Hospitals put debt collectors in the emergency room

[3point14]

Originally Posted by Skeptic Ginger

Well if you're in the political faction that thinks a progressive tax (as opposed to a flat tax) is punishment for the rich or a communist version of redistribution of the wealth instead of fair taxation, then chances are you don't see how we can provide health care for the whole population.

That's fine, but I ask you then the thing I've been saying people are in denial about, what does your position mean?

It means hospital cost shifting and an inefficient health care system. The paying medical consumers cover the costs of the deadbeats and the poor. OR let them die on the steps of the EDs.

Which is it since you don't like the option?

People with your position simply ignore the consequences of your beliefs in your fairy tale where those people without health insurance get magical health care no one pays for.

Well said.

The options as I see it are:


1 - Provide healthcare for the entire population and charge the entire population a fee (tax, insurance, however) that all must pay into.

2 - Provide healthcare only for those that pay, but make those that pay also pay for those that don't.

3 - Provide only healthcare for those that pay. Let those that don't pay get sick and die.


Those opposed to universal healthcare insist there is a fourth option, but I haven't seen it.

[Tatyana]

Originally Posted by 3point14

Well said.

The options as I see it are:


1 - Provide healthcare for the entire population and charge the entire population a fee (tax, insurance, however) that all must pay into.

2 - Provide healthcare only for those that pay, but make those that pay also pay for those that don't.

3 - Provide only healthcare for those that pay. Let those that don't pay get sick and die.


Those opposed to universal healthcare insist there is a fourth option, but I haven't seen it.

The issue is that there are numerous chronic conditions that people can have for years and years, for example, diabetes, that without regular medication and monitoring can deteriorate to a life threatening, emergency, situation.

All the ER in the US has to do is to stabilise someone who comes in in diabetic ketoacidosis (which could mean a stint in ITU/ICU) or to remove a gangrenous foot.

The ER is not the place to manage these sort of conditions, however, it has become in the US.

[slingblade]

Originally Posted by 3point14

Well said.

The options as I see it are:


1 - Provide healthcare for the entire population and charge the entire population a fee (tax, insurance, however) that all must pay into.

2 - Provide healthcare only for those that pay, but make those that pay also pay for those that don't.

3 - Provide only healthcare for those that pay. Let those that don't pay get sick and die.


Those opposed to universal healthcare insist there is a fourth option, but I haven't seen it.

Re-allocate a portion of the taxes we already pay into a health-care system, instead of using it to fund pork/wasteful projects.

Probably not a viable idea at all, but the poor, such as myself, can't magically crap out more money, no matter how much we might like to. I'd LOVE being able to buy insurance and getting to see a doctor, but as I said, I know I am going to die earlier than I have to, because I can't do those things.

[fuelair]

Hospitals put debt collectors in the emergency room...


That's a great idea! Though as mean as some are, the morgue might be even better!

Though it does beg the question of after the hospital puts them in the ER, do they send the debt collectors bills for their treatment. And what did the hospitals do that caused the debt collectors to have to be sent to the ERs anyway (salting and flaying maybe??


Enquirer minds want to know!

[Skeptic Ginger]

Originally Posted by slingblade

Re-allocate a portion of the taxes we already pay into a health-care system, instead of using it to fund pork/wasteful projects.

Probably not a viable idea at all, but the poor, such as myself, can't magically crap out more money, no matter how much we might like to. I'd LOVE being able to buy insurance and getting to see a doctor, but as I said, I know I am going to die earlier than I have to, because I can't do those things.

Probably getting too far off topic but the narrative that all additional taxes on the rich are merely redistributing the wealth leads people not to see that a lot of our taxes actually pay for legitimate government services.

I'm all for ending subsidies to wealthy corporations including the military industrial complex. However, as long as we are going to subsidize the rich, shouldn't the rich pay more? They are the ones benefitting.

I think we are better off treating these as separate issues. Publicly funded health care, just like publicly funded courts, police, fire, and the infrastructure involved with transportation, parks and so one all should be the norm and a progressive tax should support these important public services. And there's no reason we shouldn't subsidize food and shelter for the poor as well.

Then you can argue separately if we should tax the rich more to pay the rich their subsidies.

[xjx388]

Originally Posted by Skeptic Ginger

Well if you're in the political faction that

I can stop you right there. I'm not in any "political faction."

Quote:

thinks a progressive tax (as opposed to a flat tax) is punishment for the rich or a communist version of redistribution of the wealth instead of fair taxation, then chances are you don't see how we can provide health care for the whole population.

