I find it just wonderful that conservatives are still pulling out the “A government bureaucrat between you and your doctor” canard in their fight against health care reform. I guess I can see that argument working during the Clinton years, when things weren’t quite as bleak as they are now (although, being a teenage dependent with two well-off parents, I never had to worry about health insurance during the Clinton years, so what do I know?). But relying on it again now? Balls, folks: that takes some.
For a little under twenty years, I’ve been dealing with chronic pain. (No, not my back problems. I’m going to refrain from discussing my specific condition itself in order to keep the focus on the politics.) Because this condition is hard to diagnose and often misunderstood, I’ve gone without treatment for most of my life. In fact, the only two times I’ve had regular treatment for it were in college and grad school, when I had the twin luxuries of student health insurance and autonomy from my parents. In college, the doctor I found was well-meaning, but ineffective. In grad school I had a great doctor, and together we started to make progress. But then I finished grad school.
For about a year, I went untreated again until a flare-up made me realize that I needed to find a doctor despite the cost. My husband and I did some budgeting – I currently subscribe to Blue Shield’s cheapest plan, which only covers basic exams and major disasters – and found a doctor who charged a sliding scale. She was awful. For a few months, I went untreated again, and had another flare-up. It turned out that a friend of mine has a similar condition, and she gave me the name of her specialist.
Here’s where the story gets interesting.
I made an appointment with the specialist – and loved her. Within ten minutes of our first appointment, she’d described my condition with eerie accuracy and outlined what sounded like an effective treatment plan, with options that I’d barely even known about. Her bedside manner and level of expertise were terrific; she put even my grad school doctor to shame. At the end of the appointment we talked money. My current insurance didn’t cover regular office visits, so I’d be paying completely out of pocket. I gulped at her office visit fee – even paying for that first appointment was going to be interesting. I talked to my husband and we agreed that I’d have to get a new insurance plan. If we ditched the cable, the Netflix subscription, and a couple other amenities here and there, we could pay more for something better.
I looked at other Blue Shield plans while my husband looked at Kaiser. I figured that while I was getting a new plan, I might as well search for something that covered maternity. I looked at plans going up to $200, $250 a month – nope, nope, nope. Blue Shield doesn’t like its members having babies.
Meanwhile, my husband found a Kaiser PPO (at least, we thought it was a PPO, but I guess that’s kind of rare for Kaiser) just barely within our price range. It was $139 a month – yikes, but okay. It had a fairly good maternity plan. We called their office to find out if this doctor was in their network. They didn’t know. They gave us a regional number to call. We called. No, this doctor was not in their network.
Next we tried Blue Cross. I don’t even remember what plan we eventually found, because the whole website was so labyrinthine. We didn’t bother calling them before we filled out the form because, hey, everyone takes Blue Cross, right? The application took all morning – and we even left off in the middle because I needed to dig up some old information.
Later that day, I talked to the doctor to reschedule our next appointment, since it was taking so long to find a new plan. I asked if she took Blue Cross (just to be absolutely sure – because everyone takes Blue Cross!). “Uh, some of their plans,” she said. “I don’t know, some but not others. It’s all very strange. I don’t even handle that part of it.”
We called Blue Cross. No, the plan we’d selected didn’t cover her. Were there any plans in our price range that did? Tappa tappa tap, pause. No, there were not.
So we went back and called Blue Shield, told them I was already a member. We asked for any plans at all that covered this one doctor. Damn the cost! We’d use our savings! We’d move into a smaller apartment! We’d rob a bank if we had to! What was the doctor’s name again? We spelled it. Nope, they said. Blue Shield of California does not cover this doctor at all.
We called the doctor again, canceled the appointment, told her we just couldn’t afford her. I still owe her for our first (now useless) meeting – $150 down the drain. I cried, I was so disappointed. All that work, all that hope, for nothing.
I’ll probably never know why no insurance plan would touch her. She wasn’t some bizarre, esoteric practitioner or anything; my best guess is that only employer-paid plans cover her. But when I hear conservatives trotting out the specter of “a government bureaucrat between you and your doctor,” I have to laugh. Because right now, at this moment, I am gritting my teeth through 20-year-old pain while the doctor who could have treated me goes about her business 2 miles from my apartment. Bureaucrats are standing between me and my doctor.
