health insurance bill

[2manyrocks]

Most people seem to like the fact that the health care bill disallows the use of pre-existing conditions to deny coverage. I think it would be fair to say that most think this is the best part of the bill.
l.

One negative effect is that those who are uninsurable because of effects of past drug abuse or other moral hazard behaviors can now be covered by insurance, and the insurance companies have to find ways to pass the costs of their medical treatment onto the "pool."

 

[canoetrpr]

One negative effect is that those who are uninsurable because of effects of past drug abuse or other moral hazard behaviors can now be covered by insurance, and the insurance companies have to find ways to pass the costs of their medical treatment onto the "pool."

Very true. That said, I don't think the numbers are as nearly as large as lots of other preexisting conditions - hypertension, acid reflux, back pain etc. that are really beyond most of our control and tend to affect many many of us as we age.

The problem with leaving any loophole for the insurer is that it being a private enterprise whose goal is to make a profit, will do its best to find a way to get out of paying for eventual health problems that may even be remotely related to whatever the pre-existing condition / past drug use / moral hazard was. The insurance companies are not daemons. They are simply businesses and do what businesses do best and try to make a the most for their shareholders.

Just my $0.02 CND (and it is worth quite a bit these days!)

 

[2manyrocks]

Does anyone know the number of truly "uninsurables" in the 30 million that are supposedly going to be added or have any idea of what it will actually cost to provide their medical care?

Aren't the uninsurable those at the ends of the statistical bell curve for which there aren't that many in number, but for whom the costs of treatment are, by conventional thought, unaffordable. But with malpractice being what it is, and now having access to insurance, now healthcare providers are going to have to do whatever it takes to provide healthcare at whatever it costs?

If I have a health plan that has comparatively low rates now because the insurance company has done a good job of screening risks, what happens to my rates when the insurance company can't screen risks any longer? Will I be able to afford insurance coverage?

What if my insurance company, because of its low rates, has an influx of coverage it can't deny that results in a disproportionate number of claims and expense causing it to become insolvent? What happened to the coverage I've been paying for? What do I do then?

If I am a large employer in the US and I'm faced with increasing employee costs, including increasing health care costs, why shouldn't I outsource manufacturing to China where I don't have to pay for them?

 

[dave1949]

If I have a health plan that has comparatively low rates now because the insurance company has done a good job of screening risks, what happens to my rates when the insurance company can't screen risks any longer? Will I be able to afford insurance coverage?

What happens now to the people who are screened out? They get treated for the most part. Except, since they were screened out, they didn't pay any insurance cost like you did. It gets paid for somehow by all taxpayers and/or insurance rate payers.

Your question is based on the assumption that a person should enjoy low insurance costs if their risks are low. How far are you willing to take that in principle? For example, a low risk man and his low risk wife can bear very high risk children. Then what? Or, you may be exposed to something that causes a chronic condition years after the fact, how is your risk determined? Do we kick you to curb now that you are a poor risk?

The fact that companies off-shore when possible is just a race to the bottom, that hasn't changed. They don't have a lot left to move to China by now, do they? The real irony is the Indian radiologist who reads your X-ray/MRI/etc. remotely from his office in India.

Dave.

 

[canoetrpr]

2manyrocks, I found this excellent breakdown of who the uninsured are. It dosen't completely answer your question completely bit it is worth reading. The article is written by a former Bush staffer who has some detailed background into some of this data.

This seems to suggest (at least to me) that only a portion of the uninsured are may even be in the category of 'uninsurable'. I'd say that the 10 or so % that are below 300% of the poverty level are simply cannot afford it. 300% of the poverty level is still not a very high number so there may well be a lot in the 10% that are over the 300% of the poverty level may not be able to afford health insurance either.

Your point is perfectly valid about a possible rise in premiums to cover those with preexisting conditions that are not covered today. I suspect that many of these are insured but exempt from coverage for certain things. I think the counterpoint is that the mandate for everyone to have cover (including those that are healthy) will offset the increased cost of providing coverage for preexisting conditions.

