feature of Obamacare plans. They all start the first day of a month. Also, once you declare that you are opting into Obamacare, you can't opt into COBRA. COBRA has an interesting feature as well. You have sixty days to decide to take COBRA, but it's retroactive if you decide in those sixty days. If you opt in to COBRA, you can't take Obamacare.

So, on July 23rd, I found myself having to make a decision. COBRA or Obamacare? Once I choose, I'm committed. I haven't had any bills since mid June, when I lost regular coverage. Obamacare can't start until August 1. If I say I want Obamacare starting on August 1, I can't change my mind if something happens. So, what do I do?

I get a very short term, catastrophic care only, no pre-existing condition, plan, that covers me for a week. It costs about 400 dollars, because it actually covers me for 30 days, which is the shortest policy they sell, but you can start on any day. Problem solved.

Oh...for other reasons, it made more sense for my wife to take COBRA. You see, she had already met the deductible, and had some planned medical procedures coming up.

Now, I get a job. Sign up for the new job's coverage? Not so fast. My new job is "contract to hire". Very common for the software biz, especially when hiring old guys. That means I'm going to be an employee of the contract house for six months and then (if all goes well), join my new company officially. So, I have to sign up for the contract house's insurance. The deductible restarts. Then, the first of the year rolls around, and the deductible restarts. Then, on the 1st of March, I join the new company, which has a new insurance plan, and a new deductible.

Over the course of 12 months, I will have been covered by five different insurance companies. (The old company plan, the catastrophic short term plan, the Obamacare plan, the contract house plan, and the new company plan.) And I still haven't decided whether to keep my wife on COBRA. It's expensive, but she has an expensive procedure coming up, and she has met the COBRA deductible. Oh...and the new company and the contract house both have the same insurance network, and the doctor my wife is going to isn't in network. So, change doctors because your husband gets a new job. Who came up with this madness?

It's insane. Fortunately, the new plans include mental health coverage I'll need it by the time I sort out the paperwork.
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Old 19th September 2019, 09:13 PM   #2
arthwollipot
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The rest of us look at America an we're like

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Old 19th September 2019, 09:17 PM   #3
The Great Zaganza
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The US health care system does exactly what it is designed to do: make some people extremely rich.
No other health system in the world does that better.
USA! USA!
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Old 19th September 2019, 09:36 PM   #4
a_unique_person
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Originally Posted by arthwollipot View Post
The rest of us look at America an we're like



https://i.imgur.com/ZvWxgChm.png
Australia is doing it's best to make a system as dysfunctional as the American one. The"free gp" visit us being shut down slowly but surely
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Old 19th September 2019, 11:07 PM   #5
Norman Alexander
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I think what puzzles us the most is that there is so much earnest discussion and screaming about "it's gonna be SO expensive how can we afford it!" Including from some Democrat candidates who, frankly, should know a lot better than that.

This sort of message indicates a complete misunderstanding about how single-payer works. Bernie has it right: It is a LOT cheaper to provide the same level of medical care in a single-payer system than the current US model. But is is not "free", as in costs nobody anything. That seems to be the source of the misunderstanding. And it's a major misunderstanding. Believe me, medical care in Australia costs a bomb, and it does have to be paid for.

At it's very basic, a single-payer system is almost exactly the same as your federal taxes pay hundreds of billions for the military. Everyone chips in a little, rather than a few paying a lot. And since it is a federal tax, nobody is exempt. It comes out of your pre-tax pay just like any other withholding. How little? In Australia, it's simply a 2.5% levy on pre-tax earnings for everyone. Other countries do this differently.

The money so collected goes to public medical care. We have publicly-funded hospitals - they are world-class and quite big. Doctors and specialists are reimbursed standard amounts for various procedures. Patients pay zero or very little visit fees at the time of the visit for certain types of procedures. Some prescription drugs are subsidised to a certain level. Many hospital procedures and basic levels of hospital accommodation are covered in full or subsidised. And so on.

