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Healthcare Discussion on CNN


oec2000

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I can’t imagine living in the U.S. without insurance.

 

In my recent experience, if you show up to clinic or ER  they are merciless in the services they recommend and charges. Some of it may be related to fears of being sued. 

 

Two quick examples

 

-a women shows up with some lower abdominal pain due to urinary tract infection-gets $4000US worth of services (blood tests, US, specialist consultation), back home it would cost <$50 in total.

 

Last example- a retiree vacationing in Florida has blood in urine-spends 4 d in hospital, has cystoscopy + resection of a polyp-gets a bill for $40,000-OUCH! (he gets charged $3000 fee for pathology report that was not done as they lost the specimen) His travel insurance does not want to pay claiming that it was a preexisting condition. Our government insurance will only pay if it is life threatening and you need to ask for approval before service is rendered.

 

I have seen patients put on a private jet + limo'd home by their travel insurance, so that patients work up would be payed by government plan  rather than have them worked up in the U.S. at their cost.

 

Don t get me wrong however. The problem is in the system. I believe the technology, innovation, and all the great people providing the services are probably second to none and the rest of the world benefits from it. The resulting cost has got to be hurting your other industries. Where I live, where the auto industry is the biggest employer our workers had a competitive advantage directly related to health care cost (thousands of dollars of savings per car built just based on health savings)

 

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Btw, the system is not exactly free. A typical family of 4 pays about $1300 a yr in premium to the govt. in BC and many costs -some drugs, physiotherapy, routine check-ups, etc - are not covered by the system. Many people, if they are not covered by their employers, pay several thousand $ more to have supplemental insurance cover.

 

Wow, $1300 would be awesome!  My mother is 59 years, on no medication, healthy as a 30 year old and has individual coverage from Blue Cross for about $9,000 per year.

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Gentlemen,  Lets recast the US health insurance "Public Option" into

a different setting : Financial Care Reforn.  

 

 

How about 911 dispatcher?  Shouldn't that be run for profit?  Or how about police protection, shouldn't that be run for profit?  And shouldn't the fire department be run for profit?  That's why I can't stand this socialist country -- people don't deserve a police force unless they can afford security fences and armed private security guards.  If a house doesn't have fire insurance, should a for-profit fire department be required to respond?  And if the for-profit fire department responds to an uninsured fire and the owner can't pay for the cost of the fire fighting, who pays?  The other policy holders?  Isn't that basically what's going on today with health insurance?

 

One could see states/counties eliminating their public police force and contracting with Blackwater USA to provide police protection.  Does having a for-profit police force bring it's own set of moral hazards?  Is it desirable to have a police force with a profit motive?  Blackwater actually already has done this within the US -- providing police protection in the wake of Katrina.

 

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Gentlemen,  Lets recast the US health insurance "Public Option" into

a different setting : Financial Care Reforn. 

 

 

How about 911 dispatcher?  Shouldn't that be run for profit?  Or how about police protection, shouldn't that be run for profit?  And shouldn't the fire department be run for profit?  That's why I can't stand this socialist country -- people don't deserve a police force unless they can afford security fences and armed private security guards.

 

 

Great point and thats my problem with these debates. People are either retardedly capitalistic (though no one wants to privatize the army, even though we have effectively) or believe that we should have a nanny state where no one can do wrong, get hurt, or has to work. There has to be some middle ground. We should be trying to solve these problems, not pushing ideologies. I would put healthcare on the side of rights or basics which should be provided. It shouldnt be the best of care and shouldnt cover everything under the sun, but there should be some basic super cat and maybe even preventative care.

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How about a third path.  The main problem as I see it is the mixing of catastrophic coverage with routine care via regulated monopolies.  If we divide the problem into 2 areas I think the answer to the problem will make more sense.  For the routine care, the market should set the rates and individuals could chose providers/care providers.  For the catastrophic care, either the gov't or insurance can compete for the business.  Employers would provide a certain $ amount for routine care and pay for a catastrophic policy from either the gov't or an insurance company.  The development of the catastrophic market can also be accessed by self employed individuals.  This approach would also bend the cost curve down and use markets to everyone's advantage and remove the monopolistic health insurance providers from the equation.  For the poor, routine care can be provided via subsidies.  This would be using markets and gov't to everyone's advantage.

 

Packer

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Hey Eric,

 

Do they sell critical illness insurance in the USA? It might be the supercat insurance you are looking for. They have it in Canada... it covers the treatment costs and drugs for major illnesses (defined in insurance contract).  

