×
INTELLIGENT WORK FORUMS
FOR ENGINEERING PROFESSIONALS

Contact US

Log In

Come Join Us!

Are you an
Engineering professional?
Join Eng-Tips Forums!
  • Talk With Other Members
  • Be Notified Of Responses
    To Your Posts
  • Keyword Search
  • One-Click Access To Your
    Favorite Forums
  • Automated Signatures
    On Your Posts
  • Best Of All, It's Free!

*Eng-Tips's functionality depends on members receiving e-mail. By joining you are opting in to receive e-mail.

Posting Guidelines

Promoting, selling, recruiting, coursework and thesis posting is forbidden.

Students Click Here

Health Insurance
44

Health Insurance

Health Insurance

(OP)
I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

RE: Health Insurance

Not all have been similarly affected; however, many premiums have increased with increased out of pocket expenses. Mine and those of others, who I know, have not icreased/decreased as severely as yours appears to have been.

RE: Health Insurance

excellent ... a topic less politicised than climate change !

is this a company benefit (ie no charge), or a taxable benefit ? or can you opt out and arrange your own insurance ??

another day in paradise, or is paradise one day closer ?

RE: Health Insurance

Working for State government in Indiana, we've been forced (they say we have a choice, but this is the cheapest option) into High Deductible Health Saving Accounts. When it started a few years ago, for the family plan the State would put around $3k in our accounts, have a max Out of Pocket of $8k (actually $5k when you take out what the State would put into our account) and no premiums. Now, the State is only putting in $2.25k and our premiums have gone up to $1k per year and Max OOP is still $8k.

RE: Health Insurance

Zounds and Gadzooks! Am I to understand that Obamacare didn't magically cure all insurance ills?

My employer pays a respectable share of my insurance, but after everything, my premiums still run very close to 10k annually, sans dental coverage. A flex plan helps keep my OOP manageable, somewhere around 4 or 5k for the family, if memory serves.

It's not that the healthcare system is broken, the US still has the finest in the world, it's just that the door is now wide open for gross opportunism with the whole insurance thing.

The cost to my parents for me to be born in a hospital, doctor's bill and the whole nine yards, was less than $200. Yes, the dinosaurs had all died off by that time, for those of you wondering. For my children, the 3 who were born in the US started somewhere in the $6 to 8,000 range (20+ years ago). Had basic commodity items followed that same curve, we'd be paying north of $25 for a gallon of milk and $100k for a new Chevy. Healthcare is just totally disproportionate from everything else, reality included. I'd greatly prefer healthcare in step with other costs, and the reasonable ability to opt out completely and just pay-as-I-go.

My afternoon rant thus concludes.

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

RE: Health Insurance

"It's not that the healthcare system is broken, the US still has the finest in the world" - sure if you happen to have the right insurance, location and/or money to work around those 2 limitations.

My employer pays most of our healthcare and it's a pretty good PPO. I forget the exact numbers but I think I end up directly paying less than half the amount ornery mentions in premiums.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

2
Health insurance is appallingly expensive in the US. I run my own office and pay $1700/mo for an ordinary HMO family plan by Aetna which doesn't even cover the doctors we want to see, let alone dental or optical. There are so many snouts in the trough, ranging from doctors to insurance companies to pharmaceutical companies, it makes me want to vomit. But not that I would actually vomit and go to the doctor because I can't afford the copay.

RE: Health Insurance

I guess I'm lucky as I've always had pretty good insurance from where I work. Of course, years ago when I worked for McDonnell Douglas, it was really good. The company paid for it 100% and we had small deductibles and it covered dental and optical as well.

Now we have to pay part of the cost and the deductibles are much higher and the dental insurance is a separate policy, but optical is still covered (at least an eye exam and one pair of single vision glasses per year).

For my wife and myself, I pay about $3,500/year for medical and another $450/year for dental (pre-tax dollars). Note that it's a traditional PPO plan with deductibles of $500 per person and there's a $25 co-pay for doctor visits ($40 for specialists). Perscriptions are included with a co-pay based on a percentage of the retail cost. Generics are very low cost (I'm on 2 Rx's for high blood pressure, a thyroid replacement, a statin for my cholesterol and oral medication for my diabetes, and it costs me less than $40 every 3 months with the thyroid replacement being the most expensive, accounting for about a 3rd of the total).

Note that we also have a pre-tax medical savings account that I can put in up to $2500 so at least we can cover the deductibles and co-pays with tax-exempt dollars.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

I think that if the US retains the current health care model than all health insurance cost should be considered as if it were a mandatory tax , and as such should be tax deductible and including in statements of US tax rate vs foreign tax rates.

I am in favor of a single payer model, and it may likely require the addition of a national VAT to pay for it, as with most other countries. As I recall, 18% of the US GNP is ascribed to health care costs under the current model, yet there are many towns and counties in the US where there are no hospitals within 100 miles and no doctors within several 100 miles that would accept new patients using medicare.

It is strange that there is a hysterical reaction against "socialized medicine" but there is absolutely no complaint when we socialize the costs of the education system, the police, the military , the various welfare programs ( including corporate welfare via tax credits etc), and of course the government in general.

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

Without a chip in your game, I can say I've lived under/with several health care system types and single payer is best. I hope you all eventually get a "Medicare part E" style system.

Should this be of interest, your senate has been looking at international systems. I simply loved watching, and adored what happened when the Republican tried to spank the Canadian:

Quote:


Watch: Canadian doctor schools American senator on health care
EDITOR'S PICKToronto physician Dr. Danielle Martin appeared before a U.S. Senate committee March 11, 2014, to speak about health outcomes under different health care models.
Toronto physician Dr. Danielle Martin appeared before a U.S. Senate committee March 11, 2014, to speak about health outcomes under different health care models.
PHOTO: CPAC/SCREENSHOT
COMMENT
Ishmael N. Daro
Published: March 12, 2014, 11:35 pm
Updated: 6 months ago
A A A
Dr. Danielle Martin is about to become a national hero, at least to those who value Canada’s universal health care system.

The Toronto physician was in Washington D.C. Tuesday to speak to a Senate subcommittee about the virtues of the single-payer model employed in Canada, the U.K. and most other Western countries.

But when North Carolina Republican Senator Richard Burr had an opportunity to question Martin, he tried to paint the Canadian system as riddled with inefficiencies that had doctors fleeing in droves.

“Why are doctors exiting the public system in Canada?” Burr asked.

“If I didn’t express myself in a way to make myself understood, I apologize,” Martin noted with a hint of irony. “There are no doctors exiting the public system in Canada, and in fact we see a net influx of physicians from the United States into the Canadian system over the last number of years.”

The most pointed exchange, however, was about Canadians dying due to long wait times for surgeries.

“How many Canadian patients on a waiting list die each year?” Burr asked Martin. “Do you know?”

“I don’t, sir,” said Martin, “but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.”

Ouch..

RE: Health Insurance

Rich Americans have excellent healthcare, plenty of options etc. But overall, the simple accounting shows a key difference: we Canadians pay around 11% of GDP to insure 100% of our population in our single payor system, despite our amazingly low population density compared to the US which should make care coverage more expensive. Other full-coverage jurisdictions manage to provide care of similar quality for an even lower fraction of GDP. You Americans pay around 17% and you're still not covering 100% of your population. Our outcomes are similar to yours. And despite this fact, I'm sure there are a few people here who will continue to maintain, contrary to this evidence, that the private sector is still and always more efficient than government could ever be. Even when the "commodity" in question isn't a commodity but rather much closer to a human right.

Friends of mine run a mobile X-ray/ultrasound service. A few years ago they had 15 full time employers, five of whom were dedicated entirely to billing the 2000 or so payors, each with their own forms etc. Yep, that's private sector efficiency for you!

The Canadian system is far from perfect. We treat doctors as little "businesses" rather than as government employees who go where the work is. Dental care, which is essential healthcare too, is not covered publicly at all. We continue to make specialization much more attractive than family practice. We should be setting up more multidisciplinary practices which would take care of the majority of family physician visits with much lower-cost staff (dieticians, nurse practitioners, midwives etc.). We continue to clog up hospital beds with people who can't find subsidized long-term care beds, which can't help but affect wait times for somebody. But at least here, your coverage is NOT tied to employment, and there's no "pre existing condition" horsesh*t to worry about. Healthcare here is NOT a payroll tax- it is hence not a powerful disincentive to employment.

RE: Health Insurance

davefitz, that is a good point you bring up. I think people rant and rave about socialized medicine because the payer would end up being socialized (tax base) whilst the payee would largely remain private. Kind of like the military/industrial complex, no?

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

RE: Health Insurance

The Canadian system seems to be a hybrid system, in that the wealthy yet have the resources to visit a hospital in the US if they cannot wait for the Canadian system to address their immediate needs, and much of the cost can be back-charged to Canada. The remaining blue collar workers are covered, but there remains issues with the ability to attract health care workers to work out in the boonies. The waiting period for some procedures can be several years if you do not live in Toronto , Calgary, or Vancouver. And another characteristic of socialized medicine is that in order to convince the government to improve the services, it is necessary to plaster the local newspapers with stories of insufferable waiting periods etc.

A hybrid system can work in the US as well ( or a 2-tiered system) with the lower tier similar to the VA hospitals ( socialized) with the 2nd tier of boutique hospitals and clinics, and there is always the availability of "medical tourism" to other countries for those that cannot afford the wait but can afford the airfare. Unfortunately , medical tourism brings with it the risk of transporting new diseases from overseas back to the US.

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

In other countries (this may not include our friends to the North) they have goverment hospitals with doctors who can't be taken to court for malpractice, and the cost is reasonable. But the care is very poor. I can stand for that here, because they also have privite hospitals which require you to pay up frount, with Visa or mastercard, or an insurance card.

The bigest problem I would have with a single payer system, is the same problem I have with the post office, or DMV. Workers who are underpaid, and no longer care about the customers.

The comment about people not having a hospital within a hundred miles, is true, but it is also true some people live more than a hundred miles from any towns.

It is my openion that the free market, if allowed. will be able to solve many of these problems (towns in Alaska have doctors, because the state helpes pay part of the education costs).
Part of the problem is the political will, or lack of free market to provide the solutions.

RE: Health Insurance

"It is my openion that the free market, if allowed. will be able to solve many of these problems (towns in Alaska have doctors, because the state helpes pay part of the education costs).
Part of the problem is the political will, or lack of free market to provide the solutions."

That, by definition, is not free a market. A free market would not have a government subsidy or incentive. A free market will NEVER have incentive on its own to serve customers where profit cannot be made.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

You said the magic word "profit". If a market is not big enough to suport a doctor, hospital, etc. and the people of that community want that, there local goverment can be a method to make such a venture profitable.
However, complaining about a problem, in hopes that privite industry will fix the problem dosen't work.

One new trend is doctors limiting there selves to fewer patents, but requiring upfrount yearly payments for being there exclusive patents (less the other fewer patents), is an idea taking hold. The problem is my insurance dosen't work that way. The advantage is less waiting in line for an appointment, and no fees (or reduced) for office visits.
The advantage for the doctor is they know there income, provided they manage there office correctly. And they get to better know there patents better.

RE: Health Insurance

In other words, you think we should be moving toward a system of 'country club' doctors where only the wealthy will have access to medical care, eh?

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

"One new trend is doctors limiting there selves to fewer patents, but requiring upfrount yearly payments for being there exclusive patents (less the other fewer patents), is an idea taking hold. The problem is my insurance dosen't work that way. The advantage is less waiting in line for an appointment, and no fees (or reduced) for office visits.
The advantage for the doctor is they know there income, provided they manage there office correctly. And they get to better know there patents better."

Right, but only those who can pay. So who's going to take care of the 40 million that couldn't pay before Obamacare, as well as those that are currently getting shorted because their companies can now get away with it? And how well will the US handle the as yet to appear next pandemic disease, when all those people without insurance get really sick?

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Contrary to davefitz's assertion, if you travel outside Canada deliberately to jump the local queue, you can't claim any of that money back from the public system. You want to short-circuit the queue for a hip or knee replacement or "liberation therapy" for MS, then YOU pay the whole shot. Here, the queue is determined by the nature of the therapy (i.e. "liberation therapy" is not covered because there is no conclusive evidence that it is effective), and your medical need as determined by doctors.

Medical tourism exists, for sure. But as cheap as hospitals can be in India etc., it's not a major cost saver for the system right now. The vast majority of healthcare needs are met by the local publicly-insured system.

Where the local system saves plenty of dollars and also keeps wait lists shorter is by providing the opportunity for people to get tests (primarily) done faster if they choose to travel to a MRI machine across the border. In that case you pay the travel but the public system pays for the test. Sometimes they pay for the travel too, if the local machines are clogged and there's a medical emergency requiring a test ASAP. The public system doesn't therefore have to build spare MRI capacity so it can sit idle most of the time so it's there to provide fast access during peak demand periods, i.e. the public system is taking advantage of the excesses of the US system to be efficient and keep its own costs low. Having a neighbour who spends an extra 7% of GDP on excess capacity that sits idle most of the time, definitely has its benefits!

BTW for every person going south of the border for a MRI, there are probably two retiree Americans going north of the border to load up on low price pharmaceuticals which are low price precisely BECAUSE the public system here negotiated bulk purchase pricing for us collectively from the pharma companies. So that border goes both ways, folks.

I forgot to mention the obvious- my friends who run the mobile medical imaging business are in the US. Here they would likely not have a business at all, or it would be a niche private business at most.

RE: Health Insurance

2
Part of the reason US medical costs are so high is that the uninsured go to county hospital emergency rooms that are required to treat them regardless of insurance, thereby jacking up the cost of what might be a routine visit to a family doctor into a emergency room visit that's about 5x higher in cost. There are additional side effects of this system:
> Because of the lack of insurance, these people wait until their illness get so bad that that they have to go to the ER
> Which further jacks up the cost of what might have been a trivial thing to treat at an earlier time
> This delay in treatment has the potential of getting other people sick, who may, or may not, have insurance. In either case, more people get sick than is necessary
> The additional demand on ER resources means that critically ill patients wind up competing with those that shouldn't have had to go to the ER for those resources
> This further means that county ERs have to have additional staffing to treat all the extra patients

And, we pay for all of that through property or other taxes. In effect, we are creating a single payer system with a guaranteed poor outcome, because we pay for those services at ER rates, and have to spend even more because the patients are sicker than they could have been had they had insurance.

The bottom line is that those that have insurance are still paying for the uninsured, and the rates that we pay are higher because non-county hospitals are likewise building in operating margin to cover the non-paying patients. My son stayed in the hospital for 2 days for pneumonia and the "bill" as $10k, which is an insane amount of money.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Molten: Depends and varies province by province. While I lived in NZ I was covered by OHIP (Ontario) for three years... Newfoundland refunds US treatments up to their local payment rate AND treats all dental up to the age of 18 (excluding orthodontics).

RE: Health Insurance

The post starts with a statement that TBONEBANJO pays annually $12,500 USD + deductables for a family's health insurance. That sounds normal . If a family, or a single mom, happens to be earning less than $40K per annum ( so-called "working poor") or is unemployed , certainly they will not be able to afford such health insurance, and may even qualify for Medicare/Medicaid. Unfortunately, in most of the US it is nearly impossible to find a doctor to accept a new patient whose payment method is Medicaid/ medicare. As a direct result of this issue, many less fortunate persons who cannot afford insurance also cannot get prompt attention from a doctor unless they use the ER room. The belated realization of this conundrum seems to be the rationale for Obamacare.

I have a cabin just south of the US-Canada border, and a few years ago (2005) found an elderly man hitch-hiking on the side of the road. I asked him where he was expecting to go, and he indicated he just crossed the border from Canada, and needed to get to the US hospital in Bellingham, Washington state ( 30 miles away). When I asked him why he doesn't use the Canadian facilities in Abbotsford or Vancouver, he replied" I am 70 yrs old , and they found I have brain tumor , and that they can schedule the operation in Canada after a 2 yr waiting period . There is no way I will survive 2 yrs with this tumor, so I will have it removed in Bellingham , where they will backcharge Canada Health".

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

Obviously must vary province by province. Here in Ontario, if you are sick outside of your home province, you get enough care to get you stable enough to transport home, and even that coverage is limited. CELinOttawa, your experience was from a different era...Medical services obtained out of province in Canada, much less out of country, must be pre-approved or there'll be no payment from OHIP for you!

http://www.health.gov.on.ca/en/public/publications...

RE: Health Insurance

Where is all the money going in the US? Who is benefiting most from the procedure-by-procedure, test-by-test medicine being dispensed? Where's all that money going? Obviously the healthcare providers and the insurance companies! I took my son into the dermatologist for his severe acne and to have a wart removed. The PA (not an MD) concluded he needed Accutane and then used a liquid nitrogen gun to freeze the wart. Total time = 20min. Our cost = $180 US (and that's with the insurance company discount). That's $540/hr for someone who isn't even an MD! I called the insurance company and they said that they have agreed to reimburse PAs at the same rate as MDs! Obviously the insurance companies and healthcare providers are in cahoots to milk the consumer of as much of his cash as possible!

Tunalover

RE: Health Insurance

"Obviously the healthcare providers and the insurance companies!"

Please distinguish between family doctors, surgeons, and hospitals. My wife is the former, and spends about ~20 minutes per patient doing charts, for which there is there no billable, yet, the billables must cover her time spent, so she sees fewer patients. That means that she spends about 10 hrs a week just doing charts, and only 30 hours seeing patients. Refills, referrals, medical excuse forms, etc., are also not billable, and must also be accounted for in the actual revenue stream, as are the MAs answering the phones, and doing the routine stuff. So, for those that can pay with PPO, the rates have to cover this. Medicare is generally very skimpy, and she basically loses money seeing those patients, so she declines to see those.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff-
Not so much the hospitals as the doctors. The hospitals have so many other tasks that aren't billable plus they have to somehow stay afloat in spite of the many uninsured/under-insured clogging the ERs. Granted the doctors have costs to bear besides a PA providing 20min of services, but there is no excuse for a rate of $540/hr for someone who isn't even an MD.

Tunalover

RE: Health Insurance

Looks like you're right Molten... Times have changed. Also, while Newfoundland still reimburses for out of Province and Country, their coverage for Dental has dropped to 12 years of age and under, this *with* a co-pay. Given the amount of financial hardship in that province, such a co-pay would likely be denying coverage to the majority. Sigh/Tear.

RE: Health Insurance

tunalover, you realize the PA isn't getting that $540/hr an hour in his check right? That $540/hr includes a whole bunch of overhead be it paying for the building, the equipment in the building, the receptionist, the billing person, the one that weighs you on the way in, liability insurance, taxes, the supervising physicians cut ... Plus, given that there was probably some time spent before or after your visit on updating the charts etc. then even $540 may not be an accurate number for the time the provider spent on your sons visit.

Don't get me wrong, I happen to think that MD or not $540/hr seems excessive for the actual services you received but you make it sound the like the PA is pocketing the cash.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

FWIW $400-500/hr is the market rate for surgeon consulting/time (e.g. product development).

[Source: I work in medical devices.]

RE: Health Insurance

No matter what happens the wealthy will always be able to get good medical care. The question is what is wealthy? Do you drag the middle class into the class of the wealthy, or the class of the poor? Which makes more since? Healthy middle class or sick middle class?

The problem of the poor will always be a problem, that will only increase as the cost of living or the definition of poor keeps growing.

If you need a resource of doctors, all you need to do is look at the number of doctors doing nose and face jobs for people who diden't take care of there skin in the first place. You don't see many of these doctors doing charity work, or performing procedures for medicare.

Another resource of doctors that don't do much charity work is the ones next to the pot shops that issue medical pot cards (Making pot legal might reduce the number of these, but I don't wish to discuss it here).

The bottom line is money talks, and there are far too few free clinics, and the wait time of several hours is needed to keep the greedy out.

RE: Health Insurance

"Granted the doctors have costs to bear besides a PA providing 20min of services, but there is no excuse for a rate of $540/hr for someone who isn't even an MD."

All PAs, NPs, and MAs are technically under the direct supervision of the doctor who signs off on the charts and who pays for the liability insurance, and who is the one that gets sued if things go south. They get less than the 4 yrs of medical training, and ZERO residency training, and they're "ready" to do things that doctors are supposed to do. The risk and work content is still the same. The charts still need to be done or checked, by the doctor, as are any followups or telephone calls, etc. That's all part of the overhead of running the business, and specialists, like dermatologists, are billed out at higher rates than family doctors.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Two of the largest health care networks in the US are "socialized" medicine, if you count the DoD as one single health care provider network, and the VA as a separate. The USPHS could be added on top of that, as they have considerble amount of facilities availability and funding, as well as medical officers. Doesn't matter if your rich or poor, just as long as you can make it through the door. VA bene. Most recently, my father-in-law, whom lived in a rural area, needed extensive, intensive medical care. He called me from another state to help him transfer to the VA system. He, my mother-in-law, and I could all tell you once you get in the door, the care is first rate. Of course, you do have to be a Vet. A lot of motivation was shown from people wanting to treat our Vets with the respect, courtesy and best treatment possible, so not all motivation is financial.

RE: Health Insurance

And let's not forget Medicare, at least Parts A, B and D (but not including supplementals which are sold by private insurance companies). Also Medicaid in many states is a pure single-payer system. With an aging population (more people living past 65 when Medicare kicks in) as well as programs like the VA and the DoD, a larger percentage of Americans are already, or will soon be, getting their healthcare under a single-payer scheme. It would not be that big of a shift if the entire country were moved to something like the proposed 'Medicare Part E' since we're almost half-way there already. And if you want to look at it from purely taxpayer's point of view, we're even closer:

http://www.pnhp.org/resources/60-percent-of-health...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

KENAT-
Of course I realize that the PA doesn't get that rate! The rate goes to the practice who probably pays the PA a $50-$70k annual salary or the least they can pay to get the PA to do the job, whatever that is.


Tunalover

RE: Health Insurance

Engineering school: Efficiency is the only thing which matters -> Result = Trans Atlantic Flight.

Medical school: The patient's wellbeing at any cost.-> Result = my HMO.

Solution: Let engineers run hospitals.

RE: Health Insurance

Your comment about HMO's is an interesting one as we just started to get the information that we will need when our open enrollment starts for choosing next year's benefit options. The first thing we were told was that the company was dropping all HMO options, as they state that they've simply priced themselves out of consideration. We will now have three basic plans to choose from, two high-deductable, lower payroll cost plans with a couple of different ways to set aside a combination of employee contributed tax-exempt dollars and company contributed taxable dollars to help offset the higher deductibles. The 3rd plan is a traditional PPO with smaller deductibles but higher payroll costs, with a smaller health care saving account funded only with tax-exempt dollars from the employee. Note that the deductibles and co-pays for the PPO will be going up from last year as well as the what will be taken from our payroll to pay for medical insurance (we won't learn what that will be until the open enrollment actually opens in a few weeks).

My wife and I are currently covered by the PPO plan and I'm assuming that we will continue with the PPO for next year, which will be my last before I retire and we move to Medicare starting in 2016 (I'll be 68 by then and my wife will be close to 70).

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Another way to reduce costs is like what my company does, they have there own pharmacy, and clinic. No free loaders there.

And it just might come to pass that companies will have there own medical staff so they can avoid the free loader fees of the current medical system.

RE: Health Insurance

My wife, and RN, works for a health insurance company and our coverage has a lot to be desired: family deductible=$3400, max out of pocket for family=$6500, 20% copays after deductible is met. One would think that someone who works for a health insurance company would get stellar insurance, but NOOO!

Tunalover

RE: Health Insurance

Engineer's in general, have not been successful in running companies. And note that the current crop of airline companies have demanded ever smaller pitch on airline seats, to the point where fights now break out if what little extra room we are supposedly entitled to get infringed upon. So, yes, you get to fly trans-Atlantic, but do so packed as a sardine in a tin, or composite, can. The future plane won't even allow you to see out a real window.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: In spite of high oil prices and the obvious difficulty of getting a 200ton chunk of aluminum to fly, air travel is cheaper and more accessible to the mass of humanity than it has ever been. Bitch about the food or whatever, but I still chalk it up as +1 for engineering. Over the same period, the cost of a simple trip to the doctor for a runny nose has tripled. Two of the largest and most revolutionary corporations of our age, Google and Apple are run by engineers. A little bit of efficiency injected into the medical world could do no harm.

RE: Health Insurance

I beg to differ with you IRStuff. You pushed a button with your opening statement.

Some of the best run companies in the world are run by exceptional engineers. It's the MBAs that have hurt their companies by focusing only on short-term profits, failing to gain an understanding of the departments they control, cutting training, shortening schedules, cutting budgets, and making asinine decisions affecting engineering and manufacturing. The success of a company depends on the sale of its products. It takes good engineers and production people to make these products of sufficient quality, function, and appearance to sell. Thus it takes good engineering and production for a company to be successful. Perhaps the biggest shortcoming of many engineers-turned-executives is their shortage of emotional intelligence and people skills. Exceptional engineers-turned-CEOs have these skills but also appreciate the profound effect engineering and manufacturing have on the company's success. Of course I'm probably preaching to the choir in this forum bigsmile!

Tunalover

RE: Health Insurance

Tuna: Yes, you are preaching to the choir, but that's ok. Insofar as emotional intelligence goes, its not like doctors or MBA's are really that amazing. They just lack the intellectual rigor of engineers. I don't think Elon Musk has ever felt an emotion in his life other than being excited about space ships, yet he manages to struggle on. My only hope is that he has a go at health care.

RE: Health Insurance

Sorry to pile on, IRstuff, but I agree with glass99 and tunalover. Approximately a third of S&P 500 companies have engineers as CEO.

RE: Health Insurance

I would argue that there are two parts to medicine: the exciting progressive part that invents things like penicillin and genetic therapy and looks like engineering, and then the part which doctors do which looks like haggling about camels at a Moroccan bazaar.

RE: Health Insurance

In the context of whether the CEO's WERE engineers, they had engineering educations. Therefore, they had the grounding necessary to succeed in the corporate world.

My memory was faulty, and this was from 2006. The number with undergraduate engineering degrees was 23%, still greater than any other category.

http://www.arecentstudy.com/studies/S&P%20500%...

RE: Health Insurance

Many things about healthcare drive me crazy, but the one I understand least is why doctors are so stubborn about the division of labour. Their lives, and the cost of the overall healthcare service, would be much better if they allowed cheaper staff to do more of the routine work, saving them for the things really needing a physician. That works at least in theory in hospitals (though nurses complain about the doctors being tyrants there too), but in family practices it's all on the physician usually and we pay the whole shot as taxpayers for that. Probably 80% of what a family GP does could be done by people with far less training at far less cost, and health outcomes wouldn't suffer one iota. There'd be no shortage of people wanting those jobs, which even though they pay less than what a physician earns, they still offer people an opportunity to earn a very good living. I've met the odd enlightened GP here who sets up a multidisciplinary practice and loves it, again because they get to focus on what they're trained for.

The other professions, including ours, have figured this out, at least better than the docs have.

...oh, and the medical error-related deaths too- if we killed even 1/10th as many people with our mistakes as doctors do, there'd be a Royal Commission of Inquiry into the profession of engineering in a heartbeat.

RE: Health Insurance

Can any Canadians shed light on the negotiated prescription drug prices? Why would the drug companies even participate unless they are still making a profit? It is also my understanding that Canada's program does not cover ALL drugs and the companies are still free to charge market prices on those. Yes, no?

RE: Health Insurance

My wife was a consultant for years in the dental segment of medical care. She specialized in the 'front office' part of the business and that was where the problem was, it was a 'business'. Now I realize that a dental office is a much less complicated environment than a GP's office, but it's still a 'business'. As my wife used to say (she's been retired for about 7 years now) these dentists, and I suspect the same could be said for GP's, spend years in medical school yet they learn very little about what it takes to run a business. They get little or no training in accounting, marketing, employee relations, etc, yet most of them end up trying to run 'million dollar' businesses. For something like 25 years my wife made a very good living helping these 'amateur entrepreneurs' get their offices running smoothly, usually after they had screwed things up to where they realized that they needed the help of an outside 'professional'.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Negotiated drug prices occur because the Canadian Confederated (long story, but most people just call it "Federal") government and most of the provincial governments are not shy to threaten legislation.

It is also not at all unique to Canada. There just seems to be no will for it to occur in the US.

It goes like this:

Gov: We'd like to negotiate a bulk-buy of your medication.
Producer: We don't sell in bulk or negotiate market prices.
Gov: Sure you do. Besides, you want to help us out.
Producer: It is our policy to no sell in bulk or negotiate market prices.
Gov: We've been thinking about passing legislation making it legal to copy your drugs without payment, and may also work to ensure that you cannot obtain any of our research grants, while denying any future approvals in order to deny you what is effectively a large fifty-first state of market share.
Producer: We'll take cost plus ten percent.
Gov: Make it five percent; Sign here, here, and here. Thanks. Knew you could help us make this work for everyone.

Many of the drug companies cave under very little pressure, and genuinely don't know that the Gov's both could not and would not follow through on any of their threats. Frankly I think the current government might actually follow through on some of those threats if they needed to, so it is likely wise that the drug manufacturers blink.

Note that it could be far more effective than it already is, and in fact I paid far less for drugs while living in New Zealand than I do here. It just isn't as bad as the states.

Business is business. As long as it is more production for more profit, the drug companies will negotiate and will set far lower prices than people in the States pay.

RE: Health Insurance

The downside to the coercion scenario is that, once companies have that happen to them a few times, especially as everything becomes more NWO and globalized, there is no longer any incentive to offset the cost and risk in new drug development. Money makes the world go 'round, and as more things come under the thumb of government and regulation, we slowly grow toward a soviet-style utopia with less and less innovation and enterprise. The government doesn't give a damn if we cure diabetes or find a way to beat cancer.

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

RE: Health Insurance

Pharma companies spend more money on marketing than they do on research and development, trials and all, so there's no shortage of money for R&D in their coffers. What they don't do is try to cure disease- they like to make drugs for chronic diseases so you have to keep buying the drugs. There's no money in new antibiotics, so they don't develop any. And no money in a cure for malaria either, despite how many people it still kills yearly.

I suggest that we all stop thinking about these products as if the laws of the free market work on them: they're NOT commodities when a person's life hangs in the balance!

The reason the pharma companies cave is that they have to. They cave big time when the patents expire and the generics come on the market. The patents give them a monopoly on supply for 20 years- the government is merely being a monopoly buyer, leaning back a bit.

The provincial plan doesn't cover ordinary prescription meds- yet. Most people with decent company bennies get their prescription meds covered that way, just like in the US. The provincial plans vary in what they cover and what they don't, and for whom and under which circumstances, and those assessments for very costly but potentially life-extending drugs are based on medical evidence- there are still stories in the media about people mortgaging the house to pay for some of these high-cost drugs because they're not on the provincial formulary yet. But even for the drugs that aren't covered by the provincial plan for the average Joe, the provincial health system is a major purchaser simply because it buys all the meds used in all the hospitals. They are hence a huge purchaser and they use that power to lean back. The price they set is the price the local pharmacies buy at too, making the price for all of us lower.

RE: Health Insurance

Drug companies in the US make obscene profits; they just don't report net profits that large. And that's because their drug reps are allocated sufficient money to pop into a doctor's office every month and buy everyone a REALLY NICE lunch.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Well, there are many critiques of the drugs companies that can voiced here, but it doesn't seem to be related to engineering per se. In any case, it has been elsewhere reported that the drug companies have on staff 4 lobbyists for each and every member of congress, so they are able to exercise their "right of free speech" far more than does any competing interest. On the same subject, the US evening news on the 3 major televised networks seems to be primarily a platform for advertizing the latest fashion drug. The policy of allowing the drug companies to "own the news coverage" implies that they also have editorial control of what is not discussed on the news. So, between owning the news program editors and owning the congress, one can suggest they can fashion the laws to their benefit and prevent any effective discussion of their misdeeds . I t goes without saying that each and every cash settlement negotiated with their court plaintiffs comes with a "non-disclosure agreement" so the same evidence cannot be used in further court cases on be published in the newspapers. Like some other aspects of our modern life, it displays some systemic defects of our means of governing ourselves.

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

Lets pretend that someone passed a law stating that car insurance should be changed to a "car plan," covering oil changes. For our own safety. But you can only get oil changes "in network," and you can't do them yourself, because that's dangerous, and the government is worried about your safety. So the cost of car insurance (now Car Plans) goes up. Furthermore, since nobody's actually paying for the oil change, nobody shops around, so the mechanics start charging double. Some even go so far as to charge different people different sums of money for the same oil change, since nobody's paying attention anyway.

Then lets pretend that the Car Plans also cover gas, with a $5 co-pay at the gas station, regardless of how fat your car is. Well then nobody'd buy fuel efficient (skinny) cars, and nobody'd conserve their own gas use, and the cost of Car Plans goes up even more. Oh and since nobody's shopping for cheap gas, they can charge more per gallon as well.

Oh but each station only sells one kind of gas. If you need premium gas, you need a referral, and you can't get buy it unless you go to the Regular gas station, talk to the attendant, and he refers you to the premium gas station.

Also, wait a sec, he needs to be qualified to give the recommendation, with at least an 8 year college degree and another four years worth of residency at Quik Trip. So, you know, higher wages for him, and the price of the Car Plan continues to climb.

Then the Car Wash Lobby gets in and convinces folks to change the coverage rules, so Car Plans have to provide a car wash once a month. Everyone has shinier cars, and the cost goes up again.

And because the costs keep skyrocketing, everyone clamors about how the Free Market simply isn't working! Oh golly, shopping for Car Plans just isn't keeping our costs low. We need Single Payer car plans. Universal MediCar! ObamaCar!

...

So yeah. That's why health care is expensive here. If I get a ear ache in Mexico I go to the pharmacist, buy some amoxil, go home and eat it. My total cost to the system is ten bucks. If I get an ear ache in the US, I have to go to primary care, pay a copay, he bills the insurance company and says "go see an ENT," I go to the ENT, pay another copay, he bills the insurance company again, gives me permission to buy a highly proprietary patented expensive version of amoxil he's on the take to peddle, sends me to the pharmacist, and I pay another copay there while the pharmacist bills the rest of the bill to the health plan.

Unless you blow that completely stupid business model up, health care is going to continue to be completely stupid in the USA. It's got nothing to do with who shares the costs, whether it's public or private. It's got everything to do with the lack of an individual's motivation to keep their own costs down, and the systems motivation to do everything to drive costs up, since they're billing the shared pool anyway.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

2
beej67, oh, the car plan IS coming at some point in time. We have the makings of it already in annual inspections in certain states. And why not, dammit, it makes everyone safer and it's good for the environment, right?!? Let's not forget the home situation, either, with checking for mold, radon and allergens in your house, if you're doing an adequate job raising your kids, etc.

The problem with the vision of a government that's "gone nanny", is that they don't know when to stop. This will continue to regress until the liberties and freedoms acknowledged by the constitution and bill of rights are simply a fond and faded memory, a footnote in the history books. Put some serious thought into it, 1984 is not that far off. (waits for the slight pause as the staunch traditionalists become alarmed and emit a proper blubbering of protest)

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

RE: Health Insurance

Quote (ornerynorsk)

It’s not that the healthcare system is broken, the US still has the finest in the world
Ummm...is it?

beej67, applying this same logic to other countries such as Sweden or the UK, it would seem that they too would suffer from a “lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”. Being publically funded (socialized), they should be even worse than the US. However, this is opposite from reality. The (2011) health expenditure cost per capita of both Sweden ($3,925) and the UK ($3,405) is less than half that of the US ($8,508). Furthermore, the socialized systems of the UK and Sweden should, according to this logic, be bogged down to bureaucratic inefficiencies. However, they ranked first and second in “efficiency”, while the US was dead last amongst other Western nations.

The free market is not the panacea of the health care system, quite the opposite. The free market is great at commodifying and profiting off things. Sometimes, it has the co-benefit of improving society but this is not it’s goal. If there is a conflict between profits and what’s in the best interest of society, profits win (actually, they LEGALLY must win due to Dodge v. Ford). This is fundamentally problematic for something such as healthcare which, as moltenmetal stated, is closer to a basic human right than a commodity.

The failure to recognize this by free market enthusiasts largely stems from a bizarre and contradictory notion that when good things happen, it was the free market working the way it should and when bad things happen, it was regulations preventing the free market from operating efficiently.
1) The free market is the most flexible, adaptable, responsive system ever contrived. It is the solution to all social and economic issues, under every possible situation. (i.e. free market during boom periods)
2) Regulations, regardless of their extent or rigidity, completely undermine the free market and destroy its ability to operate effectively. The free market is completely inept at being able to adjust to any and all regulations imposed upon it. (i.e. free market during bust periods)

1) Without the competition that the free market offers, companies will greedily raise prices and lazily let quality slide. Consumers, being mindless drones, won’t respond. A 1984-esque society will emerge. (i.e. socialized healthcare…despite all real world evidence)
2) Without the regulations and corporate laws, companies will act in the best interest of the consumer and society at large. Consumers, being citizens of change, will effectively boycott, in mass, those companies that don’t. An egalitarian society will prosper. (i.e. free market healthcare…despite all real world evidence)

1) The free market works efficiently because consumers respond strongly to price points and thus puts pressure on companies to improve efficiency and drive down costs. (i.e. why Walmart does so well)
2) The free market works ethically because consumers don’t respond strongly to price points and thus will encourage companies to act ethically and in the best interest of society even if that means increasing prices to do so. (i.e. why Walmart does so poorly…wait…)

Given this contradictory stance, it’s no wonder that some will continue to believe that the US health care system needs more free market solutions, not less, despite all the evidence supporting the opposite.

