We need a national health CARE plan

Parent Cafe
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<p>“Perhaps most importantly, it became very frustrating work for me. Understanding the psychosocial factors that belled into the mental health ones, but also understanding that a pot of health insurance money is not intended to cover things like housing.”</p>

<p>Actually, what happens in this specific case, is just the opposite. Formerly, these clients were being admitted to emergency rooms, and then sent to pychiatric EnT units (at stupefying costs). They would then either be sent to psychiatric hospitals, or loaded up with meds (which, often, the patients weren’t competent to self-administer). We discovered patients in the state psyche hospital who had been there for as long as nine years (! yes, really!), who had never even had a mental health problem - just a substance abuse one.</p>

<p>By avoiding ERs, and detoxing first, we can (at least in theory) discover which ones might truly have a mental health diagnosis (more than half don’t). Those who do not (or who can be provided with meds) then can access substance abuse treatment - counseling as you suggested - and (with a lot of coordination), eventually housing with support services. (and, yes, housing is a bear, and, sometimes, not for lack of funds, but lack of expertise on the part of social service providers at the local level who believe they aren’t - or shouldn’t be - in the housing business. But we’ve had some astonishing successes, like the 1811 Project in Seattle, that houses 75 formerly homeless chronic public inebriates who were seen at the Harborview ER as often as 180 days a year (!). The cost savings have been astonishing.</p>

<p>From the average citizens’ perspective, the payoff is not just in the dollars saved through these patients avoiding costly services, but in better access to ERs for themselves, which can be lifesaving.</p>

<p>In my more general experience in public health, providing the right care to the right patient in the right place at the right time is almost always less expensive, and more likely to result in better outcomes. Our “lack of” health system is often rigged in such a way as to provide incentives to do nothing of the sort.</p>

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<p>None of these ideas have much magic. Most lower costs by drastically cutting payments for doctors, tests, pills tec. Here’s parts of an NPR report nobody wanted to quote. </p>

<p>"Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can’t deny a claim. And they have to cover everybody. </p>

<p>Even an applicant with heart disease can’t be turned down, says Ikegami, the professor. “That is forbidden.”</p>

<p>Nor do health care plans covering basic health care for workers and their families make a profit.</p>

<p>“Anything left over is carried over to the next year,” Ikegami says. If the carryover was big, “then the premium rate would go down.” </p>

<p>Perhaps Too Cheap?</p>

<p>So here’s a country with the longest life expectancy, excellent health results, no waiting lists and rock-bottom costs. Is anyone complaining?</p>

<p>Well, the doctors are. Kono says he’s getting paid peanuts for all his hard work. </p>

<p>If somebody comes in with a cut less than 6 square inches, Kono gets 450 yen, or about $4.30, to sew it up.</p>

<p>“It’s extremely cheap,” he says. </p>

<p>Kono is forced to look for other ways to make a yen. He has four vending machines in the waiting room. In a part of Tokyo with free street parking, he charges $4 an hour to park at his clinic"
"So the patients are safe from bankruptcy. But the system itself is under strain. Chang says that Taiwan spends 6.23 percent of its GDP on health care, compared to 16 percent in America.</p>

<p>So the United States spends too much on health care, and doesn’t even cover everybody. But the Taiwanese don’t bring in enough money to pay for all the services they offer. </p>

<p>“So actually, as we speak, the government is borrowing from banks to pay what there isn’t enough to pay the providers,” Cheng says. </p>

<p>Taiwan’s politicians are reluctant to increase premiums: they’re afraid the voters will punish them. </p>

<p>So that’s the problem here. And frankly, the solution is fairly obvious: increase the spending a little, to maybe 8 percent of GDP. </p>

<p>Of course, if Taiwan did that, it would still be spending less than half of what America spends.</p>

<p>Also what is the cost of putting all the now surplus insurance industry workers, medical office billing people, etc out of work?</p>

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<p>mini; sounds good, but I can’t help being a little skeptical. Do you know how your doctors feel? Are they hard to recruit?..Got any openings? ( smile)</p>