I think it will simply take some time to figure out how premiums are affected by this new reality.

On the China thing, there is more than just healthcare that is causing the movement of manufacturing jobs there. It is certainly a non trivial part of it. Over time, I expect the Chinese will have to start providing social services (they are already seeing the pressure) like social security and health care. The beef I have about the Chinese is that their markets are no where near open to us as ours are to them. Additionally the fixed and undervalued yuan is causing significant distortions in the trade balance.

 

[Dennisfly]

So, the bill hires over 15000 new IRS agents and auditors and not one doctor. It puts student loans under government control and puts private student loan companies out of business. Read the bill. This is what it says. How does this relate to health care?

It doesn't speak at all to tort reform or allowing competition across state boundries, both of which would significantly lower costs.

This is not about health care. It is about government control and wealth redistribution. Wake up people!!!

 

[dave1949]

So, the bill hires over 15000 new IRS agents and auditors and not one doctor. It puts student loans under government control and puts private student loan companies out of business. Read the bill. This is what it says. How does this relate to health care?

It doesn't speak at all to tort reform or allowing competition across state boundries, both of which would significantly lower costs.

This is not about health care. It is about government control and wealth redistribution. Wake up people!!!

Those private student loan companies are making loans guaranteed by the US taxpayer at no risk to the loan company. It's good work if you can get it.
Dave.

 

[LostInTheWoods]

Lost, you are a gentleman to debate/discuss with.

Likewise.

Too many people get lost in all the rhetoric and are unwilling to debate the actual issues.

Unfortunately, that is the standard and not the exception. As you likely know, we have two main political parties here. Bad and Worse. Even the party we have which one would most associate with Peace, Love, and Happiness is rife with intolerance and insular thought. All the more galling because they loudly proclaim their progressiveness. All's peachy unless, of course, you're not toeing the party line. Its opposition tends to be little better.

We have a very very different health care system in Canada from what you have in America. It is completely a single payer system, otherwise known as 'socialist'

I could handle socialism. Or communism. Or any of the other -isms. If I thought they worked as well as CAPITAL-ism and democracy. They tend to look great on paper, but fail (often miserably) in practice. Yes, I know the -isms are already at work in the USA, and have been for a very long time. We are not a true democracy, and that's OK with me. So long as we keep what works, and jettison what doesn't.

Most people seem to like the fact that the health care bill disallows the use of pre-existing conditions to deny coverage. I think it would be fair to say that most think this is the best part of the bill.

The requirement to purchase healthcare (individual mandate) is least liked as it takes away the freedom for one to have the individual freedom to decide whether they would like to have it or not.

What I don't think has been communicated effectively is that you cannot have one without the other...

Some would argue that alone is reason enough not to pass this bill. I don't necessarily count myself in that group, but it does trouble me.

If insurance companies are no longer allowed to deny coverage for pre-existing conditions, then there is no point for any one to get insurance until they actually get sick enough to need it. It is much cheaper to pay for regular doctors visits, the odd treatment and so on. When you need insurance is when you have a condition that is going to cost a lot of money.

Besides, there are ways I think you could work around that problem. You could make it available only in "blocks" of time. You want in, great, but you're locked in for 5 years at a time. So no getting that bypass surgery, and then cancelling your plan. Smarter folks than I could probably think of even more workarounds to this problem.

Each province administers its own public health insurance system. Doctors, X ray clinics, pathology labs etc. are private operations which simply bill the province's health insurance when you need their services. In Ontario, the public insurance is called OHIP (Ontario Health Insurance Plan).

"Administers?" Smells like beurocracy. Which begets waste, increases hassle, runs up cost, and generally upsets my digestive tract. From my experience, the things "administered" by the government have been poor cousins to their closest "real world" counterparts. Poor in respest to their effectiveness, not necessarily cost. Perhaps they have been more successful in Canada?

Do you have any means of independent confirmation that the Canadian system has been successful at delievering on its promises? That the populace, as a whole is happy or unhappy with healthcare there?