I don't necessarily think a progressive tax scheme is bad. But SP-UHC does not necessarily follow from the idea of progressive taxation. What I am saying is that creating a SP-UHC will necessitate an increase in taxes across the board -which most Americans would not support. You simply can't do it without putting more money into the system.

Do you even have any idea how much it would cost America to implement a NHS-style system?

Quote:

That's fine, but I ask you then the thing I've been saying people are in denial about, what does your position mean?

It means hospital cost shifting and an inefficient health care system. The paying medical consumers cover the costs of the deadbeats and the poor. OR let them die on the steps of the EDs.

No one is dying because the ED turned them away. If someone did die, that would be a clear violation of EMTALA. And an SP-UHC system simply shifts the cost over to the people paying the most taxes. Not much different than now: The people with insurance or means to self-pay are picking up those costs now. Who will pick them up under an SP-UHC? The people who are paying taxes -which is clearly not everyone in a progressive tax system.

Besides, you can't guarantee that an SP-UHC system will miraculously be more efficient than now. See the UK and Canada and their rising health costs.

Quote:

Which is it since you don't like the option?

People with your position simply ignore the consequences of your beliefs in your fairy tale where those people without health insurance get magical health care no one pays for.

Similarly SP-UHC proponents ignore the consequences of their fairy tale where money magically appears to pay for every American citizen's (along with all the illegal immigrants') health care.

There are a lot of fairy tales told by either side of the political aisle which is why I tend to ignore political arguments. What we need are actual solutions that meets the need of every stakeholder.

That probably belongs in a different thread though.

[Jarlaxle]

Originally Posted by Skeptic Ginger

Not if you don't need emergency care. Just because you go to an ED doesn't mean you have an emergent medical problem.

No, but they have to treat you as if you do! The ER's in this area (and most areas, I expect) are overrun with illegal aliens using them as free clinics.

[Jarlaxle]

Originally Posted by Coffee

I work for a non-profit Hospital where the last CEO attempted to extract payments from people who owed money when they visited the ER for non emergency conditions. He didn't use debt collectors but he had an ATM machine placed in the ER waiting room and people were asked for payment for past bills by the admissions clerk and they were directed to the ATM to get the money before they would be seen. This action created quite a stir in the community and as a result the board of trustees fired the CEO and the ATM was removed. I am not sure if what he did was illegal but it was certainly very bad for public relations.

Honestly...I wish more hospitals had CEO's with the stones to do that!

[xjx388]

Originally Posted by 3point14

Well said.

The options as I see it are:


1 - Provide healthcare for the entire population and charge the entire population a fee (tax, insurance, however) that all must pay into.

2 - Provide healthcare only for those that pay, but make those that pay also pay for those that don't.

3 - Provide only healthcare for those that pay. Let those that don't pay get sick and die.


Those opposed to universal healthcare insist there is a fourth option, but I haven't seen it.

4 - A scheme where the focus is on personal responsibility for healthcare spending with a safety net for the poor.

[Skeptic Ginger]

Originally Posted by Jarlaxle

No, but they have to treat you as if you do! The ER's in this area (and most areas, I expect) are overrun with illegal aliens using them as free clinics.

I'm not sure what your point is here. Poor US citizens also use the ED as a primary care provider. As for "have to treat you", they have to provide emergency care. The law does not say all patients have to be seen. Most EDs however, do see anyone who shows up as a matter of policy.

[KoihimeNakamura]

xjx: Stop right there, that puts you in the Republican camp. Also, speaking ofr myself, I'd pay more taxes if I knew I'd get healthcare out of it, so...

(And yes, I'm in the lowest bracket.)

[Skeptic Ginger]

Originally Posted by xjx388

4 - A scheme where the focus is on personal responsibility for healthcare spending with a safety net for the poor.

I believe that's what the Affordable Health Care Act accomplishes with the insurance mandate.

How do you enforce "personal responsibility" when people gamble they won't need expensive care, refuse to buy insurance, and show up in the ED with medical needs they cannot afford?

Is the ED supposed to make the judgement to let that person die? Who pays if the ED cannot make that determination, provides the care and now has an unpaid debt? Currently they shift that debt to the paying consumer.

[Skeptic Ginger]

Originally Posted by xjx388

I can stop you right there. I'm not in any "political faction."

If you believe we should not raise taxes on the rich you are in the faction I speak of regardless of how you label your lack of political party affiliation.

Originally Posted by xjx388

I don't necessarily think a progressive tax scheme is bad. But SP-UHC does not necessarily follow from the idea of progressive taxation. What I am saying is that creating a SP-UHC will necessitate an increase in taxes across the board -which most Americans would not support. You simply can't do it without putting more money into the system.