<p>Also, what are mental health services like for everybody else in your community? In the setting I worked in, if you weren’t chronically and persistantly mentally ill, but shared resources with those who were, you basically had to go outside your insurance and pay privately for anything more than an annual refill of the “psychotropic du jur”. Or you could be in a therapy group. I know this thread isn’t about just mental health services, but historically, the government has not followed through on promises in that area.</p>

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<p>I appreciate everyone’s thoughtful input in response to my queries.</p>

<p>So, assuming that a national health insurance plan is a big win for everyone, how does it begin? Am act of Congress? Who breaks the news to the insurance companies and their shareholders that they are now obsolete? How does the government gear up to handle this work? Who funds the initial outlays for national health insurance? In other words, what does the transition look like?</p>

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<p>Publicly funded mental health services are downright awful in our state (like most everywhere else), with only those with the most severe Axis I diagnoses being able to access services (which may be little more than pills). We do have “mental health parity” in private insurance coverage, but of course that doesn’t mean folks are necessarily able to access care. In my single-payor plan that I receive from the state, I receive up to 50 visits a year, with a 10% copay until deductible ($600/person) is reached. And my premiums, already much lower than those offered by the insurers, are going down. Use of the counseling benefit is generally encouraged, as it has been shown to cut down on need for medical care.</p>

<p>“Are they hard to recruit?..Got any openings? ( smile)”</p>

<p>Because the program avoids the EnTs and the Emergency Rooms, there are very, very few physicians involved. There are county designated crises responders and chemical dependency/mental health coordinators. A “shrink” is needed if there is an involuntary commitment, but the vast majority of clients volunteer. </p>

<p>Of course, patients in need of medical care do receive it; just not in the ER.</p>

<p>"Also what is the cost of putting all the now surplus insurance industry workers, medical office billing people, etc out of work?'</p>

<p>Pay 'em off, just like auto companies do for surplus auto workers. It’s still cheaper than Obama’s boondoggle.</p>

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<p>Barrons, here is a quote that you included in your post on the NPR article about Taiwan:</p>

<p>" And frankly, the solution is fairly obvious: increase the spending a little, to maybe 8 percent of GDP. </p>

<p>Of course, if Taiwan did that, it would still be spending less than half of what America spends."</p>

<p>So Taiwan could increase taxes, spend a little more, and still be spending only 1/2 of what the US spends w/o covering everyone.</p>

<p>As for Japan, my facts were relating to the Taiwan plan, not to Japan. I have no idea how Japan’s health care works.</p>

<p>btw - according to the Guardian article, Taiwan modeled their health care sytem off the US Medicare system.</p>

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<p>" So mercymom, in the setting you describe, there is not simple allergy evaluation or treatment to add a little job satisfaction for the doctors? I’m imaginig in mental health, that would mean antidepressants from the p[harmacist, and only when they “stop working”, do they see a doctor? How does therapy happen?"</p>

<p>Shrinkrap, I don’t think that in Italy you can walk in the drugstore and get antidepressants or psycho therapy from a pharmacist. But my friend said you could get prescription cold/allergy medicine and simple antibiotics for simple problems. I thought from your earlier post you were worried about people abusing a national health insurance with lots of doctor visits and/or prescriptions for simple stuff, like complaining about a sore throat or an allergic runny nose or cough, etc. It seemed like you didn’t want people running in all the time with pesky little problems at public expense. So the Italian idea that these things are taken care of w/o a doctor visit or a prescription sounded like a good one.</p>

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<p>Read that Guardian article closely. Here are some quotes:</p>

<p>"It is a compulsory, mostly premium-financed insurance system, which negotiates a single payment schedule with the municipal- or government-owned providers and the 70% or so of private hospitals and clinics.</p>

<p>Taiwanese do not have to worry that changing or losing their jobs will lose them their healthcare. They do not have to make choices between paying the food bills and getting essential prescriptions. Their doctors will not drop their insurance coverage, nor do they get post-operative sticker shock when they discover the anesthetist the hospital booked does not accept their insurance. They do not have to worry about big bills for out-of-network providers - because if a doctor is out of the network the chances are they were thrown out for fraud or malpractice."</p>

<p>And this: </p>

<p>"The doctors like it as well. They are assured payment without wrestling with cost-cutting HMO bureaucrats who get bonuses and promotions based on how many treatment courses they can deny.</p>

