Health care discussions in the U.S.A.

[omlick]

If you demand that someone treat you when you are sick, you are turning that someone into a slave.  Hear it all from Rand Paul, Ron Paul's son and Senator from Kentucky:

http://www.humanistnewswire.com/2011/05/kentucky-senator-rand-paul-right-to.html

[James]

Saskatchewan was the first jurisdiction in Canada to adopt universal health care and that model was then copied across the country. It's not the first time the Saskatchewan has been used as a model.

Montana looks to Saskatchewan for health-care model

Montana’s governor says he’s interested in setting up a universal health-care system in his state similar to that of his northern Canadian neighbour, Saskatchewan.

Brian Schweitzer, who has caused controversy previously on the issue of health care, is seeking approval from the federal government in the U.S. to establish a single-payer system of health care in Montana.

However, Mr. Schweitzer, a Democrat, has been quoted as saying he expects authorities in Washington, D.C., to reject his proposal.

In 1999, Mr. Schweitzer made headlines for chartering buses for people to travel to Canada so they could fill drug prescriptions at lower prices than in the U.S.

In an interview with the Washington Post, Schweitzer noted that Saskatchewan, with about one million people, has a population similar to Montana’s. However, he added that health-care costs in Saskatchewan are about $4-billion a year, or half of Montana’s total. He also commented on Saskatchewan’s lower infant-mortality rates.

“Imagine if you went to a gas station, and you looked over at a car with a Canadian licence plate,” he told the Post. “They were paying $1 a gallon for gas, and you’re paying $2. Wouldn’t that make you mad? That’s exactly what’s happening. I’m mad for all the people in the country.”

Mr. Schweitzer said he has consulted Saskatchewan Premier Brad Wall about how the province’s health system is run and funded.

The Associated Press quoted Schweitzer as saying Saskatchewan is able to limit costs of the health-care system by negotiating down drug costs and limiting non-emergency procedures, such as MRIs.

[Dil Bert]

The Associated Press quoted Schweitzer as saying Saskatchewan is able to limit costs of the health-care system by negotiating down drug costs and limiting non-emergency procedures, such as MRIs.

The lack of negotiation in drug prices and competition in drug production are big, obvious problems in the US health care system.

It's pretty radical, but I'd like to address drug production by changing the patent system to limit protection based on the value to society.  A treatment that cured a condition would get more years of protection than one (like most drugs) which just kept the condition under control.

[omlick]

It will be an uphill climb to get universal health care which is not provided by private insurance companies.  Vermont is also trying to come up with a plan, these states will need some kind of waiver to achieve these goals.  I am hoping that they will achieve them.

[James]

The lack of negotiation in drug prices and competition in drug production are big, obvious problems in the US health care system.

There's an informal organisation known as the Council of Confederation, representing all the provinces collectively, and they're in the process of organising purchases of drugs for all provinces collectively. It'll save huge money. Provinces already do this individually, but the smaller ones don't have the same clout as the larger ones, so this will go a big way to cutting costs...

It's pretty radical, but I'd like to address drug production by changing the patent system to limit protection based on the value to society.  A treatment that cured a condition would get more years of protection than one (like most drugs) which just kept the condition under control.

The culture's also changed so much. Insulin was discovered at the University of Toronto and Banting and Best never claimed patent so everyone could collectively benefit. There aren't too many magnanimous folk like that around these days.

It will be an uphill climb to get universal health care which is not provided by private insurance companies.  Vermont is also trying to come up with a plan, these states will need some kind of waiver to achieve these goals.  I am hoping that they will achieve them.

What kind of waiver, Omlick? Do you mean it would be unconstitutional to do so, or there's some other legal issue?

[Manturo]

James,

The Healthcare mandate requires Americans to buy insurance in most cases (see http://en.wikipedia.org/wiki/Affordable_Care_Act#Overview_of_provisions, bullet point 2). If Vermont were to wish to create their own insurance pool, they would need to file a legal case to not be subject to this law's penalties, because someone may argue that they're not following the mandate, take them to court, etc. etc. Essentially, the state of Vermont would need to prove that their universal insurance plan covers everyone equally and fairly under the provisions of the Affordable Care Act.

