Why no preventative health care in the US? Here's why:

[Jackpine Radical]

In their inception, HMO's--health maintenance organizations--were supposed to reduce long-term health care costs by putting more resources into preventative health care. That would mean, for example, paying for smoking cessation, stress management, weight loss, dietary education, and the like. But the HMO's never followed through on any of this. At most, maybe a few of them will give you a partial rebate on a health club membership. What happened? Why wouldn't they carry through on such an obvious way to save money?

The answer is very simple. It turns out that the average person is on a given HMO plan for only about 20 months (I don't know the current exact number but it is in that vicinity) before shifting to some other plan (or maybe losing their coverage or whatever). Therefore, if the HMO puts money into heading off a problem that is not likely to manifest for a number of years, they will never reap the benefits of their expenditure. Some other HMO or insurance plan will harvest those future savings in medical expenses. It's just not good business policy for your MO to try to keep you healthy for the long run. So they don't. Just another of those little instances where localized capitalist greed works to the detriment of the overall society.

[nebula]

1. In other words,

The US healthcare system is basically designed to kill you, not help you.

[CountAllVotes]

2. Medicare does NOT pay for annual physicals/exams either

Why the hell they do not is beyond me. They could find/identify a medical condition before it turns into an ER visit and/or emergency surgery, etc. However, they are just plain stupid IMO for not paying for an annual physical/exam.

:dem:

[MRM]

25. For starters

An annual physical exam isn't going to find most medical problems (particular in older folks). That's not what it's designed to do. It's going to test your heart rate, blood pressure, ability to cough with your head turned ;-) basic stuff you could do on a machine at Walmart for free. My father had an extensive annual two weeks before he died. More extensive than a typical exam because of the job he held. It said he was in great shape. Two weeks later he was dead from an abdominal aneurism. At 58.

Secondly, You can get an annual physical exam at any county health clinic for about 10 bucks. Less if you are low income.

There are a lot of problems with Medicare. This isn't one of them.

[FloridaJudy]

73. Short of a CAT scan or MRI

An annual physical isn't going to pick up an abdominal aneurysm - and no one's going to order one of those unless there are symptoms (and usually there aren't any until it's ready to blow). Aneurysms - both abdominal and brain - are one of those sudden death events that can't be predicted.

Unfortunately, few health departments will do physicals for the general public these days. I used to work for the health department: most of them are scrambling to provide care to the clients they already have. They also have "means tests" so if you're not living below the poverty line, the HD won't take you on as a client. Even if you are, they won't take you if they're already over-budget, and given how the Republicans have short-changed public health that's true more often then not.

As a medical provider, I used to do physicals on Medicare clients. We'd usually bill for whatever health problems we found, and since it's rare to find someone over 65 who doesn't have at least one, we usually got paid. The standards are pretty strict, so we'd occasionally have to eat our fees. If Medicare is extended to younger groups, that's probably something that needs to be fixed.

Extending Medicare to all isn't a perfect solution, but it's better than what we have now.

[bemildred]

3. Look, the health care business has no real pecuniary interest in you being healthy.

Just like dentistry doesn't really want nobody to have cavities, and car repair places don't really want maintenance free cars. When you go visit the Doc, does he try to fix you up and send you on your way? Or does he try to get you on some drug regimen where you have to check in every month of so to "see how you are doing?" All of these sorts of business need a steady flow of customers, which means in the various cases: you being sick, having cavities, or your car breaking down.

[azurnoir]

10. Also they will not treat 2 problems in the same visit

Say you do go in for a regular exam,for most females every 3 years at least, now say you have a simple wart that needs to be treated (burned off) takes 5 minutes whether it is chemically or with liquid nitrogen,MD writes order nurse or Medical Assistant does actual work. So why not do them in one visit more efficient right? But what is not commonly known is that where the most money is made is in "facility fees" that is every time you walk into your MD's office the insurance is charged anywhere from $250 to $600 depending on length of appointment, the MD, and where you live. Not much incentive to be efficient.
Added for clarity: the facility fee doesn't not include MD's fee, or any treatment you might receive those are separate charges, this fee is for just being in the clinic.

[MRM]

35. I'd really like to see evidence of this

It's simply not true for any facility I've been associated with (Major hospital with 5 specialty facilities and 45 clinics)and my own family experience which includes a family of 4 that has seen 5 surgeries, two years of physical therapy for myself and 6 months for my wife, and dozens of office and E.R. visits over the years. We get itemized statements of every dime charged and every dime paid by the insurance company at my request. I've never EVER seen an office charge anything CLOSE to $250, let alone $600. Generally they range from $20-$60 depending on specialty. If you have evidence to the contrary, please provide it.

Aside from all that, the claim that a doc won't see you for two issues on the same visit is also bogus from my experience as long as you make the appointment telling them you want to be seen for both. It's certainly true that most docs won't sit and listen to every problem you have when you come in for a specific reason. They don't have time for that. Not long ago I made a doc appointment for three separate, unrelated issues. The doc scolded me for putting two of them off, but he was scheduled to see me for all three. And he did.

Besides, don't you see a gyno for the female thing? Not the same kind of doc you'd see for a wart removal. I wouldn't expect him to take care of it then and there.

[ikojo]

52. If it's a free standing surgical center some facilities

will unbundle and charge for the surgeon's fee for the surgery on one bill. They will then charge approx $2k for the facility fee on another bill sent to the insurance company. Had a claim like this come across my desk on Friday. The physician was loaded in the data base but the facility he was billing the facility fee under was not, so I had to get that added.

