Why the health care problem will never be solved

[OldSaw]

So, I will preface my response with some background about me. I am a healthcare "suit", I manage 7 pediatric surgeons, I set the fees for the practice, I am 26 (so not much living history), I have two Master's degrees in Health Administration, and I have this discussion a LOT.

This mess is best answered by a complex visual diagram, but I do not have one of those in B&B so I will try to provide my opinion as best I can...

One question: Where is this mythical land of "usual and customary charges?" Is there such a place that actually exists, because I would like to move there and never again be charged the mystery fees for exceeding "usual and customary charges" again.

 

[blantyre]

The flip side of Ouch's experience is one I had. I buy insurance with a very large deductible mainly to cover the risk of an expensive hospital stay or similar. A couple of years ago I had minor surgery. The cost billed for the services (hospital, anasthetic, surgery, followup) was ~$12,500. The amount allowed by the insruance company was ~$3,980 - about 32%. The allowed amount was well below my deductable so I paid it in full. However, if I had approached the hosptial as an individual and had the same surgery and paid in cash on the spot, the best I might have been able to negotiate would be ~10% discount for prompt payment. What I "saved" as a result of the insurance company discounts was equivalent to almost a years insurance premium for both my wife and me.

 

[Sluggo]

One question: Where is this mythical land of "usual and customary charges?" Is there such a place that actually exists, because I would like to move there and never again be charged the mystery fees for exceeding "usual and customary charges" again.

Yeah I know that was really the prime time. You could do a procedure charge the govt your actual cost and they would pay you more than you charged! You can see how quickly people would take advantage of that, and how one or two bad apples spoiled the enitre basket.

 

[Kratos]

To put it simply, greed. Having a national health care system won't change this. The "someone else will foot the bill" attitude has landed us where we're at economically, and in health care.

 

[Sluggo]

To put it simply, greed. Having a national health care system won't change this. The "someone else will foot the bill" attitude has landed us where we're at economically, and in health care.

I certainly agree. Even if you had a two level system for those with insurance and those with goverement insurance (at a steeply discounted price) I bet you would have a lot of your, healthy people move into the govt product. Why? Heath insurance is expensive and they represent low risk, but if something happens to them then the gov't picks up the tab (i.e. us)

 

[marvin100]

There was this time when I was one of the 46 million Americans without healthcare.

True story.

 

[_JP_]

This health care mess is so deep, I don't see how we will ever dig our way out of it.

Don't dig. Blow it up so that we can start over.

 

[mretzloff]

This thread makes me so happy I benefit from Canada's health care system...I feel for our southern brothers in this regard. Here's to your health!

Comments, such as the one you made, are what start flame wars. And please, do not feel sorry for me or my fellow Americans.

 

[professorchaos]

Comments, such as the one you made, are what start flame wars. And please, do not feel sorry for me or my fellow Americans.

+1,000,000. I had a concise, directed rebuttal to that post which did not get posted.

 

[adonnellyr]

Comments, such as the one you made, are what start flame wars. And please, do not feel sorry for me or my fellow Americans.

Huh. I didn't think it was a confrontational post at all, and I still don't. Sorry you took it as such.

 

[adonnellyr]

Also, I enjoy reading the multitude of posts by both of you (Henry and Matthew) and I certainly wouldn't have wanted to offend either of you. I just feel that, personally, I would rather have the health care we have up here and I hear way more complaints from my American friends than Canadian ones. I was merely trying to express empathy, not act like I'm somehow superior because I have a different health care plan--that would be pretty foolish...

 

[Brodirt]

...and we were all so cool for so long!

Anyway, I don't think the complaint here in the USA will ever be the quality of care that we get...it is top notch. I think the complaint we have is the intermingling of politics, big business, bigger bureaucracies, massive costs and a loss of personal control eroding what once was considered the best system in the world.

 

[Lavaine]

I didn't think that Anthony's post was inflammatory, any more than I would be offended by an American member posting that they are glad they have excellent health insurance and do not have to suffer the long wait times that occur in Canada.
As a Canadian working in the health care field, I do feel fortunate to have our health care system. Brodirt is right, there is nothing wrong with the overall quality of health care in the US, it is amongst the best in the world. The 'problem' is with the minefield that many Americans have to navigate when dealing with health insurance, and the lack of universal access to care. Our health care is far from perfect, as is definitely not the panacea that Micheal Moore would have you believe. Wait times for access are a big problem, as well as staffing shortages.
Having said that, I think that both systems are a long way from perfect. One big area that both countries have failed to address adequately is in preventative care. A certain country to the south, despite its many problems of poverty, oppressive goverment etc., has it right when it comes to preventative health. They have a system in which EVERY citizen has a family physician (a big problem in Canada, as mentioned earlier), and has routine physical exams and screenings. Prevention is the key to fixing health care in North America, wether in a public or private system.