 

I've tried to ascertain if it is worth buying such coverage in Canada... since we do have the basic public coverage to fall back on.

 

I grew up with good healthcare as my father was an HP employee.  Then I had great insurance through UCLA, then hired right out of college by Microsoft (the very best health insurance available).

 

Now, I am not employed and I went on COBRA for my first few months.  Then I didn't know which health insurance to get, so we went with a local business that acts as a broker and she found our insurance for us.  This was an interesting process because I discovered that I can't find insurance to cover prescriptions... anywhere!  Literally, it's just not available.  So if one of us gets cancer, I'm fully on the hook for chemotherapy (which I hear is easily running people into six figure bills annually).

 

So I frankly don't see how the government is going to crowd out the private sector, when the private sector isn't even offering the kind of insurance I want!

 

I can pay for broken bones out of pocket... what I want insurance for is the "supercat" of health coverage... cancer treatment.

 

There is a loophole though that I can exploit... I just have to create some phony corporation (any corporation) and then the insurance companies are required to offer me a plan that has prescriptive coverage (to cover cancer chemotherapy).  How stupid can this be!!!

 

 

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Hey Eric,

 

Do they sell critical illness insurance in the USA? It might be the supercat insurance you are looking for. They have it in Canada... it covers the treatment costs and drugs for major illnesses (defined in insurance contract).  

 

I've tried to ascertain if it is worth buying such coverage in Canada... since we do have the basic public coverage to fall back on.

 

I grew up with good healthcare as my father was an HP employee.  Then I had great insurance through UCLA, then hired right out of college by Microsoft (the very best health insurance available).

 

Now, I am not employed and I went on COBRA for my first few months.  Then I didn't know which health insurance to get, so we went with a local business that acts as a broker and she found our insurance for us.  This was an interesting process because I discovered that I can't find insurance to cover prescriptions... anywhere!  Literally, it's just not available.  So if one of us gets cancer, I'm fully on the hook for chemotherapy (which I hear is easily running people into six figure bills annually).

 

So I frankly don't see how the government is going to crowd out the private sector, when the private sector isn't even offering the kind of insurance I want!

 

I can pay for broken bones out of pocket... what I want insurance for is the "supercat" of health coverage... cancer treatment.

 

There is a loophole though that I can exploit... I just have to create some phony corporation (any corporation) and then the insurance companies are required to offer me a plan that has prescriptive coverage (to cover cancer chemotherapy).  How stupid can this be!!!

 

 

 

 

I told my agent that I had millions and can pay -- don't just offer me policies that you think I can afford, I want to know if there is an expensive policy out there that can pay for chemotherapy.

 

She told me that no, it doesn't even exist!  Hey free market ethusiasts, what do you have to say about that?

 

She recommended that I form a corporation, make myself an employee, and then options are available to me that will cover cost of prescriptions (which is where chemotherapy falls into play).  So I can incorporate a lemonade stand, or I can have chickens and sell eggs, or something else completely stupid just so I can get full coverage.

 

What a joke.  The free market works?  Let's say I could get care... down the road they can deny my claims if they find out that I lied about a mental illness or a pre-existing heart condition... even if I'm filing for reimbursement on chemotherapy.  Nice system folks.

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Some of you guys really dont seem to understand. Why do you want for profit companies deciding who lives and who dies. They are have a strong motive not to provide care or to only provide care to those who dont need it.

 

 

The supposed free market profits are also illusory -- the P&L of the insurance industry does not include the cost of me fighting with the insurance company over a claim (my time and legal costs).  It also does not include the public cost of a court system used to resolve these disputes. 

 

Make the private insurers bear these costs, and then we'll see how efficient it really is.

 

 

 

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Get really sick, & the cost of your 'super-cat' is really just the cost of ambulance/flight to another country.

Something that every vacationing snow-bird almost automatically thinks of.

 

Medical tourism exists for a reason, & in most of the 'better' Asian centres the quality & reliabilty of the average care is often superior to much of the 'average' care in the US.

 

'Market' wise I have an incentive to offer US residents health insurance that will pay for those foreign treatments (Fairfax Asia?), but once I achieve critical mass - US insurers will be forced to follow. The recipient countries get state-of-the-art new hospitals to meet the demand, & their medical profession gets to use their perfectly qualified doctors, that the US excludes to reduce local competition.