Forgetting for the moment about all the money that is already being paid as health care insurance premiums and all the shifted costs those payments include which already pay the care you believe is unfunded, if you believe we need more than that to provide care for everyone so what if we tax the rich more to pay it? Let the government cut subsidies to the rich if they want the rich to pay lower taxes.

Originally Posted by xjx388

Do you even have any idea how much it would cost America to implement a NHS-style system?

Less than we are currently paying according to the evidence. Who pays might need to be rearranged.

Originally Posted by xjx388

No one is dying because the ED turned them away. If someone did die, that would be a clear violation of EMTALA. And an SP-UHC system simply shifts the cost over to the people paying the most taxes. Not much different than now: The people with insurance or means to self-pay are picking up those costs now. Who will pick them up under an SP-UHC? The people who are paying taxes -which is clearly not everyone in a progressive tax system.

Excuse me? Do you hear yourself? Let me echo that for you: "people with insurance or means to self-pay are picking up those costs now", "people with insurance or means to self-pay are picking up those costs now", "people with insurance or means to self-pay are picking up those costs now"...

Originally Posted by xjx388

Besides, you can't guarantee that an SP-UHC system will miraculously be more efficient than now. See the UK and Canada and their rising health costs.

The evidence shows we get poorer outcomes for more cost. Only free market ideologues cannot see that fact.

Originally Posted by xjx388

Similarly SP-UHC proponents ignore the consequences of their fairy tale where money magically appears to pay for every American citizen's (along with all the illegal immigrants') health care.

There are a lot of fairy tales told by either side of the political aisle which is why I tend to ignore political arguments. What we need are actual solutions that meets the need of every stakeholder.

That probably belongs in a different thread though.

The evidence shows we get poorer outcomes for more cost. Only free market ideologues cannot see that fact.
The evidence shows we get poorer outcomes for more cost. Only free market ideologues cannot see that fact.
The evidence shows we get poorer outcomes for more cost. Only free market ideologues cannot see that fact.
The evidence shows we get poorer outcomes for more cost. Only free market ideologues cannot see that fact.

Hear that echo?

[rwguinn]

Let's do it the Canadian way-charge everybody who has a job a high tax rate to pay for it, then deny coverage to anyone who is not a citizen or permanent resident, then gloat how superior our system is over those who don't have "Universal Coverage".

[slingblade]

Originally Posted by Jarlaxle

No, but they have to treat you as if you do! The ER's in this area (and most areas, I expect) are overrun with illegal aliens using them as free clinics.

The ER's in south Georgia are overrun with poor white trash legal citizens using them the exact same way. Go ask my wife-in-law (my husband's first wife) who her doctor is..."whoever's in the ER that day, I guess."

Is it okay with you that legal citizens do the same thing the illegals do, is that more okay, more better, more gooder?

If an illegal using the system means his child doesn't die or something, I am ALL FOR IT. Damn, whatever happened to *********** EMPATHY????

[slingblade]

Originally Posted by Skeptic Ginger

Probably getting too far off topic but the narrative that all additional taxes on the rich are merely redistributing the wealth leads people not to see that a lot of our taxes actually pay for legitimate government services.

I'm all for ending subsidies to wealthy corporations including the military industrial complex. However, as long as we are going to subsidize the rich, shouldn't the rich pay more? They are the ones benefitting.

I think we are better off treating these as separate issues. Publicly funded health care, just like publicly funded courts, police, fire, and the infrastructure involved with transportation, parks and so one all should be the norm and a progressive tax should support these important public services. And there's no reason we shouldn't subsidize food and shelter for the poor as well.

Then you can argue separately if we should tax the rich more to pay the rich their subsidies.

Not with YOU.

Oh, sorry...the appropriate answer is surely, "Whatever."

[Jarlaxle]

Originally Posted by slingblade

The ER's in south Georgia are overrun with poor white trash legal citizens using them the exact same way. Go ask my wife-in-law (my husband's first wife) who her doctor is..."whoever's in the ER that day, I guess."

Is it okay with you that legal citizens do the same thing the illegals do, is that more okay, more better, more gooder?

They can be tracked down and billed! Liens can be placed on property, wages can be attached. Illegal aliens simply give a fake name and walk out on the bills.

Quote:

If an illegal using the system means his child doesn't die or something, I am ALL FOR IT. Damn, whatever happened to *********** EMPATHY????

My give-a-damn is busted & has been for a while. Hospitals should be REQUIRED (as in: NOT doing so should be a felony) to turn in illegal aliens to ICE when they show up.