I’m getting déjà vu from this discussion…one side using belief that the free market will solve all life’s problems (and, conversely, regulations cause all of life’s problems) and the other side using real world evidence to counter this stance…sounds oddly familiar…

RE: Health Insurance

That is a pretty silly statement ornery. We're clearly in the Brave New World, not 1984.

RE: Health Insurance

I must have missed where the US has a "free market" in healthcare (or in anything else to be fair)? I'm sure this news will shock the Regulatory and Compliance departments at my company.

RE: Health Insurance

Those 'country club' doctors don't sound so bad do they. Beats black market health care because no one can afford to wait for the goverment health care system.

I agree it's the goverment that is the problem, not the solution to the problem.

However, local goverments can help, as long as they are restricted by the people in the community.

RE: Health Insurance

One fun fact is that health insurers only pay out 80% of their premiums in claims. What percentage of GDP is going towards health insurance OH&P?

RE: Health Insurance

I think you'll find that, at lesat prior to the Affordable Care Act going into effect, that this number was closer to 70%.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

"If I get a ear ache in Mexico I go to the pharmacist, buy some amoxil, go home and eat it"

Then it turns out I misdiagnosed myself and the amoxil doesn't do anything to help 'cause it was a virus. However, it has handily helped set up an antibiotic resistant strain of some bacteria that later cause me to have such a bad infection I have to have a several night hospital stay on the strongest antibiotics available which have nasty side effects/end up needing an amputation/end up dead.

Yep, no downfalls in that system beej67.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Quote (rconnor)

beej67, applying this same logic to other countries such as Sweden or the UK, it would seem that they too would suffer from a “lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”. Being publically funded (socialized), they should be even worse than the US. However, this is opposite from reality.

No no no.

Single payer would be cheaper than what we have now. A free market would be cheaper than what we have now. What we have now is a perfect blend of the worst and most expensive elements of both systems, because that's what funnels the most money to the following groups:

Doctors
Hospitals
Pharma
Insurance

...all of which have lobbyists, and the lobbyists write the laws.

What we had before Obamacare was a very terrible blend of highly restrictive government regulations and for-profit cost sharing mechanisms that forced costs up. All Obamacare did was double down on the stupid. It was supposed to be a bill to address costs, but instead turned into a bill to broaden the number of things covered (which costs more) and to force everyone to buy it (which sucks in more money) and to fuel the buying spree with federal dollars (which drives prices even higher).

We took a terrible, broken system and turned everything that made it expensive in the first place up to Spinal Tap Eleven.

Only an idiot would think that the best way to reduce costs is to make the insurance cover more stuff and then hold a gun to everyone's head forcing them to buy insurance.


Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (rconnor)

The free market is not the panacea of the health care system, quite the opposite. The free market is great at commodifying and profiting off things.

This sentence is contradictory, and speaks to your poor understanding of how business in the western hemisphere works. You say you're a mechanical engineer. What sort of engineering do you do? Do you bid on projects? Are they least cost bidder projects?

Let me break it down for you. The free market is great at commoditizing (not "comodifying") goods and services, but the act of commoditizing them reduces the profit to be made from them. In a perfectly elastic marketplace with perfectly robust competition, nobody makes money. Everybody saves money. You're falling into the common Blue Shirt trap of confusing free markets with capitalism.

Free Markets means you and I exchange goods or services for a price we both agree to.

Capitalism means I loan money to you and expect a return on my investment.

Capitalists are forever attempting to fight against free markets, because in a perfect marketplace there's no ROI. Capitalists want to corner markets. They want to be the only seller, or one of a very few sellers who can collude, so the buyer has to pay more than the product took to create. In a marketplace where 100% of the market share goes to the lowest price product, profits of all sellers shrink to the margin.

This is why ASCE wants to make all PEs get a masters degree. They want to reduce the number of 'sellers' to corner a market and drive the margins up. This is why the AMA has such a restrictive process to become a doctor, to create artificial scarcity of supply. This is why I can't just walk up to a pharmacist when I have an ear ache and buy the Amoxil that I know will cure the ear ache, without first going to a doctor, paying a copay, having the doctor bill my insurance, having the doctor refer me to an ENT, paying another copay, having the ENT also bill my insurance, getting a prescription for a highly proprietary and totally new version of Amoxil that costs ten times as much, going to the pharmacist, paying another copay, and having the pharmacist bill my insurance for the expensive alternative to Amoxil. All of those things obscure the marketplace, to drive up the margins.

If I was in Mexico, where there's a free market, I could walk up to to a pharmacist and buy the Amoxil, and my total cost to the system would be fifteen bucks.

See?

It's just like the car insurance analogy above.

Your comparisons to England and Sweden are hollow and pointless, because England and Sweden don't have anything like what we have here. Our laws are written by corporations.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Now, before you go there, rconnor, I will absolutely say this:

For many kinds of health care, the free market flat DOES NOT work. In order for a free market to work, you need to have two things:

1) the knowledge of what you're shopping for, and
2) the ability to shop at all

If I get in a car wreck, I can do neither. The free marketplace does not work for car wrecks. It doesn't work for heart attacks. It does not work for strokes. It does not work for any scenario in which an ambulance or helicopter shows up to rescue you from certain death and trucks you off to a pack of highly trained specialists. Trying to apply free market principles to that scenario is doomed to fail from the beginning.

If I were to craft the perfect system from scratch, all emergency services would be handled on a single government payer model, with the costs to the government published and critiqued by the media. Insurance would not cover emergency services at all. Taxes would.

On the other hand, prescription drugs are absolutely something that free market principles could be applied to, and the many layers of market obfuscation could be stripped out and replaced simply with education and individual responsibility. We could take 95% of the prescription drugs on the market today and make them over the counter. We could take the remaining 5% and allow them to be issued with merely the recommendation of a pharmacist, not a doctor. We could reduce the patent limit on drugs to 4 years. We could move cannabis off the schedule 1 list. Then once the costs plummet, we pull them off of the health plans.

Then, with no emergency services and no prescription drugs on the health plans, we make buying insurance optional again.

That's the kind of solution that would work. But look what it does:

Takes money from hospitals
Takes money from pharma
Takes money from doctors
Takes money from insurance companies

..which is why it won't be implemented. It won't be implemented because our very system of governance itself is completely rotten.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

I've been avoiding this discussion because it doesn't really have a solution, just a nearly infinite number of opinions.

The question I've never gotten an answer to is "exactly where in the U.S. Constitution is Obamacare, Medicare, or federal contribution to Medicade authorized?". I've read that document very carefully and I'm pretty sure that healthcare comes under the 10th amendment:

Quote (Tenth Amendment)

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people

That seems pretty clear. The ramifications of that is at least 50 different ways to skin this onion. It is very clear from the discussion above that a plan that works good enough in Alaska would really be a problem in Florida. OK. Fine. That is why we have states and the free will to choose where we live.

There is one reasonable role of the Federal Government in health care -- Tort Reform. When a Doctor in New Mexico must spend more on malpractice insurance than on rent, heat, light, and office payroll combined something is messed up. When a one-doctor medical practice must spend $500k computerizing their medical records to comply with Federal requirements something is messed up.

I'm one of those "free market" guys denigrated above, but there is so much noise in this discussion that "truth" is in really short supply. People can find anecdotes to support any position that they want to take. Bottom line is that people get medical advice from medical professionals, and then either follow it or don't. I can't find a single example of where providing health care (or most any other service) is enhanced by a central government getting involved.

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

RE: Health Insurance

Try the 'Interstate Commerce' clause as well as shades of the 14th Amendment.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

To say nothing of the ideal of "Life, Liberty and the pursuit of Happiness".

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

How the heck do you resolve your right to pursue happiness with my right to liberty not to pay for your pursuits? If I really need to strangle a prominent politician to be happy, how does that impact their right to life? That one simply does not work on any non-emotional level.

14th amendment? It says

Quote:

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
Section 2. Representatives shall be apportioned [rest is about apportionment and qualifications or representatives]
Section 3. [Anti-insurrection clause].
Section 4. [allows the federal government to incur debt]
Section 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article
Section 1 of the 14 amendment is all about states not revoking federal rights and privileges. To say it applies to health care is to say that Alaska is violating the 14th amendment because the Federal Government has provided subway's in Washington DC, but Alaska doesn't have any subways. Ludicrous on the face of it.

As to the Commerce Clause (Article 1 Section 8), the paragraph that people always point to is:

Quote:

To make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.
but for that to apply you have to somehow read the foregoing 17 paragraphs to include some mention of healthcare. I can see support for a Navy, the Patent Office, and the Post Office, but not Obamacare.

According to the Federist Papers, the very reason that the framers of the Constitution went into such tedious detail on the things that the Federal Government was allowed to do is because they weren't allowed to do anything else. Interpreting the Commerce Clause or the 14th amendment otherwise is trying to revise the Constitution by tort. That attempt happens all the time, and everyone who believes in this country should resist all of these outrageous attempts.

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

RE: Health Insurance

That's why the supremes called it a tax.

RE: Health Insurance

That is my understanding as well. Seems like the definition of "tax" has more flexibility than the definition of "pornography".

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

RE: Health Insurance

I'll admit that the 14th Amendment has been used as a bit of a catch all recently. For example, George W. Bush used it as the basis for his arguement that he had the right to demand that the courts halt the Florida vote recount in 2000 ostensibly because the outcome could potentially deny him the presidency. How that was an "equal protection of the laws" issue is beyond me, but five activist Supreme Court justices agreed with him, resulting in the 8 year disaster of the Cheney/Bush presidency.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

States regulate utilities, why not hospitals? Specific territories for hospitals. So if a privite company wants more patents, they can build more hospitals. Or mini hospitals that feed into larger hospitals for extreem cases. That would work for small towns.

Strange how my doctor recommends antibiotics for viral infections, so why do I need him if the same antibiotics seemly work for both types of infections?

Also why don't I see price lists in hospitals? It would make it easer to shop around for my next set of tests.

RE: Health Insurance

I'm a Canadian and I can tell you that your understanding of the 2000 Florida recount is flawed. A lot of myth, smoke and mirrors becomes "fact" in the US. I simply don't know why...

We suffer from the same self-deluding BS on other issues, but nowhere near as often as the average US citizen when it comes to politics. It seems that if you introduce politics, you drop thirty points of the mean US IQ. I can't explain why; some of the smartest people I know are Americans, but you guys and gals suffer crowd think like nobody's business!

RE: Health Insurance

beej67, firstly, let’s clarify our terms. While certainly not the exact same thing, the free market and capitalism are not mutually exclusive terms. To say, “but the free market is when things are traded fairly, whereas capitalism is when companies try to cheat consumers for profits!” is analogous to my (mocking) definition that “the free market is when good things happen and when bad things happen it’s not the free market”. It doesn’t work that way.

Capitalism sets up the “market” and the “free” part comes from removing restrictions and regulations such that consumers and producers can operate independently. In reality, you can’t have a producer (of any substantially large size…to say produce drugs safely) that operates independently of a capitalist market. Therefore, the free markets operates within a capitalistic frame work and advocating for a more free market healthcare system is to advocate for a more capitalist healthcare system. The only way it isn’t is if you are advocating for market anarchism (which I mean in an ideological way and certainly not a disparaging way. In fact, it would be quite interesting if you were). However, you’d have to not just blow up the entire US healthcare system but fundamentally change the entire US economic system (in which capitalism is just a little, teeny, tiny bit rooted). The only practical way to limit the effect of profit-driven capitalism on healthcare is to limit participation in the market and move to a universal healthcare system.

Quote (beej67)

What we have now is a perfect blend of the worst and most expensive elements of both systems, because that's what funnels the most money to the following groups…
I agree with this for the most part. However, your (and my) issue with the prime objective being to funnel money to individuals and corporations is an issue with a right end aspects of this blended system, not a left end aspect. Moving towards the left end, and a universal healthcare system, addresses this issue. This is one reason why universal healthcare systems, in the real world, continually rank head and shoulders better than a privatized system. The other is that whole equity thing and supporting the disenfranchised in your society...you know, leftist nonsense.

Quote (beej67)

Your comparisons to England and Sweden are hollow and pointless, because England and Sweden don't have anything like what we have here. Our laws are written by corporations.
How so? All countries that have universal health care systems moved from non-universal health care systems to universal health care (UK – 1948, Sweden 1955, Canada 1968, etc).

If we can’t use universal healthcare as an option to compare against than what are you advocating for? What is your plan? What is a “truly” free market healthcare system? What it sounds like is “if you can pay for it directly, you can get healthcare.” No insurance companies, no middle men, no support for low-income. If this is correct then you’ve describe a system that is the most apathetic, inequitable system imaginable.

Quote (beej67)

replaced simply with education and individual responsibility
So in this free market utopia every citizen has the access to proper medical education such that they can self-diagnose without error, won’t abuse an uncontrolled drug market and every citizen has the money to afford the drugs that they need (through accurate self-diagnoses). This system perfectly encapsulates the two fundamental and fundamentally incorrect assumptions of free market ideology:
1) Opportunity applies equally to everyone. There’s no such thing is social, cultural, economic impediments.
2) Once a fully free market is obtain, people will magically live altruistically, co-operatively, and efficiently. While under restrictions/regulations, people are selfish, greedy and lazy (“lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”).

Quote (zdas04)

I can't find a single example of where providing health care (or most any other service) is enhanced by a central government getting involved.
Honestly?

Quote (zdas04)

How the heck do you resolve your right to pursue happiness with my right to liberty not to pay for your pursuits
It’s not right to pursue happiness, it’s right to life. Access to healthcare should NOT be a purchasable privilege in the richest country in the world, it should be a right. But at the end of the day, if you feel you have the “right to liberty not to pay for” others right to life, then what can I say – we wish to live in different ethical worlds.

RE: Health Insurance

A paragraph taken from an appropriately named source (link provided below) which explains the outcome of the 2000 Supreme Court case 'Bush v Gore' (emphasis added):

The Court's third and final intervention in the 2000 presidential election came just days later. In its unsigned opinion, the Court explained that it had voted 5-4 to put a stop to the Florida recount. Allowing the recount to go forward, the Court said, would violate the Equal Protection Clause of the Fourteenth Amendment. The U.S. Supreme Court sent the case back down to the Florida Supreme Court, which had no alternative but to dismiss it. The presidential election of 2000 had been decided, in essence, by the vote of one Supreme Court justice.

For the full article, go to:

http://www.dummies.com/how-to/content/supreme-cour...

And if you'd like something from a source with perhaps a bit more credibility, here's a link to an item posted by Princeton University which reported the same bssic "facts":

http://www.princeton.edu/~achaney/tmve/wiki100k/do...

As for my humble opinion as to the consequences of the Cheney/Bush presidency, you only need to look at the recent headlines of any major newspaper in the world to see what they are.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Try Section 8:
The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

General Welfare would seem to fit the bill, and is the basis for most of the arguments in favor of taxation for general welfare items.

Note that the Constitution doesn't explicitly acknowledge the right to privacy, so, kind of hard to argue narrowing the Constitution in one aspect, but expanding it elsewhere. SCOTUS has made the Constitution quite flexible and expandable.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

JohnRBaker,
History judges past presidents. The further back, the more objectively it seems to me, and it is mostly looking more kindly on GW every year. Your opinion is clearly on record pretty much anytime anyone mentions a court case, or any President, or pretty much any topic. I hope you've noticed that people don't rise to drag the conversation into those particular weeds. Enough already, you didn't like Bush/Cheney, got it, don't know what it has to do with health care, but got it.

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

RE: Health Insurance

So with the words "uniform throughout the United States", why does the Presedent get better health care the the rest of us? Is that uniform? Did Obomacare fix that?

Section 8 seems to say the Presedent should not recieve better care than the remander of the US.

I don't think that is what this section means at all. I don't even think it was intended to apply to healthcare.

I still think it would have been better if we were allowed to purchase insurance over state lines, and not required to purchase insurance we don't need, or want.
After all if contraseptives are part of this health thing, don't allow them to be over the counter. Make people go to the doctor for a note to allow them to buy them.
This has no business in health care.

Another way to reduce the health care costs, is to reduce the regulations on bill collectors. Allow them to call people in the middle of the night, and during dinner. Allow them to staple signs on people frount door.

Regulate hospitals, not doctors, the way they do utilities, by state. Eliminate secondary billing by doctors you have not agreed to hire.

RE: Health Insurance

rconnor,
In the threads that I've decided to stop commenting on, I developed the habit of simply not reading your posts. I was doing that just now and noticed my handle.

Yes, honestly. Can you describe a single service (which doesn't include the military) that federal government does better than states? Education? Give me a break, I want education to be at the community level, but getting the Feds out of it is a step in the right direction. Regulation of hospitals? No question, the states do it worlds better (compare your local hospital to a VA facility). Aid to the poor? Again, communities do it better than states, and states do it better than the Feds. Federal social programs are simply too big to: (1) be effective; or (2) avoid fraud and waste.

Access to healthcare is a "right"? Take that to its logical conclusion and providing that "right" becomes an "obligation". Not for the government, but for providers. If a nose-job is a right and doctors are obligated to provide them then who would become a doctor? One person's "right" that requires a disinterested party to "contribute" is simply slavery. Pretty it up with a pretty diploma and assigned parking space and it is still whips and chains. How to you supply that "right" if all of the providers decide to find other ways to make a living? Oh yeah, it is only a "right" if you can coerce qualified people into supplying it. The only "right" I can see in this field is the right to live until you stop. We all stop living sooner or later. If the people of the world had a "right" to medical care, then it would be immoral to have a doctor/patient ratio disparity between the developed world and the developing world. It is not a right, it is a service that we should be willing to pay for. We should be willing to pay the portion of our income that it is worth to us. A Christian Scientist would tell you in the strongest possible terms that it is immoral for you to forcibly take his money to pay for someone else's trip to a doctor that the Christian Scientist does not believe is able to add value. Someone who is anti-vaccine resents paying for vaccinations. Someone who anti-birth-control resents having to pay for others to have access to that technology. "Right" to medical care is a really slippery slope.

The article you linked to has specific criteria (not disclosed) to place a country in a position in the ranking. This is common, and last year I tried to find raw scores and weighting algorithms for one of the studies. When I finally dug out the basis for a score, I found that they were heavily weighted towards "providing health care to all without stigma". "Quality of care" (measured by the number of fatalities compared to number of doctor visits) was weighted 10th in that study. It also gave zero credit to someone being able to walk into an ER and be seen, because there is a stigma attached. It gave no weight at all to ratio of patients to doctors, to number of citizens served by a hospital, or to geographic area served by a hospital. When a study considers these minor points the rankings change a bit.

David Simpson, PE
MuleShoe Engineering

In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual. —Galileo Galilei, Italian Physicist

RE: Health Insurance

"After all if contraseptives are part of this health thing, don't allow them to be over the counter. Make people go to the doctor for a note to allow them to buy them."

To be totally fair, you'd have to include condoms in this as well . . . or are you going to suggest that that's different? If so, how so (be careful how you respond as we're now getting down to the real crux of the issue aren't we)...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Quote (rconnor)

beej67, firstly, let’s clarify our terms...

...Capitalism sets up the “market” and the “free” part comes from removing restrictions and regulations such that consumers and producers can operate independently. In reality, you can’t have a producer (of any substantially large size…to say produce drugs safely) that operates independently of a capitalist market. Therefore, the free markets operates within a capitalistic frame work and advocating for a more free market healthcare system is to advocate for a more capitalist healthcare system...

No.

Capitalists corner markets for profit. Free markets are not cornered markets. See above. I'm not going to type the same things again, I want you to read it the first time and take the time to understand it. Our current healthcare system is very capitalist, but in no way free. There are ten reasons I can't go buy penicillin, even if I need it, and someone else wanted to sell it to me. That is not a free market. Not a free market. It is a cornered market. If you think our system, before or after Obamacare, was a free market, then you are part of the problem.

Quote:

However, you’d have to not just blow up the entire US healthcare system but fundamentally change the entire US economic system (in which capitalism is just a little, teeny, tiny bit rooted). The only practical way to limit the effect of profit-driven capitalism on healthcare is to limit participation in the market and move to a universal healthcare system.

No you would not. You would merely have to remove the obstructions to the free exchange of goods and services that I wrote about above. Further limiting people from participating in the marketplace only drives costs up, and entrenches the big money makers. That's why the big companies love regulation. Regulation squeezes out the little guy and carves their market position in stone. You Blues are the worst, because you think you're sticking it to the man, when in fact you're giving the man a free ride for the next century.

Quote:

If we can’t use universal healthcare as an option to compare against than what are you advocating for?

Read the post at (23 Sep 14 9:52).

I'm totally with you on car wrecks and heart attacks.

I'm virulently against you on prescription drugs and routine health care.

You can't compare us to Sweden because we're not made of Swedes. For that system to work here, we would need to replace our population with a bunch of Swedes, with the Swedish mindset, Swedish pride in their work, Swedish sense of cultural responsibility, and Swedish government that's not completely beholden to money. If you want to know how single-provider health care plays out in the United States, we already know how that plays out. We already have that. It's called the VA.

Quote:

So in this free market utopia every citizen has the access to proper medical education such that they can self-diagnose without error, won’t abuse an uncontrolled drug market and every citizen has the money to afford the drugs that they need (through accurate self-diagnoses). This system perfectly encapsulates the two fundamental and fundamentally incorrect assumptions of free market ideology:
1) Opportunity applies equally to everyone. There’s no such thing is social, cultural, economic impediments.
2) Once a fully free market is obtain, people will magically live altruistically, co-operatively, and efficiently. While under restrictions/regulations, people are selfish, greedy and lazy (“lack of an individual’s motivation to keep their own costs down and the systems motivation to do everything to drive costs up”).

I don't know if you've noticed or not, but for 99% of ailments all the doctor is doing is spouting off the same BS you can get off WebMD. I've been misdiagnosed more than I've been properly diagnosed. Your position, and the position of the whole industry to date, suffers from the two fundamental flaws of nanny state progressivism:

1) People can't be trusted to do what's right for themselves
2) The government can't be bought

Your progressive government is bought. The people you voted for are bought. The head of the FDA is a Montsanto lobbyist. The head of the FCC is a Comcast lobbyist. Obamacare was written by lobbyists. The fundamental underpinnings of progressive nannystateism don't work if the government is bought. It works in Sweden because the Swedes don't put their government up for auction. That's why it won't work here.

I'm not saying it doesn't work there. I'm saying we are not them.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

David (AKA zdas04), I will give Geoge Bush credit for one thing; he promised that when he left office he would walk away from the political arena and that further, he would not publicly second-guess his predecessor, and he's pretty much kept his word and I applaud him for that. Too bad the same can't be said of Dick Cheney...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Applicability of the fourteen amendment to your constitution was near unanimous. If memory serves it was seven or eight judges who agreed.

s to the form of the objection, it was a speculative play at best. The recount which DID occur later as forced through court actions by Gore supported and the media (gee, I wonder what cause they had to see continued controversy) showed that, while smaller, Bush still had more than a marginal victory in Florida.

Look to the form of your elections if you want a constructive place to lay blame, not technicalities on vote counting. Your country was founded with an inherent paranoia regarding delay in declaring the uncontested winner. Together with that ungodly Electoral College system it has produced several permanently controversial results.

RE: Health Insurance

I agree that the Electoral College system has long outlived any sort of applicability in our modern society (eliminating it would have of course made the entire Florida insanity in 2000 moot since Gore took the popular vote by better than a HALF MILLION votes). With that in mind, in 1992, I voted for Ross Perot with the hope that enough other concerned Americans would do the same so that he would get enough votes so as to scare the Congress and the rest of the country into demanding that we do away with the Electoral College system before we had a situation where the House of Representatives would end-up being the ones who choose the new President. If we thought the 2000 election was something with the guy who got the most votes losing, what if the guy who came in 3rd, but who was of the same party as was controlling the House, was picked for President? That would be too much to stand and would probably lead to something a lot worse than what did happened in 2000.

But back to the idea that IF the Florida recount had been allowed to continue. Well that would have been a lot better situation than having 5 activists judges make that decision for us when there was still a chance that a recount could have shown that Bush had NOT gotten the most votes in Florida. In some ways, we were damned lucky that the recount was finally done (which BTW was paid for by several Florida media outlets) and that it did show that Bush got the most votes and that he did deserve Florida's Electoral votes after all. But what would it have been like in this country if that exercise had shown the opposite? Just think about it...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

My bet as a reasonably impartial third party: Controversy for a few weeks followed by the same pernament "he didn't deserve it" style of grumbling that I see all over the internet as it is...

RE: Health Insurance

NO, it would have been a lot worse than that. For sure it could very well have changed the course of history in terms of both the aftermath of 9/11 and the presidential election of 2004.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Your country, I'm likely wrong. It isn't like everyone in the states represents polar extremes that never seem to be able to find any functional middle ground... /sarcasm

A sincere bit of praise, from a citizen of a country founded by the Loyalists who fled the American Revolution: You were founded by some of the greatest free thinkers of their time, men who demanded equal say in their futures. Many of them are inspirational even to this day... They also happen to be a well off group working for their own self-interest, a number of whom were terrified of the democracy they were creating. In many ways the fears Thomas Jefferson expressed when wishing for a revolution every twenty years have been realized.

If you think TJ's wishes unrealistic, just look to the French... That is if you can get over the whole "Freedom Fries" bit and see that they were once your greatest and most important ally. That and the fact that just because someone doesn't agree with you shouldn't mean they should be derided and mocked. Google "French Military Victories" and hit -I'm feeling lucky-. Classy.

Now how did we get here from health care? *sigh*

RE: Health Insurance

That whole "Freedom Fries" thing was an unmitigated load of crap, period. Besides, "French Fries" are NOT even French. They originated in Belgium, but Americans have a 'soft spot' for alliterations.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

A reasonable healthcare system in the US is impossible, period. There are too many people making too much money- 7% of the US GDP is a VERY large amount of money, and that large amount of money has incredible power. The only power which can rival it is the power of the people- but you will not use it.

You're all getting hosed, big time, and there's virtually nothing truly effective you can do about it which is a political POSSIBILITY in the United States. There are too many people in your country that fear their own government to the point where any kind of trust is impossible. See where it's getting you on this one? Enormously greater cost than any other jurisdiction where this idealization of the so-called "free market" doesn't border on religion...And yes, despite its failings it does provide excellent health care- for the very richest among you, who will always be able to hire their own doctors.

RE: Health Insurance

"the democracy they were creating"

Nope. That's definitely not what they were after. That's partly why we're in this mess now. Mob rule.

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

RE: Health Insurance

"a country founded by the Loyalists who fled the American Revolution" ... really CEL ? really ?

i thought the French had a hand in it, and the Brits, some 100 years before.

ok, they gave us the Loyalists, we gave them Cajans (Arcadians).

another day in paradise, or is paradise one day closer ?

RE: Health Insurance

In fact I am French Canadian, of a sort... I'm a Jackatar. For our southern friends I thought I'd keep it simple and highlight the pertinent part of the story...

You're quite right however, a gross oversimplification. Apologies to the other Canucks. *smiles*

RE: Health Insurance

The electoral college was set up so that it was fair for both small and big states. Each state has at least three votes, where larger states have more. And the intent was to force the perspective office holders to visit as many states as possible, and not just the more populus states. The rural states would be neglected and oppressed by city dwellers if this reminit from the past were to go away. So it does help even out the concerns of rural America in the elections.

Besides, the recount was something like in only 9 counties, and not the whole state of Florida. After all Al was not interested in what rural Florida had to say.

RE: Health Insurance

For comparison, the 7% of GDP the US is spending on health care in excess of what countries like Canada, the UK, Germany etc. are spending, is greater than the total US expenditure on national defense, which was around 4.7% in 2010. That is the amount of extra money we're talking about, and I take that as an approximate measure of just how much power that much money has over government policy...It's for that reason primarily that I would conclude that no real solution for health care is politically possible in the US. And let's be clear- part of that additional expenditure arises because there IS a partial parallel public system in the US- medicare, Medicaid and the VA system etc.

What concerns me is that many greedy people in Canada would also love to slice off an additional 7% of our GDP for their own private gain. They would like to subvert our single payor system by providing an "out" for the rich in the form of a parallel private system. While that apparently does exist without the total destruction of the public system in some jurisdictions, I can guarantee you that the minute rich people here were allowed to opt out, they would DEMAND a dramatic reduction to the taxes which fund the public system everyone else depends on. When there's no out for the rich and powerful, there's a motivation on their part to maintain the public system for their own benefit, which coincidentally also benefits everyone else in society. The very wealthiest can of course fly wherever they prefer and obtain whatever gold-plated healthcare they desire, irrespective of where they live normally.

RE: Health Insurance

Beej67, firstly I mistakenly forgot to delete my paragraph that starts with “If we can’t use…”. I wrote it prior to seeing your 3rd response, where you did outline your position. My mistake.

Fundamentally, I feel we are pretty close to the same core understanding of the issue but our solutions go in completely different directions. We both see the US as an corporate oligarchy and that this has directly caused the healthcare system to not be in the people’s best interest. Your stance, if I can attempt to paraphrase and correct me if I’m wrong, is because of the corporate corruption of the political system, healthcare shouldn’t be controlled by the government (i.e. universal/socialized). Instead, it should be allowed to operate, as much as possible and as closely as possible, directly between the producer and consumer.

My stance is that the “producers” in this case will, as they always will in a capitalist economy, put profits before creating an equitable healthcare system. That same corrupting influence on our government is now directly, and with less regulation, in charge of the healthcare system. Even though the government is far from perfect, it is much more accountable to the people than a for-profit hospital or big pharma company. I just cannot understand how a producer in an idealized free-market is not the same as a producer in a capitalist economy. It is also easier to be much more equitable to all citizens in a universal, socialized sense than on an individual level. I feel that a free-market solution would “help those that can help themselves” and make it even harder for the disenfranchised in the society.

Now to your two objections to my ideology:
1) I think that people, in mass, will naturally do what’s right for themselves but not what’s right for society. That’s my point. Furthermore, culture and advertising tells people “what’s right for them”, which really may not be what’s right for them (hence why so many people live outside their means, eat terrible food, smoke, etc.). Free-market ideology promotes an individualistic society, centered around consumption and predicated on a “you get what you deserve” attitude. The disenfranchised are seen as people that do not want to work for themselves, which completely ignores any and all social, economic or cultural barriers. That’s just fundamentally not a society I want to live in.
2) I touched on this already but I absolutely agree that government can be bought. However, I still have much more say in how the government works than I do how corporations work. Mass boycotting of companies on ethically grounds (which is the only “voice” you have in an idealized free-market) is difficult for the average person, especially if the companies costs are lower than competitors (i.e. the Walmart example or why 99% of clothes coming from sweat shops, etc.). People respond to the product, not the means of producing the product. Therefore, while, in theory, an idealized free market should promote cheap, quality products, it has no control (nor does it care to control) the ethical and ecological means of production. This is a problem for me.

zdas04,
…I just deleted the rest of my reply to you after I read this gem: “One person's "right" that requires a disinterested party to "contribute" is simply slavery”. This is disgustingly apathetic and so grossly extenuates actual slavery. So you feel that universal healthcare is slavery - where you, the tax payer, are the “slave” and under privileged families, receiving free, publically healthcare, are the “slave masters”. The fact that you are “disinterested” in supporting the disenfranchised in your society does not make you a “slave”, it makes you egocentric.

Leave it to some white, middle-upper class, libertarian male to declare themselves a “slave” because they have to pay into social welfare programs that support the disenfranchised and most marginalized groups in their society. That’s insulting on so many levels.

RE: Health Insurance

CEL--I am curious (and want to learn more) about your comment that Canada was "founded by loyalists that fled the American Revolution". My recollection of history is that in what was to become the U.S. , there were folks that did not want to break away from Britain. These people were known as "Tories", if I recall. Some may have moved to Canada, then part of Britain. Canada did not become an independent country until roughly the time of the U.S. War Between the States, aka the Civil War. The time between the signing of the Declaration of Independence and the outbreak of the civil war is roughly 80 years. That seems like a long time for a group of Tories to have finally got around to forming Canada.

RE: Health Insurance

Well swall, rather like "Irish" Americans or "Italian" Americans, Loyalists have been a rather peculiar lot... It isn't just the ones who left the USA, but their children who count themselves to be "Loyalists". I have a client who is a Loyalist, and they continue to consider themselves to be "Loyalists" generation through generation.

This page has more information that you'll likely care about: http://www.uelac.org/ I'll warn you this is an old fashioned way of seeing the world which now seems to be finally waining; They aren't exactly tech savvy, and that page shows it.

You're quite right about the "Tory" bit. Pre-rebellion the folks who were most unhappy with the King and country (as it then stood) were the "Whigs". Roughly speaking, the Tories weren't all that happy either - They just did not support taking up arms, but believed that independence or equal representation in the British Parliament could be obtained through negotiation with the Crown. They, or rather their children, were a very prominent force amongst those who did indeed succeed in obtaining independence from Britain in a peaceful manner some years later.

Note that Tories who moved to Upper Canada (now Ontario), Nova Scotia, New Brunswick, etc, provided badly needed professionals and tradesmen. In many ways Canada was a minor outpost before the Loyalists arrived and the founding of the USA forced the British to refocus efforts. We are, to my view, the bastard child of one group's (fairly reasonable) refusal to pay taxes levied in order to pay for a war with France in absence of the right to vote, and another's placing loyalty to one's King (or, at a minimum, to the oath to the King) above all other concerns. Without both the rebels and the loyalists, we would never have existed at all.

Yes this is all a gross over simplification, but it is as valid as any other generalization.

RE: Health Insurance

rconnor - "Leave it to some white, middle-upper class, libertarian male to declare themselves a “slave” because they have to pay into social welfare programs that support the disenfranchised and most marginalized groups in their society. That’s insulting on so many levels."

WOW, are we going there now?!?! Yes, that is insulting, and you owe the forum an apology.

And Yes, coerced participation in social welfare programs can easily be viewed as a form of slavery. How about we look at the real reasons why healthcare is so grossly out of whack in the US to begin with, and is not affordable.

Google - Davy Crockett not yours to give

It is better to have enough ideas for some of them to be wrong, than to be always right by having no ideas at all.

RE: Health Insurance

2
I do agree that coerced participation in any social welfare programs is wrong, but the health care is just the tip of the iceberg, and part of the reason it is so difficult to get out of social welfare trap.
Social Welfare is not just healthcare, but also food, housing, energy, schools, goods, drugs, etc. and part of the problem is some of those people are just free loaders, and don't want to be productive.
I agree some of those people do need help, but the goverment just dosen't do a good job of removing the free loaders from the list of the needy. Also the black market makes it harder to measure real income.

This is why churches were the vehicle for help of the needy. They have people who can take the time to evaluate the needs of the needy.

But forced paricipation in anything is a form of slavery, and we are all becoming slaves of the goverment masters, in the name of the poor.

And no amount of goverment givaways has reduced the people begging on the streets.

RE: Health Insurance

Quote (rconnor)

Fundamentally, I feel we are pretty close to the same core understanding of the issue but our solutions go in completely different directions. We both see the US as an corporate oligarchy and that this has directly caused the healthcare system to not be in the people’s best interest. Your stance, if I can attempt to paraphrase and correct me if I’m wrong, is because of the corporate corruption of the political system, healthcare shouldn’t be controlled by the government (i.e. universal/socialized). Instead, it should be allowed to operate, as much as possible and as closely as possible, directly between the producer and consumer.

Only for the things we can shop for. Not for the things we can't. We can't shop for emergency services, yet emergency services are the primary reason everyone pays insurance. Emergency services should be single payer, paid out of taxes, just like the police and the firemen. I am arm and arm with you on that one. If you don't know what you're shopping for, you can't shop. I can't even shop for insurance properly not knowing whether I'm going to get in a car wreck or have a stroke or none of the above. You can't shop when you don't know what you're buying.

Our system tries to make us shop for emergency ailments in advance. That's dumb.

Then our system obscures our ability to shop for ailments that we could ordinarily shop for. Like cancer or prescription drugs. Equally dumb.

Quote (rconnor)

My stance is that the “producers” in this case will, as they always will in a capitalist economy, put profits before creating an equitable healthcare system. That same corrupting influence on our government is now directly, and with less regulation, in charge of the healthcare system.

Only because we're not allowed to shop around. The consumer can vote with his dollars if he knows what he's shopping for. Corrupt and Evil corporations go the way of the Dodo Bird once people are given the choice to spend their money elsewhere. General Motors makes crappy cars, therefore they fail and Toyota grows.

Right now, we don't have any real choice in the matter. And Obamacare is even worse, because those of us who chose not to pay into the pot are now FORCED to buy the flawed, screwed up product, by the very government you want to put in charge of everything.

Quote (rconnor)

Even though the government is far from perfect, it is much more accountable to the people than a for-profit hospital or big pharma company.