One very key difference between our systems is that in Canada you cannot as a patient decide to go see a specialist. You must be referred by your family doctor. Consequently, in Canada the ratio of of GPs to specialists is 3:1

Some plans here are the same. Or at least, have been in the past. Required a visit to your primary care provider as a "doorkeeper" before you could see a specialist. The downside is it might actually increase the overall cost in some cases. For example, if you have a hernia, who else would fix it other than a surgeon. Yet, you still must see the primary provider for "clearance" to see the surgeon.

Do you have any information as to whether the physicians there are happy with their chosen career and the system of healthcare?

 

[canoetrpr]

"Administers?" Smells like beurocracy. Which begets waste, increases hassle, runs up cost, and generally upsets my digestive tract. From my experience, the things "administered" by the government have been poor cousins to their closest "real world" counterparts. Poor in respest to their effectiveness, not necessarily cost. Perhaps they have been more successful in Canada?

Do you have any means of independent confirmation that the Canadian system has been successful at delievering on its promises? That the populace, as a whole is happy or unhappy with healthcare there?

OHIP is fairly straightfoward. You go to a health care provider (doctor, hospital, E.R.), they bill OHIP directly. OHIP pays the bill. You don't have to be pre-approved for procedures that your doctor GP/specialist asks for. In that sense, it is not bureaucratic. I frankly don't know what the experience is at the doctor's end. The bureaucracy might well show up at their end of the experience.

OHIP openly lists what is covered and what is not. You are free to purchase additional insurance for things above the basic healthcare that OHIP provides, or pay for it e.g. no chiropractic care is provided, if you are hospitalized, basic OHIP care is for a ward room that you share etc. etc. OHIP sets rates of remuneration for procedures and visits. On balance, our doctors make a lot less money than your doctors. A good friend of mine is an accountant. He has about 10 GPs that are his clients. He says on average they make $300000 per year. Specialists make $800000 to $1000000 a year. Based on these figures, I would say they are not underpaid.

Yes there are wait times for things. My wife just had an MRI done on her knee. It was three weeks after the doctor asked for it. It was not an emergency. I don't consider it unreasonable. If you needed one for in case of an emergency, you would get one right away. I have been in hospital for a 4 week stretch. Hospital care was good - not excellent but it was good. On average, a really good private insurance plan in the USA would be far better than being treated in the single payer system. However our system is designed to provide a basic level of care to everyone. If you can afford more, you can pay the extra for a private room, etc. What you can't pay extra for is to jump the queue - that is determined by urgency of the situation.

We do have pockets of pretty serious problems. In some areas, there is a shortage of GPs and so people don't have a family doctor and have to go into a walk in clinic.

On the plus side, basic coverage exists for everyone. If you need heart surgery, you get it. If you want a tummy tuck - then its on your tab .

Here is an interesting link to a poll done by gallup on satisfaction with the health care systems in the USA, UK and Canada. Of course not all is evident from a single poll but I thought it made interesting reading.

Anecdotally, you would be hard pressed to find too many people here that that would want something fundamentally different than the publically funded system we have. It is very much cherished. We don't have to give health coverage a second thought when it comes to changing jobs or considering to become self employed, or if you lose a job. At times it works against us as it can become a bit of a religion as well and can prevent reasonable debate about how best to have health care delivered. On balance, I would say it is a relatively decent system that does need improvements. I would like to see an approach that is more customer oriented. I don't like the fact that the nurse staff are unionized and thus the best ones get pay raises equal to the worst. I'd like to see more private delivery of health care through the public system i.e. more for-profit hospitals, MRI clincs etc. There is nothing that prevents this as X Ray, Ultra sound clinics are privately run but the bill is sent to OHIP and OHIP pays for them so long as your doctor asked for the procedure. I'd like to see hospitals compete with each other and I believe that they will do this best if they are for profit institutions. The funding rates can continue to be set by OHIP. Procedures can still be paid for by the public insurance plan.

Neither system is perfect.

 

[wingerT]

Just look at Massachusetts, there was an article in the paper that i have on April 11th, we are in for one wild ride in the years to come, it was in the commentary section, by rich lowry of the national review. I hope i'm not around by then.

