For those of us who stick our necks out and try to make a living on our own, the task of acquiring affordable health care is a daunting one.
We have all had to wait weeks for appointments that cost $150 or more. Is there a way to see a doctor right away without going through the emergency room? There was a piece on 60 Minutes about "concierge" service. You pay a $5k or $10k annual membership fee so you can see the doctor right away. And then it's still $150 or more. Or you can find someone like my doctor of 20 years who is old school and has practiced for 40. He believes medicine is a right and needs to be affordable. He is as good as or better than any of the doctors in the 60 Minutes thing. Maybe he doesn't have an expensive office and an MRI machine but he still can effectively practice medicine from his no frills office on Milwaukee Avenue. He charges $40 a visit. And you just show up and get in the queue. Sometimes you can see him right away. $40 for immediate service! And it's sound advice.
This recent article in the New Yorker spells out why medical costs in some places keep going up and up. Basically, it compares practices in a couple of towns. The practice where prices keep going up are run like businesses. Actually, like monopolies where they set prices and there's no local competition to keep them in check. And they invest a lot in expensive technologies that get used much more than they need to... So they run amuck and prices keep go higher and higher.
Why sue an architect, Blue? -- they aren't the ones with deep pockets... doctors, hospitals, pharmaceutical companies are the ones with the tall cash. ...citizen / cryzko got it right when they say that's one factor.
High malpractice insurance premiums paid by doctors to help cover the risk of paying out large damage awards is one contributing factor.
The thing is that's what the research in the article disproves. Texas took action and cut much of the malpractice suits out. So it wasn't malpractice suits.
It's creating a business model that provides too many many expensive services and procedures that are not necessary but create a huge income stream.
look up blue cross/blue shield temporary health insurance. you can buy up to six months, and are allowed to renew it once (one year total). there are different rates for different levels of coverage and deductables, but $90/mo will get you about $1000 deductable, which is pretty affordable. usually you have to pay the entire balance up front.
true... but i'm sure the medical field is tied into the medicine field and they all are making money by keeping people sick.
case in point, my grandmother, who is 85, was told to take all this medication. after 6 months she stopped taking most of it and actually feels alot better and gets around...
: Why sue an architect -- they aren't the ones with deep pockets...
Maybe so ... but we still pay high E&O premiums and we still have way too many people who sue us, or threaten to sue us, in order to gain access to our insurance companys' "deep pockets". Those conditions were the main premise of the first two posts by citizen + cryzko
All I know about health insurance is this: my doctor, as is typical, employs at least one person fulltime dealing with the paperwork the various insurance companies require. It takes an incredible amount of man-hours to accomplish something that *could* be as easy as paying for your groceries.
I have a high deductible policy, which means I pay for a lot of my healthcare out of pocket. Which is FINE - I do shop around a bit, and I don't have to deal with referrals or whatever. The main point of the policy is to cover unforeseen disasters like cancer or a car crash. IMO, a national program covering those high dollar, unexpected issues would mean I could just pay for my flu shots, skin rashes, ear tubes, etc. myself and NOT be spending $500 a month just in case.
But like I said, I don't really know anything about health insurance. I just pay the monthly premium and keep my fingers crossed.
but look at the how many people the doctors deal with compared to architects.
architects might have a few clients a year to make happy
doctors/surgeons might have 200+ people that they might work on in a year. (speaking more on surgeries than waiting in a doc's office)
i would like that as an architect, you deal with other industries such as engineers,consultants,etc... so when it's time to sue and architect, the blame game starts to happen. tooo many people to chase/etc
if you were to sue a doctor, you would end up sueing the hospital and thats it. your not going to sue the receptionist and the valet person/etc..
it's about the quick cash/court/fees that create the problems. i'm sure there are good truthful lawyers out there, but the majority of them just look at the bottom line and collect.
"but look at the how many people the doctors deal with compared to architects."
Every person who walks through a building you design is a potential "slip and fall" claim -- clients aren't the only people who go after architects.
our firm is defending a case right now where a guest in a hotel fell in the bathtub of his guestroom and (supposedly) was injured. we were brought into the claim because we were the interior designers of the public areas of that hotel. we never did any design work on the guestrooms. we are having to prove that we never gave the owner of the hotel any advice on what type of 'non slip surface' needed to be installed in the guestroom bathtubs.
but ... we're starting to hijack this thread and I'm sure our discussion isn't what make intended when he started this thread. let's move on .
All I know about health insurance is this: my doctor, as is typical, employs at least one person fulltime dealing with the paperwork the various insurance companies require. It takes an incredible amount of man-hours to accomplish something that *could* be as easy as paying for your groceries.
My doctor does his paperwork himself. It's most documenting his diagnosis. I just pay him out of pocket. He mainly takes cash from his Latino patients. He's a real mensch.
I go to the doctor twice a year to check up on a condition for which I need surgery. Although I understand that I do pay taxes for this privilege (actually, I don't pay taxes because I'm too poor as a student), these visits cost me $0.
My big expense is my medication, which I renewed yesterday and costs me $13 a month (or $55 if I wasn't covered by my school plan). Still pretty affordable if you ask me.
The fact that the current system works on a 15 minute visit is seriously ridiculous. Health must be more flexible...and LB you are correct in the analysis of paper work. My wife is an fp doctor and spends easily 20 hours a week in typing out notes, onto an online system that is a point and click nightmare of a gui, that have already been written. That is not even counting the paperwork in regards to the insurance companies.
There should be a single system in regards to how data is collected, standardized, etc. Laws need to be changed to allow for insurance to be guaranteed no matter what your history so that your history can be used to help you, not to condemn you. Then it could be used to help a much larger group of people, earlier. People are afraid of getting screened in case they find out they are predisposed for something and their insurance company will try and deny them.