On the one hand, if conservatives are going to try to block affordable health care, the least they could do is come up with a less insulting argument. On the other, I guess it’s to my advantage that they’re making themselves look like total idiots.
We’ll go ahead and give Pacificare and Aetna a call, but I think my course of action now is to go for the original Kaiser plan we found and hope that there’s a doctor as good as this one in their network. (Of course, the maternity coverage raises some troubling questions. Does Kaiser have midwives? Doulas? Birthing centers? Will I have to give birth on my back? But I’m not pregnant, so I can cross that bridge when I come to it.) If we ever get a national health plan in place, then sign me up – but I’m not holding my breath. My one wish for those who oppose it is that they someday experience health insurance that is comparable to mine.
(A note on comments: because I know what types of comments posts like these tend to receive, I am declaring myself Queen Tyrant on this thread and will delete offensive comments without warnings or justification.)
(Cross-posted at Modern Mitzvot.)
I can understand why you’d be unhappy that the private insurers aren’t willing (for whatever reason) to cover this particular doctor. What makes you confident that a government insurer isn’t going to do the same thing? The private companies seek to control costs because that adds to their profits and so that’s the incentive tied to management’s compensation and promotion. The government agency is going to seek to control costs because that improves their political position in seeking funding every year and so that’s the incentive tied to management’s promotion and career prospects.
Both types of entity are going to seek to control costs, and (assuming there is some cost-related reasoning somewhere in the insurers’ decision not to cover this doctor) I don’t see any reason to think the government insurer is going to be any more generous.
I don’t think there’s any provision in the proposed public plan to do the sort of “network” that’s keeping Julie from seeing the doctor she wants. (AFAIK) And in most of the wealthy world, people have a lot more freedom to see the doctor they want to, then we do here in the states (assuming we rely on insurance).
So yeah, it’s possible that a government insurer would do the same thing. But there’s no reason to think it will.
Today on Talk of the Nation they discussed health care.
A caller phoned in to make two points:
1) Insurance has got to stop paying for unnecessary treatments, like (MRIs for dizziness, or something?)
2) The government can not tell doctors how to do their jobs.
The total disconnect between points 1 and 2 almost took my breath away.
Purely in the interest of getting you treated, go to her office and ask to talk to her billing specialist. The specialist will know which plans will cover her.
So. I know everyone has really bad experiences with kaiser, but I have always had really good ones. I think this may be because I’ve always been covered with really good corporate care, so I can’t really speak to the bureacracy covering people who aren’t in group plans (or who are paying for less care than we get through Mike’s / I got through my dad’s employers).
However, IME, specialists tend to be universally good. Kaiser may not be a bad thing, ultimately, though of course I wish you could have worked with the person you already knew you were comfortable with.
Also: It may not be that Blue Shield of California won’t take this doctor into their network.
It may be that their reimbursement rates are so criminally low that the doctor (or her group practice) has opted not to participate in the plan.
When I had a private practice as a therapist, it was bad enough that most plans tried to convince me that $65 or $70 an hour was the “usual and customary” rate for my area (I shopped for my own, out-of-pocket therapist: I found people charging between $125 and $200 an hour. I charged $90). The plans that wanted to reimburse me $45? Forget it. The time I spent just managing billing and reimbursement tracking and the endless, endless phone calls when one (or two, or three) of the plans I did deal with ate into my bottom line so badly that my cash clients were essential to help cover the administrative costs of the insurance clients. Taking on more plans, with even worse payments, was a total loser of a proposition.
And THAT’S why health care in this country costs so much, right there. Because one part-time therapist seeing 8-15 clients per week, participating in only 3 insurance plans, was drowning in administration. And my weren’t there a million people willing to sell me services to “take the paperwork off your hands,” but that would have eaten even MORE into my productivity. Given that I had to cobble together my income with two other jobs, I was already working upwards of 50+ hours a week much of the time. I couldn’t take on more clients because I couldn’t fit any more in around my more stable income sources, and since sometimes it would be months between the time the client came to therapy and the time I actually saw a check for their visit, I had to have regular income in order to make sure my bills (including my business insurance, my office rent, etc.) got paid on time.
