Sicko (the movie)

Parent Cafe
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<p>“After seeing the movie, my wife and I briefly (but seriously) talked about moving. She’s a hospice nurse, and in demand virtually everywhere. But because of her “prior condition”, if I retire, there isn’t a health insurance company in the country that will write us coverage.”</p>

<p>mini, if you and/or your wife get jobs that have insurance, then you both will be accepted on to the insurance without any preexisting conditions being excluded. In addition, some states have laws that cover this for individual policies.</p>

<p>There are now some companies that won’t hire smokers, because it makes their health insurance more costly due to predictable complications, but most companies that offer insurance are universal in covering employees and then adding on family members (for an extra fee, of course.)</p>

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<p>Also, mini, why don’t you just go on Medicare (national health insurance), when you retire?</p>

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<p>My wife is substantially younger than I am. The pre-existing loopholes, we have discovered to our chagrin, are in fact VAST. We could get insurance which covers the pre-existing conditions, but it would cost roughly half her post-tax salary. The state says they have to “offer” it, but doesn’t control how much we’d have to pay for it.</p>

<p>At any rate, I have had multiple opportunities to take other employment (at higher rates of pay), but I’d never risk it. In fact, I could take my boss’ job, but since he is in a class of employees more likely to be downsized, I’m not going ANYWHERE. I could double my salary for a decade, and it wouldn’t cover what we have received through my government-run health insurance plan (no HMO; state self-insured) in the past two years.</p>

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<p>You can check it yourself: it’s in all of their annual SEC filings. (Most of the big companies “develop” new drugs by simply buying smaller companies - my sister-in-law is the patent attorney for a major “producer”, and that’s virtually all she does.)</p>

<p>Every single AIDS drug and every single new cancer drug produced in the U.S. in the past two decades has received major r&d funding from NIH.</p>

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<p>Mini: Ah yes, I was on the state’s policy for a while. What a joy that was. Seriously. I can only assume it will go away sooner rather than later. Washington cannot afford to keep that policy much longer. However, it’s only recently that Regence Blue Shield started offering individual coverage in WA–and we got it for the kids. It’s a catastrophic policy, but very reasonably priced. You might want to take another look. </p>

<p>Another option for health insurance for anyone in a small business in the western states is through Costco. You only need to have two employees. We use their insurance to provide health insurance for our small (well, it was, now we have 14 employees!) bike business. Very reasonably priced, and our employees like it.</p>

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<p>By the way, now for something positive: I want to tell you all about my (current) WONDERFUL government-run single-payer health plan in Washington State. State employees receive a choice among several HMOs/PPOs, or a state-run “uniform” fee-for-service plan. For years, we had Group Death (whoops, I mean Group Health); I’ve told you about the horror stories already (actually, I have many more that I haven’t shared). </p>

<p>Because of my younger d’s knee, we switched to “Uniform”, and it has been fabulous. As it turns out, when my wife discovered she had breast cancer, we had another friend who had (the previous year) discovered the same, and she had Group Death HMO coverage, so we were able to compare notes. After we did some of our own research, we discovered that for 30 years, in Europe they have been using a different standard chemo regimen than in the U.S., one with a proven mortality rate 11% lower. So we asked our oncologist about it - of course he knew what it was (in fact, he has been involved in some further clinical trials for other uses for the regimen). He asked what insurance we had - we told him, and he wiped his brow and said, “should be no problem”. It was approved in days. The regimen is considered “experimental” at the HMO.</p>

<p>When we went on to the second stage of chemo, my wife developed some neuropathy symptoms with Taxol, so we asked whether we could switch to Taxitere. Again, it was a matter of insurance. No problem. My friend, who had worse neuropathy symptoms was denied the drug switch, and the HMO didn’t treat her for the neuropathy symptoms, which she now still has more than a year after finishing treatment.</p>

<p>We were able to choose our own doctor for breast surgery, for medi-port, for hysterectomy, for reconstruction; we could choose the hospital. We paid a visit to the naturopath of our choice. All of this was covered. NONE of these choices were available to our friend.</p>

<p>Oh, did I tell you that the government-run, self-insured, single-payer system that allows us to choose whatever providers we wish, and which has a maximum out-of-pocket of $1,500 (not including drugs, unfortunately - they only cover 80%-90% for those), has premiums for us that are 70% lower than the so-called “non-profit” HMO?</p>

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<p>“By the way, now for something positive: I want to tell you all about my (current) WONDERFUL government-run single-payer health plan in Washington State. State employees receive a choice among several HMOs/PPOs, or a state-run “uniform” fee-for-service plan. For years, we had Group Death (whoops, I mean Group Health); I’ve told you about the horror stories already (actually, I have many more that I haven’t shared).”</p>

<p>I think this is the model used for federal workers, and actually it is insurance by insurance companies which is subsidized by the government. So if you are looking for government single-payer that does not include insurance companies, then this is not it.</p>

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<p>Nope. The Uniform Medical Plan (UMP) is a self-insured government-run health program administered by the Washington State Health Care Authority. The benefits are designed by the state government-run and funded Public Employees Benefits Board (PEBB).</p>