The system is so fractured it is sad. The biggest problem is the more complex and fractured it is, the more there is money to be made. Take the profit element out of the system and you might begin to make the kind of changes at the systematic level that have to be dealt with for there to be any real solution to the number one cause of bankruptcy in the united states.
The fact that someone can sprain a knee and then have the system that is supposed to help him, put him in financial ruin with no long term care or support is just insane.
The main reasons for the high costs are administrative costs, patients overusing the system when someone else is paying for their care, and malpractice lawsuits.
... let's not forget that doctors and other heath care professionals are paid a LOT of money to do what they do -- and, many of them also have ownership interests in the affiliated companies that provide lab services, x-ray services, etc. to their clinics.
Between pre-existing condition restrictions and costs for individual coverage being astronomical, a lot of people are needlessly chained to their employer. I think this is hurting America. Imagine how many more business and employment opportunities would be available if people didn't need that 40hr/week job to be eligible for insurance coverage.
Dustin,
I'm just waiting for somebody to bash the health care system in Canda....like you have to wait, and blah blah blah. Fact is if you don't have insurance in the U.S. you are screwed and we all know that. Actually even if you do have insurance you still are screwed, because on the end you will still end up paying for god knows what! I have an uncle in Vancouver and he recently had a heart attack (hes fine now), but he was coming down to visit and was afraid to stay even a day down here, because he knew if something happened he'd be paying it out of pocket. I on the other hand, went to visit them, got in a bar fight, needed some stitches and just walked in and got it done, no questions asked. Try that here!
4arch, that a point that's being kicked around more and more... makes sense in many ways... we buy insurance as individuals for houses, cars, life, etc., but our employers control our health insurance.... It does seem odd.
blue,
you can thank the lawyers also for that...their mentality is to sue everyone that touched anything. so now, you have to defend your role and pay your lawyers out of pocket maybe, to cover something that doesn't even have anything to do with you. too bad you can't counter sue to cover your costs. in this day and age, people can practically sue for anything and if they lose, they won't be out anything, but on the other hand.
as for insurance, when i blew out my knee in '92, my parents coverage wouldnt cover my knee surgury if i needed it. in 2002 i blew out my other knee and didn't get surgury until late 2004, and by that time i screwed up my knee more. all this because i didnt have coverage at the time of my injury. my surgury in 2004 was covered by a client and i had to have my acl replaced and menicus sewn back up. this was a total of $24,000 which included a few months of therapy.
there should be national health insurance. but then if it's national, then the profit margin would be lost.
agreed, its an antiquated system which im sure weve all read about now. The original reasons for empolyer based health care are antiquated... let everyone have a choice where they get their health care from... let private insurers compete for individual coverages (like kurt says, it seems to be working for car, life, home owners insurance) and open up a public option so that everyone has at least 'minimum' coverage... sorta like a liability only option for car insurance!
i personally tore some knee ligaments, but had to wait 6 months to have them repaired because my insurance company contended acl reconstruction was an 'elective' surgery and so wasnt covered by my HMO... ( i learned my lesson about HMO's...) i found that pretty ridiculous... obviously i could survive without the surgery, but it would end virtually all opportunity for physical activity outside of swimming and biking for the rest of my life... that doesnt seem like a legit option for anyone... and after it was all said and down, im still paying off thousands of dollars which my insurance didnt cover.
on a side note, when i called about health insurance about 6 months ago, i had to pay around $350 a month with a $5000 deductable since i had a pre-existing condition (my knees). I just needed coverage for emergencies and surguries really, but still got a high rate. so i passed since i was broke then (and still broke now)
down,
that is just horrible. I was in the same situation about 10 years ago and my insurance would not cover it either and I've always had knee problems, knee would pop out, could not straighten my leg etc. Well a few months after that, I went to graduate school and had insurance, covered by the tuition etc. So intentionally I went and played soccer with couple of my buddies knowing that sudden cut would mess up my knee again, which I always avoided. Well, that exactly happened and next day I went to the hospital and explained what happened and few weeks later I had my MCL surgery without them knowing that it was a past injury. The system is playing us, and I played them. Now, I'm back on the soccer field again jammin to KURT's new songs on my ipod!
The main reasons for the high costs are administrative costs, patients overusing the system when someone else is paying for their care, and malpractice lawsuits.
Kurt,
That's only partially right. The last item is wrong in the Texas example as the State Legislature has neutralized the lawsuits.
The big problem is doctors ordering unnecessary tests and procedures and then charging astounding amounts of money for them. In many places they have a monopoly on care and there's no check to balance that.
Please read the article. It's a good study. ¡Enjoy!
i am canadian so i never paid for healthcare except indirectly though taxes. i feel such things are the honor/duty of a citizen of any country, so never minded paying...
now i live in japan i pay into a federal mandatory insurance plan that the government oversees. the cost is connected to income, so poor people do not pay much, or even nothing. children and seniors are free. for that plan i pay 30% of costs, which is actually pretty cheap in most instances, especially since it includes dentist, medications, and eye-doctor. we have also additional insurance that is pretty cheap and that covers the rest.
when i had surgery for a broken a few years ago i didn't pay for anything, so it felt a bit like canada, only more complicated. i guess that is what usa is aiming for.
there are still injustices here though. my father in law has cancer. he is a multi-millionaire and can/could afford to pay for the best treatment in the country, including a fancy machine (new version of gamma-knife for all you medically inclined people) that costs him $15,000 a pop. I guess some of the other people who were diagnosed with him are already dead. Which is i suppose the kind of things radical republicans are happy to see. the market at work, where only the rich survive, as god intended.
for that reason i prefer canadian system. it has issues. waiting sometimes is one of them, but at least no one is denied access to medicine because they weren't good capitalistas...
make -- good for Texas. Makes sense. However, those three items I listed are nationwide, and are the top problems.