<p>There are no prohibitions on doctors operating outside the Taiwanese system - but no one in his right mind will go to one when they can go to any in-system provider and, for nominal (try $1.50!) co-payments, simply have their insurance card scanned, confident that the NHI will settle the bill with none of the hassle that Americans have come to know and hate from HMO’s and multiple billings from different practitioners."</p>

<p>And this:</p>

<p>“Most astoundingly, for any capitalist with an accountant, is the difference in costs and efficiency. Taiwan gives everyone healthcare for less than one sixth the price per head of the US. In fact by 2005, US healthcare amounted to almost $2 trillion, or $6,697 per person, amounting to 16% of GDP - and still left 47 million people without insurance, more than 20 million inadequately covered, and, as GM’s recent manoeuvres show, untold millions more whose insurance is not as secure as they once thought. Taiwan spent 5.7% of GDP and less than $900 a head.”</p>

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<p>And as far as that argument about not being able to get the tests you need with a national health insurance, well here you get the same thing in the form of your insurance co. denying coverage and refusing to pay for your tests. The best example of how absurd this can get in my own experience was when I had amniocentesis done with my third pregnancy as I was 38 and my doctor recommended it. My baby (DS) was healthy, yea! The insurance co denied coverage saying it was an unnecessary test. The reason it was unnecessary? The fetus was healthy! Which you wouldn’t have known w/o the test!</p>

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<p>Sure, one can count on the leftist “Guardian” to point out anything but positives. For one they are spending less by cramming down the fees to doctors and providers. Even the articl pointed out that the current rates were not adequate. I’m sure there are many who would be quoted as less enthusiastic than those by the Guardian.</p>

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<p>“I thought from your earlier post you were worried about people abusing a national health insurance with lots of doctor visits and/or prescriptions for simple stuff, like complaining about a sore throat or an allergic runny nose or cough, etc. It seemed like you didn’t want people running in all the time with pesky little problems at public expense. So the Italian idea that these things are taken care of w/o a doctor visit or a prescription sounded like a good one.”</p>

<p>I have mixed feelings about it. i like to do it because it makes people happy, and that’s one of the satisfying things about being a health care provider . (As opposed to saying NO! all the time , which makes people mad, patients and providers, and what I ended up doing to all but the most severly impaired in my previous life.) I like saying yes, it just seems like the first thing to go when you are being “efficient”.</p>

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<p>Yes, Barrons, the Guardian did point out the current rates were inadequate, but your own NPR quote said they could raise the rates to cover their losses and still be spending less than the US and covering more people.</p>

<p>Nevertheless, I will agree with you that the Taiwan model is not perfect and you’d be hard pressed to find a perfect model. Here is an article about Taiwan with lots of negative details you can have fun pointing out, but it is a clinical and balanced outlay of the facts:</p>

<p>[Does</a> Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan – Lu and Hsiao 22 (3): 77 – Health Affairs](<a href=“http://content.healthaffairs.org/cgi/content/full/22/3/77]Does”>http://content.healthaffairs.org/cgi/content/full/22/3/77)</p>

<p>Taiwan didn’t have the kind of health care options the US has to begin with, but their new insurance has made what they do have more affordable and with increased access to most of their people. It seems now only people living in remote mountain regions lack access and that is primarily physical access.</p>

<p>I doubt the US could move to single payor health care any time soon. Our insurance industry is too big to permit that. That’s why I would be willing to move to a new private insurance model like Hillary Clinton proposed (sorry Mini) or start smaller with something like that SHOP act that I mentioned above. What I do NOT approve of is McCain’s fend for yourself idea, and I say that as a McCain supporter. Maybe he will pick Romney for VP and Romney can talk some sense (or sensitivity) into him.</p>

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<p>“a new private insurance model like Hillary Clinton proposed (sorry Mini)”</p>

<p>Other than the mandate, Hillary and Obama’s models are essentially the same. Both giant trillion dollar giveaways to the private health insurers so that they can further prey upon us.</p>

<p>But both have a little “peephole” into the future - folks can sign up for a “Congressional-style” plan. This is a self-insured, single-payor option, like state employees have access to in my state. Our experience is that, once consumers discover it, they will flock to it. It now covers some 60% of state employees who are given the choice between it and the private insurers, and the percentage goes up each year.</p>

