Comments (66)

1. I’ve always been amazed/confused by the differences between mental and physical health coverage. There are mental health parity laws in some states that require coverage to be equal, but in many places you’ll find yourself very limited should you need some kind of mental health care. I’d be interested in more on this topic — why is there a difference, is this difference eroding over time, etc.?

   posted by Higgins on 9-13-2007 at 11:50 am

2. I’m curious as to how socialized health care is funded, exactly, in countries that have it. Their taxes are higher, right? But are they so much higher that the people end up paying more than they would for insurance? The straight math of it is what I need explained.

   posted by Megan on 9-13-2007 at 11:55 am

3. I’d like to know what can be done to keep our emergency rooms from being used as primary care facilities.

   I’d also like to know if people believe that they are entitled to unlimited health care and where they are willing to draw a line.

   posted by Karen on 9-13-2007 at 11:58 am

4. Why is dental care neglected when we know that dental problem can be a red flag of other problems and untreated dental problems can cause serious physical problems?

   Why are we eager to treat pregnancy but afraid to help prevent it?

   Why does it take a celebrity and overpaid lobbyists to get funding for serious illnesses?

   posted by Cathy on 9-13-2007 at 11:58 am

5. Health care costs have increased much higher than inflation and other costs over the past 10, 15, 20(?) years, how is the way our Health Care system set up driving the costs of health care and health insurance up so much.

   Who are pharmacy benefit managers and why are they making so much money?

   What are the arguments for and against a government-provided health care system? See Canada, England, Holland and other countries.

   What are the arguments for and against our current insurance system?

   What is COBRA? How does Medicare work? Aren’t there Medicare A, B, C and D, or more? What are these? Should I count on it when I’m 65?

   posted by Michelle on 9-13-2007 at 11:59 am

6. As a physician who has chosen to work outside of the insurance / non-reimbursement system, I can answer many questions for you from that perspective.

   My biggest question is that while the current for-profit insurance system seems to be broken, how can we expect a single payer (read government-run) insurance to work any better than Medicare, Medi-caid or even the VA system? Is there a way to take Capitalism and Profit for denying insurance coverage out of the equation and actually just take care of people?

   posted by Karen Hansen-Smith, MD on 9-13-2007 at 12:06 pm

7. I’ve become incredibly cynical with this whole issue – insurance companies picking and choosing what constitutes a disease or person “worth” treating; scientists so self-absorbed in their labs “discovering” something new that they discount all that came before and all that will come in the future; doctors who have become little more than mechanics; pharmaceutical companies buying “science”, doctors and patients….

   What would be interesting to me would be to show the evolution of treatment for certain diseases – maybe both psychological and physical, or evolution of medical advice.

   This would be especially interesting for advice that’s come full circle. I’m a strong advocate of breastfeeding and am fascinated how, within a generation, so many physicians could convince their patients that something made by a factory could seamlessly replace something our bodies produce, and how hard it is for the next generation of physicians to go back and say, “whoops, maybe ‘breast is best’.” For many of us with children now, we’re finding the hardest time getting information and support on nursing our children from our own mothers and older women in our families.

   I’m sure you wanted tirades when you posted this, right? ;-)

   posted by Debi on 9-13-2007 at 12:08 pm

8. I know that there are some state run health care insurance for low income/working poor (but not midicare/medicaid) CHILDREN that include well care. Will we ever have a national ‘No Child Left without Healthcare’ in the same manner we have the ‘No Child Left Behind’ policies?

   posted by JaneM on 9-13-2007 at 12:16 pm

9. People who are self-employed get shafted when it comes to health insurance. What are our rights, and what can we do to get a decent insurance rate?

   posted by Downchez on 9-13-2007 at 12:17 pm

10. Why do I have to wait so long when I go to the doctor’s office. Even if I make an appointment first thing in the morning and call ahead to see if they are running on time, I always end up waiting for 45 minutes. And when they do finally call you, they lead you to a room and have you change out of your clothes only to wait another 15 minutes for the doctor.

    posted by jdp on 9-13-2007 at 12:40 pm

11. What level of health care do death row inmates get? How does that compare to Medicare and Medicaid?

    posted by Charles on 9-13-2007 at 12:41 pm

12. I used to temp for an HMO so I have a little insight into the “physicians hating” p.o.v.
    HMOs pay physicians a flat fee for all the folks enrolled. So if you have a lot of healthy 23 year-olds, it’s profitable. If you have a lot of cancerous 50-somethings, not so much.
    The incentive pushes towards minimal treatment, minimal involvement, etc. because the more time, the less profit.
    Hope that points you in a useful direction.

    posted by Drew on 9-13-2007 at 12:50 pm

13. I came to this country from Canada a few years ago, just in time to work on an HMO Y2K project where I learned quite a bit about how the insurance companies with their proprietary software, hardware, and claim coding systems/knowledge requirements contribute heavily to what are horrendously high adminstration costs for American healthcare.

    My question therefore is why have I never heard any politician discuss any really viable approach to making healthcare really affordable for Americans – such as a) requiring all insurance companies to use the same codes for the same conditions b) requiring all insurance companies to allow doctors/hospitals to use the same software (and hardware) for submitting insurance claims and c) streaming all claims through a central data center of some kind which could be used to monitor insurance claim denials, etc. All I ever hear are vague but radical suggestions (such as full-out nationalization) or, more usually, just platitudes like ‘I/my party will fix this’.