An aside to this issue: The sad thing that a lot of the extreme right wingers don't want to understand that the provision to make insurance coverage mandatory is a handout to the insurance industry to protect against adverse selection - that is, a sicker and costlier individual insuring themselves versus healthy people skipping insurance. So in reality what pro-business people protest in the health mandate is really a protection to the insurance industry. If this hadn't been included in the mandate, the act would have never passed as the insurance lobby would've killed it upon arrival.

[James]

James,

The Healthcare mandate requires Americans to buy insurance in most cases (see http://en.wikipedia.org/wiki/Affordable_Care_Act#Overview_of_provisions, bullet point 2). If Vermont were to wish to create their own insurance pool, they would need to file a legal case to not be subject to this law's penalties, because someone may argue that they're not following the mandate, take them to court, etc. etc. Essentially, the state of Vermont would need to prove that their universal insurance plan covers everyone equally and fairly under the provisions of the Affordable Care Act.

Gotcha, thanks for this, Manturo.

An aside to this issue: The sad thing that a lot of the extreme right wingers don't want to understand that the provision to make insurance coverage mandatory is a handout to the insurance industry to protect against adverse selection - that is, a sicker and costlier individual insuring themselves versus healthy people skipping insurance. So in reality what pro-business people protest in the health mandate is really a protection to the insurance industry. If this hadn't been included in the mandate, the act would have never passed as the insurance lobby would've killed it upon arrival.

House insurance and car insurance are mandatory where I live, too, so why shouldn't health insurance be mandatory, too, with provisions for folk who can't afford it to be taken care of by the state? I don't get this point of view...everyone needs a doctor sooner or later. Anyway, once people feel the benefits, this type of legislation will not disappear. It hasn't anywhere where there's universal health care.

[Manturo]

Gotcha, thanks for this, Manturo.

House insurance and car insurance are mandatory where I live, too, so why shouldn't health insurance be mandatory, too, with provisions for folk who can't afford it to be taken care of by the state? I don't get this point of view...everyone needs a doctor sooner or later.

I am likewise baffled by this position. And the fact that it's somehow political - the humanitarian stand that there is a social contract and that everyone gets sick and old and requires care: - likewise baffles me.

I worked in health insurance sales and administration and the loopholes were amazing to say the least. And I'm in a generous-mandated benefit state, New York, with community rating - that is, the insurers in the state are NOT allowed to charge you more if you have a health condition (e.g. diabetes, cancer, etc.) than for a healthy person. In other states, you can be terminated without warning if your claims are too high or turned down for coverage if you have a condition, etc. Very scary. And very inhumane.

The ignorance is astounding that people don't realize that not offering universal health coverage is just pushing the cost to the most expensive place - the hospital emergency room - where if the services remain unpaid, the hospital just jacks up the rates to cover these losses and we all end up paying more. We can manage it up front at a lower cost or, if pay more later. Logic would suggest nipping it in the bud now, right?

Anyway, once people feel the benefits, this type of legislation will not disappear. It hasn't anywhere where there's universal health care.

I sure hope so. But I foresee the law being challenged for years to come because of the polarized and poisonous politics of the current generation running the political machine.

[Dil Bert]

House insurance and car insurance are mandatory where I live, too, so why shouldn't health insurance be mandatory, too, with provisions for folk who can't afford it to be taken care of by the state? I don't get this point of view...everyone needs a doctor sooner or later.

My understanding of the opposition to the law is that it mandates individuals buy a product (in this case, health care insurance).  One does not have to own a house or car (and thus wouldn't have to buy insurance on them).  So far some courts have agreed with this reasoning.

WRT to not having health insurance, Corbie has posted a few times about how she gets low-cost care on her own.  Not saying that's an ideal situation.

