Who is responsible for paying health care premiums for working, able bodied citizens in the US?
The individual
The employer
The government
Who is responsible for paying health care premiums for working, able bodied citizens in the US?
I voted for Government, with the understanding that it would come through general taxation. I would not want to see it come from debt. I also am a fan of sin taxes. Let's have those who cause the problem pay for it. If you smoke causes me second hand smoke, then you should pay part of the my medical bill. Therefore, taxing cigarettes will compensate for damage caused by smoking cigarettes.
I do not think it should be 100% on the shoulders of individuals or companies.
Originally Posted by For-Life
I've got a stomach ache and fever. I think I will go out and ask 100 people for $1. Then I will be able to afford to go to the doctor.
Sounds good up front. Nice, fair system. Except I have gone to the doctor maybe 4 times in the last 10 years. We have patients in our office with recurrent eye infections that are non-compliant with meds that come back twice a week for 2-3 months before it finally clears up.
Under the above example, that person will pay $1 every 18 months for me to see a doctor. I, on the other hand, will pay $20 in 3 months for this person who doesn't care enough about their own health to follow the instructions. (I know this is a grossly over-simplified example)
If we are going to make it fair, the taxes should be levied based on how many times you went to a covered doctor during the previous year. And an additional tax will be levied for Emergency Room visits. This will help to minimize the wasted trips to the ER because they didn't want to wait for an appointment.
The down side to this is that, at least where I am at, the majority of the people in the ER at any given time are Medicaid patients who don't pay taxes anyway.
They tend to flock to the ER because they will be seen and they will be treated and they will not be asked to pay. No one can be refused treatment in an Emergency Room.
Social programs are great for helping people get back on their feet. They are not meant for people who won't get off their @$$ to better themselves.
Any attempt at socialized medicine or national healthcare or universal healthcare or whatever name it has this month is just going to widen the gap that already exists between the people that are trying to provide for themselves and those that hold their hands our and wait.
A lack of planning on your part DOES NOT constitute an emergency on mine!
Why would someone on medicare and someone who has no money be in emerge more than a rich person?
Because trying to get into a doctor that accepts Medicaid can result in a wait of 2-3 months. Its much faster to go to the ER for every little thing.
There is one situation that I remember hearing that happened in Oregon. A woman on Medicaid tried to make an appointment with her gynecologist for a yeast infection. They told her it would be about 2 months for an appointment. She then got the idea to go to the Emergency Room. When she got there, there was about a 12 hour wait. She left the ER and went home. When she got home, she called 911 and had an ambulance sent. I don't know what she told the operator when she called, but the ambulance was sent and she was taken to the hospital and seen immediately for her yeast infection. Total cost to her, $0. Time saved, 2 months.
The system is definately broken. But bringing everyone down the the lowest level is not going to fix it. When everyone has a government ordered insurance plan, then everyone is going to have to deal with this type of situation.
A lack of planning on your part DOES NOT constitute an emergency on mine!
So ignoring the problem or removing medicare, that is a better solution? It seems that these individuals have a problem and are looking for a solution.
I hope you are not one of those people who decide to throw out a whole car when you only have a punctured tire. Fix the problem, don't throw everything else.
Why don't the US gov take a couple billion from the money they are printing up for GM, and pay for the few that have preexisting conditions? Why take over the intire medical industry? I guess it's the democratic way. Take over the banks, auto manufactures and now the medical industry. Who cares about taxes we want to own it ALL?
Why don't the insurance companies do what they are paid to do, instead of hiring people to investigate all medical claims? Why is it that someone who pays over $10k a year for medical insurance is being told that they cannot get medical treatment. They were responsible, they followed all of the rules, they are no agent of welfare who was not prepared.
Maybe they were not prepare enough and on top of the $10k a year they paid for insurance, they should have saved $10k a year for contingency. Is that the system you want? Where all of your salary is spent on taxes to Insurance Companies? Yes, it is a tax. It is just one you pay to a private business versus the government.
I didn't vote, since the choices are all the same.
If I pay as an individual, I end up paying for my healthcare or for my insurance.
If all employers pay for healthcare or insurance, the price I pay for goods and services will be higher, so I end up paying for my healthcare or for my insurance.
If the government pays for healthcare or insurance, my taxes will be higher, so I end up paying for my healthcare or for my insurance.