[MRM]

62. Of course

There are going to be separate charges for the facility and the Doc. Most docs, and every surgeon I'm aware of, work independent of the facility where the actual surgery is performed. I ask my insurance company to send me an itemized bill of what they receive for a very simple reason. Whatever the insurance company refuses, I'm billed by the facility/Doctor. From the facility I'm going to get a bill stating "you owe us $458 that your insurance didn't pay", but If my insurance co. sends me an itemized statement that shows they paid X because they had Y agreement with the facility on such procedures then I can tell the facility to go to hell.

Most people don't realize that insurance companies make deals with Docs and facilities to pay far under normal billing rates. When I get an itemized statement, I get what those agreed upon rates were. If a Doc or facility tries to bill me the rest I have evidence to throw at them.

[FloridaJudy]

82. Girly parts can get warts.

I've treated my share.

[Ms. Toad]

107. Some of us also go to family physicians

for routine gyn exams and pap tests. Given that a gyn exam is one of the first hands on experiences most docs have in medical school (or at least it was when I was in close contact with medical students a few years ago), most family physicians have the appropriate training to do the routine exams AND to identify when you have a problem beyond their training to refer you to a specialist - just like they do for any other body part.

I never understood why family physicians were deemed good enough to peek in your throat, then treat you for routine problems or send you to an ENT if your problem was beyond routine and required a specialist - but their abilities in treating the other end of the body aren't presumed to be good enough to peek in and determine whether they can treat routine issues or send you on to a GYN if your problem is beyond routine...

[azurnoir]

100. The amount of the facicility fee

depends on where you live, the charges must be "typical" to that area. The facility fee is an "out patient" charge, hospital fees are separate and usually much more. In my area insurance companies will not pay for a clinic visit and "in patient" hospital charges on the same day, since the clinic and hospital are almost always part of the same company the clinic takes the hit. Again though this depends on where you live.
I am a CMA I have seen the billing, done some coding (ICD9 insurance codes) the facility fee is true. Also in my area unless you ask specifically you will male or female generally be seen first by a "family practice" either nurse practitioner or MD, the only "specialist" that can be seen without a prior referral from "family practice" is OB/GYN.
The 2 examples I used were not the best, however for the common wart most "family practices" do those, I have done them, as I said MD or Practitioner writes the order, nurse or CMA does the job. As for facility fees the highest I have seen is $600, this was for a very specialized clinic, ie Bone Marrow Transplant and that was 5 years ago.

[MRM]

26. Quite cynical

Amazingly cynical to compare a health care professional to an auto mechanic.

Have you read the hippocratic oath?

I've know, literally, hundreds of doctors in my time. Many are arrogant jackasses. But I don't know I've ever met a single one I'd accuse of what you accuse them of. Follow up visits aren't designed to be "see how you are doing" and, in fact, are almost never billable anyhow, as they are considered ongoing to the first visit. IOW, insurance companies won't pay them for the follow up and they can't charge you a co-pay for something the insurance company won't pay for. If you know a doc who does this, call him on it. But I've yet to see it.

[bemildred]

71. I knew someone would be outraged.

I accused nobody of anything. I just pointed out where the pecuniary incentives in the current system lie. I could make exactly the same sort of point about a long list of other organizations, but we were talking health care. And yes, I am cynical, you say that like it was a bad thing.

[NotGivingUp]

95. you are SO right! and THIS is why the capitalist system does NOT work.

The system makes things work in the opposite way than they SHOULD work. It does not work in the way of providing a healthier, happier existence. It works AGAINST us.

[pepperbear]

4. oh dear, and then there's the chance that they'll refuse to pay....

for the "experimental" treatment for the disease they helped to perpetuate.

:wow:

[Lint Head]

5. The insurance companies make money when you get

sick or injured by denying coverage. If you die they keep your premiums because they didn't have to pay anything.
We live in a society that trades in death and killing. The funeral industry cleans up literally and figuratively after the corporations and fascist political criminals kill people with food, drugs, pollution, bullets and torture.:dem:

[CountAllVotes]

6. I recently figured out 10 years worth of premiums

and the amount I paid out and they paid out. Guess what? They've made a sh*t load off of me! :mad:

[MRM]

44. I should hope so

Businesses aren't going to lose money and stay in business long. Insurance is one of the riskier businesses out there because there is no control over what your clients are going to do. The majority WILL pay more than they use. Of course, you probably paid premiums for life insurance last year too. You lost 100% of that since you didn't DIE. Car insurance doesn't work out as a good "investment" if you don't get into a wreck, either. Insurance isn't supposed to be an investment, it's supposed to be a safety net. "Just in case". There are lots of people who have claimed far more than they paid in, too.

[Ms. Toad]

108. They make money off of me -

but they lose money on my spouse and daughter. I'd drastically rework the system to remove the intermediate money makers, the surcharge to the uninsured to pay for the discounts given to the insured, the disincentives to routine preventative care noted by the OP. That said, as long as I can afford insurance for our family, we will never go without - and as a family come out with more money in our pockets.

[TwilightZone]

7. If you think about it, it's really more than just health care.

Everything is reactive, not proactive. Reaction is the basis for the entire Republican platform.

Health care? Treat you *after* you're sick.

Foreign policy? Wait until there's a crisis, then act.

Disaster planning? Wait until there's already been a disaster, then react (abysmally)

9/11? Ignore the warnings, then invade the wrong country.

[CTyankee]

13. Remember a couple of weeks ago Bush said we had great health

care in this country. "You can always go to the Emergency Room in a hospital," he said in all sincerity.

Unbelievable.

[MRM]

27. I don't know or care what Bush said

But that statement is 100% fact.

You can also go to your county clinic for the vast majority of things.

NOBODY in this country can claim they don't have access to basic health care. It's simply not true.

Virtually every paid health care policy requires a co-pay higher than what a poor person would pay for the same treatment at a county clinic. That's a fact.

Doctors in county clinics are more qualified and better paid than doctors in hospital emergency rooms.

