General chatter - Health Care Reform




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georgiad
09-04-2009, 05:07 PM
Hey,

As a British politics student with an interest in health care, and with a course this year on US Government, I'm really interested in what's going on right now in the US regarding Obama's health care reform.

Now I don't want this to turn into a big rage topic, I'm just curious to people's opinions and their justifications for those opinions.

That said, however, being British, I am ever so slightly biased. I and the people I know (and as far as I'm aware, the vast majority of the British/European population) are kind of baffled by the seemingly bizarre response the US seems to have had by Obama's plans to introduce free healthcare for 46m US citizens.

I live in a country where nearly 65m people are offered free healthcare, and it appears to me to me fantastic free healthcare. I do owe my life to the NHS, and can't imagine how different/worse my health would be if I had to pay for it.

Anyway, I'm interested to hear what people think about this as I research the ins and outs of what's really going on in America. Most of us on this site either are or were overweight, which is typically thought of as a 'health issue' and I know that some people on here have had issues with insurance things, so I wonder whether people welcome this reform, and the possibility of not having to worry about this anymore?


Shannon in ATL
09-04-2009, 05:32 PM
IMO, The American healthcare system is broken, from top to bottom. Something has to change, somewhere. I personally find it abhorrent to hear people talk about how health care is not a right, or to say things like "the system works for me, why does it need to change?" Which I've heard more than once.

I work in HR in the restaurant industry - I have 600 employees, only 50 on our health insurance. Of those 50, none of the line employees can afford to cover spouse or children. And, we pay 90% of the employee premium, more than a lot of other places in the industry. The renewals kill us every year. This year we received a quote for a 20% increase based on our estimated usage for next year. Estimated usage for the coming year, not actual use for the plan year ending. We had to raise the deductible and copay to keep it to only a 5% increase. And our utilization for the ending plan year was only 72%. The insurance company collected 28% of our premiums in straight profit and still raised our rates. Insane.

So many people are uninsured or under insured. I welcome health care reform.

sharongracepjs
09-04-2009, 05:47 PM
I agree. Having been raised very conservative, and over the past couple years moving to a more moderate/centrist position, I can testify that many conservatives have a knee-jerk reaction to oppose anything government-run as socialistic, biasing themselves against an actual plan before fully considering why it's needed, how it's designed, etc. This response is often in part inspired by religiously motivated concerns about erosion of freedoms - understandable, but also divisive, as each side starts looking for buzzwords in each other's positions, and getting more caught up in being "right" than in finding solutions. It's disheartening to sit in the middle, see merit on both sides (even when I agree with one over the other, I believe there are usually sincere motives and valid logic on each side) and be hated by both. Unfortunately, the crankiest, weirdest and most extreme opinions are usually loudest and seem to carry more sway.

That being said...I haven't had health care coverage since I graduated from college and became ineligible for my parents. In fact, I could count on one hand my friends and classmates who have effective coverage. While I'm not sure if I entirely support every practical detail of the Obama plan, I am grateful that he and some of the lawmakers are acknowledging this grave issue and attempting a solution. And at this point, I feel that the lesser evil is to accept it, though it is imperfect, rather than reject it and leave millions uncared for.

I have yet to find an Obamacare opponent who doesn't have coverage, or one who has an alternative to propose other than, "well, I'm covered and I want to keep what I've got!" - it's hard to understand the dire need until you're trapped in it.

This is an interesting discussion. Thanks for starting it! I hope we can all stay friendlier than my Facebook newsfeed seems to be :)


sharongracepjs
09-04-2009, 05:52 PM
and by the way, Georgiad, I'm so interested to hear that you have a positive opinion of your nationalized healthcare - all we seem to hear over here is how inefficient it is and how many people have to wait so long for inadequate healthcare (to which I say, isn't a long wait for poor care better than...instant non-existent care?! :p )

Windchime
09-04-2009, 05:54 PM
I welcome it as well. I know personally of someone who works full time but only earns $15/hour. That's apparently considered "rich" by the government, because he earns too much money to qualify for reduced-rate services or the state health care plan that is supposed to serve the working poor. But he doesn't earn enough to pay exhorbitant premiums on a private plan. There are lots and lots of people in this situation; one broken limb could send them to the poorhouse. Something needs to change!

