How to fix health care June 12: Dr. Ezekiel Emanuel, author of “Healthcare Guaranteed,” talks to TODAY’s Matt Lauer about a plan for everyone in the U.S. to have access to health care.
Video Interview with Author

.....missed the point....there is health care for every one in USA.....it is a matter of who pays for it that is the issue.....geofkaye

Exactly.

Went to the ER a couple of years ago, preliminary diagnosis: stroke. Received a bill for $1,000 for the visit. Insurance paid it. Received another bill from the hospital for $5,000. Insurance agent said it was a common practice to send out bills to those with insurance to get extra money. When you discover your error forget about getting a refund. Had surgery on another occasion was double billed for anesthetist. I have a high deductible since retiring so I am even more aware of line items. After having a procedure with complications I called around for prices. No two hospitals the same. Set up a repayment plan balance divided by $100 a month and no interest to give me time to research. Received several credits for billing errors. Made monthly payments for for 7 months then paid in full, received a 15% discount.

Dr.s should post all procedure's fees before performed with the exception of 911. Patients should know how much their visit and subsequent procedures will cost before they walk into the treatment room. All people receiving care should receive a itemized bill, line by line not just a summary, so they know what they and or their insurance company is paying for. Insurance or HMO's may be convenient just show your card, receive your care and be on your way. But when individuals start seeing what the care is really costing they may start being more proactive. Unfortunately medical care for the majority isn't needed till later years when you are less able to navigate the maze of health care and are taken advantage of. We need to treat medical care like a business but the life or death nature of the beast skews our decision making ability.

I started to watch the video and just got frustrated. His logic escapes me how everyone would get insurance regardless of state of employment or health issues. If I understood the speaker, all of this would be provided by an additional tax and when Matt asked him how this would help those already stretched financially, he said workers would get more pay because employers wouldn't have to pay for the insurance, or some other explanation that didn't represent the retired person that is too young for Medicare yet, or anyone else that doesn't have benefits with their jobs.
It really would be great if everyone could have insurance, but if it's up to the federal government to provide it, we all know it will come at a great cost and be as messed up as Medicare and Medicaid are now.
Why can't groups of individuals or small businesses or individuals form co-ops and act in the same way a larger company does in providing insurance to their employees? Rather than the funds coming from the larger company, it would come from the coop but provide the same coverage and benefits the larger company gives their employees? Maybe it wouldn't work, but seems like it could work better than the government getting into it. They haven't done so well with Social Security or Medicare.

mrs crj - Your idea of medical coops already exists. It's called a mutual insurance company, one where the insured are also the stockholders and the motive is not profit, just healthcare for the members. Years ago Blue Cross/ Blue Shield plans were just that. Now many of them have become for profit companies.

Just for discussion, let's form the smallest possible coop, you and I. You are healthy as can be and rich to boot. I've been healthy, but not ever rich. Our little coop goes along, setting our premiums each year to just cover our total expenses, splitting them evenly between all members, us. They average $500 per person per month. Then, one year, I get really sick, $250,000 in medical costs. Premiums shoot through the roof. How much longer do you want to split the premiums? What if I can't pay mine? So, you say, lets make the pool larger than the two of us. OK, who do we leave out? How about people over 65? Costs a lot to keep them healthy. Or sky divers. Or people with the gene for leukemia? Keeps the premiums down that way.

Dr Emanuel's idea is this: "create a pretty good basic national health plan, put everybody in the pool, every insurer who wants to be part of the system must sell the basic plan to anyone, and the payment to the insurer for the basic plan would be via a national healthcare voucher". The cost of the voucher would be paid for by a new national Value Added Tax (VAT, think national sales tax). He thinks the impact of the VAT would be offset by the generosity of employers giving the money they save on healthcare to their employees. No discussion of old farts on fixed incomes, of which I am one.

I like the idea of everybody having access to healthcare, but I see problems with this approach:
1 it basically funds the existing system, which costs twice as much as better healthcare systems in other countries. There is no incentive for costs to go down.