To be clear: Some of these do require additional payments, what I understand in the US is called "co-pays". Not everything is covered. There are regular media articles about what is and is not, and regular argy-bargy about it. As AUP describes, our current ultra conservative government is trying to force us towards the "user-pays" US model, but I suspect they will be spectacularly unsuccessful with that.

We do have private medical insurance as well, and private doctors and specialists and hospitals. These operate much the same as in the USA. You get what you pay for.

Just to be clear: There is no one way this can be achieved. How we do it in Australia is modeled on the Canadian system but does not work exactly like it. Both Australian and Canadian systems have similarities to the UK NHS, but that is a different model again. Each has pluses and minuses, and none of them are perfect. And they do change over time.
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Old 19th September 2019, 11:31 PM   #6
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I think many Americans have a hard time untethering their insurance plan from actual healthcare. They always want reassurance about keeping their insurance or doctor.
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Old 19th September 2019, 11:32 PM   #7
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Here's another thing. "Preexisting conditions" is an American invention. To the rest of us it's just your medical history.
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Old 20th September 2019, 02:37 AM   #8
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Originally Posted by Meadmaker View Post
See the title.

But, specifically, the thing that is so awful about it is employer provided health insurance. That is just the dumbest thing in the world. Is there any other nation where that's considered normal?

People, especially conservatives, complain that they don't want government to choose their doctors. I can understand that. However, these same people seem to think it makes perfect sense for their boss to choose their doctors.
Where does this ridiculous idea come from?

I have no idea how universal healthcare works in other countries, but in Canada:

The government doesn't choose my doctor.
Employers don't choose my doctor.

I choose my doctor.

Any doctor, any hospital, any clinic, anywhere in the country, any time I want, as often as I want.

The government plays absolutely no part in my life whatsoever with regards to my healthcare. None, zip, zilch, zero, nada.
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Old 20th September 2019, 03:11 AM   #9
cullennz
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Originally Posted by Meadmaker View Post
See the title.

But, specifically, the thing that is so awful about it is employer provided health insurance. That is just the dumbest thing in the world. Is there any other nation where that's considered normal?

People, especially conservatives, complain that they don't want government to choose their doctors. I can understand that. However, these same people seem to think it makes perfect sense for their boss to choose their doctors.

How dumb is that?

I was generally supportive of Obamacare when it was introduced. I thought the basic principle was fine....except. It strengthened the ties between employment and health care. That was very, very, unfortunate.

So, why is it that this thought is occurring to me now, and I feel compelled to rant on the internet about it. I want to assure you that I've thought this way for a long time, but there is, in fact, something about present circumstances that bring home just how stupid this connection is.

In June, I lost a job. Unceremoniously dumped, in the middle of the month (that will be significant later). Well, the truth is that I'm pretty financially secure, and I really hated that workplace. Therefore, inconvenient, but not catastrophic. Unfortunately, it means I also had to start paying for health insurance. Well, this is a problem. As I said, I am financially secure, but that doesn't mean I enjoyed the prospect of shelling out my own money for health care.

So, in the US, we have COBRA. Named for an act of Congress that established the law, but whose acronym has nothing to do with health care, it requires that employers allow recently former employees to continue health care coverage, as long as the employees are willing to foot the entire bill. As it turns out, that entire bill is usually quite large. It turns out that most people don't really understand how much their health care costs. But, even without the individual mandate, I am the sort of person who insists on having health insurance, and it not lapsing even for one day. If that's the day you happen to be in a car crash, you're screwed. So, no matter what, I'm going to be covered every single day. And, I'm financially secure, so I can do that. A lot of people can't, but that's not the subject of this thread (until someone makes it that, because it really can't be avoided.)

Since COBRA is expensive, it would be better to have some other alternative. There are "marketplace", i.e. Obamacare, plans. They are not cheap, but more importantly, they have very high deductibles. They have to, because they cover preexisting conditions. The insurance companies know that there will be people who wait until they need care to sign up. Those high deductibles help mitigate that problem.