On the other hand, I saw our friend cfmama languish for months with a painful gallbladder because of the red tape in the Canadian healthcare system. There is no way that a patient (covered or not covered) would have to wait for months like that in the US. So I wouldn't want that built into our healthcare system.

Something must be done, but I'm not sure if government-run healthcare is the answer. I work in a medical facility and a good percentage of our patient population has Medicare, which is the government plan for senior citizens. We don't make any profit at all on those patients, so if all our patients were covered like that, we would most likely go out of business which would leave a huge region in my state without medical care.

It's complicated. But I agree with Shannon, that the attitude of many Americans ("I've got mine; so we don't need reform!") is deplorable. When you think about it, it's kind of barbaric. Emergencies get treated for everyone (supposedly), but my guess is that a ton of poor people go without getting mammograms, treatment for chronic conditions like diabetes, etc. Something needs to be done; I'm just not sure what or how.

caryesings
09-04-2009, 06:08 PM
On the other hand, I saw our friend cfmama languish for months with a painful gallbladder because of the red tape in the Canadian healthcare system. There is no way that a patient (covered or not covered) would have to wait for months like that in the US. So I wouldn't want that built into our healthcare system.



US Citizen here responding -

While I only had to wait 10 days after my emergency room trip for Gallstones, I have 2 friends here who had to wait more than 1 year because their insurance companies would not approve gall bladder removal due to no visible stones. So I get a bit annoyed when I hear "our government" is going to deny healthcare. Insurance companies already are when they can get away with it.

sharongracepjs
09-04-2009, 06:24 PM
Excellent point, caryesings! Private insurance companies can make your life more miserable than your ailment did, with their non-medicinal bases for approving or denying care.

And Windchime - everyone gets treated for emergencies supposedly...but my friends, relatives and acquaintances will wait until a limb has fallen right off to go in for it, out of fear of the crushing bills after the fact.

Long story short - maybe government healthcare isn't THE answer...but it is AN answer. Let's at least be spurred on to find more solutions, rather than paranoidly shooting down this one and going back to the failing status quo!

TXJess
09-04-2009, 07:00 PM
While I do have excellent coverage (I chose a much lower paying job that had stellar benefits and very helpful insurance company representatives), I do think aspects of the system are not functioning as well as they should.

I do not think the government should run or control it however. I have not read the plan in depth enough to say whether I think they are or not. Just if that's where it's going, I would be very apprehensive. I've already had to deal with VA hospitals/"care" and it was just... beyond awful.

I won't get in too deep because... well, my beliefs and ideals piss people off in general (from both sides) and I don't think it would be appropriate for the forums. I just wanted to give my small 2 cents on having had experience with VA.

We'll see how it all plays out though.

jelder227
09-04-2009, 07:02 PM
I have yet to find an Obamacare opponent who doesn't have coverage, or one who has an alternative to propose other than, "well, I'm covered and I want to keep what I've got!" - it's hard to understand the dire need until you're trapped in it.

Meet your first - I've been covered for about 2 years out of the last 15. And haven't been since very shortly after my son was born, 5 years ago.

We are very middle income, but my husband's income fluctuates wildly making us reluctant to commit to monthly premiums. That large monthly commitment is really scary for the 4 or 5 months a year that we are frequently on one income.

Also, I haven't heard any offers for free healthcare. I've heard lots of plans to get more people covered by healthcare, but someone will pay for it. Unfortunately, my income group tends to bear the brunt of the tax burden and increases. We also tend to not qualify for much in the way of "assistance".

I've heard people say that it should be mandatory for employers to ensure their employees are covered. Insurance is expensive - incomes will be reduced or people will be laid off to compensate.