Now. Are there some treatments and surgeries that the poor simply don't have access to? Absolutely. And that should be addressed. Is it 40 million children with no access to health care as is frequently stated? Not even 1% of that number is accurate.

[tkmorris]

41. Are you high right now?

"Doctors in county clinics are more qualified and better paid than doctors in hospital emergency rooms."

I can't believe you even said that. Did your face scrunch up all weird when you typed that?

[MRM]

47. Nope

No scrunching necessary. What you don't know is that most of those docs in those clinics started out where most docs without an affiliation start out...in ERs.

If you think for a second that you are getting a top notch Doc in an ER you are clueless. NOBODY wants to work in an ER, this is where BEGINNING docs AND Nurses start. Absolute fact, like it or not.

[ikojo]

54. Oh I don't know about that. I was at a Yom Kippur

Break the Fast dinner a few years ago. Sitting across from me was an ER doctor. I asked him about his work and he said he really enjoyed it because he got to do all sorts of medicine rather than one type.

I make sure new providers are loaded into the physician data base and what I see a lot of are hospitalists. Many of these also work in the ER.

[moondust]

58. You are a phony.

Since "I had a very limited interaction with the Emergency room" (post #24) in your 3 short years in some hands-off training job that you quite understandably no longer hold, your goofy propaganda about docs and nurses has no credibility whatsoever much less being "absolute fact, like it or not."

Did you spend 3 years training cooks or janitors? Or is that a fabrication as well?

[MRM]

63. No

I spent three years training Docs and nurses on using the computer systems if you must know.

[moondust]

66. I do know.

That you are a phony. Let's cut through the bullshit. Are you a health care insurance troll? A Wall Street troll? I don't think you're a generic Republican troll because of your persistence in pushing your propaganda. Even the dumber Republicans can sense when they've hit the wall.

[MRM]

70. It's not propaganda

And anyone who looks at it OBJECTIVELY knows that

[PA Democrat]

85. Again. Site some reliable sources to back up your claims.

I have requested that you do so on a number of ridiculous assertions that you've made in this thread. So far, you have provided NOT ONE reliable source.

[Lasher]

90. 'cricket, cricket'

What, no reputable sources to back up the expert advice of one who worked as a PC training coordinator at a hospital for 3 years? I am shocked.

Oh but look, he's already the self-declared victor in the debate. From downthread:

Not a single person could dispute my "agenda" BTW.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=1461156&mesg_id=1464936

Looks like hard evidence from unimpeachable sources doesn't qualify as something we could use to dispute his claims.

[Ms. Toad]

110. I beg to differ.

The best docs we now have as our regular physicians were ones we encountered in the ER. Yes, there are lots of docs in training in the ER, but they are backed up by some of the finest physicians I have ever met, and I have yet to meet a fully trained doc in the ER who isn't someone I would be willing to see regularly. We have four specialists we picked up through ER encounters, three of whom we still see regularly. Meanwhile, we have been going through family physicians at a pretty fast clip recently - we're hoping the most recent one will stick, but two of the last three were real stinkers.

[bemildred]

111. I agree.

ER docs are the best out there these days. I stopped going to "family physicians" some time ago because they were useless.

[PA Democrat]

84. Not true. 18,000 Americans die each year because they are uninsured.

Here's a source:

http://www.iom.edu/?id=19175

Unlike you, I will provide sources to back my claims.

[CTyankee]

106. OK, my point was about preventive care. Since ER's are by definition ACUTE CARE facilities

and we know that acute care is more expensive than preventive care, this is not a GOOD indicator of our health care in this country. That was my point about Bush's statement. I am still amazed that he said it.

[davsand]

8. I had no idea any HMO rebated gym membership fees!

That makes WAY too much sense to me! Similarly, I'd think free consults with a nutritionist at any time would be a given...

My HMO does have drug coverage. It isn't the best--top tier is $40 per fill, but it is better than nothing. Anyhow, my HMO won't pay for drugs for smoking cessation. Not even if you have a heart attack!!! I about fell off my chair in the ICU when my husband had his heart attack and they told him his HMO did not cover any drugs for that purpose.

Similarly, he was covered for 8 weeks of cardiac rehab in their gym but no more--in spite of the fact that they know full well that ongoing aerobic exercise provides a huge benefit to heart patients. We pay for and actively use a gym membership now for the entire family, but it is out of our own pocket.

We have to be logged in to work out at our gym--so it would be NO big deal to provide those logs to our insurance company to obtain even a partial reimbursement but it sure isn't an option even IF it will save them money and maybe save our lives.

They don't cover fish oil--which is accepted and proven to help reduce the number of sudden cardiac arrest--nor do they cover CoQ10 which is an accepted treatment for specific cardiac issues in other nations.

I could go on with the list, but the bottom line is that the medical industry really don't make a lot a cash off selling vitamins, food supplements and gym memberships. They make a hell of a lot off heart attacks and chemotherapy.


Laura

[lapislzi]

18. yes, my HMO (Oxford) reimburses gym fees

I only get about 1/3 back from the cheapest gym membership (YMCA), but it's better than nothing. They also paid (go figure) for SO's acupuncture...but not for his hearing aid.

Hell if I know...:shrug:

[MRM]

29. There are lots of heart healthy choices

One can make. But why should the insurance company pay for them? You are complaining they won't pay for gym memberships and fish oil purchases? Should they pay him to not eat salt or smoke, too? Oh, wait, you DO want them to pay for him to quit smoking. Please explain to me why an insurance company should be responsible for ANY lifestyle choices?

(I have HUGE problems with the health insurance industry, but the things you are complaining about aren't among them)You are basically saying your husband had a heart attack due to his OWN negligence (out of shape, smokes, etc) and you want the insurance company to fix it. Not only THAT, you are upset that they don't cover something that isn't even mainstream in the USA (where you presumably live).