Personally I think health care (insurance) needs to change, as fewer people work for the same company for years and years, with more people working as contractors and in other temporary forms of employment.  So the old model of getting insurance from a company is no longer best for a growing part of the work force.  I don't know what's the best replacement for it in the case of the US, where if we went single-payer I would expect our results to be much more similar to the UK than Canada.  Maybe the government collects taxes and pays private hospitals/doctors which compete for business based on medical outcomes/satisfaction/cost-effectiveness?  Dunno.

[Manturo]

I think the most livable solution would to have expanded Medicare to all with provisions to curtail the current fraud and abuse AND doing more to cover services that prevent illness like regular nutritional counseling, exercise related expenses and healthy food incentives. We really needed to have pilot programs tailored to the needs of each population as well in terms of disease burden, educational level, and income level-which predicts in most cases follows educational level-to solve the preventable disease expenditures that are the bulk of Medicare expenditures (just read up on the reports online). I also think that healthcare should be non-profit. I don't think for-profit healthcare has improved the lives of people substantially. Many vaccines and medicines were invented for the good of humanity not for pecuniary motives. Love of money is a poor motive to sustain people in medical professions for long.

[omlick]

The Republican judges find it quite amusing that if they strike down this law millions will remain without health insurance.  I guess it is quite amusing to these very wealthy judge who have their healthcare insurance from the big govmint,  yeah theyi just  have a great sense of humor:

Robert Scheer writes in a truthdig.com article:

My problem is not with the Republicans who dominate the court questioning the obviously flawed individual mandate for the purchasing of private-sector health insurance but rather with their zeal to limit federal power only when it threatens to help the most vulnerable. The laughter noted in the court transcription that greeted the prospect of millions of the uninsured suddenly being deprived of already extended protection under the now threatened law was unconscionable. The Republican justices seem determined to strike down not only the mandate but also the entire package of accompanying health care rights because of the likelihood that, without an individual mandate, tax revenue will be needed to extend insurance coverage to those who cannot afford it.

[omlick]

If  the SC does chuck the whole law out, and I know a lot of young adults who will be booted from their parents' insurance because they are not full time students or whatever, then this may be an opportunity to go the single payer way.  This may justify the existence of government health care afterall because it will show that  private health insurance just can't do the job for a lot of people.

[omlick]

Well, they are saying that it is going down, but there may be some hope, maybe, nah, not in a million years.    I thoiught the odds were against it being struck down, but the five judges have no shame.  They just don't care about us I guess, not in the least.  And whiy should they when they can give the Obama Administration a good kick in the behind so that he looks lame for the election.  Obama set himself up for this  by passing such a lame health reform law to begin with.  Soon the insurance companies will be back to their old tricks.  If you have a preexisting condition you mgith not be able to ever get health insurance in your lifetimes.  What a wonderful country America has turned out to be!

[corbie]

I do not understand why they are calling Social Security and Medicare "entitlements" We and others paid into it for years. I still am, husband did before he became disabled. Medicare charges 110 a month for coverage. Husband doesn't come close to using that much a year even with his disability. Only a few percent use up all the money and end of life stuff which is ridiculous as to what they do that is so unnecessary. Have detailed about my father in law in the past.

I simply cannot afford current prices for health "insurance" 600 a month with 10,000 deductible, latest figures. My last bout with the medical profession cost me a total of $600 with cash pay. Would have been about 10,000 if I wasn't smart, figured it out, used herbs etc. And would still be dying! Their solution would fix a symptom, not the problem. I did end up spending about $500 on herbs over a year, which did work.

Our whole medical system is a joke. Making people sick and charging them for the privilege. I have been on about statins for years. The FDA finally said I was right. The real problems are not being addressed. Bad food, bad drugs and no amount of "health care" is going to fix people until they take responsibility for their own health!