I just haven't heard a good solution - find me one that really isn't going to cost me a fortune (when I'm already living more check-to-check than I'd like) and I'll get behind it!

Mainah
09-04-2009, 07:37 PM
I am concerned about why we are not hearing more about Insurance Company Reform. Either as part of the Health Care Reform plan, or just on it's own. Insurance companies (and their higher ranking management) are making millions, even billions, in annual profits. I would like to see them cut their profits and offer more affordable coverage to working individuals.

Along the same lines of what Windchime said about Medicare, many hospitals and healthcare providers accept lower payments from private insurance companies to keep their "preferred provider" status. I think the general public doesn't really know/understand that if they have a bill for $2000, their insurance company does NOT pay the hospital $2000. It is almost always less, and the balance cannot be billed to the patient so the hospital writes it off (basically eats the difference).

So...our insurance companies are collecting outrageous premiums AND paying hospitals/providers less than what they are billed. That's quite a profit they are turning.

ddc
09-04-2009, 07:40 PM
Does anyone know what is even in the Obamacare plan?
Got a link??

I've just heard alot of rumor and speculation and not about what is really in the plan?
Is there a plan?????

cbmare
09-04-2009, 07:45 PM
Look at what every single political critter in Washington does to Medicare AND Medical. They dip into the funds to put that money towards other projects that have absolutely nothing to do with healthcare. Everyone of them are guilty of it. My fear is that they will start tapping into the healthcare fund for other things and it will be facing the problems that plague Medicare.

We've got to make these critters be responsible for doing the right thing and leaving those funds alone.

Social Security is another of their dipping pools.

I am, however, afraid of all the horror stories we've heard about having to wait for cancer treatment and the like.

At least we can challenge insurance companies and at times we may have to go to the press to embarass them, but at least it isn't a political critter who cares even less than the insurance company.

cbmare
09-04-2009, 07:48 PM
I am concerned about why we are not hearing more about Insurance Company Reform. Either as part of the Health Care Reform plan, or just on it's own. Insurance companies (and their higher ranking management) are making millions, even billions, in annual profits. I would like to see them cut their profits and offer more affordable coverage to working individuals.

Along the same lines of what Windchime said about Medicare, many hospitals and healthcare providers accept lower payments from private insurance companies to keep their "preferred provider" status. I think the general public doesn't really know/understand that if they have a bill for $2000, their insurance company does NOT pay the hospital $2000. It is almost always less, and the balance cannot be billed to the patient so the hospital writes it off (basically eats the difference).

So...our insurance companies are collecting outrageous premiums AND paying hospitals/providers less than what they are billed. That's quite a profit they are turning.


You got that right! It is also difficult to negotiate with the hospital and certain doctors if you want to pay for your treatment. They seem to think it is OK to expect Suzie Somebody to pay that $2K while trying to support her children but give the crooks at Blue Cross all the breaks.

georgiad
09-04-2009, 07:52 PM
Man, I can't believe how interesting these replies have been, primarily because we haven't yet encountered a real opponent. Over here we've been bombarded with 'crazy Americans don't want free healthcare: WTH?' and stories and comments from Sarah Palin, Glenn Beck etc., probably because it seems so strange, maybe much like shannongracepjs mentioned that she's only heard bad things about nationalised health care, because it might seem strange to Americans.

Put it this way. Almost 4 years ago I had a really bad pain in my leg, swelling etc. which turned out to be a blood clot and a pulmonary embolism. When I went into hospital, I was informed that I had been twelve hours away from death without treatment. If I would have had to pay to go into hospital, I'm pretty sure I would have waited it out at least twelve hours.

Similarly, I was reading an American magazine a few weeks ago that was talking about how people have been switching birth control to save money, or ditching it altogether, a strange concept to someone who is able to choose whatever birth control she wants (from condoms, to the pill, to depo provera, to Implanon, which is what I had) without spending a penny.

