<p>My neighbors kid just got laid off so the security of being covered under his parents coverage is a big relief. He will pay the additional cost to his dad but the security of knowing he does not have to worry about coverage is a big help.</p>
<p>In one year, we will have a 26 year old who will be in grad school. She will have to get an individual policy at that time, as the ones the colleges offer are…well…terrible. It is what it is. I’d scrub floors to make sure my kids had health insurance coverage. </p>
<p>Re: other countries. We know folks who were expats in Singapore. They are Australian citizens and say the Australian coverage is far better…and their choice (one reason they moved back to Australia).</p>
<p>Mini’s post about his mother got me thinking. How open are insurance plans to support care provided outside of US? Are there any that encourage this route for major medical procedures?</p>
<p>We already have problems with providers refusing additional (or any) medicare patients. It is not possible for a provider to make a living…heck it’s not possible to even cover costs…at Medicare reimbursement rates. My insurance contract pays a provider anywhere from 2 to 5 times what Medicare reimburses. So unless the ‘Medicare for All’ plan includes a large hike in payments to providers…it won’t be pretty. </p>
<p>As a small employer - the company consists of DH and myself - we currently pay about 13K premiums (which went up 20% at last renewal). We have a $2500 pp deductible. So, our annual OOP costs with the two kids would be 23K if we all needed care to the level of meeting the deductible. It makes sense to drop the coverage and pay the penalty until the price/penalty cost point is much closer. If the penalty is truly 2K the first year then why not spend 4K and take the guaranteed 11K savings. (which would be much greater if any of us actually had to use the plan and start paying the deductible).</p>
<p>I predict a rise in concierge type practices. One pays an annual membership fee and is guaranteed access to the physician. Those that can, will pay out of pocket for access and care. Those now ‘insured’ will proudly carry their insurance card only to find out being insured and having access to care are two very different things. </p>
<p>I think we should let Costco manage our healthcare. They seem to do everything better than our elected officials ;)</p>
<p>From what I have read countries with national coverage have no problem getting doctors. The charts I have seen indicate they have very similar ratio of doctors to population that we have. </p>
<p>How is it that they offer coverage for any where from 3-11% GDP while we are at 18%. Getting our costs down to even 15% significantly solves our debt and deficit issues.</p>
<p>Years ago I was in Germany with my kids. While in the bath, S then 3 years old, and his 6 year old S were in the bathtub. They were playing around as kids will do. S started screaming and there was blood coming from somewhere in the head area. Between the water and the panic caused by two kids crying, I really couldn’t tell the source. </p>
<p>I bundled him up, ran to the neighbors and she drove me to the local ER. There, a young intern spent 5 minutes looking at him while I held him on my lap in the waiting room. He determined a bit tongue was the source of the blood. Gave ME a pat on the head and sent us home. No MRI, no CT, no 5 pages of intake forms. No taking S’s temperature, no second opinion no $35 pediatric aspirin. </p>
<p>Last year my sister was in France biking with her hubby and D. D fell off bike. D had deep gashes with obvious material in the wound. At the next town the local Dr. was called. Dr. injected a little bit of lidocane, removed the rocks and debris and put in a couple of stitches. My sib remarked on the fact that…there were no intake forms, no X-Rays, no ortho consult. No one took her daughters temp or spent 15 minutes asking if either mother or dad had a history of heart disease, stroke, kidney failure or depression. </p>
<p>Oh…and neither country has a problem with malpractice suits. No TV ads with lawyers listing all the things you can sue for if you just call in the next `10 minutes. Yes, we do things differently here.</p>
<p>I agree we should have tort reform but I have also read it is not the cost driver it is made out to be, I will find a link. A national plan would be the best way to get tort reform done in my opinion.</p>
<p>Factcheck said 1/2 of 1% and the washington post has an article that since Texas passed tort reform their HC costs increased at a greater rate than the rest of the country.Not saying it is a good or bad idea but I do not believe it is anywhere near the solution.</p>
<p>Thanks for the facts on tort reform. That is interesting.</p>
<p>My examples show a very different philosophy. Sometimes simple things are really…well…just simple things. But for some reason, and my guess it the major driver is the need to CYA…our approach includes an over use of technology and diagnostics. We can’t seem to keep anything simple.</p>
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<p>There are some things in life where there’s a finite demand - if the government is prepared to put as much money into, say the bread industry, you reach a point very quickly where there simply isn’t any need/demand for any more money. </p>
<p>This is not true in a variety of other industries where you can always find a way to spend an infinite amount of money. Healthcare is a great example of that because every advance in medicine does not fill a need in permanent terms - the penicillin you gave to the 30 year old guys didn’t solve all the health problems for these guys; they have morphed to 90 year olds with cancer, alzheimers, etc., and if these are addressed, you’ll have the next generation of diseases, each of which needing as much money as you can put in. </p>