[WildCat]

Originally Posted by xjx388

Everyone in America wants to get rich -or at least not have to worry about money issues. Many here seem to think that this is a bad thing. Yes, American doctors want to make money. So? They provide a valuable service and they work hard and paid alot in money and time to get where they are.

If we move to a single payer system, I understand that we would be trading premiums for taxes. Of course, along with this, we'd be trading debt collectors for tax collectors and to me, that's worse. And further, if a person can't pay the premiums for insurance, what makes us think they can pay the equivalent in taxes?

They can't, which is why costs have to be addressed.

[Skeptic Ginger]

Originally Posted by slingblade

Not with YOU.

Oh, sorry...the appropriate answer is surely, "Whatever."

Perhaps if you are worried about, "DO PLEASE ARGUE ME TO DEATH NOW", you shouldn't reply to my posts.

[WildCat]

Here's a few charts showing the pay of doctors and nurses in many different countries: http://economix.blogs.nytimes.com/20...ountries-make/

The US doctors and nurses make significantly more than any other country. And doctor and nurse salaries make up a big chunk of health care spending (doctor salaries alone accounted for over $400 billion as of 2008), cutting back those salaries closer to what they are paid in other UHC countries would go a very long way to reducing costs.

Skeptic Ginger, do you think you and your felloow medical professionals would take a pay cut in order to make true UHC possible in the USA?

[Jarlaxle]

Considering many of them are paying off medical school bills until they are in their 40's (or even longer), I would say probably not.

[Skeptic Ginger]

Originally Posted by WildCat

Here's a few charts showing the pay of doctors and nurses in many different countries: http://economix.blogs.nytimes.com/20...ountries-make/

It's a false assumption that the private health care system is the only variable in worker salaries. You need to look at what those dollars buy, the cost of education, other comparable wages and so on. To just declare the difference is NHS vs a private system is jumping to a conclusion without a critically thought out analysis.

Originally Posted by WildCat

The US doctors and nurses make significantly more than any other country. And doctor and nurse salaries make up a big chunk of health care spending (doctor salaries alone accounted for over $400 billion as of 2008), cutting back those salaries closer to what they are paid in other UHC countries would go a very long way to reducing costs.

Typical corporate 'blame the worker' narratives. I've heard that rubbish my whole career, if we pay nurses more the patients will suffer.

Try my approach: NHS and health care worker salaries are two separate issues. You put the NHS in place and salaries are what they are. Nurses' salaries and the type of health care system are separate issues as the CA example demonstrates: California Nurses Lead the Fight against Arnold Schwarzenegger's Anti-Union Ballot Measures. No NHS service was involved in that wage battle.

Nurses were underpaid for a century because hospitals were allowed to control wages by collusion. In any other industry it wouldn't have been tolerated. Only in the last couple decades was the cabal broken by agency competition for hospital nurses.

I don't want to derail the thread with all the variables that affect nurses' salary but suffice it to say your over simplistic view is just that, over simplistic.

Originally Posted by WildCat

Skeptic Ginger, do you think you and your felloow medical professionals would take a pay cut in order to make true UHC possible in the USA?

I already charge less than any of my competitors. Currently I provide employee health and occupational infectious disease services to employers at a cost much lower than any occupational health clinics in the area. I do this by avoiding third party payers which add considerable overhead in administration fees. I also work out of my home so I have no office overhead. By offering a unique practice my entrepreneurial endeavor already lowered the cost of the services I provide.

[uk_dave]

Originally Posted by xjx388

And further, if a person can't pay the premiums for insurance, what makes us think they can pay the equivalent in taxes?

Because, currently there are more taxpayers in the US than those who pay for medical insurance, and yet many of those without medical insurance will still receive emergency medical treatment at no cost to themselves, whereas as taxpayers they would actually be contributing.

[Halfcentaur]

Originally Posted by Caper

My shift partners wife sued for the same thing here in Canada... broke her ankle at a camp ground.... she won money.... and this is in Canada. So I would do it.

I actually need to see if the parking lot hole is still there, it's been about 8 months since I last saw it. But I still have pictures and iphone video of the hole even if it's not there any longer. But it seemed to be some kind of crude drain along the edge of my parking spot.

[davefoc]

Originally Posted by WildCat

And how many countries have tied health insurance to employment like the US does? That's another reason why it's so expensive and ********** up here.

IMHO those ties need to be broken, the easiest way to do that is tax benefits likew regular income and stop allowing employers to deduct medical insurance premiums as a business expense.