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<p>I have not read all 11 pages: Here’s my story of how things are not right.</p>

<p>My son badly sprained his ankle. He was given a aircast in the doctor’s office.
this exact product (not from this supplier, but a local dealer in my city)</p>

<p><a href=“http://www.betterbraces.com/ViewProducts/AircastAnkleSprainCareKit/170.aspx[/url]”>http://www.betterbraces.com/ViewProducts/AircastAnkleSprainCareKit/170.aspx&lt;/a&gt;&lt;/p&gt;

<p>I got a statement from the insurance company that said they had paid $141 of the $200 charge for this item. A bill for the difference of $60 to be paid directly to the dealer soon followed.</p>

<p>I called this local dealer and told them that I knew this was a $50 item. I got bumped up the chain of command and was told that I could “disregard” that bill.</p>

<p>And I contacted the insurance company and said they were overcharged. They told me they would look in to it. I won’t hold my breath.</p>

<p>I’m not against anybody making an honest living, but this is one BROKE system.</p>

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<p>sue, my parents have had the same experiences with Medicare (they’re in their 70’s). They get the statements of how much was paid for this and that and we all just have to gasp.</p>

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<p>“And I contacted the insurance company and said they were overcharged. They told me they would look in to it. I won’t hold my breath.”</p>

<p>You are not at all taking into account the doctor’s overhead in ordering, placing and billing for this item. And the overhead expenses in staffing the office, paying other types of overhead, etc. Do you go a supermarket and refuse to pay 3.99 a pound for cherries because the grocer paid 1.59? </p>

<p>Same deal. You can skip the doctor’s office and just buy the air cast online (+ shipping), and you can grow the cherries yourself.</p>

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<p>“When I was in college, I spent a summer studying in Denmark and living outside Copenhagan with a host family. At some point during my stay, I became very ill during the middle of the night. My host parents called their family doctor, who came out to the house at 3:30 AM (mind you, we lived in a rural farming area well outside the city), examined me, gave me an injection, antibiotics and something to help me sleep, and took only a bottle of wine (reluctantly) from my host father as a thank you for the house call. The doctor called the next day to see how I was doing. Although I had student health insurance, the Danish government paid the entire tab. Now THERE’s a government that knows how to run a national healthcare plan. I’ve stayed in touch with my friends in Denmark and little has changed – cradle to grave social safety net, including national healthcare, for all. The Danes pay a much larger percentage of their income in taxes than we do, but they sure get a lot more for their money.”</p>

<p>Wow, that’s amazing! But, I wonder what Denmark’s policies are on immigration, both legal and illegal. Same for Germany, Norway, Sweden, Australia, and other countries whose Universal Health Care Systems are so highly touted in this country. How many millions of uninsured illegals (with that number rapidly growing daily) among their population, do they cover under their USC systems? What are their educational demographics? Unemployment demographics? </p>

<p>What about Canada? Are illegal immigrants pouring across the Canadian border looking for employment and education for their children as they are here in the US? If any of us wanted to immigrate to Sweden, or Germany in order to take advantage of their Cradle to Grave, tax fed system of social support, how easy would it be? Personally, Denmark looks pretty good to me. I’d be more than willing to learn Danish(or whichever language they currently speak). But would they let me in?</p>

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<p>There is also a big difference with the populations in these countries vs the US. The US has an incredibly high rate of crime (paying for so many casulties and injuries is expensive), drug abuse, teenaged pregnancy, illegals, etc etc etc. This is very expensive. We also have incredible entitlement programs to support teenaged mothers and their children. The rate of massive obesity is also much higher than other countries.</p>

<p>These are some reasons why it is so expensive to have National Health in this country. Although we are all paying for all of this anyway, in one way or another.</p>

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<p>“There is also a big difference with the populations in these countries vs the US.”</p>

<p>My point exactly. The particulars of America’s complex demographics make UHC a much more difficult proposition, not to mention the complexities of our current political landscape. Call me cynical, but I have a hard time seeing the health insurance lobby stepping aside for European style Universal Health Care. Nor do I see the massively profitable Pharmaceutical Industry sacrificing anything for “the greater good” of affordable health care for all.</p>

<p>Has anyone ever noticed that the drug companies only seem interested in developing drugs for ailments that require one or more daily doses for as long as a person lives? There’s no genuine interest in CURING anything—certainly not cancer, or even diabetes. But daily “treatment” in perpetuity, now that’s where the money is!</p>

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<p>mini:</p>

<p>does the state happen to publish the TOTAL cost of your plan by enrollee/family , not your copays, but the true actuarial costs, including the state-employee processors (and their pensions)?</p>

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<p>I think so (I’ll bet you can even find it on line) because the amount the employee pays is by law a fixed percentage of the total cost. </p>

