<p>By the way, I am open to a baseline coverage option, such as in the public school / private school example.</p>
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<p>Calmom: please define what is “necessary” and who decides?</p>
<p>Well, my H watched a little girl die because her family couldn’t afford a heart transplant; maybe that’s necessary?</p>
<p>One of the reasons he quit medicine.</p>
<p>Bluebayou, our elected officials or their designated agencies would decide what was “necessary” in such a system. Obviously routine preventive care, life-saving measures, and things like mending broken bones would be covered. If the government system was too stingy, that would provide an incentive for the private insurers to offer better – and if the government system was very efficient and generous, it could put the private insurers out of business. But I don’t see private schools going out of business because of the public schools doing such a bang up job of things, and at the same time I don’t see poor kids without a school to go to, and we seem to have all agreed as a society that reading and math are subjects that must be taught in all schools, even if we can’t agree on art and music. </p>
<p>The point is: everyone can get the sort of preventive care that saves costs in the long run by avoiding more serious health problems — no one dies for lack of funds to pay for accepted procedures for common injuries and illnesses – and no one is forced into bankruptcy to pay for unavoidable hospital expenses. Will the government plan pay for a sex change operation or fertility treatment of chelation therapy for autism (a highly controversial therapy)? - probably not.</p>
<p>But those are the types of things that private insurers tend to exclude from coverage as well – so I doubt that it would make that much of a difference to most people, except that health care would be accessible to those who now can’t afford it, and costs would go down for those of use who can afford insurance but are paying through the nose for it. One reason our health insurance premiums are so high is that we are largely underwriting the costs of the uninsured who still are treated when they show up in a hospital emergency room riddled with gunshot wounds. </p>
<p>Doctors and nurses know when they get an unconscious patient delivered to an emergency room what is “necessary” and what is not. They don’t go worrying about insurance when it’s a matter of life and death – they render the treatment. As it now stands, if it turns out later that the patient has neither money nor insurance…it’s a wash --the doctors and hospital have no one to bill for those serviced. Under a government program, every patient treated would be funded, at least for those emergency, life saving measures.</p>
<p>“Who decides” is an easy one as far as I’m concerned. Anyone who not does stand to financially profit in any way, directly or indirectly, as individuals or as a class, from the decision.</p>
<p>At my old HMO, doctors received incentive payments NOT to refer patients to specialists. It meant waiting lists for specialists seemed shorter. It also meant that patients never got to see the specialists they needed. Specialists were, in turn, chosen based on negotiated price with the insurer. As far as I am aware, this is standard HMO practice.</p>
<p>I’ll take longer waiting times, thank you.</p>
<p>Garland, I find it hard to believe that a child was turned down for financial reasons. Our heart surgeons have done a lot of them on children. I remember when they started. The first child was from a poor family so the surgeons were vilified in the press for experimenting on the poor. The second child was insured, so the surgeons were accused of only operating on the well paying patients.</p>
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<p>I agree. We as a society will have to define “necessary” medical care, and there will be diffrerences of opinion. The problem with state mandates (in other words, state governments have decreed that certain treatments must be covered in insurance plans offered in those states) is that they have been pressured/influenced by lobbying groups – of chiropractors, or acupuncturists, and even of citizens. As just one example, in NJ, infertility treatment must be covered. </p>
<p>Actually, we already have the government deciding in some cases what must be covered. For example, the Women’s Health and Cancer Rights Act of 1998 – a federal law – requires that insurance plans cover breast reconstruction following a mastectomy, including reconstruction on the other breast to maintain symetry, and the cost of prostheses. Is reconstruction on the “other” breast “necessary” medical treatment? I don’t know. But we already have a law that says it must be covered, even in self-insured plans.</p>
<p>Another law that exists in many states is the one requiring women to stay in the hospital for at least 24 hours after childbirth for a vaginal delivery, or 48 hours for a caesarean, unless the woman and her doctor agree to discharge her earlier. I don’t have a problem with this requirement as a guidleine, but I’m not sure I’m so crazy about it as a law.</p>
<p>My point is that there are already numerous laws about what’s covered and what’s not; we just don’t realize it. But unless this is dealt with all together, we’re going to continue to get patch-work laws that cover patch-work medical care.</p>
<p>tricare covers everything.</p>
<p>Go here to get coverage:</p>
<p><a href=“http://www.navy.com/[/url]”>http://www.navy.com/</a></p>
<p>636</p>
<p>Mardad–she was here legally but did not yet have permanent residency.</p>
<p>Bad luck for her.</p>
<p>THXZPI636: Yes, Tricare covers everything. It is one of the many healthcare programs in this country that the government manages and pays for. If you’re lucky enough to get Tricare or one of the other military programs, you’re very lucky indeed.</p>
<p>The government pays for about 50% of all U.S. healthcare expenditures already.</p>
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<p>mini: sounds a lot like Plato’s philosopher king. :)</p>
<p>But, of course, there is absolutely no one on earth who does not benefit “from the decision,” i.e., by definition, someone has to benefit, if only the patient. However, not all patients are knowledgeable enough to differentiate beneficial treatments from non-beneficial treatments (remember laetrile back in the '80s?).</p>
<p>VH: don’t forget the tax deduction to employers and employees; the “feds” pay way more than 50% of health costs (feds in quotes since it really means taxpayers).</p>
<p>luck’s got nothing to do with it.</p>
<p>636</p>
<p>“But, of course, there is absolutely no one on earth who does not benefit from the decision,”</p>
<p>very true, and don’t forget the doctor also stands to profit from it.</p>
<p>If one counts “tax collections foregone” and “spending for health coverage for public employees” as government spending, then the government spends 56% of all health care.</p>
<p>I dled it a couple weeks ago since Moore recommended it. Liked it.</p>
<p>Question for people in the know: my son will be 21 this year. He will be graduating from college next year. How long will he be covered by my insurance (I work at a company, and receive private insurance). I am going to ask my insurance carrier, just wondering if people already know. I have a lot of pre-existing conditions like diabetes etc. but since I am employed, I haven’t (yet) been dropped.
Thanks.</p>
<p>It depends on the company’s policy. Mine covers till December 31 of the year they graduate from college.</p>
<p>My D, in and out of jobs the first couple years, did a lot of paying out of pocket and was lucky to have a doctor who gave her samples whenever possible. Just when she didn’t have insurance it seemed like she was always sick.</p>
<p>Ours ins is to age 25 if in school, and terminates 30 days (?) after graduation. There is/are a provider that offers short term, major med ins. Some professional, college associations, also offer major medical. We pay extra for a family plan and I am thinking that by dropping son, and he picks up a major med program that we will save money.</p>
<p>“But, of course, there is absolutely no one on earth who does not benefit “from the decision,” i.e., by definition, someone has to benefit, if only the patient.”</p>
<p>Oh, we put together panels, regulatory and otherwise - including medical panels – all the time, with explicit “no financial interest” clauses. It really isn’t all that difficult to do, if there is political will. Don’t make out something as difficult when in fact it isn’t. (The state board of health that I worked for had such a requirement, and it just wasn’t very difficult for the Attorney General’s office to know when there was a financial conflict of interest, and when there was not.) Probably means you couldn’t work for, or have substantial stock in, a health insurance company, or in a health equipment company, or worked for an HMO, etc., etc.</p>
<p>Thanks Garland and thisoldman. Will ask my insurance carrier soon.</p>