[Manturo]

The sad irony of this all: these are people who enjoy taxpayer funded salaries and healthcare who are about to deny that to the public.

But on to my plan B as I proposed on the NY Times comment page:

First, create urgent care centers that have physician, physician assistants, nurse practitioners, physical therapists, exercise physiologist, nutritionists, psychologists and psychiatrists that would take place of people using the ER for emergency care. If they want federal dollars, then they have to take Medicaid and Medicare patients. And they have to non-profit. The goal is to steer people away from high-cost ER care and let ER doctors do what they're supposed to do which is not primary care but ER care. And they have to provide the medical home to the chronically ill - like diabetics - to keep a good quality of life and costs low and accessible to working people.


Secondly, I would amend the EMTALA (http://www.emtala.com/law/index.html) to read that if someone shows up at the ER and the doctors examine them and it's not a life and death emergency, then they have to pay something according to a sliding scale fee at the end of the visit. Sort of a fee to discourage ER visits that are NOT life-threatening (e.g. heart attacks, diabetic shocks, gunshot wounds, etc.) If they keep showing up - unless they're mentally ill or keep being dropped off unconscious - they get fined and have to perform community service. If they're not using the urgent care center, they're not using the right resource.


Third, create a tax to fund national catastrophic insurance plan. This is the insurance plan like Medicare that will pay for accidents, genetic diseases and catastrophic illness (think cancer, ALS, lupus, etc.) for all citizens. It should be means-tested where if you make a lot of money, you pay a higher premium.

End the SS tax limit.

Provide incentives for doctors to provide indigent care and cash-only preferred pricing of services through tax cuts. Make indigent care 100% tax-deductible. It is after all charity care. Make it legal with adequate protections for doctor and patients to create pricing arrangements for patients on fixed incomes with chronic health problems or those with disabling conditions - autism, lupus, paraplegia, cerebral palsy COPD, etc.

Create an open-source electronic medical record and practice financial management for doctors to use that is federally-funded to measure health outcomes on a national level.

Or barring all that - mandate that any state receiving Medicaid funds must provide universal health insurance programs and let the states execute it. That would end the challenge of the Commerce Clause. But I believe that the corollary to the rights of "life, liberty and happiness" must involve adequate access to health services and financial protection for catastrophic illness. No one asks to have lupus, get cancer, or have child with ADHD or autism. It's the humane thing to do to care for those people whose lot in life is bad.

[corbie]

I agree. It is so hard when you have not asked for a problem. My husband had a serious accident and never recovered.

It is soooooo hard for me to watch perfectly healthy people throw their health away saying things like "its my only vice" They don't know yet the hell of the health gone and can never get it back.

Something has to change. People are so sick now and the government seems to want them to die. Health care should never ever ever have been for profit!

[Manturo]

Health care should never ever ever have been for profit!

And that is why healthcare systems in other countries work. The insurance carriers are for the most part non-profit as well as the hospital and clinic systems.

What makes them expensive is mismanagement and over utilization. So to counter that: make catastrophic coverage universal but primary and preventative cheap enough that people can afford it and you don't then have the issues that the NHS and French health systems have of budgetary problems and long wait times for elective procedures.

Health insurance carriers don't make money on sick people; they make money off healthy people; therefore, the solution is to create publicly funded catastrophic insurance that is funded by tax dollars, i.e. the compulsory mandate - all must participate - to prevent adverse selection (only sick people with a high healthcare costs signing up for insurance and no healthy people). Then let the schyster-I mean heath insurance carriers sell whatever supplemental coverage they want to employers and individuals.

But for the life of me, I don't understand why this wasn't proposed first to test the political waters. For example - the financial meltdown and rescue of the banks was an example of lemon socialization where private business wants the government only to be involved to rescue it and then hands off when the times are good. Shouldn't we employ the same strategy for healthcare, that is, insuring the sick people that the health industry doesn't want? I think it would at least solve 50% of the problem.