The more plans you take, the more nightmare it turns into, and the low-paying ones just aren’t worth it to many providers.
Oh, and I decided I couldn’t afford my own therapist.
What makes you confident that a government insurer isn’t going to do the same thing?
Anecdote warning, but here’s my experience as a provider with government systems (Medicare, the VA) versus private insurance: Government institutions couldn’t care less. If you have the paperwork they’ll approve the visit, test, treatment plan, side trip to Mars, whatever it is. If you don’t, forget it, there’s no way it’s going through. But if you have the correct and correctly filled out paperwork saying that this is what’s supposed to happen they’ll do whatever it is, whether it’s approving the MRI or stripping to a G string and yodelling. (Ok, I’ll admit I’ve never tried to get the second and am not sure what paperwork it would involve…)
Private insurers on the other hand do care. About their bottom line. So they have a motive to NOT approve the visit, test, etc. You can do all the paperwork properly, jump through any hoop they demand, and fetch a shrubbery and still be refused. Because it’s in the interest of the company to refuse.
I’d rather deal with a faceless government bureaucrat than a malicious faceless private insurance bureaucrat any day. Especially if I can find the G string and yodelling form.
Addendum to above: I realized after hitting “post” that the comment could come off sounding like I’m not taking the patients’ problems seriously. I am. The reason I’m making flippant comments about bureaucracy (any, private or public) and the inevitable problems that they cause to efficient medical care is that a macabre sense of humor is all that keeps me from screaming and swearing at the bureaucrats, which is really just never productive. As I can tell you from personal experience. Better to make fun of them in the privacy of one’s own mind or to friends than to annoy them and end all possibility of making progress.
Anyway, I want to apologize if my comment caused Julie or anyone else distress.
Living in a country with universal healthcare, I have full access to any damn specialist I need – all I need is a referral from a GP. If I didn’t have a referral but I had buckets of cash, I could still see them and pay for it. As Diane says, if you have the paperwork – which is pretty simple – you can do whatever you need, and it’s paid for. Only, for me, it covers 99% of all doctors – there are a few who opt out of the system entirely and work only through private hospitals, but that’s unusual.
Why *wouldn’t* you want a system like that? It’s not perfect, mostly because of underfunding, but it’s about a million times better than the US.
In order to be a covered doctor, many practices have to agree to various other strings from the insurance companies: both regarding what they will or will not treat (i.e. things which affect their medical judgment) and how much they get paid (generally unrealistic.)
Successful practitioners with a large and wealthy client base will often simply refuse to take insurance. It is just too much of a pain for them, and/or loses them to much money, and/or they don’t like the oversight.
However, you may want to read your policy more carefully. Sometimes you can get “reimbursement” coverage, where you pay the doctor directly and then you get reimbursed for some portion of their services. This can permit you to see an out-of-network doctor, IF you are willing to shoulder the initial payments and IF you are willing to do the slog of attempting to get reimbursed.
I will second Dianne’s comment; I am covered by my husband’s government-supplied insurance plan, and I also have chronic pain of a difficult and elusive nature. I see a pain specialist every two months (mostly to keep up my scrips, since I’m on some controlled stuff), I get covered for almost everything, including dental, I get to see whom I want (no fuss about who takes the plan or not), Rx is covered, and I’ve never had a problem with a referral.
I have to jump through some hoops (mostly because of the heavy meds), but overall, I get everything at a very reasonable price. It is infuriating and horrifying to know how many people are denied basic relief because of insurance companies who really don’t give a damn about anything but making money. The one huge advantage of the government insured is that it’s not for profit.
I’ve lived in the UK; my cousin lives in Canada. Both systems cost the government less than the insurance company subsidies here. Everything the repubs are claiming will happen? Already happens, but they don’t care because it only happens to other people, not them. *rage*
Like lilacsigil I live in a place with single payer health insurance run by the government.
