There are a number of health systems that are supposedly non-profit but are sitting on huge piles of cash. One is sitting on $6B. That’s not-so-not-for-profit.
What’s sad about that is that it negatively effects staff and patients.
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I’m absolutely in favor of Coloradans voting for Prop 69. I want to see a single payer system put to the test with American patients and doctors. I want to see what works as planned and what doesn’t work before making any changes nationwide.
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OK, technically you’re right, it just PAYS for less.
Look, it’s not ACA, exactly, it’s just the fact that the insurance companies are still in charge. The article we are commenting on is about how expensive health care is in the USA. I have some very relevant experience in this.
I seem to have raised your ire in criticizing the ACA. Sorry.
Peace.
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No, no ire. I think we’re just looking at the glass from the 50% full/50% empty dichotomy.
ITA that health care is too expensive in the US, that the major cause of it is for-profit companies valuing money over humans, and that the ACA was a horrible compromise that keeps the insurance companies in the driver’s seat to the detriment of REAL coverage for all U.S. citizens.
But I’m coming at the situation of having always, except for 3 short years with a large firm and real health insurance, worked in small companies (the kind that actually DO create jobs) or self-employed and thus without the ability to get health insurance. At all. As in, turned down repeatedly despite being totally healthy and getting annual checkups. Finally, pregnant in my late 30’s, I decided a catastrophic-only policy was better than nothing – which would not pay for prenatal care, or labor/delivery, or well baby checkups – just in case something major happened. You start thinking that way when you’re a parent. Was turned down for “having the potential for future infertility”. For a catastrophic-only policy, that wouldn’t have paid for infertility treatments if I had wanted them. Oh, and I was 4 months pregnant at the time. And old enough that some other women my age were in peri-menopause…which, it is true, is an indication of future infertility. 
My first year on the Marketplace, I got Platinum coverage for 34% of the cost of the catastrophic-only policy I had finally been able to get (only after that insurance company had used their own medical staff to test me for future problems such as the risk factor of developing Type 2 Diabetes), and of course the ACA coverage actually covered things like annual checkups, vaccines, etc. Just in time, as I had been diagnosed with cancer despite my ridiculously healthy lifestyle. So for me, as far from the finish line as it is, the ACA made a demonstrative difference in my life. That’s where I’m coming from.
But yes, I totally agree with you that it’s nowhere near enough.
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And when you’re dealing with a serious illness, like you have been, one should not have to also worry about being out on the street, because you can’t afford rent.
I hope you’re doing well, though. That sounds like a scary time, even with all this covered. Good luck.
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But what makes Canadian or European doctors substantially different? This is a tried and tested system already and has been for years. It’s not a mystery how and why it works.
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Dunno if I’m scared, Mindy. I’m a tough old bird, and I’ll do what is required of me with a will, but I can’t control everything - I accepted that years ago. I won’t go gently, but if shit happens, it happens, and I’ve had a full life already.
As it is, we’ll see how things are mending after RT. It takes a while for the fatigue and aches to go, and the results to settle in.
Absolutely nothing.
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You sound like a tough old bird and I’m thinking good thoughts at ya. I’ve seen enough cancer in my family lately to know how hard it can be.
And yeah, we can have a single payer, but there isn’t the political will to do so here.
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Make the political will, Mindy. It’s going to take a whole bunch of people at the grassroots to create the pressure to do this, and none of you can afford to say “there isn’t the political will” or it will never be done.
Take the time to point out to all of your countrymen that the “taxes” they are so worried about are generally quite a bit less than their current premiums, and yugely less than the premiums they would pay to get the kind of coverage I get. And, being taxes, they are geared to income.
And this all makes sense, given that your insurers and networks are pure middlemen, pure rentiers: they haven’t got anything to add to the service, so perforce they must jack up the prices and limit payouts to make good profits. This is the standard practice in neo-liberal capitalism - look at the rise of the financial services industry and our friends in the MAFIAA (RIAA, MPAA). Time to roll back this pernicious ideology, one sector at a time, eh?
So maybe use the Colorado initiative, maybe even this BBS, as a springboard to start gathering like-minded souls. Start contemplating the kinds of propaganda needed to make the situation real to those who have swallowed the corporatist bullshit hook, line and sinker, maybe even sneaky tricks like a website which, after people plug in their yearly premiums and terms of coverage, presents the costs of treating certain very common grave ailments (like breast or prostate cancer), then shows how much “more” they’d have to pay in taxes (*cough*, *cough*, *wheeze*…) to get equal or better coverage.
You all need to lose despondency, because this will only get worse if you don’t, and, unfortunately, your country’s ruling ideology (of which this is a symptom) is having a pernicious effect not only on your own country, but the rest of the world as well.
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Does it come back to our tort system (legal costs), disparate compensation (high profits and C-Suite pay), and arduous and artificially high barriers to qualify doctors to practice?
I’ve been lucky enough to have very good healthcare and no major illnesses, so it is so hard to understand and sort through all the opinions and how to make things better. As a parent who has Epi-pens for my kid and occasional emergency room visitor, I totally get that part of the outrage around overly high pricing and low cost material (you charged me WHAT for some 4x4s?)