 

End of the nicely protected US 'monopoly' market

 

SD

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Eric, something's wrong with the story you've been

told: that no insurance company, dealing in a free

market, will offer a policy that includes chemotherapy for

cancer treatment.  If the market in your state were truly

free you would be able to buy such a policy because chemotherapy

is standard on most employer provided policies.  I suspect

that you may live in one of our more socialist states like

California where insurance cos can't price non group

policies with complete coverage above their break even

points.  There is the phenomenon of adverse selection

on the sale of individual policies especially policies with

generous benefits.  Therefore in a quasi socialist US

state with mandates and price caps, such policies

may be big losers for  insurers.

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I told my agent that I had millions and can pay -- don't just offer me policies that you think I can afford, I want to know if there is an expensive policy out there that can pay for chemotherapy.

 

She told me that no, it doesn't even exist!  Hey free market ethusiasts, what do you have to say about that?

 

 

Hey, I know someone who might be able to help you out. Call 1-800-786-6426 and ask for Ajit. If he's not available, Warren might be able to give you a quote. Caveat: They might actually ask for your millions! ;D

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Eric, something's wrong with the story you've been

told: that no insurance company, dealing in a free

market, will offer a policy that includes chemotherapy for

cancer treatment.  If the market in your state were truly

free you would be able to buy such a policy because chemotherapy

is standard on most employer provided policies.

 

 

I live in Washington state, and you are right... it is standard on employer policies.  Law requires the insurers to provide it to employees of corporations, and that's why if I incorporate a lemonade stand in my front yard I can then be assured of getting such a policy.  But if I don't pull that bullshit stunt, they won't offer it! 

 

Thus, without the law putting a gun to their head, one can see how the free market behaves... they refuse to offer prescriptive coverage to individuals for example.  Do unemployed individuals have a higher rate of cancer than employees of lemonade stands?

 

Can anyone enumerate the benefits we get as a society by having private health insurance?  All the money they make from their float, we can keep it for ourselves... and that's an obvious gain.  So what do we lose by getting rid of the private system?

 

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Great point and thats my problem with these debates. People are either retardedly capitalistic (though no one wants to privatize the army, even though we have effectively) or believe that we should have a nanny state where no one can do wrong, get hurt, or has to work. There has to be some middle ground. We should be trying to solve these problems, not pushing ideologies.

 

Exactly! Which is precisely why I was so impressed by the panel discussion on CNN.

 

Packer, the 3rd path suggested by you is one of the recommendations brought up on the panel discussion. That's why I recommend anyone who has not watched the show or read the transcript to do so - it will broaden your perspective on the debate. On an issue as important as this, individuals need to take a more active role to understand the issues and problems directly rather than simply relying on and empowering and enriching the spin merchants and pundits out there. Believe me, they don't have your best interests at heart!

 

In Canada, we also have similar ideological debates about one-tier (public only) and two-tier (public and private) health systems and it drives me crazy to see people acting like 3rd graders - while the healthcare customers suffer. Unfortunately, there is not enough momentum here right now for reform to work.

 

It's good that there is lots of momentum for reform in the US - the problem is that it is being handled in the most asinine of ways. You guys should make Lee Kuan Yew a honanry citizen and then appoint him the Health Czar - he'll fix the problem in no time! (He'll just deny healthcare to those who do not support him!) ;D ;D ;D

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Eric, the big thing you lose when you get rid of a private

health care system is innovation: continual improvements

that are extremely difficult to make in government

controlled systems where acceptable standards of care

are ingraved in stone and there are unpleasant consequences

for physicians who might upset the status quo ante.

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Eric, the next thing you may lose in a government controlled

health care system is your life if you are in a category that the

authorities deem expendable.  I have personal knowledge

of a sad situation of a gentleman who lived nearby a few years

ago.  He was otherwise in good health,but had developed

a kidney insufficiency as he approached retirement at 65and had

to have dialysis.  He wanted to go home to England and removed

there shortly after retiring.  Sadly, we learned from his relatives

weeks later that he had died in England of kidney

failure because the national health care system did not allow dialysis

for those age 65 and older.

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Eric, the next thing you may lose in a government controlled

health care system is your life if you are in a category that the

authorities deem expendable. 