Stone -- I was referring to a current nationwide dialog on an alternative frameworking of the problem. I believe I understand that my employer controls my healthcare because he pays for it.
Texas is the point. The top problem is that doctors are charging whatever they want for a lot of unnecessary services. Even in a place where lawsuits have been neutralized. That's key. It's the business practices that are the issue.
Real health reform is coming because what we have is bankrupting the country.
"The top problem is that doctors are charging whatever they want for a lot of unnecessary services".
wow, that's quite a statement -- a number of things would have to be true for that to make any sense, not the least of which would be that all or most doctors operate unscrupulously.
You're barking up the wrong tree, but here's a clue in the right direction:
Couple of you have thrown in a few "free market" digs relative to this issue -- hmmm...you will really have to perform some admirable gyrations to argue that medicine operates as a free market business in the U.S. That's nuts.
I'll help you a little further, Make -- do you find nothing at all curious about the fact that administrative costs are one of the main forces driving the cost of healthcare? I mean, why would you think that is? Do you know what most of that paperwork is about? Where do you think the need for it comes from?
You must know some doctors -- here's an experiment to get your answer: Let a doctor friend knwo that you're on to their little scam -- you know, how they can "charge whatever they want" for their services. See what they say. When they're done laughing at you, tell them you still need a hint where most of the administrative costs originate.... because by your logic thus far, you think they'll answer that the free market demands it.
Helathcare operates within a very complicated framework, my friend, and it ain't a free market framework.
damn right it's not free. GOP wrote anti-competitive legislation so "insurance companies" manage health care instead of health care oriented companies. insurance co. wco-write legislation and the GOP rubber stamps the hell out of it. even some sheisty blue dogs have been purchased. it's a racket. these companies can deny health coverage that should be covered to maximize their gains. they bilk those that can afford it, and ruin those that can't. big pharma has been bilking americans lfor years.
so whenever congress wants to make it truly competitive by requring all health coverage companies to not disallow anyone and have caps, or better yet introduce the same system congress gets, i'll be happy.
Insurance - this is it. Both from a malpractice standpoint and a power/paperwork standpoint.
Nothing more to it. That takes up the dr's time and resources and controls what they can/can't get paid (nice to think they control it, but that ain't the facts).
I am all for our "socialist" Obama-driven healthcare, I just pray and pray and pray that he sticks to his word about pre existing conditions. The minute he allows for insurance companies to eliminate anyone based on preexisting conditions. I'll start shouting foul.
"The top problem is that doctors are charging whatever they want for a lot of unnecessary services".
wow, that's quite a statement -- a number of things would have to be true for that to make any sense, not the least of which would be that all or most doctors operate unscrupulously.
Well, Kurt, it is happening. I recommend reading the New Yorker article before you fly off the handle.
There's a lot to do and I think this study of two towns in Texas is very powerful. Leave your preconceptions at home.
isn't it also about insurance COMPANIES instead of insurance institutions. The main goal of the company is to make a profit for their shareholders instead of keeping people healthy at affordable prices so they can contribute to society. [/2cents]
Years ago the father of someone I was dating had his own OB GYN practice. It was very interesting getting his perspective on the state of health care, and LB is right, one of his biggest complaints was the paperwork. And that paperwork is not just insurance co's but also Medicare/Medicade. So, anyone who is thinking a gov't run system is faster or cheaper just needs to look at the gov't system we already have. It's a mess.
This doctor also felt that things started to run off the rails years ago when people had "cadillac" style insurance coverage with co-pays as low as $5 or less. What happened is people started visiting the doc for anything and everything, all costing the insurance co's billions, because there is a cost to visiting the doctor. Thus insurance co's had to raise premiums to pay for it. Everything snowballing from there.
He thought that insurance should only be in place for catastrophic coverage, i.e. cancer, child birth, etc. The common cold or annual flu shot should be paid out of pocket. No so much for the reason that people would use the free market to shop around for the "cheapest" doctor, but that it would eliminate thousands of hours in paperwork and make routine doctor visits much much cheaper.
That makes sense. Preventative healthcare is what everyone needs, not "take this shots and you'll be ok" crap. But people are lazy and would rather take a pile of pills than walk around teh block or change their eating habits.
The problem is the power. With the recent cut backs (to M/M) they are going after old claims, trying to pin any "extra" tests or fees on the doctors. This could easily be 10s of thousands, if not more, per dr per year. This is all purely paper chasing and flexing there power.
I am sure a Govt system won't be more efficient, at least not at first, but hopefully with level playing field there will be some progress. Right now, things couldn't be much worse or more expensive.
Make -- Preconceptions? What might those be? Take a read of what aqua and trace are getting at as the main, prevalent problems... should sound familiar.
If satisfactory answers for you to the question posed in your thread title are found in two Texas towns, GREAT! For the rest of us, it's a national problem, with nationwide, basic similarities that for whatever reason, you're trying to deny.
However, all that aside...my favorite statement so far:
"...so whenever congress wants to make it truly competitive by requring all health coverage companies to..."
Reform starts with paying for quality, not quantity. According to a study at the Dartmouth Institute for Health Policy and Clinical Practice, as much as $750 billion is spent each year on procedures or health-related services that don’t necessarily help patients get better. For example, when discharging patients, hospitals have an obligation to provide patients with a care plan to ensure they don’t end up readmitted. However, Medicare pays more to hospitals when a patient ends up back in the hospital. And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not.
Aqua said: "What happened is people started visiting the doc for anything and everything, all costing the insurance co's billions, because there is a cost to visiting the doctor. Thus insurance co's had to raise premiums to pay for it. Everything snowballing from there.
He thought that insurance should only be in place for catastrophic coverage, i.e. cancer, child birth, etc. The common cold or annual flu shot should be paid out of pocket. No so much for the reason that people would use the free market to shop around for the "cheapest" doctor, but that it would eliminate thousands of hours in paperwork and make routine doctor visits much much cheaper."