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You’re completely right here. I have no excuse to not do something. [quote=“PatRx2, post:150, topic:87223”]
You all need to lose despondency, because this will only get worse if you don’t, and, unfortunately, your country’s ruling ideology (of which this is a symptom) is having a pernicious effect not only on your own country, but the rest of the world as well.
[/quote]
And this is why.
I promise to do better.
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That’s crazy talk! Europe is thousands of miles away. Why, for a sensible comparison, you’d need an Anglophone nation with a broadly similar culture that is right next door that Americans could simply drive to. Anything else would be comparing apples to oranges. Of course, should such a nation exist, then some corollaries could be drawn, but as this spurious utopia is simply a rhetorical device, well…
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Doesnt single payer bring down costs in two basic ways? 1) by taking out the insurance company profit margins which should reduce costs by maybe 10% 2) by using the monopsony power to force medical costs down - ie paying drug companies and medical staff less.
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Those things may make a small contribution, but the problems of US health care are overwhelmingly the fault of parasitic rent extraction by the completely unproductive for-profit health insurance industry. You’re burning billions on nothing.
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Sure, and 3) taking out provider and insurer administrative costs. TONS of time is spent in the US by providers and insurers deciding and arguing about who should pay for a service, how much the payer should pay for it, and who should pay the rest. TONS of people are employed just working on this problem. In contrast, where there is one price for a service, and one payor which pays the entire price, then everything is vastly simplified.
As an example, when I go to the doctor, my doctor has to figure out which insurance to bill, and follow that insurer’s specific procedures and forms. Then the insurer has to figure out what the contract is with that specific doctor and what their contract is with me in order to determine how much they will pay. Assuming they pay anything, then they send me an Explanation of Benefits laying this all out and the doctor then has to decide how to get the remainder of the money if there is some left over: do I have secondary insurance? Or can they bill me for the rest? or is there a legal or contractual reason that they have to write off the balance? Often they will bill me – usually using a third party billing company that exists solely for this purpose.
In contrast, my son, because of his disability, has some services covered by medicaid (Medi-Cal in California). For those services, we simply show up at the doctor. The doctor bills Medi-Cal for the Medi-Cal established price for the service (probably too little but that’s a different topic). Medi-Cal pays that one established price in full. Nobody bills us.
In the US., 25% of hospital spending is administrative vs. 12% in canada: http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs
In some states, over 50% of doctors’ expenses are for billing and insurance. Thus, multiple studies find that we could save hundreds of billions of dollars in administrative costs by going with single payer. Billing and insurance-related administrative costs in United States’ health care: synthesis of micro-costing evidence - PMC
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No, no, you must be mistaken. “If you like your plan, you can keep your plan.” Obama said so.
10%? If your per capita administrative costs are slightly more than twice ours, and your overall costs are somewhat more than twice ours, then it follows that costs other than administrative are also somewhat more than twice ours, and that strongly suggests that 10% is low-balling the probable cost reduction.
That’s even allowing for monopsony, because, for a variety of reasons, the monopsony isn’t perfect - our provinces have jurisdiction over healthcare, so there can be competing markets between provinces for staff (and that doesn’t take into account the fact that we share a continent with a certain high-paying country). We have far fewer constraints on generics, but we are constrained by treaties with regards to items still covered by IP rights. I haven’t the figures, but I would hazard a guess that the costs covered by monopsony here still fall around 50% of the costs in your country for the same items.
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Curious: do you know what it was about your old policy that made it illegal under current law? Did it fail to offer something considered essential, or was it structured in a fraudulent manner, or what?
Presumably there was some legal justification for the elimination of that policy, whether or not that reason is sensible.
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The basic reason is that the US rewards heroic interventions, rather than basic medicine, to a much greater degree than other countries, with both prestige and money. Which means that our doctors are incentivized to spend their time and our money on hugely expensive procedures which net people at the end of their lives another 6 months, not necessarily of good quality; whereas stuff like ensuring pregnant women get sufficient vitamins is downplayed, and doesn’t get done. As a result, the US has a lot of low birth weight babies, which results in a high infant mortality, which drives life expectancy down obviously, and the survivors end up sicker throughout their lives, with shorter life expectancies and higher costs. The net result is both high costs and low life expectancy. If you see a table of life expectancies vs age for the US and other countries, you see the results of the above situation; our relative performance is worst at birth, gradually catches up to other countries, and actually becomes best in the world at advanced ages, which is, of course, where Americans get single payer government insurance. .
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For profit health insurers are required by law to spend at least 80% of their premium income on actual medical expenses, with all overhead including salaries and profits representing the other 20% (For nonprofits, 70%). Most people wouldn’t be satisfied with a 20% drop in health insurance costs. And, for that 20%, in return you get the insurers’ market clout which bargains with the medical providers for lower charges. If you look at the EOB the insurer sends you after every transaction, you see the providers’ list price, vs what the insurer bargained for on your behalf, and it’s usually more than 50% off, which more than makes up for the 20% overhead. In fact, in the system as it is, the only force which is allied with you to cut costs is the insurer, ironically. Of course, a single payer and/or nonprofit will do that as well; in fact, Medicare with its huge member base, is the gold standard for discounted charges that all other insurers strive for
If you look at where the costs go, the biggest are hospital admissions, mainly the doctors’ charges, and pharmaceuticals.