I haven't read the rest of the thread but I agree strongly with WildCat on this and I thought I'd quote his post. Tying heath care insurance to employment was a bad idea that with time has become a lot worse. One of McCain's good ideas in the last election was to remove the link between employment and health insurance. Unfortunately, health care in the US has become hopelessly mired in partisan political rhetoric and an unbreakable connection between special interests and government policy so I don't see much hope for a positive restructuring of US health care.

As to the issue that this thread is about, my opinion (though less informed) is that SG was right about everything that she said.

FWIW, I'm not horrified by a libertarian let-people-die-if-they-don't-have- health-insurance approach. I'm not opposed to some kind of minimal government mandated health insurance either. I am opposed to the stupid idea of forcing hospitals to take patients for free and pretend that something has been fixed. If the government doesn't want sick people turned away at hospitals it needs to pay for their care. The current system is bizarrely wasteful. People are treated, they incur debts that they can't possibly pay in a timely way, the bill is transferred to a collection company and the hospital even when it is paid receives only a fraction of the total bill and the costs to every other patient are jacked up to pay for this nonsense.

[Tatyana]

Originally Posted by xjx388

4 - A scheme where the focus is on personal responsibility for healthcare spending with a safety net for the poor.

What would personal responsibility for healthcare spending look like?

People have to prove they eat five portions of fruit and veg per day to have reduced insurance rates or be treated?

People have to maintain the correct 'BMI and exercise three times per week to have reduced insurance rates or be treated?

People that smoke or drink to excess or use drugs are excluded from medical treatment (what do you do with addicted pregnant women if this is the case)?

People must have enough savings (what would that be $ 20,000-50,000?) for a catastrophic medical emergency?

Genetic screening of couples intending to have children to ensure that various inborn errors that require extensive treatment (often lifelong) are not born?

Everyone is screened for risk factors and if they do not follow preventative steps for these diseases they are excluded from treatment?

The current situation where people spend insurance premiums of anywhere from $ 200-$1500 per month for varying levels of cover?

And lastly, what do you think YOU are doing to ensure personal responsibility for your own health care and what do you recommend?

PS. If we ran a genetic profile on you right now, I would bet you $100 we would find some sort of mutation that would put you at a higher risk of some sort of disease.

[MatildaGage]

There is a lot more to hospital finances than most people know, yet they feel completely qualified to form firm opinions about it. This has been and is a source of frustration to those of us who are trying to reform it based on what it actually is (instead of what people imagine it is).

Medicaid in my state is notorious for not paying its bills for years at a time, without legitimate cause. This is a serious financial burden for healthcare providers. If you were running a business, how well do you think you'd function if your main customers paid their bills several years after you provided the service (millions of dollars)?

Collecting co-pays by "tracking people down"--while it may sound feasible, it's a fairy tale. Many patients move often and lie about their addresses. They don't care about their credit scores.

Even if you do find them, collection fees are high which means the amount collected loses most its value. But much bad debt is never collected at all. Some of that is due to the attitude that healthcare should be free--an attitude found in patients of all socioeconomic levels--probably people who previously opposed healthcare reform until they were faced with a bill themselves.

It's a well-known, proven fact that co-pays need to be collected at the time of service under our current system if the organization wants to be successful. It's Revenue Cycle Management 101.

The current system has a lot of waste (collection costs being one example). If we took all the $ we're spending on healthcare and just spent it on an efficient system, we'd get a better system.

[WildCat]

Originally Posted by Jarlaxle

Considering many of them are paying off medical school bills until they are in their 40's (or even longer), I would say probably not.

A GP in the US averages $43,000 more per year in salary than a GP in the UK. Average yearly tuition for medical school in the US is $28,685 for a public college and $46,899 at a private college.

So US doctors still make way more than their UK counterparts even when the cost of medical school tuition is considered, they make that difference up in salary in just 3-5 years. So I'm not buying that excuse.

[WildCat]

Originally Posted by Skeptic Ginger

It's a false assumption that the private health care system is the only variable in worker salaries. You need to look at what those dollars buy, the cost of education, other comparable wages and so on. To just declare the difference is NHS vs a private system is jumping to a conclusion without a critically thought out analysis.

Those were PPP dollars - purchasing power parity. So nothing false or misleading about it. It's an apples-to-apples comparison.

Originally Posted by Skeptic Ginger

Typical corporate 'blame the worker' narratives. I've heard that rubbish my whole career, if we pay nurses more the patients will suffer.

So everyone else should pay more, but you shouldn't share the sacrifice? It really is about money then, and not about getting health care for all. That's fine to be in a business for the money, but don't try to claim you're in it for the joy of serving your fellow human beings when you've made it quite clear that your money is more important.