Boo-freakin-hoo for those poor doctors! Give me a break (don't take that personally, I know it's not your opinion, but the dr's). The rest of us working stiffs also have to do paperwork, and I surely will never earn as much money as any doctor.
So what if people go to the doctor more often? Most people avoid going to the doctor. If some are hypochondriacs, then so be it. I especially like the absolute insanity of this part of the quote: "all costing the insurance co's billions." HAHAHAHA. These are the same insurance companies making many MANY more billions by denying claims and operating for-profit. How absurd is a for-profit medical system in the first place??
I also take issue with the opinion that the common cold or annual flu shot (etc) should be paid out of pocket. The people who need these things most are generally those who have the hardest time paying. What the good doctor is saying is that he doesn't want to waste his time with poor folks.
I'm of the opinion that if you have a healthy (and educated) populace, you have a healthy and vibrant society. The idea that people declare bankruptcy (or don't get treatment at all) because they can't afford health care is truly - truly - beyond my comprehension. Yes, my tax dollars go to helping poor people get treatment, and I won't get my money back directly. BUT - if that treatment helps people get back on their feet (without thousands of dollars in debt), they'll likely be a contributor to society and we, as a populace, will all benefit. Some people might take advantage of the system, but that is true of any system. It doesn't mean we shouldn't do it.
Lastly, I'll remind everybody that the US is the only first-world country without universal healthcare. Even without universal care, your government spends about 50% more (% of GDP) on health care than in Canada. Insurance companies are making billions while people like you and I go broke trying to pay for knee surgery.
Dustin, if the paperwork and insurance profits disappeared, do you think the cost of a flu shot, pap smear, etc. would all drop to the point of being more affordable for more people? I ask this seriously. My uneducated understanding is that there is an unnaturally high cost for simple medical procedures that rests squarely on the profit motives of insurance companies.
I've thought about it. I think that there's always going to be paperwork, so that's a non-issue really.
But insurance is where you're getting screwed. I'll try to say it concisely this time: The US government, despite the fact that its medical system is private, pays 50% more as a percentage of GDP for medical costs, as compared to Canada.
I'm not saying my country's system is perfect. But we have universal care, and spend half as much as your government.
The difference is the insurance companies. They operate as any corporation does, for profit. So yes, I think that when insurance companies are out of the picture, the costs of medical care do drop if we assume that doctors wages and capital costs are all the same. Take the profit away from the insurers.
So I think we agree. But too many people are making too much money to want to change the current system in your country, so I doubt we'll see an overhaul any time soon. Some minor changes, maybe, but probably only if you're a senior or a vet.
My country does allow for private medical care, and there are more private practices popping up all the time. Personally, I think that's a slippery slope because as hospitals and insurers (we have private insurance up here as well) get a taste of the money to be made, many are going to jump ship into the private field.
I pay taxes when I'm earning a living (I'm currently a student so I generally don't make enough to pay anything), so anything taken out of my paycheck, I don't really see and I don't really miss. I think it's worth it at the end of the day to know that if I get sick or hurt, I don't have to think twice about getting the treatment I need. I don't have to fill out forms or argue with insurers, I just get treated. I've said it before and I'll say it again: there are some really nice parts of your country where I wouldn't mind working and living, but the medical care situation is the one thing that will always prevent me from doing so.
I'm certainly not overly well informed on this topic, but I do have some interesting personal experience that seems germane to this discussion.
my father lives in a nursing home and I now handle all of his finances. although he has private insurance, his age makes it possible for Medicare to cover a part of his health care.
it seems that almost every medical invoice I receive in connection with his care shows a) the "standard" charge for the procedure he received; b) the service provider's "write off" amount; c) the amount Medicare will pay; d) the amount his private insurance will pay; and e) the amount he's expected to pay.
what I find interesting about this is b) the service provider's "write off" amount -- it's usually about 20-25% of the standard charge. I'm pretty sure if I went in for this procedure, I'd be asked to pay the standard charge since I'm not on Medicare.
maybe I'm wrong, but that suggests two things to me. first: isn't it likely that they really never needed the amount shown as the standard charge; and second: if they do need it, then those of us who aren't on Medicare probably are picking up the amount that's being written off.
when i was employed about 2 months ago, they changed the insurance. we had a $1500 'debit' that we could use for medical things. the company put this into the 'pot' per employee. the deductible was a total of $2500 for surguries/etc. you could use the $1500 that was in your 'account' to help pay the $2500 if needed.... then there was preferred networks/etc... all this other ish that no-one could understand.
now here's the tricky part.
co-worker went to get a prescription and asked the pharmacist what the cost would be if he paid cash...it was $15... then he asked what the cost is if he pays with the bc/bs card that we had the $1500 on...the pharmacist said it would be $30....wtf.... so we had this dicussion back at work and tried to figure out why. we came to the conclusion that the drug company is trying to dip more into the insurance pockets and drain 'our' debit cash flow ($1500)..... this way once the $1500 is gone then the full deductable of $2500 would have to be paid additionally......
then, the head finacial guy in charge of the insurance, dropped his policy and got on his wifes policy. i think due to the fact that no-one understood the way the entire policy worked.... maybe the insurance companies just confuse people so when it comes time for them to pay out, they have an escape route.....
Health Care - How do you afford it and why is it so expensive?
For those of us who stick our necks out and try to make a living on our own, the task of acquiring affordable health care is a daunting one.
