Sunday, August 2, 2009

Health care

This is not a post about Obama's national health care bill that is now working its way through Congress. That was so hastily put together that it probably won't pass. (I don't know if that is a good or bad thing, because nobody seems to know the particulars or fine print of that bill - only that, like the infamous "stimulus package", Obama wants it rushed through immediately one way or the other.) I am not one who believes that ANY health bill is better than NO new health bill. So we will have to wait and see on that.

The talk about a national health care program, however, has prompted me to give it considerable thought. I have seen interest in my blog travels to other blogs, for example on the blog of Stephanie B, so I am apparently not alone in my pondering.

As usual, I clarify my thinking (for myself, in my own mind) by writing out what I am thinking, and I am now in the process of trying to put in writing what I think is a workable solution. This is certainly not the the place that bit of writing, but I will link to it when it is finished. Right now I just want to throw out an outline of what a good health care bill should include, as well as some of the obstacles or problems that I see. Here are my initial observations. Some are obvious, some may not be.

1. Everyone who lives in the USA should have access to adequate and quality health care. (Everyone in the world should too, but this post is about U.S. health care.)

2. Not everyone can afford to buy private health insurance.

3. History (especially recent history) shows us that large private corporations are often dishonest, lazy price-fixing entities which defeat the concept of honest competition.

4. History shows us that the Federal Government is good at doing certain things, but are often not the most economical or fast-responding people in the world.

5. Although our Federal Government is corrupt to varying degrees in every branch, Congress is the real obstacle to getting a GOOD health bill passed, because they are just too beholden to special interests.

My own version of such a health bill would HAVE to include AT LEAST the following points, or I wouldn't support it.

1. Everyone would have to be covered.

2. Everyone would have to help pay for it (although perhaps with their labor or service instead of money.)

3. It would have to be administered fairly, effectively - and as economically as practicable while still providing the proper coverage and level of service.

Must stop here or I will break my shortness rule, if I haven't already. But if I WERE to continue, I would talk about how I want to see GOOD SERVICE, MORE HEALTH CARE PROVIDERS, BETTER FACILITIES, AND WELLNESS CARE INSTEAD OF JUST EMERGENCY CARE.

28 comments:

Stephanie B said...

I agree with everything you've said.

I guess there is an advantage to this shortness thing. I got no issues with your statements.

Sage said...

Everyone no matter who they are or wherever they are should receive the basics of clean water, education and health care.. until we can do that instead of getting involved in wars man's lack of humanity shows up our shortcomings..

Relax Max said...

@Stephanie B - Say that again? Heh.

@Sage - I do agree with you of course. My problem has always been the inabilty to think of a way to bridge the gap between the ideal and the actual delivery of services. And so we are mostly left with “doing what we can.” I would sure welcome the absence of war, though.

Thank you, Sage. Missed you. :)

A. said...

That sounds remarkably like how the National Health Service is supposed to work. It doesn't always, and many people complain. On the other hand, many people haven't experienced health services elsewhere. In my own and my family's experience, the NHS has unfailingly performed extremely well, and I can only give credit where it is due.

Relax Max said...

I could use some ideas from your system. How does it work? Can you go to any clinic or hospital you want? Choose what doctor you like? Does the government own the buildings? Does the government pay the doctors? Do you just walk in and sign or do you have to pay part of it? What about foreigners who are in the country illegally? - do they get treated? And then ratted out? Or just treated and left alone? (This is a serious question, because there are some in the US who think they should be turned over to immigration authorities, as the law says, after treatment. But most health providers are not into doing that.) Is the tax for the NHS taken out of one's paycheck or is the whole system just paid for out of general taxes that have been collected? (Here, medicare is taken out of people's paychecks. And I assume if we get a new comprehensive plan, a percentage will come out of paychecks.) What if you are not sick? I mean, like flu shots or children's vaccinations? What if you want elective surgery? Is a facelift covered? Or do you still have private doctors? Some of these questions may seem stupid and obvious but I don't know the answers. Do they tell you what your treatment plan must be or can you look for other opinions? I have more. Is Canada the same as you are? Do you know? Don't make me ask Canucklehead.