No it's not. It's not it's not it's not. I can choose not to give a company my money. I cannot choose to not give government my money. And now, with Obamacare, the government is forcing me to give money to the very company you seem to hate so much. I remind you...

Quote (beej67)

Your position, and the position of the whole industry to date, suffers from the two fundamental flaws of nanny state progressivism:

1) People can't be trusted to do what's right for themselves
2) The government can't be bought

Your progressive government is bought. The people you voted for are bought. The head of the FDA is a Montsanto lobbyist. The head of the FCC is a Comcast lobbyist. Obamacare was written by lobbyists. The fundamental underpinnings of progressive nannystateism don't work if the government is bought.

There is no vote I can cast on election day that is for someone who isn't bought.

Quote (rconnor)

Now to your two objections to my ideology:
1) I think that people, in mass, will naturally do what’s right for themselves but not what’s right for society. That’s my point.

And government will, in mass, naturally do what's right for the people who bought it, not what's right for society. That's my point. It's been that way since the Sumerians, and it has never changed. You have been duped into thinking that the people you vote for are doing what's right for society, when actually they're just jockeying for insider trading positions.

http://www.npr.org/blogs/itsallpolitics/2013/04/16...

...and funneling money to the people who donate to their reelection campaigns...

https://www.opensecrets.org/lobby/issuesum.php?id=...

...and cutting deals with those same corporations to find fat, high paying lobbyist jobs for themselves when they quit politics...

http://www.opensecrets.org/revolving/

Quote:

2) I touched on this already but I absolutely agree that government can be bought. However, I still have much more say in how the government works than I do how corporations work.

You do not. You have an infinite amount of say in what a corporation does with your money because you can choose not to give them your money. You have no say in what the government does with your money, because when you go to the ballot box, you are choosing between two bought candidates with different colored shirts on, each of which is going to do the same thing once he gets to Washington, which is take money from lobbyists and then invite the lobbyist to write the laws. You have no say in that.

You have no say in state government either. You have some say in local government, because you can talk to your local representative, and your vote means something to them. Our modern system at a national level simply turns money into votes via marketing tricks. We're a cashocracy. Sweden isn't. That's why you can't do Sweden's system here.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"The consumer can vote with his dollars if he knows what he's shopping for. Corrupt and Evil corporations go the way of the Dodo Bird once people are given the choice to spend their money elsewhere. "

That's assuming there's no patent protection on the drugs. Up until recently Lipitor was still protected, and you paid whatever the drug company wanted.

"You have an infinite amount of say in what a corporation does with your money because you can choose not to give them your money. "

Not by your lonesome. Unless there's an en masse exodus, the corporations are only beholden to the stockholders. This is well-known and documented. Moreover, corporations rely on the typical consumer being totally lazy, otherwise, 7-11s would go out of business. But, they don't because people are lazy enough to go there and pay double or triple what it costs in a grocery store, because of the "convenience."

Likewise, people shop for doctors by convenience, and they would probably pay a premium for that. This is what makes ERs more attractive than most urgent care facilities; although, there are now more urgent cares that are open 24/7, and they generally have shorter waits.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

beej67, I really enjoyed and agreed with a lot of your post.

Firstly, you still seem to be trying to convince me that corporate money has corrupted politics. You don’t need to convince me (I’ve referenced it before, but I believe Lawrence Lessig’s “Republic, Lost” does a great job explaining the situation. I feel you’d enjoy it beej). However, where we differ is you want to scrap the whole system, I just want to remove the poison. You are using Sweden as an example that is unreachable (I disagree but it matters little) but the UK is much closer to the US in terms of corporate influence in government. While I agree, drastic changes in the American political system are required (speaking of Lessig, see the MayDay campaign), I feel it’s a stretch to say that it is forever doomed.

Quote (beej67)

The consumer can vote with his dollars if he knows what he's shopping for. Corrupt and Evil corporations go the way of the Dodo Bird once people are given the choice to spend their money elsewhere.
This nicely summarizes our second fundamental difference. While I agree this works to control product quality and cost, it does nothing to control the means of production (fair wages, local employment, treatment of workers, environmental impacts, usage of profits, etc.). As I stated:

Quote (rconnor)

Mass boycotting of companies on ethically grounds (which is the only “voice” you have in an idealized free-market) is difficult for the average person, especially if the companies costs are lower than competitors (i.e. the Walmart example or why 99% of clothes coming from sweat shops, etc.). People respond to the product, not the means of producing the product. Therefore, while, in theory, an idealized free market should promote cheap, quality products, it has no control (nor does it care to control) the ethical and ecological means of production. This is a problem for me.

Quote (rconnor)

I just cannot understand how a producer in an idealized free-market is not the same as a producer in a capitalist economy.

But beyond this, and addressing the third difference, equity is none existent in this picture. All we are talking about is the “efficiency” of the system, not the equity of it. As a producer, if enough rich folk buy my product, I have absolutely no incentive to support the lower class. Quality becomes more and more a premium for those that can afford it. This may be fine for tee-shirts but it is not acceptable for a healthcare system. As a consumer, if I can afford quality, I have absolutely no incentive to support those that can’t. As a few posters have made abundantly clear, they have absolutely no issues with this scenario. I do. I hope that you, beej67, do as well. How does a free market solution, predicated on individual gains, create an equitable system?

So, we share a lot of ground but differ on these three areas:
  • The government is inherently self-serving, you can fix corporations to be more “for the people”/Corporations are inherently self-serving, you can fix the government to be more “for the people”
  • Given choice, consumers will force producers to act efficiently and ethically/Consumers will response to the product but ignore the means of production, Producers will aim to maximize profits over acting in societies best interest
  • The free-market will create a more efficient healthcare system/The free-market does nothing to create an equitable healthcare system, in fact it could exacerbate issues of inequality

RE: Health Insurance

Quote (IR)

"The consumer can vote with his dollars if he knows what he's shopping for. Corrupt and Evil corporations go the way of the Dodo Bird once people are given the choice to spend their money elsewhere. "

That's assuming there's no patent protection on the drugs. Up until recently Lipitor was still protected, and you paid whatever the drug company wanted.

Patents are one of the many ways that government obscures and interferes with the free marketplace. Patents need an overhaul. Five years tops. See above.

Quote (IR)

"You have an infinite amount of say in what a corporation does with your money because you can choose not to give them your money. "

Not by your lonesome. Unless there's an en masse exodus, the corporations are only beholden to the stockholders. This is well-known and documented.

GM can make cars that explode, but if there's a marketplace (there is) then I can choose to buy a Ford. They make their choice, I make mine, and none of my money goes to the corporation that makes the exploding cars. Simple. That's the free market. If enough people decide they don't want exploding cars, GM goes away. (unless their lobbyists buy the government and in so doing buy themselves a bailout)

I cannot choose to stop paying taxes to the government, even when that government uses them to build bombs that explode, and I cannot influence in any way their choice to go bomb brown people in Iraq even though it didn't do us any good the last three times we tried it. Similarly, I cannot choose what government decides to cover with Medicare, and now under Obamacare I can't even choose not to buy insurance from a private, for-profit company.

Quote (IR)

Moreover, corporations rely on the typical consumer being totally lazy, otherwise, 7-11s would go out of business. But, they don't because people are lazy enough to go there and pay double or triple what it costs in a grocery store, because of the "convenience."

Likewise, people shop for doctors by convenience, and they would probably pay a premium for that. This is what makes ERs more attractive than most urgent care facilities; although, there are now more urgent cares that are open 24/7, and they generally have shorter waits.

So? Convenience is an aspect of quality. I fail to see the problem with 7-11s, nor with Urgent Care facilities.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (rconnor)

Firstly, you still seem to be trying to convince me that corporate money has corrupted politics. You don’t need to convince me (I’ve referenced it before, but I believe Lawrence Lessig’s “Republic, Lost” does a great job explaining the situation. I feel you’d enjoy it beej). However, where we differ is you want to scrap the whole system, I just want to remove the poison. You are using Sweden as an example that is unreachable (I disagree but it matters little) but the UK is much closer to the US in terms of corporate influence in government. While I agree, drastic changes in the American political system are required (speaking of Lessig, see the MayDay campaign), I feel it’s a stretch to say that it is forever doomed.

Would you at least agree that big-government progressive policies such as universal single payer healthcare can't work until the prior poison of money-in-politics is fixed?

Growing a broken government before fixing that government just entrenches the brokenness of the government.

Now I contend that power corrupts, and the more power you give government the more likely it's going to be to become corrupted. The more money you push through Washington DC, the higher the ROI is on trying to manipulate government to your own ends. And the higher that ROI climbs, the more lobbyists will descend on DC to try and squeeze more money for themselves or their companies from the public largess. It is inevitable, and the only way to stop it is to starve the beast. You may disagree with that, and I will respect your opinion.

But we should be able to build upon the common ground we do have, that we both realize that government is currently bought. Until it gets un-bought, how can we put it in charge of health care?

Quote (rconnor)

This nicely summarizes our second fundamental difference. While I agree this works to control product quality and cost, it does nothing to control the means of production (fair wages, local employment, treatment of workers, environmental impacts, usage of profits, etc.).

I agree. But it's great to control cost, and the problem with our healthcare system is the cost. That's why they oh so ironically named Obamacare the "Affordable Care Act." And that brings us to this:

Quote (rconnor)

All we are talking about is the “efficiency” of the system, not the equity of it. As a producer, if enough rich folk buy my product, I have absolutely no incentive to support the lower class. Quality becomes more and more a premium for those that can afford it.

I'm an engineer. When I see a problem, I identify the problem, and I develop a solution to that problem. When a politician sees a problem, they seek within that problem a way to grow government and kick more money back to whoever donated to their campaign.

The problem with health care was rising costs. Costs. Nobody complained about healthcare back when it was cheap because pretty much everybody could afford it, and the ones who couldn't could rely on public safety nets that didn't have to bear such a huge burden. Cost is what broke everything. Cost.

So what happens when the problem, Cost, gets put in the hands of politicians? We get a bill that does nothing to address cost, and does everything to expand coverage. Obamacare wasn't a cost bill, it was a coverage expansion bill. Their solution to the cost problem was to make everything more expensive and then force everyone to buy it.

Seriously.

Think about it.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Isen't it strange that we have all of these mandated safety measures in cars to reduce injury, yet the cost of the (assumed) fewer injury's is higher?
Did the mandates some how expose the problem is too many hospitals? Or that hospitals can't control costs in the face of (assumed) reduced number of injurys?

Just maybe we have too much health care?

RE: Health Insurance

"Isen't it strange that we have all of these mandated safety measures in cars to reduce injury, yet the cost of the (assumed) fewer injury's is higher"

The simple answer is that people are surviving the more severe collisions that would have killed them outright 20 years ago, both because the cars are more robust, and the emergency services do a better job of keeping victims alive in the "golden hour." This is corroborated by the fact that US soldiers fighting the last 3 wars are returning with more severe injuries that would previously have resulted in a combat death. That's one reason why VAs are swamped with more disabled vets than ever. Traumatic brain injuries (TBIs) are now survivable because of the better helmets, but the result is life-long mental and medical care costs.

So, not strange at all. It's essentially an unintended consequence of raising the threshold for causing a fatality.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

The disabled care I would think is mostly out patient, which can happen in less expencive facilities (assuming they don't need MRI's, and rooms etc.). So while the cost in the long run should be higher, the cost of the additional services should be in a more competive facility.

So that's what is driving the long-term disability insurance rates, and the fact that people don't want, or can't take of there parrents.

Just think that all this has led to more demand, so adding more demand on top of this is just going to increase costs. However, this is not the same as the hospital issue, as hospital stay rates seem to be on a downward trend.

RE: Health Insurance

Hospital stay rates tend to be driven by insurance companies; a pregnancy with no complications only allows for one night of stay after delivery. The hospital will push you out because they won't get reimbursed by the insurance.

There are a lot of things that drive the short term costs through the roof. A single premature baby can generate both increased delivery and NICU costs as well as long-term disability costs.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Its not clear to me why places like the NICU are as expensive as they are. Yes they have a bunch of fancy equipment, but my conspiracy theory is that the really big expense of hospitals is are the administrators, and that overhead gets lumped into the NICU. The fancy equipment just creates the appearance of value.

RE: Health Insurance

beej67: Brilliant! Its like the Monty Python guys had a crystal ball.

RE: Health Insurance

When I got laid off in 2007 my COBRA coverage was $1650/mo for the family. It was nearly as high as our mortgage! Does this seem high even seven years later, for BCBS coverage? Excellent Monty Python spoof on healthcare BTW beej67!

Tunalover

RE: Health Insurance

tunalover: $1650/mo for a family plan is about right in 2014 (its what I pay), but high for 2007 which should be more around $1200 for an HMO. Its even a little bit more appalling than what the cost should have been.

RE: Health Insurance

glass99 of course there never is a way to confirm that COBRA recipients are REALLY paying only the cost of the plan.

Tunalover

RE: Health Insurance

One upside to the gross overpayment we all make to our healthcare system is that its a stable core of the economy. Unlike we in the real estate business who are either in a frenzy of activity in the boom or crawled into a cave like a hermit in a bust, health care just marches on. I have never heard of a laid off doctor.

If you think of it as a form of stimulus, and you compare it with say bailing out wall st, GM or quantitative easing, its actually quite a bit bigger and probably preferable.

RE: Health Insurance

Along those lines, there are some in the world of politics who have already commented on the fact that America can't really afford to have a more cost effective health care system for those very reasons. If the preventative care provisions actually reduces the long term cost of health care, as was argued when they were scoring the economic impact of the AKA over the next 10 years, some think that this could lead to significant layoffs and the closing of many hospitals and longterm treatment facilities.

As someone once told me years ago, as long as it continues to COST hundreds of thousands of dollars to DIE from cancer, there will be little or no economic motivation to CURE it for less.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Tunalover--could you elaborate on your comment about COBRA recipients only paying the cost of the plan? My understanding of COBRA, is that you are basically picking up the tab (plus a slight fee) of your employer's plan. BTW, I'm COBRA right now (voluntarily quite my employer to retire early).

RE: Health Insurance

For the OP, who seems to have been completely neglected in this discussion:
"I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way? "

My company is offering a private, high-deductible plan with $3000 deductible for a family (I think $1500 for an individual), after which you pay only copays. The company starts off our HSA each year with a $1250 contribution. I don't recall what my out-of-pocket maximum is, but each year I end up spending the deductible and not a whole lot more.

David

RE: Health Insurance

John, I do think you might be on to something. And that would explain why the goverment wants to entrench as much of the current systems as possible.

I'm not so sure it that preventive care is what may be driving this, but if so many old people can't afford health care, and the goverment which has inserted itself can't afford, then we may have a large number of old people dieing in the streets, which would put the goverment in a very bad position. Tends to make voters change how they vote.

The healthy eating thing may also be in trouble because of the water issues in CA, which is where most of the fruits and nuts in this country come from. So we will be seeing more imported fruits and nuts soon.

The problem appears to be that socialists want to be the 'be all and end all' for everything, but they can't seem to fund it all.

RE: Health Insurance

I always read these discussions knowing that "Americans think death is optional."

- Steve

RE: Health Insurance

If everyone had a large deductible, people would shop for care so the system would be more efficient. Of course, it would be nice if your salary went up a bit if someone changed the game in this way.

But maybe inefficiency is the answer. Aside from the millions of middle class jobs, all those high priced hip implants even create some engineering jobs! Doctors do have a bit of engineering fetish, and its possible that health care could be the new defense industry in respect to big stable R+D budgets. Like defense, we waste trillions of dollars on stationing troops in Berlin for decades, but the upshot was we got microprocessors. Massive efficiency followed in the form of the internet, so it was worth it. Would this have occurred if the DARPA folk were a bit more efficiency minded? Who knows what we boffins will come up with!

RE: Health Insurance

The truth is, many jobs depend on people over paying for things they may not need. So the size of our economy, and tax revinues, depends on jobs to produce things we don't need.
Now that we have shiped the production of those things we don't need to China, we now need to invent jobs for services we may not need.

RE: Health Insurance

cranky: yes, for quite a long time now "need" has been a small part why people buy things. You don't need a 3000sft house any more than you need a meal at the local restaurant. Perhaps more interesting is the idea that some portion of health care is want and not a need. I am not talking about the obvious cosmetic surgery and hypochondria, but folks with serious ailments in extreme old age who are making their insurance companies pay huge amounts to extend their life by a few months. If you are 90 years old with overlapping dementia, heart disease, cancer, and kidney failure with only 3 months to live, do you really need a crack team of the best 10 doctors in the city at your bed side 24/7? Its tough to see the bigger picture if its you or someone you love, but it really is pretty ego-centric luxury to suck up resources in this way. Maybe I will think differently when I am old...

RE: Health Insurance

cranky,
I don't think you need to import any more fruits and nuts. CA has plenty of those, water or not.

RE: Health Insurance

The "death panel" issue exists whether you are conservative or liberal - I don't want some MBA w*nker at Aetna deciding when to pull the plug on Grandpa! I don't want some DC bureaucrat making the call either.

RE: Health Insurance

The other side is that the poor don't need death panels, they can't afford the cost, and they die. The rich also don't need death panels, they will pay, and go where ever they need to for the care they want. Death panels are for the reduction of goverment insurance costs for the rest of us.

The term 'life begains at 40' is sort of a joke when viewed from the point that life at one time was only about 40 years.

The presumption the lifes will be longer in the future, assumes that we will be productive longer. And the issue resting that is that natural selection only eleminates desease, etc. that cut life shorter than reproduction. Man must step up to extend life beyond that. However if life does become longer, and the death panel charts don't follow that, then we will be truly wasting human experence for little political gain.

RE: Health Insurance

cranky: yes, it is true that it is the folks in the middle that are most affected by the death panels.

RE: Health Insurance

"The "death panel" issue exists whether you are conservative or liberal"

Yeah, that was supposed to be ironic...

Up until recently, care was was rationed, so it's not necessarily about affordability, but also about profit. There are stories galore about insurance companies that play the "coverage denied" game until patients give up, die, or sue, just to make an extra buck. Interestingly, people die on organ transplant lists because of the shortage of viable organs, but it's illegal to sell organs. Seems to me that this would be a perfect solution for redistribution of wealth in a truly equitable fashion. There are lots of poor, with lots of organs, and there are the rich, in need of organs..... Aside from the nagging ethical issues...

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: ok, irony is good. You are right though, insurance companies are not to be trusted. They are not capitalists like we folk who make innovative widgets, they are sleazy brokers who ration access without adding value. What % of GDP goes to insurance company OH&P?

RE: Health Insurance

Quote (glass99)

The "death panel" issue exists whether you are conservative or liberal - I don't want some MBA w*nker at Aetna deciding when to pull the plug on Grandpa! I don't want some DC bureaucrat making the call either.

Tough luck there, glass, they already do that, and already did so well before Obamacare. It's called a "QALY Calculation," and insurance companies have been doing it for my entire lifetime.

http://en.wikipedia.org/wiki/Quality-adjusted_life...

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej: Nice formula! I hope they don't type the wrong number in their calculator before they pull the plug on Gramps.

RE: Health Insurance

As for the various comments about what sorts of things are keeping the cost of healthcare up, here's another case in point:

http://www.huffingtonpost.com/2014/09/30/doctors-b...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

That's a crual joke, make the medical arenia transparent, but not goverment.

The medical arenia is just like universitys, in that with insurance, the bill is tailered to what they can squeeze out of each victim/ patent. It's called an imperfect monopoly. They need to be regulated like the utility companies in each state.

RE: Health Insurance

"They need to be regulated like the utility companies in each state."

Not sure where you've been for the last 20 yrs, but the state utility companies were deregulated, which is one of the reasons why PG&E has exploding gas mains.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

I haven't been in CA. Most other states still have regulations on rate of return.

RE: Health Insurance

Local goverments regulate hotel rates, so why not hospital rooms?

RE: Health Insurance

An easy first step would be if they posted their rates online. Classic move is that a hip replacement costs between $15k and $90k for basically the same thing, depending on what hospitals think they can get away with. If there was transparency there could be competition.

RE: Health Insurance

Personally I think it should be illegal for an employer to provide health insurance. Make everybody write a check each month and see what happens. It will be similar to the change in attitude that is experienced when an individual leaves an employer and starts a small business and has to write that quarterly check to the IRS.

RE: Health Insurance

The problem with health care costs is not rising profits, it's rising revenues. It's the Cost.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

GTstartup: Agreed that health insurance should be held by individuals. Part of the idea with Obamacare is to make it easier for individuals to get health insurance. Individuals will pay more attention to what their individual needs are rather than assuming the 100,000 employees of Ford Motor area all the same. Up until recently, it was practically impossible to get individual coverage because insurance companies assumed you had cancer and were not telling them. It became a self fulfilling prophesy because the rates became so expensive that only people motivated by having cancer would front the $3000/mo, thus starting a vicious cycle.

RE: Health Insurance

GTstartup, unless you also remove the legal requirements for Emergency care to all comers any idea like that can't work.

If we're going to have a requirement for ER's etc. to provide Emergency care to all comers then shouldn't 'all comers' (i.e. tax paying public) be paying for it?

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat,

My point is that if companies did not include health insurance as part of a compensation package but instead gave the cash, when you had to write the check every month, you might pay more attention to whether or not you have the correct insurance and whether or not you have the best deal. If you cannot shop around because your employer provides insurance through xyz company then competition is stifled.

RE: Health Insurance

"If you cannot shop around because your employer provides insurance through xyz company then competition is stifled."

Competition is stifled, regardless. I don't think I'll get the same deal as an individual for the coverage I have now from a group coverage. Volume discount makes a big difference.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Increase that "volume discount" to include everyone and you have the Canadian system. As an added bonus, you get no "pre-existing condition" problems- everyone is covered, always, irrespective of their employment status etc.

RE: Health Insurance

Are there economies of scale in health insurance? Seems like doctors and drug companies set their prices, and insurers just pull them out of network if they are too expensive. It does not seem like they have much purchasing power.

Also, if running a health insurance bureaucracy is anything like running a consulting engineering office, the bigger you are the more overhead you have.

RE: Health Insurance

Quote (glass99)


Also, if running a health insurance bureaucracy is anything like running a consulting engineering office, the bigger you are the more overhead you have.

I don't think anyone has EVER argued that this was NOT the case. Executive compensation alone can eat up millions of dollars that could have been used to pay benefits.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Quote:


Increase that "volume discount" to include everyone and you have the Canadian system. As an added bonus, you get no "pre-existing condition" problems- everyone is covered, always, irrespective of their employment status etc.

Indeed, and despite what some in the US say, the Canadian system works well.

RE: Health Insurance

Part of the reason that the Canadian and European systems are as cheap as they are is that the "engineering" component of their costs is significantly bankrolled by US consumers, especially drugs and medical devices.

RE: Health Insurance

Kenat: correct, there are many factors contributing to cost. But if the US had a single payer system like Europe, global advancement in medical technology would slow. That plus US military R+D are little gifts of engineering that ordinary Americans give to the rest of the world.

RE: Health Insurance

That's a cost, one of many costs, buried in our system. But the greatest cost is the cost of people not managing their own expenditures, since the costs are shared.

I hurt my knee playing soccer in June.

I went to the PCP. He said, "probably strained MCL or ACL, you'll be out six weeks, get an MRI." Gave me a number for a specialist. I paid $20, he billed the insurance company $200 or something.

I wait two weeks for my appointment with the specialist. She says "No, it's probably a bruised miniscus, go get an MRI." Gave me the MRI joint's number. I paid $20 and she billed the insurance company $500 or something.

I go to the MRI joint. Walk in, walk out, they tell me nothing, give me no data, and bill my insurance company $3000 or something.

Specialist never calls me back. I call them, they say they can't give me the results on the phone, I have to come in. Wait two more weeks for my appointment. I go in, lady says "well the MRI says it's just tendinitus, but I know that's not true because I can do this" (repeatedly pops my knee) "so here, do these exercises." "But what's wrong?" "We don't know." Sends me on my way, I pay another $20, and they bill my insurance company $500 or something.

So add all that up. $4,200? Something like that?

Europeans don't do this song and dance.

The song and dance is where the cost is.

If I was told I had to pay for all that crap out of pocket, I would never have gone to the doctor at all. I would have googled up some knee rehab exercises, and been doing the same thing the lady told me to do five thousand bucks later. But under our system, you're damn skippy I'm going to got to the doctor and go through the song and dance, because I've already paid for it. If I don't, then I don't get the value for the product I've already bought. It's pre-bought, and you lose it if you don't use it.

If everyone pre-bought into a shared "Food Plan," you think more folks would order lobster? Of course they would.

It's systemic.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

The idea that the US system is effectively the engine that drives medical research is total bollocks. The US contributes approximately the right amount of new research and innovation as would be expected for a Western nation of its size. In fact I recently read a paper that showed the US was falling behind in new and or innovative research per capita due to medical "tricks" such as changing a drug so that your body metabolises to form the active drug in order to extent a patent. This is not innovative, it is a business practice. The subsequent marketing blitz to keep people from buying the (now significantly cheaper generic) is something I would expect to be illegal in the French and multiple other European systems.

These drug research "games" also make it hard to measure real innovative drive, as this is frequently measured in large part through the number of research papers published. When a drug is "tweaked", manufacturers quickly conduct and publish as much info as possible, often of dubious merit, simply to have the latest drug research all be on their "new" drug.

I am the first person to point out that the US is a great nation, but also at the head of the line to condemn the tremendous wealth of your nation being concentrated into the smallest of minorities at the top. Many of the ills I see accross our southern boarder are extensions of the desire to become ever wealthier despite already being incredibly rich. Playing with drugs to keep them proprietary rather than working on new drugs is one such ill, and artificially inflates the research papers and apparent innovation without really being innovative.

RE: Health Insurance

beej67: agreed with your song and dance idea. That kind of thing is very expensive.

CELinOttawa: Americans pay way more for drugs than Canadians. Witness folks who live in Detroit sneaking across the border to Windsor to stock up. In terms of drug companies finances, American customers carry the load, and the rest of the world picks up the product at its marginal cost of production. In terms of public research spending, the US may be about the the same as Europe per capita, but a large portion of bringing drugs to market is non-academic, commercial work. Not just R+D, but marketing, distribution networks, etc. Remember also that many drug companies are not American. AstraZeneca, Beyer, GlaxoSmithKlein and other majors are European/global but make most of their money in the US. Absent these profits, who knows whether the publicly funded research would ever reach consumers.

RE: Health Insurance

Oh, the poor drug companies- they can spend less money on marketing and they'll have plenty to spend on actual R&D, since as I already noted, they spend WAY more on the former than on the latter.

RE: Health Insurance

Plus, my guess is the marketing expenses are probably a lot higher in the US than many countries.

In the UK before I moved to the US you rarely saw adds for prescription drugs - presumably due to the National Health Service deciding what drugs you got, not you going into the doctor and begging for a specific brand name drug. Maybe things have changed in the last 10 years, I don't know.

Don't get me wrong, Drug reps still lavished their largess on Doctors to some extent but I doubt it reaches the overall marketing budget in the US (pro rated for population of course).

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

I expect that McDonalds makes a significant portion of its income in the US, too, so I suppose the world is supposed to thank US consumers for generously subsidising that export.

RE: Health Insurance

At my old bridge design firm, the Department of Transportation used to micromanage the fees down to the level of how much we were allowed to spend on office furniture and how much maximum profit we could make, kind of how Canada does with drug companies. The result was a relatively safe business which made a couple of percent profit, but one that was petrified to do anything remotely different or "risky". My bosses insisted that we design steel to 12ksi allowable stress because even though we specified 50ksi steel, it might get built with A36 so it was "better to be safe". The client got cheap engineering fees, but no innovation.

If you took the US profits out of the global marketplace, drugs would not disappear but would be ossified in time at 2014. I personally feel as though there is a lot of technical development yet to complete in the pharma world. Right now drugs are battle axe blunt tools that have 5 side effects for every primary effect.

RE: Health Insurance

Kenat: defense contractors have achieved some amazing technical things especially during the cold war (including the microchip), but they are no model for cost efficiency. Think of the famous $10,000 toilet seats. But your point it valid, it is possible to have innovation in a government funded environment.

RE: Health Insurance

Sometimes the yardstick used to measure the $10000 toilet seat includes all sunk costs (such as the salaries of all persons involved in the purchase). Just a flawed, but less creepy and black. Walmart's toilet seats would be just as expensive if measured in such a way.

That said, my tinfoil hat tells me that most $10000 toilet seats are actually $12 toilet seats and $9988 hidden procurement.

Hidden procurement isn't right, and I don't agree with it... But it is often what is really going on.

Besides these two alternative, there have been some boondoggles of mind-bending size, just not with the regularity people seem to believe. On the subject of stupidly crazy government waste, our Provincial government recently cost the tax payer $1Billion (yet, with a 'B') for TWO SEATS in the legislature. They were promptly rewarded with re-elect. As a larger proportion of the house. As a MAJORITY... My head nearly exploded. Frankly the Premier, former Premier, as well as the whole cabinet should have been ON TRIAL, not RE-ELECTED. *sigh* Okay, I'm done.

RE: Health Insurance

I spend my days in the construction industry doing things like finite element analysis and specifying precipitation hardened stainless steel and teflon for my glass structures, none of which would have been possible without the massive investment in military R+D during the cold war. The military R+D was never going to happen without the them having a spent a bunch of cash on troops, pentagon bureaucrats etc. And we are richer for it.

In the post 1989 military wind down days, a bunch of defense engineers shifted over the the medical devise realm. I work with one now who switched from Pratt & Whitney to a hip implant maker. Who is going to pay for the development of the 3D printed human livers and genetic therapy? Bad ass engineering is expensive, and its also the primary driver of civilization. If not medical kit then what? We beat the Soviets so that motivation is gone, but we are old and sick, so lets write a big check to the nation's nerds and send them to the lab!

RE: Health Insurance

CEL- everybody in Ontario should be indignant about the gas plant cancellations and their cost. But their indignance should be directed toward the flawed system that makes the location of a power plant a political issue. It is easily forgotten that ALL THREE political parties supported the cancellation of the Mississauga gas plant by election day- the Tories caved around 5 days before the election, a fact they now conveniently forget.

I'd have fixed that problem. I'd have given the people of Mississauga and Oakville a choice: either allow the plant to be built, or a) pay the cancellation charges with a special levy on THEIR property taxes, or b) disconnect them from the province's grid and force them to make their own power. That the entire province has to pay the cost of the NIMBYism of the highest-earning postal district in Canada should make anyone's blood boil- but that's useless if it's just used in a, "Don't blame me, I voted for Kodos" argument!

http://en.wikipedia.org/wiki/Treehouse_of_Horror_V...

If I was building ANYTHING even arms-length government-related in this province, I'd spend far more time negotiating cancellation terms than worrying about what it would cost to build. There are some people that no doubt never have to work another day in their lives as a result of writing a particularly good contract in this case- good for them, terrible for the entire rest of us in this case.

RE: Health Insurance

Good points Molten.

RE: Health Insurance

"Walmart's toilet seats would be just as expensive if measured in such a way."

Walmart's toilet seat ARE priced to cover all overhead in their manufacture and distribution. These companies have no other secret source of income. They work very hard at keeping general overhead costs down, and spreading the cost over very large sales volume.

Defense contractor's have exorbitant overhead, which just keeps growing, and that is spread over very low sales volume.

RE: Health Insurance

*sigh* I meant the toilets Walmart installs in their stores, not the ones they JIT from China to their shelves.

RE: Health Insurance

"Defense contractor's have exorbitant overhead, which just keeps growing, and that is spread over very low sales volume."

The overhead is because the public would be unwilling to accept product failures for their precious soldiers, but are willing to accept the failures for the products they pay for, because they can always take them back to the store. Kind of hard to do that sort of thing on the battlefield. This is all imposed by government contracts, so if you're complaining about the cost of military hardware, complain to the person in the mirror and your "representatives." As an example, consider the (in)famous MIL-STD-883B qualified integrated circuits, which are made on the exact same production line as the parts you'd find in your laptops. The difference in cost comes from the extensive testing, life testing, documentation, special handling, and yield loss from all the testing. When you drop your M14 equivalent in the mud, you stop, sit down, and clean it before trying to use it. The soldier using the M14 in the field often didn't have that option, and while US arms are known to be somewhat delicate, the Автомат Калашникова can be literally be manufactured in a barn and can work in pretty much any harsh conditions.

Much of this can be traced back to the False Claims Act of the Civil War, as well as the discovery during WWII that US fasteners weren't interchangeable with the British ones. Once the need for standardization became evident, it also became evident that the typical product and component is woefully under-specified. Contract law allows consumers to buy a product in a store based on a few sentences of description, and the understanding that such products are intended for, and designed for, a certain environment. However, the military has a much wider range of environments, including both temperatures, pressures, water immersion, vibration, etc. What is described in a few sentences on a placard in a store, or on the face of the product packaging, can be turned into 40 pages of single spaced specifications. These specifications protect both the consumer (the soldier) and the contractor, since the specifications are supposed to encompass almost all the conditions in which a soldier might use the product, and if the contractor has tested for compliance to the specifications, they are protected from the False Claims Act. The additional kicker is that the volumes that the military consume, while large in the military sense, are puny in the consumer sense. Trying to buy a part to a military specification from Samsung, or the like, and the first question they'll ask is, "how many are you going to order?" Your answer would be, "Well, we're only looking to buy about 100 now, but in 5 years, we might want 5000" They politely chuckle and point out that they sell millions of these things each month, and your business simply isn't profitable to them. This often forces custom designs, which are built to small production volumes, and which are then (over)extensively tested, all of which increases costs.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Best insurance I have had is with a company that was self insured (I assume they had some limit however). They did use a company to adminstrator it, but they did not play a bunch of games, because they would have to pay anyway, or find new employees and fight lawsuits. They also gave back the excess which encuraged everyone to keep medical costs reasonable.
Now with the goverment mandate, self insurance isen't allowed. So cost reduction never was the intent.

RE: Health Insurance

cranky - I am a huge fan of self insurance. Also for Errors & Omissions insurance. In traditional insurance you are literally paying a the salary of an insurance company administrator to justify denying paying your claim.

RE: Health Insurance

Self-insurance is an interesting idea, but how does one ensure that the self-insured has any, or enough, assets to provide the insurance? The concept evolves into the idea of NO health insurance whatsoever, everyone should 'self insure', but how do you do that?

RE: Health Insurance

In terms of health insurance and E+O, to self insure you need a lot of scale because the worst case risks are substantial. You can't do it as an individual or small firm. You can start to think about self insurance at the scale of 1000 people. My old firm self insured for E+O.

The one place you can "self insure" as an individual (i.e. go bare) is dental insurance. A root canal costs $3000 or so, which most of us have in our savings accounts. Why pay insurance company markups on that? The only things with it is you need a CAFE plan or similar so you can pay for it with pre-tax money.

RE: Health Insurance

The only difference between self-insuring and a normal insurance is who gets to hold the money, and who manages claims and risks. For a given coverage, the risk pool is still about the same, less the insurance company profit and skim. The advantage for a large company for self-insurance is that they could potentially still use the money for funding ongoing operations, as opposed to forking over the premiums and letting the insurance company play with the cash.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Health insurance companies only pay out 80% of premiums in claims, so there is a decent margin to play with in respect to self insurance. If I were an MBA rather than an engineer, I would offer consulting services to big companies to help them administer their in house health insurance. If you take a 10,000 person company who pays $10,000 per year per staff member, they are spending $20MM per year on health insurance OH+P, which could be a consulting fee instead!

RE: Health Insurance

For a company, the advantage to using an insurance company over self insuring for health coverage is that it makes for a 'disinterested' third party who is responsible for denying claims. If you are self insured, any time a claim is denied, the whining and complaining will start, someone with a denied claim will hold a grudge, become a grumpy employee, etc etc. It's 'cleaner' to be able to blame an outside force for any problems.

(I know that the insurance company is not actually disinterested, in fact they have a stake in denying claims, but the point is there.)

RE: Health Insurance

TenPenny - yes, you are right that there is a significant hassle factor in administering health plans, including having to play the bad guy. This is going to be offset by the elimination of some of the more grating requirements of traditional insurers, like having to go to a general practitioner before you are allowed to see a specialist.

RE: Health Insurance

The real benefit for a large company self-insuring is that they can narrow the pool of folks sharing the cost by not hiring unhealthy people.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"...they can narrow the pool of folks sharing the cost by not hiring unhealthy people."

And here we have ONE MORE REASON for moving to a single-payer health care system not dependent on your employement status.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

If Hillary wins in 2016, are we going to get a single payer system?

RE: Health Insurance

By then I'll be on Medicare, but I've got three sons who could benefit from it.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Quote:

...they can narrow the pool of folks sharing the cost by not hiring unhealthy people."

And here we have ONE MORE REASON for moving to a single-payer health care system not dependent on your employement status.

OR we have one more reason to make people responsible for their own burdens.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"If Hillary wins in 2016, are we going to get a single payer system"

Not likely, given the relatively even political split in Congress, made worse by the religious-like fervor in branding the opposing political party as "un-American" or worse.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

There are two potent political forces on the landscape right now pushing for single payer - one is senior citizens, the other is women. Both constituencies are on the march right now, both want a single payer system pretty bad. Just look how quick the Republicans dropped their opposition to same sex marriage, basically under pressure from women. It was Blitzkrieg.