Bottom line: medical professionals in the US are in it for the money, while in other countries helping their fellow human beings has greater value.

[xjx388]

Originally Posted by Tatyana

What would personal responsibility for healthcare spending look like?

People have to prove they eat five portions of fruit and veg per day to have reduced insurance rates or be treated?

People have to maintain the correct 'BMI and exercise three times per week to have reduced insurance rates or be treated?

People that smoke or drink to excess or use drugs are excluded from medical treatment (what do you do with addicted pregnant women if this is the case)?

People must have enough savings (what would that be $ 20,000-50,000?) for a catastrophic medical emergency?

Genetic screening of couples intending to have children to ensure that various inborn errors that require extensive treatment (often lifelong) are not born?

Everyone is screened for risk factors and if they do not follow preventative steps for these diseases they are excluded from treatment?

The current situation where people spend insurance premiums of anywhere from $ 200-$1500 per month for varying levels of cover?

And lastly, what do you think YOU are doing to ensure personal responsibility for your own health care and what do you recommend?

PS. If we ran a genetic profile on you right now, I would bet you $100 we would find some sort of mutation that would put you at a higher risk of some sort of disease.

That's the road we'd be going down in a SP-UHC.

If, instead, we actually do value freedom, then everyone has to pay their own way. Why should society pay the price for bad health choices? As I've been saying for years, catastrophic insurance that kicks in after a certain level of spending emphasizes personal financial responsibility for healthcare and covers you in case something really goes wrong. I would even back mandated catastrophic coverage since everyone thinks it's so important.

[WildCat]

Originally Posted by xjx388

That's the road we'd be going down in a SP-UHC.

If, instead, we actually do value freedom, then everyone has to pay their own way. Why should society pay the price for bad health choices? As I've been saying for years, catastrophic insurance that kicks in after a certain level of spending emphasizes personal financial responsibility for healthcare and covers you in case something really goes wrong. I would even back mandated catastrophic coverage since everyone thinks it's so important.

Are you against public schools and public roads too? How about public fire departments? Police?

[Tatyana]

Originally Posted by xjx388

That's the road we'd be going down in a SP-UHC.

If, instead, we actually do value freedom, then everyone has to pay their own way. Why should society pay the price for bad health choices? As I've been saying for years, catastrophic insurance that kicks in after a certain level of spending emphasizes personal financial responsibility for healthcare and covers you in case something really goes wrong. I would even back mandated catastrophic coverage since everyone thinks it's so important.

You didn't answer the question entirely.

So you think that catastrophic medical insurance is one of the answers.

I think you will find that UHC countries don't mandate any of the things that I listed, however, it does seem like 'pre-existing conditions' in the US does exclude you from medical care (including obesity).


Just for intellectual honesty, the only country that I am aware of that requires genetic screening of parents is Sardinia, which did have an awful situation with thalassaemia, which is a evil genetic disorder.

They did require this and they do have UHC, however, anyone who is aware of thalassaemia would not want anyone to suffer this disorder.

[Blue Mountain]

Originally Posted by xjx388

That's the road we'd be going down in a SP-UHC.

If, instead, we actually do value freedom, then everyone has to pay their own way. Why should society pay the price for bad health choices? As I've been saying for years, catastrophic insurance that kicks in after a certain level of spending emphasizes personal financial responsibility for healthcare and covers you in case something really goes wrong. I would even back mandated catastrophic coverage since everyone thinks it's so important.

Was it my grandfather's fault that he had two heat attacks and two strokes in the last decade of his life, despite the fact he had been working in an active job? he was a switcher and brakeman in a railway yard, not exactly a sit on your butt all day sort of job. Was it his wife's fault that she developed type I diabetes in her thirties and was insulin dependent the rest of her life? My aunt passed away two years ago from pancreatic cancer and her brother followed a year later from prostrate cancer; what lifestyle choices should they have made to prevent that outcome?. And what did Reverend Clog's son Jake do wrong to develop leukemia at the age of three?

Of all the people in my family who have passed away over the years, only one that I can think of died as a result of poor lifestyle choices. That was my brother, who smoked a pack of cigarettes a day and died at home of pneumonia following a bout of flu. In your world that was all right, because he at least didn't cost the healthcare system very much money.

It's a fantasy that all healthcare problems are the fault of an individual's lifestyle. A well designed UHC does not blame individuals for their poor health; it concentrates on making sick people well, or helping them die peacefully (as in the case of my aunt and uncle.) Other programs in the public and private sectors can concentrate on the lifestyle stuff.