 

[mjarrels]

Scary thing is that this bill was wrote by staffers... No elected officals wrote this 2000 plus bill. Saw some thing the other day that many staffers earn more money than the elected officals do. My clerk of the court (120.000 income) is a prior district 6 congressman staffer who will probably be feed of the public for his entire life.

mark

 

[LostInTheWoods]

OHIP is fairly straightfoward. You go to a health care provider (doctor, hospital, E.R.), they bill OHIP directly. OHIP pays the bill. You don't have to be pre-approved for procedures that your doctor GP/specialist asks for. In that sense, it is not bureaucratic. I frankly don't know what the experience is at the doctor's end. The bureaucracy might well show up at their end of the experience.

I like simplicity for the consumer. Go in, get your service, go home. A certain amount of bureaucracy on the provider's end is acceptable. So long as it is not too cumbersome.

OHIP openly lists what is covered and what is not. You are free to purchase additional insurance for things above the basic healthcare that OHIP provides, or pay for it e.g. no chiropractic care is provided, if you are hospitalized, basic OHIP care is for a ward room that you share etc. etc. OHIP sets rates of remuneration for procedures and visits

This would boil down to just how "basic" the basic healthcare is. If it covers the vast majority of what is commonly needed in delivering quality healthcare, then I would argue its acceptable.

Typically, most insurance here will net you a roomie during hospital stays, unless ,as examples, you have a highly communicable disease, or are there for labor and delivery. I think this is perfectly acceptable.

I am assuming there's no outcry from physicians about the rates of remuneration. So far, so good.

On balance, our doctors make a lot less money than your doctors. A good friend of mine is an accountant. He has about 10 GPs that are his clients. He says on average they make $300000 per year. Specialists make $800000 to $1000000 a year. Based on these figures, I would say they are not underpaid.

I'm not sure what the exchange rates are these days, but the numbers you're quoting are way more than average physician pay here. To the tune of 30-50%. If these numbers are acorrect, you may have to teach me how to sing O Canada!

Unless the cost of living is dramatically higher in Canada, I don't know how those numbers could be accurate.

Yes there are wait times for things. My wife just had an MRI done on her knee. It was three weeks after the doctor asked for it. It was not an emergency. I don't consider it unreasonable.

Nor would I, for the majority of cases. While true, if you need an MRI in my area, I could probably get you seen for a non-emergent one within 72 hours (and an emergent one instantly). What if your injury were severe enough to keep you on crutches and prevent you from working on an assembly line, but not urgent enough to avoid the three week wait?

On the plus side, basic coverage exists for everyone. If you need heart surgery, you get it. If you want a tummy tuck - then its on your tab .

Good luck finding an insurance plan here that covers cosmetic surgery. Unless, that is, it is required to restore function after burns/trauma/etc. Would the Canadian system provide cosmetic surgery in cases like this, or would that exceed "basic" care?

On balance, I would say it is a relatively decent system that does need improvements. I would like to see an approach that is more customer oriented. I don't like the fact that the nurse staff are unionized and thus the best ones get pay raises equal to the worst. I'd like to see more private delivery of health care through the public system i.e. more for-profit hospitals, MRI clincs etc. There is nothing that prevents this as X Ray, Ultra sound clinics are privately run but the bill is sent to OHIP and OHIP pays for them so long as your doctor asked for the procedure. I'd like to see hospitals compete with each other and I believe that they will do this best if they are for profit institutions. The funding rates can continue to be set by OHIP. Procedures can still be paid for by the public insurance plan.

I'm not sure what you mean by "customer oriented". Are you saying that when being treated you essentially feel like "just another number"?

As far as unions, well, it's a lot like healthcare, there's good and bad. Part of the bad is, yes, you see the bad rewarded with the good. I don't think I can go down that path without grossly violating the site's rules, so, let's just say I know what you're saying.