I have never been told I could not see a specific doctor, or that a treatment plan would not be covered. The very idea seems ludicrous.
You’ve practically told my story, except – here’s the really sad part – I HAVE INSURANCE via my employer. When it comes to seeing a pain specialist, however, I may as well not, for they will not cover one.
Which strikes me as horribly ironic, since it’s the degenerative pain condition that will force me into early
retirementdisability and therefore onto Medicaid, instead of keeping me working and therefore paying the insurer premiums for the next thirty years.Robert:
While I realize that the US isn’t going to to adopt a single-payer health care system this time around, and as a Canadian I do recognize the problems with our system*, this is one problem that we don’t have. If I were in Julie’s shoes, I might have had to spend the same amount of time* finding a good doctor, but once found, I wouldn’t have had any problems at all sticking with her. One swipe of my OHIP card would be all it took. So that *is* a solvable problem.
*In addition to wait times for non-critical care, the lack of public coverage for dental and vision care is a problem, as is the spottiness of drug coverage: I wouldn’t trade my health care system for yours, but we can do better than we do, I think.
*I do live in a big city with numerous high quality doctors and hospitals, but I imagine that lesser access to a variety of doctors in rural settings is the same in the US?
What Dianne and Sailorman have said. I also second the idea of checking for reimbursement coverage. One specialist I see on occasion has this arrangement, and my insurance company reimburses me about 30%. Not perfect, but it does make it affordable when I need an office visit.
If there has to a bureaucrat standing between me and my doctor, I would much rather have a civil servant who doesn’t have a personal financial interest in denying my claim. Your standard G-6s are generally more interested in whether or not the paperwork is filled out correctly (therefore making their lives easier), not in denying x number of claims so they can go to Bermuda for vacation.
What I wonder about is lobbying.
With my employer-provided insurance, I know what the bottom line is: money. They want to save money. I know their motive in every decision, and while it’s a hard motive to fight, it’s stable.
I wonder whether government-provided health care (whether through payment or direct provision of services) will be affected by the latest popular (bad) science (like the obesity stuff going on right now), or by the latest lobbyist donation to the elected official in charge, rather than by tested and generally accepted medical judgment. The ambiguity and unpredictable changeability of standards of care frighten me. Is this an unreasonable worry? Have I missed something?
Do talk to the billing specialist of the physician you like. I was in a similar situation once (every member of an entire specialty in my entire service area stopped taking my insurance, because the reimbursement allowed for office visits was too low), and the office worked out with me that I would pay only a reduced fee, one that I could manage.
I wonder whether government-provided health care (whether through payment or direct provision of services) will be affected by the latest popular (bad) science (like the obesity stuff going on right now), or by the latest lobbyist donation to the elected official in charge, rather than by tested and generally accepted medical judgment. The ambiguity and unpredictable changeability of standards of care frighten me. Is this an unreasonable worry? Have I missed something?
Does this happen with Medicare? (Or Medicaid, CHIP, veterans care…) If not, why would it be likely to happen with a larger government insurance program?
I’m with Mandolin, I have also had good experiences with Kaiser. My dad had a long-term fatal illness and Kaiser paid in full ($200,000 a month) for my dad to be in a rehab hospital for a year and a half before giving him the boot– and let’s just say it was obvious by six months into the stay that “rehab” to get him back home was not really going to be doable.
Sure, they don’t pay for in-home care or when we had to put him into a rest home at $24k a month (that’s about where my mom finally was all, “okay, we can let him die now”), but that is darned good for insurance in this day and age.
@ Kai Jones
Simple answer: no.
In Canada, we have an (elected) minister responsible for the Health portfolio – but a platoon of unelected career civil servants run the show. We also have (relatively new) donation laws that really restrict what political parties can get for donations. (Also, realize that we are a Brit-style system – our ministers are sitting members of Parliament, not a separate branch of gov’t like your cabinet is. It is very much party-centered in terms of finances and finance laws: of course individual MPs get donations for their campaigns, but that can’t be counted as ‘outside’ the oversight of party finances).
