Not to be political...but the elephant in the room...health care reform

gcvmom

Here we go again!
Actually, with regard to auto insurance, at least in California, you do have the option of putting up a cash deposit or a surety bond in lieu of purchasing a policy from an insurance company and you can also self-insure. So you are not forced to buy a policy from an insurance company, you simply have to prove that you are financially responsible for a certain amount of liability.

I am also concerned about how the whole ball of wax is getting paid for...
 

DammitJanet

Well-Known Member
The auto insurance thing is different in different states. VA used to be that way...dont know if it still is. Here, you best have auto insurance...lol.
 

Nancy

Well-Known Member
Well I wonder how many people would opt to post a surety bond for their health care too and pay as you go.

Nancy
 

Marguerite

Active Member
Again, from the land of being controlled by the government - in Australia we have to have at the very least, Third Party Personal insurance before we are allowed to register our car. It's called the "green slip". We also have to have a certificate of roadworthiness (the "pink slip") before our car can be registered. It is a serious offence to drive an unregistered vehicle and if caught, you lose the car.

We have problems when kids (like difficult child 1) think the green slip also covers them for third party property. So when he ran a red light in abysmal wet weather and peak hour traffic and cleaned up a doctor's leased BMW, difficult child 1 was out of pocket $80,000. He was on the point of having to declare bankruptcy when the doctor's insurance company came knocking. They saw that they would get less than nothing out of him if he went bankrupt, plus it would make them look bad, so they dropped it all. Thank goodness.

As for how your health scheme gets paid for - I haven't read the document, so I can't say. But in Australia, our health scheme gets paid for via a very small tax levy. This means the people who can most afford it pay more than the poor people. Below a certain income level, you pay nothing. But this does require linking in everybody's tax return details to the health system. We do have to endure a lot of Big Brother to get this working. However, there are also very strict rules as to who can access the information and people (health employees or tax employees) do occasionally get caught and prosecuted for breaches of the law (with regard to not treating people's information with respect).

Something we also have in Australia with our private health 'extension' to our cover (which is optional) - we can choose to pay for 100% cover, or we can choose to have an excess, as we have with car insurance. In our case we have an excess. So for things our national health insurance doesn't cover us for, or for my recent choice to go private re my breast cancer in order to have it removed as soon as possible, we had to pay a certain dollar amount towards the fees. Also in our case, if a doctor chooses to charge more than the scheduled fee (which is set by the AMA) then the patient has to pay the extra. Anaesthetists, for example, always charge more than schedule fee because their costs are higher (someone has to pay for the anaesthetic medication and materials, that actually comes out of the anaesthetist's fee). The anaesthetists are always campaigning to have their schedule fee increased. But as a lobby group they are not so powerful as, say, orthopedic surgeons.

Continuing my example - there is no rush now that my tumour has been removed. So I have happily accepted the longer waiting time for the radiotherapy, and gone public. I'm not even sure there IS a private option. So all my specialist visits, and all my radiotherapy treatment, will be covered by Medicare (ie I won't have to pay anything). They even have dedicated parking right outside, for patients of the radiotherapy clinic! So I won't even have to pay a parking fee.

I have to go see my GP this afternoon for my regular monthly appointment to get my pain medications. My GP chooses to "bulk bill" which means she has accepted 85% of the schedule fee as payment, in exchange for not having to worry about making up accounts and trying to get the full fee up front from the patients. Doctors here are not allowed to charge the 'gap' and then bulk-bill.
Doctors who bulk-bill simply send the patient's Medicare number (a unique number for every Aussie citizen) plus the "item number" which identifies what kind of service, to the Medicare computer. The doctor's practice then gets a regular payment transfer from Medicare.