What else is available? Well, I'm 56 years old and diabetic. The answer is that nothing else is available. Literally. It's COBRA or Obamacare.

There's another interesting feature of Obamacare plans. They all start the first day of a month. Also, once you declare that you are opting into Obamacare, you can't opt into COBRA. COBRA has an interesting feature as well. You have sixty days to decide to take COBRA, but it's retroactive if you decide in those sixty days. If you opt in to COBRA, you can't take Obamacare.

So, on July 23rd, I found myself having to make a decision. COBRA or Obamacare? Once I choose, I'm committed. I haven't had any bills since mid June, when I lost regular coverage. Obamacare can't start until August 1. If I say I want Obamacare starting on August 1, I can't change my mind if something happens. So, what do I do?

I get a very short term, catastrophic care only, no pre-existing condition, plan, that covers me for a week. It costs about 400 dollars, because it actually covers me for 30 days, which is the shortest policy they sell, but you can start on any day. Problem solved.

Oh...for other reasons, it made more sense for my wife to take COBRA. You see, she had already met the deductible, and had some planned medical procedures coming up.

Now, I get a job. Sign up for the new job's coverage? Not so fast. My new job is "contract to hire". Very common for the software biz, especially when hiring old guys. That means I'm going to be an employee of the contract house for six months and then (if all goes well), join my new company officially. So, I have to sign up for the contract house's insurance. The deductible restarts. Then, the first of the year rolls around, and the deductible restarts. Then, on the 1st of March, I join the new company, which has a new insurance plan, and a new deductible.

Over the course of 12 months, I will have been covered by five different insurance companies. (The old company plan, the catastrophic short term plan, the Obamacare plan, the contract house plan, and the new company plan.) And I still haven't decided whether to keep my wife on COBRA. It's expensive, but she has an expensive procedure coming up, and she has met the COBRA deductible. Oh...and the new company and the contract house both have the same insurance network, and the doctor my wife is going to isn't in network. So, change doctors because your husband gets a new job. Who came up with this madness?

It's insane. Fortunately, the new plans include mental health coverage I'll need it by the time I sort out the paperwork.
Sounds like an ugly system.

The US is an oddity.

Right, left, middle in other countries would never go the insurance route over free national health systems.

It maybe slightly slower, but there is a tendency for less not well off people to not die and you don't have to deal with lawyers.

That and the prices are stupid for what you seem to actually get.
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Old 20th September 2019, 04:13 AM   #10
kellyb
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Originally Posted by Norman Alexander View Post
Everyone chips in a little, rather than a few paying a lot. And since it is a federal tax, nobody is exempt. It comes out of your pre-tax pay just like any other withholding. How little? In Australia, it's simply a 2.5% levy on pre-tax earnings for everyone. Other countries do this differently.

The money so collected goes to public medical care.
That's exactly like the US system, except we pay 3% in taxes, just for Medicare. But it it only covers people over 65. And it only partially covers them. They have to pay quite a bit out of pocket, in addition.

So, where does the money actually go?

Quote:
We have publicly-funded hospitals - they are world-class and quite big.
We have private hospitals that price-gouge the ever-loving SNOT out of Medicare, private insurance companies, and the uninsured. And private x-ray companies operating out of the hospitals. And private lab companies and phlebotomy companies. A squillion little points of contact for price-gouging to pay for corporate profits.

That's what the same amount on money is taxed per person in the US as everywhere else, but everywhere else can cover the entire population with that money, but it'll only cover the over 65 crowd here.
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Old 20th September 2019, 04:29 AM   #11
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US healthcare system is just one big giant snowball of unintended consequences that has been allowed to roll and grow larger for decades.

There is no good reason to tie the ability to receive health services to employment. It increases the complexity and expense of hiring, disincentives worker job mobility, and leaves wide swaths of the populace uninsured or underinsured.