Just so you know, the medical industry does NOT make money off of heart attacks. They lose a lot of money because of them, though. Dead people don't pay insurance premiums...or hospital bills.

[ikojo]

51. On some Medicare HMO plans the HMO will also

reimburse gym fees. I wish they'd do the same for the EMPLOYEES!!!

[NMMNG]

9. Bingo

My agency changes HMOs every year or so because the premiums increase so much every year. Therefore there's no incentive for the HMOs to do anything in the interest of the patients.

[NotGivingUp]

11. There's no preventative health care because our monopolistic medical system won't allow it. n/t

[MRM]

28. Except

You are completely wrong in stating that there is no preventative health care.

[tkmorris]

43. There is very little

Preventative medicine costs money and HMO's do NOT like spending money and you damned well know it. Give it a rest.

[MRM]

48. I damn well know it?

"Preventative medicine costs money and HMO's do NOT like spending money and you damned well know it"

Lets see. My family is of four. In the last year all four of us have had physicals, dental checkups, and eye exams (except me on the last one, I had lasik surgery a couple of years ago). All of which were covered by our HMO. Additionally I had a chloresterol check and a blood pressure check due to my own paranoia. Both covered. I had a cyst removed by a cosmetic surgeon because it was cosmetic in nature and posed no physical threat. Covered. Exactly what "preventative medicine" isn't covered by HMO's? Oh, I know, I'm a smoker...they won't pay for me to get non-smoking drugs. Well, smoking is my CHOICE. No insurance company SHOULD pay for my attempt to quit.

[rucky]

113. Don't forget big Pharma

who only gets paid when we get sick.

[ProgressiveEconomist]

12. Great find! Of course! The "benevolent HMO" model is suitable only for monopolies sure to hold on

to their customers for decades, rather than for competitive companies that lose their customers whenever they change employers.

Since the "benevolent HMO" model doesn't work, survival demands transformation into the "evil HMO" model. The one that makes money by denying care and just pocketing "capitation payments" every year. Operation needed? "Maybe next year".

[supernova]

14. I think the absent wellness programs are tied to our volatile job market

It works like this:

1. Our health care is tied to our jobs.
   
   
2. We stay at our jobs on average about two years. Then we get either laid off/promoted/move elsewhere. Here's where the OP comes in:
   
   
3. The HMO/PPO has no interest in providing wellness programs, no ROI.
   
   
4. Your in network MD has no interest in seeing to your long-term welfare because he knows you will probably have to change docs in another two years.
   

I think continuity of care is a really huge problem in our system. No body is building long term relationships and no body is the better off for it.

edit: spelling

[heidler1]

15. IMO most of the health care problems are due to the patient.

I've belonged to the same medicare supplement insurer for 16 years since I turned 65 and have had at least 10 different primary care Doctors. None of them were perfect, but most of them were willing for me to see a specialist if I wanted to. There is an additional fee for doing this. All of them paid for annual blood work to see if something is out of balance with my prescriptions. I take three. Two of them were over prescribed IMO so I halved the dosage and watched the results of my blood work to see if there was any indication of a problem. There wasn't any. I never told the Doctor. So my $5 each co-pay on those two lasts an extra month. I believe that eventually a persons blood work plus a genetic read will be the way to go with deciding if a persons body is functioning OK.

Way too many people are told to quit smoking and refuse to do it. I noticed if I drink two cups of coffee my heart would skip beats so I gave up one and no more problem. If I over indulge in alcohol my pulse rate goes way up so I quit doing that. We all need to be tuned into our body and react accordingly.

[supernova]

16. With all due respect

there are things about a person's health that s/he can control, like the lifestyle issues you mentioned. And I heartily support efforts for all of us in that vein, ergo, wellness programs. In fact I fully support people becoming as responsible and knowledgeable about their own health as they possibly can. The end result being a full partnership between MD and patient.

Then there are things that are not in that person's control and need medical attention. Is it your fault if you catch a contagious disease for instance? (Lots of diseases are transmitted when the carrier is showing no symptoms) Or suffer complications in childbirth? Illnesses happen. Accidents happen. I so abhor the mentality that blames the person first for all health misfortunes.

In my case, I was born with a heart defect. Now, it is well within my control to keep myself in good physical condition so that my heart functions as well as it can. In fact, I've had to become an armchair cardiologist because of my birth defect. I do in fact have to see a special cardiologist (a special specialist, as it were) There isn't much a newly minted MD could tell me about my condition that I'm not already familiar with. But I can't control if someday I might need a new heart valve, or heart failure drugs, despite my best efforts.

As for what I wrote originally, I am glad you have been able to stay with the same carrier for the last 16 years. What you need to understand is how increasingly rare your situation is. And it's likely to get even rarer if we don't enact Universal Health Care. Oh, and tell your doc you changed your meds. Pronto. It could make a difference down the line.

[heidler1]

19. The main thing about this IMO is a very high percentage of people can't deal with the complex issues

on their own and there is no way to suddenly create Doctors who can solve all of their problems. We have a neighbor who can't read and understand, he admits this. My wife told him about our HMO and he joined and immediately got in trouble by not following their rules. If you recommend anything many people will misunderstand and blame you. I'll pass on telling the Doc.

[supernova]

20. So, what are you saying?

We shouldn't have univeral health care because people are simple creatures who can't understand anything anyway?

Please tell me I'm wrong.

[heidler1]

21. My view point is from a 81 year old.

I doubt if your even close to my age. There's still hope, but it's tough. I want universal health care too and I hope we get it.

[MRM]

49. Exactly correct

Health care is a personal issue. It's up to you to take care of yourself first and foremost.

The VAST majority of health problems are self inflicted.