 

[turbo36]

canoetrpr, lostinthewoods, Just want to say I'm really enjoying the discussions going on here, a very refreshing change from the normal name calling and "out-rage" statements. :thumbsup:

 

[2manyrocks]

The problem with leaving any loophole for the insurer is that it being a private enterprise whose goal is to make a profit, will do its best to find a way to get out of paying for eventual health problems that may even be remotely related to whatever the pre-existing condition / past drug use / moral hazard was. The insurance companies are not daemons. They are simply businesses and do what businesses do best and try to make a the most for their shareholders.

Just my $0.02 CND (and it is worth quite a bit these days!)

So what happens under the bill to treatments that were considered "experimental" and not usual, customary and reasonable under most insurance plans? If they have to cover all prexisting conditions, what treatment do they have to provide?

 

[canoetrpr]

So what happens under the bill to treatments that were considered "experimental" and not usual, customary and reasonable under most insurance plans? If they have to cover all prexisting conditions, what treatment do they have to provide?

2manyrocks, that is an excellent point. Here in Canada, we often find that the basic public health insurance will not cover every "experimental" treatment. There were some cases where very expensive pills could extend a persons lifespan by several months/years when they had a terminal form of cancer, and not all of those are covered.

I think that the business of what happens with such treatments is orthogonal to your present legislation for the most part. Although it might expedite the eventuality of 'rationing' and generate the reasonable debate that needs to be had. Reality is that we will not all be able to be kept alive no matter what the cost. Problem is that when we are individually affected, or our loved ones are, we will want every treatment that is available. It is a very difficult discussion.

 

[LostInTheWoods]

canoetrpr, lostinthewoods, Just want to say I'm really enjoying the discussions going on here, a very refreshing change from the normal name calling and "out-rage" statements. :thumbsup:

Name-calling and demagoguery have been all too evident in politics. For my entire adult life, I have seen it displayed from all angles. To a point, it is understandable. Often, its just a visceral response to something that doesn't feel right. And when you see your elected officials involved in scandal after scandal, repetitively engaging in the egregious mishandling of other people's money...well, I can see where they're coming from.

Take this guy, for example: FOXNews.com - Teacher Who Sought to 'Demolish' Tea Party Placed on Leave From School

I think I covered this before. You can't argue your point logically? Try villainizing.

But how does this really help your country, and by extension, yourself?

I've learned many lessons in life. One of the hardest lessons to learn is to not cut off your nose to spite your face. What if what the other guy is proposing really is better? There are a few areas where there's really no room to compromise. Abortion, for example (And no, I'm not arguing for or against abortion. And no, I don't want to discuss abortion in any detail).

But healthcare is not one of those areas.

 

[LostInTheWoods]

2manyrocks, that is an excellent point. Here in Canada, we often find that the basic public health insurance will not cover every "experimental" treatment. There were some cases where very expensive pills could extend a persons lifespan by several months/years when they had a terminal form of cancer, and not all of those are covered.

Um, just how many months or years does one need to be prepared to forgo for the "greater good"?

Is this situational?

"Mrs. Johnson, you're 83 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

Vs.

"Mrs. Johnson, you're 38 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

 

[canoetrpr]

I'm not sure what the exchange rates are these days, but the numbers you're quoting are way more than average physician pay here. To the tune of 30-50%. If these numbers are acorrect, you may have to teach me how to sing O Canada!

Unless the cost of living is dramatically higher in Canada, I don't know how those numbers could be accurate.

Hmm. I was quite sure those numbers were correct. I'm meeting with my accountant buddy this week so I will double check with him. To be honest I am quite surprised if the average physician makes less than this in the USA.

What if your injury were severe enough to keep you on crutches and prevent you from working on an assembly line, but not urgent enough to avoid the three week wait?

I think things get murky here and I believe that these are the kind of reasons why people believe it is unacceptable to have as long as a 3 week wait. That said, most employers will accommodate you through some sort of a short term disability plan. If you are a tradesperson, or a contractor working on your own, a 3 week wait would be terribly hard on you. Here I'd be inclined to pay the cash and get an MRI done outside the system - which can be had.