RE: Health Insurance

Quote (beej67)


OR we have one more reason to make people responsible for their own burdens.

How do you explain that to someone born with a congenital condition, such as Type 1 diabetes? Or someone like my wife, who when she was a child contracted hepatitis through no fault of her own? What about people suffering from the long term effects of a childhood accident or a wounded veterans when they try to move back into the workforce after serving their country?

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Glass99--Medicare already is single payer. Why would senior citizens be characterized as "pushing for single payer"? I also question the "Women are pushing for it" comment. We have professional women, covered by various employer plans, unionized women workers already covered by plans, poor women already covered by Medicaid and the "Somewhat Affordable Healthcare Act" that the rest would be eligible for.

RE: Health Insurance

swall: At a minimum senior citizens are protective of the medicare benefits they have, and are always pushing for more. Old folk get quite emotional when you try to take their doctor away. Women have a much greater enthusiasm for going to the doctor than men. For all the husbands out there - how many times have you been to the doctor or dentist only because your wife made you? I will have to dig it up, but I have seen a poll showing a substantial majority (~two-thirds) of women support for single payer healthcare. A senior citizens plus women coalition would be pretty much unassailable by even the most biased media or powerful corporate interest.

The other constituency for single payer are the 50 and 60 something white and blue collar workers who have slightly out of date skills and are worried about getting laid off. How long would your savings pay for COBRA? 20 and 30 somethings either don't care or are more liberal.

The only constituencies really for the current private heavy system are men in their 40's with good jobs because they don't want to get lumped with paying for everything, and doctors who like getting paid $300k/yr.

RE: Health Insurance

Hey, single payer would be great for small businesses. Wouldn't have to fool with Obamacare. But it would be a pretty big disaster overall once the lobbyists realized they could buy off the government to get unnecessary stuff covered. Costs > infinity.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"But it would be a pretty big disaster overall once the lobbyists realized they could buy off the government to get unnecessary stuff covered. Costs > infinity."

Amusing, but the costs are already pretty much near infinity. According to: http://www.forbes.com/sites/danmunro/2014/02/02/an... we're spending about $13,000 per capita already. That's at least double the annual premiums for a typical single-person insurance package. Given the median household income of about $52,000, we are, on average, as a country, spending more than our yearly salaries, so there's already a truckload of subsidization going on.

Going to single payer might actually drop the costs.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

An efficient and effective single payer system would likely have an impact on other areas of society- more women would likely prefer to stay at home as opposed to going to work to obtain insurance coverage, and many workers would retire earlier and leave open more employment spots for younger workers that are currently unable to enter the workforce. If the insurance was paid from a national VAT ( also imposed on all imported goods and services) it would also help share the cost of government with overseas mfr's, who currently pay no share of this cost.

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

For the current private system to survive the costs are going to have to come down - at some point it becomes irrational to pay double what the rest of the world pays. The only way I can see cost control happening is though technological innovation. Elizabeth Holmes, do you have any other ideas?

RE: Health Insurance

glass99 - seriously with the way things work you expect technological innovation to bring down cost in the current US system?

Historically it seems in healthcare technological innovation often increases cost. This is because rather than using technology to do the same thing better & cheaper, it often plays a role in doing things they just couldn't before i.e. conditions where there was once minimal treatment options now have treatments that cost tens or even hundreds of thousands of $ per patient.

A big factor in growing health care costs regardless of how it's payed for or organized is just that the medical condition can do more and more and more then they could a few years ago and that 'more' ends up meaning more $.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat - Technology can be used to either make Volkswagens or Porsches. You are right that thus far the medical tech focus has been on quality not cost. Obvious Volkswagen tech projects include electronic medical records, automated blood tests, and laproscopic surgery. A Porsche project would be a cure for ALS (though the ice bucket challenge guys seem to have that under control).

RE: Health Insurance

Kenat: You are correct that they are continually expanding their scope of new diseases. That does not change the fact that we could switch focus to efficiency - What if some of the fancy kit that doctors use could be made for cheaper, like CT scan machines? What if some clever boffin comes up with a cheap and user friendly attachment that plugs into an iPhone rather than the quarter million dollar CT dinosaur that has high secondary costs related to storage, handling, staff training and real estate? What if we could do scans without a $300,000/yr radiologist to review them because a computer could do the same job?

In my view there is a huge business opportunity for low cost health care technology. The medical industry is filled with routine commodity procedures with huge volume which are really expensive on a unit basis. Its classic industrial revolution stuff. Blacksmiths have been hand hammering the horseshoes, and someone is going to invent steam anvil which does it for 10% of the cost. Testing perhaps the most obvious area.

RE: Health Insurance

A basic question for all of you single payer advocates--why to you think that single payer would bring down costs?

RE: Health Insurance

If you drill down to the numbers, the efficiency of the payment method is only about a 10% swing on health care costs.

The problem is the song and dance, and on the sheer amount of stuff that we cover that other countries don't. It's not the profit that's the problem, it's the revenue. No other country in the world buys battery powered fat chairs for their Medicare recipients to drive around in Wal Mart. We do. That's a shared cost that other countries aren't sharing.

The problem is not how we share the cost. The problem is that we share the cost, without controlling how much cost we share.

In order for single payer to work here, we would need some kind of function that prevents unnecessary costs from being shared. In the USA, we have the opposite. We have a system where unnecessary costs can lobby their way onto the coverage list. In the USA, Medicare spent $172 million dollars in the last five years on penis pumps.

Let that sink in, before saying one more word about single payer systems here.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

swall: One big factor makes public health (including US Medicare) cheaper than private: they reimburse at lower rates for doctors, procedures, tests, drugs, and devices. When Canada went public there was this exodus of Canadian doctors across the border to the US who were so appalled at the prospect of only being paid double what an engineer made that they were willing to abandon their homeland.

RE: Health Insurance

" That does not change the fact that we could switch focus to efficiency - What if some of the fancy kit that doctors use could be made for cheaper, like CT scan machines? What if some clever boffin comes up with a cheap and user friendly attachment that plugs into an iPhone rather than the quarter million dollar CT dinosaur that has high secondary costs related to storage, handling, staff training and real estate? What if we could do scans without a $300,000/yr radiologist to review them because a computer could do the same job?"

That technology already exists; it's called a DOCTOR. The majority of added cost is not because of the equipment, per se, it's because of fear of malpractice suits, and the need to fill the time on the machine. Buying a $10M machine also entails making a return on it. But, most doctors are not in the mode of only using their own judgement in a diagnosis; they want the evidence from the CT or MRI, and they want the opinion of the radiologist to back them up. Changing the way malpractice is handled will go a long ways toward reducing unnecessary testing and imaging.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Swall, seriously? I'd have thought the apparent* fact that a bunch of other first world nations who have single payer systems get much better value for money would be some indicator.

Depending how it's set up single payer could also improve the mal practice situation and assorted costs attributed to that - not just insurance & legal fees but also the defensive medicine etc..

Depending how it's set if it might eliminate some of the billing mess, but of course many would expect that would get replaced by some government bureaucracy.

Bunch of other reasons too but if you haven't picked up on most of them yet I doubt I'll convince you.

Again depending how it's set up it would probably remove a bunch of the 'for profit'.

(* apparent because I admit I haven't researched it personally in great depth)

beej67 - careful you're getting into death panel territory with your penis pump line of thinking.

glass unless the big pharma etc. companies can be convinced that they can make more money with cheap solutions than what they currently supply there's not much incentive to find cheaper ways to do stuff. Getting drugs etc. through the FDA is probably enough of a hurdle to stop many smaller innovative efforts - especially if big companies decide to lobby against them.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

IRStuff: There is this old fashioned notion that doctors can tell what's wrong with a patient with a stethoscope and a few kind words, and that all the fancy kit is extraneous. As engineers we understand that simple solutions are usually the best, but we also understand that automation is always more efficient than hand methods. Yes steam shovels were expensive to develop, but we could not have dug the Panama canal with shovels.

Medicine is presently different to engineering in that the diagnostic procedures are not accurate enough, and the grey gets filled in with a "human touch", which frankly is ineffective and cover for ignorance. Low cost point of use tests which are accurate are much better than any professional's eyeball. If the emotional response from a human touch is what's necessary, alternate medicine like naturopathy is much cheaper.

RE: Health Insurance

Kenat: Elizabeth Holmes is a multi-billionaire at aged 30 because of her low cost blood testing. Its a different business model because she is venture capital rich not cash flow rich, but she's still a billionaire. She is going to have a $10 blood testing machine in every Walgreens in the country. I don't really see the old guard being able to adapt to this. Healthcare will have a few "Kodak" moments (i.e. shriveling of old businesses) in the years to come.

RE: Health Insurance

"There is this old fashioned notion that doctors can tell what's wrong with a patient with a stethoscope and a few kind words, and that all the fancy kit is extraneous."

Medicine is not engineering. An MRI does not provide a diagnosis, nor does an ultrasound. All of these require "interpretation" by a TRAINED radiologist. As an example, I dislocated my elbow, and the ortho deemed that the x-ray was insufficient to tell what was going on, but his experience was that I probably tore at least a couple of muscles, and the only thing the MRI provided was a sheet of paper signed by the radiologist that specifically identified the muscles torn. No new information was provided that would have changed the diagnosis nor outcome given by the ortho.

What has increased the number of tests is the fact that there are tons more NPs doing diagnosis who were never trained as doctors, so they have to run tests to back up their diagnoses. The doctors do the same so that there's a paper trail of due diligence in case of suits. If there were no fear of suits, testing would drop substantially, as would secondary consults.

Obviously, there are those that need specialized tests because they've got oddball diseases, but most people don't have those diseases. The majority of sick people have common diseases, and the doctor will usually be correct by playing by the statistics.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

And, when I was an engineering technician, we did the same sort of thing. I was tasked with fixing Pong boards, and I had a diagnosis list that would have lines like:

If no paddles are present, solder a capacitor between pins 5 and 7 of U12, or somesuch.

A truly fun few weeks, since I basically had to play the game to identify the fault, fix the fault, and play the game again to verify the fix and determine if there were any more problems. Of course, I never played Pong ever again...

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote:

I'd have thought the apparent* fact that a bunch of other first world nations who have single payer systems get much better value for money would be some indicator.

There are a bunch of first world countries with private systems that get more value for their money as well.

Everybody in the world, no matter how they do it, gets more for their value than we do.

Single payer is government cost sharing. Insurance is private cost sharing. Which way we share the costs does not make the costs go up or down. Over-use of the system is what makes the costs go up. The problem is the cost, not the way in which the cost is shared. The problem is the cost. It's not the profits, it's the revenues.

Quote:

beej67 - careful you're getting into death panel territory with your penis pump line of thinking.

Private insurance already has "death panels" now.

http://en.wikipedia.org/wiki/Quality-adjusted_life...

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej: which country has private insurance and low costs?

RE: Health Insurance

I think you will find that in those countries which depend on private insurance and yet has still maintained lower costs and good outcomes, are also countries which highly regulate their insurance industry and which also dictates that basic healhcare coverage has to be provided by not-for-profit organizations. This would include, I suspect, places like Switzerland.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

IRStuff: If doctor's time was cheaper, the notion that we should have them figure out your ailment the old way make senses. At a salary of $300k/yr plus a bunch of overhead, those are some expensive hands feeling out your elbow injury. I think doctor's pay is scandalous. They are walking medical dictionaries, not geniuses. A lot of the liability avoidance behavior can be blamed on the lawyers, but its also that doc's are kind of prima donna's.

We are talking about replacing McDonalds checkout workers with touch screen displays because they want a pay raise from $11/hr to $15/hr, yet our $400/hr doc's are too precious.
-> I say let them have their investment banker salaries and restrictive business practices, but find ways of automation.

RE: Health Insurance

$400k - I wish; then I could retire and let my wife do the heavy lifting. The so-called "average" or even median salary is skewed by the specialist salaries.

MediCal reimbursements are only on the order of $12 per patient visit. So even if a doctor could see 6 patients an hour, that would only get $72/hr, or less than $150k per year, out of which is paid salaries of the office staff, office expenses, including rental and supplies, and malpractice insurance. Medicare pays better, but not that much better. A typical single-provider family practice office must bill ~$400k/yr to net about $200k for gross salary for the doctor. Note that not all bills are ever collectible, and billings are often rejected or decremented by the insurance companies.

The one good argument to reverting to a reimbursement-style insurance plan would be so that the patient could see how much they're paying for the specialist referrals.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote:

beej: which country has private insurance and low costs?

All of them.

We are an outlyer not because of how we spend, but because of our lack of cost controls. Our system intentionally encourages and often mandates extreme over-use of the system. It is systemic, and changing who pays for it will not change the system itself.



We basically already have "single payer." It's just multiple single payer pools. The problem is not who shares the cost. The problem is the cost. All "single payer" really is, is everyone on the same insurance plan. We could achieve that just as easily by making everyone buy Blue Cross Blue Shield as we could taxing everyone more to pay for giving everyone Medicare. Doing either wouldn't significantly affect cost, because the profits aren't a significant amount of the cost. The margins on insurance are quite low.

The problem is if I sprain my knee in Denmark, I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage.

Changing who pays doesn't fix that.

I'll type it again, slower this time.

Changing who pays doesn't fix that.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej67 has the only plausible answer. All the other factors are just nibbling around the edges. If you want less cost, you have to reduce the service. The cluster at the top of the chart includes Australia, and we think we pay too much.

RE: Health Insurance

"I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage."

Most HMO plans already clamp down on that, because they ca deny referrals, but the "Cadillac" plans actually have gone the other way, with "self-referrals."

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

A question to those in the US: could the apparently high per-capita spend and apparently below-average life expectancy in the US be a result of the wealth divide, where the relatively small numbers who have the ability to pay for a first-class service are likely to achieve a relatively long lifespan, but the far greater numbers who have limited access to premier quality health care drag your average lifespan right down?

It's interesting that the nations with equal-for-all systems - France, UK, Canada, Australia and the rest - are all in a cluster achieving similar results for similar expenditures, and out-performing the US system in both lifespan achieved and in per-capita cost.

RE: Health Insurance

ScottyUK,
Australia is not really an equal-for-all system, although it does have a publicly paid hospital system running in conjunction with a private or insurance based system. It's complicated, as most health systems are.

I think the high per capita spend and low life expectancy issues in the US are due more to lifestyle choices than anything else...too many fat people.

RE: Health Insurance

Perversely, fat-inducing, high-carb, food is made and sold more cheaply that healthy food; so, yes, there is some factor of income disparity that drives poorer people into less healthy food, coupled with the fact that most of the poor are uninsured, so they can't take are of their health problems as well as they should.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Hokie - my misunderstanding, thanks for the clarification.

FWIW, the British system is equal-for-all, except those with deep pockets (or a generous bennies package) can get private cover which allows them to jump the sometimes long waiting times for the routine stuff. I don't have a problem with that, except when the private work ties up resources and manpower in an NHS hospital which tends to happen more often than you might imagine. Unsurprisingly the insurers don't tend to cough up for the really big expensive emergency jobs like the operation which kept me out of a wheelchair four years ago; they still get picked up by the state. My family and I are all immensely grateful to the NHS for what they did for me, and even though I have good private cover through work I am a massive supporter of the state system.

RE: Health Insurance

beej67: One option is to make purchasing healthcare no different from purchasing real estate or automobiles, and make it completely deregulated individual market. It would be by far the best way of weeding out the "song and dance" inefficiencies you speak of. The problem with it is that human beings take sympathy on other human beings who are sick, and there is a tendency to call is a "right" not a "privilege". Its actually incredibly difficult to see someone with cancer and not want to help them.

RE: Health Insurance

"make it completely deregulated individual market. It would be by far the best way of weeding out the "song and dance" inefficiencies you speak of. The problem with it is that human beings take sympathy on other human beings who are sick"

It's not a question of sympathy, but sharing risk. Individuals will never get anywhere near the premiums that a group can get, precisely because of the lack of shared risk. For an individual policy, the premiums have to have a high probability of covering the risks, and will therefore be higher than for a group policy for the same individual, since the probability of everyone in the group getting the same diseases is lower. To make it deregulated simply adds to the cost, since the insurers would have no incentive to keep their profits down.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: If deregulated and totally individual, why would health insurance be any less efficient than car or home insurance? You have no expectation of single payer car insurance. Sharing risks creates a moral hazard - it does not provide incentive to find ways of reducing cost.

RE: Health Insurance

I don't think that car and house insurance are that similar to health insurance, other than the shared risk. Houses and cars don't get strokes, or necrotizing faciitis or MRSAs. Car and house claims are generally from external forces or agents, while sizable chunks of the panoply of diseases are inherent in the body. At some point, well before complete system fail, a car or house is declared a complete loss, and the value of the policy is paid out. Cars and houses, in general, are not put on life support, racking up $20k/day in costs.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Health and Transport are a cliché apples and oranges comparison. No one wants their child to need serious and or long term treatment, but it is rarely a choice you can make.

Any form of single payer system is, fundamentally, a far more noble, just, and democratic way to deliver health care. People who believe otherwise are heartless, brainless, souless, greed filled, or otherwise evil. It is nearly impossible to be naïve once you've had any opportunity to read about healthcare.

Not that I have an opinion...

RE: Health Insurance

CEL,
You are entitled to your opinion, but do you have to be so harsh about it? Some of those adjectives are over the top, and just wrong.

RE: Health Insurance

CEL + IRStuff: I'm not advocating for highly individual health insurance necessarily, just pointing out that at present its a pretty arthritic system, and a deregulated market would have the flexibilty to adapt itself to the contours of the market. Part of the problem with the current US system is that it is neither here nor there. Its not a proper free market solution because there are so many restrictions and subsidies, and its not a proper single payer system. Totally agree that there is a "moral" dimension to health insurance that doesn't exist with car insurance.

RE: Health Insurance

CELinOttawa,

Our system over here is far from perfect. It wastes money on a barely imaginable scale because of bureaucracy and inefficiency, and the layers of expensive underloaded management which have invented themselves over the past few of decades are a disgrace, yet it is so very good at the difficult things like fixing broken people and looking after those with long-term and chronic conditions without question or judgement. There is much to admire about our state-funded system, but many non-clinical aspects of the operation need to be run more like a commercial organisation where value for money is an important factor, except any savings aren't shareholder dividend but additional funds to spend on a better service.

RE: Health Insurance

I'm certainly no expert on health or health funding, but have come to the conclusion that the Australian system of mixed public/private works well, even if it is too complex. As to hospitals, the mix is about 2/3 public and 1/3 private. The public hospitals are without cost to admitted patients, but there are sometimes long waiting lists involved. The waits can sometimes be shortened by electing to be treated as private patient in a public hospital, in which case private insurance or personal contribution kicks in. I think that in those cases, you can have a say in who your doctor(s) are, which public patients don't. Employed people are encouraged to have private insurance, as tax penalties apply if you don't, depending on income. There are two types of private insurance, one for just hospital coverage, one for "extras" like dental, physiotherapy, etc.

The public hospitals are the large teaching hospitals and the place you want to be with something bad wrong. For instance, all organ transplants are done in the public hospitals.

For visits to doctors, not hospitalisation, we get government rebates, about half the cost of the visit, unless your doctor "bulk bills" or there are government concessions involved. Referrals are required for specialists, but if you have a continuing issue, the referral can be made continuing.

Every country has its variation, and it may be just good luck when a system works well.

RE: Health Insurance

Quote (IRStuff)

"I sprain my knee in Denmark. I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage."

Most HMO plans already clamp down on that, because they ca deny referrals, but the "Cadillac" plans actually have gone the other way, with "self-referrals."

Yes, but how much money does it take for the insurance company to "clamp down" on that? They end up spending a bunch of money on claims management to cut costs, but the claims management itself is a cost.

In Denmark, they just do what they're supposed to do.

Just like we used to do here when we paid for our sprained knees out of pocket, before the days of MRIs and Specialists and fancy MRI Reading People.

Quote (IRStuff)

I don't think that car and house insurance are that similar to health insurance, other than the shared risk.

See my post above from 21 Sep 14 20:47. The reason they're not comparable is that health insurance isn't insurance at all, in the USA. It's a "Health Plan" that covers lots of things other than emergency care. If all health insurance covered was emergency care, it would work pretty much like car insurance does.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej: what's the secret sauce that makes it work in Denmark? I assume its something cultural, not the fact that they have a single payer system.

RE: Health Insurance

1) Their country is full of Danes.
1.a) Their government still works.
1.a.1) Their corporations aren't using the force of government to funnel money to themselves.
1.a.2) Their votes mean something.

http://en.wikipedia.org/wiki/List_of_freedom_indic...
(sort by democracy index)

2) Their country is small enough that corruption within the system has very little place to hide.

http://en.wikipedia.org/wiki/Corruption_Perception...

3) They don't sit around all day eating cheetos watching Maury Povich.

(sorry, don't have a link for world rankings of cheeto delivery / Maury reruns)

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"Yes, but how much money does it take for the insurance company to "clamp down" on that? "

not so much that they are both doing it right now, and making a profit. It's just a simple rationing system.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Some how I think there is a point that is being missed. The goverment created this health care problem by requiring doctors and hospitals to take care of everyone no matter there ability to pay.
And by making limiting collections methods used by bill collectors. This makes the healthcare system left with setting a high price for everything so they can offset the cost of those who can't pay.

If you had a members only hospital the cost would be much lower because those who can't pay woulden't be allowed.

So fix the free loader problem. Single payer dosen't do that, because the free loaders also don't usually pay taxes.

Now I am not saying we should let the poor die, but we need to put the problem into perspective in order to solve it.

I also agree that we are putting things as medical costs, that should not be. Electric wheel chairs, or power chairs are good examples. I have to move about under my own power, why not everyone else.
Lets face it, I can't count my allergy medicine as a medical expence, so why should someone be able to count sex drugs, or appritis as a medical expence?

There is a load of fat called medical need that really isn't needed at all.

RE: Health Insurance

That all boils down to what we, as a society, think we should do for other people.

That's the fundamental difference between the US and Canada; Canada decided that, as a society, it was better to use sales taxes to cover essential medical costs so that nobody had to worry about their healthcare costs. The US has a different belief on this.

It's a basic philosophical difference, that has led to a lot of misunderstanding, and fuelled many talk show performers who know nothing but how to spew the party line.

RE: Health Insurance

Quote:

Some how I think there is a point that is being missed. The goverment created this health care problem by requiring doctors and hospitals to take care of everyone no matter there ability to pay.

And by making limiting collections methods used by bill collectors. This makes the healthcare system left with setting a high price for everything so they can offset the cost of those who can't pay.

That's a problem, but it's only one of a dozen problems. But each of the problems are a result of people being encouraged, and often even required by law or regulation, to go through an expensive process that's not necessary or won't do any good.

When we all used to pay for our own stuff, we had incentive to tell a doctor "no, I really don't need that MRI for five thousand dollars if it's not going to change your recommendation anyway." When we pay into a shared pool, we have every incentive in the world to go get the free MRI that we don't really need, because why not? We've already paid for it. And the doctor has every incentive in the world to recommend the MRI, since we're not going to say no, and he makes more money when we say yes, and in fact he could get sued if he doesn't recommend it.

That's it. That's the deal. The U.S. system is a feedback loop of cost pressures. And flipping the switch between private cost sharing and public cost sharing will do nothing to fix that feedback loop. In fact, feeding the beast with tax money instead of premiums will just make it worse. The only thing more wicked than doing that would be forcing everyone at gunpoint to buy a private plan, and then forcing the private plan to cover things we don't want it to cover.

..sound familiar?

It should, because that's what Obamacare is.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

" And flipping the switch between private cost sharing and public cost sharing will do nothing to fix that feedback loop."

Depends to some extent on how it's implemented as I think I alluded to above.

Not that the lawyers and politicians would necessarily allow it (seeing as many politicians trained as lawyers) potentially going to govt central payer the malpractice suits could be significantly reduced if not eliminated entirely due to certain constitutional rights. In turn this could reduce some of the defensive medicine. Likewise no one directly getting money just from giving MRI's etc. removes their incentive to do as many as possible and so on.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

The MRI guys would still get money from the MRIs. If it went public, they'd just have to shift their "Market our MRI Services" expenditures over to lobbying expenditures, and pass laws or codify regulations requiring MRIs under certain circumstances which exceed those actually necessary, "for our own good."

They already did exactly that with all the Obamacare plans. Forced things we don't need onto the plans, at the behest of lobbyists.

The fundamental problem is that government in the USA is broken, so any attempt to grant it more power just allows the people who broke it to break it further.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

One of the big reasons that doctors order tests is because they are available, and they'll get sued if they don't and something happens, even when they know the tests won't help the outcome.

The standard for determining tests used to be, 'what is the point? what will I do with the results, will it alter treatment in any way?' Now, the standard is, 'it's available, and the patient will complain if I don't order it, so I'd better order it'.

Like going to the doctor for a cold, what's the point? It achieves nothing, but yet, many people do it.

RE: Health Insurance

Why not require every medical plan to have a $2000 deductable. That way everyone must fork over the first $2000 cost and might just think a little about how it gets spent.

So a hip replacement cost is $2000 out of pocket, the same as the MRI. However if the doctor recommends you see a specalist for an in-grown nail, you might think twice as it's out of pocket for you.

RE: Health Insurance

Or you just move everyone to very high deductable plans with pretax Health Savings Accounts, to incentivize everyone to keep their costs down since it's their own money that's paying for most of what they buy...

...but...

...Plans like that were specifically made illegal by Obamacare. Specifically singled out to be made illegal. Because those people "weren't sharing enough cost." Translation: those plans didn't drive up the cost of healthcare enough.

Seriously.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

America is not Denmark - Capitalism is heart felt culturally for the 300 million immigrant strivers and their descendants that populate the country. America resisted the nationalization of the telephone system in the 20th century - how much did that contribute to the subsequent communications and internet revolution in the 80's and 90's? Norway has state control of oil extraction, but the American economy is presently being powered to a significant extent by shale oil and gas. Pretty much every big success that America has had including being the world's only superpower, has been on the back of its capitalist economy. Its fair to say that nationalizing 18% of the economy feels weird.

RE: Health Insurance

I don't think you need to nationalise. Canadian health care is nearly entirely delivered by private sector companies...

RE: Health Insurance

@Hokkie: Over a number of years, it has slowly become my honest opinion. I should, however, have been much more politically correct about it. It was, as you say, far too strong.

You all deserve better, and I apologise.

RE: Health Insurance

"Plans like that were specifically made illegal by Obamacare."

Huh? One of my company's plans is a high-deductible with HSA.

But, an HSA's advantage is pre-tax, but if you aren't going to owe taxes, that's sort of irrelevant, so if you couldn't afford $2000 for medical expenses and owe little in taxes, an HSA-based plane is not particularly useful.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: More practical question: What is the deductible on your high deductible plan? Do you know how much the policy costs? Is it a decent coverage network?

RE: Health Insurance

I have to admit that I let out a big sigh of relief when my time living in USA was done and I no longer had to think about health insurance: what was covered, what was not, how sick I could get and stay solvent.

- Steve

RE: Health Insurance

OK, the plan works out to $2084 per year, with a total of $6000 deductible and reimburses about 90% of costs above deductible, with and out of pocket maximum of $12000, but the company contributes $3000 to the HSA. Still, it's not exactly affordable for the unwashed masses. While it would probably make me look at the costs, the biggest costs like ER are probably mot shoppable; I mean, who's going to be trying to shop for the cheapest ER when their kid is can't breathe and is so dehydrated that they can't even get an IV in?

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Well, I'll eat crow on that one. I had a friend who was wailing about the horrible changes Obamacare was going to make to his HSA, but reading about them it seems that the changes weren't that huge. The family HSA contribution cap is still around $6k, which is what it was in 2009.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

I find that's the case with a lot of the complaining about, and praise of, Obamacare. It's based on nothing approaching actual facts.

I guess that makes for the best political commentary, though.

RE: Health Insurance

IRStuff: I assume you are not on minimum wage - how does the high deductible + HSA combination work for you in the real world? I always worry about putting money into the HSA which I won't use and losing it.

TenPenny: the thing about Obamacare is that it is pretty much exactly what I would have expected the Republicans to have done had they reformed healthcare. It retains a fully private system and empowers individuals to get insurance independent of their employers. No corporation was harmed in the making of this bill! Its exactly what I would have expected from a Dick Cheney with his down home on the ranch / look a man in the eye before you shoot him / Ayn Rand ethics.

RE: Health Insurance

I thought money in the HSA carried over from year to year if you didn't use it, and only the FSA money is truly "lost."

Is that not how it works?

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

3
glass99: capitalism is so heart-felt in the US that they try to apply it to stuff to which it CANNOT apply. Is this love of capitalism sensible and rational, or has it become ideological?

If you don't want people to die of causes which can easily be treated by medicine, and you are unwilling to let them die merely because they lack the money to pay for that medical care, then you have de facto rendered basic health care a human right rather than a commodity. You cannot trade human rights. A market cannot assign them a fair trade value.

It is also a mistake, proven easily by measurement and comparison, that the private sector always delivers goods and services for less total cost than the public sector can. Proof is the % GDP expenditure difference to provide health care to Canadians and Americans. Outcomes are similar- costs are VERY different, and the reason is simply this: the public system, though imperfect, is far more efficient than the mix of public/private you have in the US. Not by a little- by 7% of GDP.

The question really isn't one of government takeover of 17% of your GDP- it's whether or not you want to continue to spend 7% of your GDP to enrich people in return for NOTHING. Your country, your choice.

You need not fear, because in reality you have no choice. That 7% of GDP wields more power than the US military which in its entirety costs less than 5% of GDP. Those parasites are in your bloodstream and there's no drug which will remove them.

RE: Health Insurance

Quote (moltenmetal)

If you don't want people to die of causes which can easily be treated by medicine, and you are unwilling to let them die merely because they lack the money to pay for that medical care, then you have de facto rendered basic health care a human right rather than a commodity. You cannot trade human rights. A market cannot assign them a fair trade value.

molten, I wish I could give you more than 1 star for this.

RE: Health Insurance

moltenmetal: 17% of GPD is of course appalling. However, in defense of the current mess:
- America subsidizes the rest of the world for practical drug and device development. When America stops overpaying for drugs, Canadians better get used to their generics at whatever level of development they were at the year the US went public.
- A private system has the possibility of technical innovation, which largely does not exist in single payer systems. If the government just sets the price for commodities, its hard for a young plucky entrepreneur like Elizabeth Holmes to get off the ground. Right now there are gigantic incentives in place for private firms to do better. America was built on techno-capitalism.
- It is not a coincidence that Silicon Valley is in the US and not in France.
- Getting 300 million Americans to agree on a single approach is harder than getting 30 million Canadians on board. Even Obamacare is controversial! What would healthcare in the EU look like if it was one system? They can barely manage a currency. The whole structure of government is geared to make central control difficult. The founding fathers baked in the current deadlock with the congress/senate/president/court demarcation.
- It could be viewed that the primary problem with US healthcare is its market system is clogged. Market forces are blunted by the structure of insurance.

RE: Health Insurance

Can I give a negative star?

If Canadian health care is so much better, then why do Canadians come to the US for health care? Or if our health care is so great, why is health travel happening?

In both cases the healthcare system is lacking something, and if free market were really allowed in the US, our insurance would pay for us to seek health care outside the US. The fact is our health insurance is regulated to keep people in the US, and not seek medical care in a free market of the world. Yea there might be risks, but what of the risks here?

Of course I am not talking about emergency care.

And let me say I am not concerned about the poor, I am concerned about myself. The poor can eat cake.

I see that maybe a dual system maybe an answer to this problem. A healthy privite free market system, and an under funded public system. And the public system needs to appear to be underfunded to encurage people to use the privite system when they can.

However, O care was sold as making health care equal for everyone. But apperently the VA did not get the message. Do you supose the White House doctor provides equal care?

RE: Health Insurance

Quote (cranky108)

I am not concerned about the poor, I am concerned about myself. The poor can eat cake.
...he said while grasping his copy of Atlas Shrugged.

RE: Health Insurance

I think Ayn Rand would be appalled by the current state of US healthcare.

RE: Health Insurance

We should just allow everyone who wants socialized healthcare to pay extra taxes and use the VA.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Glass99--my HSA has a $2500 deductible. (some preventative medicine is covered 100% with no deductible, however). The cost of the policy I have is $502. I know that exact amount as I am paying for it currently (via COBRA).The HSA has worked well for me and I have been using the accumulated funds to pay my COBRA premiums. Beej67--Obamacare DID effect HSA plans to some extent. It put some limits on them, i.e. you couldn't have a plan that had like $20,000 deductible.

RE: Health Insurance

Quote (glass99)

moltenmetal: 17% of GPD is of course appalling. However, in defense of the current mess:
- America subsidizes the rest of the world for practical drug and device development. When America stops overpaying for drugs, Canadians better get used to their generics at whatever level of development they were at the year the US went public.

Prescription drugs are not covered by the Canadian plan, except for the very poor and for drugs given in hospital. But because the governments are a major purchaser and are unafraid to use their purchasing power to negotiate, we all benefit from lower prices. Think of it as a tax on profit. If the US didn't exist, drug companies would still exist, and would still do drug development. What you'd see though is far less peddling of drugs on TV- far less "market building" on the part of drug companies. Those ads you see on US TV- they are absent from Canadian TV entirely. The cost of drugs in Canada also comes with a dramatic reduction in marketing/advertising cost for the drug companies, not by their own choosing I might add.

Quote (glass99)

- A private system has the possibility of technical innovation, which largely does not exist in single payer systems. If the government just sets the price for commodities, its hard for a young plucky entrepreneur like Elizabeth Holmes to get off the ground.

The public system reduces the maximum profit attainable from such innovation but by no means does it prevent innovation entirely.

Quote (glass99)

Right now there are gigantic incentives in place for private firms to do better. America was built on techno-capitalism.
- It is not a coincidence that Silicon Valley is in the US and not in France.

All this "innovation" your country is built on isn't making your healthcare cheaper for one simple reason: healthcare is not a market commodity. It's not an IPad you can choose to buy or not buy.

Quote (glass99)

- Getting 300 million Americans to agree on a single approach is harder than getting 30 million Canadians on board. Even Obamacare is controversial! What would healthcare in the EU look like if it was one system? They can barely manage a currency. The whole structure of government is geared to make central control difficult. The founding fathers baked in the current deadlock with the congress/senate/president/court demarcation.

There are three core reasons your system is screwed:

1) You aren't a totally compassionless country and hence you have a parallel public system- just a totally messed up one which is fragmented into several disparate programs. This fact limits competition- sets a floor for the prices of services etc. But it's impossible to avoid, unless you surgically remove compassion
2) Your political system, like all others but moreso than most, is subject to the power of money. 7% of GDP buys a lot of political power to prevent government "innovation" which might take away private profit
3) You are a nation that from its founding has feared its own government. You don't view government as something you do collectively for each other's benefit- something you can do better together than any of you can do independently. Hence government is always viewed as an evil- by some among you, not even as a necessary evil. You therefore push things onto the private sector that it cannot efficiently provide

Quote (glass99)

- It could be viewed that the primary problem with US healthcare is its market system is clogged. Market forces are blunted by the structure of insurance.

No, the fundamental problem is that the "commodity" of healthcare isn't a commodity- it's a human right. Accordingly the market cannot function to minimize its cost through competition. The insurance companies are a symptom of this problem- they are private entities set up to intercept the necessary and unavoidable flow of money from people needing care to the care providers, and take away as much of that for themselves as possible. They are, by definition, parasites.

RE: Health Insurance

Since Ayn Rand was a user of Medicare, I'm sure that she would be appalled.

I've often wondered how anyone could take her seriously, but many do.

RE: Health Insurance

Moltenmetal--how is health care a human right?

RE: Health Insurance

swall: see my post previous to this one, with three LPS so far. 2nd paragraph.

RE: Health Insurance

Moltenmetal--yes, I just reread your post. I see your examples of treatment of the indigents being acts of a good Samaritan, but I just can't make the leap to healthcare being a human right.

RE: Health Insurance

I don't think that MM said it that it was a human right, just that we, in the US, treat it as such, because we have mandated that the indigent be treated, regardless of cost or ability to pay for it.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

moltenmetal: If healthcare is such an inalienable human right, were Canadians abusing said rights for the majority of their history were they spent less than 5% of GDP on healthcare? Is the extra 5% of GDP Canadians now spend really a human right, or is it a bunch of exotic treatments which push more folks into extreme old age? At some point which we probably passed a while ago, health care has a component of luxury. It is not your right to have the full resources of the state deployed to extend your life to 100. End of life care gets confused sometimes with a sick kid or a single parent with cancer.

RE: Health Insurance

glass99: there is much room for debate and discussion about where the rights end and entitlements begin. Some things that are covered, probably shouldn't be. Other things that aren't covered, probably should be. There are better ways to promote wellness rather than providing health care, to provide healthcare for less money with less expensive staff, and to provide a disincentive to wasting the provided services merely because they're "free". That's true in any system. However, my argument was more about the effectiveness of the market in setting prices for such services versus providing the services publicly as a benefit of citizenship.