2 tendency of Congress to fail to fund the real cost of programs. The main Medicare problems are related to payment reductions and schemes to dodge the costs. Just look at Part D (for Doughnut hole).

3 no discussion of copays, annual deductibles, etc, etc, etc. This is a huge money waster in the current system. I recently spent a night in the hospital for suspected heart problems. Nothing found, but by the time it was over, I paid about 10 different providers copays ranging from $10 to $25. The whole thing ran about $8000 retail, $5000 negotiated price to Blue Cross, about $400 (including $200 annual deductible) out of pocket to me. My policy costs my former employer about $600 per month in premiums. Why bother with the administrative costs of copay schemes?

4 doubtful employers are going to raise anyone's pay voluntarily. This plan would just pass all costs currently paid by employers over to taxpayers.


So, I say great goal but iffy approach. Healthcare is not broken. The system of paying for it is the problem, and can't be fixed as long as it is a profit making industry. They used to have fire insurance companies that hired firefighters to fight fires at the homes of their policyholders. Eventually, we saw, as a community, there was a better way to protect against fires. Perhaps we'll figure healthcare out before too much longer.

.....OR...you pay your own Healthcare insurance as you go to the Dr. Or hospital or whatever and there are NO 3rd Party payers......the cost of health care will drop over nite to a reasonable price.....geofkaye

quote:

.....OR...you pay your own Healthcare insurance as you go to the Dr. Or hospital or whatever and there are NO 3rd Party payers......the cost of health care will drop over nite to a reasonable price.....geofkaye

Back to the fire fighting example. If you have a fire, you just put it out yourself?

Or, if you need extensive treatment, like leukemia, and you're not rich, you just wait to die? Or maybe your friends and neighbors could hold a benefit BBQ to try to raise the money? (saw this over the weekend in Grove, OK)

Your proposal is actually the health care system they have in China today. Per capita health care expenditures are a fraction os the US ($63 per person per year vs $5,374 in the US). But the life expectancy at birth is 71 vs 77 in the US and infant mortality is 37 per 1000 live births, vs 8 in the US.

I'd rather be more like France or even Switzerland. They're not socialized medicine. The doctors don't work for the government. Socialized medicine is what the US has with the VA, except it's only available to some citizens.

Healthcare in France costs half as much as the US ($2,384 vs $5,274) and gets better health outcomes (80 vs 77 and 5 vs 8).

In Switzerland, all health insurance companies are required to offer a basic national plan, very similar to Dr Emanuel's proposal. All citizens are required to buy health insurance (fined if they don't) and assistance is provided to low income citizens, rather than a voucher for all.

Not surprisingly, Switzerland has the worlds second most expensive healthcare system. Keeping the insurance companies alive does have a cost. Annual cost per capita is $4,219 vs US at $5,274. Their outcomes are even better, 81 vs 77 and 5 vs 8.

Free market magic doesn't always work. Healthcare is not an optional consumer purchase, it's a necessity for life. There are some goods that you just can't wait for them to come down to your price point (a sale on gall bladder surgeries, perhaps?) and really should be available to all citizens, not just the rich.

Last night on 60 minutes they re-ran a show:
U.S. Health Care Gets Boost From Charity

"RAM operates on a shoestring budget of about $250,000 a year. Yet, last year, it treated 17,000 patients."

"In a matter of hours, Remote Area Medical set up its massive clinic, for a weekend, in an exhibit hall in Knoxville, Tenn. Tools for dentists were laid out by the yard, optometrists prepared to make hundreds of pairs of glasses, general medical doctors set up for whatever might come though the door. Nearly everything is donated, and everyone is a volunteer."

It seem so simple till you figure in the cost of a medical education, medical equipment, malpractice insurance, and information gathering and storage. BUT this looks like a pretty efficient operation, what if this were applied to regular medical offices?