We have all had to wait weeks for appointments that cost $150 or more. Is there a way to see a doctor right away without going through the emergency room? There was a piece on 60 Minutes about "concierge" service. You pay a $5k or $10k annual membership fee so you can see the doctor right away. And then it's still $150 or more. Or you can find someone like my doctor of 20 years who is old school and has practiced for 40. He believes medicine is a right and needs to be affordable. He is as good as or better than any of the doctors in the 60 Minutes thing. Maybe he doesn't have an expensive office and an MRI machine but he still can effectively practice medicine from his no frills office on Milwaukee Avenue. He charges $40 a visit. And you just show up and get in the queue. Sometimes you can see him right away. $40 for immediate service! And it's sound advice.
This recent article in the New Yorker spells out why medical costs in some places keep going up and up. Basically, it compares practices in a couple of towns. The practice where prices keep going up are run like businesses. Actually, like monopolies where they set prices and there's no local competition to keep them in check. And they invest a lot in expensive technologies that get used much more than they need to... So they run amuck and prices keep go higher and higher.
It is an interesting read:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail
High malpractice insurance premiums paid by doctors to help cover the risk of paying out large damage awards is one contributing factor.
talk to all the lawyers that sue everyone for everything......they are one reason
: if those were the real reasons, the cost of architectural services would be as high as the cost of medical care.
Why sue an architect, Blue? -- they aren't the ones with deep pockets... doctors, hospitals, pharmaceutical companies are the ones with the tall cash. ...citizen / cryzko got it right when they say that's one factor.
The thing is that's what the research in the article disproves. Texas took action and cut much of the malpractice suits out. So it wasn't malpractice suits.
It's creating a business model that provides too many many expensive services and procedures that are not necessary but create a huge income stream.
This will be focus of the health care reform.
look up blue cross/blue shield temporary health insurance. you can buy up to six months, and are allowed to renew it once (one year total). there are different rates for different levels of coverage and deductables, but $90/mo will get you about $1000 deductable, which is pretty affordable. usually you have to pay the entire balance up front.
true... but i'm sure the medical field is tied into the medicine field and they all are making money by keeping people sick.
case in point, my grandmother, who is 85, was told to take all this medication. after 6 months she stopped taking most of it and actually feels alot better and gets around...
: Why sue an architect -- they aren't the ones with deep pockets...
Maybe so ... but we still pay high E&O premiums and we still have way too many people who sue us, or threaten to sue us, in order to gain access to our insurance companys' "deep pockets". Those conditions were the main premise of the first two posts by citizen + cryzko
All I know about health insurance is this: my doctor, as is typical, employs at least one person fulltime dealing with the paperwork the various insurance companies require. It takes an incredible amount of man-hours to accomplish something that *could* be as easy as paying for your groceries.
I have a high deductible policy, which means I pay for a lot of my healthcare out of pocket. Which is FINE - I do shop around a bit, and I don't have to deal with referrals or whatever. The main point of the policy is to cover unforeseen disasters like cancer or a car crash. IMO, a national program covering those high dollar, unexpected issues would mean I could just pay for my flu shots, skin rashes, ear tubes, etc. myself and NOT be spending $500 a month just in case.
But like I said, I don't really know anything about health insurance. I just pay the monthly premium and keep my fingers crossed.
but look at the how many people the doctors deal with compared to architects.
architects might have a few clients a year to make happy
doctors/surgeons might have 200+ people that they might work on in a year. (speaking more on surgeries than waiting in a doc's office)
i would like that as an architect, you deal with other industries such as engineers,consultants,etc... so when it's time to sue and architect, the blame game starts to happen. tooo many people to chase/etc
if you were to sue a doctor, you would end up sueing the hospital and thats it. your not going to sue the receptionist and the valet person/etc..
it's about the quick cash/court/fees that create the problems. i'm sure there are good truthful lawyers out there, but the majority of them just look at the bottom line and collect.
Blue,
I wrote that insurance premiums were a contributing factor, not the alpha and omega. As an economic process, the causes are bound to be multiple.
Every person who walks through a building you design is a potential "slip and fall" claim -- clients aren't the only people who go after architects.
our firm is defending a case right now where a guest in a hotel fell in the bathtub of his guestroom and (supposedly) was injured. we were brought into the claim because we were the interior designers of the public areas of that hotel. we never did any design work on the guestrooms. we are having to prove that we never gave the owner of the hotel any advice on what type of 'non slip surface' needed to be installed in the guestroom bathtubs.
but ... we're starting to hijack this thread and I'm sure our discussion isn't what make intended when he started this thread. let's move on .
I'm quite sure it's unavoidable that you'll have to wait to be treated, regardless of the healthcare system you employ. Doctors are busy people.
My doctor does his paperwork himself. It's most documenting his diagnosis. I just pay him out of pocket. He mainly takes cash from his Latino patients. He's a real mensch.
That's interesting, Bluegoose. It's very sad.
I live in Canada, that's how.
I go to the doctor twice a year to check up on a condition for which I need surgery. Although I understand that I do pay taxes for this privilege (actually, I don't pay taxes because I'm too poor as a student), these visits cost me $0.
My big expense is my medication, which I renewed yesterday and costs me $13 a month (or $55 if I wasn't covered by my school plan). Still pretty affordable if you ask me.
The fact that the current system works on a 15 minute visit is seriously ridiculous. Health must be more flexible...and LB you are correct in the analysis of paper work. My wife is an fp doctor and spends easily 20 hours a week in typing out notes, onto an online system that is a point and click nightmare of a gui, that have already been written. That is not even counting the paperwork in regards to the insurance companies.
There should be a single system in regards to how data is collected, standardized, etc. Laws need to be changed to allow for insurance to be guaranteed no matter what your history so that your history can be used to help you, not to condemn you. Then it could be used to help a much larger group of people, earlier. People are afraid of getting screened in case they find out they are predisposed for something and their insurance company will try and deny them.
The system is so fractured it is sad. The biggest problem is the more complex and fractured it is, the more there is money to be made. Take the profit element out of the system and you might begin to make the kind of changes at the systematic level that have to be dealt with for there to be any real solution to the number one cause of bankruptcy in the united states.