It’s very much a canard to think government-provided care is more susceptible to ‘fads’ than for-profit care, as if we have no professional medical oversight or input at our disposal. We have the Canadian Medical Association, etc here as well. We don’t have to cater to for-profit companies in policy decisions. We can actually employ people to set policy based at least somewhat on the welfare of Canadians rather than the bottom line. (Now pharmaceuticals is another Q).
Understand, I don’t have to ask anyone to be able to show up at a doctor. There is no bureaucrat in my way – because I got my health card at birth umpteen years ago (just like a Social Security number) and never had to talk to anyone else but a doctor since. They don’t sit around at the Ministry and decide which doctors and which treatments are open to what people.
– until you get to the highest-risk surgeries level, when sometimes the gov’t will not pay for people to go to the US for highly experimental stuff costing tens of thousands of dollars, when in the opinion of several doctors there is not sufficient chance of success. Note that it is the opinion of doctors, not bureaucrats.
But here we’re talking routine doctor visits, pain specialists, and maternity care. That’s free and not subject to intervention like Julie had – just show your card at the door.
(That’s not speaking of dental/eye care – which is on an insurer system like the US. But being able to see a doc or specialist? Free and easy. You may, of course, have to wait to see that specialist depending on their bookings – like anywhere else.)
On saying that, health care $$ is routinely a political hot topic, though public opinion is firm on health care being a priority and obvious cuts are (now) usually met with outrage. (Doesn’t mean they don’t do things off the radar).
Just from the experiences I and my fiance have had, I wish we could move overseas. We both have chronic pain, varying mental health issues, and possible rheumatoid arthritis. He has intestinal problems, I have migraines. My mom (I’m 19) decided that she no longer wanted to pay for me on the insurance policy, which has been surprisingly good, considering all the crap my brother and I have gone through, and now I can’t afford to even go see my primary, not to mention my psychiatrist, neurologist, rheumatologist, and gynecologist. Now I’ve been diagnosed with HPV (despite having Gardasil) and need a biopsy, but guess what? Can’t afford it.
It’s going to be a fun few years.
Now I’ve been diagnosed with HPV (despite having Gardasil) and need a biopsy, but guess what? Can’t afford it.
Go to the nearest public hospital and get yourself signed up for whatever your state calls its medicaid program. Before you’re wondering how to pay for the cancer treatments. You may have one of the non-oncogenic versions of HPV, but this is not something to play around with.
I’ve been filing some claims lately and my insurance so far has been pretty good. It should be, I spend about half of my monthly income on premiums. But it’s paid everything so far even most of the bills for CBT sessions.
The pain in the butt part comes from paying the bills on the medical side and getting threatening letters that I haven’t paid when the payments take over two months to get processed due to their backlog.
That aside, I so envy my two sisters who live in countries with nationalized medicine. I had to seek medical assistance in one country. It was 20 minutes wait in urgent care and medicine that cost $10 there which without insurance cost $125 in the U.S. Recently, I spent three hours in an ER (weekend and Urgent Care was closed) and saw a MA for five minutes who asked questions and took my pulse. The bill was $1,200 and I was billed another $400 through an association of ER doctors on behalf of a doctor I never saw (who probably was supervising the MA). Thankfully insurance has dented down medical bills that without it, would be nearly $5000 by now.
My younger sister has an easier time with seeing a doctor in this country through her country’s plan than I or my U.S.-based family does. And I have a niece who’s training to be a doctor in one of these countries. My older sister lives in a country where you are beginning to have to pay more but it’s still a lot cheaper and there’s excellent medical care than the U.S.
I used to be covered by one of Blue Cross and Blue sheild’s barebones plans. I left them for greener pastures when I was able to get on better insurance via my job and then when I got fired, my husban’s insurance. I got a phone call from them a few weeks ago begging me to come back to blue cross and asking me if I’d be interest in a plan where every time I needed to go talk to a specialist I’d need a referal from my primary care doctor AND it would only cost me “30 copay for a regular physican, 40 for a specialist.” me “So that means I’d spend 70 dollars every time I wanted to go to a specialist which is pertty much all I do anyway is go to an obgyn to get a birth control perscription refil which by the way blue cross wouldn’t cover? yeahhh no”
In my experience, women’s health care coverage in particular is atrocious in the US, and is particularly tied in with the notion of the patriarchy deciding what’s in a woman’s best interest. Birth control hasn’t really made any significant advancements in 30 years despite the fact that it’s one of the more trying and constant issues in a woman’s life (hormone jags, bloating, weight gain, the list goes on,) and forget about what decisions are made for you when you want to have a child.