A. said...

Oh I SEE! Shorter posts, longer comments. :)

Answers, after careful consideration, tomorrow. At the moment I need some sleep.

Relax Max said...

Are all buildings and doctors private and they just bill the government instead of an insurance company?

Relax Max said...

Wait! It's not even midnight in England. Talk to me!

ettarose said...

Max you have brought up some very good questions. Some things people never think about when they think of health coverage. One of the things that really bother me is what is termed preexisting conditions not being covered or if it is it comes at a much higher price. I will be changing insurance soon and I am being told that my husbands' illness may not be covered. He has to have certain medications to live, and one if he does not take he loses sight in both eyes. I would love to see something positive for all come out of the White House. I know, go back to sleep now Etta.

Relax Max said...

Hello Ettarose. Those are the questions I would want to know before I got on the bandwagon for any national healthcare program. I was asking A. how it worked under their system, but the questions are the same as I would want to know from Obama.

As for yourself, I don't want to get into the heath insurance advisory business since I'm not an insurance agent anymore, but the first thing I would do if I were you would be to get that old heath insurance policy you had with your old employer converted over to a personal-pay one before the grace period for forced-transfer expires. Otherwise, you MAY be looking at an exclusionary period for preexisting conditions. Which can be a year or even more (some states allow permanent exclusions for existing conditions for new customers - hope NC isn't one of them.)

You really needed to have that explained to you during your exit interviews, or at least talked with the health insurance provider's customer service section. Don't delay. Call the insurance company that covered you at your old job today and ask them questions about what is going to happen when you convert the policy into your name from the old group policy.

If you are buying a replacement policy from a completely new company under your own name you will almost certainly face that period of exclusion. Why would you not want to just convert your old work policy over to your name? They have to take you if you are still in the mandatory transfer period. Of course you get to pay more than your old employer did.

I saw an insurance company (but had never heard of the name, so I am leery) the other day advertising on TV that they specialized in private (personal) health insurance and they didn't exclude preexisting conditions at all. They were bragging about it in the commercial. I didn't get the name except to remember I had never heard of them before. I will see if I see it again and try to write it down.

Relax Max said...

Ettarose, you know what? You are too young to retire. You need to get off your butt and go out and get a job with the Federal Government that has Federal Blue Cross benefits. Maybe at that Federal prison in your town as a secretary or something. Anything. Even if the pay is crap. Get over there and start taking their tests and get in line for employment. Don't wait for the right job - it's easier to transfer to another job internally once you've been hired. I'm telling you. Time's wasting, girl.

A. said...

Can you choose what doctor you like?

Everyone has to be registered with a General Practitioner. When you move into an area you choose to register with one GP practice but usually there is then a choice of GPs within a practice. The GP acts as gatekeeper for the specialists at hospitals. You can't unilaterally decide to see a specialist but in my experience, if you have good reason, the GP will refer you to the specialist of choice.

Can you go to any clinic or hospital you want?

I'm not sure how you differentiate between clinic and hospital. To me a clinic is a session held in a hospital or GP surgery. Yes you can choose your hospital, after discussion with your GP. In practice most people will be guided by the GP.

Does the government pay the doctors? Does the government own the buildings?

The government, via the NHS, pays all the doctors and for the hospital buildings. The GP practices own their practice buildings but they do have allowances for that.

Do you just walk in and sign or do you have to pay part of it?

There are no charges whatsoever for the patient whether registered, a visitor from another part of the country, or from overseas. It follows then, that illegals will be treated free of charge. I think it unlikely they will be "ratted out" unless there is a further reason.

Is the tax for the NHS taken out of one's paycheck or is the whole system just paid for out of general taxes that have been collected?

From general taxes.

What if you are not sick? I mean, like flu shots or children's vaccinations?

