<p>"the government actually does a better job "</p>
<p>It does - think of Medicare</p>
<p>Everyone knows most government jobs are low stress with longer vacations. Of course they don’t get sick as often. ;-)</p>
<p>Read my link on Medicare fraud. Then say they are doing a great job.</p>
<p>“I’m a big fan of mini’s idea: get the government into the industry, and make them the low cost alternative; tie their providing healthcare to recommendations by actual practitioners; and then allow private firms to compete as well.”</p>
<p>Thanks. But it’s interesting: both Hillary’s Plan and, especially, Edwards’ Plan would put billions of dollars per year into the hands of private insurers to “manage to care less”. You would think that, like SCHIP, they would be screamingly in favor of them.</p>
<p>But they’re not. And the reason is - the single-payor alternative offered inside each plan. Over time, people will discover, as they already are here, that the single-payor alternative can offer higher quality care at a lower cost (and with shorter waiting lists for care), and that all the private plans can do to offset that reality is market and advertise. They can’t offer care of the same quality (we have customer satisfaction data in our state proving it) or at a similar cost. </p>
<p>So competition scares the heck out of them, and they don’t want any part of it. </p>
<p>Frankly, I think Hillary’s Plan, and to a lesser extent, Obama’s Plan, are absurdist - the experiment has already been done, so why do we have to pay an extra $150 billion a year into a system that is already broken, when it doesn’t have to cost us an extra dime? Why not just pay the private insurers $150 billion a year for five years TO DO NOTHING, and build a system that really works?</p>
<p>BedHead: Going back to something you wrote earlier- it is unfortunately true that general pediatrics and most primary care is reimbursed relatively poorly in the US. Eye doctors on the other hand are among the best paid physicians and enjoy a wonderful quality of life. Eye doctors are able to spend more time on each patient, while the pediatricians have to turn around patients faster even for their relatively modest income. Perhaps it shouldn’t be so, but the most talented and motivated doctors tend to follow the money and choose the more well-paid specialties. </p>
<p>Perhaps that might explain some of the differences between your experience and barron’s.</p>
<p>My opinion on this health care debate is that the current system is really very inefficient and anti-competitive. But before we reform the system we may well have to reform the process by which politicians are vulnerable to lobbying by the industries that benefit from the current system.</p>
<p>I did a bit of checking on the Washington state plan. It costs them an average of about $3500/person covered. My Cigna policy covers me for nearly the same amount as part of the company plan. That’s the total cost including company contribution.</p>
<p>Does Cigna give you freedom to choose any doctor or do you pay a penalty for going “out of network”?</p>
<p>“I did a bit of checking on the Washington state plan. It costs them an average of about $3500/person covered. My Cigna policy covers me for nearly the same amount as part of the company plan. That’s the total cost including company contribution.”</p>
<p>Didn’t bother to check the differences BETWEEN the plans offered, did you? Or the differences per family. Or the differences in coverage between the state plan and your Cigna policy. </p>
<p>Ah, that was convenient.</p>
<p>Well, let me do that for you:</p>
<p>For the “unslimmed down” versions of coverage, premiums per month, for individuals/families - for exactly the same package of benefits (except generic drugs cost less under Uniform), and choice of providers/specialists is “free” under Uniform:</p>
<p>Aetna - $104/$296
Kaiser Permanente - $101/$288
Group Health - $74/$214
Uniform Medical Plan (the single-payor option) - $28/$87</p>
<p>Now I can tell you from 20 years of firsthand experience that those offering care will change roughly every three years: once care has been delayed or denied often enough in a private plan, they “quit”, and often come back in another incarnation three years later. I expect this will happen less now, as indivduals increasingly discover the higher quality of the single-payor option (cost was always transparent). I have been on three other plans prior to the single-payor, and there is absolutely no comparison in the quality of care.</p>
<p>You can see why the private insurers aren’t jumping for joy with Hillary’s or Obama’s plans, even though they will initially net billions of dollars in extra revenue through them.</p>
<p>“their providing healthcare to recommendations by actual practitioners; and then allow private firms to compete as well.”</p>
<p>There’s a startup, Carol, doing just that. They’re testing in Minnesota and will be launching nationally very soon. Mini, Seattle and Boston are the next markets Carol is entering. Happy? ;)</p>