I wish you the best of luck, Julie, in finding, and being able to stick with, a decent care provider.
Add me to one of those who doesn’t get the whole “public health care puts a bureaucrat between you and your doctor” thing. I’m Canadian. Whenever I’ve moved, I could select any primary care physician taking new patients (admittedly a problem in rural areas) without calling an insurance company bureaucrat to see if that doctor was in the right network. Whenever my doctor has wanted me to see a specialist, she’s referred me. I just show my OHIP card, and the doctor gets paid. No insurance company pre-approval necessary. It seems to me that Americans are a lot more likely to find a bureaucrat between themselves and their doctors than we are.
We have always had insurance but every time we start to get ahead, we get broken by medical costs. Our 10 month old son had a bowel blockage on a Saturday morning which would have killed him by Sunday. The only hospital here with a pediatric intensive care unit was not on our plan. Some bureaucrat first tried to tell us that it wasn’t necessary surgery, and then, after much fighting, they only paid 60% because it “wasn’t preauthorized”. This problem is the equivalent of a car accident – you can’t plan it. Thank god he was breast fed, because we were out of the hospital in two days rther than four. (it was the surgeon that told us that is why we got out so fast.)
I have chronic disease and know that if we ever have to change insurances or go private pay then I won’t get covered, even though my illnesses are manageable. But the stress of always being on the verge of financial disaster doesn’t help matters at all.
It has taken me 6 months of calling every week to get the insurance company to stop denying a claim that they *pre-authorized*. And that was with the physical authorization letter in my hand.
Come. On.
Why are the naysayers so unpatriotic? When did America become the land of “well, we just can’t figure that out?” We used to be able to look at challenges and solve them. Now we can’t even be arsed to improve on models that already exist?
Why are the naysayers so unpatriotic? When did America become the land of “well, we just can’t figure that out?” We used to be able to look at challenges and solve them. Now we can’t even be arsed to improve on models that already exist?
What’s unpatriotic, IMNSHO, is to trust the government. That’s what goes against the philosophy that guided the architecture of the Constitution.
To say that opposing the current health care plan proposal or to distrust government-run health care in general is equivalent to saying “well, we just can’t figure that out” is misdirection, I think. We can figure out how to make health care better for people in the U.S. without letting the government run it. That’s the problem I think we need to solve, not “how do we make government-centric health care work?”
As far as I can tell one of the main requirements would be that nobody has to change insurance carriers if they don’t wish to. As someone with a family member with chronic pain issues I can tell you that’s a nightmare.
Then there’s the fact that we’re looking at changing our HI carrier at work so we only have an 18% increase in cost as opposed to the 31% increase if we stay with our current carrier. The woman with cancer has called me twice today worried about the change in coverage. The second time she was in tears. Will her doctor be covered by the plan? Will her reconstructive surgery be covered? How about the drugs she needs to take for the next 5 years? This sucks.
My real life experience working in and around the HI industry – even working with the best insurance I could imagine in this country – has left me with no question that a universal, single payer system is far superior to anything that can be managed by private industry. 28 of 36 industrialized countries agree.
RonF:
Even if what you said were true, which I would contest, it still remains that:
if we have a health system entirely run by insurance companies for-profit (which I will stipulate for the sake of argument),
***the only way*** that that system will cover all Americans, actually pay for their care rather than just take their money and then use rescission to cut people out of their policies when they actually get sick, make care portable rather than job-dependent, make insurance companies cover the things they promise, get rid of the ‘pre-existing condition’ malarkey, etc etc…
is for… wait for it…
** government to regulate the insurance industry. **
So still, we are talking about government-enforced policy. And that is just if we do it the most expensive way, ie for-profit, all-corporate.