The fact that someone can sprain a knee and then have the system that is supposed to help him, put him in financial ruin with no long term care or support is just insane.
The main reasons for the high costs are administrative costs, patients overusing the system when someone else is paying for their care, and malpractice lawsuits.
... let's not forget that doctors and other heath care professionals are paid a LOT of money to do what they do -- and, many of them also have ownership interests in the affiliated companies that provide lab services, x-ray services, etc. to their clinics.
Between pre-existing condition restrictions and costs for individual coverage being astronomical, a lot of people are needlessly chained to their employer. I think this is hurting America. Imagine how many more business and employment opportunities would be available if people didn't need that 40hr/week job to be eligible for insurance coverage.
Dustin,
I'm just waiting for somebody to bash the health care system in Canda....like you have to wait, and blah blah blah. Fact is if you don't have insurance in the U.S. you are screwed and we all know that. Actually even if you do have insurance you still are screwed, because on the end you will still end up paying for god knows what! I have an uncle in Vancouver and he recently had a heart attack (hes fine now), but he was coming down to visit and was afraid to stay even a day down here, because he knew if something happened he'd be paying it out of pocket. I on the other hand, went to visit them, got in a bar fight, needed some stitches and just walked in and got it done, no questions asked. Try that here!
4arch, that a point that's being kicked around more and more... makes sense in many ways... we buy insurance as individuals for houses, cars, life, etc., but our employers control our health insurance.... It does seem odd.
I just wrote a song: "Poop, the Bar-Fightin' Architect"... coming soon to your Ipod...
our employers control our heath insurance because our employers pay for our health insurance (for the most part)
you're always free to go out and purchase your own health insurance policy if you want.
blue,
you can thank the lawyers also for that...their mentality is to sue everyone that touched anything. so now, you have to defend your role and pay your lawyers out of pocket maybe, to cover something that doesn't even have anything to do with you. too bad you can't counter sue to cover your costs. in this day and age, people can practically sue for anything and if they lose, they won't be out anything, but on the other hand.
as for insurance, when i blew out my knee in '92, my parents coverage wouldnt cover my knee surgury if i needed it. in 2002 i blew out my other knee and didn't get surgury until late 2004, and by that time i screwed up my knee more. all this because i didnt have coverage at the time of my injury. my surgury in 2004 was covered by a client and i had to have my acl replaced and menicus sewn back up. this was a total of $24,000 which included a few months of therapy.
there should be national health insurance. but then if it's national, then the profit margin would be lost.
agreed, its an antiquated system which im sure weve all read about now. The original reasons for empolyer based health care are antiquated... let everyone have a choice where they get their health care from... let private insurers compete for individual coverages (like kurt says, it seems to be working for car, life, home owners insurance) and open up a public option so that everyone has at least 'minimum' coverage... sorta like a liability only option for car insurance!
i personally tore some knee ligaments, but had to wait 6 months to have them repaired because my insurance company contended acl reconstruction was an 'elective' surgery and so wasnt covered by my HMO... ( i learned my lesson about HMO's...) i found that pretty ridiculous... obviously i could survive without the surgery, but it would end virtually all opportunity for physical activity outside of swimming and biking for the rest of my life... that doesnt seem like a legit option for anyone... and after it was all said and down, im still paying off thousands of dollars which my insurance didnt cover.
Got that part, Stone. Not really the point --
on a side note, when i called about health insurance about 6 months ago, i had to pay around $350 a month with a $5000 deductable since i had a pre-existing condition (my knees). I just needed coverage for emergencies and surguries really, but still got a high rate. so i passed since i was broke then (and still broke now)
down,
that is just horrible. I was in the same situation about 10 years ago and my insurance would not cover it either and I've always had knee problems, knee would pop out, could not straighten my leg etc. Well a few months after that, I went to graduate school and had insurance, covered by the tuition etc. So intentionally I went and played soccer with couple of my buddies knowing that sudden cut would mess up my knee again, which I always avoided. Well, that exactly happened and next day I went to the hospital and explained what happened and few weeks later I had my MCL surgery without them knowing that it was a past injury. The system is playing us, and I played them. Now, I'm back on the soccer field again jammin to KURT's new songs on my ipod!
ok Kurt ... what is the point?
Kurt,
That's only partially right. The last item is wrong in the Texas example as the State Legislature has neutralized the lawsuits.
The big problem is doctors ordering unnecessary tests and procedures and then charging astounding amounts of money for them. In many places they have a monopoly on care and there's no check to balance that.
Please read the article. It's a good study. ¡Enjoy!
i am canadian so i never paid for healthcare except indirectly though taxes. i feel such things are the honor/duty of a citizen of any country, so never minded paying...
now i live in japan i pay into a federal mandatory insurance plan that the government oversees. the cost is connected to income, so poor people do not pay much, or even nothing. children and seniors are free. for that plan i pay 30% of costs, which is actually pretty cheap in most instances, especially since it includes dentist, medications, and eye-doctor. we have also additional insurance that is pretty cheap and that covers the rest.
when i had surgery for a broken a few years ago i didn't pay for anything, so it felt a bit like canada, only more complicated. i guess that is what usa is aiming for.
there are still injustices here though. my father in law has cancer. he is a multi-millionaire and can/could afford to pay for the best treatment in the country, including a fancy machine (new version of gamma-knife for all you medically inclined people) that costs him $15,000 a pop. I guess some of the other people who were diagnosed with him are already dead. Which is i suppose the kind of things radical republicans are happy to see. the market at work, where only the rich survive, as god intended.
for that reason i prefer canadian system. it has issues. waiting sometimes is one of them, but at least no one is denied access to medicine because they weren't good capitalistas...
make -- good for Texas. Makes sense. However, those three items I listed are nationwide, and are the top problems.