 

Granted, I recognize that you were only providing an example... but I wonder whether the example is something that describes an untenable system altogether, or a good example of public coverage not completely crowding out the private sector... it's some meat left on the bone that private insurers can write coverage for.  Is there some reason why the private sector isn't providing an insurance plan to cover people age 65 and older to get dialysis?  I really don't know, but is it illegal to write any form of health insurance in the UK to cover the obvious holes?

 

 

 

 

 

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Don't know about UK. In Australia there are good GP's

who treat patients for a fee

A lot of Canadians come to the US for surgery  because of wait lists

there, according to articles in the press.  By the way

chemo isn't a very effective treatment for most cancers

according to Superfreakonomics.

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How is it that the U.S. spends so much more on health care as a percentage of GDP than other industrialized countries, yet so many Americans are uninsured?  There is no reason why every person in a rich country should not have health insurance, and there is no reason for it to cost as much as it does in the U.S.  Maybe the Congress should ask Canada or the U.K. to help figure this out?

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It is only the emergency stuff that kills you. For non emergency stuff, one can shop around. It is possible to get a bypass surgery done with hospital stay + food expenses costing about $2500 if you are willing to go to India. The doctors are also world class - e.g: Narayan Hridayalaya which was features in business week. There is also the Apollo group which apparently is looking at doing telemedicine.

 

http://en.wikipedia.org/wiki/Apollo_Hospitals

 

 

If there is enough demand, one can setup a ship in international waters off the US coast and ferry the passengers to that location  ;D

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It is only the emergency stuff that kills you. For non emergency stuff, one can shop around. It is possible to get a bypass surgery done with hospital stay + food expenses costing about $2500 if you are willing to go to India. The doctors are also world class - e.g: Narayan Hridayalaya which was features in business week. There is also the Apollo group which apparently is looking at doing telemedicine.

 

http://en.wikipedia.org/wiki/Apollo_Hospitals

 

If there is enough demand, one can setup a ship in international waters off the US coast and ferry the passengers to that location  ;D

 

 

$2,500 is not realistic in the US for bypass surgery.  It's not even realistic for surgery on a pet.  Two years ago I spent $5,000 getting a double knee operation for my dog (non emergency).  It's not like malpractice risk is as high with a dog, it's just what they charge (those bastards).  I can afford the operation, and I want to walk my dog.  Dog is only 4 yrs old at the time... they have me over a barrel so I choose the dog over the money (I care more about the dog than the money).  This same dog also slipped a disc a few years ago ($2,000), and 10 months later was attacked by another dog ($1,500).  The dog cost $1,500 to purchase from the breeder... so thus far I'm sunk $10,000 on this dog in just 6 years.

 

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I hope this is not a dumb question because I'm not too clear how Medicare or Medicaid work in the US.

 

If someone without health insurance gets cancer or a heart attack or has kidney failure, does he truly have no access to any healthcare at all? Is he left to die without treatment?

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I hope this is not a dumb question because I'm not too clear how Medicare or Medicaid work in the US.

 

If someone without health insurance gets cancer or a heart attack or has kidney failure, does he truly have no access to any healthcare at all? Is he left to die without treatment?

 

 

I believe the socialists intervene and he gets treatment (we could let him die if we'd just let the free market work for once)  :)

 

It's like TARP, but for sick people (we choose to treat them in the emergency room at higher cost than preventive medicine).

 

 

 

 

 

 

 

 

 

 

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The system in the US is broken ( for the patient ) for several reasons:

 

Although the insurance companies are blamed ( they face the customer ), there are numerous parties with large lobbies.

 

Atul Gawade of the "Check List" has written some nice articles on this. He had one where one of the counties in Texas with the lowest per capita income has the highest per capita medical expenditure. It was pretty interesting to read.

 

People are referred to multiple specialists

Each specialist will recommend the same tests again and again

Although Atul won't say this, the entire system and lobbies are setup for the various constituents who are happy with the current arrangement

Recently NPR aired a story on how the drug companies and insurance people are fighting each other. e.g; generics cost $40/prescription and insurance company will pay it in full. The brand will cost $600 for the same prescription but the insurance company will charge $80/copay. Here the drug company will reimburse the customer for $80 and still come out ahead.

 

Then there are the lawyers and others who like the system.

 

The system can't continue as is. Even a multi millionnaire can go bankrupt in the current system in the US without insurance coverage. When my son was born, the first day he had some difficulty breathing and had to be kept under watch for a couple of days in the hospital. Fortunately my insurance covered it, otherwise I would have been down some 50K.

 

cheers!

shalab

 

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