There's nothing more uniquely American than having a co-worker who is seriously ill, but refuses to leave a job because they can't afford their insurance or health bills without their employer plan that will terminate once they have exhausted their short and long term leave (if they even have any). I worked with a woman who was going through chemo and was trying to stay on as long as she can, because she knew that she would be laid off once her long-term sick leave had expired and that she could not pay for her own premiums.

So you can get sick, but if you get too sick for too long, you'll still be bankrupted by medical bills. Huzzah!
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Old 20th September 2019, 04:39 AM   #12
Norman Alexander
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Originally Posted by kellyb View Post
That's exactly like the US system, except we pay 3% in taxes, just for Medicare. But it it only covers people over 65. And it only partially covers them. They have to pay quite a bit out of pocket, in addition.
Then you are already mostly there. But there's more than just rates and coverage.
Quote:
So, where does the money actually go?
Good question.

Quote:
We have private hospitals that price-gouge the ever-loving SNOT out of Medicare, private insurance companies, and the uninsured. And private x-ray companies operating out of the hospitals. And private lab companies and phlebotomy companies. A squillion little points of contact for price-gouging to pay for corporate profits.
Here, we have those too. If you want a higher level of care, or to get a procedure that is not on the public list, or want to see your favourite specialist but he only works "privately" then we have exactly the same deal. You pay, through the nose. And if you want to take out extra private insurance to cover this then go right ahead - there's options available.

I think the difference is that because basic medical care is "universal", everyone is entitled to basic coverage, all the time, no arguments. It's nothing to do with insurance or employment. Employers do not manage or revoke our health care, or try to tempt you into jobs with "health plan benefits". They have nothing to do with it beyond withholding the levy out of pay and remitting it along with all other payroll taxes collected. If you lose your job, it has no effect on your medical care - you still get it. You don't have to panic while job-hunting because you have no health plan.

Quote:
That's what the same amount on money is taxed per person in the US as everywhere else, but everywhere else can cover the entire population with that money, but it'll only cover the over 65 crowd here.
Strange. Smaller countries with tinier economies still manage to provide basic health care for all to some extent using a universal health care approach. So the argument that the USA can't afford it seems to be an admission that the current method is loads of money being poorly spent rather than a lack of money.

We feel sure that the USA can develop a really great Medicare For All system that is both cost-effective and good medicine. Just that some people really do need to let go of some bad ideas about it.
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Old 20th September 2019, 06:20 AM   #13
kellyb
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Originally Posted by Norman Alexander View Post
So the argument that the USA can't afford it seems to be an admission that the current method is loads of money being poorly spent rather than a lack of money.
It's apparently a point of pride for some members of the political class.

From the last debate:

https://abcnews.go.com/US/read-full-...ry?id=65587810

--------------------------------------

WARREN: So, let's be clear, I've actually never met anybody who likes their health insurance company.

(APPLAUSE)

I've met people who like their doctors. I've met people who like their nurses. I've met people who like their pharmacists. I've met people who like their physical therapists. What they want is access to health care. And we just need to be clear about what Medicare for All is all about.

Instead of paying premiums into insurance companies and then having insurance companies build their profits by saying no to coverage, we're going to do this by saying, everyone is covered by Medicare for All, every health care provider is covered. And the only question here in terms of difference is where to send the bill?

STEPHANOPOULOS: Senator Sanders.

SANDERS: Let us be clear, Joe, in the United States of America, we are spending twice as much per capita on health care as the Canadians or any other major country on earth.

BIDEN: This is America.

SANDERS: Yes, but Americans don't want to pay twice as much as other countries. And they guarantee health care to all people.