Stone -- I was referring to a current nationwide dialog on an alternative frameworking of the problem. I believe I understand that my employer controls my healthcare because he pays for it.
Jump -- sorry about your father in law.
Kurt,
Texas is the point. The top problem is that doctors are charging whatever they want for a lot of unnecessary services. Even in a place where lawsuits have been neutralized. That's key. It's the business practices that are the issue.
Real health reform is coming because what we have is bankrupting the country.
"The top problem is that doctors are charging whatever they want for a lot of unnecessary services".
wow, that's quite a statement -- a number of things would have to be true for that to make any sense, not the least of which would be that all or most doctors operate unscrupulously.
You're barking up the wrong tree, but here's a clue in the right direction:
Couple of you have thrown in a few "free market" digs relative to this issue -- hmmm...you will really have to perform some admirable gyrations to argue that medicine operates as a free market business in the U.S. That's nuts.
I'll help you a little further, Make -- do you find nothing at all curious about the fact that administrative costs are one of the main forces driving the cost of healthcare? I mean, why would you think that is? Do you know what most of that paperwork is about? Where do you think the need for it comes from?
You must know some doctors -- here's an experiment to get your answer: Let a doctor friend knwo that you're on to their little scam -- you know, how they can "charge whatever they want" for their services. See what they say. When they're done laughing at you, tell them you still need a hint where most of the administrative costs originate.... because by your logic thus far, you think they'll answer that the free market demands it.
Helathcare operates within a very complicated framework, my friend, and it ain't a free market framework.
damn right it's not free. GOP wrote anti-competitive legislation so "insurance companies" manage health care instead of health care oriented companies. insurance co. wco-write legislation and the GOP rubber stamps the hell out of it. even some sheisty blue dogs have been purchased. it's a racket. these companies can deny health coverage that should be covered to maximize their gains. they bilk those that can afford it, and ruin those that can't. big pharma has been bilking americans lfor years.
so whenever congress wants to make it truly competitive by requring all health coverage companies to not disallow anyone and have caps, or better yet introduce the same system congress gets, i'll be happy.
Insurance - this is it. Both from a malpractice standpoint and a power/paperwork standpoint.
Nothing more to it. That takes up the dr's time and resources and controls what they can/can't get paid (nice to think they control it, but that ain't the facts).
I am all for our "socialist" Obama-driven healthcare, I just pray and pray and pray that he sticks to his word about pre existing conditions. The minute he allows for insurance companies to eliminate anyone based on preexisting conditions. I'll start shouting foul.
Everyone should have healthcare, period.
wow, that's quite a statement -- a number of things would have to be true for that to make any sense, not the least of which would be that all or most doctors operate unscrupulously.
Well, Kurt, it is happening. I recommend reading the New Yorker article before you fly off the handle.
There's a lot to do and I think this study of two towns in Texas is very powerful. Leave your preconceptions at home.
isn't it also about insurance COMPANIES instead of insurance institutions. The main goal of the company is to make a profit for their shareholders instead of keeping people healthy at affordable prices so they can contribute to society. [/2cents]
Years ago the father of someone I was dating had his own OB GYN practice. It was very interesting getting his perspective on the state of health care, and LB is right, one of his biggest complaints was the paperwork. And that paperwork is not just insurance co's but also Medicare/Medicade. So, anyone who is thinking a gov't run system is faster or cheaper just needs to look at the gov't system we already have. It's a mess.
This doctor also felt that things started to run off the rails years ago when people had "cadillac" style insurance coverage with co-pays as low as $5 or less. What happened is people started visiting the doc for anything and everything, all costing the insurance co's billions, because there is a cost to visiting the doctor. Thus insurance co's had to raise premiums to pay for it. Everything snowballing from there.
He thought that insurance should only be in place for catastrophic coverage, i.e. cancer, child birth, etc. The common cold or annual flu shot should be paid out of pocket. No so much for the reason that people would use the free market to shop around for the "cheapest" doctor, but that it would eliminate thousands of hours in paperwork and make routine doctor visits much much cheaper.
That makes sense. Preventative healthcare is what everyone needs, not "take this shots and you'll be ok" crap. But people are lazy and would rather take a pile of pills than walk around teh block or change their eating habits.
The problem is the power. With the recent cut backs (to M/M) they are going after old claims, trying to pin any "extra" tests or fees on the doctors. This could easily be 10s of thousands, if not more, per dr per year. This is all purely paper chasing and flexing there power.
I am sure a Govt system won't be more efficient, at least not at first, but hopefully with level playing field there will be some progress. Right now, things couldn't be much worse or more expensive.
Make -- Preconceptions? What might those be? Take a read of what aqua and trace are getting at as the main, prevalent problems... should sound familiar.
If satisfactory answers for you to the question posed in your thread title are found in two Texas towns, GREAT! For the rest of us, it's a national problem, with nationwide, basic similarities that for whatever reason, you're trying to deny.
However, all that aside...my favorite statement so far:
"...so whenever congress wants to make it truly competitive by requring all health coverage companies to..."
Judd Gregg:
Reform starts with paying for quality, not quantity. According to a study at the Dartmouth Institute for Health Policy and Clinical Practice, as much as $750 billion is spent each year on procedures or health-related services that don’t necessarily help patients get better. For example, when discharging patients, hospitals have an obligation to provide patients with a care plan to ensure they don’t end up readmitted. However, Medicare pays more to hospitals when a patient ends up back in the hospital. And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not.
Aqua said: "What happened is people started visiting the doc for anything and everything, all costing the insurance co's billions, because there is a cost to visiting the doctor. Thus insurance co's had to raise premiums to pay for it. Everything snowballing from there.
He thought that insurance should only be in place for catastrophic coverage, i.e. cancer, child birth, etc. The common cold or annual flu shot should be paid out of pocket. No so much for the reason that people would use the free market to shop around for the "cheapest" doctor, but that it would eliminate thousands of hours in paperwork and make routine doctor visits much much cheaper."