Care obviously becomes more expensive when we can do more- and when people live longer. That expense grows faster than the economy and there has to be a limit- somewhere. But that growth in cost doesn't explain the difference in % GDP expended between the US and Canada for essentially the same outcome NOW. That difference is almost entirely explained by the inefficiency of the combined private/public model in the US relative to the single payor public-only model in Canada.

We weren't always there: healthcare was once entirely a combination of private and church/charitable provision in Canada. We won the battle to put in place a public single payor health insurance system by fighting the doctors in one province- Saskatchewan - in the early 1950s. Many doctors left the province, but replacement doctors who believed in the system, came in to replace them. Eventually it spread to other provinces- once Tommy Douglas's CCF did the heavy lifting and prevailed, showing that the predicted end of the world and people dying in the streets didn't come to pass. Regrettably, the battle to have such a system for auto insurance was lost in most provinces- only a few have provincial auto insurance, and they pay vastly less for car insurance than we do here in Ontario .

Now we hear US media reports about how everyone in Canada is dying in a waiting line, how we ration the provision of essential health care etc. It's sickening how a distorted view of our system is presented in the US by people with a vested interest in maintaining the status quo. 7% of GDP buys a lot of airtime...

RE: Health Insurance

moltenmetal: The US contingent who make fun of Canadian healthcare tend to be pretty unsophisticated. Everyone fetishizes all things Scandinavian in my neck of the woods. As it stands, Canadian healthcare is definitely better than the US system simply because its so much cheaper.

Canadian success notwithstanding, its not clear to me that a Euro style single payer system is right for America. I think America will forge its own path. In a bunch of instances where its looked like America was hopelessly behind, people start saying the US needs to become more like Japan/Norway/Germany/wherever, but the US comes from nowhere and invents its own stuff that turns out to be better. I remember a bunch of conversations from 2000 to 2006 about how much better Japanese cell phones were than US equivalents. All kinds of techno gloom post 2000 bubble bursting. Then 2007 rolls around, and Mr Jobs shows up with the iPhone. Had the government said that mobile communications are a human right, and that they were going to reimburse cell phone manufacturers at the cost plus 10%, we would still be carting around Blackberry's (sorry Canada) and thumbing out SMS's on a number pad. There is no way that a government bureaucrat could have picked Apple as the winner that they turned out to be.

This kind of entrepreneurial activity is the only thing which moves the needle of economic growth at scale. Like Norway, Canada has become a liberal petro-state - all manner of largess is financed by the tar sands of Alberta distributed among a small population. Much of the Euro breakup crisis of 2008 was a function of their governments having gigantic fixed costs with a shrinking tax base. Its arguable that the current sclerotic economy of France, Italy and Spain is due to their addiction to being taken care of. Frankly I would rather be a sick American with bad health insurance than an unemployed Spanish twenty-something living with grandma and contemplating suicide because there is no opportunity.

RE: Health Insurance

"Frankly I would rather be a sick American with bad health insurance than an unemployed Spanish twenty-something living with grandma and contemplating suicide because there is no opportunity."

I have a tendency to believe that there might be more options than just those two.

RE: Health Insurance

And why do I need electronic records of my medical history? Where is the benifit to me?

In places in South America you don't need a note from a doctor to buy medicines from a pharmacy. Which is really nice if you know what you problem is, you don't need to visit a doctor. And in many cases you know what you have. And maybe that is part of the problem, we are expected to see a doctor when we already know what problem we have. After all how many times has someone OD on butt cream. It is regulated for what reason?

So now, if I have a sinus infection, a visit to the doctor. A case of pink eye, a visit to the doctor. A rash, a visit to the doctor. An ear infection, a visit to the doctor. So the real problem really appears to be regulation, and not the cost of medical insurance, or a shortage of doctors.

So why can't I pay the pharmacy directly and get the medication perscribed by the nurse who usually gives the flu shots.

RE: Health Insurance

The primary reason we have nearly run out of effective antibiotics is that people overprescribe them- even when physicians are in charge of the prescription, their patients demand them and the docs are reluctant to say no. If we let individuals decide, everybody will be taking antibiotics all the time...The regulations over prescriptions exist for reasons- good ones- and the profession of pharmacy similarly exists for good reasons.

RE: Health Insurance

Everybody else in the world is already burning the antibiotics up. Tightening their supply here does us no good, and in many cases can be fatal.

I had a friend who almost died from a superbug infection he got at a hospital. The surgeons did all sorts of insane (and expensive, to keep it on topic) procedures to him to try to keep him alive, which included implanting tubes all through his body to pump certain antibiotics. Nothing worked. As his teeth were falling out, he went to a dentist, who decided to simply proscribe him a different (very powerful) oral antibiotic. He was cured in two weeks. By the dentist. The surgeons made over a hundred thousand dollars off him first though.

All because he was having a boil on his foot lanced.

Everyone actually knows what the problem is, because everyone knows someone who's been through the ringer of our healthcare system. We just don't stop and think about what the problems are when we watch others, or ourselves, go through it. The problem is that nobody is allowed to do anything for themselves, everyone must see a doctor for every little thing, the doctors are all trying not to get sued, and the doctors know that they can prescribe anything they want and the costs will be shared. That's the source of the problem, and that problem will remain whether the costs are shared through premiums, or shared through taxes.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Most doctors over the age of 45 don't see any value to electronic medical records either. With the learning curve and the cost, the payback isn't there to justify the investment.

RE: Health Insurance

I do agree that a few things should be regulated, but they are already being over perscribed anyway. But regulate everything?

The problem with antibiotics did not start with doctors, I believe it started with feeding it to animals, which is largely unregulated. The organic, and probiotic movements are currently making a dent in that issue, but it still exists.

And the best part of having your foot lanced at home is not having to visit a unhealthy hospital. Notice I say unhealthy, and not unclean. Hospitals typically look clean, but as they have pressures to reduce costs, they miss things.

The problem with percription drugs, is the perception that a magic pill will solve everything, and it won't. Just look at the side effects on any of them.
The medical profession started this dream, and they need to fix it.

RE: Health Insurance

The animal anti-biotic issue is only one aspect of the issue, and possible not the most significant.

People being over prescribed antibiotics, not finishing their courses as instructed, helping themselves to their friends/families medicine, diagnosing themselves and buying from pharmacy in other countries... are major factors in development of antibiotic resistant infections.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Superbugs aren't evolving in homes, they're evolving in hospitals. The most important thing you could do to fight the superbugs is decentralize hospital care.

But nobody's going to do that, because hospitals are big money.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej67, you are mistaken.

Part of the reason they are more obvious in hospitals is because the people there are already sick and so potentially more vulnerable to picking up an infection.

However, they also evolve at home/in the community.

http://newsinhealth.nih.gov/issue/Feb2014/Feature1 gives some information, or maybe you don't trust the govt but there you have it.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Yeah, no, most of the people who catch MSRA catch it in the hospital.

http://www.scientificamerican.com/article/hospital...

Quote:

MRSA causes some 94,000 invasive infections in the U.S. each year, resulting in almost 19,000 deaths—more than those caused by human immunodeficiency virus (HIV)—said a study published this week in JAMA The Journal of the American Medical Association. And "the majority of these cases appeared to be health care–acquired,"

Quote:

Gehrke asked her ob/gyn why this had happened. "'These things happen in hospitals' is pretty much what he told me," she says.

It is difficult to pinpoint the source of Gehrke's infection. It may have stemmed from a dirty instrument used during her C-section or from unwashed hands or the contaminated gloves of a health care worker. But one thing is almost certain: she picked up the bug at the hospital.

Gehrke is one of millions of patients who have unwittingly contracted infections in hospitals, where they went expecting to get well—but instead got sicker. Every year nearly 100,000 people die of infections they developed in U.S. hospitals and healthcare facilities, a greater number than those killed in homicides and car accidents combined.

Pretty strong numbers.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

This from the Mayo Clinic. They have two categories, contracted in hospital and outside. I think beej67 is correct. My wife is a nurse, and she says some hospitals are worse than others. She works in a rehab hospital, and they take different precautions depending on which hospital their patients come from.

http://www.mayoclinic.org/diseases-conditions/mrsa...

RE: Health Insurance

Read the Scientific American article, KENAT. The hospital environment breeds these things.

Quote:

Gehrke is one of millions of patients who have unwittingly contracted infections in hospitals, where they went expecting to get well—but instead got sicker. Every year nearly 100,000 people die of infections they developed in U.S. hospitals and healthcare facilities, a greater number than those killed in homicides and car accidents combined. Some 1.7 million patients contract hospital infections annually, according to the most recent data from the Centers for Disease Control and Prevention (CDC).

Many of these infections are caused by multidrug-resistant superbugs such as MRSA and vancomycin-resistant enterococci (VRE). Heavy use of antibiotics in hospitals encourages the emergence of stronger and stronger bacteria. Exposing a bacterial strain to one antibiotic essentially weeds out the weak and selects the hearty bugs that can survive. Then the next generation of antibiotics is called on; eventually the bugs become resistant to that as well and the bacteria continue evolving until eventually no antibiotic can kill them. "You can end up with bugs that we really don't have medications to kill," says Allison Aiello, assistant professor of epidemiology at the University of Michigan School of Public Health. Experts estimate that more than 70 percent of all hospital-acquired infections are caused by bacteria that are resistant to at least one of the drugs commonly used to treat them.

Hospitals not only provide optimum conditions for the evolution of superbugs, but they also provide a plethora of inviting pathways for bacteria to get inside human bodies: open wounds from surgical incisions, catheter tubes running in and out of blood vessels and urinary tracts, and ventilators inserted through noses or throats and into windpipes.

The hospital environment is tailor made to breed superbugs. If we could somehow decentralize the surgical environment, even going so far as to move the equipment to the patient's home and perform the surgery there, then this tailor made environment would not exist to breed such superbugs. The rapid evolution of superbugs is because of the high density of surgical procedures done in one place, with a continued culling of weak bacteria between each surgery, in the hospital. It is the hospital environment itself at fault for the evolution of these things.

The article I linked is a good one, and fairly comprehensive, but it's only one of dozens that say the same thing. Superbugs are not created by too many people taking Amoxil for ear aches. Superbugs are created in hospitals where there is a high density of exotic antibiotic use and open surgeries to act as petri dishes.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Here in SoCal, virtually all orthopedic surgeries are performed in specialized surgical centers, because there are NO 'sick people' in the building. 7 years ago I had my Right shoulder operated on and this past summer, my Left knee, and in both cases is was done at a dedicated orthopedic surgical center.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Beej67 I fear I fell into the trap of picking up on your specific wording as implying something it perhaps did not, partly based on recollection earlier posts implying that we should be able to go into pharmacies and pick up antibiotics as we see fit. Additionally some of my own wording may have been sloppy. If indeed this is the case then I apologize.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

If people mis-taking antibiotics is a real concern, then why are they made into pills? Make them injectible only, or some other way to make there taking more difficult. What's the real problem, lazyness?

Why not make some medicines with ditastful side effects. Turns you whole mouth orange, tastes real bad, and smells like s**t (other than antibiotics).

No we make them look like gummy bears, with nice flavors. Easy to take narcotics, real bad thing.

RE: Health Insurance

If there are negative externalities to taking antibiotics, perhaps they should be taxed accordingly? Lets say a higher co-pay. Use the tax money to provide subsidized care.

RE: Health Insurance

No problem KENAT.

My point, or at least one of them, is that the "We'll burn up all the antibiotics!" is always trotted out by the medical industry as an excuse for making everyone in the USA go to the doctor for every little ailment that may require antibiotics. When in truth:

1) other countries don't do that, so the amount of "burning up" that happens here is inconsequential, and
2) our doctors just hand out antibiotics anyway, and
3) the really nasty antibiotic resistant bugs aren't being created by over use of common antibiotics for common infections, they're being created in hospitals by the concentration of people having surgery, which is...
4) ...exacerbated by our system's priority to "cut first, ask questions later," because our system is dominated by surgeons who have no financial incentive to recommend paths to health that don't involve expensive surgeries.

Here's one of many articles on the higher rates of surgery in the US:

http://www.ncbi.nlm.nih.gov/pubmed/8073310

US citizens in 1994 had back surgery at five times the rate the English did. That contributes to both our overall increased cost of shared medicine, and also to the increased breeding ground for superbugs, which in turn cost more money. But since back surgery has the fiscal benefit of being A) expensive, and B) covered, our doctors jump at that as the preferred option for treatment.

..and that won't change by switching to a government-payer health care model, either.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Sure, but it's not "because" of the single payer system.

Medicare is a single payer here in the USA, and Medicare recipients do not have a lower rate of surgeries than insurance buyers. The payer is not the only difference between England and the USA. The systems themselves are different.

Now, if we go full Communism and not only do single payer, but also single provider, then the rate of surgeries goes down. We have evidence of that. It's called the VA, who let people die because they were lazy and didn't have to compete with private care for the patients dollars. Not even one of the country's most decorated and dedicated Army Generals could steer the VA towards a semblance of respectability.

On that topic ..the whole "VA Reform" movement just kills me. We have Obamacare now, and it's not going away no matter how much some of us would love it. So why have a VA at all? Just fire everyone, give vets an Obamacare voucher, and sell the VA hospitals off to the highest bidder. Problem solved.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

In the article which beej67 linked above, the study found that back surgery rates were related linearly with the number of surgeons available to perform them. Therefore, the solution is less doctors.

RE: Health Insurance

Interesting. Perhaps Hokkie has a point. In Canada the number of Doctors, as well as the type, is controlled by the Doctors. I've always thought that was more to keep the costs up, but maybe it has genuine benefits as well...

RE: Health Insurance

The American Medical Association is a cartel. Is there a Canadian equivalent?

RE: Health Insurance

In the U.S. there is a board that sets rates for Medicare reimbursements for various procedures. The influence of medical specialists on the board has skewed the reimbursement structure such that specialists get higher fees/make more money than general practitioners. So guess what? More medical students study to be come specialists rather than GP's. It is my understanding that many of the insurance companies follow the Medicare reimbursement guidelines, so most of the medical profession if affected.

RE: Health Insurance

The medical association here in Canada is a de-facto union, since the doctors have one employer (the government). They negotiate fees for service etc. The provincial governments and the doctors BOTH want the number of doctors to be low... But instead of deploying the limited number of doctors where they're actually needed (because they're really government employees anyway), we give them the choice to set up shop wherever they like. Because these services aren't optional, the public travel to where the doctors are- we have "under-serviced areas". Pretending that these guys are private businesspeople is not helping matters.

Regrettably, although the doctors and provinces are good at controlling the total number of doctors, they're less good at controlling the number of specialists. Specializing gives the doc a huge return on investment relative to staying a family doctor, so we have a shortage of family doctors- and are a net exporter of trained specialists to the US where the returns on that educational investment (for the person, not the province who subsidized it) is enormous. Time to start handing them a bill for recovery of those subsidies at the border in my opinion, until they've put in 10+ years of practice here at least.

RE: Health Insurance

Quote (IRStuff)

"Sure, but it's not "because" of the single payer system."

Right, but it's not the single payer system that prevents that from happening either.

Sure. So why is the whole debate about who pays for the overpriced dysfunctional product, instead of discussing the overpricedness and brokenness?

The primary thing that fuels the engine of our system's brokenness is the exploitation of the cost sharing mechanism by the medical industry itself.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

We engineers have to compete for our jobs with others educated internationally, so why shouldn't doctors? There are too many restrictions on doctors educated in India and similar places. There are plenty of stories of doctors educated in Egypt working as cab drivers because they are denied licensure. The AMA is an enforcer of this anti-competitive behavior, plus there is a culture of entitlement among the medical community.

RE: Health Insurance

glass, I have heard the same of doctors from other countries. The issue seems to be the AMA attempting to restrict the supply of doctors. Maybe we should invite doctors with out borders in to serve underserved areas of the US. As these doctors don't seem to need a licence for the countries they visit. And just maybe we can have the US army build hospitals in underserved parts of the US.
We can call all of this 'nation building'.

So what I am getting is this is a political issue that is causing the rise in health care, and we have a goverment that has no desire to fix the real problem.

RE: Health Insurance

The H1B visa program is supposed to be for easing shortages of skilled professionals - if civil engineers have tight supply, why not cardiologists? They earn something like 4x as much as engineers, which would seem to indicate that there is a shortage which needs to be eased. The competition would be useful for medical schools too who currently just charge student doctors through the nose because they can.

RE: Health Insurance

Health care poses a unique problem. It has advanced to the point the average person cannot afford it,
but we are compassionate people who don't turn away the sick ( mostly ).

It seems there are only two ways to handle this.

1 Spread the cost out over the population and over time requiring people to pay in constantly for that day when they need it.

2 Government takeover of the health care system so whats available for free is limited and without risk of litigation.


Also I think every medical service and doctor must publish their fixed price to do procedures. They would have to weight in
their risks for handling complications ( resulting from treatment of a single condition named in the price ) and perform
the service at the quoted cost.


It simply won't work allowing the medical community to run a locked in system where the consumer is handed the bill after everything
is finished and just has nothing to say about it.


RE: Health Insurance

Or allow the free market to solve the cost issue by breaking the goverment limit on the free market.

Truthfully why is there a restrictive choke on the medical profession, but a desire to allow engineers from other countries?

RE: Health Insurance

"There are plenty of stories of doctors educated in Egypt working as cab drivers because they are denied licensure."

Not true. They generally have difficulties in the following:
> Passing the Step 1 and 2 medical exams, because they're in English
> Passing the TOEFL English exam
> Getting residencies, which are in limited supply.
> Passing Step 3 medical exam.
> Passing their respective board certifications

> Just because someone was a doctor somewhere else, does not mean they are qualified or trained to the same level as a US-educated doctors.
> For the limited slots available for residency, it's mostly a meritocracy, at least, in the sense that graduates of the best medical schools will tend to get the best slots.

Assuming that a foreign person does all of the above, they cannot be "denied" licensure. My wife is foreign born and trained, and is licensed, but went through all of the above hoops.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

The thing they control here is residencies. Some argue that a residency requirement is too much to ask of a foreign-trained doctor, but most people admit that it's actually legitimate for public protection.

The medical associations and provincial governments set aside enough residencies for the (controlled) number of local medical graduates, plus a small number (I think it's about 100 per year in Ontario total) for everyone else. If you have 1000 foreign trained doctors coming in and 100 residencies per year, you end up with trained doctors doing something else. So: why let the rest of them immigrate? That's been an argument for a long time- in all the professions- except in engineering, where the engineering community was basically asleep or in denial, thinking that we could accommodate any number of immigrants who chose to come.

In fact, they tried for a while in the late '80s to let doctors come in ONLY if they signed an undertaking prior to immigration stating that they would not seek licensure as doctors. Of those signing the undertaking, it was found that over 50% did actually seek licensure anyway...so they abandoned that practice.

Somehow, a doctor's training going to waste is viewed as a huge sin, but an engineer's training going to waste is not something anyone cares about. I guess we're not a profession after all, at least not in any way that truly matters.

RE: Health Insurance

There are no such quotas in the US, but many of the steps I outlined are huge stumbling blocks for foreign doctors. Back about 10 yrs ago, when my wife was looking for a residency, we met someone from the former Yugoslavia who was supposedly a department head back home, but was slogging it out with freshly minted med-school grads for residency. I don't remember what his job was here, while waiting to get lucky, but it was nowhere near what his former job was.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

I now work with several engineers from other countries, and most of them speak very good english. However when I was in school I had many instructors that did not speak english very well.
So at this point I need to ask why those doctors from other countries don't teach?

Also while observing the elections last night, I noticed the corner is an elected position, and I think, that a corner may not need to be a very good doctor as all their patents are dead.

RE: Health Insurance

"So at this point I need to ask why those doctors from other countries don't teach"

For same reason that they have trouble getting residencies; they're competing with already licensed doctors who have the full paper trail of residency, board certification, etc. Given the number of foreign-trained doctors already working, I don't see that there is a real problem, those, like my wife were indeed able to get pass the medical exams, get residencies, and pass the board exams. I think that if we dug through the records, we'd see an equally large, if not larger, group of US-trained grads that fail to get into the path toward licensure. It's awfully easy to blame others for one's own failures.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

A residency is a years long rigorous undertaking, and forcing a foreign doctor who has done one overseas to do one again in the US is straight up anti-competitive behavior. Is a German doctor really trained to such lax standards? Surely some sort of foreign accreditation program could be arranged. A little foreign competition would do the medical profession no harm.

RE: Health Insurance

A full-on residency may be too much to ask, but a year of fully mentored experience under the direct supervision of another licensed doctor would be appropriate. It's akin to what we require here for licensed professional engineers, with only one difference- to work as an engineer here, the only person you need to convince of your abilities, education etc. is your boss- you only need a license to provide services directly to the public. There is no such non-licensed doctor equivalent.

Better using the training of doctors from overseas is one thing, but better using the services of doctors in general is another. Right now too much healthcare is delivered by people with too much training- a little bit of "division of labour" would help that profession a heck of a lot more than merely fixing the mess related to residencies.

RE: Health Insurance

Specialist doctors getting paid $400k/yr is a significant cost to the system, and we need to take away some of the excuses for why they "need" to be paid so much. Doctors will always point to their 12+ years of higher education to justify their investment banker salaries.
- US med school needs to be cheaper
- Med school needs to be shorter, at least for some percentage of doctors.
- If education input is such an expensive piece of the puzzle, we should be looking to offshore to lower labor cost locations where possible.

RE: Health Insurance

They command that kind of wage due to artificial scarcity created within the system.

Nothing about fixing that in the ACA.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

glass99, well to resolve a couple of you points...

How about we tax the investment banker salaries, use that money to make the doctors government employees (with generous but limited salary) in a state monopoly for healthcare with strict limitations on being sued. Maybe negotiate better prices with various med suppliers due to the monopoly status. Little bit of central planning to cut down on duplicate facilities and equipment not being used to capacity...

You know, something like at least some of those damn commie socialist lazy Europeans do with their single payer systems.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

"Is a German doctor really trained to such lax standards"

No, but there are people who fail to get into the US medical educational system and go elsewhere, because it is easily, like the D.R. Additionally, you don't know that a German doctor was actually trained in Germany, just like not all US doctors were trained in the US. The other issue is that the equipment and nomenclature and procedures are different, and while family practice could probably tolerate a doctor fumbling for the right phrase to use with the M.A., that might not go that well in the O.R.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

beej: yes, it is an artificial shortage of doctors.

Teddy Roosevelt busted up Standard Oil and the railroads over a century ago with the Sherman Act. Watch out Yale School of Medicine! No more boasting about being selective!

RE: Health Insurance

IRstuff, I'd imagine in a field like medicine where you're dealing with the general public, often at times of great stress, potentially life & death situations etc. that aspects such as general culture and language skills could be quite a significant issue to which having some kind of residency may not be a bad approach.

We have engineers & scientists from all around the world here and language skills* & to a lesser extent general cultural norms can be an issue.



* I'm primarily thinking their English skills not always being fantastic but in fairness I'm mediocre at English, terrible at French and it goes down hill from there.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat: in communist France, the man on the street embraces the strong arm of a paternalistic government, and is comfortable with his government using its power to compel doctors to work for low wages. We in the US believe in the principle that consenting adults should be able to deal directly with each other.

RE: Health Insurance

"We in the US believe in the principle that consenting adults should be able to deal directly with each other."

Perhaps, but in reality this only works to the extent that our wealth and station in society allows us to...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

And the parties have to be on reasonably even footing... You cannot have fair dealing when the individual basis of power from which they negotiate is worlds apart.

RE: Health Insurance

One way that the US government is to blame for the current healthcare cost problem is its WWII era decision to make health insurance tax deductible. If we pay 30% tax on income and zero out the tax selectively, we basically pay 30% more for that item. It is a market distortion.
- Why is food any less of a human right than healthcare? Organic kale, whole grains, and humanely raised meat are much better for you than a deep fried hormone laden double down from Micky D's, though it is more expensive. Its arguable that we would have better health outcomes if food was tax deductible and healthcare was taxed. Lets give it to the underpaid farmers rather than the overpaid cardiologist.

RE: Health Insurance

Actually food is exempt from sales tax in some states, the same as health care. But than again, items purchased for food production is also sales tax exempt, and if it's a business, it's also a cost of production which is income tax exempt.

RE: Health Insurance

cranky: yes food is typically sales tax exempt but not income tax exempt.

RE: Health Insurance

I remember that, but there grew a plethora of exceptions, both on the hot and cold side. I remember growing up in San Francisco where stores wound up having to keep track of individual items on the grocery shelf, where taxable items were next to tax-exempt items.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Mayor Mike Bloomberg here in NYC tried to impose a high sales tax on sugary soft drinks. He was unsuccessful because of opposition from a coalition between Coke and the tabloid news outlets. Mayor Mike was criticized as being out of touch with working class ways of life. A $1 soda is a cheap daily pleasure for the 99%.

Soda has an appalling amount of sugar it in, and it more responsible for more expensive health problems (especially diabetes) than practically anything other than cigarettes and alcohol.

-> Soda should be taxed like cigarettes
-> Kale should be income tax deductible

RE: Health Insurance

So now health has transformed into the food police. And did we not see it coming?

The problem is who decides what is good, and bad for us, and how much is too much. And how long ago were tomatoes thought a health problem? And what about those foods that are taboo in some places and not others? Any one try horse, pork, cow, deer, bear, carp, corn, beer, wine, dandelion, dog, cat, road kill? Where does it stop? (Not that I choose to consume all of these).

At some point a government who limits what we consume for health reasons, will over reach. Which is why we should not go down that route in the first place.

And at some point we should look at health at a multipoint level. There is what we need to live for after an accident. What we need to live for after we have over consumed. And what we want because we want to look better. And what we need because our body is failing us.

RE: Health Insurance

"Which is why we should not go down that route in the first place."

That's fine, but why are the rest of us forced to pay increased insurance premiums to cover all the health problems caused by the consumption of all these things? Juvenile diabetes rate is going through the roof, so we're all paying for the insulin now, and all the complications of their diabetes later. By ignoring the root cause, we guarantee the worst possible economic and health outcome. For a society that came up with pithy sayings like, "A stitch in time saves nine," and, "Penny wise, pound foolish," we seem hellbent on going the exact opposite direction.

It's all very fine and dandy to protest government intrusion into our lives, but is the willful negligence by others resulting in the sucking up of health care resources somehow better? If they want to do all these things in the name of freedom from government nannyism, that's fine, but they should pay for that privilege. You want to smoke and fill your body with carcinogens, fine, then every pack of cigarettes should include your share of your eventual burden on the health care system. To do otherwise is to simply toe some inane dogmatic line, bury your head in the sand, and open up your wallet and leave on the sidewalk.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

In some insurance policies, they do charge more for smokers, and I would trust an insurance company more than the government, because I can change insurance companies or policies, or even have a health saving account.
And in fact if I get a yearly blood test I get points into a health spending account, and even more points if I meet some targets. So I am infact penalized for not being healthy. And I have no government restrictions on what I eat.

In reality, peanut butter is a known chocking hazard, so why not outlaw peanut butter?

I am in favor of government restrictions like "no spitting on the side walk", or a waiting period if you have been eboli areas.

But why the double standard, don't eat this, but if you have a eboli you can go into public places.

RE: Health Insurance

cranky: We need to get a point where the costs imposed on others of personal choices are paid for by the individuals making those choices. If you are a libertarian you should believe that.

In principle I am somewhat of a libertarian too and agree that tax is a perversion, but a soda tax to me is a no brainer. Its kind of is like the "no spitting on the sidewalk" rule in the sense that you are asking people to not make a mess for others to clean up.

America has a cultural problem with soda. There are many people in this country who don't like drinking water, and consider it normal to hydrate with soda. If we lived in a parallel universe where a person's sickness affected only themselves, that's one thing, but it doesn't work like that. If you let your boss down by not showing up for work because you just had a stroke caused by having chugged 6 cans of Dr Pepper a day, that's a cost.

Soda is a luxury!

RE: Health Insurance

The problem with insurance companies is:
> I don't trust them that much more than the government, possibly less, because their motivations are strictly monetary
> that sort of adder is based on self-reporting, for the most part. If the true cost of smoking were reflected in the premiums, smokers would LIE about it, and they would only get caught after they wind up diagnosed with a smoking-related disease.

Tying the consequence cost to the actual product eliminates all that lying, aside from the inevitable workarounds that resulted from the temperance laws we attempted at the front end of the last century.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: People should not drink alcohol either. Its actually irrational to do so in many ways. If it were strictly an occasional luxury it would be rational to consume, but there are large swathes of the population who are addicted to alcohol and whose health and productivity suffers disproportionately.

Its going to be hard to ban alcohol, but we have the more current issue of marijuana. Are we going to see an uptick in lung cancer in 10 years because of the current legalization effort?

RE: Health Insurance

There's been a lot of interest in various circles in determining the "true" cost of things like electricity, integrated circuits, etc. Likewise, alcohol has a lot of costs to society: broken homes, lost days at work, liver illness, etc. It would seem plausible that one could assign an actuarial cost to alcohol that could be applied like an insurance.

At the risk of being labeled a "nannyism" advocate, I could imagine doing adders and subtractors to the prices of foods to account for downsides and upsides, with the eventual goal of demonstrating that the true cost of the cheap sugary and starchy drinks and snacks belie their retail prices, and that vegetables and fruits would get priced more competitively, based on their benefits.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Wow from health care to the FOOD POLICE. In an engineering forum!bigsmile

I was the insurers dream. Company paid insurance, rarely go to doctor. In relatively good health (well into 50's). As far as individuals going into the marketplace and obtaining competitive insurance as opposed to a group policy that's just not going to happen. Unfortunately, as an employee you have no control whether your employer has a good or bad plan.

I was blessed to have a HR lady who worked extremely hard to negotiate the best coverage possible on an annual or two-year basis. It did mean switching providers from time (which did give some heartache when suddenly your primary care provider was no longer in the covered network). My own experience is therefore not against employer paid plans.

I am now in the free market place and what I am seeing is dreadful. $600 per month with $5000 deductible. I am better off without a plan and risking I won't spend more than $5000 (I suppose that's one hospital stay). There are plans with lower deductibles, but with higher monthly costs. It's hard to predict what will happen.

As far as the uninsured, I do believe there is some role for subsidies or low cost care to be provided for those that qualify. It ultimately results in an improved society (IMHO).

I am near that point now, being recently unemployed, unable to afford COBRA or any other health care. Yet somehow BIG BROTHER says I must have it. Just how? Unless it's GIVEN to me.

I don't really believe the US Government is going to deliver healthcare to me efficiently (too much bureaucracy, sloth, and graft). Not that I believe that the current system is very efficient or cost effective either (too profit driven).

One example I can provide is that the radiology departments act as their own revenue generating centers in the hospital. How often have you got a bill from them stating your insurance carrier hasn't paid? Thus your Doctor no longer truly reads your X-ray.

Well that's enough of my 2 cents.

RE: Health Insurance

"I am better off without a plan and risking I won't spend more than $5000 (I suppose that's one hospital stay). "

Dream on, %5k was ONE DAY in intensive care, the last time that happened.

"I don't really believe the US Government is going to deliver healthcare to me efficiently (too much bureaucracy, sloth, and graft). Not that I believe that the current system is very efficient or cost effective either (too profit driven)."

Luckily, we're doing neither, or rather, we're doing both

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote (IRstuff)


It would seem plausible that one could assign an actuarial cost to alcohol that could be applied like an insurance.

Have you ever been to a Scandinavian country likr Sweden or Denmark? If you're ever there, try buying a beer, or better yet, a bottle of liquor, and you'll experience first hand what it's like to live where they 'tax' your vices, at least the ones which tend to place an undo burden on their national health care system.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

No, I have not. Assuming that the tax is consistent with the total cost of the drink, then it sounds like they got that part right. Since you recognize that that's a plausible situation, what' the problem? The alternative is that you or your heir are contractually obligated to let you consume no medical or other care without paying full price, and that when live transplants are available, you are ineligible. Would you rather they do it that way?

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote:

It would seem plausible that one could assign an actuarial cost to alcohol that could be applied like an insurance.

I quite like that idea, actually. It would be a lot more grounded in realism than carbon taxes.

The thing to really tax, though, is sugar.

If all of Obamacare was funded out of a national sugar tax, and food stamps were instead replaced with "all you can eat free vegetables," this country would undergo a drastic change for the better, health wise. The corporate food lobbyists would never let that happen though.

All sorts of funny things show up when you start applying actual actuarial principles to health care. For instance, tobacco use is a net positive, because it kills people off before they get old and draw too much social security. Alcohol might be similar.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

The problem is that in both cases, there are those that will suck up huge amounts of medical resources before they kick the bucket. Just consider a single DUI causing semi-permanent disability to a victim, or even the perp.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Alcohol kills a crazy number of Americans every year, frequently in really tragic ways. I would be interested to see the increment in health care costs caused by alcohol related illness. It probably exceeds the whole turnover of Budweiser, Coors, and Miller. Manufacturing, sales, and distribution costs are the smallest component of the true cost of alcohol.

-> It should not be affordable to get drunk every night. Buying a can of beer for $1 is perverse, it should be $10/can. Cigarettes are about $12/pack in the bodega downstairs from my office, which is still about half what it should be.

RE: Health Insurance

With that logic, I expect to see bootlegers speeding down the highway, and I wonder how many people that will hurt?

One of the big problems with any of this high tax stuff, is what if the studies are wrong. What if a little wine is actually good for you? Who decides what is taxed and what is not, or what is good for you and what is not. Do you trust that person or group to be honest, and not payed off?

If you want to fix a disfunctional food consumption problem, then teach it in the schools.

Another option is make food that is good for you, to taste good to you.

RE: Health Insurance

Plus of course alcohol ties into the health care debate in other ways.

There is a correlation between mental illness and problem drinking (and other addiction issues) but the causation is not necessarily as simple as 'drinking/using drugs fried their brain'.

In many cases the substance abuse may be a form of self medication for pre existing mental illness - at least according to many psych types.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

"If you want to fix a disfunctional food consumption problem, then teach it in the schools."

How is that supposed to "fix a disfunctional food consumption," given that much of today's problems in nutrition can be squarely placed on the food pyramid that was taught in schools and media for 40+ yrs. Additionally, the same question of "who do you trust?" exists. The "war on fat" can now be traced to a certain zealot who cherry-picked his data and sold a bill of goods to the country that reverberates even now.

"Another option is make food that is good for you, to taste good to you. "

The only way to pay for that is to tax the bad stuff... But, seriously, the reason the bad stuff tastes good was the fat and salt and all that bad stuff. Put enough cheese and salt, even tomatoes might taste good. Of course, we've successfully removed 90% of the tomato's taste to ensure that we don't have go to the market every day to avoid spoilage and shipping damage. Almost everything that was tasty that we buy in the produce section has been bred into dull, lifeless, cardboard taste.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Another problem with many health studies is that they are strong on the correlation and weak on the causation.

Hence every few years a food that was meant to be 'bad' for you is now 'good' for you and vice versa.

The human body is an incredibly complex system, that varies somewhat amongst the population, in a variable environment... so to my mind to any claim that tweaking one input slightly can be expected to have a significant impact on overall health of everyone is worth of scrutiny.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Good food is hard to define in an objective way. Our species has evolved favouring foods that provide easy and quick energy. Very good for feeding the evolution machine. Not so good (so it would seem) at keeping the gene-carrying individuals running after their work is done.

- Steve

RE: Health Insurance

It is true that reasonable people can disagree about things like how many eggs a day you should eat, so we should be humble about our regulation of it, but no reasonable person thinks that soda or beer is good for you.

Part of the perversion in the US are the farm subsidies for corn growers. It artificially reduces the price of corn syrup.

RE: Health Insurance

"no reasonable person thinks that soda or beer is good for you"

Then I am unreasonable, and apparently so are at least some scientific researchers.

http://www.huffingtonpost.com/2013/10/26/beer-facts_n_4151575.html
http://news.health.com/2014/09/23/health-benefits-of-beer/
http://www.eatright.org/Public/content.aspx?id=6442463947
http://www.realbeer.com/edu/health/

Then again, as we don't trust them about the climate should we trust them about bear?

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat: perhaps if you start drinking shandies you can get all your empty calories in one neat package

en.wikipedia.org/wiki/Shandy

RE: Health Insurance

There is absolutely NOTHING wrong with an occasional soda or beer. Life would be totally boring and they might as well kill me now, if that's the end result. "Moderation in all things," should be the motto. Too much of anything is bad, regardless, just like the old joke about too much water being bad for you. Too much oxygen, which is vital, is bad for you. Too much salt, etc.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

"It is true that reasonable people can disagree about things like how many eggs a day you should eat, so we should be humble about our regulation of it, but no reasonable person thinks that soda or beer is good for you."

That's certainly one way to make your credibility approach zero.

RE: Health Insurance

The dose makes the poison. Always.

Prohibition doesn't work, and cannot be made to work in an open society, since you can get heroin in a maximum security prison. QED.

If you want to reduce harm, that's one thing. If you want to enforce morality, that's something else entirely. Prohibition doesn't do the former at all effectively.