What level of spending should be involved before the catastrophic insurance kicks in? Leaving your bank account empty? How about your retirement fund? (You do save for your retirement, right? Don't want to have to force the taxpayers to support you in your later years. But what the hell good is a retirement fund if you can lose it all to a mild heart attack or a benign tumor in your fifties?)

What about your house? Should it be protected? If that's the case, what might happen is people will pour money into an overly expensive house as a sort of secondary insurance policy, so if they get sick they can sell the house to cover the medical bills. But if that happens, then public policy will change to protect a house only up to a certain value.

People on this forum are arguing of some form of UHC for the United States not because they feel left out of some global club but because they work.

[Skeptic Ginger]

Originally Posted by Tatyana

What would personal responsibility for healthcare spending look like?

People have to prove they eat five portions of fruit and veg per day to have reduced insurance rates or be treated?

People have to maintain the correct 'BMI and exercise three times per week to have reduced insurance rates or be treated?

People that smoke or drink to excess or use drugs are excluded from medical treatment (what do you do with addicted pregnant women if this is the case)?

This kind of distortion is interesting. Did/do you one who believes these things also believe the health care reform in the US included death panels?

The actual bill requires third party payers include coverage for preventative care and nothing that says consumers must take advantage of that care or pay more.

Cigarettes are taxed and some of those fees could be put back in the health care system to cover the added cost of smoking. If insurers had a higher rate for smokers it wouldn't bother me. Smoking is a proven 'choice'.

But the rest of your the examples have more complex causes and I don't see any move in the direction you claimed except added sales tax to sugar drinks. Despite the beliefs some hold that obese people choose to overeat the evidence doesn't support that. I won't derail the thread and the people who don't believe the evidence can weigh in but I won't debate it here. I will cite two examples: Cutting calories slows down one's metabolism in response. People have set weight points and going below those points causes cravings for high calorie foods

Originally Posted by Tatyana

People must have enough savings (what would that be $ 20,000-50,000?) for a catastrophic medical emergency?

I think the rich could declare themselves self insured. Bill Gates once received a ticket from a by-the-book cop because Gates didn't have proof of car insurance when he was stopped. The judge dismissed the charges.

Originally Posted by Tatyana

Genetic screening of couples intending to have children to ensure that various inborn errors that require extensive treatment (often lifelong) are not born?

Everyone is screened for risk factors and if they do not follow preventative steps for these diseases they are excluded from treatment?

These are back to your an example of a imaginary dystopia. Maybe in some Gattaca future world but no one is talking about this kind of nonsense except in the Fox News dishonest talking points.

Originally Posted by Tatyana

The current situation where people spend insurance premiums of anywhere from $ 200-$1500 per month for varying levels of cover?

You One who believes these things would be back to the choice, people pay or we let them die when they choose not to. I shouldn't cover the gambling losses when a person chooses not to carry health insurance. The cost would be $0 to whatever, though, not $200. That has already been established with Medicaid.

Originally Posted by Tatyana

And lastly, what do you think YOU are doing to ensure personal responsibility for your own health care and what do you recommend?

PS. If we ran a genetic profile on you right now, I would bet you $100 we would find some sort of mutation that would put you at a higher risk of some sort of disease.

Again your an example of a Gattaca dystopia is fictional.

[Skeptic Ginger]

Originally Posted by MatildaGage

...
Medicaid in my state is notorious for not paying its bills for years at a time, without legitimate cause. ...

It's a well-known, proven fact that co-pays need to be collected at the time of service under our current system if the organization wants to be successful. It's Revenue Cycle Management 101.

The current system has a lot of waste (collection costs being one example). If we took all the $ we're spending on healthcare and just spent it on an efficient system, we'd get a better system.

I set my practice up 20 years ago as an employee heath service instead of a occupational health clinic because the worker's comp reimbursement system is so problematic. One of my services is treating people who have had blood exposures. Initially the w.comp. system called a needle stick and injury but blood splashed in your face was only a potential injury. The law required pre and post exposure HIV test counseling but w.comp didn't cover "counseling". It was absurd. But I digress....

Those problems occur with private insurance carriers as well including not paying.

I bill employers but for self pay like flu vaccinations I won't give the vaccine without payment. Not only is there a problem collecting, but the billing itself adds admin costs.

[Skeptic Ginger]

Originally Posted by WildCat

Those were PPP dollars - purchasing power parity. So nothing false or misleading about it. It's an apples-to-apples comparison.