You smoked too much, you ate too much, you drank too much, you sat on the couch too much, but NOW you want the Government to pay for the consequences of your own actions?

[MRM]

30. Wow

Personal responsibility for your own health. What a concept. And you are right. 70% of doctor/hospital visits wouldn't even be necessary if people looked out for themselves.

Thank you for posting this.

[PA Democrat]

75. How about a source for that 70% statistic?

[Lasher]

93. I think I recognize the source.

I can't nail it down specifically but I'm pretty sure it's some kind of body cavity.

[supernova]

99. So do you oppose or support

universal healthcare?

[Lasher]

115. He can't answer you, he's been tombstoned.

I don't think he has the same beliefs as most Democrats.

In answer to your question, he's strongly opposed to universal health care.

[SoCalDem]

17. Everyone should have a yearly physical, dental check & eye exam

but of course, most people do not..and especially when insurance does not cover it..

People wait until they are sick..too sick to stand it any longer..and then they go to the doctor.
And, people these days often don't have a "family doctor" who knows them and their whole family.. You get 5 minutes with a doctor you never saw before, and if you are lucky he/she speaks english well enough for you to understand what they are saying.

[Raine]

23. Yeah and all these doctors specialize

in something and you don't even know who or what kind of doctor you should go to. :-(

[MRM]

40. EVERY HMO

Is going to require you to see a general practitioner first. To see any specialist is going to require a general practitioner recommending you. It's not hard to figure out. Get a family doc you trust and let him tell you who to see from there.

[ikojo]

55. No, most HMOs have gotten away from what was

called the gatekeeper HMO model where a patient was required to seek a referral to see a specialist. While many do allow a patient to see a specialist without a referral (as I can) they disincent that activity by making the co-pay much higher to see a specialist rather than a PCP.

I had a sebaceous cyst removed from my head this year and I did not require a referral to see the surgeon.

[Lydia Leftcoast]

76. I was on Kaiser-Permanente in Oregon for 10 years, and I think I saw my

alleged primary physician for a total of three visits, each about ten minutes long, and she was late for all three appointments (a sign of over-scheduling). That was after waiting months for appointments.

On 3/4 of the occasions, I saw a nurse practitioner or physician's assistant.

[MRM]

31. And what do you think will happen

If we have "universal health care"?

The REASON so many doctors "don't speak English well enough..." is we already have a doctor shortage in this country.

Make it "FREE" to go to the doctor and you better be able to double what we currently have.

[SoCalDem]

36. Nothing is "free" in the USA, you silly goose.

or anywhere else, for that matter.. I don't see the streets littered with dead candians or dead French people or dead Brits, so there has to be a way to "manage"..

Perhaps if we had a complete overhaul, and people did not graduate medical school owing 1/2 a million, they could afford to practice "family medicine"..and perhaps if the AMA did not try so hard to limit medical school entries, we would have more doctors...but then the HMOs prefer to import "cheaper" doctors..

That's why there can be NO insurance companies in the mix , when and if we ever get universal care..

[MRM]

39. No insurance companies?

So you want a health care system completely regulated and paid for by the Government?

Are you kidding?

If you saw what a mess medicaid is you'd be begging the Gov't to get OUT of the health care business, not take it over. My God, I can't afford the 70% income tax it would take for the Gov't to take over health care.

[tkmorris]

46. Do Canadians pay 70%? Does anyone??

You have an agenda you are pushing but I aint buying. Who is paying you?

[MRM]

53. I wish someone was paying me

70% income tax? No. When you add in other taxes, yes.

You think $3/gallon of gas is horrible, right?

In Germany it's around $7 a gallon.

Most smokers complain about the $3pack of cigs here.

In Canada it's $8

All tax to pay for "universal health care"

In countries with "universal health care" the overall tax is very close to 70% of income. The care is lesser and the wait time is much longer. This is simple fact.

You can't give something away for "free" and expect it to be used as intended. Ever been to the "projects"? That's government subsidized housing, where people LIVE. FREE or low cost housing. What happens to it? It gets destroyed. Why? "Who cares, I didn't pay for it."

If people don't have a personal responsibility to use a system correctly they WILL abuse said system. This has been proven with EVERY social program ever enacted.

[davsand]

87. Wow. The "talking points" almost word for word.

Wasn't it Dick and Irene they used in the commercials the last time Universal Health care came up?


Irene? Is that you? Or would you be the Dick...


:nuke:

[Lasher]

61. But I thought everybody already had access to basic health care.

That's what you said upthread. So why would we need twice the number of doctors we have now if people have access to health care already? Are people going to suddenly flock to county health clinics for those high quality annual physical exams if they find out they no longer have to pay the $10 (less for low income) you cited?

Any word on how they're addressing the doctor shortage chrisis in Canada?

[MRM]

65. Everyone does

Have access to basic health care now.

We will need twice the doctors because of the abuse of system that occurs when you give it away for "free".

They AREN'T addressing the doctor shortage in Canada. It's a complete mess, there. God forbid you need major surgery in some provinces...it could be months before you get it. Well to do Canadians are coming here in droves for medical care.

[PA Democrat]

77. Please site some sources for your claims.

We will need TWICE as many doctors? Canadians come here in "droves"?

Please site some sources.

[Lasher]

83. Sources? Try this on for size.

A 2002 Health Affairs study examined hospitals near the border, as well as national surveys to tease out how many Canadians actually visit the U.S. to receive elective procedures.

In terms of hospitals along the border offering advanced treatments or special diagnostic technology (i.e. CT scans and MRIs), about 640 Canadians were seen, along with 270 for procedures like cataract surgery. They compare this to about 375,000 and 44,000 similar procedures in the region of Quebec alone during the same period. If you divide the total number of Canadians seeking those treatments in the US, divided by the number in Quebec alone that's about 0.09%. Not even a tenth of a percent.