The other issue is that we really shouldn't pay for stuff that's not proven to work. Take for example the debacle about Avastin not working for breast cancer and people going up in arms about it. It's been proven not to work; but Medicare and other insurers still chose to cover the cost. It doesn't work across the board for this particular cancer but does in other cancers (http://en.wikipedia.org/wiki/Avastin).  It's price (note I use the word "price" not "cost) is $90,000+ per year per patient. I don't believe it cost Roche et. al $90,000 per batch to produce. I work in a cancer research facility that produce monoclonal antibodies of which Avastin is and we're not charging anyone some exorbitant amount to clone antibodies, so this price stinks of R&D plus a lot of profit recovery which is IMMORAL -- but that's my opinion.

[Anamika]

Since we now had three different topics about health care discussions in the U.S.A., I took the liberty to merge them into one thread.

[corbie]

http://consumerist.com/2012/03/tobacco-companies-must-now-report-levels-of-dozens-of-toxic-chemicals-in-cigarrettes.html

After coming out with the warnings about statins and memory loss and confusion and diabetes, they did this. I also heard they were going to rethink all the antibiotics in meat. Maybe there is hope yet!

[omlick]

Here is a good one to read about, if you have no insurance, you can wind up in jail  if you go to an emergency room and then you can die in the jail cell. 

http://www.dailymail.co.uk/news/article-2122701/Anger-homeless-woman-29-dies-police-cell-arrested-refusing-leave-hospital-treatment-sprained-ankle.html

[BollyThis]

One of the problems with trying to find  a solution for this crisis is that almost everyone only complains about their pet peeves (or political agenda) but are not really interested in solving the problem.

IMO, the following items should be taken care off...Its all or nothing. This entire list should be treated as one atomic unit. No cherry picking according to your political agenda.

1) Reign in the Pharmaceutical Industry: In economics, there is supply and demand for the majority of items which arbitrates a price point that satisfies the supplier and the buyer.  This demand and supply does not work for all items.. For .e.g. Cocaine for drug addicts. A Drug addict would not follow the normal laws of elasticity of supply/demand curve. He/she would steal or even kill for the drug. So a drug peddler could use this to steal from their addicts.   This is also true for life saving drugs. IF a loved one is sick, the normal laws of elasticity and diminishing utility of purchasing an extra pair of shoes does not work. A family would go bankrupt to save some loved ones life. Under these conditions, pharmaceutical companies can do the same. In fact they currently indeed do this. They price the drugs to such an extent to even bankrupt families.  Putting a check on them is not against capitalism. They need to be restrained without breaking them. Govt interference in this is not a violation of Demand and supply and free market capitalism Anymore than putting speed limits on highway is  interference on ones liberty or freedom. To maximise freedom and liberty you need a nation of laws.. (Unlike India, where its anarchy mistaken for freedom and its not a nation of laws.. but that's a different topic.  )

2) Physicians and the AMA in the US. Currently they are sacred cows in the US.  Like their physicians can do no wrong. This hogwosh.. The AMA is a union for physicians. This monopoly needs to be broken. Take the airlines industry for e.g. they have a pilots union and then there is the FAA (federal aviation regulations) that represents the public which sets policies. there is even the FDA that represents the public for drug and food safety. However, there is no federal organization that protects the public from physicians., The AMA is not a govt body.. Its a representatives for physicians alone. This AMA has too much power and a fundamental conflict of interest.  Physicians are as good and as bad as the general public or Pilots.

For e,g, the AMA has too much say in how many medical schools can be opened in the US (they control Supply)..They also have too much say in foreign physicians entering the US to practice medicine.. (again control of supply). Just like there are computer programmers entering the country under free market, physicians from Canada, Australia, UK and western Europe should be allowed to come into the US and practice freely. If you want them to tell their patience where they did training, as part of full disclosure make them put a big sign next to their certificate if you want..but don't restrict them practicing in the country to keep wages low.  Let the free market of supply and demand dictate what money the physicians make. IF you think its low, don't bother going to medical school and start driving trucks as the market dictates. the AMA's only job maybe set standards for qualification that all should meet. Setting policy on public health should be the purvey of the public and not the phsycians.