As for cancer treatment etc., I'm very fortunate that neither I nor a close family member or friend has had to go through such a thing (touch wood) but the NHS does compulsory screening for various conditions (including smear tests from 20, mammograms from 40 I think) and as far as I'm aware, cancer treatment is thorough and quick, and I've never heard of anyone waiting for cancer treatment. One thing which has made the news is people wanting experimental but potentially life-prolonging anti-cancer drugs which are too expensive to be put onto the NHS, and those people having to go private to pay for their drugs. But I think those stories are extremely rare.

Sure, the NHS isn't perfect, and some things you do have to pay for (such as dentistry, but it's heavily subsidised, and costs something like 15 for me to get a check-up and a hygienist visit, or prescriptions, but even then, I don't think they go over about 6) but I think it's an amazing system which is expected to achieve something which can only happen with an infinite budget, on a very finite budget, and considering what we pay for it (and as I recall from a comparative social policy essay I did, Britons in general don't pay much more income tax than Americans) we get something truly amazing in return.

kaplods
09-04-2009, 09:15 PM
I think most people with great health insurance are pretty oblivious to the cost of services. I know I was. For most of my life, I've had excellent health care insurance, but a downside of that, is that I never considered medical costs. I assumed that my doctor was prescribing the best, most effective drugs when I needed them, and I assumed that my pharmacy was charging a fair price (or at least a competitive price, similar to most of the other pharmacies). I assumed that small, privately-owned pharmacies had to charge more to make a profit, but that large chains would charge similar prices. I also had no idea that many medical service providers charge twice as much for services when a patient has insurance.

I went into most most medical services, blind regarding the costs. I didn't "bargain hunt," because I didn't know it was possible, or that there was any benefit in doing so.

Then my husband and I had to go onto disability (one year apart), and while we didn't have to go without any medical coverage, we had a few eye-opening experiences.

Under the current medicare system, once a person goes onto SSDI, they're not eligible for medicare for two years (unless they have a one of a few conditions that make them immediately eligible, such as an organ transplant and some cancers).

When I went onto medicare, I found myself quickly out of coverage for prescription medications (the "donut hole" that is often talked about). This is how I discovered that all pharmacies do not charge the same, and that the "cash price" for drugs (to an uninsured person) at Walgreen's is half that of the price sent to insurance companies. It's no wonder insurance costs are so high.

My doctor switched me to older (and cheaper) medications. I asked, because I expected the older medications to be less effective, or have more side effects, and I learned that while this can be true, more often new medications are not significantly bette/safer than previous versions of the medication or older medications. Often the "improved" part is swithing to extended release versions, so that a person can take fewer doses. However, extended release pills can't be "split." Pills that are not extended release, can often be split. For one of my most expensive medications, all the doses are similar price, so I buy the largest dose and use a pill cutter to cut the pills into four pills - thus I get 12 month supply for the cost of 3. I switched to Sam's Club pharmacy and was able to get most of my prescriptions from their $4 list (and a couple for $6 to $9). For all of the Sam's or Walmart drugs, you can get a 3 month supply for the cost of 2.5 months.

I also learned that I was allergic to NSAIDS (like ibuprofen, naproxen...). When I ran out of coverage, I couldn't refill my relafen (a perscription nsaid), and we didn't even have the money to buy some otc ibuprofen from the dollar store. So I did without, and suddenly all of my asthma symptoms disappeared. As a result, I was able to discontinue all asthma meds. I learned that this is a well-known possible reaction to NSAIDS, and yet no doctor had ever suggested this, they just piled on asthma medication over the years.

We've done a lot of self-educating, and it wasn't easy. When trying to find a medicare supplement, most of the people who could give us information (doctor's personnel and billing departments, pharmacy personnel...) were legally prevented from doing so (because of possible "conflict of interest" issues).

Medical costs (for everyone) could be drastically cut if patients were better informed. Most people aren't making truly informed decisions, because they trust that the system is working in their best interest, and that's not necessarily so.

Even if you have the best insurance in the world, it makes no sense for you to be paying $150 for a medication that is no better, or marginally better than a $4 medication. Why aren't more people using the $4 options? Mostly, because they don't know they exist.