In San Diego California Kaiser has their "Health Appraisal" facility. You make an appointment for a check up and a follow up 3 weeks later, receive a multi page questionnaire to submit at your first appointment. Based on your answers, age, gender, and past history etc tests are performed. You kind of go from room to room instead of a the medic coming to you. High school scheduling comes to mind student/teacher...If you are diagnosed with a condition needing more care you are referred to the specialist. Yes it may seem impersonal but your bottom line is your health. If a central location could be set up in larger populations centers to serve volumes of people it could save costs due to duplication/overlapping of medical offices. It would be easier to keep one facility current and modern than 3.

Emergency care is a whole other ball game but preventive care could potentially save a lot of money down the road.

One last thought if Medical Educations were free in return for 4-8 years of service the concept seems ideal unfortunately it has been tried an individuals decided they didn't like where they were assigned and skipped out. On a smaller scale some small towns have done this successfully.

Some facilities have gone to Nurse Practitioners or Physicians Assistants. Less schooling so less costly.

It all comes down to money and priorities.

France not have socialized health care? The cost of health insurance in France is for insurance above what their socialized system provides. Health care is available for all here, the issue being if you don't work for it here, you will either have to be a welfare baby, go broke, or go without. I don't have a problem with it do to the fact you get what you pay for and yes if you don't take care of yourself or spend the money to provide medical care for yourself or make the sacrifice to earn the care you will die. I'm will feel bad for you and if you asked me I would probably help if I could but in no way in h@#$%@#$ am I obligated to pay taxes or anything else to pay for your healthcare. This is not the Soviet Union, Canada, England, France, Cuba, or any other Socialistic/Communistic society, if you haven't forgotten this is the United States of America, you stand on your own as well as prosper on your own. You can always leave. I apolojise for being blunt but this is what I thought so many of paid for in blood to do. Our right to choose our own path in life, not the government. Let the free market work it out, we only have so many resources and when ever the government has gotten involved it just gets worse.

So, Pat1, you favor the Chinese system? Which is: If you're lucky enough to have a job that pays well enough, either in benefits or cash, to afford treatment, you get it, otherwise beg or die. Sorry, not how I choose to treat my brother and not how I believe it should be for citizens of this country.

OBTW, the numbers I quoted are total expenditures on health care per person, from all sources, not, as you imply, private insurance over and above tax-funded government spending. If you're going to argue numbers, use numbers, not you opinion or beliefs. Everyone is entitled to their own beliefs, but not their own facts.

Speaking of blunt, I have a couple of questions.
First - How do you receive your healthcare? Wouldn't be the TAXPAYER SUPPORTED VA system, would it? (I'm not against it, I just hate hypocrisy. I think the citizens of this country owe a debt to every man and woman who've had their lives screwed up as a result of service to the country. It embarrasses me to see Congress and the White House try to dodge the debt and nickel-and-dime the funding.)

Second - Does wrapping yourself in that flag impede your arm waving and jumping up and down? It sure doesn't enable you to gather facts and think for yourself. You really need to start paying attention. Kind of bothers me that an individual with your ability to reason takes TAXPAYER MONEY as a teacher.

I'm getting that government spending that benefits you is OK (disability, healthcare, job), just not spending to provide all citizens with a basic level of access to healthcare. When you have truly made it as a rugged individualist, divested yourself of the TAXPAYER FUNDED benefits to you personally, come back and blather on about:

quote:

if you haven't forgotten this is the United States of America, you stand on your own as well as prosper on your own. You can always leave

Until then, ***.

As far as "probably be willing to help" goes, I've got a message for you and the horse you rode in on.

This message has been edited. Last edited by: Kellie Rossow,

Enough!!

I let this thread hang because I thought a few of you would want to chat about healthcare along the road. Well, it has definitely taken an ugly turn.

Either get back on track......not government-related either, or this thread will be closed.

--Kellie

quiviran,
I have sent you a PM.

I am sorry to have affended anyone and did not mean to my only comment was that I don't believe the system is broke and that if there are problems then let the system work (free market system). On the questions asked I use the Tricare system and the VA system I paid for both.

The French system is a socialistic system follow the link for more info I did not make it up.


The French Health Care System

Sorry, Kellie. I apologize for my overly stated reply. I get real tense when flag waving and jingoism gets substituted for data and reason and I sure don't like being lectured to about what it means to be a real American.