If you have public healthcare it makes sense to have taxes on stuff that prematurely kills people, including foodstuffs that contain nothing but empty calories. Most people don't mind so-called "sin taxes" and just take them in stride, so they're not all that effective, but they do deter some consumption. They also generate revenue to cover some of the cost of the negative outcomes from consuming these things, which is better than taxing income to do the same.

RE: Health Insurance

Actions should consequences -- but they're meaningful only when the consequences are relatively immediate. Smoking had been known to be a bad thing for a long time, but people continued to smoke because the consequences were remotely in the future, and few people would publicly declare having lung cancers. Had cigarettes been $30 or $40 a pack, fewer people would have smoked, or smoked less, mainly because a surrogate consequence - the emptying of one's wallet - would be immediate. When a single cigarette costs $3, I think there would be a drastic and immediate cost/benefit trade that would swing the decision to something else.

Of course, the downside would be that roast duck would probably wind up being $40/each instead of the current $16/each cry

Current sin taxes are not sufficiently high enough to be deterrents, simply because they're not really actuarially prescribed. Rather, the tax is usually something that would up as a compromise between opposing sides that paid lip service to being a sin tax. This would be the biggest obstacle to a true valuation of the life cycle cost of most items; their manufacturers and their lobbyists would be crying a river about loss of jobs, restraint of trade, blah, blah, blah.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

That may be true; it's unclear how much of that will happen if there is a legitimate outlet for goods, as compared to prohibition, where there was no legitimate outlet for the liquor, otherwise. Taxes are pretty high on tobacco, but I've not heard much about duty-free cigarettes, but I've heard of a couple of cases of stolen cigarette shipments.

Another difference is that the manufacturers of cigarettes now are quite large and there really aren't any small-scale suppliers that could be suborned into supplying them duty-free.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

America is the obesity capital of the world because it over consumes cheaply produced junk food. It is so cheap that a person living on minimum wage can afford to eat candy, soda and beer every day until they can't eat any more. This combined with longer life expectancy drives health care costs perhaps more than any other single factor. Diabetes is huge, especially when considering all the secondary ailments it causes.

Cheap junk food is actually the fault of we engineers - if we had not invented super efficient production lines, it would still be expensive and therefore not a health problem. Its kind of like the Formula One engineers who got the weight of the vehicle down less than the regulations allow, and you have to add a lump of lead in the trunk. Add enough tax to the Cokes and the Hershey Bars to bring the price back to what it would be if you actually made these things by hand.

RE: Health Insurance

glass, how many carrots do you think you can grow? Have you priced gardening supplies lately?

Maybe we should be making people do exercise? No more snow throwers. No more Sunday football. No more netflix.

Maybe no more electric shopping carts.

The problem is not what we eat, it's because we don't have anything else to do. We eat because it makes us happy. Does TV make us happy?

Try enticing people to do exercise. Maybe actually paying prize money for winning local sports teams.

I really think the over weight problem is people are board.

RE: Health Insurance

Actually glass99 I've seen some recent articles claiming that lack of exercise is probably a bigger direct factor than simple over consumption, or alternatively that just refined sugar (of any form) is the main issue not many of the other 'unhealthy' calories.

However, it's harder to tax folks for not exercising enough so forget I said anything.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Actually, I just worked out how to do it.

Everyone gets govt issued pedometers (they may have to be implanted 'mark of the beast' style to cut down on fraud), you start off owing the govt X$ each day but for each bit of exercise over some sedentary threshold you can reduce that tax burden.

Excess exercise credits could be banked for future lazy days, or maybe even traded like carbon tax credits because we know that's a sure fire winner.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

kenat: I could see an insurance company offering discounts on premiums if you carry a pedometer and you walk more than a certain amount. Its a little bit out there, but could be doable. I just got an iPhone6 which has a permanent pedometer built in which tracks my every step.

From a health cost standpoint, exercise is low hanging fruit. Maybe $1BB spent on a national exercise promotion campaign would save $100BB in chronic health problems. Suburban lifestyles are a culprit here.

When I was growing up in Australia in the 80's, they had this ridiculous "slip slop slap" campaign to get people to wear sunscreen when they went to the beach. Most Australians are lilly white Euro descendants, and in the 70's it was considered wussy to wear a hat at the beach. As a result Australia was the skin cancer capital of the world. Pretty much everyone in my parents generation got skin cancer in some form, but now its much more rare, in part because of the "slip slop slap" campaign.

www.sunsmart.com.au/tools/videos/past-tv-campaigns...

RE: Health Insurance

Quote (glass99)

When I was growing up in Australia in the 80's

It was a pretty interesting ad campaign.

Interesting too, that these days, school children are mandated to wear a hat (think French Foreign Legion type) whilst in the school grounds, or no outside play.

Also, have you purchased alcohol in Australia recently? About AU$50 for a case of non-premium beer. Lucky I don't drink!

Cigarettes will set you back AU$20 a pack - and the photos on the packs of past smokers with cancerous diseases! Lucky I don't smoke!



RE: Health Insurance

"The problem is not what we eat, it's because we don't have anything else to do. "

Actually, it is, at least partly. We've substituted starches and sugars for fats, specifically because of the USDA's "war on fat," which was specifically justified based on cherry-picked data. And, if we actually ate in moderation, we wouldn't need massive amounts of exercise to burn off the calories we ingested. Most restaurant meals contain twice as many calories as they should, and are often more calories than we need for an entire day. The Cheesecake Factory's walk of shame dinner clocks in at over 3000 calories.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Our health plan does give points for steps walked, however a coworker told me that washing, and mostly drying the pedometers will add a bunch of steps. So much for counting steps.

A magizene years ago had a funny exercise plan that went like placing strong springs on doors, and placing push signs on pull doors. They likely reused it many times like most of there work.

The whole exercise thing could be helped by getting rid of the TV, or making the fire lanes at stores bigger so people have to walk more.

In any case the drought in Ca won't help as it will rase good food prices.

RE: Health Insurance

Ingenuity: AU$20/pack for cigarettes is both ridiculous and amazing. I remember in the 90's a JJJ radio presenter (Mikey Robins) making jokes about $20/pack cigarettes like it was this totally ridiculous thing that would never happen. But its good. Cigarettes are bad for you!

RE: Health Insurance

The AU cigarette packaging is pretty hard core:

RE: Health Insurance

Hold on- What are you folks trying to do? If you raise the average life span, our social security and medicare systems will really be screwed (more than they are now). The government is counting on people dropping dead at a nice early age.

RE: Health Insurance

hawkaz: correct that long lifespans are the problem. But if you smoke it means you get sick and they plug you into the hyper expensive medical apparatus at age 55 through death at 75. If you go jogging every day before you tuck into your breakfast of whole grain porridge, you only spend the years from 80-85 plugged into the hyper expensive medical system.

RE: Health Insurance

I agreed with hawkaz...until I reached 70. Now I am not so sure. But I still don't want to be kept alive just for the hell of it. I suppose everybody's definition of quality of life is different, and everybody's opinion of which of the population deserves "hyper expensive" medical care.

RE: Health Insurance

Live fast and die pretty.

RE: Health Insurance

Not trying to prolong life, just trying to make sure that the prolongation while in the hospital is effectively pre-paid through the sin taxes.

What's his face (actor) eschewed wearing a helmet and got into an accident, with head injury. I don't know if he paid for his hospital bills himself or through insurance. If the latter, then I would likewise advocate some form of "sin tax" that would cover those types of medical bills as well.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

I just saw a report of a Canadian woman who had her child while vacationing in Hawaii (US), and the US hospital sent her a bill for $600 K USD. Talk about post-partum depression.

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

Why not rate car drivers ability to drive and tax them accordingly for the same medical reasons. It taxes people who drive fast, and a factor for miles driven.

Make sin taxes inclusive. Motorcycle drivers pay more in taxes, and even more if they don't wear helments.

It's the same a sin taxes on food.

RE: Health Insurance

Well, if you look at automotive insurance as a kind of tax since govt requires you to have it then this already happens, mostly based on statistical norms but at least one Insurance company will loan you a device that plugs into you cars on board computer to gather certain driving behavior data and supposedly adjust your rate accordingly.

Of course, one of the outcomes of the statistical side of car insurance rate setting is that women tend to get charged less than men, other factors being nominally equal. Statistically total costs of accidents by male drivers is apparently higher.

In health care, the cost of care for women tends to be higher than for men. However, the idea of charging women more for healthcare is highly contentious and often legislated against. Mostly because much of the difference in cost is probably related to the role women pay in reproduction of our species and it is arguably a bit unfair to charge them more for doing the heavy lifting when it comes to maintaining our genetic line.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

davefitz: $15k/day for neo natal intensive care adds up pretty quick. I would be interested to see how the hospital thinks that $15k/day is broken down.

cranky + Kenat: driving is an inherently risky business, and offloading your risk to other drivers is kind of sketchy. If you commute 100 miles a day at 90mph, you should not expect to be paying the same flat rate as someone who only drives on weekends. If we all had a straightforward metric we could track and control which is tied to our insurance premiums (like distance driven or speed), it lets us work to reduce cost. When we have no levers to pull, we finish up with the US healthcare system.

-> Could our health premiums be tied to our BMI's?

RE: Health Insurance

"I just saw a report of a Canadian woman who had her child while vacationing in Hawaii (US), and the US hospital sent her a bill for $600 K USD. Talk about post-partum depression."

http://www.today.com/parents/canadian-mom-who-give... note that the supposed charge was actually around $900k US

So, the baby was 10 wks premature at birth, hence neo-natal for 2 months. The roughly $15k/day is not that unusual, given that my kid's stay in the non-ICU hospital for pneumonia clocked in at $5k/day

Interesting that this is suddenly coming up now, even though the baby in question is almost a year old.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote:

davefitz: $15k/day for neo natal intensive care adds up pretty quick.

Unless I'm crazy, it takes somewhere around 40 days for it to add up to $600,000.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

My response appears to have been sniped.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"-> Could our health premiums be tied to our BMI's?"

I pray not, BMI is an extremely crude measurement. People with a lot of muscle mass and/or naturally high bone density (i.e. those of us who sink in the swimming pool) may have very poor BMI scores despite being relatively healthy. Many serious athletes have poor BMI due to all the muscle despite getting lots of exercise and being relatively fit by most measures. (Obviously participation in sports increases certain health risks though.)

Don't get me wrong, I know I'm a bit overweight but my BMI gives a truly misleading impression of just how badly - at my last annual exam my doctor even came out and said so.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat: acknowledged that BMI is crude, but its not that crude. An athlete with six pack abs is going to have lower BMI than couch potato with a different kind of six pack. BMI is tied to all kinds of expensive health risks ranging from heart disease to cancer. BMI is also something comprehensible and controllable by individuals.

RE: Health Insurance

My comment was in reference that people who have more auto accedents use more medical care. Medical care usage is not just limited to a persons health, but people who maybe more accident prone also use more medical care. So why would a cost allocation be solely based on a persons health.

RE: Health Insurance

Depends on the athlete. A football player with 3% body fat is still going to have an overweight / borderline obese BMI. A tennis player won't. It all depends on what you're training for.

BMI is too crude, but timing a one mile jog wouldn't be a bad idea at all.

Good luck getting that past the voters.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (KENAT)

In health care, the cost of care for women tends to be higher than for men. However, the idea of charging women more for healthcare is highly contentious and often legislated against. Mostly because much of the difference in cost is probably related to the role women pay in reproduction of our species and it is arguably a bit unfair to charge them more for doing the heavy lifting when it comes to maintaining our genetic line.

While obstetrical is certainly a factor adding to the discrepancy in male and female health care costs, women still consume more across the board healthcare than men.

If you are in favor of a high sin tax to pay for the future care of alcohol and tobacco consumers, what is the difference between a government taxing those consumers in order to offset the perceived future costs they will cause a public service, and a tax on say parents to compensate the government for the perceived cost of educating their child.

RE: Health Insurance

The baby was supposedly in neonatal for 2 months given that the article states that the overall bill was over $900k, not $600k. Possibly, that's factoring in the cost of the delivery, but that's usually less than $50k. The hospital and state apparently chipped in enough to just get the bill down to $900k.

"An athlete with six pack abs is going to have lower BMI than couch potato with a different kind of six pack"

In many cases, the BMIs for athletes, particularly those that require strength muscular as opposed to fast twitch, will be considerably higher than BMI guidelines for obese. BMI is so blunt that a weighlifter or bodybuilder can have substantially higher than 30 BMI. Of course, one might possibly argue that neither of those are particularly healthy...

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Apparently neither the province nor their travel insurance company want to pay this bill...if they'd not left the country, it wouldn't have cost them a cent.

RE: Health Insurance

One thing they attempted to do, but failed, was to acquire travel insurance, which was rejected due to the pregnancy being an "pre-existing condition." From a business perspective, that insurance company made the correct decision, given that the premium would have been insignificant compared to the eventual hospital bill.

This is one of the horns of the dilemma of insurance, "pre-existing conditions" generate definitive, nearly certain, cost exposure, which is not really the model of classical insurance.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

One thing which is cruder than using BMI to determine health insurance rates is not using BMI. By not having any incentive or cost in place tied to people being responsible for their weight, people rationally become irresponsible. You the responsible whole grain eating person are paying for the dude driving down the street with a 48oz Big Gulp in one hand and a insulin needle in the other. This guy is stealing from you if you pay the same insurance rate.

RE: Health Insurance

But, a blunt instrument is not necessarily any better, particularly if it winds up getting pushback from those that will be erroneously penalized. BMI does not measure health; it measures weight relative to some arbitrary reference. To force everyone into the BMI metric may have the same unintended consequences as the "war of fat." One would hope that given all that's transpires over the last century with missteps medical and health advice, we should now know that what is seemingly and intuitively "right" can turn out to be drastically wrong.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

I'll say again, time everyone in a 1 mile jog. I bet you get a very tight correlation between that and overall healthcare costs. Most healthy people I know, regardless of BMI, would knock that out no problem. Most unhealthy people I know, regardless of BMI, would really struggle with it.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

IRStuff: We can't ignore the obesity problem - it drives health costs as much as practically any other factor. If not BMI linked premiums, then what? While I agree that medical science has been wrong about a bunch of things, I think they are correct when they say it is unhealthy to be 300lbs if you are 5ft tall.

RE: Health Insurance

I would see a plausible approach as one using a personally-keyed FitBit, which I think is a better approach than a BMI approach, since the latter is a rather passive measure, and more difficult to convert into meaningful progress. There are already literature that says a substantial uptick in activity will still drastically improve your health, even if there is no significant change in BMI.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

beej: Maybe a timed run on a treadmill at the insurance companies office? You could adjust the time required to finish your mile by age.

IRStuff: Showing 10,000 steps a day on a pedometer is good idea. Though it will be unfair to bike commuters such as myself.

Agreed with you both that exercise makes a big difference to health. I know that I always feel better when exercising.

RE: Health Insurance

"is the $300,000/yr treatment the root of the problem?"

How is that the problem? Is compassion "the problem?" Do you wish an early death to all those that suffer from this illness? Or are you suggesting that we abort any fetus that lacks a working CFTR gene? That would save lots of money. Should we likewise put out all the frail, aged, etc., into the wild and let them die? Where do you want to draw the line? Or do you want someone else to draw that line?

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: Its a problem if you think that a big pharma company is profiteering off the backs of sick kids and beat down middle class Americans. Its also a problem if the true cost of these exotic drugs is so much that it sinks the whole system. Its a problem if a small business has to drop dental insurance because of the increase in premium for this new treatment.

On the other hand its not a problem if you believe that the technology, now invented will not get uninvented and will get cheaper in the future. We may get gouged by the drug maker for the 20 years of the patent, but when it expires the technology will be free. Or perhaps its not a problem if the $300k/yr drug cost is actually cheaper than all the other treatments the patients are currently receiving. Or if you think that the mad profit that the pharma company is making inspire them to find cures to other diseases.

RE: Health Insurance

If a person is concerned that 'big pharma' is profiting off the downtrodden middle class, one would hope that the same person avoids any investments in any stocks, bonds, or pension plans, because the real vultures in society are in the banking/investment business.

RE: Health Insurance

IRStuff: How to set priorities is a good question. I think this is a huge issue that needs to be publicly discussed. Thus far the answer is "whatever the doctor thinks", which is kind of a 19th century paternalistic answer. Equally bad is letting insurance companies decide, or even a government committee with some idiotic value of life formula. It should be people who are both paying for and receiving the treatment who decide.

It is possible that we can all be educated about what really goes into the health care costs, and buy insurance accordingly. If an individual places a priority on being kept alive with the most aggressive treatments when they have cancer at at 80, they can pay more than someone who is happy to receive palliative care and die with dignity.

A parallel issue is retirement. In the 50's through the 80's everyone was promised a pension. The amount of the pension was set by a panel of experts who were subject to various political pressures. Because of the lack of personal accountability in the decision making, some incredibly bad decisions were made. For example, Detroit promising to let its fire fighters retire at age 45. Meanwhile life expectancy ballooned and they fudged their contribution numbers. Why would a Detroit politician in 1975 bother to push back on pension demands they don't know can be paid for in 2015? Their incentive was to get re-elected in November, not avoid disaster decades after they have left office. American city, state, and federal pension funds are underfunded cumulatively in the trillions because of this dynamic.

RE: Health Insurance

re: stocks -- That's complicated. We've driven the interest markets downwards as part of Fed policies for many decades now, ostensibly to make it easier to do business investments. The (unintended) consequence is that the average person lost a significant way to build up nest eggs by having savings account interest rates less than 1%. The 1% rate results in a doubling of principal in 70 years, that's right, even if you started at birth, it would literally take your entire lifetime to double your money. This results in a number of things:
> Lower savings rate, and buying instead of saving
> Increased borrowing, because of cheap interest, for buying things
> Increased pressure on stocks to perform extremely well, since that's now the new savings account

This is all compounded by the fact that pensions have slowly gone sway to be replaced by 401K accounts, which again puts pressure on companies to get more profits.

As Pogo observed, "Yep, son, we have met the enemy, and he is us."

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

If you think that a pharmaceutical or any other company is profiteering unethically, it is not that expensive to exclude that stock from your portfolio.

RE: Health Insurance

But if you think about anyone profiting unethically, you shouldn't have a portfolio at all, because the most unethical profiteers are those who get bonuses while their employers need government bailouts, and that pretty much rules out all investment houses.

RE: Health Insurance

TenPenny: Goldman Sachs and the bailout crew are sketchy for sure, but what about Novartis? Are you going to divest your portfolio of their stock? Is developing drugs and taking advantage of desperate sick people for the patent duration unethical? Would the world be net better off without theses drugs? These kind of drugs are a big part of the reason the US spends 18% of GDP on healthcare, but after they go generic they are so cheap that even starving Africans can afford them. Obviously the promise of outsized profit motivates the drug discovery. But in the case of the cystic fibrosis drug, development was paid for by a charity and the charity got a gigantic payout.
-> I am inclined to believe its capitalism at its finest, though would listen to an argument that it was craven greed on the part of the drug companies.

RE: Health Insurance

"development was paid for by a charity and the charity got a gigantic payout."

They spent $150M !!! That could have all gone into nothingness; it was a huge gamble; there are plenty of drugs that were promising and effective, but failed miserably during trials or even afterwards. COX-2 comes to mind.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

IRStuff: yes, it was a gamble which paid off big time. The thing people are having trouble getting their heads around is charities making so much money. You can build the World Trade Center a couple of times over for $3.3BB. Are they competitors to drug co's now? Will this much money corrupt their mission? Maybe charities are better suited to drug discovery than big pharma, and big pharma should just focus on manufacturing and marketing.

RE: Health Insurance

One thing which is great about this cystic fibrosis drug is it shows that caring about the actuality of a specific result is more effective than just a purely economic return or a government mandate. In some ways the cystic fibrosis foundation has usurped the role of both investment capitalism and the government. We don't need the MBA's of Novartis, the traders of Wall St, or the bureaucrats of the NIF any more. Hurray! Ayn Rand, you won!

RE: Health Insurance

I still don't understand how a single payer system, or an all insurance based system will make medical treatment cheeper. Unless you have to pay the first $1000 out of pocket yourself.
It becomes a fixed cost no matter who pays for it, so why not use as much as we can. That's why there is a copay with insurance. To take a bite that should make most people think about how much health care costs.

Free medical help usually comes with a long line, because the wait is the cost (time is money).

Insurance companies have a vested interest in making as many drugs as possible non-percription. Drug makers have an incentive to develop new drugs because of the money they will make. Doctors get a kick back for perscribing the new drugs, which I think is wrong.

Yes in a perfect world medical care is free. But then again so is housing and food. The world isen't perfect, so we have to make of it the best that we can. And free, or apperently free isen't realistic. It increases demand, while decreasing supply. Basic economics.

What comes after the food police? Maybe the clothing police? Don't buy from China, Russia, etc. When the goverment does this it becomes a problem. If in a privite contract with an insurance company, you agree, then it's ok (never mind that your employer pays for half or more of this insurance).

RE: Health Insurance

A single payer is a monopoly, which means that it theoretically has the clout to force any and every doctor to get the same amount for the same treatment, which, if it's working correctly, will be the lowest possible amount the market will bear, which would apply to both primary and specialist care.

It can theoretically force specialists to make less.

It can theoretically force hospitals to become more efficient, since they will no longer be able to up their charges to cover slack in usage, i.e., the hospital has lots of fixed costs that are amortized over all of the patients treated, so if there are fewer patients, they will charge those patients more. This would be no different than factories that are underutilized and need to make changes to up the utilization rate.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

cranky, the numbers don't lie. 11% vs 17-18% of GDP, for similar health outcomes between Canada and the US. You've been given plenty of reasons why this is the case earlier in this thread. Obviously the myth that the private sector can always do things more efficiently than government is a hard one for you to accept, but it's a MYTH and you need to get over it. A regulated market is the best way to distribute commodities which you can shop around for in a meaningful way or choose not to consume, but it is NOT the best way to distribute essentials and utilities. You can claim that it's the fault of the government portion of your system in the US and you're partially right- that fact explains part of the difference in cost. But the biggest part of the difference is simply this: your country has parasites, who are taking a huge swath of your GDP as private profit because your system permits them to do so. And they're so entrenched, and so rich, you'll never be rid of them. Our system has reduced the parasites by eliminating the middleman- the insurance company. We're very lucky we managed it, and we as a nation have to fight off the hordes of parasites who are itching to steal 7% of our GDP too- if we give them the chance.

RE: Health Insurance

I believe you live under the MYTH that goverment can solve everything. The truth is goverment medical care is not that good, just look at the VA in the US. I agree regulation is needed, but not goverment control. Parasites also happen in the goverment, and the solution is free market.

At one time I wondered why companies would change from in-sourcing to out-sourcing, and back to in-sourcing, and the truth is to shake out the dead wood. But when does goverment do this? Never, just look at the post office. Yes parasites happen at every level. but when you cap doctors ability to make money, you also cap the number of people who want to become doctors.

One issue is abortion, and I am not interested in the morality at this point, but if I have to pay for, or subsidize it then I become an enablier of irresponcable behavior, sort of like the food police above. We have done nothing but exchanged one type of bad behavior for another. How is that reducing medical costs? Where are the sex police?

In that 11% vs 17-18%, have you factored in the wait times, and the number of people suffering, or dead? Or the number of people that go else where and pay out of there own pocket?

To make medical costs lower, there should be a provision to pay for medical costs performed in other countries, and there isen't. Why?

RE: Health Insurance

"One issue is abortion, and I am not interested in the morality at this point, but if I have to pay for, or subsidize it then I become an enablier of irresponcable behavior, sort of like the food police above. We have done nothing but exchanged one type of bad behavior for another. How is that reducing medical costs? Where are the sex police?"

If you're not interested in the morality, why did you make that the whole point of your paragraph?

RE: Health Insurance

Cranky, to your comment on the long wait times, here’s some numbers to put things in perspective:

% of Responses stating they could see a doctor the same/next day – Canada 41% (worst amongst OECD), US 43% (second worst), Germany 74% (best) (source)

Wait time for emergency case was 2 hours or more – Canada 48% (worst, 11th), US 28% (7th), UK 16% (2nd best) New Zealand 14% (best) (source)

% of people that did not get adequate care due to costs (fill prescription, visit doctor, get test, etc.) – US 37% (worst), Netherlands 22% (2nd worst), Canada 13%, UK 4% (best) (Source)

Number of annual deaths due to lack of insurance in the US – (2005 estimate, working age only) 44,789 (estimate according to this 2009 Harvard study)

2011 Health Expenditures/Capita – US $8,508 (worst, 11th), Canada $4,522 (6th), UK $3,405 (2nd) New Zealand $3,182 (best) (Source)

To claim that the solution to the current US healthcare issues is to move further away from what works in other countries (universal/socialized healthcare) flies in the face of facts and reason. Moving to a “free-market” healthcare system certainly does not address, and likely will make worse, the most crucial issue in the US medical system, equity. And if you don’t care about the fact that millions of disenfranchised people don’t have proper access to healthcare (and tens of thousands die as a result of that) in the “richest and most powerful” country in the world, well, that’s just sad (to put it as lightly as I can).

RE: Health Insurance

The irony of course is that the same people who oppose abortion are also the ones who want to remove sex education from the schools as well as make contraceptives impossible to get, at least for those age-groups where the issue of unwanted pregnancies is most prevalent. I'm sorry, but you can't have it both ways. Now don't get me wrong, I also oppose abortion, when it's being used simply as a form of birth-control, but if, after private consultation between a women and her doctor, it's determined that this is the best medical treatment going forward, who am I to say that it should be denied. After all, what other medical procedure does society think that the average 'joe on the street' (and I do mean 'JOE') should have the right to protest and demand that it be denied when it has no personal impact on HIMSELF?

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

OK, I grew up in one of the countries that has single payer, govt run healthcare but have lived in the US now for over 10 years.

I'm not a high consumer of healthcare either but based on my limited experience I've got to say considering how much more I seem to spend in the US, I don't get more for it - maybe less.

It's harder to find a primary care doctor here in the US, and a lot more time consuming to actually get to see them e.g. waiting several days or weeks to see 'your' primary care physician.

When I get to the office waiting for my scheduled appt, waiting times in the US are generally comparable to or maybe worse than in the UK. They game the system by having the nurse weigh you and stick you in an exam room fairly promptly (though I've been stuck waiting for this for a long time before now) but then you get stuck waiting in that room for 30+ minutes for the actual doctor to come see you.

When I have needed a non emergency X ray the service in the US was quicker - within the hour after being told I needed it V waiting a week or two for an appointment. However, I had to spend infinitely longer filling out extra paperwork each time (i.e. none in the UK, reams of it in the US).

My perception is that if you have the right insurance (and/or money) and live in a location with good clinics/hospitals etc. then you do get slightly better overall quality of care in the US. However, the value is not as good.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

I just think that having food police and not have sex police when both can be bad behavor, is wrong. So who decided this? It was a control and desire issue, not a moral thought.

Sex education is only valuable if morality is also tought. The (many) public schools don't teach morality, and some how believe free condoms is a subistute.

So is bad behavor of one type better than bad behavor of another? That's what I am hearing.

So if I have to pay for your medical care if you over eat, why is that a concern, when some one else is doing something risky, and you don't seem to care?

And if medical care is intended to be equal, why can't I have the presedent's plan? It's better than mine, and much better than what the homeless people's plan.
However it's not being offered under the Obama care options.

And if care is to be equal, how exactly do you intend to move doctors to where they don't want to live?

RE: Health Insurance

No cranky, I don't live under the myth that government is the solution to all problems- it absolutely isn't. I do live in an example of the FACT that the public sector is more efficient at delivering essential public services than the private sector could ever be. rconnor has given you the facts and figures, and other jurisdictions do some of it way better than Canada does. I'm not holding Canada out as an example of best practice in health care- I'm only using it as the closest and most direct comparison to the disaster of private/public that you people in the US put up with.

As to your direct concerns:

1) Wait times for essential procedures and emergency care are quite modest here unless you live in a remote location. Most of the people waiting 2hrs or more for "emergency care" here aren't in need of emergency care- they are taking advantage of the free access to the emergency room we get here 24/7, either deliberately or as a precaution (for a sick child etc.). They're having their needs triaged against those of others who truly do need emergency care. When someone dies in an emergency room here because they were inappropriately triaged, it is a HUGE deal and national news- it happened to a First Nations man in Winnipeg recently and there was a hue and cry from sea to sea about it. Deaths while waiting for care here are truly rare.

2) Virtually nobody pays out of pocket for anything other than procedures or services that are not covered, or non-emergency, or are elective. Yes there are "medical tourists" here, most of them getting hip or knee replacements where wait times are still a problem, or precautionary MRIs etc.. There are plenty of medical tourists from the US too, going to hospitals in eastern Europe or India etc.

3) Yes, someone here who needs a hip or knee replacement and is on a wait list, or who is worried about a condition they won't know about until an MRI can be scheduled, is suffering. But so too is anyone in the US who is out of a job and lets their medical insurance lapse because they can't afford the premiums- and then discovers that their wife has cancer, and can't get insurance now for any money because it's a "pre-existing condition"...that NEVER happens here. No employer here has to make a decision between healthcare coverage for their employees or hiring new staff, and nobody has to worry about whether or not their job offers coverage- the essentials that you cannot live without are provided as a right of citizenship (in fact, even as a right of permanent residency). The one exception is basic dental care.

4) The proof of the comparative number of parasites is in the COST NUMBERS, not in your ideology. Your private/public mess costs you far more of your GDP than our purely public system does- and in other countries they do it even cheaper still. Your system costs more- very substantially more. It costs you more by a proportion of your GDP which is much greater than the ENTIRE cost of your "national defense". So you, and most Americans, need to give your heads a shake on that one, because your ideology is leading you to a conclusion which is demonstrably FALSE.

RE: Health Insurance

A little-publicized fact here in Canada is that there is a significant 'medical tourism' factor for rich folk coming TO Canada for specialized expert health care in hotel-like private rooms, for a REALLY hefty fee.

Typical clients are uber-wealthy folk from the middle east and South America

It is a dirty-little not-so secret that many hospitals, etc do this to subsidize their costs.

Domestic clients can't do this.

So, were the USA to adopt a Canada-like system completely, there will ALWAYS be a pay-for-use outlet SOMEWHERE for the wealthy to jump the queues or cherry-pick a superior doctor. It just may not be in your own country.

Meanwhile, the system will likely get better for most, in particular the lower income folk.

The only losers would be the accountants and lawyers charging 'rent' per Adam Smith on a process to which they add no real value.

RE: Health Insurance

A good analogy for this might be the US school system.

Americans have a two-tiered education system. Public schools are funded via taxes and paid for by everyone to pays taxes. The system does not care if you have kids or not, you pay for it.

However, there exists a private school system for those that want to send their kids there. They pay for using this system. But they still fund the public system too. Please leave out the 'voucher debate' on this as it is a red herring to the discussion.

Generally, the private school system is high quality. It HAS to be, or they would have no customers.

The quality of the public system is mixed. In areas where voter apathy permits it, the system can be poor. In other areas, voter concern has created a decent system. There are large portions of the country where private schools have little traction because the public system is good enough that there is no market for the privates.

So, by offering a good easy-to-understand universal health care system without the hype, hysteria, and outright disinformation to everyone, you would create an incentive (via voter attention) for politicians to support it (or perish in the NEXT election). The wealthy will always have a Plan B.

The same thing happened here in Canada back in the day when Universal Health Care was created. Conservatives initially opposed it, Pundits slammed it and lied about it, but they went away once the results were clear.

RE: Health Insurance

Going in for health insurance revamp tomorrow. Thanks to the "Affordable" Care Act, my crappy insurance has tripled in price.

RE: Health Insurance

As I have said, why not a dual system. And an example is the public school system. That's not what has been troughted. What is being proposed is only a public health system.
The bigest problem with the VA issue is that any of these people could have gone around the VA and paid for the treatment themselves. They choose not to do that because the VA was free to them.

A dual system will ensure public hospitals keep up with standards, as they do have a competetor.

The problem here is any hospital, public, or privite, must take all patents no matter there ability to pay. But doctors don't, so if you don't have any money, you wait until it is an emergency to see the hospital for there basic needs.
So the emergency rooms are full of not so urgent people.

And the mandate states we must all pay for abortion and berth control, which I believe should be optional. The cost have been incerased, because of things we don't really need, due to goverment requirments.

Does Canada provide free abortions, and burth control? Tuba lessons for cruked teeth? Message theropy? etc. That's what passes for medical insurance costs here.

RE: Health Insurance

cranky108,
so , it is now proven that mechanical engs can spell better than electrical engs. Lets take that question off the list.

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

Quote (irstuff)

"is the $300,000/yr treatment the root of the problem?"

How is that the problem? Is compassion "the problem?" Do you wish an early death to all those that suffer from this illness? Or are you suggesting that we abort any fetus that lacks a working CFTR gene? That would save lots of money. Should we likewise put out all the frail, aged, etc., into the wild and let them die? Where do you want to draw the line? Or do you want someone else to draw that line?

In my lifetime, medical researchers are going to achieve immortality, at a price.

A very expensive price.

So ... immortality for everyone? Who pays for that? Everyone else?

It's not argument-ad-absurdum when we're well on our way to having exactly that.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (moltenmetal)

cranky, the numbers don't lie. 11% vs 17-18% of GDP, for similar health outcomes between Canada and the US. You've been given plenty of reasons why this is the case earlier in this thread. Obviously the myth that the private sector can always do things more efficiently than government is a hard one for you to accept, but it's a MYTH and you need to get over it

And both you guys need to get over this idea that you can fix the problem by changing who shares the cost. "Single Payer" is just everyone buys Blue Cross Blue Shield, or everyone pays extra taxes and gets Medicare. It does not solve the problem. The problem is cost. See my numerous posts above.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

The problem is not just cost, it's adminstration, and regulations. What exactly is medical, and what is optional?

Who gets rationed, in there perspective? The poor, or the hard to justify?

If you can't pay doctors enough to attrect more into the profession, then those are the choices around single payer.

It's not all bad or all good, it's just not perfect.

RE: Health Insurance

TheTick, your rates went up because now health insurance companies actually have to pay for proper treatment of people whom pay to be insured when they get sick (I know, what an absurd concept!), which is eating into their revenues. Shrinking revenues are unacceptable to the board of directors, so now you have to pay more to cover the difference. So ya, the problem is the Affordable Care Act (well, Obama personally), not at all with the health insurance companies!

Another fine example of how the “free market” sounds like a wonderful solution to your health care problems…let’s give these corporations MORE power and LESS regulations! That will solve the problem! I mean, thank goodness you didn’t get some commie-universal healthcare system, then your rates would have been…ahhh….well I don’t know but it would have been bad!

Quote (cranky108)

a dual system will ensure public hospitals keep up with standards
This implies that “public” hospitals (i.e. all hospitals in a universal health care system) offer poor quality care compared to private hospitals. That is false as demonstrated by the rank of quality of care in countries with universal healthcare.

Quote (cranky108)

The problem here is any hospital, public, or privite, must take all patents no matter there ability to pay. But doctors don't, so if you don't have any money, you wait until it is an emergency to see the hospital for there basic needs.
This problem is NOT solved in a “free-market” system (and likely exacerbated) and is inherently solved in a universal healthcare system because going to the doctor is just as free as going to the hospital. This is one reason why costs are lower in universal healthcare systems – preventative and routine care are free and easily accessible, thus reducing the amount of emergencies required.

Quote (beej67)

"Single Payer" is just everyone buys Blue Cross Blue Shield, or everyone pays extra taxes and gets Medicare. It does not solve the problem. The problem is cost.
And where do these costs come from? All universal healthcare systems COST LESS PER CAPTIA than the US system. A sampling of the problem with costs in the US system, all of which are inherently solved by a universal healthcare system, are the following:
  • Preventative and Routine care cost too much for the uninsured or underinsured, so they don’t do it. Then little (and inexpensive) problems, become big (and expensive) problems.
  • Hospitals, insurance companies, etc. get to run as for-profit organizations. Their objective is to increase profits, pure and simple. If low cost, quality care is a by-product of that, great, but it doesn’t have to be and usually isn’t in the real world. In other words, they will keep costs as high as they can possibly get away with. (Even if there is some “fair” trade-off between quality care and inexpensive care, then are you suggesting that poor people should get bad care because that’s all they can afford?) Every step along the way is trying to skim profits off the customer and this will increase costs.
  • A for-profit system has a negative incentive to promote healthy life-styles. They benefit off sick people. However, insurance companies lose profits on sick people and are therefore encouraged to deny coverage to unhealthy people (and they do whenever possible…the ACA tries to combat this slightly though). So when you have one half of the system that profits off sick people (hospitals) and the other half that wants to deny coverage to sick people (insurance companies), you get this messy inequitable, costly system. Whereas a non-profit system is intrinsically benefited by a healthy population.
  • Because you have to deal with insurance companies, there is a lot of time spent dealing with paper work and disputes related to coverage which adds unnecessary overhead. Much of the doctors time is spent dealing with this paper work or themselves fighting the insurance companies so that patients can get needed medication/treatment blocked by coverage restrictions. Furthermore, the insurance company itself is an added cost to the system.
  • Lawsuits due to malpractice are a huge issue in the US. It takes a lot of money to protect yourself against them, fight them when they arise and payout if you are found guilty. Like with any for-profit organization, this cost and risk is eventually passed onto the customer through higher rates.
None of these issues are solved by going to a “free-market”, insurance based system. If anything, they put more emphasis on the for-profit model and less control over providing proper care. All of these are solved by going to a universal, non-insurance based system. This is the reason why the real-life numbers demonstrate that universal healthcare systems are, across the board, less expensive than non-universal healthcare systems. So if cost is your only concern, then I think we have our winner.