But as Jake Squid said, there are better ways to do it. They are all around us. Why do we refuse to look at them seriously, and then use our fabulous ingenuity to take the best of what works and apply it here?
I have a sister who is on Medicare due to disability. I really, truly wish my insurance worked anywhere near as well as hers does, or covered as much.
Or, to put it another way: we don’t need insurance. We need health care.
Well, yes, the healthcare industries currently are and will continue to need to be government regulated. But that’s a different story from government owned and run. Government can set constraints and requirements and let the private sector come up with creative ways to meet them. I trust them more than I trust Rep. Pelosi and her ilk.
I think that assurances from the current administration that you’ll be able to keep your present insurance if you like it better ring hollow. Those companies have to make a profit. As currently proposed taxpayer-supported healthcare doesn’t. Political forces will over time compel public insurance to cover more and more people and costs and simply take more and more tax money and dedicate it to healthcare purposes to the point that private insurance can’t compete. I realize that to many people here that’s not a bug, that’s a feature, but the Obama administration is saying that they’re NOT trying to put in a single-payer system and I think that’s a lie. It may be that they’re lying to themselves first, but it’s a lie nonetheless.
Want me to support government-run healthcare? Want to be honest when you talk about it providing true competition? Add this constraint to it, then; it has to at least break even. It can’t pay out more money than it takes in, and that has to include an honest accounting of administration costs, just like private insurance has to. And the money it takes in must come solely from premium payments (or investments thereof), not from tax revenues. Add to that the guarantee that everyone is still free to have private insurance instead and we’ll have true competition.
In passing I think that one essential part of any government-run health care plan would be that there would be one class of Americans that would be compelled to use it; every Senator and Representative. No special plan for them. Let them eat their own cooking and they’ll be a lot more careful about how they prepare it.
Although it’s not at all clear to me that a private insurance company has to be for-profit. It has to make a profit, of course, but that’s not the same thing. I used to work for a hosptial that was not-for-profit. They had to make a profit to be able to invest in themselves – build a new wing, buy another MRI machine, etc., etc. But they had no stockholders or partners to whom dividends or other profit distributions had to be made to, which in the U.S. is the distinction between for-profit and not-for-profit. I also wonder if the cooperative model could work for insurance. Everyone pays for insurance, and any profits over the needs of the company are distributed back to the policy holders.
The thing to me, though, is that what we need to focus on most is cost, and I haven’t heard much about that. Lots of complaints about how drug companies charge large amounts of money for drugs and how those prices should be driven down by government negotiations, but the comparisons of “here’s how much it costs to make this drug vs. what they charge for it” don’t seem to take into account the fact that a drug company has to pay for all it’s failed R&D – their dry holes, if you will – as well as the development and regulatory costs for the drugs that do succeed. What we don’t want to do is to choke off medical advances, which cost a lot of money to come up with.
RonF,
But that’s a different story from government owned and run.
If we’re going to be honest, who is proposing that the government own and run health care facilities? Does Medicare entail the government’s owning and running health care? (Most of my dad’s patients are Medicare-covered; he’d be shocked to discover that he’s actually been a government employee all this time simply because he accepts Medicare-insured patients as well as folks with other insurance, and sometimes folks with no insurance — he’s been paid in catfish before.)
If you have a concern about the health care reform proposals, perhaps you should cite which one you’re discussing (the House bill? the Senate bill?) and precisely which bit worries you. Otherwise we get into misleading stuff like “government owned.”
In passing I think that one essential part of any government-run health care plan would be that there would be one class of Americans that would be compelled to use it; every Senator and Representative. No special plan for them. Let them eat their own cooking and they’ll be a lot more careful about how they prepare it.
What health plan do you think Congress is on now?
Like everyone else, members of Congress (and their staffs) are required to buy a health insurance plan through their state exchange, or the Federal exchange. Unlike everyone else, though, members of Congress and their staff receive a huge subsidy for their premiums, $5000 for individuals and $12000 for families.
In fairness, that is roughly the amount that the government was subsidizing them before the ACA. The optics of that arrangement weren’t great then, and are worse now.