<p><a href=“Plataforma de dados e inteligência artificial - TOTVS”>Plataforma de dados e inteligência artificial - TOTVS;
<p>It’s pretty useless if decisions about your providers are made by health insurers and employers, rather than by you. (And both Washington and, especially Oregon, already have very extensive, publicly available customer satisfaction surveys available on large parts of the health care system.)</p>
<p>^ ^ </p>
<p>Carol isn’t a survey company. Read the website. They’re “selling” services.</p>
<p>“Health care is sold in the Carol Marketplace in care packages—bundles of condition-specific services designed to treat everything from asthma to varicose veins. Care packages are created by clinical experts from each of the member institutions and include a range of traditional medical services that run the gamut from allergy evaluations to same-day surgeries. In the Web-based marketplace, consumers can compare diagnostic imaging packages such as MRI and CT scans, annual physical, dental and eye exams and the costs of physician-recommended services such as mammography or physical rehabilitation.”</p>
<p>"In the Carol marketplace, everyone plays a role in changing the way health care is consumed. As in any well-functioning industry, the purchase decisions of consumers will inspire innovation from producers and create new value for consumers. In a retail environment, health care providers can price services more effectively and aggressively, differentiate their services and manage consumer demand. And physicians and medical staff can enhance the consumer experience with a better understanding of consumer expectations.</p>
<p>I understood that. But under most employer-supplied health care, consumers don’t BUY the services. It isn’t a “retail” environment.</p>
<p>I had freedom to choose my doctor from a long list and my old doctor was on their so no need to change. If you go out of the network there is a penalty however virtually all the major hospitals are in the network including Swedish which is considered blue chip. No I did not compare the coverage line for line but I have small copays on drugs and doctors and 100% hospital coverage. Those are the big ticket items. I don’t care if they don’t cover accupuncture or a weekly massage. My hospital bills were about $25,000. I paid $0. That’s where the rubber meets the road. All the frills in some policies are not that useful.</p>
<p>“But rationing has pretty much assured that they don’t have the same insurance, or the same doctors.”</p>
<p>Mini, could you define what you mean by “rationing”? As for the single-payor system in your state, who is eligible for this? If it is such a successful program why aren’t politicians like Edwards, Clinton or Obama considering similar plans?</p>
<p>I looked into the ethnic composition of Brazil - 40% European white, 60% mixed African and Native Indian. Like I said, far less ethnically diverse than the US. Same with economic diversity - it’s essentially a society with a few “haves” and mostly “have nots” - unlike US which, despite alarmists, has a vast in between. And the same for education. So I still maintain that Brazil is far less varied in its patient base, far easier to distribute health care to than the US.</p>
<p>As for Medicare - well, the oldsters are fierce about it - they love it - but docs hate it because of the price fixing by the government. In some states physicians are refusing to take on new medicare patients. Is that what you call a success? And there’s also an argument to be made that Medicare mostly just helped drive up health care costs much the same as student loans and grants helped drive up college tuition. Subsidies drive up price.</p>
<p>Mini, if I’m reading you right I’m kind of in agreement. Although I see the need to compensate those in the health care industry who actually produce health care - docs, researchers, device makers, nurses, drug companies - I do question what exactly the insurers bring to the table. But “single payer” packs a whallop of implications. How on earth can there be competition if there’s only one payer? Are you talking about a health care savings account wherein you – the consumer – has the discretion of where and what you purchase for your health care? Then the single payer is the provider of the the health care saving account, or at least a portion of it. I’m fine with that so long as the single payer does not start setting prices for tonsilectomies and colonoscopies. There I think we indeed need competition and incentives for innovation, and price fixing kills both.</p>
<p>“How on earth can there be competition if there’s only one payer?”</p>
<p>Single payer is NOT single provider. Once it is clear that you can take your payment to any provider, the providers in turn have to compete on the basis of quality (which includes convenience, waiting time) etc., knowing full well that you can take your payment elsewhere. It’s called competition. Corporate socialists hate it.</p>