But the most striking stats come from the Canadian National Population Health Survey (NPHS). From the article:

Only 90 of 18,000 respondents to the 1996 Canadian NPHS indicated that they had received care in the United States during the previous twelve months, and only twenty had indicated that they had gone to the United States expressly for the purpose of getting that care.

Only 20 of 18,000 sought care in the United States. I can't believe how many people are coming over here! Their system but be truly awful.

http://www.tpmcafe.com/node/29232

[PA Democrat]

86. Thanks. I was just about to look for that one.

That poster has yet to site a single source to back up his wild claims.

[Lasher]

79. I don't think $10 or less would be much of an incentive for abuse

I was wondering how they would freeload off the taxpayers for gas money but I guess you think they will all call ambulances for the trip there and back, right? Better double the number of ambulances in the country, right?

What doctor shortage in Canada are you talking about? What complete mess? What droves of rich Canadians? These are all myths, just like your medical malpractice tort reform bullshit. There are those who do not like Canada's health care system but none of them seem to be Canadians.

So what type of work do you do for the insurance industry?

[Raine]

22. Not enough money to be made on healthy

people, sick people is where the money is made. The drug companies have to have someone to sell all those prescription drugs they advertise on TV to.

[MRM]

32. This is only half true.

If nobody was sick, the insurance companies would make a fortune.

The drug companies, on the other hand, make their living by the misuse of the products they sell.

Drug advertising on television should be outlawed before ANY other law concerning health care is enacted. Period. To advertise prescription drugs to a layman audience that can't obtain them without a doctors script is dangerous, to say the least. It promotes self diagnosis and for you to pressure the doc to give it to you. Hell, the ads tell you what to go in complaining of to obtain the script.

For anyone other than a qualified doctor to decide what a patient should take is ridiculous. For a drug company to be able to advertise on television while a liquor or cigarette company can not is beyond ridiculous. What sense does it make to ban advertising of unregulated drugs while permitting advertising of regulated drugs?

[MRM]

24. On the flip side

Government provided health care is far costlier. It IS the reason we pay $9 for a Tylenol and thousands for a simple, outpatient surgery.

I worked in a major Hospital as a training coordinator for 3 years. Most of what I saw disgusted me (which is why I no longer work there) but nothing more than medicaid.

I had a very limited interaction with the Emergency room, but here are a few things I personally saw Medicaid patients CALL AN AMBULANCE for:

Headache
Toothache
Sprained finger
Broken fingernail
stubbed toe
"hurt my finger punching someone in a fight"
"Needed a ride downtown"
"My boyfriend kicked me out and I had nowhere else to go"
"A cop beat me up, but I'm feeling better now"

I'm not making any of this up. These are all reasons given by medicaid patients that I personally witnessed. The admitting nurse down there told me this kind of nonsense happens several times per day. See, when a medicaid recipient calls an ambulance, they HAVE to respond and transport. The hospital HAS to "treat" them. The rest of us PAY for it. I was told of one patient who called an ambulance 40 times over a two month period to take her to the E.R. for various bogus reasons. Not only did that single patient cost the tax payers tens of thousands of dollars, it also cost the hospital similarly. And you can't just send her to a Psych facility without her permission. Her regular doctor would have to request a court to do that first, an ER doc can't make that diagnosis. Since she didn't HAVE a regular doctor, everyones hands are tied. Great laws.

Then there is the federal law that any hospital that accepts medicaid has to accept anyone off the street, regardless of ability to pay. AND the fact that medicaid doesn't even cover the cost of treatment. THEY determine what they pay.

So why does anyone accept medicaid if what I say is true, you ask? No choice. If you are a non-profit hospital (as most are) you HAVE to accept medicaid. That is also federal law. If you are the only hospital within a given range, regardless of non-profit status, you have to accept medicaid.

And this doesn't even take into account that every county in this country with a population of more than 10k has a Government subsidized clinic that treats patients and charges based solely on ability to pay. (most also dispense drugs on the same able to pay scale).

The purpose of all this? Well, when ANY politician gets on the "we have 40 million American children who go untreated because they don't have health insurance" nonsense you might realize they are full of shit. They go untreated because they aren't brought in for treatment. Plain and simple. NOBODY in this country is denied basic health care.

Don't believe me? Walk in to your local hospitals Emergency room and read the "patients rights" which are required by law to be posted on the wall in a prominent place.

[piesRsquare]

33. I noticed you joined DU less than two weeks ago

And you seem to have a lot to say on this subject.

"Sicko" got you antsy, eh?

[MRM]

37. Well

I thought it was longer ago than that, but not sure.

Sicko has no bearing on me. Haven't seen it, don't know much about it.

I do know a lot more about health care than the average person, though. It's important to me that people know what is actually the truth and not what either political party is spouting.

Read what I write and dispute it if you can, but please don't accuse me of having an agenda without exploring what I say.

[PA Democrat]

81. But apparently you don't know enough to site any reliable sources for the claims you are making.

Site some sources, or deal with accusations that you have an agenda

[Occulus]

96. Wow, you are SO blatantly full of shit

it is so unbelievable you haven't exploded from it yet.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=1461156&mesg_id=1464883

:freak: :spray: :rofl:

Three years doing nothing related to actual care, perhaps.

"I do know a lot more about health care than the average person, though. It's important to me that people know what is actually the truth and not what either political party is spouting."

Important in the sense that if they themselves know and state the truth, you have to counter with rightwing talking points. I wonder why that might be.

"Read what I write and dispute it if you can, but please don't accuse me of having an agenda without exploring what I say."

I have done so, and I can say with 100% certainty that you have an agenda after exploring your jagged terrain.

[moondust]

34. Yes, that is certainly the wingnut side.

Pure bullshit and everybody here knows it. You appear to be lost.