Boo-freakin-hoo for those poor doctors! Give me a break (don't take that personally, I know it's not your opinion, but the dr's). The rest of us working stiffs also have to do paperwork, and I surely will never earn as much money as any doctor.
So what if people go to the doctor more often? Most people avoid going to the doctor. If some are hypochondriacs, then so be it. I especially like the absolute insanity of this part of the quote: "all costing the insurance co's billions." HAHAHAHA. These are the same insurance companies making many MANY more billions by denying claims and operating for-profit. How absurd is a for-profit medical system in the first place??
I also take issue with the opinion that the common cold or annual flu shot (etc) should be paid out of pocket. The people who need these things most are generally those who have the hardest time paying. What the good doctor is saying is that he doesn't want to waste his time with poor folks.
I'm of the opinion that if you have a healthy (and educated) populace, you have a healthy and vibrant society. The idea that people declare bankruptcy (or don't get treatment at all) because they can't afford health care is truly - truly - beyond my comprehension. Yes, my tax dollars go to helping poor people get treatment, and I won't get my money back directly. BUT - if that treatment helps people get back on their feet (without thousands of dollars in debt), they'll likely be a contributor to society and we, as a populace, will all benefit. Some people might take advantage of the system, but that is true of any system. It doesn't mean we shouldn't do it.
Lastly, I'll remind everybody that the US is the only first-world country without universal healthcare. Even without universal care, your government spends about 50% more (% of GDP) on health care than in Canada. Insurance companies are making billions while people like you and I go broke trying to pay for knee surgery.
Nuts.
Oh, here is the report with the numbers: http://www.who.int/whosis/whostat/EN_WHS08_Table4_HSR.pdf
"And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not."
Make, I'd agree with most of your quote, except for that last part.
Well, if it really is your position that most (all?)doctors operate unethically, then for your purposes, you are good to go.
Dustin, if the paperwork and insurance profits disappeared, do you think the cost of a flu shot, pap smear, etc. would all drop to the point of being more affordable for more people? I ask this seriously. My uneducated understanding is that there is an unnaturally high cost for simple medical procedures that rests squarely on the profit motives of insurance companies.
I've thought about it. I think that there's always going to be paperwork, so that's a non-issue really.
But insurance is where you're getting screwed. I'll try to say it concisely this time: The US government, despite the fact that its medical system is private, pays 50% more as a percentage of GDP for medical costs, as compared to Canada.
I'm not saying my country's system is perfect. But we have universal care, and spend half as much as your government.
The difference is the insurance companies. They operate as any corporation does, for profit. So yes, I think that when insurance companies are out of the picture, the costs of medical care do drop if we assume that doctors wages and capital costs are all the same. Take the profit away from the insurers.
So I think we agree. But too many people are making too much money to want to change the current system in your country, so I doubt we'll see an overhaul any time soon. Some minor changes, maybe, but probably only if you're a senior or a vet.
My country does allow for private medical care, and there are more private practices popping up all the time. Personally, I think that's a slippery slope because as hospitals and insurers (we have private insurance up here as well) get a taste of the money to be made, many are going to jump ship into the private field.
I pay taxes when I'm earning a living (I'm currently a student so I generally don't make enough to pay anything), so anything taken out of my paycheck, I don't really see and I don't really miss. I think it's worth it at the end of the day to know that if I get sick or hurt, I don't have to think twice about getting the treatment I need. I don't have to fill out forms or argue with insurers, I just get treated. I've said it before and I'll say it again: there are some really nice parts of your country where I wouldn't mind working and living, but the medical care situation is the one thing that will always prevent me from doing so.
I'm certainly not overly well informed on this topic, but I do have some interesting personal experience that seems germane to this discussion.
my father lives in a nursing home and I now handle all of his finances. although he has private insurance, his age makes it possible for Medicare to cover a part of his health care.
it seems that almost every medical invoice I receive in connection with his care shows a) the "standard" charge for the procedure he received; b) the service provider's "write off" amount; c) the amount Medicare will pay; d) the amount his private insurance will pay; and e) the amount he's expected to pay.
what I find interesting about this is b) the service provider's "write off" amount -- it's usually about 20-25% of the standard charge. I'm pretty sure if I went in for this procedure, I'd be asked to pay the standard charge since I'm not on Medicare.
maybe I'm wrong, but that suggests two things to me. first: isn't it likely that they really never needed the amount shown as the standard charge; and second: if they do need it, then those of us who aren't on Medicare probably are picking up the amount that's being written off.
clearly, something is screwed up.
Doctors make too much goddamn money and they don't deserve it. that's why our healthcare costs are so high.
check this...
when i was employed about 2 months ago, they changed the insurance. we had a $1500 'debit' that we could use for medical things. the company put this into the 'pot' per employee. the deductible was a total of $2500 for surguries/etc. you could use the $1500 that was in your 'account' to help pay the $2500 if needed.... then there was preferred networks/etc... all this other ish that no-one could understand.
now here's the tricky part.
co-worker went to get a prescription and asked the pharmacist what the cost would be if he paid cash...it was $15... then he asked what the cost is if he pays with the bc/bs card that we had the $1500 on...the pharmacist said it would be $30....wtf.... so we had this dicussion back at work and tried to figure out why. we came to the conclusion that the drug company is trying to dip more into the insurance pockets and drain 'our' debit cash flow ($1500)..... this way once the $1500 is gone then the full deductable of $2500 would have to be paid additionally......
then, the head finacial guy in charge of the insurance, dropped his policy and got on his wifes policy. i think due to the fact that no-one understood the way the entire policy worked.... maybe the insurance companies just confuse people so when it comes time for them to pay out, they have an escape route.....
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