To "keep the B)(*&^ honest" (a famous Aussie political phrase) the Medicare computer keeps databanks on all the Medicare numbers and the doctor provider numbers as well as the item numbers, as well as the dates. So if I begin doctor-shopping, for example, seeing multiple GPs in the same day for the same sort of item number, Medicare will flag it and watch. They may even begin to ask questions. Similarly, if Medicare notice that a GP is servicing several thousand patients in one day, the computer will flag it and ask for an explanation. Even pharmacies are hooked in - a doctor who over-prescribes can get flagged. A pharmacy that allows too many addictive drugs to be dispensed without asking questions, can find themselves getting a visit also.

Another example - I was waiting outside the hamburger shop for difficult child 3 and noticed an almost empty rubbish bin beside me. At the bottom, glued perhaps by a remnant of bubble gum, was an empty packet of very strong pain medications. I removed the empty packet and noted the name of the patient, the name of the prescribing doctor, the amount of medications prescribed (a very hefty jolt, twice as much as I take and I know I take enough to make an ER doctor gasp) and TODAY's date! And the packet was empty. Underneath tat packet was another empty packet of a different but also addictive pain medication, also massive doses. Same patient, same doctor, same pharmacy, same date. I suspect the ink was still wet on the label.
Every capsule had been removed and the empty foil was also in the bin.

I went in to the pharmacy, the bin was right by the pharmacy back door.

The number of possible explanations were limited, and none of the explanations gave valid reasons for what I found. What I had found had to be the end result of drug-seeking behaviour and someone obtaining prescriptions for the purpose of abuse. A patient who NEEDS those medications for legitimate medical reasons, would not remove them from the packet, because the pack is a legal 'permission' to have those medications in that amount. Otherwise the police can run you in if they catch you with those drugs and no prescription label in your name.

So I reported my find to the pharmacist. Now it is possible that the pharmacist was in one some scam, but I doubt it - they can't risk losing their license and this is a major pharmacy, they would make far more from legitimate medications than from a payoff from a local junkie. They also have to justify ordering those medications from the warehouse, the government watches these prescriptions closely, and addictive medications require an authority prescription. A doctor prescribing for a patient who did what I found, would get flagged and questioned, risks losing his job.

as I left, the pharmacist was calling the police.

It is possible that the patient whose name was on the label, was a genuinely inform relative who had their prescriptions stolen, But this would need to be reported in order for replacement prescriptions to be issued. And if it happens again - questions get asked.

I'm trying to explain here, how our system has had to be made intricate and ever-watchful. If you are genuine, you have nothing to fear. But if you are trying to abuse the system, we have a system with cross-checks tat will catch up with the wrong-doers.

Some people find this level of official scrutiny to be a concern. I've never had it interfere with my personal freedoms, nor have I found the health system to be a problem when it comes to confidentiality. I live in a very small village with a neighbour (or a few) who would love to gossip about my pain medications, if they knew what I take. So my pharmacist who is aware of my concerns, always goes to great lengths to make absolutely sure that nobody knows. He packs my pain medications below the counter into an opaque bag and won't mention the name of the medications aloud if there is anyone else in the shop.

With any level of government involvement in a service to the community, you will need some level of official scrutiny in order to make sure it is working well. It is one of the costs that come with the hoped-for benefit. I know you all value the perceived freedoms in your country highly. We also consider Australia to be a very free country. I'm sure we give that imprssion to visitors. But we have become very accustomed to a high level of government 'tweaking' and watching.

it is so prevalent that we hardly notice it any more.

Marg
 

Nancy

Well-Known Member
Marg I hope they get to the bottom of that empty prescription bottle and if the doctor writing prescriptions unlawfully I hope his license is taken away. We have that problem here too. One only needs to look at Michael Jackson or Anna Nicole Smith to see what abuse is out there.

Nancy
 

Star*

call 911........call 911
Well as a person of border-line low income with poor health? I'm forced to pay out $438 a month in health insurance for myself ALONE. Had I not done some quick talking and negotiated THAT in lieu of a .50 raise when all the other men got their raises, and health insurance and benefits? I would be in the grave I'm sure.