Good luck finding an insurance plan here that covers cosmetic surgery. Unless, that is, it is required to restore function after burns/trauma/etc. Would the Canadian system provide cosmetic surgery in cases like this, or would that exceed "basic" care?

Yes the system would cover cosmetic surgery in cases like this.

I'm not sure what you mean by "customer oriented". Are you saying that when being treated you essentially feel like "just another number"?.

Yes there are times where you feel like a bit of a number. Depends a lot on your provider of healthcare. Not always. This is a bit union related as well and perhaps I am mixing my perception up a bit based on that. I would like patients to be asked to evaluate the care that they receive from their nurses, and for the nurses to be remunerated based on those patient evaluations. The nurse's union isn't going to be doing that. As a result in my hospital stay, I found a range of nurses. Some were simply fantastic. Others were terrible.

We have a big debate here on whether providers of healthcare (like hospitals and MRI clincs, basic outpatient procedures) should be allowed to be for profit. It is a no brainer to me. The public insurance plan should not care about how the services are delivered. They should have the freedom to set the rates and if a private clinic can provide it with the appropriate quality of care, then they should be allowed to do so and the patient should decide where they want to go for their treatment.

The counterpoint that the 'socialists' use to allowing 'for-profit' surgery clincs etc. is they will tend to suck the most profitable parts of a publicly run hospital's business (e.g. basic outpatient procedures like knee replacement, etc .etc.) and the complex and non-profitable stuff will be left with the publicly / not for profit run hospitals.

I also support a two tier system where people can pay more to avoid longer wait times for non emergency procedures. This is also not supported by the majority of the population here I believe. They have a valid point of view - I'm not debating that they don't. The biggest fear about allowing this is that it is a slippery slope which will result in the so called 'rich' to get better care then 'the rest of us'. The reality is that we already have a two tier system. The USA (and India and other countries who allow these services to be offered for profit) are already our second tier. If you need a procedure done pronto, and the wait list to get it done is too long for you, you can get it done in the USA or India - and some people do. The expenses to do this sort of thing are very high and so it is only the very well off that can afford it.

I don't get too upset as a result if some politician or someone else went to the USA for a procedure. They decided that they needed it badly enough, quicker than the public system could provide and they were willing to pay for it. That does not mean that the public system does not work for most of us. There are of course areas from time to time where the wait list might be ridiculous for the procedure and if it is not fixed in a reasonable amount of time, governments get voted out.

 

[LostInTheWoods]

2manyrocks, that is an excellent point. Here in Canada, we often find that the basic public health insurance will not cover every "experimental" treatment. There were some cases where very expensive pills could extend a persons lifespan by several months/years when they had a terminal form of cancer, and not all of those are covered.

Another problem with that is that the wealthy...say, oh, I don't know, your average politician...aren't much worried by that little caveat, are they? Things get bad, we'll just go wherever we need to and pay cash.

 

[canoetrpr]

Um, just how many months or years does one need to be prepared to forgo for the "greater good"?

Is this situational?

"Mrs. Johnson, you're 83 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

Vs.

"Mrs. Johnson, you're 38 years old today, but I hate to bear bad news. You have cancer and you likely have only a few months to live. There's an expensive new treatment across the border that shows a lot of promise. You'd likely live another five years with that, but..."

To be honest I don't know the exact details on the cases I was telling you about. That said I think these are exactly the difficult conversations that we are all going to have to be willing to have.

I don't think this is only related to a publicly funded system. The availability of new health procedures and drugs is going to get us to a point such that if you would want to have access to every single procedure out there, no matter the cost or the probability of success, you would have to pay your whole income and perhaps more to be able to afford insurance that could provide it.

All systems are going to have to set a 'reasonable' bar as to what treatments they will pay for and what they will not pay for. What is considered 'reasonable' is well.... a tough call. Suffice it to say that if a pill costs a billion dollars a month and will extend your lifespan from 'you've got six months to live' to you can live to 85, no healthcare system could afford that. The entire economy would just be healthcare otherwise.