[MRM]

38. Pure bullshit

From someone who was on the inside.

Amazing.

"everyone here knows it"

So everyone here is so close minded that they believe the 30 second sound bites? Please, feel free to dispute anything I've said with fact. Not political numbers, not speculation, actual fact. I was there, for 3 years.

[moondust]

42. Pardner,

lots of people here have many years experience as health care providers. Including me. I have personally been involved in providing emergency care to many thousands of ER patients in a number of different states. I can say without qualification that YOU DO NOT KNOW WHAT YOU ARE TALKING ABOUT.

You are in way over your head at this website. I'm certain that you'll have better luck somewhere else.

[MRM]

45. Stating something

Doesn't make it true.

If you have so many years of experience, why don't you just disprove my assertions rather than claim you know more than I do and that's all there is to it?

I'm in "way over your head", yet you...who proclaims "I have personally been involved in providing emergency care to many thousands of ER patients in a number of different states" don't provide a single rebuttal to anything I've said?

Claim what you like, I gave specific examples and specific laws in my posts. Your response is "You are in way over your head at this website. I'm certain that you'll have better luck somewhere else." Interesting. And telling.

See this is an extremely important topic to me. Since my view doesn't fit your political agenda you pretend to be something you aren't. That's sad.

[Quantess]

50. What do you suggest, then?

You don't seem to like the status quo, either. Do you?

[MRM]

57. You are correct

I don't like the status quo at all.

I have a few suggestions:

1) Immediately outlaw prescription drug ads.

2) Set a maximum for doctor liability in lawsuits (the largest expense for a doc is liability insurance due to the ridiculous amount of frivolous lawsuits) and make it law that anyone suing a doc must pay his legal fees if they lose.

3)Make "ambulance chasing" illegal.

4)Expand the local clinic system. Put more money into counties and states that expand the services of said clinics.

5)Make non-profit hospitals accountable for their expenditures/freebies. I worked in a hospital where Garth Brooks was treated like a king, and wasn't charged a dime, while little old ladies on medicare were harassed to pay "their share". I witnessed a negotiation to get Johnny Cash's son to come to the hospital (free of charge, of course) when he broke his arm. That same hospital has 5 suites for celebs. And I'm talking about suites as nice as you'll find in any 5 star hotel. You or I can't get one, though. That kind of nonsense has to come to an end. Garth "paid" for his wifes stay by doing a commercial saying "I'm donating my time to tell you about XXX hospital". Barbara Mandrell "paid" the same way after a several month stay in one of the aforementioned suites when she had that serious car wreck some years ago. If you are going to be a "non-profit" then EVERYONE gets the same care and circumstance.

There are a lot of things than can be done. Letting the federal government take over healthcare would be to abandon democracy (yes, I know we aren't a true democracy) completely. It would turn us into a socialist country. I want no part of that.

[Mayberry Machiavelli]

94. Ahem...

Letting the federal government take over healthcare would be to abandon democracy (yes, I know we aren't a true democracy) completely. It would turn us into a socialist country. I want no part of that.

Please explain how this would be true. Does having the federal government run the military, or air traffic control, or any other service, make the U.S. socialist?

What makes medicine different, then, that federal control would automatically change the whole nature of the U.S. government?

[ikojo]

56. Medicaid is not to fault for why the patients call

an ambulance. It's the culture of poverty. Most Medicaid patients have no experience with regular health care. They don't know what it's like to have the same doctor over a period of time. They have been conditioned, by their poverty, to seek medical care in the ER, the MOST expensive place to receive medical care. They KNOW they cannot be turned away from an ER and they will receive treatment, eventually. They will be stabilized at least.

I wish there was some way to educate this population about the proper use of an ambulance and ER. I do know that all of the Medicaid HMOs I have had contact with either as an employee of said HMO or as a friend of a current employee, will pay for transportation to a doctor's office if a patient has an appointment. The problem is that this is such a transient population (they come in and out of Medicaid or they move frequently and do not advise the HMO of their new address) that it's difficult to maintain communication with them and to educate them. Heck some of these people CANNOT READ the simple newsletters sent out by the HMO, and they are written at an 8th grade reading level.

Medicaid doesn't call up the person and say "gee we LIKE it when you use an ambulance for stupid reasons like stubbing a toe, please do MORE of this and encourage your friends to do the same!"

[MRM]

59. This might be true

the FIRST time they go to an E.R. But they are educated at that time to, in the future, seek a regular doc in their area for non-emergencies. In addition, when they are put ON medicaid, they are told who the doc in their area is and where to go for non-emergencies.

It's not like an attempt at education isn't made. When it's FREE it's not about being educated, it's about convenience. "I can walk down the street, catch a bus, and go to the doctors office or I can just call an ambulance to come get me".

Being poor does NOT equal being stupid.

[ikojo]

60. When you learned how to add and subtract

were you told ONCE and it stuck? NO, you had to be instructed time and time again. Being told something once by an overworked triage nurse in an ER does not equal truly being educated about the proper use of an ER. Many Medicaid patients have a long history of receiving care only in the ER, it will be difficult to break that pattern.

I think if ministers and schools helped educate this population about the proper uses of the ER and ambulance and they heard this message over and over again, maybe it would stick and such uses would decline.

They need to hear this message repeatedly, not just once in the ER.

I have a friend who works for a Medicaid HMO, I'll bet she could give me real numbers on the incident rates of people using an ambulance for non emergent reasons. I will bet they are far lower than people think. Of course when poor people do anything it gets blown out of proportion.

[MRM]

67. You confuse poor

with stupid.

How many times, exactly, do you tell someone "don't go to the ER for non-emergencies" before they get it? This isn't times tables in the 3rd grade as you state. We are talking about a basic, simple concept told to adults, not children.