--------------------------------

Go figure. Getting bilked by insurance companies and all the other profit-making health care enterprises is...super American?
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Old 20th September 2019, 06:29 AM   #14
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Well, it's super American to Biden, whose donors include large health insurance corporations. Between those and the banks Biden's donors are mostly the parasites Warren and Sanders want to get rid of.
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Old 20th September 2019, 07:05 AM   #15
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Originally Posted by Meadmaker View Post
So, in the US, we have COBRA. Named for an act of Congress that established the law, but whose acronym has nothing to do with health care, it requires that employers allow recently former employees to continue health care coverage, as long as the employees are willing to foot the entire bill.

When I was laid off from New York State at the end of 2010, one of the clauses in the union contract was that NY would continue to cover their portion of the insurance for two years (I think; it's been a while and I only used it for 8 months).
Damn Communist unions!!

But seriously, only having to pay what I had already been paying was a life saver. I guess it's another reason for the steady erosion of worker representation over the decades.
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Old 20th September 2019, 07:48 AM   #16
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Our system here in the US makes little sense. And many of the arguments you'll hear against universal coverage are based on misunderstandings. However, there is something important underlying them that requires acknowledgment. We typically in the USA do not have any confidence in our government to accomplish things. When you see your government abuse taxpayer dollars the way ours does, it's more difficult to convince yourself that it won't happen THIS time. I think this viewpoint intensifies with age as you experience the cyclical patterns of politics, and I believe it's at the foundation of many of the arguments against nationalization.
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Old 20th September 2019, 08:04 AM   #17
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Originally Posted by cullennz View Post
Sounds like an ugly system.

The US is an oddity.

Right, left, middle in other countries would never go the insurance route over free national health systems.

It maybe slightly slower, but there is a tendency for less not well off people to not die and you don't have to deal with lawyers.

That and the prices are stupid for what you seem to actually get.
For the bulk of the poorer people it wouldn't even be slower actually. Most of them, out of fear of being harassed, bankrupted or have their checks taken, don't even go to the doctor until it's an emergency. So even if they had to wait an extra month it would be much faster than not going until you have no choice.
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Old 20th September 2019, 09:59 AM   #18
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Aw, rub a little dirt on it, pinkos. America doesn't have a healthcare system--"system" is just another word for "tyranny". We have the freedom to choose which hospital we go to as we shed the blood of patriots in the back of an ambulance (if you want to save money, try walking, you millennials). Just keep your copy of Consumer Reports at hand. If everyone would do that, the market would be able to work its magic. But noooo, you'd rather turn over your decisions to the man in Washington, and that is how liberty dies. Who's better at making healthcare decisions--some government doctor or you?
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Old 20th September 2019, 10:14 AM   #19
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The fundamental problem with the American health care system is that it's not at all a system. It's a collection of crap that grew up over time.
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Old 20th September 2019, 10:55 AM   #20
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Originally Posted by init15jw View Post
.....
We typically in the USA do not have any confidence in our government to accomplish things. When you see your government abuse taxpayer dollars the way ours does, it's more difficult to convince yourself that it won't happen
.....
I don't think that's generally true. Medicare recipients generally are happy with their coverage, even if they don't understand it. Presidential candidates have been told more than once at town meetings "keep the government out of my Medicare!" Voters disparage "Congress," but they are generally happy with their own Congressperson, and are much more likely than not to return him to office. And "waste" is very often just a program somebody doesn't like, where "wise and essential appropriations" pay for programs that benefit them and their interests. Few speak out against spending vast mega-billions for the military, without any clarity even about what it's paying for, let alone whether we need it.

And back to the subject, let's note that Medicare is a single-payer insurance system. Patients choose their own providers (who decide whether to accept Medicare, which is the large majority), and Medicare pays the bills. It is not a government-operated program comparable to the UK's NHS or the U.S. VA. A transition to a Medicare-for-All program would be a big step for the country, but for providers and patients, the main thing that would change is who pays the bills.
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Old 20th September 2019, 11:01 AM   #21
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Originally Posted by init15jw View Post
Our system here in the US makes little sense. And many of the arguments you'll hear against universal coverage are based on misunderstandings. However, there is something important underlying them that requires acknowledgment. We typically in the USA do not have any confidence in our government to accomplish things. When you see your government abuse taxpayer dollars the way ours does, it's more difficult to convince yourself that it won't happen THIS time. I think this viewpoint intensifies with age as you experience the cyclical patterns of politics, and I believe it's at the foundation of many of the arguments against nationalization.
You think we don't think the same about our governments outside the USA?
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Old 20th September 2019, 12:50 PM   #22
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Originally Posted by SuburbanTurkey View Post