So everyone else should pay more, but you shouldn't share the sacrifice? It really is about money then, and not about getting health care for all. That's fine to be in a business for the money, but don't try to claim you're in it for the joy of serving your fellow human beings when you've made it quite clear that your money is more important.

Bottom line: medical professionals in the US are in it for the money, while in other countries helping their fellow human beings has greater value.

You are so dishonest in your posts. If a provider has an already discounted service and one has an overpriced service the 'sacrifice' you imagine (because it is not, but I'll get to that) is needed should logically differ.

You insist on blaming the wrong causes for the excessive health care costs in the US. 'Nurses salaries' is the hospital industry narrative they pull out every time union negotiations are being worked on. The fact hospital administrators were often paid on a higher scale than any nurse managers was never discussed.

But again that's getting off topic.

You are describing a single variable in the US health care system compared to countries with NHSs. You conveniently ignore one of the truly great disparities in costs, that of pharmaceuticals. Excessive costs for redundant services is another. That isn't excessive care, it's excessive services like more MRI or CT Scan machines in an area than there is need for.

Why the US pays more and gets less is a very complex issue. What we do know is country after country with NHSs do better than we do. It makes for a strong case for a NHS.

[Skeptic Ginger]

Originally Posted by xjx388

That's the road we'd be going down in a SP-UHC. ...

Evidence?

[Skeptic Ginger]

Originally Posted by Tatyana

You didn't answer the question entirely.

So you think that catastrophic medical insurance is one of the answers.

I think you will find that UHC countries don't mandate any of the things that I listed, however, it does seem like 'pre-existing conditions' in the US does exclude you from medical care (including obesity).


Just for intellectual honesty, the only country that I am aware of that requires genetic screening of parents is Sardinia, which did have an awful situation with thalassaemia, which is a evil genetic disorder.

They did require this and they do have UHC, however, anyone who is aware of thalassaemia would not want anyone to suffer this disorder.

Apparently I didn't get the gist of your other post so consider my answers aimed at someone who does believe those things.

[davefoc]

Originally Posted by Skeptic Ginger

...

Why the US pays more and gets less is a very complex issue. What we do know is country after country with NHSs do better than we do. It makes for a strong case for a NHS.

I agree that why the US pays more and gets less is a complex issue. I am not sure that it is much of an argument for universal health coverage. At the core of the US problem is massive political corruption. The pharmaceutical companies have bought a big piece of the government and I don't think they are going to give that up. I think doctors get by without a general four year degree in other countries before they begin their medical training in other countries. Are the various interest groups that benefit from that situation going to change that? The AMA is a powerful lobby in the US and its main purpose is to insure large incomes for US doctors by limiting procedures that can be done by non-physicians and by working to maintain a limited number of physicians. It does seem that some of the AMA's power has waned a bit on those issues but I don't see them folding their tent for the benefit of the nation either.

I favor some form of minimalist universal national health care but my guess is the corruption that dominates current US health care policy will only be exacerbated by it and it will do nothing to stem the massive cost of medical care in the US. And the US will continue to be encumbered by the inappropriate connection between health care and employment. This will continue to skew our import and export markets and it will continue to skew other effects as well such as the undesirability of older workers when the employer is on the hook for their medical costs.

As an aside, I see quite a few credit reports because we own a small apartment building. The most common financial disaster to strike young people is massive medical debt. Rightly or wrongly a lot of young people decide not to get medical insurance and unknown to them a lot of young people get sick and need expensive medical care. When they find out their credit is destroyed and they live under the cloud of debt that may never be completely paid off.

[RandFan]

Originally Posted by davefoc

As an aside, I see quite a few credit reports because we own a small apartment building. The most common financial disaster to strike young people is massive medical debt. Rightly or wrongly a lot of young people decide not to get medical insurance and unknown to them a lot of young people get sick and need expensive medical care. When they find out their credit is destroyed and they live under the cloud of debt that may never be completely paid off.

I think that is an important point of discussion. If we accept that personal responsibility is good for society and we accept that the best way to ensure and foster personal responsibility is to allow people to make choices and then suffer the consequences of their actions or reap the reward. Then I think we need to ask the following, does requiring the purchase of health insurance to ward off financial disaster convey some net good to American society? IOW: Are US citizens on average more likely to demonstrate personal responsibility because of this requirement?

I ask because I think we as a society have become overly fixated on the concept. As important as it is, and it is, I don't think we would significantly lose anything by ensuring health care for all. In fact I think there is much to gain. I don't think you can look at Canada, Japan or England and say that their citizens are significantly lacking in personal responsibility because of paternalistic health care.

As a percentage of GDP the money is already being spent. We just aren't getting our money's worth, IMO.