Yes, I believe in healthcare reform. In an absolute democracy, majority rules. This can mean that minorities can be trampled upon. It's wonderful that most people are satisfied with their health care coverage and availability, but if most people think "I'm ok, so I don't want anything to change," means that a significant portion of the population is SOL, because they're not ok, but don't have the numbers to outvote those that are satisfied.

I think most people who ARE satisfied have no experience with the people who are doing without. Mostly, because the people who are doing without, generally aren't complaining about it - they're too embarassed to. So many people think that the only people without healthcare are those who are living irresponsible lifestyles, the lazy, jobless-by-choice, substance-abusers.

I think the waste in the healthcare system could easily pay for the people being underserved, but no bandaid plan is going to work completely. It's a process that may take decades to fix, and I think we're living in a society that expects instant fixes. People, even in the media were criticizing Obama for not having made a difference "yet" before he was even technically president. "How's he doing so far," was being asked before the end of November 2008.

A year is an eyeblink in terms of a presidency. It's going to take years to make significant changes (regardless of the president's party). Ideally, I'd like them to get it right the first time, but instead I think it's going to largely be trial-and-error.

HotWings
09-04-2009, 09:48 PM
In my opinion, we don't need a completely new system. Nor do we need government control over everyone's healthcare. We do need healthcare reform, though. However, I think the uprising is over much more than healthcare reform for a lot of people. It has to do with government control, erosion of freedoms, etc etc. BTW.. concern over erosion of freedoms is not necessarily religiously motivated, as someone else said earlier. People like living here because we have choices. I'm pretty sure I don't want the government making any kind of healthcare decisions for me - and I don't consider myself "religious". I have also been on both ends of the spectrum.. I've had good health insurance and I also lived a long time without any at all... and it was a scary thing. But with all the government bail-outs (that are supposed to be helping the economy) & the budget deficit in the trillions now.. people are getting p!ssed. Healthcare reform is just one part of the pissyness and sort of the last straw for some because of the cost and who will be footing the bill :)

A lot of small business owners (who are the real fabric of our financial society) are screaming for torte reform. Someone mentioned in this thread about insurance company reform - and that is what torte reform is. Right now there is no real competition between states for insurance policies & options. If you are a small business owner - you can only choose from a very small handful (most times you can count them on one hand!) of insurance companies that offer plans in your state when you offer plans to your employees. There are about 1300 insurance companies in the US. If the free market were allowed to do its thing.. competition would take care of insurance costs for nearly everyone - it would be significantly more affordable than it is now. But that in itself is a huge political gamble for politicians - insurance co lobbyists, etc are able to put *a lot* of pressure on our lawmakers. That's mainly why you don't see torte reform in Obama's plan. And if you can actually read Obama's plan and understand it.. you are better than a lot of folks with doctorates who are having trouble figuring out what it actually says - that's part of the problem as well. No one really knows how it will affect them because the plan is littered with legalese & foggy language.

We are told that we can keep our private plans if we want. The trouble with that, is many, many people get their insurance through their place of employment. When the business owners feel the sting of rising costs (and they will be required to provide health insurance) you can bet that cost will be passed on to the consumers or it will result in layoffs, or both. In our current economy, neither is desirable.

There is so much.. much much happening here. It's not a simple matter at all. I could write a book here about my opinions on it, but I'm not going to go on. Personally, I'd prefer they just fix what is broken - starting with torte reform (which will greatly help business owners so that they can provide decent insurance for their employees).. and then go from there.

Just my 2 cents and I know there are other sides :)

junebug41
09-04-2009, 10:02 PM
IMO, The American healthcare system is broken, from top to bottom. Something has to change, somewhere. I personally find it abhorrent to hear people talk about how health care is not a right, or to say things like "the system works for me, why does it need to change?" Which I've heard more than once.