There is no good reason to tie the ability to receive health services to employment. It increases the complexity and expense of hiring, disincentives worker job mobility, and leaves wide swaths of the populace uninsured or underinsured.
The reason is that insurance companies need to have risk pools that The reason is that insurance companies need to have risk pools that discourage free riders and self-selection. Basing these risk pools on employment is far from ideal, but the alternative is higher premiums and intensive policing of prohibitions on pre-existing conditions.

The way everyone else does it is to put everyone into the same risk pool, but this would mean the wealthy don’t get special treatment and Americans won’t stand for the wealthy being treated just like everyone else.
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Old 20th September 2019, 01:08 PM   #23
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Originally Posted by lomiller View Post
The reason is that insurance companies need to have risk pools that The reason is that insurance companies need to have risk pools that discourage free riders and self-selection. Basing these risk pools on employment is far from ideal, but the alternative is higher premiums and intensive policing of prohibitions on pre-existing conditions.

The way everyone else does it is to put everyone into the same risk pool, but this would mean the wealthy don’t get special treatment and Americans won’t stand for the wealthy being treated just like everyone else.
Healthcare is too important to be equitable.
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Old 20th September 2019, 02:03 PM   #24
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Someone put it beautifully when they said most Americans want Universal Health Care but don't want a government bureaucracy to run it...….

Seriously, I think any Health Care system to work in the US would have to give a lot of choice to the individual as to which doctor he goes to. American love to have a variety of choices;and I don't think a system that just assigns them a doctor without any choice in the matter would ever be accepted by the American people.
Question is if a Single Payer system can accomidate that. I think the Canadian system which incorporates a great deal of individual choice should be looked at.
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Old 20th September 2019, 02:11 PM   #25
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Originally Posted by dudalb View Post
Someone put it beautifully when they said most Americans want Universal Health Care but don't want a government bureaucracy to run it...….

Seriously, I think any Health Care system to work in the US would have to give a lot of choice to the individual as to which doctor he goes to. American love to have a variety of choices;and I don't think a system that just assigns them a doctor without any choice in the matter would ever be accepted by the American people.
Question is if a Single Payer system can accomidate that.
What single payer system tells you which doctor you have to go to?
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Old 20th September 2019, 02:16 PM   #26
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Originally Posted by dudalb View Post
.....
Seriously, I think any Health Care system to work in the US would have to give a lot of choice to the individual as to which doctor he goes to. American love to have a variety of choices;and I don't think a system that just assigns them a doctor without any choice in the matter would ever be accepted by the American people.
....
That's how Medicare and Medicare Advantage work now. People choose their providers, and Medicare pays them, or the private insurance company that operates the Advantage plan pays, pretty much like corporate group insurance. A Medicare for All or public option plan would work the same way. Why would you imagine any plan under consideration in the U.S. would "just assign" a doctor? No one has proposed anything like the UK's NHS.

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Old 20th September 2019, 02:48 PM   #27
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Originally Posted by mumblethrax View Post
Aw, rub a little dirt on it, pinkos. America doesn't have a healthcare system--"system" is just another word for "tyranny". We have the freedom to choose which hospital we go to as we shed the blood of patriots in the back of an ambulance (if you want to save money, try walking, you millennials). Just keep your copy of Consumer Reports at hand. If everyone would do that, the market would be able to work its magic. But noooo, you'd rather turn over your decisions to the man in Washington, and that is how liberty dies. Who's better at making healthcare decisions--some government doctor or you?
You seem to be missing the point that no one is forcing you to go free public health system.