I agree with you, Pat1. The system is not broken, for you. I'll keep paying the taxes that keep the VA open until a national system is available for all Americans.

I followed your link. I was using Socialized Medicine in the sense of the UK National Health Service, where essentially all of the medical staff are employees of the government and the government owns the facilities. In France, according to the article, about 1/3 of doctors work for the government and 3/5 of the hospitals are government facilities. They have a system of cost sharing between taxes, patient co-pays and employer contributions. As in the US, it is a mix of public and private facilities and public and private payers.

No matter what label you put on the French system, the question remains: Why are the French able to deliver better health outcomes for half the annual per capita expenditure of the US? Because the French government regulates how much can be charged for each type of treatment. Much like the US does with Medicare. The fees are negotiated with the doctor's union. Everyone pays the same for a given treatment and providers all get paid the same.

In a similar sense, insurance companies in the US (at least the big ones like Blue Cross) negotiate with hospitals and doctors how much they will pay for each type of treatment. This gives rise to at least three tiers of pricing in any given situation: what the provider would like for you to pay; what the insurance company will pay and what the provider can get you to pay, if you're poor.

Let's take these in reverse order. First, we must be clear: There is the COST for the procedure or service. This is what it costs the provider to perform the procedure. He doesn't make any money on this number. There is the PRICE for the procedure, what the provider would like for the patient to pay. Then, there is the PAYMENT for the procedure, how much the provider winds up getting.

If you're poor, the provider may get something from you, but probably not enough to cover the COST. He loses money on you. Does he want you back? Probably not. The law says if you show up at an Emergency Room, they have to treat you. Beyond that, if you don't have the money, you won't get into the doctor's office. You may be able to find a free clinic, if you're lucky.

If you have insurance, they have negotiated with the provider an amount, the PAYMENT, which exceeds the COST, so the provider makes some money on the deal. This is bread and butter.

If you don't have insurance, but are not poor, the provider is in happy land. He gets to charge you the PRICE. This is what persons who work, but can't get insurance (chronic condition, preexisting condition) get to pay. Where do you think the provider makes up the money he loses on the poor guy that couldn't pay. Sock it to me, baby. 25% of all family bankruptcies in the US are as a result of medical expenses. This is the group that gets hit, since the poor patient didn't have any assets to capture.

As a beneficiary of the VA/ Tricare system, you are protected from the insanity of the health insurance system. You are a vet, you will remain a vet and you can't be thrown out. For instance, there are companies that specialize in certain healthy groups, like college students, which have few actual benefits, just collect premiums. There are small employers who try to buy insurance for their employees, only to see their premiums shoot up if anyone actually submits a claim. You can pay premiums to a company for years, but be dropped in an instant if you turn up with cancer. You can die trying to get an insurance company to agree that a treatment is covered by their policy. These stories abound.

I happen to be attentive for two reasons: my sister developed leukemia in 2003. I watched her doctor negotiate with the premier cancer care facility in her area to take her as a patient. Had she not had excellent group insurance through her major-sized employer, they would not have accepted her as a patient and she would not be alive today. The treatment was excellent, but it cost upwards of $500,000.

The other is my son, who was diagnosed with Crohn's Disease at 17. He will have a chronic condition for life. His daily medications run $24,000 per year. That's a hell of a big income requirement when your are looking for a job. The same medications would be less than $6000 in Canada.

Why do these situations exist? Free market capitalism. There is no profit in sick people. There is quite a bit to be made from collecting premiums, but it goes downhill pretty quickly when you have to start paying claims.

The free market is very good at creating wealth. Good public policy should concern itself with more that wealth creation. After all, life was one of the Founding Fathers inalienable rights. They were my kind of Americans.

I decided I will remove my comments from this forum due to the aggressive behavior that has been expressed here. It saddens me that some individuals have taken it upon themselves to personnaly attack me for reasons only they know. God Bless.

This message has been edited. Last edited by: Pat1,

Wow, i've been away a while! Here's a controversial thread that I didn't participate in.

Mac