As far as all the hype and sky is falling? I'm with Flutter on that one. This entire thing whether you're an elephant or a donkey has really split our country and not brought us together. I am just so sick of all the uninformed people spouting off about how this is going to cost 94 trillion dollars and we'll never recover - that by the time this does come to fruition? I just chuckled at Mutt's comment - I too had to turn the TV off because I kept thinking I'm going to have a stroke before it's over and not reap the benefits of any program.

As far as SC suing? OMG when I heard our State Atty. Henry McMaster was suing calling this unconstitutional and why he citied the reasons? I nearly turned in my party hat. Honestly.

It occurs to me regardless of party - that our President has undertaken a job that NO ONE in their right mind would ever have said "OH YES, give this job to me I want to attempt to fix this mess." and there is absolutely no denying this country was and is in a horrible mess. We could sit and point fingers but to the best of his ability? I don't think he has. I see him trying to do his level best to improve things. For that? He has my respect. I don't always agree with his ideals, but I don't agree with everyone everyday. I don't know how to run a country? But ....when you're trying to clean up a mess? Sometimes you make a bigger mess before you actually get the place clean, and maybe that's what this is.

I just wish someone would put that health care reform into simple terms and say - OKAY you over there with this problem.....THIS is your page - read it....this will happen. You over there with this problem...now this will happen.

With regard to Medicaid and the failing of that system? I think you'd have to really look at California and why their system bankrupted. They had the no-turn anyone away policy - which included treating illegals. For a fact that had a lot to do with why county hospitals and Medicaid is in the red. (not being prejudiced) Then again, how could you look at a child with a broken arm or a cut regardless of where they were born and not treat them? I couldn't not turn someone away - just couldn't. (shrug) I guess others who took a hypocratic oath couldn't either. And here we are. All brothers and sisters....struggling. Amazing isn't it?

Interesting post.....thanks mods for allowing it.
 

GoingNorth

Crazy Cat Lady
I also thank the mods for allowing this. I really thank people for discussing this like the mature adults I know they are. I learned from these postings
 

DammitJanet

Well-Known Member
I think I would really like to look at Massachusetts and their health care reform and see how they have managed to do it. They have had it up and running for at least a few years now. Maybe that will be light reading for tomorrow...lol.
 

Marguerite

Active Member
Star, you raised the issue of the Californian system treating illegals - we dealt with this in Australia. I think in the early days of Medibank in the 70s, we had an 'all-comers" policy which in itself didn't bankrupt the system, but it was symptomatic of a general financial haemorrhaging which had Medibank finally overturned, teeth pulled and remodelled into a slimline version with the tax levy added to each person's tax bill.

Ours is not a free system. We each pay for it. But the cost to our country is $3,397 per person. It does cost more than the levy, I'm sure of it, but it means the government top-up is not that great.

I found an interesting website for you to have a look at. It's 8 years old so the per capita cost given for Australia is lower. But the comparison between countries is interesting. I think the reason for the lower cost for Australia, is the levy we all pay. And as I said before, when you're being taxed at 40%, what's 1% more?

http://www.nationmaster.com/graph/hea_spe_per_per-health-spending-per-person

In this chart, you can see that health expenditure in the US PER CAPITA is the highest in the world. And yet - you have NOT had the best system in the world. Why should we in Australia have a much better system that you, for a lower cost?

Incidentally, New Zealand's system is similar to ours, we also have reciprocal agreements. You might find in your new US system (I don't know but it could be something included) that the US could well set up similar reciprocal agreements with other countries. It's one more step to a world economy (which delights some people and scares others.

My sister who has been in intensive care for nearly three weeks now, will have incurred a huge bill. I'm glad that bill is capped and also will mostly be paid by our Medicare system. Also, if the lung transplant goes ahead (and I think it is going to be the only thing that will save her), it needn't cost my sister a cent more than the Medicare levy she has already paid through her taxation. It's all covered. The lot. She could be a homeless bloke on the street but if eligible for a transplant, he would get the same care.