Children's vaccinations are all free, so are most others. Flu shots are free for over 60 (maybe 65) and for anyone vulnerable such as asthma patients. There is often a charge for travel vaccinations.

What if you want elective surgery?

Free if the GP considers it's medically needed - such as gall bladder removal. A facelift is unlikely to be considered a necessity.

Do you still have private doctors?

GPs do hardly any private work, though a little, such as the travel vaccinations. Hospital doctors can choose to work entirely on the NHS or part time NHS, part time privately. A few may work entirely privately, not many.

Do they tell you what your treatment plan must be or can you look for other opinions?

You can always ask for a second opinion, whether from your GP or a hospital specialist.

I don't know about Canada, though it's similar. You can ask Canucklehead or I'll ask my sister who works in a hospital there.

Relax Max said...

Let me make sure I understand before we continue.

1. Can you choose what doctor you like?

"No."

2. Can you choose your own hospital or clinic?

"No" (your assigned doctor does that, but you can try to get him to let you.)
-----
A clinic is a building with several (usually) doctors in it who see patients. Sometimes the patients are there because they like a certain doctor, sometimes just because they like the clinic. Sometimes just because it is close to their house. A hospital is a place sick people go to recover or have surgical operations performed. We wouldn't call a doctor's office, in or out of a clinic, his "surgery". (Clinic is just a different term for that which we use more often here.)
---------
3. Government owns the medical buildings? Government pays the doctors?

Still not fully clear on that. Gov't owns hospitals but doctors own the buildings that house their day-to-day practices? And are they on a gov't "payroll" or do they just get reimbursed when they turn in claims, as if the gov't was a big insurance company? Who pays nurses and aides and janitors?

4. Do you have to pay any of the charges?

No. It's free for all. (Although I must take exception to the loose way you use the word "free". :)

I was assuming non-citizens in the country illegally wouldn't be enrolled or have a magic account number or card to present, and was wondering what happened when they didn't have that number or the right papers. Of course, if the doctors are just on a payroll and not a billing system, the government would never know who they treated, I guess.

5. Elective surgery.

I KNOW a gall bladder operation is not elective surgery. Sheesh. But a boob job is. So, not unless the doc says it is needed. But it isn't. That's why they call it elective. So "no". K.
---------

Overall, a good system, I think, although Americans are going to balk at the "lack of choices" - although they don't really bother to pick and choose anyway.
---------
I told you not to make me ask Canucklehead. He is lucky to even find his way to work in the morning. Ask him about Canada's health care system? Puhleeze. He would only say his wife takes care of that stuff.

Thank you for taking the time. Your explanations were very clear, I thought. Send your bill to Canucklehead. :)

A. said...

1. "yes" - you choose which practice then which GP within the practice.

2. In reality most people wouldn't know what specialist to ask for. And would want a nearby hospital. In the past I've been asked if there was anyone I wanted to see.

3. What's not clear? The NHS owns the hospitals where specialists work. GP practices own their practices. GPs are on payrolls, but there is an allowance per patient registered.

4. Free at the point of delivery is a slogan for the NHS.

5. Anything non-emergency is considered elective here. Therefore having your gall bladder removed before you're carted off in an ambulance is elective. Cosmetic surgery is something else again.

A. said...

And a PS for 4.

When you go in to see a GP, they have their list of patients registered on computer. You can register as a visitor if temporarily in the area.

Relax Max said...

@A. - I wasn't arguing. Far be it for me to argue. I was just trying to clarify. I think I will register as a visitor and check it out. :)

PS- I like that motto. "Point of Delivery" meaning "from birth" right? :) :)

A. said...

I didn't think you were arguing. Nor was I.

You've reminded me - a new nursing and midwifery centre was built at my place of work. Outside they put up a sign "School of Nursing and Midwifery. Deliveries at rear of building." It must be very uncomfortable out there in the car park.

Janet said...