And this doesn’t even begin to touch on the issue of an equitable system, which is apparently a non-issue to “free-market” enthusiasts….

RE: Health Insurance

The ONLY thing that President Obama can be blamed for is conceding to so many of the demands made by the Republicans when they were crafting the ACA. In the end not a single Republican voted for the bill. What he should have done was blow-them-off right from the get go and we would have had a much simpler and easier to implement law today. And lets not forget the role that the Robert's Court has played in this, gutting the Medicaid supplement provisions which was a fundamental part of the law (and which was part of what the GOP wanted based on the work done by the Right-wing Heritage Foundation in the 90's). And then to make matters worse, the Court continued their idiotic insistence that public corporations have the same rights as individuals including the right to practice religion in the Hobby Lobby case, something that will have far reaching consequences in this country for years to come. What's next, giving corporations 2nd and 5th Amendment rights as well? And it's not over yet; the Court is on the verge of gutting the law even more, all over what was basically a 'typo' when a single word was left out of the description of who qualified for subsides based on what type of exchange that they got their insurance through, be it a state versus a federally run program. Again, the idea of subsides was part of that original Heritage Foundation proposal which the Republicans insisted should the 'model' for any sort of comprehensive insurance program being considered. And let's not forget that this is also where the so-called 'personal mandate', that the Right loves to harp on all the time, originally came from as well.

Sorry, but if you're going to condemn the ACA for not being what it could have been, just keep in mind that there were a lot more actors in this play than just the President and his people.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Funny, JohnRBaker, I don't recall the debate the way you do. I don't recall any Republican input--there was no need for it, as the Dems had majorities in both the house and senate. I DO recall the insurance companies having a voice in the debate in order to protect their interests. AND, I blame Obama for not managing the process--he just threw the whole thing over the wall to Congress and let them write it.

RE: Health Insurance

Y'all do know how your separations of powers is supposed to work, right?

Congress is SUPPOSED to draft the bills/laws

The Executive is SUPPOSED to bless or reject it.


Obama does NOT write the dang laws.
He also did not cause the BP oil spill or Hurricane Sandy.

Stop blaming him for these things.

RE: Health Insurance

It wasn't Hurricane Obama or the Obama oil spill. If you put your name on something you better expect the majority of criticism to be directed to you, so you better stay in the loop and have significant input. Not saying that happened, but it is greatly in part to why he gets the criticism and would have gotten the praise if things would have worked out differently.

RE: Health Insurance

tinfoil, I'm afraid your understanding of education system in the US doesn't seem to match what I've seen. Many of the private schools are actually religious based and at least in our town the level of education provided by most of them is well below that the public schools provide. So perhaps the dual system would be a choice between public healthcare and a faith healer?

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Quote (swall)


I don't recall the debate the way you do. I don't recall any Republican input--

Perhaps you read too many Newsweek articles or listened to too many FauxNews reports, but the facts were quite different. For example, here an excerpt from the linked item below:

"Almost no one is noting the extraordinary influence Republicans had on the healthcare reform bill crafted by the Senate, as it made its way through the committee process last year. The bill approved by Sen. Christopher Dodd’s Health, Education, Labor and Pensions committee, for instance, included 161 amendments authored by Republicans. Only 49 Republican amendments were rejected out of 210 considered. Yet the bill got zero Republican votes when it passed out of the committee."

And then there was this final recap:

"To recap: Senate Democrats have accepted at least 161 Republican amendments to their healthcare reform legislation, they’ve incorporated core GOP planks, and they’ve scuttled an aspect of the plan most popular with its base, the public option, because of opposition by Republicans as well as red state Democrats.

But they haven’t compromised with Republicans? It seems as though the GOP’s definition of compromise and collaboration involves the president and the Democrats dropping all of their ideas and passing the Republican platform. That’s OK; it’s their job to push their party line. But too much of the media seems to be falling for it."


For the complete article, go to:

http://www.salon.com/2010/02/23/hcr_amendments/

And here's another item that talks about the influence that the Heritage Foundation and previous Republican proposals had on the ACA:

http://www.politifact.com/punditfact/statements/20...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

Quote (rconnor)

And where do these costs come from? All universal healthcare systems COST LESS PER CAPTIA than the US system.

I'm not going to type all the same crap all over again. Please re-read the posts made at the following dates/times in this thread by me. Bolded dates are posts that specifically discuss the source of our higher cost per capita, while non-bolded dates are posts that discuss how changing the methodology of cost sharing doesn't affect the problem.

21 Sep 14 20:47

Quote (beej67)

If I get a ear ache in Mexico I go to the pharmacist, buy some amoxil, go home and eat it. My total cost to the system is ten bucks. If I get an ear ache in the US, I have to go to primary care, pay a copay, he bills the insurance company and says "go see an ENT," I go to the ENT, pay another copay, he bills the insurance company again, gives me permission to buy a highly proprietary patented expensive version of amoxil he's on the take to peddle, sends me to the pharmacist, and I pay another copay there while the pharmacist bills the rest of the bill to the health plan.

Unless you blow that completely stupid business model up, health care is going to continue to be completely stupid in the USA. It's got nothing to do with who shares the costs, whether it's public or private. It's got everything to do with the lack of an individual's motivation to keep their own costs down, and the systems motivation to do everything to drive costs up, since they're billing the shared pool anyway.

23 Sep 14 7:36
23 Sep 14 15:30
25 Sep 14 15:37
8 Oct 14 11:39
17 Oct 14 15:39
19 Oct 14 17:19

Quote (beej67)

The problem is if I sprain my knee in Denmark, I go to the doctor, he sends me home with some pills and an ACE bandage. I sprain my knee in the USA, I go to the doctor, he sends me to a specialist, who sends me to an MRI, which must be read by a specially trained/paid MRI Reading Person, who tells the specialist, who tells the generalist, that I should go home with some pills and a highly specialized proprietary knee brace that does the same thing as an ACE bandage.

21 Oct 14 12:57
21 Oct 14 16:07

Quote (beej67)

When we all used to pay for our own stuff, we had incentive to tell a doctor "no, I really don't need that MRI for five thousand dollars if it's not going to change your recommendation anyway." When we pay into a shared pool, we have every incentive in the world to go get the free MRI that we don't really need, because why not? We've already paid for it. And the doctor has every incentive in the world to recommend the MRI, since we're not going to say no, and he makes more money when we say yes, and in fact he could get sued if he doesn't recommend it.

That's it. That's the deal. The U.S. system is a feedback loop of cost pressures.

21 Oct 14 21:21
28 Oct 14 11:17
30 Oct 14 15:04

Quote (beej67)

Medicare is a single payer here in the USA, and Medicare recipients do not have a lower rate of surgeries than insurance buyers. The payer is not the only difference between England and the USA. The systems themselves are different.

Now, if we go full Communism and not only do single payer, but also single provider, then the rate of surgeries goes down. We have evidence of that. It's called the VA, who let people die because they were lazy and didn't have to compete with private care for the patients dollars. Not even one of the country's most decorated and dedicated Army Generals could steer the VA towards a semblance of respectability.

Much more in the referenced posts. Quoting everything would have been burdensome.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej67, that is correct and why a single payer system will not fit the problem in the US, and is why medical costs are higher.

The issue is that many in congress and the president don't want to fix the system, as it provides a system of control over the people. That's the issue. The food police is just more of that control of it.

Now that the "operation strangle hold" has been open it is even deeper that most of us thought. Gun police, porn police, payday loans police, and what's next?

The medical issues in the US is nothing more that control of the people, and that's why costs are going up. You don't pay enough in taxes is the issue.

RE: Health Insurance

beej67,

I fail to see how any of that supports a “free-market” system or provides a rational argument against a universal healthcare system.

Your first example (the ear ache) deals with Mexico, which has universal healthcare. Your second example (sprained knee) deals with Denmark, which has universal healthcare. You seem to be arguing that universal healthcare would be the better option, I don’t disagree.

Your third quote assumes that in a “shared pool” we have no incentive to keep costs down, so costs will be high. This is typical libertarian ideology and, equally typical, is not supported by the data. Universal healthcare is the epitome of a shared pool and yet, in the real world, the costs of operation are very low. Much lower than the US’s mixed system.

Furthermore, I have provided examples as to why the insurance aspect of the US system is where the majority of the increases in cost come from. In a universal healthcare system, these issues disappear as there are no private insurance companies to deal with. I don’t see anything that suggests otherwise from you.

A “free-market” system either has private insurance companies, and then is left with many of the existing issues plaguing the US system, or it doesn’t have private insurance companies (everyone pays out-of-pocket), and then the issues of inequity and lack of available healthcare for the poor become much worse. Correct me if I’m wrong but I don’t see a third option. The third option would be public “insurance” companies (i.e. the government) but that would defeat the purpose of a “free-market” system.

Your fourth quote seems to suggest that universal healthcare is simply everyone buying into Medicare. That’s a false assumption. You also state that the “payer is not the only difference between England and the USA”. That is a correct assumption. The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything. In true universal healthcare systems, the people don’t need to deal with insurance or “healthcare plans” for basic healthcare needs (and “basic healthcare needs” depends on the country but usually covers everything expect cosmetic surgery, dental, glasses, some physio, etc.). As a resident you get a healthcare card which you present when receiving “basic healthcare”. No plans that you have to update. No need to be screened for “pre-existing conditions”. Simply, resident = healthcare card = free basic healthcare. So the universal healthcare I, and others, are advocating for is more than simply forcing people to buy into Medicare. You need to get rid of the whole concept of applying for and acquiring insurance to receive basic healthcare. Your residency should entitle (yes, that dirty word for our libertarian friends) you to free basic healthcare. Just as you residency entitles you to other basic human rights.

RE: Health Insurance

Quote (rconnor)

I fail to see how any of that supports a “free-market” system or provides a rational argument against a universal healthcare system.

Start by identifying the problem you're trying to solve. That's what we engineers do. First identify the problem.

Is the problem "lack of coverage?" Or is the problem "cost?"

If we identify "cost" as the problem, then examining cases of unnecessary cost in our system, as compared to all the other systems in the world, should be of paramount importance. If, upon examination, it becomes clear that the "publicness" or "privateness" of the cost sharing pool would not have affected the cost, then we rational engineers must turn our attentions to aspects other than "publicness/privateness" to find our solution.

Quote:

You also state that the “payer is not the only difference between England and the USA”. That is a correct assumption. The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything.

You appear to be trying to claim that the "privateness" of our cost sharing pool is the source of our higher cost. This argument doesn't hold water, because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients. This is because when a medicare recipient strains their knee playing soccer, they go through the same highly expensive song and dance that a private insurance recipient goes through. The problem is not how the cost is shared. The problem is the song and dance itself. And we have all the evidence in the world that putting everyone on Medicare instead of private insurance would still mean the same song and dance, which means the same cost.

We already have vast, extensive test cases for "single payer" (Medicare) and for "single provider" (the VA) here in the US. We already know how they work here, within the rest of the system. Single payer does not make things cheaper. Single provider does, but at the cost of letting people die while they wait for treatment. Those facts are plain as day. Spending all day arguing about public vs private cost sharing is like trying to fix a broken car by repainting it over and over, and swapping out the hubcaps.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

" because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients."

That's not a valid comparison, since Medicare does not provide the health care itself; that care is still provided by the same people who provide the care to other insurance recipients. It's not a true single-payer system, since Medicare doesn't have sufficient clout to force costs down. In fact, there are lots of doctors that refuse Medicare and Medicaid because the reimbursements are too low. In a true single-payer system, Medicare would be the only game in town; to refuse their patients would then be tantamount to choosing another profession.

A more valid comparison would be the VA system, which administers both cost and providers: http://www.rand.org/blog/2012/08/socialized-or-not... Nevertheless, one should be cognizant of the fact that the VA's patients have an inherently different mix ailments compared to the general population.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

The VA system is not "single-payer," it is "single-payer-single-provider." It's true bread-line style communism. I'm presuming not even the Blues think switching the country over to the VA is a smart idea. I personally don't see why we don't simply do away with it entirely and give vets a voucher.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

I don't see how - their efficiency is reported to be about half that of the private system.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Further, this right here:

Quote:

That's not a valid comparison, since Medicare does not provide the health care itself; that care is still provided by the same people who provide the care to other insurance recipients.

...is pretty much my point. It is the only valid comparison, since it is the only attempt on the planet to produce a single payer version of our system. Single payer in the USA is simply "everybody gets Medicare," in which case all our taxes go up to cover it, and the cost per capita doesn't really change. That's because the cost problem is not the payer, the cost problem is the system. If we could somehow wipe our system out and drop in Denmark's system in its place, with Denmark's doctors, Denmark's nurses, Denmark's lawyers, Denmark's tort law, Denmark's version of their AMA, and Denmark's citizens (which are healthier than ours) then single payer would work great with it. The reason why isn't the payer, it's because my primary care doctor would be sending me home with a bottle of advil and an ace bandage instead of sending me off to see a specialist before getting a needless MRI, seeing the specialist again, and going home with a prescription for something that's not fundamentally better than Advil and a brace that's not fundamentally better than an ace bandage.

Do you see?

The payer is not the problem. The system is a feedback loop of cost pressures.

In order to fix the thing, we need a way to prevent doctors from prescribing needless medicine. In Denmark, the doctors do that on their own because they're Danish and that's what the Danes do. In the USA, our doctors are like McDonalds front line clerks, asking "Would you like to upsize for an MRI and a large coke?" ..and they justify that by a blend of extreme hippocratic oath-taking and liability avoidance. Look no further than surgery rates. Can't remember whether this was linked above or not, but check out the abstract:

http://www.ncbi.nlm.nih.gov/pubmed/8073310

For back surgeries, the US had at least 40% higher rate per capita than anywhere else in the world. That's a cost. It gets shared. If the same stands for all other types of surgeries, then our per capita health cost rate is pretty easy to explain, and it has very little to do with whether the sharing pool is funded with taxes or earnings.

These are the sorts of things that engineers, focused on the actual problem, should be looking at when they struggle with fixing the health care problem here.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

"It is the only valid comparison"

No, it's not. 44 million people were covered by Medicare in 2010, which is only 17.3% of the total number of people covered by any sort of insurance. That's not enough of a market share to drive prices as low as they could go. Medicare costs are still climbing at about the same rate as the general insurance population. But, because of the low market share, this does not prove that a single-payer system in the US wouldn't work. That's not to say that there aren't other issues, but to continually bash doctors isn't exactly the answer. They respond to market forces; if a patient demands a certain drug or treatment and is refused, the doctor is likely to be complained against, which, while less than a malpractice suit, is still a nuisance, time consuming, and affects their standing relative to insurance payers.

A more valid comparison might be Walmart. They do have sufficient market share against their suppliers and are able to demand pretty much any sort of price control they want. The suppliers either find a way to make cost cuts, or basically go out of business. So we know that in the full-blown free-market, a single payer can and does command whatever price it wants.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

On further reflection, it is a valid comparison, because it does prove that a single payer system could work. Medicare covers 44 million people, yet there are doctors refusing Medicare and Medicaid patients because of the low reimbursement rates. This says two things, in areas where doctors have plenty of other payers, they can and will bail, but in areas where Medicare patients are in the majority, the doctors and hospitals do knuckle under. This, therefore, does confirm that a single payer system can and will work in the US.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote (beej67)

You appear to be trying to claim that the "privateness" of our cost sharing pool is the source of our higher cost. This argument doesn't hold water, because our cost per capita for Medicare recipients is approximately as high as our cost per capita for insurance recipients
No. It’s the for-profit nature of insurance companies and hospitals in the US is the reason your costs are so high. Sending you off for expensive treatments and tests is a great way to increase profits and so these for-profit hospitals are highly motivated to do so. Insurance companies, for those that can afford insurance, should step in and put a stop to this. However, it’s much easier and cost efficient to either (a) deny coverage (which was the modus operandi prior to the ACA) or (b) raise rates (which is now the modus operandi after the ACA). Thus, both for-profit insurance companies and for-profit hospitals privatize the gains and pass the costs onto the public. A “free-market” system does nothing to alleviate this problem.

In a universal healthcare system, where there are private or public non-profit hospital and a single public payer, this same profit-driven model inherently does not exist. Rather than profits, the right care for the right cost is paramount. This is why, in the real world, the cost of universal healthcare is much lower and the people are healthier.

Beyond that, the very existence of insurance companies and healthcare plans for basic healthcare is an unnecessary expense that does not exist in universal healthcare systems. As I just explained:

Quote (rconnor)

Your fourth quote seems to suggest that universal healthcare is simply everyone buying into Medicare. That’s a false assumption…The system in the US is so convoluted and expensive due to insurance companies being the middle man in everything. In true universal healthcare systems, the people don’t need to deal with insurance or “healthcare plans” for basic healthcare needs…As a resident you get a healthcare card which you present when receiving “basic healthcare”. No plans that you have to update. No need to be screened for “pre-existing conditions”. Simply, resident = healthcare card = free basic healthcare. So the universal healthcare I, and others, are advocating for is more than simply forcing people to buy into Medicare. You need to get rid of the whole concept of applying for and acquiring insurance to receive basic healthcare.

My response to you at 4 Dec 14 16:05 listed numerous reasons why insurance companies are culpable in US healthcare costs being the highest in the developed world. You (in your 23 Sep 14 9:32 post) state that your “perfect system” would be to have emergency services “handled on a single government payer model” but seem to imply that insurance would handle non-emergency care (correct me if I’m wrong). Would routine checkups be on insurance? What about treatment for chronic, non-emergency ailments? What about cancer treatments? You still have insurance companies involved in a very large portion of healthcare system and so the issues remain, specifically with the added costs of making preventative care inaccessible to many such that small things become large healthcare problems. The inaccessibility (due to cost/lack of coverage) of preventative care is a major reason why the US system is the worst in the developed world.

This leads into your asinine question - is the problem “lack of coverage” OR “costs”? As an engineer, if a design is BOTH unsafe and expensive, I don’t choose to fix one and ignore the other. There is no OR, BOTH are serious problems with the US healthcare system, as supported by the research. And, as supported by the research, BOTH appear to be much less of a problem in universal healthcare. No evidence has been brought forth to support a “free-market” system solving EITHER - most certainly not the former and, if you keep insurance companies as a middleman in everything, likely not the latter. So as an engineer, if I have one alternative that solves both problems and a second that MIGHT solve one problem but likely makes the other problem worse, I’d go with the first alternative. But that’s just me.

Regarding “single payer”/”single provider”, again you miss the point. Almost all other universal healthcare systems are not “single provider”, they allow private non-profit hospitals which bill the government (as long as they meet certain standards) and people are free to choose which doctor and which hospital they visit (which is actually untrue in an insurance based system). And as previously discussed (at least twice now), universal healthcare is NOT simply everyone buying into Medicare insurance as true universal healthcare is NOT an insurance based system when it comes to basic healthcare needs.

RE: Health Insurance

Quote (beej67)

The payer is not the problem. The system is a feedback loop of cost pressures.
I agree (mostly). The system is feedback loop of cost pressures due to private, for-profit insurance companies and private, for-profit hospitals trying to squeeze as much out of the consumer as possible. Universal healthcare inherently eliminates that, as per all your examples of how universal healthcare in other countries is so much better...while at the same time fighting tooth and nail against the US adopting universal healthcare(!?!?!??!?!?!?!?!?!?!?). A “free-market” system does not. It puts more power into the hands of insurance companies and private, for-profit hospitals and asks the consumer to fend for themselves. This makes the “feedback loop of cost pressures” worse.

Quote (beej67)

In the USA, our doctors are like McDonalds front line clerks, asking "Would you like to upsize for an MRI and a large coke?" ..and they justify that by a blend of extreme hippocratic oath-taking and liability avoidance
Agreed! All of which is solved by going to a universal healthcare system (note: most universal healthcare systems came with laws that limit the liability of doctors). None of which is solved by a “free-market” system.

Beej67, 95% of your posts are explaining the issues with the US system, that exist only because there isn’t universal healthcare, and why these issues don’t exist in countries with universal healthcare. The remaining 5% is concluding that the US shouldn’t adopt universal healthcare and should adopt a “free-market” system that doesn’t address any of the issues with the current US system (and likely makes them worse).

RE: Health Insurance

Quote (rconnor)

No. It’s the for-profit nature of insurance companies and hospitals in the US is the reason your costs are so high.

This is a talking point that the single-payer crowd loves to repeat, but the numbers simply don't back this up. Lets look at this graph again, which summarizes the problem:



We pay double what we should be paying per capita. If the profits were the problem, then 50% of the gross revenue in healthcare in this country would go towards profit. It does not. Most health insurance companies report profit margins at or below 5%:

http://abcnews.go.com/Business/health-insurance-pr...

If you switched everyone in our system to non-profit, you get a 5% savings, not a 50% savings.

It's not the profit that's the problem. It's the revenue that's the problem. The problem is over-use of the system. The problem, again, is this:

Quote (beej67)

..it's because my (Denmark) primary care doctor would be sending me home with a bottle of advil and an ace bandage instead of sending me off to see a specialist before getting a needless MRI, seeing the specialist again, and going home with a prescription for something that's not fundamentally better than Advil and a brace that's not fundamentally better than an ace bandage.

Now, on to the meat of the issue..

Quote (rconnor)

The system is feedback loop of cost pressures due to private, for-profit insurance companies and private, for-profit hospitals trying to squeeze as much out of the consumer as possible. Universal healthcare inherently eliminates that, as per all your examples of how universal healthcare in other countries is so much better...

Please explain to me how switching from multi-payer to single-payer eliminates over-use of the system. "Single payer" is just "everyone gets Medicare." That's all it is. Explain to me how "everyone gets Medicare" eliminates over-use of the system. People on Medicare currently use the heck out of the system, at the recommendation of doctors, who are steered by their "at-all-costs" hippocratic oath and their desire to avoid lawsuit. How does "everyone gets Medicare" fix that, and why is that fix unique to the "everyone gets Medicare" solution?

In what seems like a thousand posts, you have failed to make that connection clear.

Please consider, when crafting your response, how Medicare in the United States is beholden to medical lobbyists trying to shoehorn every proprietary medicine into blanket coverage, to make their company more money. Also consider how modern medicare doctors actually over-prescribe procedures and tests on the presumption that they'll get paid enough on some of them to make their ends meet.

Changing the payer doesn't fix this. Hell, insurance companies have every incentive in the world to fight this, and do their very best to do so, and can barely keep it under control. And every attempt they make to keep this trend under control gets attacked from the AMA, because the insurance company is "interfering with the doctor's judgment." How would Medicare-for-everyone fix this, without interfering even more with the doctor's judgment?

That's the question. That's the thing that needs to get fixed. In the old days when we were paying cash, we customers opted out of the pointless MRI. Now that we're sharing costs, we customers are opting in for extra pointless MRIs. Fix that. Show me how "everyone gets Medicare" fixes that.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

If you REALLY wanted to solve this problem in the US, along with a bunch of others, just remove, or at least drastically reduce, the infusion of corporate cash going into the reelection coffers of our elected officials and their political parties. And if you've been following the national news recently, you'll know that it's only going to be getting worse. The soon to be signed end-of-the-year spending bill coming out of Congress will open the floodgates even further for the billionaires and corporations being able to 'buy' virtually all of our politicians and it was designed specifically to assure that anyone not toeing the lines of the two major parties, that they will be completely cut-out from getting virtually any money whatsoever.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Digital Factory
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Health Insurance

If you believe that only 5% of your healthcare system's cost is in the form of profit, there's no point in talking about this further.

One important reason that single payor systems are cheaper is that the entire profit motive is eliminated from the system. That's a hell of a lot more than 5% of the cost!

The other important reason is that single payor is more efficient, i.e. it costs less in administration cost to deliver services of the same value in terms of outcome. As I've noted before, I have friends who own a mobile medical imaging business- and 30% of their employees are associated merely with the process of BILLING for their services. That entire infrastructure is GONE from our single payor system.

RE: Health Insurance

"We pay double what we should be paying per capita. If the profits were the problem, then 50% of the gross revenue in healthcare in this country would go towards profit. It does not. Most health insurance companies report profit margins at or below 5%:"

Profit margins are mythical, just like the movies that gross $1B with a cost of $250M, and claim no profit exists. Moreover, profit is made through the additional and unnecessary procedures that you pointed out. For-profit company executives are not graded on just profit margin, but increased absolute profit, which requires increased absolute revenue. This is what their bonuses are based upon.

The graph shows that our health system's performance is quite pathetic, so I'm not sure why anyone would even imagine that the current system can be "fixed." It looks like we're actually spending more than 3x what we should be spending to get the results that we have. Given that the government insurance plans cover less than 1/5th of the US population, with the remainder being either covered with private insurance or none at all, what possible reason is there for maintaining that the current system is even plausible?

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Has anyone thought that maybe the problem is a lack of doctors and hospitals. And that allowing more doctors from other countries might be the answer?

After all who ever thought you could cure anything by sticking needles in your back?

The failure is the education system more than anything. Those costs keep going up, and I don't hear any commonalities with that.

RE: Health Insurance

There's nothing in the statistics that suggests that the cost increase is due to a lack of doctors. If anything the number of doctors per 100,000 population has remained fairly constant, so the supply is keeping up with the total population growth.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote (moltenmetal)

If you believe that only 5% of your healthcare system's cost is in the form of profit, there's no point in talking about this further.

If one of us refuses to acknowledge hard evidence, then yes, there is indeed no point in talking about this, or anything, further. The only way to reach logical consensus is to start with an agreement about the data, and then apply logic to that data. That goes for any discussion, of anything.

The data is out in the open. Google it. Insurance companies profit margins are around 5%, and have stayed that way, for a very long time. Insurance of all kinds is not a high margin business. They set their expectations of costs in a shared pool based on risk projections and apply a small markup. That's how insurance works. That's why it's as hard to become an actuary as it is to become an engineer. Very smart people project that risk, apply the small markup, and the insurance company moves on. That's the business model.

Quote (irstuff)

Profit margins are mythical...

I don't even know what to say. Do you work? Are you, in fact, an engineer, that works for an engineering firm, that does engineering, for, you know, profit? Are your firm's profits "mythical?" Can you let me know who you work for, so I don't apply for a job there?

Quote (irstuff)

For-profit company executives are not graded on just profit margin, but increased absolute profit, which requires increased absolute revenue. This is what their bonuses are based upon.

Noooo. Insurance is the very opposite of what you describe. If Insurance was raking a percentage of claims paid, then you'd be correct, but that's not at all what insurance is. Insurance gets paid up front, in premiums, and then strives to maximize profit by paying as few claims as possible. Every claim paid is lost profit. They have more incentive than anyone to not pay claims. In fact, my biggest gripe about insurance in general is that they are so stingy with paying claims.

Quote (irstuff)

The graph shows that our health system's performance is quite pathetic, so I'm not sure why anyone would even imagine that the current system can be "fixed."

That's what I'm getting at. Especially with such a ridiculously simple solution as "keep everything the same and bill Medicare," which is exactly what "single payer" is. If "single payer" alone would fix this, then doctors who worked purely off Medicare would be offering services at a third of the rates that private doctors are.

Quote (irstuff)

It looks like we're actually spending more than 3x what we should be spending to get the results that we have. Given that the government insurance plans cover less than 1/5th of the US population, with the remainder being either covered with private insurance or none at all, what possible reason is there for maintaining that the current system is even plausible?

There's none. There's also no possible reason to think that shifting the population entirely to the payment method already used by 20% of us would reduce costs by a factor of 3. The source of the money is a red herring. To fix it, we need to look at the actual problem.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (irstuff)

There's nothing in the statistics that suggests that the cost increase is due to a lack of doctors. If anything the number of doctors per 100,000 population has remained fairly constant, so the supply is keeping up with the total population growth.

The product is not the doctor, the product is the procedure. If the number, frequency, and cost of procedures per capita had stayed the same since the 1970s, you'd be correct.

It has not.

The number, frequency, and cost of procedures per capita in the US has skyrocketed, while the number of doctors per capita has stayed the same. That's the very core of the problem. Again, if you want to compare the US and UK, take a look at the relative number of procedures per capita. Data for back surgeries is posted above. I feel confident saying data for other surgeries is probably similar.

Just like my MRI example, when I go to a doctor in England for back pain, he sends me home with a hot pack, some advil, and instructions on how to do dead lifts. When I go to a doctor in the US for back pain, he jumps straight to the knife. Fix that somehow. Switching to "everyone gets Medicare" doesn't fix that.

To be absolutely clear, if the government offered a "everyone gets medicare" program that was optional, and paid for with taxes, and verified to be revenue neutral, and then they absolved individuals and businesses of all these unconstitutional insurance mandates, then I'd love it. I sure as heck wouldn't use it, but I'd love it. It would make businesses more lean, and remove one of the barriers to startups. But don't kid yourself that it would make a hill of beans difference in cost per capita. And cost per capita is the actual problem.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

There is profit taken at least TWICE on every single transaction, and profit is calculated after all expenses! You're taking a fact- that insurance is a low margin, high volume business- and over-generalizing it to conclude that profit is a small fraction of the cost difference between the two systems. Insurance company profit definitely is not the only thing making your system cost vastly more than ours- nobody here said that!

Profit calculations are also very easily manipulated. As an example, apparently the Tolkien family were presented with statements which made out that the Lord of the Rings films, with a combined take of over a billion dollars, didn't actually make any money...There's a whole sub-class of parasites whose job it is to make companies appear to be poor- on paper- to the right people, generally the tax man.

The 30% of my friends' business spent to seek payment by their ~ 2,000 payors is a very real cost to your system that doesn't exist in a single payor system. And then on the side of the 2,000 payors, you have a similar infrastructure for processing those forms and paying those billings, or hopefully denying the payment of as many of them as possible. Then there's the legal costs associated with the arguments between people and their insurers, the costs to businesses in paying the insurers themselves, the cost on the part of all parties to lobby government etc....all those costs are added to your system BEFORE profit is taken. All are absent from our system.

The data that matters are there in front of your face: the costs of the Canadian system and your system are both there. The outcomes are similar. The difference is absolutely undeniably a result of two things: reduced costs to the single payor system as a result of the elimination of duplication and improvement in efficiency resulting from an elimination of the profit motive, and a complete elimination of profit. If there is a rationing of services that results in further savings, it is a rationing that doesn't result in a measurable decline in outcomes. And Canada isn't brought forward as a paragon of efficiency- merely as the closest possible comparison to your own system.

I'd argue that you're coming at this not from a data-based approach but from an ideological one, that makes you deny the logical explanation because it doesn't fit your world view. You can argue the same for me, but I have the data on my side on this one. And my point of view is simply this: government can be more efficient at delivering services we need rather than merely want. Goods and services we can choose to consume, or not? The private sector and the (regulated) free market are much better at providing those sorts of things.

RE: Health Insurance

Quote (beej67)

The number, frequency, and cost of procedures per capita in the US has skyrocketed, while the number of doctors per capita has stayed the same. That's the very core of the problem. Again, if you want to compare the US and UK, take a look at the relative number of procedures per capita. Data for back surgeries is posted above. I feel confident saying data for other surgeries is probably similar.

That does not take in to account a few factors that unique to the US. Obesity rates are higher in the US. Being overweight is a significant factor in accelerating and exacerbating back injuries and pain. Another reason for high rates of back surgery in the US is the financial incentive it grants in a law suit. It is considered proof of an injury and can lead to higher financial rewards in accident and workplace injury cases. It is also likely to grant disability status to those looking for workman's comp claims.

RE: Health Insurance

"Are your firm's profits "mythical?" "

The reported profits mythical. How else do companies like GE get away with paying little or no taxes? There are gigantic tax law loopholes for companies and 1-percenters to shield hide the true profits. There are lots of "expenses" that would have been profits, if not for loopholes. How is it that executives get large salaries and bonuses, if only to generate 5% profit? Aren't their bonuses actually profits? It's why actors with sway get percentage of gross, rather than percentage of profit, since there's almost never any film profits to report, and part of the reason is that the true profits are already skimmed off, so the reported profits are either nil or negative. And yet, the studios don't go bankrupt, mostly.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

If hospitals only have 5% profits, how do they expand and gobble up other hospitals? St. Jude in Fullerton had a major expansion in the last few years, sloughing off older, decrepit buildings for shiny new state of the art facilities. Those are reported as expenses, but come out of the gross profits. The net profits, as reported, are essentially meaningless with no context.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

5% insurance company profit is actually quite lucrative for the insurance co's - they have huge volumes of predictable pass through expenses. They only pay out 80% of claims, with 15% administrative expenses and 5% profit. Its like a general contractor, 20% on the subs for OH&P. Does an insurance company add as much value as a general contractor does to a building project? I don't see any insurances site supers hanging out full time in a trailer at my local hospital.

RE: Health Insurance

Quote (moltenmetal)

The data that matters are there in front of your face: the costs of the Canadian system and your system are both there. The outcomes are similar. The difference is absolutely undeniably a result of two things: reduced costs to the single payor system as a result of the elimination of duplication and improvement in efficiency resulting from an elimination of the profit motive, and a complete elimination of profit.

No, Moltenmetal. That's simply not true. Canadian doctors recommend fewer and less expensive procedures. That is the lions share of the difference. Medicare is a non-profit payer. Medicare doesn't spend kabillions of dollars on skyscrapers and on fancy accounting. If what you're saying was true, and the difference between our per-capita cost and the rest of the world's per-capita cost was the profit motive of the payer, then Medicare would be 3 times cheaper than insurance, and doctors working off of Medicare only patients would be able to provide healthcare three times cheaper.

That's. Just. Not. True.

It's a Blue talking point. It's not true. The source of the cost difference is not the payer. The source of the cost difference is that people in the USA are ten times more likely to have back surgery than most of the rest of the first world, and changing the source of the cost sharing pool doesn't fix that problem. The same sorts of trends apply to all surgeries. Don't get me started on C-Sections. In the USA, surgery is the preferred baby delivery method. Nowhere else in the world. And delivering a baby via surgery costs four or five times as much. How does switching to "everybody-gets-Medicare" fix that?

Quote (SPDL310)

That does not take in to account a few factors that unique to the US. Obesity rates are higher in the US. Being overweight is a significant factor in accelerating and exacerbating back injuries and pain

Australia is as obese as we are, yet their medical costs are much lower per capita, as are their rates of back surgery. Americans are fat, and some kind of anti-fat program would do the country some good, but you can't blame our triple-per-capita rates entirely on fatness.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

beej67 the issue is multi factorial, at least some of the single payer systems around the world do one way or another reduce the litigious aspects that impact US system so much.

Focusing on, or ignoring any single significant aspect leads to misleading conclusions.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Quote (beej67Australia is as obese as we are, yet their medical costs are much lower per capita, as are their rates of back surgery. Americans are fat, and some kind of anti-fat program would do the country some good, but you can't blame our triple-per-capita rates entirely on fatness.)


True but, no other legal system in the world incentivizes back surgery like ours does. I am not saying that these surgeries are necessary. They clearly aren't. What I am trying to say is that the legal system rewards and incentivizes unnecessary back procedures by awarding significantly larger verdicts to plaintiffs who undergo them. My point is that if you want to talk about the US medical system as a whole you need to choose a procedure that is not influenced significantly by other factors.

RE: Health Insurance

"How does switching to "everybody-gets-Medicare" fix that?"

Medicare limits lots of things, so C-sections would become an elective, non-reimbursable, operation, unless the life of the mother or baby is threatened. If the parents can afford to pay for the C-section, out of pocket, then everything is simple. This is, of course, unacceptable per Red talking points. So, what is the Red solution for this? How are they going to ration care without calling it rationing?

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

The whole issue is like comparing the US postal service to UPS. Both do something right, and some things wrong. But because we have a choice, we get better rates from both.

And if medical treatment is less expencive in other countries, why does US insurance carriers refuse to pay for treatment in other countries?

The answer is goverment control. People in the goverment are attempting to choke the medical system to push people into demandig a govermentrun medical system. So stop whining because what ever the outcome the cost will go down afterwards.

Heads they win. Tails we loose.

RE: Health Insurance

IRStuff: Having lived in both Australia with a single payer and the US without, I can tell you that public health is very big on rationing. The classic thing when I lived in Australia in the 90's was so called "Elective Surgery". If for example you have a debilitating but not life threatening ailment like a bad knee, the government had very limited resources available. Wait times were measured in years, which is a long time to wait if you can't walk.

RE: Health Insurance

Beej67,

The Graph – What’s the difference between the US and other western healthcare systems? The US works under a for-profit, private insurance healthcare system. The others work under a non-profit, universal healthcare system. The US costs are twice as high as the other western healthcare systems. So you wish to move further away from a universal healthcare system and further towards a for-profit, private, unregulated, insurance-based healthcare system. Smart.