I work in HR in the restaurant industry - I have 600 employees, only 50 on our health insurance. Of those 50, none of the line employees can afford to cover spouse or children. And, we pay 90% of the employee premium, more than a lot of other places in the industry. The renewals kill us every year. This year we received a quote for a 20% increase based on our estimated usage for next year. Estimated usage for the coming year, not actual use for the plan year ending. We had to raise the deductible and copay to keep it to only a 5% increase. And our utilization for the ending plan year was only 72%. The insurance company collected 28% of our premiums in straight profit and still raised our rates. Insane.

So many people are uninsured or under insured. I welcome health care reform.

I don't work in HR, but I work for the restaurant/hospitality industry. Instead of 600 employees, we have 300. Instead of 50 insured, we have 25.

But everything else is identical. Our premiums went up 69% (and boy was the TIMING on that a coincidence!). We had to switch to a high deductable (company pays part of deductable) plan.

There is so much wrong with our system and people are needlessly dying because of it. Something has to be done and no matter what it is, to be effective, it will make people uncomfortable and afraid.

When the business owners feel the sting of rising costs (and they will be required to provide health insurance) you can bet that cost will be passed on to the consumers or it will result in layoffs, or both. In our current economy, neither is desirable.

Have you read what's in the plan that would remedy some of this? For example, smaller business (probable the only people who have a reasonable fear about this) will be allowed to buy into plans with other companies, thus alleviating the costs for everyone.

I thought that was interesting.

HotWings
09-04-2009, 11:04 PM
Have you read what's in the plan that would remedy some of this? For example, smaller business (probable the only people who have a reasonable fear about this) will be allowed to buy into plans with other companies, thus alleviating the costs for everyone.

I thought that was interesting.

Yes I have - it's an "insurance exchange" run by the government. It really is interesting. On the surface it looks like a good thing. But you see things are very complicated with this bill. It is the opinion of many (myself included), that allowing the public option in the bill would eventually leave us with no other choice than the government's plan.. it would erode private insurance completely. There are a myriad of complications resulting from the current combination of things in this bill. Let me just give a link that basically sums up what I think about things from the National Federation of Independent Business:

http://www.nfib.com/tabid/60/tabid/739/Default.aspx?cmsid=49241&v=1

In particular, regarding the public option, this:

http://www.nfib.com/tabid/739/Default.aspx?&cmsid=49513&v=1

Most people, and rightly so, think of a bill like this in regard to their current personal situation. So do I. But the longer term adverse consequences of this sort of bill could far outweigh any benefit one might see in the very near future.

It's complicated, for sure. The current concoction in this bill is what makes me want them to start just with torte reform first and then re-evaluate.

Edited to add: This is also why a lot of people are wanting to just be left alone - the people that are upset are not just ones that have great insurance - and it also crosses party lines.

Windchime
09-05-2009, 12:34 AM
Long story short - maybe government healthcare isn't THE answer...but it is AN answer. Let's at least be spurred on to find more solutions, rather than paranoidly shooting down this one and going back to the failing status quo!


Paranoidly shooting it down? That wasn't my intention and I'm sorry if my post came off that way.


Along the same lines of what Windchime said about Medicare, many hospitals and healthcare providers accept lower payments from private insurance companies to keep their "preferred provider" status. I think the general public doesn't really know/understand that if they have a bill for $2000, their insurance company does NOT pay the hospital $2000. It is almost always less, and the balance cannot be billed to the patient so the hospital writes it off (basically eats the difference).

So...our insurance companies are collecting outrageous premiums AND paying hospitals/providers less than what they are billed. That's quite a profit they are turning.

This is a good point. And the sad thing is....the self-pay patient who has no insurance is frequently held responsible for the full $2000 bill. Yikes. Ironically, I could afford to pay the $2000 but I don't need to because I have good health coverage. But someone with a lower-paying jog who doesn't have covereage probably also doesn't have $2000 in the bank. So as another poster mentioned, that person will put off going to the doctor or the ER until they are really, really sick.....which means a higher bill!

harrismm
09-05-2009, 01:51 AM
And hospitals are truly paying the price for this...hence most recent layoffs of nurses and support staff all over the country.Pretty sad.