As for refugees and others here on temporary visas - at a certain point, they are given a Medicare card. Not the temporary visas, but once given refugee status or granted permanent residency, they get the card, because by that stage any income they earn is levied. But it also means they can be tracked. Our tax file numbers follow us everywhere (again, a unique number) and so do our Medicare numbers. It's almost impossible to have multiple such numbers. If a new one is issued, the old one becomes obsolete.

It takes an efficient and effective computer system. It would be really interesting to know, which country(ies)' system's are being used as models for the US proposal.

Marg
 

SRL

Active Member
In this chart, you can see that health expenditure in the US PER CAPITA is the highest in the world. And yet - you have NOT had the best system in the world. Why should we in Australia have a much better system that you, for a lower cost?

I would guess that's because your government stepped in before healthcare costs started skyrocketing in the 80's.
 

LittleDudesMom

Well-Known Member
Before I share my two cents I want to commend everyone for keeping this discussion just that, a discussion. It's a shame that this topic is raising tempers to the point of obnoxious and unacceptable behavior on both sides - but not here.

I would like to agree with Heather. This was actually a bipartisan effort and if you read the bill you will find tons of special interest junk in there on both sides. Also, there has only been one link posted on this thread so far that was not an opinion piece. I believe it was the first link shared from the St. Petersburg paper. The remaining links that have been shared have been opinion pieces and therefore will be slanted toward's the writer's political persuasion. Nothing wrong with opinion pieces, I love them. Just wanted to make sure folks understand these are not factual articles.

My opinion on the bill is kinda two-fold. I'm a little troubled by the way it was passed without a the second vote, but I am convinced that our president did something that others have failed at for 20 years. Something had to give with our healthcare system and there was no way everyone was going to be happy. We have some time to tweak this thing. Some of the changes don't take effect until 2014.

The loudest thing I heard yesterday was that the republicans believe this has so divided the country that they will sweep the next elections and then, once in power, destroy/revoke the bill. Which, in my middle of the road opinion, is the worst thing we could do. It took so long for us to get anything accomplished regarding the poor and money-weighted health care system in this country, that repeal takes us back to square one and it will be long into my social security years before something else is done. I would rather not lay that burden on my children.

Sharon
 

Marguerite

Active Member
SRL, I'll have to check out the skyrocketing costs in the 80's thing. We did have a lot of problems then, with our health system looking like it was bankrupting the country. At least that's what its critics were saying.

Our bipartisan political system (it does work differently to yours) means that we can get very confused with a lot of political point-scoring and not a lot of factual information.

A lot of costs went up and are still going up. We have a lot of new technologies which make diagnostics and treatment a lot better, but which also cost.

Our health care system has been re-worked a lot of times over the years to make it cheaper. Maybe it's the current economic times, maybe it's the long list of other problems our government is working on, but right now nobody here is screaming about the cost of health care. The only health care issue on the Aussie horizon at the moment is the Federal government's planned takeover of the currently state-based hospitals. Not a whisper about Medicare costs. In fact, this will add to the Medicare workload for us.

I'll do some checking, you raised a good point.

Marg
 

hearts and roses

Mind Reader
Just a comment about the rising costs of private health insurance. I am the administrator and work with our agents/brokers every year trying to determine which policy is best for our employees. We're a 12 person company but only about half take advantage of our coverage and we're spread over 3 states, which makes it very difficult to do comparative/ competitive shopping for policies unless we're using one of the big companies such as Blue Cross/Anthem or United Healthcare (Oxford) and because we're also such a small company, that presents issues all on its own. We used to go through our local Chamber of Commerce to secure decent rates, however, in the long run that has proven to be worthless. We average facing between a 9% and 15% rate hike each year buying private health insurance, if we buy the traditional point of service plan with a primary Dr and stay within network - we will only pay co-pays. The higher the premiums, the lower the co-pays. The lower the premium, the higher the co-pays and, very often, the lower the coverage. Our annual premium costs for this year, had we remained on the same plan, would have been a total of $125,000 for 6 employees (only 4 with family coverage). out of that the company pays 80%, which is almost unheard of these days, and the employees cover the other 20% premium costs. And now, with the change in laws covering children, dependent or not, until age 26, that means that many of us currently with family coverage will be on the hook longer than expected. myself included. Younger people simply cannot find jobs that have medical coverage anymore. difficult child is what is called Long Term Temporary employee and she's paid through a temp agency. Her contract says she can be with the company for up to 3 years and the only way she will get coverage is if she purchases it through the agency at a very high price. easy child is in a similar boat. Therefore, they are remaining on my policy.