And they don't "hear it once in the ER". They hear it from their case worker when they GET welfare in the first place. They get literature that states it.

I'm not aware of any "Medicaid HMO". If your state has such a thing, I'd love to hear about it.

[PA Democrat]

88. You are apparently not aware of too much other than your own unsourced erroneous opinions.

Medicaid HMOs are very common. A simple google search would tell you that.

[ikojo]

102. Most states contract out for Medicaid

and some contract with managed care organizations...here is a blurb from cms.gov website. I did a search on Medicaid HMO. Not such a foreign concept to those who work with health insurance or in the health care field.

http://search.cms.hhs.gov/search?q=medicaid+hmo&btnG.x=0&btnG.y=0&site=default_collection&output=xml_no_dtd&client=my_frontend&proxystylesheet=my_frontend&oe=UTF-8



An Introduction to Medicaid
... If your client is eligible for Medicaid, he/she may be able to enroll in a
Medicaid HMO and may, thus, have access to expanded benefits. ...
www.cms.hhs.gov/apps/firststep/content/medicaidtips.html -

[ProgressiveEconomist]

72. How often do Medicaid patients get same-day doctor appointments? Doesn't arriving at a

crowded ER in an ambulance guarantee a much better place in line than walking in and dealing with the triage nurse yourself?

"Education" cannot usually get people to ignore actual incentives to do something that's in their best interest as they see it.

[NMMNG]

101. They're only doing what their president has told them to do

http://www.youtube.com/watch?v=dcNtnuAnTVY

[Greyhound]

64. After wading through all of your replies to about a dozen posts, your agenda is clear.

Enjoy your stay, I'm sure your compadres will enjoy the show.

[MRM]

69. "My agenda"

Should be clear, by now.

I'm totally against "universal health care" and stated the reasons it's not necessary. I also outlined how ridiculously expensive it would be.

Not a single person could dispute my "agenda" BTW.

Don't have a clue who my "compadres" are, though.

I speak for myself and myself only.

I repeat

I speak for myself and myself only.

I'm sure you aren't used to anyone who disagrees with you being something other than "the enemy" but try to keep an open mind.

[Greyhound]

74. LOL!

"Pay no attention to the man behind the curtain." - The Great Oz

Move along, nothing to see here.

psst; about 100,000,000 Americans dispute your agenda, now that they've seen where it leads...

[Jackpine Radical]

89. Which one are you?

Harry or Louise?

[davsand]

97. I got that wrong up thread.

For some reason I was thinking it was Irene and Dick that the Health Insurance Assoc of America used in that commercial. In fact, in my earlier post I said I thought this was a Dick posting in this thread with all their talking points resurrected.

Much to my chagrin, I discovered my error too late to edit my earlier comments...


Laura

[Jackpine Radical]

98. If I had a dime for every time that has happened to me...

I'd probly be able to afford a medical savings account.

[Lasher]

68. You are 100% wrong.

Government provided health care is far costlier, you say? Here is a comparison of the systems in the US and Canada:


http://www.yesmagazine.org/article.asp?ID=1503

We're paying almost twice as much and we're getting a lot less out of it. This reliably sourced fact is in sharp contrast to your ridiculous and unsupported claim.

[Lydia Leftcoast]

78. Duh, the reason Medicaid patients call an ambulance is that

1) They don't have cars
2) They can't afford a cab
3) Medicaid won't reimburse cab fare but will reimburse ambulance charages for any reason.

I read a report on this years ago. Too bad that flaw in the system hasn't been fixed. But then, if they fixed it, right-wingers would have one less thing to complain about.

[PA Democrat]

80. PLease provide a source for the claim that government provided health care is more expensive.

The US spends approximately TWICE as much per capita than other developed countries that have universal health care. Oh, and unlike you, I will provide a SOURCE for my claims.

Here:

http://www.medicalnewstoday.com/articles/27348.php

http://www.kff.org/insurance/snapshot/chcm010307oth.cfm

[Lasher]

91. 'cricket, cricket'

It's quiet in here. Too quiet.

[PA Democrat]

103. Just checking back to see if our "expert" had any reliable sources.

What a surprise that he doesn't!

[Lasher]

104. Hahahahahaha, LOL!

He is either intentionally spreading insurance industry lies, or has been duped by others who are. Too bad he bailed, I think fair debate is a noble endeavor. But I don't think him worthy of such a thing, partly because of his shameless begging of the question: (I don't have a hidden agenda because I say I don't, etc.)

Thanks fer sharin' thuh fun.

Lasher

[PA Democrat]

112. Have you checked this out?

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=1464229&mesg_id=1464561

Seems someone doesn't believe that humans are causing global warming either.

[Lasher]

114. Not until you mentioned it. He's been tombstoned now.

Buh bye! Heh heh. Praise be to the moderators!

[Mayberry Machiavelli]

92. Interesting.. so the failure to invest in preventive care is integrally tied into the failure of

employers to invest in having their workers as employees over the long term.

The lack of job security in our current work environment ties directly into health issues, how revealing.

[supernova]

109. That's my theory

and all the more reason to enact universal health care.

You get everybody into the same risk pool, sickies and healthies alike, costs come down b/c risk is spread out over a wider group. Uninsured who used to show up at the ER at the last minute, now go to their GP and get ongoing monitoring before anything becomes a big (and costly) issue.

Employers don't have the burden of the added COB for a healthcare plan

You get to remain with an MD with whom you can build an ongoing relationship.

Oh and the Health Plan negotiates with Pharms for medicines. No more Big Pharma price gouging US citizens but giving every other country price breaks.

How is this not win win?

[RB TexLa]

105. And people don't buy preventative health care

Many people aren't going to give their money to a doctor when they are not sick. I wouldn't.