Everyone is perfectly entitled to go private health care if they have the dosh and want to pay for it.

And if they strike an issue where it fails, they still get free public.
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Old 20th September 2019, 03:32 PM   #28
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Originally Posted by cullennz View Post
You seem to be missing the point that no one is forcing you to go free public health system.

Everyone is perfectly entitled to go private health care if they have the dosh and want to pay for it.

And if they strike an issue where it fails, they still get free public.
You seem to be missing the sarcasm in the post you quoted.
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Old 20th September 2019, 03:42 PM   #29
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Originally Posted by Darat View Post
You think we don't think the same about our governments outside the USA?
To be fair, one of our two parties in the US is almost philosophically anarco-capitalist now when it comes to everything besides police and war, so they actively work to get elected, just to have the ability to make government malfunction, so they can go "SEE? Government DOES NOT WORK!"
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Old 20th September 2019, 03:45 PM   #30
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Originally Posted by Dr. Keith View Post
What single payer system tells you which doctor you have to go to?
And WHY would they?

In the US now, your private insurance can refuse to cover your costs if you see a non-approved doctor who's not part of their network.

What would be the motive to assign you one specific doctor when all the doctors are paid by the same single entity?
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Old 21st September 2019, 12:26 AM   #31
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Originally Posted by dudalb View Post
Someone put it beautifully when they said most Americans want Universal Health Care but don't want a government bureaucracy to run it...….

Seriously, I think any Health Care system to work in the US would have to give a lot of choice to the individual as to which doctor he goes to. American love to have a variety of choices;and I don't think a system that just assigns them a doctor without any choice in the matter would ever be accepted by the American people.
Question is if a Single Payer system can accomidate that. I think the Canadian system which incorporates a great deal of individual choice should be looked at.
According to many people their insurance dictates the doctors, hospitals and so on a person can use. So already an unaccountable bureaucracy tells them what they can have.
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Old 21st September 2019, 12:27 AM   #32
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Originally Posted by Bob001 View Post
That's how Medicare and Medicare Advantage work now. People choose their providers, and Medicare pays them, or the private insurance company that operates the Advantage plan pays, pretty much like corporate group insurance. A Medicare for All or public option plan would work the same way. Why would you imagine any plan under consideration in the U.S. would "just assign" a doctor? No one has proposed anything like the UK's NHS.
You are not assigned a doctor in any of the UK NHS systems.
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Old 21st September 2019, 12:29 AM   #33
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Originally Posted by kellyb View Post
To be fair, one of our two parties in the US is almost philosophically anarco-capitalist now when it comes to everything besides police and war, so they actively work to get elected, just to have the ability to make government malfunction, so they can go "SEE? Government DOES NOT WORK!"
And two of our main three parties go even further than yours do as they include the police and war in their desire to allow a few people to make a lot of money, sorry allow the free market to provide services.
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Old 21st September 2019, 02:30 AM   #34
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Originally Posted by Norman Alexander View Post





To be clear: Some of these do require additional payments, what I understand in the US is called "co-pays". Not everything is covered. There are regular media articles about what is and is not, and regular argy-bargy about it. As AUP describes, our current ultra conservative government is trying to force us towards the "user-pays" US model, but I suspect they will be spectacularly unsuccessful with that.
The Medicare bulk billing payments are frozen. It is just a matter of time before bulk billing is no longer viable. Canberra already has virtually no bulk billing.
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Old 21st September 2019, 04:37 AM   #35
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Originally Posted by Darat View Post
You are not assigned a doctor in any of the UK NHS systems.

This is the weird thing. I keep reading about Americans struggling to get the care they want because "the provider has to be in-network". If their insurance company doesn't cover a particular hospital or consultant they can't go there. But here there's nothing like that. You can register with any doctor you like whose practice is geographically close enough to your home. Admittedly that might be a restricted choice if you live in a country village, but that's not the government dictating, it's just geography. In a city you can choose anyone.