<p>It’s also why my “single-payer” insurance is so inexpensive, relative to my HMO/PPO private insurance options. Every two years, the plans bid to provide the services. The Public Employees Benefits Board then decides which ones are allowed to offer coverage, and the amount of our premium related to the election is a percentage of the cost. The advantage supposedly offered by the HMOs is ease of service (because other than your primary care doctor, you don’t choose the specialists, and therefore don’t have to do the research - MISTAKE), and because they have “urgent care” clinics which, in theory, could help keep you and kiddies out of the emergency room. We did that, for years, with Group Death. Then we had a series of illnesses and disabling conditions that convinced us that not only was paying the extra in premiums not worth that, but that the quality of care was in fact low and dropping, at least partly because of the incentives built in to the system to avoid their having to pay for care. Instead of “managed care”, it has become "managed to care less.</p>

<p>With my single-payer plan, I (have to) choose the specialists, with advice if asked from my primary care doc, and the hospital, etc. Since the insurance companies have trained most of us to be such poor consumers when it comes to health care, many don’t like the hassle. I can say from experience, that’s a mistake, but private insurance has disempowered the consumer (I actually agree with the Republican critique that the health care consumer has been disempowered; I just disagree with who actually did the disempowering, and why.)</p>

<p>(Teen pregnancy, teen births, and overall crime in the U.S. are at their lowest points in 35 years. Sweden thus far has taken in 18,000 Iraqis. Britain for decades had virtually uncontrolled immigration from former Commonwealth countries; France the same with Morocco and Algeria. Germany has massive numbers of Turkish and Sri Lankan immigrants. In the case of the latter two - France and Germany - immigrants have lived in less that ideal conditions, and unemployment has been high, but it hasn’t changed the character of their health systems one iota. An Algerian living on the outskirts of Paris gets the same minimum five weeks of vacation, up to a year off for a baby, and the same help at home in the first six months as any other Frenchman. (If there was a flaw in the Moore film, it was failure to show this - instead, he interviewed the “American underclass”.)</p>

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<p>Mini the only problem with the state employees plan is it usually ruins an insurance carrier after about five years. The blues in town both have “had” their hey days with the state employees. The first couple years “hey look at us, we’ve got the state employees covered.” The next few years they hope the other guy lowballs em and takes them away. At least that how it’s been for the last 20 years here in WA. The claims rates are very very high with WA state employees. It usually takes about two years to show up. You really don’t have a single payor plan, as the group goes elsewhere in the market. Take the market away??? where you gonna go when claims climb? Who’s gonna low ball the group to get the business? </p>

<p>Yes, I agree with you on group health, I find their admin costs to be excessive for “managed care” which in theory was to cost less. They have such a bad rep from years past, they need a label change.</p>

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<p>"Mini the only problem with the state employees plan is it usually ruins an insurance carrier after about five years. The blues in town both have “had” their hey days with the state employees. "</p>

<p>Let me repeat AGAIN: Uniform Medical Plan is a self-insured plan managed by the Washington State Health Care Aythority. There aren’t any private insurance carriers involved. The premiums are 70% lower than those of the insurance carriers/HMOs who do, in fact, go in and out of the system. My part of the system is indeed “single-payer” - I can choose any health providers I want, and the single-payer pays for it, without insurance company involvement. What it is NOT is universal.</p>

<p>They don’t “low-ball” the group. Unlike the HMOs, the premiums are based on actual (and actuararily set) costs. No “low-balling” involved. The “managed to care less” group members attempt to low-ball each other, but they know they can’t compete with the single-payer based on price, so they make the argument that they provide more convenience, ease, preventive care, etc. It turns out that none of that is actually true, or is offset by the lack of choices and real patient engagement.</p>

<p>The single-payer is one option - employees are free to choose the HMOs if they choose (with the state subsidizing the more expensive private market choices to the tune of millions of dollars a year.) One of the Democratic proposals - I think it is Edwards’ - puts forward something similar, whereby individuals could choose either a government self-insured single-payer, or a private market insurance plan. I think that’s kind of dumb myself, since we already know which one is less expensive, and 22-36% of the premiums in the private system don’t go toward health care at all, but toward overhead/profit. I don’t see why I should be subsidizing Richard Scrushy as he settles into his new home.</p>

<p>One would think that as more individuals in the state system switch out of the private insurers and toward the single-payer option, the costs per individual should go up. After all, one of the insurers’ selling points is that they are (a-hem) “better for families”, and older consumers, with the kids grown, would be those moving toward the single-payer option (which is in fact the case). But, actually, as regards costs, the opposite has happened, and the premium gap between the single-payer and private insurers (which includes two major non-profit players - Group Death and Community Health Plans of Washington) has widened, mainly, I think, because those who choose single-payer become better, more knowledgeable consumers. This is one of the reasons (among many) that I think Republicans should embrace single-payer.</p>

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<p>In this movie when he was eating dinner with the goup of people in what I recall was london, there was mention of college being free in other countries. I can’t find anything that confirms nor refutes this. Does anyone else know anything about this topic and where I can find additional informantion</p>

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<p>Medical education in England is paid for by local education authorities. There are other expenses of course (living, books, etc.), but future physicians have nowhere near the indebtedness that docs here incur, and thus less in the way of incentive to avoid primary care.</p>