Profits are “5%” – What molten said. Also, what IRstuff said. Also, this is the reported profit of insurance companies only. You have to tag on the profit of hospitals and inflated, unregulated rates of “specialists” as well. All of these profit streams are eliminated or minimized in a universal healthcare system. All of these profit streams are less regulated and have less over-sight in a “free-market” system. Furthermore, and to address your point about revenues, salaries are highly inflated in the US versus regulated salaries in universal healthcare systems.

How it works in the US
  • The doctor makes much more money than in a regulated, universal healthcare system.
  • The hospital has to pay doctors more money, so they charge more money and encourage unnecessary tests and take profit off the top of that.
  • The insurance company has to pay the hospital for their services and take a profit off the top of that, so they increase rates or deny coverage. The existence of insurance companies adds another level of paper work and administrative costs. Some reports indicate doctors spend ~25% of their time dealing with insurance paper work, which inherently does not exist in a universal system.
  • The people have to pay through the nose for higher rates and fight tooth and nail to be approved for care they paid to be insured for. Many aren’t covered/can’t afford routine and preventative care, so small things develop into big emergencies, increasing the cost of the system.
How it works in universal healthcare
  • The doctors rates are regulated to the point they still have highly competent doctors (which they do – UK was 1st in quality of care, the US was 5th)
  • The hospital pays the doctor a decent wage and they charge a decent rate. No need for unnecessary tests or inflated charges because they are non-profit and regulated closely.
  • The government pays the hospital bill and is highly motivated to ensure they keep costs low while provide good quality care (UK was 1st in quality and 40% the cost of the US)
  • The people just show their healthcare and receive care. Because it’s free and available, they have primary care doctors which can properly diagnose and treat minor things during routine check-ups without the need for emergency visits. This decreases the cost of the system.
How it works in a “free-market” system
  • Free-market would have little to no regulation on the rates that doctors charge. Little would change from the current US system.
  • Free-market would encourage private, for-profit hospitals. As in a free-market, there would be little regulation over the quality of care and they’d likely cut as many corners on cost as possible. However, being for-profit, they would still attempt to charge as much as possible to maximize profit. Little would change from the current US system and likely less regulation (as per a “free-market”) would decrease the assurance of fair and quality care.
  • Private, for-profit insurance companies would still exist in a “free-market” system. They would still skim profits off the top. They would still be encouraged to get around the higher costs from the hospitals by increasing rates or denying coverage. Not much would changed.
  • The people would be left with the same broken, expensive system, except now with less regulation and oversight on insurance companies and hospitals. Disenfranchised people would be flat out screwed and receive little to no care outside of emergencies (which would then become an increased burden on the cost of the system). Middle class people would have to be in a constant search and struggle for a lower/better plan (adding more strain and stress). Routine and preventative care would be a luxury and so many would skip it, allowing minor ailments to turn into emergencies. Upper class people would likely be able to find more deluxe care (more of the “supersized” treatments you spoke of) and would be very happy.
So how are rates lower in a non-insurance based, universal healthcare system:
  • Doctors rates are regulated and lower
  • Legal liability of doctors is regulated and lower, so insurance is lower
  • Legal liability of doctors is regulated and lower, so overzealous testing is less (however, the quality of care still remains higher than the US)
  • Hospitals are non-profit and so don’t need to charge more to skim profit of the top
  • Hospitals are non-profit and so they have no incentive to perform unnecessary tests (again, quality of care is higher than the US)
  • Private, for-profit insurance companies do not exist for basic healthcare because basic healthcare is free
  • The lack of private, for-profit insurance companies means no added overhead/administrative costs, much less paper work for doctors, no increase cost due to profit skimming, less legal battles regarding coverage, etc
  • Free basic healthcare means that routine and preventative care is available to all citizens. This means less unnecessary trips to the emergency room and healthier lives.
  • Oh ya and everyone gets free basic healthcare. You don’t have 45,000 people die a year in the “richest, most powerful country” because a lack of healthcare coverage. But apparently this mean absolutely nothing to you, as you only want to discuss costs.
That’s why every other modernized western nation has universal healthcare. That’s why every other modernized western nation has cheaper healthcare than the US. That’s why every other modernized western nation has more available, equitable healthcare than the US. That’s why every other modernized western nation laughs at the US when they argue against universal healthcare systems. That’s why every shred of real world evidence supports the benefits of a universal healthcare system.

AND FOR THE LAST TIME, UNIVERSAL HEALTHCARE IS NOT SIMPLY SWITCHING EVERYONE TO MEDICARE. You need to scrap the whole insurance based system for basic care. You need to introduce regulations that limit liability of doctors. You need to introduce regulations on the quality and cost of care. You need to shift focus to primary care. That’s what makes universal healthcare successful everywhere else on the planet.

RE: Health Insurance

Quote (rconnor)

So how are rates lower in a non-insurance based, universal healthcare system:
Doctors rates are regulated and lower
Legal liability of doctors is regulated and lower, so insurance is lower
Legal liability of doctors is regulated and lower, so overzealous testing is less (however, the quality of care still remains higher than the US)
Hospitals are non-profit and so don’t need to charge more to skim profit of the top
Hospitals are non-profit and so they have no incentive to perform unnecessary tests (again, quality of care is higher than the US)
Private, for-profit insurance companies do not exist for basic healthcare because basic healthcare is free
The lack of private, for-profit insurance companies means no added overhead/administrative costs, much less paper work for doctors, no increase cost due to profit skimming, less legal battles regarding coverage, etc
Free basic healthcare means that routine and preventative care is available to all citizens. This means less unnecessary trips to the emergency room and healthier lives.
Oh ya and everyone gets free basic healthcare. You don’t have 45,000 people die a year in the “richest, most powerful country” because a lack of healthcare coverage. But apparently this mean absolutely nothing to you, as you only want to discuss costs.

1) If doctors rates are regulated and lower, then what is their incentive to stay in the healthcare industry...the goodness of their heart? I'm not insinuating that doctors are heartless toward their patients, but just as we have entered the engineering industry for a career, for profit, so to have they.
2) Two words: Tort reform
3) I would rather a doctor be overzealous to figure out what is ailing me, then to be apathetic because he won't actually gain anything from helping me
4) The majority of US hospitals are already non-profit. There are actually more gov't operated hospitals in the US than for-profit hospitals.
5) Even though most US hospitals are already non-profit, again I would rather they be overzealous in finding a correct diagnosis than to be apathetic.
6 and the rest) BASIC HEALTHCARE IS NOT FREE...NO SERVICE IS FREE...PERIOD >>> Who then pays for this "free" health care, why you and me of course.

RE: Health Insurance

For a private system to be made to work, patients (a.k.a. customers) need to push back on the cost at the time that treatment decisions are being made with the doctor. If this can't be built into the structure, costs will continue to rise. In a public system, the government has the power to impose whatever cost structure the tax payers are willing to pay for without worrying about making a profit or getting sued.

RE: Health Insurance

jguer005,

1) Right, that’s why all universal healthcare systems have no good doctors and the quality of care is poor…and then there’s reality. Quality of Care Rank: US – 5th out of 11, UK – 1st. (source)
2) And? Every nation that has universal healthcare went from non-universal to universal. Most of these transitions included limitations on liability. Difficult and impossible are two different things.
3) Right, that’s why all universal healthcare systems have poor quality of care…and then there’s reality (see above). (bonus points for using “apathetic” to describe universal healthcare while arguing for a system that lets millions go uninsured or underinsured for basic healthcare needs and ~45,000 die due to a lack of coverage.)
4) And? Are you saying it could be worse (all for-profit hospitals)? Ok. But that’s not an argument against universal healthcare. Furthermore, a true “free-market” system would have all private, for-profit hospitals. So it WOULD BE worse according to this argument.
5) Right,…never mind….just see 1 and 3 again. (and more bonus points!)
6) Right, that’s why all universal healthcare systems cost so much more than the US system…and then there’s reality. With a good portion of the medical system being paid out-of-pocket by the people (through insurance premiums or directly), the healthcare system still costs Americans much, much more than any other western nation with universal healthcare. Percentage of GDP that goes to healthcare: US – 17.7%, Canada – 11.2%, UK – 9.4%. And the per capita expenditures are even worse for the US (US - $8,508, Canada - $4,522, UK - $3,405). (source)

Ya know, facts and such.

RE: Health Insurance

"patients (a.k.a. customers) need to push back on the cost at the time that treatment decisions are being made with the doctor."

That works when you are buying a car, where you have no compelling reason to buy now, or buy here. When you are sick or dying, it's a different thing altogether.

When my son is in the ICU for pneumonia, which he was, was I really going to pull him out to go to another, cheaper, hospital, or call a bunch of hospitals and get a lowest bid? Am I really going to try an negotiate a lower price right there for the MRI that he got? Seriously? Even the free-marketers will admit that getting treatment from a doctor is not the same as buying a car.

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Bear in mind that most insurance plans go out of their way to not pay for preventative care, so the end result is that you are more likely to get sick, and when you do get sick, it's worse, both of which are good for the profit picture. Neither insurance companies or hospitals are necessarily interested in driving themselves out of business by eliminating sickness. This is why vaccinations have to be semi-mandatory. My company is self-insured, and they only recognized last year that free flu shots would reduce the number of sick days and increase productivity. What a concept!

TTFN
FAQ731-376: Eng-Tips.com Forum Policies

Need help writing a question or understanding a reply? forum1529: Translation Assistance for Engineers

Of course I can. I can do anything. I can do absolutely anything. I'm an expert!

RE: Health Insurance

Quote (kenat)

beej67 the issue is multi factorial, at least some of the single payer systems around the world do one way or another reduce the litigious aspects that impact US system so much.

Oh I agree. The litigious nature of the US system is one of the biggest difference between our system and other systems, which leads to over medication, and is a huge burden. But A) simply switching to Medicare-For-All doesn't fix that, and B) there's no reason we can't fix that in a multi-payer system.

The how-we-share-costs issue and the litigation-breeds-over-medication issue are separate issues. Either can be changed without changing the other. To date, none of the Blue "single payer" proposals has touched tort. At least as far as I've seen. And tort is one of about ten things we seriously need to overhaul, that pushes us into over-proscribing procedures.

Quote (SPDL310)

True but, no other legal system in the world incentivizes back surgery like ours does. I am not saying that these surgeries are necessary. They clearly aren't. What I am trying to say is that the legal system rewards and incentivizes unnecessary back procedures by awarding significantly larger verdicts to plaintiffs who undergo them. My point is that if you want to talk about the US medical system as a whole you need to choose a procedure that is not influenced significantly by other factors.

What, like pregnancy? Our C section rate in the US 30%, Belgium's is 15%. The reason why is we put everyone on an epidural, which slows contractions, then put them on pitocin, which causes contractions to be more violent, and then when the baby freaks out we cut it out with a knife. Birth by C section costs three times as much as vaginal delivery.

There's that X3 multiplier showing up again, and not due to a profit factor for the insurance company. They don't want to pay for C sections either.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

I want to go back to this for a second:

Quote (IRStuff)

The reported profits mythical. How else do companies like GE get away with paying little or no taxes? There are gigantic tax law loopholes for companies and 1-percenters to shield hide the true profits.

Lets talk GE. How does GE do it? I know quite a bit about how GE does it, because my brother in law is the chief alternative energy reporter for Bloomburg. GE does it by buying themselves tax breaks through carefully placed campaign donations, under the guise of things that Blue voters would support, to sneak them under the radar. Here's an example.

A few years ago, GE lobbied some language into one of the energy policy laws that was supposed to support 'green energy.' The language stated that any alternative energy project that got started that year, could be fully depreciated in that year, instead of along a normal depreciation schedule. Basically, instead of counting as an asset on their books, it was counted as an expense. So that year, if GE made 100 million in profits, they could start work on 100 million dollars worth of solar farms or wind farms or algae fuel laboratories or whatever, and fully depreciate them right then, and have no taxable income.

Neat trick, huh? How'd they get that trick off? They bought Washington.

They bought Washington.

And there, sirs, is one of the biggest difference between the USA and Denmark. You can't just knock off down to Copenhagen and buy yourself a tax break. But lobbyists don't just buy tax breaks. They also buy everything else, such as drug coverage and procedure coverage under Medicare. How on earth could you seriously support going to "Everyone Gets Medicare" as a solution, when the very things Medicare covers are up for sale, in the very same way that evil old GE's tax breaks are?

You cannot even engage the idea of putting all paying under one umbrella until you fix the umbrella. If our government worked as intended, then it might be conceivable. But it does not. It is purely a complex web of graft. Fix that first. I'm open to ideas how.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (IRStuff)

Bear in mind that most insurance plans go out of their way to not pay for preventative care, so the end result is that you are more likely to get sick, and when you do get sick, it's worse, both of which are good for the profit picture.

No.

Quote (beej67)

If Insurance was raking a percentage of claims paid, then you'd be correct, but that's not at all what insurance is. Insurance gets paid up front, in premiums, and then strives to maximize profit by paying as few claims as possible. Every claim paid is lost profit. They have more incentive than anyone to not pay claims...

...which means they have more incentive than anyone to insure healthy people. They have every incentive in the world to pay for preventative care that shows an ROI. In many cases, they are flat out prevented from doing so by law. Insurance companies would love to structure coverage by BMI or percent body fat, for instance, but it's illegal. Who made it illegal? Lobbyists.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (glass99)

For a private system to be made to work, patients (a.k.a. customers) need to push back on the cost at the time that treatment decisions are being made with the doctor. If this can't be built into the structure, costs will continue to rise. In a public system, the government has the power to impose whatever cost structure the tax payers are willing to pay for without worrying about making a profit or getting sued.

I agree with all this, and this is one of the reasons I would totally support single payer emergency care. If you get in a car wreck, you do not have time to shop for your medical provider. Car wrecks should be like your house burning down, or like getting robbed. Emergency hospital care makes complete sense to cover with taxes. No marketplace can reasonably exist for it.

Colonoscopies, however, should be paid for out of pocket. Here's an interesting article:

http://www.nytimes.com/2013/06/02/health/colonosco...

There's lots of "evil profit seekers!" in that article, and a lot of it's legit, but there are two important things to take away from it:

1) In other countries with single payer systems, the administrators of those single payer systems can decide that colonoscopies really aren't needed if there are other tests that are cheaper. That wouldn't work here, because the AMA would lobby congress to have Medicare pay for the expensive treatment.

2) In other countries with an actual free market (which is NOT what we have here) where the patient is paying with cash, the patient is free to seek the most affordable screening option, which is typically not a colonoscopy or is a colonoscopy in a doctor's office instead of a surgical center. That doesn't work here, because we're going to pass the costs on to our shared pool anyway, so the doctors brew up a more expensive version of the same thing to sell to the shared pool.

We do not have a free market here. We do not have universal healthcare here. We have the worst, most insidious blend possible of the two.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

Quote (rconnor)

jguer005,

1) Right, that’s why all universal healthcare systems have no good doctors and the quality of care is poor…and then there’s reality. Quality of Care Rank: US – 5th out of 11, UK – 1st. (source)
2) And? Every nation that has universal healthcare went from non-universal to universal. Most of these transitions included limitations on liability. Difficult and impossible are two different things.
3) Right, that’s why all universal healthcare systems have poor quality of care…and then there’s reality (see above). (bonus points for using “apathetic” to describe universal healthcare while arguing for a system that lets millions go uninsured or underinsured for basic healthcare needs and ~45,000 die due to a lack of coverage.)
4) And? Are you saying it could be worse (all for-profit hospitals)? Ok. But that’s not an argument against universal healthcare. Furthermore, a true “free-market” system would have all private, for-profit hospitals. So it WOULD BE worse according to this argument.
5) Right,…never mind….just see 1 and 3 again. (and more bonus points!)
6) Right, that’s why all universal healthcare systems cost so much more than the US system…and then there’s reality. With a good portion of the medical system being paid out-of-pocket by the people (through insurance premiums or directly), the healthcare system still costs Americans much, much more than any other western nation with universal healthcare. Percentage of GDP that goes to healthcare: US – 17.7%, Canada – 11.2%, UK – 9.4%. And the per capita expenditures are even worse for the US (US - $8,508, Canada - $4,522, UK - $3,405). (source)

Ya know, facts and such.

I think it is ironic that the "source" you cite is the Commonwealth Fund...whose president is an Obama appointee. Hmm, I guess that means they wouldn't be biased at all in this debate.

I won't disagree that "quality of care" is equal to or better in nations with universal healthcare; however, universal healthcare does not translate to access to healthcare. According to Britain's Dept. of Health, at any given time, there are 900,000 people waiting to be admitted to a NHS hospital and 50,000 canceled operations each year due to shortages. Woo-hoo! Please, put me on the next boat over so I can be on the wait list!

In Sweden, the wait list for heart surgery can be as long as 25 weeks! How many people will die during their wait time? Even the New England Journal of Medicine said in 2008 during the healthcare debate that "health insurance status was largely unrelated to quality of care."

Did you know that the CBO is estimiating that 31,000,000 US citizens will still not have health insurance by 2023. That is 10 years under the PPACA, and that is still 10% of the population uninsured.

You know, facts and such.

I won't argue with the % of GDP numbers, but I will argue that access to healthcare is not better under a universal system. It may be cheaper up front, but what are you really paying after all the taxes and fees levied by the gov't?

I shall not post anymore because I have to go to work to pay my increased taxes and health care costs.

RE: Health Insurance

The more the contribution of the public purse, the more political health care becomes. For example, I have noticed recently in Australia that there is a brewing conflict between old and young over items like healthcare in particular. Real estate has also become very expensive in Australia, which is owned to a significant extent by older people who bought in decades past. Young families argue that they can not afford the down payment on a house, but they have to pay high taxes to fund Medicare which primarily benefits their parents who are living in million dollar plus houses.

RE: Health Insurance

"The more the contribution of the public purse, the more political health care becomes"

Color me unconvinced, while it was a frequent political hot potatoe back in Blighty I'm not sure it was any worse than here in the US.

In the single payer/single provider system I'm familiar with pretty much everyone got reasonable coverage for $X of GDP. There were issues such as long waiting lists at times for some procedures, some variability on quality of care geographically based on wealth distribution etc. however my experience with it - with admittedly limited need to take advantage of it wasn't bad.

In the US a few people get fantastic coverage, a lot of people get reasonable coverage, many more get mediocre coverage and a bunch get minimal - all for $2X GDP.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat: there has been a big uptick in the controversy of healthcare because of Obamacare, i.e. the government taking on a bigger role. Hippies in Vermont have different values than gun owners in Texas, so a political process is required to sort it out. The winner of the political process is the group with the most coherent voting block. Libertarians argue that forcing people who don't like each other to share a bed is not productive.

I understand in the UK right now, politicians of both wings are falling over themselves to say how much they love the NIH, but they are also scared witless of their budget deficit. There is a lively political discussion as a result.

RE: Health Insurance

glass, I was here before Obama got elected I remember related topics coming up then.

NIH? you mean NHS?

NHS is far from perfect, overall economics, political system... is far from perfect there too. I wasn't proposing blindly copying the NHS model in the US. However, I am not swayed by arguments that the NHS is overall worse than the US system and would argue that as a minimum it gives much better overall value for money.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Health Insurance

Kenat: Its pretty clear that the British system is more efficient, which is a matter of national schadenfreude for all British citizens. But America is a big diverse country, and forcing people to share a bed when they don't want to is tough. If you are in a toxic relationship with your spouse, do you stay married just because divorce is expensive? The Texan gun owner would rather die than bunk up with a hippy, so paying double for health insurance is cheap by comparison.
-> Maybe the answer is to break America up into smaller countries. How expensive does healthcare need to get before this makes sense?

RE: Health Insurance

Jguer005,

Sources
The Commonwealth Fund study is not out-of-line with other studies. Furthermore, as cost appears to be your biggest issues, those numbers were not calculated by The Commonwealth Fund (listed in the study).

Meanwhile, you didn’t even bother linking your sources. No matter, I went to the trouble of trying to find them. Seems like your numbers came from the same paragraph in “Universal Healthcare’s Dirty Little Secrets” by Michael Tanner and Michael Cannon, of the CATO Institute! My favourite source for credible, unbiased, non-ideological driven information!

Regardless, it matters little. Let’s return to the matter at hand.

Wait Times
As you popped into this conversation about 450 replies in, I’m guessing you didn’t read my post highlighting the facts of wait times:

Quote (rconnor)

% of Responses stating they could see a doctor the same/next day – Canada 41% (worst amongst OECD), US 43% (second worst), Sweden 59%, Germany 74% (best) (source)

Wait time for emergency case was 2 hours or more – Canada 48% (worst, 11th), US 28% (7th), UK 16% (2nd best) New Zealand 14% (best) (source)

% of people that did not get adequate care due to costs (fill prescription, visit doctor, get test, etc.) – US 37% (worst), Netherlands 22% (2nd worst), Canada 13%, UK 4% (best) (Source)

Number of annual deaths due to lack of insurance in the US – (2005 estimate, working age only) 44,789 (estimate according to this 2009 Harvard study)

2011 Health Expenditures/Capita – US $8,508 (worst, 11th), Canada $4,522 (6th), UK $3,405 (2nd) New Zealand $3,182 (best) (Source)
The difference in wait times is not huge, nor is the US the best. There appears to be little value for spending 2x more per capita. The only major area of difference is the wait times to see specialists for elective surgeries. As Beej67 has been arguing (as he's doing a better job arguing for universal healthcare than anything else), the availability of all these specialists comes with a cost/benefit ratio that appears slanted towards the cost side.

Also, see moltenmetal’s excellent post on the subject:

Quote (moltenmetal)

Wait times for essential procedures and emergency care are quite modest [in Canada] unless you live in a remote location. Most of the people waiting 2hrs or more for "emergency care" here aren't in need of emergency care- they are taking advantage of the free access to the emergency room we get here 24/7, either deliberately or as a precaution (for a sick child etc.). They're having their needs triaged against those of others who truly do need emergency care. When someone dies in an emergency room here because they were inappropriately triaged, it is a HUGE deal and national news- it happened to a First Nations man in Winnipeg recently and there was a hue and cry from sea to sea about it. Deaths while waiting for care here are truly rare.

What you fail to mention (besides linking your source) is that the stats you list for the UK are for elective surgeries. As molten describes, waits can be long for non-essential aspects but overall timely, available access to healthcare in universal healthcare is on-par with the US (some are better, some are worse). You have one system that cancels 50,000 elective operations per year and another that lets 45,000 die due to lack of insurance. Still not buying that boat ticket?

Regarding the heart surgery wait times in Sweden, it again ignores the fact that cardiovascular surgery, along with all types of surgery, are tiered based on risk. Long wait times do not necessarily equate to more deaths. A study by Queen Elizabeth II Health Center concluded “prolonged waiting was not associated with worse surgical outcomes”. Another study, found that 0.48% of patients scheduled for heart surgery died while waiting for heart surgery. Certainly anything higher than 0% is non-ideal but the number does not indicate a severe issue and there is no indication that this number is sufficiently higher than the US, especially if you factor in the number of patients that died because they were not adequately covered for heart surgery. While these are Canadian studies, it does highlight that, for the most part, the prioritizing of surgery is done well for the most part.

Improvements to the system are needed and universal healthcare is not perfect. However, A 2009 Nanos Research poll found that 86.2% of Canadians support “public solutions to make our public health care stronger”. A 2008 Strategic Counsel survey found 91% of Canadians preferred their healthcare system over the US system. In addition, a 2003 Gallup Poll found only 25% of Americans were ‘very” or “somewhat” satisfied with “the availability of affordable healthcare in the nation”, compared to 50% in the UK and 57% in Canada.

CBO Estimate
What? The number of uninsured people in the US is still going to be high. How does that possibly support your point? That’s an argument FOR universal healthcare and re-emphasizes that the ACA is not universal healthcare, so it supports MY point. You, like beej67, are doing a better job arguing for universal healthcare than against it. What do you think that number would be in a “free-market” system? Greater than zero?

”It may be cheaper up front, but what are you really paying after all the taxes and fees levied by the gov't?
…% of GDP is not the “up-front cost”. It’s the cost. And the US has the highest in the western world (by a long shot).
What is Canada really paying for healthcare? 11.2% of its GDP or $4,522 per capita
What is the UK really paying for healthcare? 9.4% of its GDP or $3,405 per capita
What is the US really paying for healthcare? 17.7% of its GDP or $8,508 per capita

Another interesting figure regarding the quality of healthcare in universal systems (with those "apathetic" doctors not giving you the care you need just to save money) versus the US:

RE: Health Insurance

2
It is a curiosity that several US govt policies are contrary to what the majority of individuals seem to want. Single payer universal healthcare, an end to apparently infinite ( and undeclared) wars , "equal justice" ( as understood by the majority), the list goes on and on. Perhaps the root of the issue lies in the role that money is permitted to play in our "representative democracy".

A representative cannot be elected without obtaining and spending tens of millions of dollars in campaign funds, which are obtained from a few moneyed interests, who then obtain political favors ( at the 11th hour of an omnibus bill) which further their economic interests. Any legal challenge to individual instances of this formally permitted bribery is met with a stiff defense , since corporations are given all rights of a "person" under the law. In the case of the cash cow known as healthcare , the health insurance industry, pharmaceutical industry, AMA, medical products industry etc. can focus much more capital into "lobbying" (and other inducements) to obtain continued protection of their racket, to the detriment of the US public at large, as represented by the statistics provided earlier.

Restating statistics and facts apparently are not effective in changing US policy . IMO, either the legal system that allows moneyed interests to define policy needs to be amended, or a healthcare crisis would need to occur that can only be solved by a universal ,single payer healthcare system .

"Whom the gods would destroy, they first make mad "

RE: Health Insurance

In Canada we managed to get campaign finance reform that is unimaginable to Americans- with hard limits on contributions from individuals and corporations and unions- as a result of a pissing match between a former prime minister and his rival (his own finance minister at the time). In order to screw the other guy, Cretien did one of the greatest services for democracy that has ever been done here.

RE: Health Insurance

An aspect of the health care inflation which is not often discussed is that the industry does not have recessions. Most industries rely on recessions as a time for entrepreneurial search for new markets and efficiency. Have you ever heard of a doctor getting laid off? Where is the fear of failure? How do the weak performers get weeded out? When a hospital is underfunded, the hospital stuff ramp up the whining to 11 because they know they can get better elsewhere, but don't really make the changes necessary for long term cost control.

RE: Health Insurance

Quote (davefitz)

It is a curiosity that several US govt policies are contrary to what the majority of individuals seem to want. Single payer universal healthcare, an end to apparently infinite ( and undeclared) wars , "equal justice" ( as understood by the majority), the list goes on and on. Perhaps the root of the issue lies in the role that money is permitted to play in our "representative democracy".

Bingo.

And rconnor will also agree with that.

But then he will tell you that the solution is to have the (bought) government run everything. Which doesn't make a lot of sense. If our government was not bought, single payer healthcare would be a great way to go. He will continually bring up examples of other countries in which the government is not bought, which is like comparing a fresh apple to a rotten banana.

Quote (beej67)

1) In other countries with single payer systems, the administrators of those single payer systems can decide that colonoscopies really aren't needed if there are other tests that are cheaper. That wouldn't work here, because the AMA would lobby congress to have Medicare pay for the expensive treatment.

2) In other countries with an actual free market (which is NOT what we have here) where the patient is paying with cash, the patient is free to seek the most affordable screening option, which is typically not a colonoscopy or is a colonoscopy in a doctor's office instead of a surgical center. That doesn't work here, because we're going to pass the costs on to our shared pool anyway, so the doctors brew up a more expensive version of the same thing to sell to the shared pool.

We do not have a free market here. We do not have universal healthcare here. We have the worst, most insidious blend possible of the two.

"Medicare For Everyone" is just putting a different skin on the rotten banana. It does not fix the rot.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Health Insurance

IRStuff: Individual hospitals do occasionally close including the one in my neighborhood which they are turning into condo's, but the healthcare industry never contracts. Doctors are always employable, so have no incentive to make it work where they are. If you are an engineer at Chrysler which is failing and Ford is thriving and hiring, why bother attempting to fix things at Chrysler? Finding efficiency sucks.

RE: Health Insurance

Yes, I do agree beej. But your next point is a straw man.

But first a question, to help me understand your position more clearly. Which best describes your position:
1) Theoretically (ignoring the “money-in-government” problem), a “free-market” healthcare system is better than a universal healthcare system.
2) While theoretically a universal healthcare system is better, the corporate influence over the government in the US would make it worse than a “free-market” system in practice.
3) While theoretically a universal healthcare system is better, the corporate influence over the government in the US would prevent the transition to a universal healthcare system in the US. Therefore, the “free-market” system is the next best alternative.

If #1, then see all my previous posts. I really don’t want to go into the practical application of universal healthcare until after you agree that it is a superior system. If not, then we can continue to argue the merits of both systems.

If #2, then we can continue. We both agree that corporate influence on government is a major problem. This affects the healthcare system in the US greatly as, in the current system, healthcare is primarily ran by private, for-profit corporations. This gives them the incentive to lobby for their interests (i.e. more profits). If you take away the private, for-profit nature of the healthcare system you inherently solve that problem. There is no need for corporate corruption when there are no for-profit corporations. This is why universal healthcare works so nicely in other countries.

Your solution, the “free-market” system, minimizes or completely removes any ability for regulation. This too would remove the need for lobbyists, as corporations are allowed to do whatever they want but that is not a good thing. So you’ve identified the problem being corporate influence over government and your solution is to give all the power to the corporations and let the people fend for themselves.

If #3, then I agree with you much more than #1 or #2. However, I don’t feel it would be impossible. Difficult? Yes. Despite how bad the issue of money-in-politics is, if the voice of the people is loud enough, the government will listen. Remember that any candidate needs both money, which comes from corporations, and votes, which still comes from the people, to be in power. The first step is getting more people to understand the benefits of universal healthcare and squash some of the rumours. There is a lot of misinformation out there, usually stemming from the very lobby groups that you agree are the core of the problem. The more advocates you have for it, the more likely the government is willing to listen. Furthermore, even if a "free-market" system is in the best interest of the people and not corporations (which I completely disagree with), would it not face the exact same issues?

There is also a very interesting campaign that is attempting to develop a super-PAC to end all super-PACs. The Mayday Campaign is trying to raise money to fund candidates that are committed to push for reform to the way campaigns are financed.

RE: Health Insurance

Quote (rconnor)

But first a question, to help me understand your position more clearly. Which best describes your position:
1) Theoretically (ignoring the “money-in-government” problem), a “free-market” healthcare system is better than a universal healthcare system.
2) While theoretically a universal healthcare system is better, the corporate influence over the government in the US would make it worse than a “free-market” system in practice.
3) While theoretically a universal healthcare system is better, the corporate influence over the government in the US would prevent the transition to a universal healthcare system in the US. Therefore, the “free-market” system is the next best alternative.

4a) Free market principles don't work if you can't shop for stuff, so universal care makes complete sense for emergency services, in much the same way that it makes sense for fire protection and police protection. You will get no argument from me on that.

4b) The structure of the US health care system legacy, going all the way back, was one where health care providers made a solemn vow to "spare no expense," and their zeal was only counter balanced by the end recipient deciding to keep his own costs down, since they came out of his pocket.

4c) Shared cost pools, be they private or public, unravel that counter balance, leaving the legacy of our system to run wild. This is the seed of the rot. Sparing no expense is nice, and sharing costs is nice, but you mix those two together and the thing explodes.

4d) "Single Payer," as presented by the Blues, means nothing more than "Everyone Gets Medicare," or equivalently "Everyone shares their costs with taxes instead of premiums." It does not change the system, and the system is the problem. It is purely re-skinning the rotten banana.

Mr. Connor, you still, still, have not shown how re-skinning the banana gets rid of the rot. Now, lets punch through the rest of your post.

Quote:

If #1, then see all my previous posts. I really don’t want to go into the practical application of universal healthcare until after you agree that it is a superior system.

I think it's vastly superior for car wrecks, where I cannot shop for an ambulance. I think it's vastly inferior for headaches, where I can absolutely shop for Aspirin. I think blind zeal in one system being better for all types of healthcare over another is dangerous and not a particularly intelligent way to approach the problem.

Quote:

If #2, then we can continue. We both agree that corporate influence on government is a major problem. This affects the healthcare system in the US greatly as, in the current system, healthcare is primarily ran by private, for-profit corporations. This gives them the incentive to lobby for their interests (i.e. more profits). If you take away the private, for-profit nature of the healthcare system you inherently solve that problem. There is no need for corporate corruption when there are no for-profit corporations.

Woah there buddy. The AMA is a lobby. Every little professional subgroup (The American Osteopathic College of Proctology, etc) is a lobby. Note how they, in the link above, recommend expensive procedures instead of cheap ones even though they're a "nonprofit?" Medicare coverage is affected by lobbyists. Device manufacturers are never going to be non-profit. Drug companies are never going to be non-profit. The "Band-Aid" company is never going to be a non-profit. You could turn all hospitals into nonprofits and not change the fundamental problem at all. They still have to hire doctors, who's artificial scarcity is effectively lobbied by the AMA.

Plus, your idea of what qualifies as 'nonprofit' doesn't really jive with reality. In reality, nonprofits lobby like heck. Teachers unions are nonprofit, and lobby like crazy. Churches are nonprofit, and lobby like crazy. The NCAA is nonprofit, and they fly around in private jets that would put the guys at Citibank and Blue Cross to shame.

Also, who exactly do you think you're going to convert 'nonprofit' as part of your solution? The MRI machine manufacturers? The MRI Technicians Of America lobby? The colleges who train the MRI technicians?

Quote:

Your solution, the “free-market” system, minimizes or completely removes any ability for regulation. This too would remove the need for lobbyists, as corporations are allowed to do whatever they want but that is not a good thing. So you’ve identified the problem being corporate influence over government and your solution is to give all the power to the corporations and let the people fend for themselves.

The primary reason why doctors can't compete with big corporations is because of the regulation. This is something that's fundamentally amiss with Blue thought. (There's plenty that's fundamentally amiss with Red thought too, btw, but that's not really the subject at hand) The Blues think "corporation bad" and then want to regulate the corporation, but what they fail to see is all they're doing is entrenching that corporation's market share. In a marketplace, I can choose the better solution for me. Regulation is about eliminating choice, and preventing innovation from displacing the market share of the big corporations.

I had a very close friend, an MD, who was so sick of the health care model in this country he decided he was going to quit his practice and start a direct doctor-to-patient company, predicated entirely on house calls. He'd show up with a van, to your house, do all your checkups, see you when you were sick, etc etc. The business model was flawless, because the doctors aren't actually making a lot of the money they're charging either - it all gets sucked up into the machine. But in order for his company to work, he had to charge cash. And nobody wanted to pay cash, because they had already paid their premium. They were on the shared pool, so they wanted him to get his pay from the shared pool. Which would have ruined his whole business model. "Everyone on Medicare" would do the same thing. The high efficiency system he brewed up would continue to be rubbed out in favor of the giant corporations that can figure out how the heck to be paid by Medicare.

I think the free market would work flawlessly for routine care, if people weren't paying premiums, because then they could take that money and shop for it. I think it would work flawlessly for your kids getting sick. I think it would work flawlessly for most of the things that we have now. Cash for services would be cheaper. Even up to and including things like broken bones and MRIs. The only thing it doesn't work well for is cancer and car wrecks. It flat sucks on car wrecks, and honestly when faced with "Chemo or die" choices, it doesn't really work then either.

My position is closest to (3) of yours above, but with the caveat that some stuff is absolutely cheaper if you're buying it with cash, in our country, where we have built everything from the ground up to work that way. And our problem is a cost problem.

If you want to make our system work:
1) get rid of all these "mandates"
2) single-payer the emergency hospitals,
3) up the HSA cap, and let people cover all their routine care, OTC medications, etc through it
4) let pharmacists issue prescriptions without a doctor, buyer-beware
5) Allow "limit of liability" clauses for all medical procedures
6) let all doctors self insure for malpractice insurance, by simply holding cash in escrow based on the volume of procedures they do per year, based on the liability limit
7) force all doctors, hospitals, etc, to publish their damn rates for procedures

That would give you de-facto tort reform without having to actually get into the details of it, would insulate us from the "oh god I got in a car wreck and now I'm bankrupt" factor, and it would restore the original cost controls that used to work in our system back into our system. It wouldn't be impossible to get there from here. The moment folks start trying to go to the sort of system you're talking about, rconnor, they'll be putting us all on the VA plan. And we know how single-provider healthcare works here in the USA. It kills Army vets.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

Red Flag This Post

Please let us know here why this post is inappropriate. Reasons such as off-topic, duplicates, flames, illegal, vulgar, or students posting their homework.

Red Flag Submitted

Thank you for helping keep Eng-Tips Forums free from inappropriate posts.
The Eng-Tips staff will check this out and take appropriate action.

Reply To This Thread

Posting in the Eng-Tips forums is a member-only feature.

Click Here to join Eng-Tips and talk with other members! Already a Member? Login



News


Close Box

Join Eng-Tips® Today!

Join your peers on the Internet's largest technical engineering professional community.
It's easy to join and it's free.

Here's Why Members Love Eng-Tips Forums:

Register now while it's still free!

Already a member? Close this window and log in.

Join Us             Close