There is some trouble with health boards being a bit exclusive because they have to pay each other if they treat each other's patients. For example our designated hospital is in Melrose which is 40 miles and an hour's drive away while the Edinburgh Royal Infirmary is less than half that distance. It's because our village is only three miles from the county boundary and closer to Edinburgh than to Melrose/Galashiels. This is a bit of a pain.

A few years ago my doctor asked me if I'd rather go to Edinburgh for an x-ray and I said yes please, it was a lot more convenient. I think they're cracking down on that because of the cross-payments though. But again this is geography and admin, not government diktat. If I have an emergency the ambulance will take me to the hospital which is best placed to treat me and it won't care about the county boundary.
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Old 21st September 2019, 04:56 AM   #36
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Originally Posted by init15jw View Post
Our system here in the US makes little sense. And many of the arguments you'll hear against universal coverage are based on misunderstandings. However, there is something important underlying them that requires acknowledgment. We typically in the USA do not have any confidence in our government to accomplish things. When you see your government abuse taxpayer dollars the way ours does, it's more difficult to convince yourself that it won't happen THIS time. I think this viewpoint intensifies with age as you experience the cyclical patterns of politics, and I believe it's at the foundation of many of the arguments against nationalization.
You're not alone in lack of confidence in governments to accomplish things properly. In fact, cynicism of government is a national trait here in Australia. I suspect we are not alone.
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Old 21st September 2019, 08:11 AM   #37
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Originally Posted by Rolfe View Post
This is the weird thing. I keep reading about Americans struggling to get the care they want because "the provider has to be in-network". If their insurance company doesn't cover a particular hospital or consultant they can't go there.
.....
It's a little more complicated than that. In-network providers have contracts with insurance companies agreeing to accept the insurers' rates as full payment. But the patient can choose to go to any doctor he wants, and his insurance company generally will pay them what they would pay their in-network docs. But the out-of-network provider can bill the patient directly for any difference between the insurance company's negotiated payment and his retail rate, and sometimes the discrepancies are enormous. This has become controversial recently, because a patient who is treated in an in-network hospital might still be seen by out-of-network specialists, who will bill separately.

Balance billing:
https://www.forbes.com/sites/christi.../#599af0333115
https://www.nytimes.com/2018/09/05/o...sultPosition=4

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Old 21st September 2019, 09:05 AM   #38
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Originally Posted by Bob001 View Post
It's a little more complicated than that. In-network providers have contracts with insurance companies agreeing to accept the insurers' rates as full payment. But the patient can choose to go to any doctor he wants, and his insurance company generally will pay them what they would pay their in-network docs. But the out-of-network provider can bill the patient directly for any difference between the insurance company's negotiated payment and his retail rate, and sometimes the discrepancies are enormous. This has become controversial recently, because a patient who is treated in an in-network hospital might still be seen by out-of-network specialists, who will bill separately.

Balance billing:
https://www.forbes.com/sites/christi.../#599af0333115
https://www.nytimes.com/2018/09/05/o...sultPosition=4
Once we had a plan where, we went to see an approved provider, and that provider ordered lab work, and sent the labs to a lab that was not covered. So we we got a bill for the lab work.

I complained, and said that it was an approved provider and they did the labs, and I was not the one who made the choice on where to send for lab work.

Ultimately, I got them to cover it, but, seriously, what we were supposed to do?
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Old 21st September 2019, 12:03 PM   #39
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And this whole in network/out of network thing complicates billing a lot.

Right now we are trying to decide between COBRA and the plan of my contract house. The best choice depends on how costly the procedure is and exactly when it will be performed.

Anyone tried to ask your doctor, "How much is this going to cost?" It's almost impossible to get an answer.
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Old 21st September 2019, 01:30 PM   #40
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What would it be like if you were automatically "in network" for most basic coverage just by dint of being a US citizen?
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