I am the queen of preexisting conditions, though none of them life-threatening. The Mountain Man spends an inordinate amount of his time trying to get decent and affordable health insurance coverage for his employees. Last year's bill to cover 20 employees and their families? $450,000. He doesn't make the employees pay anything, although the insurance company does, so he just raised everyone's salary to accommodate the insurance charges. Then he had to turn around and write 3 or 4 more grants to cover those costs. We have to drive 3 hours for a decent hospital. (And when I say decent, I mean that they won't actually kill you, not necessarily that you get great treatment.) When I worked for UK (and that would be the University of Kentucky, not the United Kingdom), the insurance program for employees' families was so costly that one of our office workers typically took home a paycheck of $25 every two weeks after they took out the insurance costs. So it's no wonder that insurance companies are against any bill that might cut into their profits.

Stephanie B said...

For the record, Relax Max, I have had seven different healthy insurance policies (through varous employers in my career). In not ONE of them (and the one I have no is considered top echelon) have I had the right to sidestep a GP and go to a specialist (except Ob/Gyn).

I left my GP who I much liked four policies back and I haven't had a GP I could stand since then. Effectively, I have not had a GP since 2000, just an Ob/Gyn (and I had to find a new one then because my insurance had changed - and he just retired because of high cost of malpractice insurance so I don't even have one of those.)

To be honest, I don't think we have as much choice as we think we have in the US.

Just sayin'.

Relax Max said...

@A. - That's funny. You're lying, but it is still funny. :)

@Janet - I think that is SO cool what your wonderful man does for his employees. My respect for him just went up several notches. Even more than when he was laying those heavy rocks. (Which I thought was super cool already.) You are lucky. You probably know that. :)

@Stephanie B - Really? Well I think that sucks. Mine (Federal Empl Blue Cross) admittedly has preferred providers but the list is huge - a pretty thick book of them for the state and several pages for our small city - so I don't feel deprived. There are very few docs here who are not specialists, so I've never had any trouble in that regard. If I go to somebody not in the book (who has agreed to certain price limits) then I have to pay the difference. So I don't. But I can. My dentist is the only one I go to and pay the difference because I like him.

I guess there are so many "approved" docs (I don't really know any GPs, frankly - they all specialize in something or other) that I have never noticed the restrictions on choice you mention. They pay almost all the prescription costs too. I mean I only pay about $3 a month for a $20 prescription.

Good private health insurance is out there. I am a witness to it. The cost is reasonable in today's world - about $350 a month or something like that. Suits me. I can't believe my taxes wouldn't go up more than that and I would have sucky coverage to boot, I'll bet. So I am not a fan of redoing the whole system. I would rather pay a tax to cover the 19% or so that REALLY don't have access to health care in America. (We are already paying for the indigent ones that go to emergency rooms for their treatments.)

Relax Max said...

My concern, as I have said a few times already, is for the low-income people who don't have insurance and don't go to the doctor for wellness care, and only go to the emergency room to be seen if they are really really ill. I especially hate that children of poor parents aren't getting seen regularly, even though there are already programs in place for them and for women. I guess I just don't see the need for an entire overhaul. But I will go along with it if everyone pulls their fair share of the load. And if Congress doesn't crap out to special interests, like the drug companies.

Stephanie B said...

Relax Max - Fed health insurance is the gold standard - real people rarely get health care that good. I know, my father and grandfather were both civil servants. Mine is close now, but the variation in the insurance of a technical employee in the same environment (i.e., I've worked at JSC for 20 years) would boggle your mind. I'm definitely at the pinnacle of the health care options I've had available (because I work for an FFRDC) and some of the ones I've had were horrific. It took years to pay off the nominal, healthy, vaginal birth of my son and, yes, I had "insurance."

And, even though I have non-Fed BCBS now, prescriptions have varied from $10-$200. And getting in to doctors on that list, even here, can be a three month waiting list or you find doctors are not accepting new patients. And I'm still not allowed to just go to a specialist. And there's a $350 deductible per person in my household.