<p>“Mini, could you define what you mean by “rationing”? As for the single-payor system in your state, who is eligible for this? If it is such a successful program why aren’t politicians like Edwards, Clinton or Obama considering similar plans?”</p>
<p>Rationing means decisionmaking regarding the utilization of limited resources. It is what insurance companies do now through underwriting, and through incentives to delay or deny care. </p>
<p>My health plan is available only to government employees in Washington State. All three - Clinton, Edwards, and Obama - have embedded within them a smorgasboard approach that includes the use of a single-payor self-insured option (that’s what Congress members have access to now, and what my options are.) BUT, by having insurance continue to go from employers through private insurance companies, it delays the day – probably by decades - by which most people will, of free choice (given cost and quality - see the cost differences in my post above) choose single-payor. Meanwhile, we will be saddled with paying out hundreds of billions of dollars to a system that is broken for people with insurance, no less those without. And we don’t have to, which is why I call Hillary’s plan and, to a lesser extent, Obama’s plan, absurdist.</p>
<p>Nonetheless, even though they stand to gain those hundreds of billions from Obama’s or Hillary’s plans, private insurers would much prefer a program like SCHIP, where they get all the money, without even the acorn of better, cheaper, higher quality alternative without them embedded within.</p>
<p>I believe that “single payor” means that there’s just one administrative mechanism keeping things going. So there are no arguments between insurance companies as to who pays for what, and there’s no trying to “game the system” by having doctors add procedures they never really performed to get more $$, or by having them bill huge amounts in the hopes of being paid small amounts.</p>
<p>I just want to have my necessary care taken care of and paid for, with no hassles.</p>
<p>Cross-posted with Mini.</p>
<p>Barrons -</p>
<p>I congratulate on having very good insurance, at a very good price. I assume you are a shrewd businessperson, and know the value of a dollar.</p>
<p>Now, just suppose, I walked into your office, and offered you, by law, exactly the same minimum package you receive now. You can use exactly the same providers, though if they get backed up for some reason or you don’t like them anymore, I can guarantee you an even wider network. I will further guarantee that the “insurer” will never go out of business, and, further, I will guarantee that if you ever question whether a particular benefit should be covered and paid for, your question will be adjudicated solely by a board of consumers and health care practitioners, never by a profit-motivated pencil-pusher who is paid to delay or deny your care. I will further guarantee to you that you will never ever see a health care practitioner employed by the government, but only practitioners who will compete for your business on solely on the basis of quality. </p>
<p>And, you being the shrewd businessperson that you are, I will sell it to you at a premium of precisely 26.9% of what you currently pay.</p>
<p>Too good to be true? Well, it is EXACTLY what happened to me.</p>
<p>
</p>
<p>In one sentence, you have captured the essence of our health care problem (such that it is). The vast majority of health care dollars are spent on folks in their last year of life. A Very easy (and Happy?) way to reduce those dollars is to NOT spend money on those in their last year of life. hmmm…</p>
<p>Mini only speaks of his family’s coinsurance costs, but has yet to post what the State of Wash pays on his behalf. Until then…</p>
<p>Oh, they pay a lot! However, it’s irrelevant. The point is, my premium (by law) is exactly the same percentage of the total cost as those who choose the Aetna, Kaiser, or Group Health options, and mine is exactly 26.9% of Aetna’s. If everyone moved in that direction, that is a HUGE chunk of change. Everyone is moving in that direction, but slowly - it will take a couple of decades to get there, but I think the end result is a foregone conclusion. When I started working for the state, there were 9 plans - now there are four. Private insurers can’t compete on price; customer satisfaction surveys show they can’t compete on quality. All they can compete on is marketing and advertising.</p>
<p>My wife went to see an endocrinologist today. I went along. They began to discuss possible tests for her thryroid condition. First question from him: “what insurance do you have?” When she said the single payor, there was a big sigh of relief, and then they got down to business. </p>
<p>Of course, we could reduce care. We could reduce coverage. We could reduce quality. But we don’t have to, and we could cover EVERYONE for what we all pay now, and likely at higher quality, because health care practitioners would have to compete. Everyone. None of this absurd $150 billion a year business from Hillary or Obama to load more people into a system that already doesn’t work.</p>