American kids who enroll in the armed forces should be given govt assistance like interest free loans to enroll in medical colleges for their service in an effort to increase supply of physicians. Reasonable number of years to provide service in the Armed forces for payback could be worked out as well

I hate big govt...but sometimes govt is required.  And there needs to be a public policy agency to take all these functions away from the hands of the AMA.

3) Tort Reform: Absolute necessity to keep this in check to put curbs on some runaway Jury pool awarding millions and millions for mistakes physicians make so Physicians do not have to spend $200,000 for insurance. The liberal left is guilty in this regard for being the part of the problem here on this one. Liberals in the US love to talk about socialized medicine in the UK..but would not want to talk about the fact that in the UK there may not be the option to sue your doctor or hospitals for Millions if mistakes do happen.

4) Hospitals trying to charge/rob peter to pay for Paul should be criminalized.

5) Americans who think they are entitled to the worlds best medical care for free for ever and ever need to be educated and told to stop dreaming.  

There is no free medical care anywhere is this world somebody is paying for it... except maybe in oil producing countries.. .but they don't count as a system to emulate for countries that does have money flowing from the ground up.

6) Generic drug makers should be allowed into the county. Big Pharma seems to work with the FDA to shut down foreign generic drug makers in the guise of "standards" and "Quality". I can understand reasonable checks..but going overboard as an excuse to protect home companies should stop

7) All drugs should not have patents extended over 8 years. Within the 8 years make your money for the R&D and efforts but after that it needs to be in public domain. Not treat it like Disney products...where they get copyright protection into more than 50 years or so.


There were few more things I had thought off..but I forget. Oh whelp!

So all of these must be taken care of as one atomic unit.. put them all one piece of legislature and let the congress vote on them as a whole.

My 2C

 

[corbie]

http://www.nytimes.com/2012/04/22/opinion/sunday/why-are-we-drugging-our-soldiers.html?_r=1&partner=EXCITE&ei=5043

The whole drug this is out of control. They are drugging everyone they can whether they need drugs or not. They are bankrupting people to scare them into drugs they don't need that make them worse and then denying people drugs they do need.

Statins are a good example. Most do not need them and they are messing people up. Now they are trying to get people with normal blood pressure to take pills. It is so scary. And people just go along because the doctors scare them.

So I think some of the real issues are not being addressed. I know someone who's knee was sore to the touch for two hours. Off to the doctor as she has insurance. Lots of test for a pulled muscle for stay off it for a couple of days. Others who cannot afford it do not get badly needed care!

[Manturo]

A Gap in Health Coverage

The Supreme Court decision upholding the constitutionality of health care reform inadvertently opened a hole in health insurance coverage that could harm some of the nation’s poorest citizens. The problem arises from a mismatch between how the law was framed and how the court’s ruling will affect Medicaid, the joint state-federal health program for the poor.

The reform law sought to provide coverage to tens of millions of uninsured Americans starting in 2014 through two mechanisms. It required states to expand their Medicaid programs to cover virtually everyone earning up to 133 percent of the federal poverty level (about $31,000 for a family of four) or lose all federal financing for Medicaid. And it established new insurance exchanges through which people without affordable coverage at work could buy coverage. The law provides subsidies to help low- and middle-income families pay those costs.

http://www.nytimes.com/2012/07/05/opinion/a-gap-in-health-coverage.html?ref=opinion

Essentially, this will prove to be a bigger problem since most of the jobs being created are low-paid jobs in states where a car is a necessity to be employed, never-mind gainfully employed. The formulas have to change to incorporate cost of living and the lack of reliable public transportation that plagues most states outside of the major metropolises (yes, that's the plural, weird I know). They really need to redo those Federal Poverty calculations. They are very unrealistic in many cities.