<p>So you have a multi-trillion dollar pie with many large entities having marked their territories, and contrary to people assigning them white and black hats, they’re really all shades of gray. Unless someone has the strength to draw lines, any increases will merely magnify what we have. Our system is amenable to drugs that may cost a hundred grand that would extend life by a few months, while the rest of the world would baulk.</p>
<p>dad of 3. I think you nailed it we can not avoid the discussion of where to draw the line on care or as our great leaders said death panels. I will try to find the numbers but the amount we spend on the last few months of life in comparison to what other countries spend is a big driver in the cost of HC. Are we spending wisely or are we torturing the old and the fatally sick?</p>
<p>Tom, it really isn’t only the old and the fatally sick. I used that as an example because it is straightforward to see. It is endemic in the whole system. </p>
<p>Take someone coming to the ER with a headache. You could routinely order a CT on every such patient bringing in money for the facility, the radiologist, the CT maker, the pharma, and the one case out of thousands for whom the test found something. At the same time you exposed a thousand people unneeded radiation, and you raised the premium for everyone to cover the cost of the CTs. If you didn’t routinely order a CT, you could have missed the one guy, which could get the facility and the ER physician hit for millions of dollars.</p>
<p>At least for the few countries I know of, there is little debate on how they’ll go. The CT will be done only if the symptom persists. Here, you could have many different committes in the same institution looking at it from different angles - #1 would be looking at the radiation angle, and worry about excessive cumulative exposures and look for a protocol to minimize it; #2 will be looking at the liability issue and be worried about cases where insufficient testing at the first opportunity caused the problem not to be detected right away; #3 will be looking at their peers from a reimbursement standpoint to see if they were leaving money on the table by not doing everything that the “best practices” peers were doing; and #s 4, 5, and 6 will be studying this from their viewpoints. Keeps me employed.</p>
<p>Well we add tort reform and pass a law that doctors can not use a medical facility to run tests in which they have any financial stake. My SIL is a CPA and her firm specializes in medical practices. The doctors wages are fairly low but their business income is generally very high based on the various medical equipment that partnerships or LLC’s that they are members of own.</p>
<p>So my friend (a retired nurse) got out of the hospital yesterday. On Tuesday she started throwing up. Stomach a mess. But on Thursday, she passed out on the couch, so she called an ambulance and went in through the ER. The ambulance driver said it was norovirus - it has been going around where we are.</p>
<p>She goes to the hospital. In two days, no one felt her abdomen. She had explosive diarrhea; no one paid attention. They gave her an MRI (head), CTScan, echocardiogram; two x-rays; a battery of blood tests. On Friday, they decided it would be Medicare Part B rather than A - so that they could “hold her for observation”. And collect triple from her state employee retirement insurance rather than through Medicare. Oh, and because when she was employed before, her medical records lived in Seattle, no one bothered to get them.</p>
<p>They held her another day. Finally, on Saturday, a gastro doc comes in and says, “oh, you have norovirus, and what are you doing here?” She had fainted from dehydration. She was out in an hour.</p>
<p>The hospital made megabucks. The docs made megabucks. Medicare got bilked. State retirement systems got bilked. Everyone’s happy, right?</p>
<p>Until the profits are taken out of the health care system…this country is going to continue to be squeezed.</p>
<p>I don’t see how Obamacare is going to help in situations like your friend’s. When my dad was taken to the hospital with stomach pains, he sat in the er for over an hour and nobody looked at him. Then he was given these drugs which made him go crazy. He had to stay in the hospital for a few extra days while the drugs effects wore off. Then he was diagnosed incorrectly and sent home. He was back in the hospital in a week. </p>
<p>The hospital was understaffed. I don’t understand why not having enough doctors and nurses to help patients is a good thing. </p>
<p>One of my kids was hit in the mouth with a golf ball. I took him to the emergency to get stitches. We waited 3 hours. I was watching the doctors and nurses. I saw a lot of chatting. After 3 hours, I went up to the person at the front desk and said, “I am going to take my son home now. We have waited 3 hours.”</p>
<p>The person at the front desk replied, “Oh no no no. He needs stitches.”</p>
<p>They took my son and stitched him up immediately. Immediately after 3 hours.</p>
<p>I have to wonder if most elderly even want the expensive life-extending methods that we give them. My grandparents moved out to Oregon because of their assisted suicide laws. A lot of other people in their retirement community moved out there, too. It seems at least many are rejecting the million dollar treatments for just a few extra months. I wonder if this trend will continue.</p>
<p>Moderator’s Note: Since people only want to discuss new solutions, I am closing this thread.</p>