@Zinhead I guess I’d call them realists/pragmatists. Universal healthcare is the only system that they think will work for providing the best care for the most people. Medical professionals can always go concierge or offer voluntary procedures if they want to make more $$. The reality is that certain medical areas (primary care, internists, many OB/GYNs) have already faced reduced income and are seen as less desirable specialties for med school students. Many of the med school slots for those areas are going to foreign students.
I thought lack of time off was a bigger problem for most doctors. I wonder how that would improve under a universal healthcare program.
To lower the cost of health insurance we need to lower the costs of health care.
We need to lower the administrative costs (paperwork) at the doctor office and at the insurance company.
- doctors will not need to have as many support staff
We need to lessen the number of unneeded tests / procedures
We need to decrease the price of pharmaceuticals domestically or allow Rx to be filled in Canada if it meets all us regulations (bring some drugs way down)
Doctors need to make a bit less (not much because they will save on admin costs)
Limit lawyers reasonably to protect patients but not drive up prices
Hospital costs need to be rational (major overhaul)
I am sure there are more areas I didn’t touch on. (And keep the pre-existing clause, and no lifetime limit)
Perhaps if medical school were not so expensive, that could reduce the financial pressures to chase the money that physicians face as they start practicing.
Of course, then that just moves the “how to reduce cost” question to the medical school stage.
The biggest cost savings would come by reducing obesity in this country, through education, through cost incentives etc. Diabetes, cancer, joint and back problems and many other expensive medical issues are often a direct result of obesity.
And freedom.
Everything comes with costs.
The overall problem is we have made very little attempt to change the entire practice of medicine, from provider to insurer, and unless you do that, it will fail to work. Costs are spiralling, have been, for a long time (I debated health care policy in the late 70’s, and it was much the same ills as today). We treat the disease, not the preventative part, we have doctors doing jobs that someone with different training could do, political pressure has kept the use of AI technology out of the medical industry (Michael Crichton claimed many years ago that medical scanners could replace a large part of what doctors routinely do, needless to say it hasn’t happened), we have extended people’s lives without in many cases extended the quality of life, so we have people living much longer, but frail with a big dependence on medicine to keep them alive, rather than making it so they live longer without needing care.
We still don’t know what is and isn’t good nutrition, that which optimizes health (despite claims to the contrary, evidence is that extreme vegetarian diets, for example, don’t necessarily prolong or improve life), every day it seems like it is something new…and what we do know, that for example sugar in the diet is a disaster area, government and industrial policy is such that it actually promotes intake of sugar, or diets rich in the wrong kind of grains, or support for cheap, unhealthy protein (corn fed cattle raised on factor farms, treated with hormones and antibiotics to make them grow fast), you name it. Then, too, there are those who sadly believe, including some influential policy makers, that health care should be a function of how well off you are, that the health care system rather than being evaluated on how it helps the poorest and weakest, is a function of the miracles medicine can do if you are rich enough to pay for it, or fortunate enough…and all that inertia has meant no one has really looked at the whole picture. There are just too many people in the system, with vested interest, to ever rationalize health care, and too few who even try to look at it as a whole and say “what makes the best sense”.
I think smoking is still a larger expense (per CDC), but between the two…
The basic premise is that you contribute to the pool because you, or someone you love, may need it at any time. So, sure, when you’re younger you don’t need it, but you contribute because later on, when you’re older (or perhaps not that long from now if you’re unlucky), you’ll be glad other people compensate for the huge costs incurred by illness. Its most important aspect to me is peace of mind.
To me, it’s just part of belonging to the national community. Just like “you do for family”.
I see the ACA as making us more like a nation with individuals tied to each other, strengthening the social fabric.A kind of pay it forward. The whole basic premise is that we’re all in this together because we’ll all encounter disease, birth, catastrophe. And we all deserve to be safe and sound.
Now, some premiums and deductibles are too high, there are lots of issues that should be improved, deductibles could be income-based, etc. As for public/single payer option, sure, why not add that to the possibilities?
Pre-eisting conditions would be the one that mattered most during a time when I went from one employer to another - those were manipulated and used to deny coverage.
But the ACA only works as a whole - and I agree that the current system is not sustainable, but neither would be/was the previous one, and we’d have millions uninsured on top of it.
To me,the principle is simple but the actual realization is complicated.
(1) Obesity is not the biggest cost driver.
(2) We have no idea how to reduce obesity at a population level!!! Education does not work. Cost incentives do not work. The only thing that has been shown to work, at a population level, is bariatric surgery. (Please do not pipe up about that person you know who has lost a significant amount of weight and kept it off for over two years. Such people exist. You may be one of them. Good for you, but almost no one can lose weight and keep it off.) There is no sense in spending effort to try to urge people to do something almost no one is capable of doing.