What's the difference?
My feeling is that if you take all the money currently being spent on direct-to-provider payments, insurance premiums (by employer or individual), taxes, throw in the tax deductions exploited by using helthcare benefits as compensation, and remove the obscene profit and overhead of healthcare insurance and pharmaceutical companies, and add some inflation control, we consumers will come out ahead.
:cheers:
Wow. Sounds like the best, right, and most cost effective solution would be to see ALL patients in a timely manner.
I haven't mentioned Medicare in any of my posts. Medicare is a totally different situation than Medicaid.
Medicare is intended to help those who have worked for most of their lives and retired to still have medical benefits. Medicaid has become a substitute for getting a job.
Why not go back to the days of Major Medical Insurance? If you have a cold, you go to the doctor and pay for the office call out of pocket. If you are in a car accident or have a heart attack or come down with Ebola then the insurance company kicks in, for major injuries or illnesses.
If the insurance companies were removed from the equation, the cost of most routine medical care would drop like a rock. A doctor would much rather see 50 patients per day each paying $50 cash than seeing 50 patients per day and paying someone to file the insurance claims, half of which will be denied the first time for some reason, that will ultimately pay $40 for the office visit. Again, oversimplified, but you are looking at $2500/day without insurance vs. $2000 (eventually) minus $80 for the insurance filer ($10/hr x 8 hours) minus $100 for the billing coordinator to make collection calls minus $20 for letterhead, envelopes, postage, etc... to send out notices for delinquent accounts. Leaves $1800 income per day with insurance company involvement.
Last edited by bob_f_aboc; 07-21-2009 at 08:43 AM.
A lack of planning on your part DOES NOT constitute an emergency on mine!
I don't believe this. Sounds like one side of the story.
That's not gonna work, in bobs example it's the ones that don't go often that subsidize the ones that do go often, if we put all the high risk patients on one plan the thing will go bust fast, the idea of a government system is so that instead of corporate beuracrats we will replace them with government beuracrats. I don't know if it will work, but I'm game to try it and see. Of course if it doesn't work lets try something else, I'm kinda like For-Life on this one it'sa broke lets do something, but I also see the flaws in this plan.
It doesn't help that the corporate health plans are throwing gobs of money at our government to try and keep the status quo when they could just be using thta moneyt o run the system more efficiently and actually pay for their patients care.
Although the medicare system is broke they do have the lowest administration fee's and this is what is scaring the big insurance companies if they had to operate ont he same administration fees they'd starve and so would their investors.
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If Medicaid is a substitute for getting a job, then it's not Medicaid that's broken, it's how we compensate workers. Maybe if they could make a living with a job, including healthcrare, they'd get a job. Until then, it'll be a problem. Remember this great post?:
Yeah - who can live on $1800 a day? ;)
At least they'll be not-for-profit beaurocrats. :idea:
$1800/day x 5 days per week x 52 weeks per year - 9 holidays = $451,800
$451,800 - $60,000 ($5000/month) rent
$391,800 - $48,000 ($4000/month) equipment financing
$343,800 - $48,000 utilities, office supplies, etc...
$295,800 - $26,000 ($12.50/hr) billing coordinator
$269,800 - $20,800 ($10.00/hr) insurance filer
$249,000 - $120,000 ($40,000/year x 3) nurses
$129,000 - $83,200 ($10.00/hr x 4) front desk, lab tech, janitor, etc...
$45,800 Doctor Salary with ZERO DOLLARS re-invested in the business.
Makes med school seem worth it, huh?
A lack of planning on your part DOES NOT constitute an emergency on mine!
You're counting things twice! You're also overstaffed. This practice does at least 60 exams a day, with an office manager, a receptionist, a tech, and an insurance/letters/etc. person. And me. And I deliver more than twice your net to the doctor, by myself, from the dispensory.
FWIW Medical Insurance is NOT the same as Healthcare. In fact Insurance companies have a fiduciary incentive to deny healthcare as much as they can. Furthermore these companies are actually rewarded by the financial markets when they pay a lower percentage of their customers' premiums out for claims. It's called the Medical Loss Ratio (aka, 'Your loss is our gain'.)
Second there is no 'free market' in medical insurance. No one can freely shop around for insurance and companies do not have to compete for our business. I cna choose which store I buy my groceries from. I cannot choose a medical insurance company.