<p>But in the meantime, we’ve got to make it possible for those health insurance execs to go feather their nests.</p>

<p>The interesting thing is that my state, Hawaii, Minnesota, and Vermont would have universal single-payor today (beginning in 1993) if it wasn’t for Hillary Clinton (who basically vetoed any possibility of the states receiving ERISA waivers so that the citizens could have the health care they both wanted and deserve.)</p>

<p>(McCain’s idea seems like something that would have been invented by Herbert Hoover, which is not surprising, given their similarities in age. ;))</p>

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<p>“Other than the mandate, Hillary and Obama’s models are essentially the same.”</p>

<p>It’s the mandate that makes Hillary’s model work. You can’t get the economies of scale that make it affordable unless everyone is covered. It’s like states that mandate auto insurance. (but please I don’t have time to argue that). And I am all for the plan Congress and the federal employees have (it’s the same thing isn’t it?), but I did not know it was single payor. My federal employee cousin says he has a cafeteria plan and he has chosen the Blue Cross option (or one of the BC options if there are >1. We have Blue Cross now and my cousin pays about 30% less than we do for the same coverage cause our group is smaller than his. He doesn’t understand that it is the size of the group (among other things) that determines the rate. The bigger the group, the lower the premium.</p>

<p>Personally, I think McCain is more concerned about companies and employers getting rid of the expense and trouble of providing benefits than he is about providing better health care to employees. It’s just cloaked in lanquage that sounds like they are trying to give you better health care. Based on what Massachusetts did, I think Romney actually does want to improve your health care options. I could be wrong and I’m sure someone will point it out if I am. (smiley face)</p>

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<p>But the mandates in Romney’s plan have proven that they DON’T work. It IS like mandating auto insurance - and in our state we have more than 100,000 people driving without it. If you want universal coverage, you can either take it out of people’s taxes, or you subsidize it through point-of-care enrollment, but neither Obama’s nor Hillary’s plans get to universal coverage.</p>

<p>I don’t know if federal employees have the Congressional option as part of their cafeteria plan. My coverage is NOT Blue Cross - it is self-insured.</p>

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<p>Here’s a discussion of Massachusetts issues:</p>

<p>[Healthcare</a> cost increases dominate Mass. budget debate - The Boston Globe](<a href=“http://www.boston.com/news/local/articles/2008/03/26/healthcare_cost_increases_dominate_mass_budget_debate/?page=full]Healthcare”>http://www.boston.com/news/local/articles/2008/03/26/healthcare_cost_increases_dominate_mass_budget_debate/?page=full)</p>

<p>Some of what needs to be done is controlling costs, ie, the cost of the medical care itself. Guaranteeing access to health insurance has to be coupled with controlling the cost of the care itself and that is an issue you’d have even with single payor, wouldn’t you? Don’t we then get into the whole thing Barron’s doesn’t like, paying the doctors and hospitals less? It’s a pretty broad based coalition that got this passed in Mass. That’s a good sign. If the insurance co’s feel threatened enough they will most likely warm up to the idea of reform.</p>

<p>You have to couple the mandate with punishment. On the auto insurance front, some states down here where I live won’t let you recover anything in an accident if you don’t have insurance yourself. Texas has some pretty stiff penalties if you don’t have auto insurance, and I’m pretty sure they enforce em. So sure, there are going to be people who won’t get the insurance, but they get penalized later on in the game.</p>

<p>Look, I’m with you on this one. I’d rather have single payor. But it’s not on the horizon. I’ll have to ask my cousin if he has a congressional choice. I think he just has a choice of insurance companies.</p>

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<p>“I’d rather have single payor. But it’s not on the horizon.”</p>

<p>Agreed. Though if they just let states do their own thing, mine would have been there 15 years ago.</p>

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<p>I love comparing Taiwan to the US. As if <em>anything</em> which occurs in Asian societies could even be compared to a similar program in the US.</p>

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<p>Actually, it went the other way. Taiwan’s program was modeled on U.S. Medicare - it is directly comparable, because that’s the way they designed it.</p>

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<p>

Have you even looked at the costs of Medicare compared to the Taiwan program? They aren’t comparable.</p>