I hope I have not offended anyone with this post. My opinions are just that, mine, and I share them here to offer my perspective, not to start a battle with anyone.

 

[richmondesi]

I didn't think that Anthony's post was inflammatory, any more than I would be offended by an American member posting that they are glad they have excellent health insurance and do not have to suffer the long wait times that occur in Canada.
As a Canadian working in the health care field, I do feel fortunate to have our health care system. Brodirt is right, there is nothing wrong with the overall quality of health care in the US, it is amongst the best in the world. The 'problem' is with the minefield that many Americans have to navigate when dealing with health insurance, and the lack of universal access to care. Our health care is far from perfect, as is definitely not the panacea that Micheal Moore would have you believe. Wait times for access are a big problem, as well as staffing shortages.
Having said that, I think that both systems are a long way from perfect. One big area that both countries have failed to address adequately is in preventative care. A certain country to the south, despite its many problems of poverty, oppressive goverment etc., has it right when it comes to preventative health. They have a system in which EVERY citizen has a family physician (a big problem in Canada, as mentioned earlier), and has routine physical exams and screenings. Prevention is the key to fixing health care in North America, wether in a public or private system.

I hope I have not offended anyone with this post. My opinions are just that, mine, and I share them here to offer my perspective, not to start a battle with anyone.

Excellent point. FWIW, All Americans have access to care. I know guys that go to the emergency room for virtually everything, and they always get treatment. The system isn't perfect, but it is frustrating to hear people say that because X number of us don't have health insurance, that they don't have healthcare.

 

[professorchaos]

Also, I enjoy reading the multitude of posts by both of you (Henry and Matthew) and I certainly wouldn't have wanted to offend either of you. I just feel that, personally, I would rather have the health care we have up here and I hear way more complaints from my American friends than Canadian ones. I was merely trying to express empathy, not act like I'm somehow superior because I have a different health care plan--that would be pretty foolish...

No worries...I think both systems have their strengths and weaknesses. If it were just the three of us discussing it, I have little doubt that we could do so like adults.

 

[adonnellyr]

I was away for the evening, but I have to admit that when I got home I had an interest in seeing what the responses were in this post. All in all, as usual, everyone has come off as gentlemanly as ever and it's one of the many reasons this is the only forum of which I'm a member.

 

[dpm802]

Wasn't Hillary supposed to solve this problem way back in the early '90s? Why was it swept under the rug back then, and now the new administration is pretending like they just invented the concept in January 2009?

IMHO, the best way to nationalize health care is to start off small ... the same way that you swallow an elephant: One bite at a time.

Instead of trying to change everything all at once, the government should convert the health care system one piece at a time.

For starters, I think they should figure out a way to provide free dental care for everyone, and free eyeglasses for everyone that needs them. Another easy place to start would be free care for diabetics, and free prescriptions for anyone with either a temporary or on-going condition.

Once they get the bugs worked out of that system, then its time to move on to more complicated stuff like heart surgery and cancer treatment.

Rome wasn't built in a day, but they had to start somewhere.

 

[VR6ofpain]

This is just my opinion and in no way aimed at any particular person or group. But isn't health insurance an oxymoron of sorts. They make money by collecting premiums and denying benefits.....not caring for peoples health.

You are naive to think it is this simple. Do you think the health insurance companies are making off with huge profits or something? Look at their income compared to other industries. Their profits are far less.

 

[Pureslab]

One reason I'm very reluctant to return to USA is the sad state of the medical industry

Even while working back there in a "good job" with "good benefits" that covered my family - it still sucked with all the copay's and waiting time to see doctors or have any tests done


Fortunately I live in Thailand where medical tourism has become a big industry and some of the hospitals are amazing and affordable

60 Minutes did a segment about it

http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998.shtml

 

[Sullybob]

Snip....

Instead of trying to change everything all at once, the government should convert the health care system one piece at a time.

For starters, I think they should figure out a way to provide free dental care for everyone, and free eyeglasses for everyone that needs them. Another easy place to start would be free care for diabetics, and free prescriptions for anyone with either a temporary or on-going condition.

Once they get the bugs worked out of that system, then its time to move on to more complicated stuff like heart surgery and cancer treatment.

Rome wasn't built in a day, but they had to start somewhere.

I like the way you think.