Given these factors (not to mention the cost and results of healthcare in the U.S. vs. other industrial nations) I have trouble understanding how anyone can defend the current fiasco that is the U.S. 'healthcare' system.
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$1800/day x 5 days per week x 52 weeks per year - 9 holidays = $451,800
$451,800 - $60,000 ($5000/month) rent
$391,800 - $48,000 ($4000/month) equipment financing
$343,800 - $47,000 utilities, etc...
$297,800 - $120,000 ($40,000/year x 3) nurses
$177,800 - $83,200 ($10.00/hr x 4) front desk, lab tech, janitor, etc...
$94,600 - $35,000 Office Manager (I forgot about this position)
$59,600 Doctor Salary with ZERO DOLLARS re-invested in the business.
Makes med school seem worth it, huh?
Corrected to account for double figures.
How is this over-staffed for medical office?
A lack of planning on your part DOES NOT constitute an emergency on mine!
I can only tell you our staffing for this medical office. No need for 3 nurses, a janitor, etc.
Because that situation is not competitive and will leave Americans with larger health bills.
It is a constant story posted from many different people. When you have insurance agents and not doctors determining what tests you need, there is a problem.
I mean we always talk about bureaucratic governments, but what about bureaucratic insurance companies. I work for the Ministry of Health and we have less staff than I hear the insurance companies in the US have.
One more insurance issue to add.
I just received a letter in the mail from my health insurance company today. In it they explain that due to the high cost of prescription drugs they are changing the Rx policy. Our plan was set up with $10 generics, $40 'formulary' brand name drugs, and $50 'non-formulary' drugs.
The new policy is $10 generics and the only brand name drugs covered were listed on just over half a page. If your brand name medication is on the list, you will pay $40 or 40% of the retail cost, whichever is higher. If your brand name drug is not on the list, you will pay the full retail price with no insurance coverage.
Luckily, the 6 different medications that my daughter has to take every day are all available as generics. However, there are no ophthalmic brand name drugs anywhere on the list.
The letter goes on to say, (paraphrasing) if the medication that you take is not listed, speak to your doctor and request to have your medication switched to one of the covered brands.
I couldn't help but notice that about 75% of the covered brand names were from a single manufacturer...coincidence??
With health insurance like this, we don't even need doctors. Next time I'm sick, I will just call the insurance company and ask what they want me to take.
Just something else that points to the fact that insurance companies are what is ruining healthcare.
A lack of planning on your part DOES NOT constitute an emergency on mine!
Exactly. It amazes me when someone runs in horror at the thought of a 'government bureaucrat' determining what treatments you can have (which is a red herring that is not even something being considered) but they are perfectly happy having a insurance company bureaucrat make the same decision (which is EXACTLY what we have now.)
Let's compare the - Government bureaucrat who's ultimate resonsibility is to the taxpayer.
Or the Insurance company bureaucrat who's responsibility is to the shareholders of the company who reward them for not paying on claims (see previous link about Medical Loss Ratio.)
Anyone who prefers that latter is hopeless.
As for the bogus 'free market' claim there is no free market in healthcare in this country. Anyone making that claim either is lying or does not understand what a free market is. If there were then Medical Insurance would actually be equivalent to Health care (it isn't) and I could shop among many different companies who would compete for my business based on price and services (I can't and they don't.)
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I get daily health clippings, here is one of them. In this one, it is interesting because it criticizes the Canadian system, but also offers ideas on what route the US should take. Also, I know that me being a Canadian and commenting on the American system can be annoying. But I think it is because I do not see people as Canadians or Americans, but people, and I just want people to have the best system.
Much to learn from our health care; If Obama looked at our
successes and failures, he could avoid making the same
mistakes
(The Toronto Star)
IDNUMBER 200907190009
PUBLICATION: The Toronto Star
DATE: 2009.07.19
EDITION: Ont
SECTION: Opinion
PAGE: A15
ILLUSTRATION: PAUL LACHINE NEWSART;
BYLINE: Tom Campbell
COPYRIGHT: © 2009 Torstar Corporation
WORD COUNT: 999
CIRCULATION: 439982
As President Barack Obama drafts his health−care plan, he could profit from reviewing the successes and shortcomings of the
Canadian system that has operated successfully for more than 40 years. Canada spends more than a third less per capita on health
than the United States and still covers everyone, whereas the U.S. system leaves 46 million people without insurance.