Example of “experimental” procedures not being covered: Last fall, I needed an MRI of my knee prior to surgery. I can’t have an MRI because of my defibrillator and stents. Doc ordered a CT scan. Part of the CT scan included 3D modeling (not unlike what would happen in an MRI). Insurance refused to pay for the 3D part, claiming it was experimental. Huh? The CT scan with 3D was CHEAPER than an MRI, the doc’s office said the 3D was considered a normal part of the CT scan, and was the only medically acceptable way for me to have a determinative assessment of my knee injury before I undertook risky surgery. (I’m on three blood thinners, each for a different reason.) The insurance rejected my appeal, but the provider wrote off the 3D cost as a one-time courtesy. There was NOTHING in the plan document that said 3D CT scans were not covered.
My pharmacy provider (CVS/Caremark) sent me a letter in August with a long list of meds that were going off the formulary as of 1/1/17. The only drug left for my leukemia is the generic version of a drug that failed me several years ago and would now cause serious cardiac issues. I now get to file an appeal to see if they’ll cover what I’m currently taking. I can confidently tell you we can’t afford $100k/year for it. And we have a really good plan. Every other plan that’s available also uses CVS/Caremark, so we’re stuck between a rock and a hard place.
I’m on listserves for my illness and there are many international participants. The NHS in England lags behind the US in adding new chemo drugs to their formulary. US patients could get Gleevec years before folks in the UK. US Pharma companies have threatened to shut off production of some meds altogether when pharmaceutical companies in India tried to release more affordable versions of the drug.
Shellfell, we are both terribly paranoid about adequate insurance of all kinds. DH’s employer just had an open window to add additional coverage at work, and he did so – no health questions, though it won’t be in effect for another year. However, it provides me more cash for medical premiums/expenses (which is the major risk exposure in our financial picture) if anything were to happen to him. I know I am extremely fortunate, but live with the knowledge that my medical bills would cover a lot of primary care for a lot of people.
I also have a brother with inoperable Stage 4b who has no insurance; he lives in a state that didn’t expand Medicaid (so he can’t get that) and the only ACA option comes with a $6700 deductible. No can do on $1500/mo in SSDI. He didn’t qualify for ACA subsidies until SSDI kicked in because he had no income, but he can’t afford the deductible and copays, either. He lost his medical coverage when his business went under in 2008, so by the time he couldn’t swallow, the cancer was inoperable. He is now dependent on charity care for his treatment. Hell of a price to pay for all that smoking and drinking.
CountingDown, we aren’t happy about what we have to pay for premiums and deductible, but we have the money to do it. I feel for those who don’t have the financial resources to do so. And I keep my fingers crossed that neither DH nor I get sick.
Folks are incapable of walking for 30 minutes daily/a few times per week?
30 minute daily walking is not going to help someone who is obese, so let’s not turn this into a debate on exercise and dieting. Just want to point that the problem is so much more complex than exercise and calorie counting. Obesity comes hand in hand with being lower socioeconomic class. Unlike fresh produce and lean meats, carbs are cheap and they store well, try telling someone who depends on food banks for their meals to eat healthier:…
My son uses a food pantry and has been surprised at the variety of food. He’s not having trouble eating healthy. Even though he’s ill, he still has the disciple he did as a distance runner in high school, so he’s kept his weight in check - not a small feat on the meds he’s taking.
I guess my wish would be that we could pay reasonable rates for catastrophic insurance. Our deductible right now is $6,000/person. If we could increase that to $10,000 and pay half the premium, I would be happier. To pay as much as we are and still have a high deductible is what galls me.
ML, count your blessings that your son has access to good food AND knows something about nutrition.
BB, right! I DO think about all the people who don’t have good support systems in place. His case manager drives him to the food pantry. He couldn’t get there, otherwise. 
The state has a transportation company it uses for people like my son, but it’s undependable and stresses him out. And we’ve learned that stress puts him over the edge.
We have a giant experiment going on. We have many millions of people who are obese in our country, and we have barraged them with reasons to lose weight. They are shamed mercilessly, as a group and individually. For many people, obesity is a clear hindrance-- they are more out of breath when they try to do things, they have trouble finding pretty clothes and so forth. And yet, despite all of this, virtually nobody who is obese succeeds at becoming not obese and staying not obese. If virtually nobody can do it, why are we pretending it’s a choice?
Let’s look at the TV show The Biggest Loser. No policy you come up with for weight loss will be better than what the biggest losers did: they have personal trainers and dietitians, they have people whose job it is to make them lose weight. And yet, two years later, almost all have gained back their weight. If they can’t do it, who is going to be able to do it?
I’m only interested in policies that work, and you should be too. At a population level, telling obese people to lose weight is a big failure. Do not advocate policies that are proven failures.
I suppose the best we can do as a country is to prevent obesity in the young, because once a person is obese it is very difficult to go back to a healthy weight.