As for cost, ny company and self pay >$16K/year - less than my total income tax last year but not by an earth shattering amount.

Here's an anecdotal example. Last year, I had baby (perfectly healthy vaginal delivery with <48 hour stay), my husband had a vasectomy - which was covered, my daughter had maybe two doctor visits and my two youngest had nominal wellness visits/vaccinations. No serious illnesses, no mental illness visits, no running to the doctor every time someone threw up, no trips to the ER. Out of pocket for these effectively wellness causes? ~$8K out of pocket. That's ridiculous!

And, yes, BCBS. I add $8K to the $16K/year , and having a tax to get regular healthcare doesn't seem too ridiculous. And I have it easier than a lot of people. We're all healthy.

Relax Max said...

@Stephanie B - Well, I never thought of it as a gold standard of insurance. But if it is as bad as you say it is out there, maybe we DO need some sort of national program. But not something written by congress. Such a plan needs to be written by experts and passed by congress. You (or anyone else) shouldn't have to be footing so much of your medical bills out of your own pocket.

Stephanie B said...

You have a distinct point.

Janet said...

Yes I am lucky. Not too many non-profits offer those kinds of benefits. In fact the other one in town that I worked for offered health insurance, but the cost came out of the employees' pay. This company had about 150 employees, so their annual coverage was actually less. Smaller companies like the Mountain Man's get shafted. That's why so many just can't pay for it at all.

Stephanie B said...

So, Max, do you believe in taking a share of wages from those who are living below subsistence?

Shouldn't taxes be on what we can spare rather than taking the food from our children's mouths? Rich people just have more to spare (and I can guarantee, what they have documented as "necessary" is more than subsidence level). And, RM, I'm in one of the higher tax brackets myself, so I'm putting my money, literally, where my mouth is.

Relax Max said...

@Janet - That is something that will have to be changed if this health insurance thing does get a real overhaul. There are sooooo many things. And I was just thinking that all the states' Work-Comp laws will be out the window. I guess we will have to start from scratch. But I know Congress will only do a patchwork job. And WHY does it have to be passed so quickly without anyone reading it? Like the "stimulus" package? Why this need for passing something no one really understands? I don't get that.

I applaud, very much, what Mountain Man is doing for his employees. A great example.

Relax Max said...

@Stephanie - No, I don't believe in that. I was just answering your earlier question about you not thinking you said that Karl Marx-like thing. You said you didn't think you said it. You did. You said anything after the guy's "needs" gets to be taken from him variously. That's the communist philosophy. You are not a communist. But you said it.

But I don't think the other guy should get plundered either, just because he's more productive than the subsistence guy.

So who do you tax?

1. Everybody, according to his ability to pay.

2. Only the most successful people (and driving them out of the country in even greater numbers than is happening now.)

3. Nobody and everybody. (Dropping the income tax and adopting a VAT-like tax at the wholesale or manufacturing level (so it increases the cost of goods, but doesn't show on your receipt like sales tax.)

I favor the latter because everyone who has money to spend would pay taxes. Taxes in proportion to what he spends. Including drug dealers and mafia bosses who aren't paying taxes now. If you consume, you would pay taxes. And we don't bother asking where the income came from.

The poor people? They still pay when they consume (buy stuff, including medicine and food) but they get help from the government on the front end, so they have the same purchasing power as before. In other words, if the guy who used to make $17,000 gets a subsidy of, say, $5,000, then he will still be having the net $17,000 after paying his hidden VAT-like tax.

I hesitate to actually call it a Value-Added Tax, because there is not actual value added. And that goes for Europe too. And South Africa. And Australia. And...

Anyway, I am against income taxes for both poor and rich. I am in favor of being taxed on everything you buy. Everything. Cars. Houses. Bananas. Stocks. The more things you have the money to buy, the more underground tax you pay.

And, as always, the government gives a lot of the money they collect to the poor. Nothing changes there.

Another of my half-baked ideas. :)

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