Since our health statistics are markedly better, average Americans would be healthier and live longer if they lived in Canada.
Here, doctors do not have to waste time seeking insurance approvals. Medical need is the only requirement and pre−existing
conditions don't matter. The reduction in the bloated overheads and bureaucracy among insurance companies and government is
one of the secrets to our lower costs. If the U.S. were to copy this, it could save $1 trillion a year and cover everyone. The lower
costs would also help make employers more competitive.
In our system, wait times have been the largest complaint but some progress is being made. We do have a good referral system,
which means that urgent cases mostly get treated in a timely fashion, hence our excellent health statistics.
The Canadian health plan remains our most popular government program. However, if we could start over, we could transform a
very good system into a great one. Our main obstacle to reform is the very success of the system to date. Politicians admit
privately that reforms are needed but they hesitate to speak out. This does not make for thoughtful debate.
Most problems stem from one cause. From the beginning, we ignored advice and made taxes the single source of funding. But
there never are sufficient revenues for an open−ended system. This is why we struggle with scarcity of staff and equipment.
While the U.S. probably spends too much on health care, Canada needs to spend more. We have to pay the price if we want a
first−class system.
Our system, while very good, is due for an upgrade. But it is not realistic to expect Canadian governments to increase their share.
Health−care costs have been climbing to the point where they are crowding out other essentials such as education and welfare,
which are also important determinants of health and happiness. Increasing taxes is not recommended as Canadians are already
overtaxed. If we want our economy to thrive so we can afford these services, we have to be sensitive to these issues.
When the government is the only payer, it rules out market signals that improve service and efficiency. We provide free coverage
for minor services so we don't always have enough resources for timely major services. A more sensible system, while excluding
no one, would include co−payments for front− end costs up to a reasonable maximum, depending on the patient's ability to pay.
Only an adequately funded universal health plan can protect all of us from major and catastrophic occurrences. But there will
never be adequate funding if we continue to rely solely on government to provide for every minor expense.
Co−payments based on income would introduce a new source of funding to remedy this imbalance. It would encourage improved
service rather than rationing. It would offer incentives for patients and providers to do the right thing. The more affluent would
pay modest co−payments so the system could provide first−class service for all, rich and poor alike. This proposal would set the
top co−payment at $2,500 a year for those earning more than $100,000, tapering to zero for those with incomes less than
$25,000. In comparison, U.S. private premiums can be $15,000 a year plus co−payments.
Existing levels of tax funding should remain as a floor upon which the system can be upgraded. Funds should be distributed the
same way as university funding through an impartial commission. Government's role would then be to set standards, which it can
do well, rather than to micromanage, where it is not so good. New revenue based on service provided would create an incentive
for hospitals, which now receive global budgets, to provide more timely service rather than rationing it through wait times.
New sources of funding would empower Adam Smith's concept of the invisible hand that matches services with resources.
Waiting lists would be reduced as hospitals could use their facilities more efficiently. Surgeons, who now complain of lack of
operating room time, could treat more people. Additional funding could make possible a major drug plan and keep pace with best
equipment and practices. Surveys have shown that the public, while supporting our system, is aware that it needs upgrading.
These changes would make our public system more efficient and faster to respond. However, private health−care providers,
unlike now, should be permitted to compete. Restrictions now placed on the ability of citizens voluntarily to access private care
are a violation of our civil rights.
The United States has an opportunity to make a fresh start. While the Canadian system, if applied to the U.S. and pro−rated for
the larger economy, would save it a $1 trillion a year and cover its whole population, the U.S. reforms now being considered
could cost an additional $1 trillion over the next 10 years. These higher costs will represent an enormous additional burden on
employers and taxpayers.
Obama's expressed hope that his health−care plan can be budget neutral will, in all probability, prove illusory. In the current
unprecedented climate of spending and deficits, Americans would be wise to consider the economies that are available in a public
system similar to Canada's. While America's ultimate system may end up quite different from ours, it would nevertheless profit
from thinking carefully about what works in our system and what needs improving.
Tom Campbell is a former deputy minister of health and deputy minister of treasury and economics for Ontario.
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