This year, our company has decided to go with a high deductible plan ($2000 singles/$4000 families) and our company is funding what is called a Health Savings Account (HSA). Unlike a Flexible Spending Account (FSA), the HSA belongs to the employee and as long as she is spending the money on medically related costs, it's her money and if she leaves the company, she can take that money with her. The other beauty about an HSA/FSA is that it is pretax dollars, you can use it to buy things like aspirin. However, you must keep impeccable records and save all reciepts because the account can be audited if it's suspected that you are abusing the account and not using it to buy medically related items. If our company was not funding the account, this would not be a change I am in favor of, because really, how the heck would I be able to pay out of pocket $4000 to cover my annual deductible? Huh!

What I have read so far and covered in my social welfare class is that 'in the long run', the healthcare reforms will actually save the country money. Initially, from an economic viewpoint, this reform seems like a nightmare. However, if it goes as planned and works out the way it's been shaped to work out, it will not bankrupt our country and in fact, it may help bring us back into the black. Now if we could just stop spending a gazillion dollars for the war, we'd be well on our way to recovery as a nation. Wouldn't that be nice?
 
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Marcie Mac

Just Plain Ole Tired
For the past few years our company has employed a firm for HR who specialize in small businesses mainly for the medical coverage.. Becuase we are one of a large group of firms that have them, and there is power in numbers, we have the benefit of about 10 different plans for medical, plus get vision, dental, disability, life insurance, 401K, workers comp plus a myrad of other member benefits, and we can change our medical once a year if we don't like the opton we have chosen. Right now I have Blue Cross HMO for which i pay nothing cept a 10.00 co pay - boss pays a premium of 168 every two weeks. I will be switching to a PPO next time for which I will pay for (very small amount) and boss's share would not change. Because the majority of employees are older, illness does take a toll on the overall premium eventually, and they will switch HR firms. Works well for them cause it was a nightmare of shoping every year for individual group policies which everyone could afford, not to mention time consuming.

Marcie
Marcie
 

Nancy

Well-Known Member
Thanks for the info H&R. I'm not sure if you read my post but our deductible is $10,000 per person and $25,000 per family. My husband owns a small business which offers health insurance and he is thrilled that he will not get a tax credit. I agree that our kids will all have a difficult time finding coverage because of the job market. I believe this will not bankrupt the country and the opposition knows this. The level of threats that have been going on lately shows the desperation to get it overturned before we see that the sky hasn't fallen.

Nancy

P.S. I just watched the speech on insurance reform given in Iowa and am really pleased to see that our family can get a group coverage plan now so it may be a godsend to us. I am thankful for any help we can get. Our insurance rates nearly bankrupted us.
 
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BusynMember

Well-Known Member
I love the bill. I like the idea of expanding Medicaid to those who make too much to qualify but cant' afford private insurance OR the high priced insurance possibly offered at work. Many people will benefit. The way I look at it, if we can fight two wars and bail out Wall Street and big business, it's time for the little guy to get a break. My son, and many of our kids, won't be working at 18, like we hope..just being realistic. They will need coverage, including mental health care, and disability is not easy to get. Many of our kids, my own included I'm afraid, fall between the cracks. And for those who don't trust government, I actually like Wisconsin's Medicaid much better than any insurance I've ever had. They cover everything. There is no hassel. There is no copay. medications are covered. It's a big relief to our lower income family to know that we can always get good treatment. Sadly we have to make sure we don't make too much and we do make sure. Sometimes I write and make money under the table. You do what you must to survive.

All in all, I am grateful. I always felt that healthcare is a right, not a luxury.
 
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