    I don’t espouse a ‘nationalized’ healthcare system in the US (like those in Canada or the US) because the mentality here (which I would term extreme capitalism) would probably make that not a viable solution here, but, I do resent paying $750 a month for health insurance that pays for less than I could get under a nationalized system, especially given that I know the costs could be significantly reduced for all of us with some ‘relatively’ simple, innovative steps.

    And to partially answer one of the questions above about the costs of ‘nationalized healthcare systems’ (where there are problems definitely but the admin costs are very low compared to those in the US!), while the taxes may be higher to pay for those systems, the chances that the costs can skyrocket and that the government can/will then increase your taxes astronomically in any given year are very low vs the very good probability that healthcare costs can skyrocket any time the insurance companies want them to (and they have been without any real protest from Americans as far as I can see). To be honest, I believe I pay a lot more for taxes+healthcare here in the US than I did (a few years ago) or would (now) for taxes which included healthcare in Canada, and I would rate the service/availability about the same.

    posted by Deryn on 9-13-2007 at 12:54 pm

14. How much money is spent to treat the diseases of the few? Could this money be better distributed to provide preventative care? At what point are we willing to die or let family members die? Should/does/in what way does money play a role? In what way do advocacy groups like the American Heart/Cancer/Diabetes/Whatever Association play in generating dollars/public concern for diseases? In what ways is this detrimental? How can health care costs be reduced? More money spent on better food, exercise, wellness activities (yoga, tai chi, meditation).

    posted by Adam on 9-13-2007 at 12:55 pm

15. There is a pressing need in this country for more organ donation. Nearly every other country has solved this problem by using a “presumed consent” system which simply means that unless a patient leaves instructions to the contrary, their organs and tissues are harvest for transplant. There have been few if any problems with this system. The US, however, has a system in which even if the patient has left express wishes to be a donor, the family can opt out of donation for them. So that little heart on your license means nothing if any member of your family says no. There is also a great lack of minority members donating as well.
    Why hasn’t the US, a medical powerhouse, adopted the presumed consent policy?
    Thousands upon thousands of lives could be saved using this system.

    posted by Jenny on 9-13-2007 at 12:56 pm

16. Q) How does the American healthcare system compare to those of other countries? Is there a better model we can follow?
    A) From what I have heard, Canada GIVES health care to it’s citizens. One would think this in turn would take the insurence companies out of the diagnostic and treatment business (which is completly based on immediate financial outlay rather then proper treatment and long term effect)thus allowing Physicians to treat people based on the illness rather then the coverage!

    posted by Tommy on 9-13-2007 at 12:58 pm

17. I work for an HMO. I can tell you one reason Doctors don’t like the HMO arrangement. Doctors get a monthly stipend for every patient assigned to them by an HMO plan. If a person enrolled in an HMO plan doesn’t utilize the services of their health care provider frequently the doctor profits from that individuals lack of utilized health care. If too many of a health care providers HMO patients utilize their health care benefits the provider still receives a fixed amount of compensation which may not meet the providers costs for the treatment. The system is setup so that the healthy members should cover the excess incurred by members that require more service. If too many members assigned to a health care provider utilize services the provider will incur a loss.

    Some of problems getting a working socialized medical system in the USA is plain unadulterated greed. Some of the problem with socialized medical care in the USA is that many people are reticent to give up any portion of their wealth or potential wealth to assist people that are perceived as having less social value than themselves. Coupled with the notion that some have that if the lazy bums / welfare recipients would just work harder they could afford the private medical care they themselves probably can’t afford either.

    posted by DaveD on 9-13-2007 at 12:59 pm

18. Vermont has a state health care system set up for lower class pregnant women and children under 18. Why can’t we implement this nationwide?

    posted by Tim on 9-13-2007 at 1:03 pm

19. How will this effect not-for-profit hospitals?

    and

    How will this change how controversial procedures like gastric bypasses and reconstructive plastic surgery are covered?

    posted by Stephanie Felker on 9-13-2007 at 1:06 pm

20. socialized medicine issues. why is it thrown around as such a dirty thing. (we do have socialized education or socialized police force).

    posted by simone on 9-13-2007 at 1:08 pm

21. I would like to know more about what kind of Health Insurance our Representatives in Congress have. I keep hearing how great it is, but I’ve never heard what exactly makes it so great. I do know that Sherrod Brown, from Ohio, has refused the Gov. healthcare program until everyone in the US gets the same deal. Which sounds really great, but I still don’t know what is so great about the Gov. Health Insurance Plan.

    posted by Stacy on 9-13-2007 at 1:26 pm

22. Who is Tommy Douglas?

    Why do we accept socialized mail, libraries, and fire departments but not socialized medicine?

    Why are US citizens accepting the fact that their care is expensive not just financially but in terms of the liv..deaths of the uninsured as well as their own financial costs?

    posted by vorpal on 9-13-2007 at 1:33 pm

23. One of my grad school profs did some work a while back on portable medical records – essentially a computerized network that would allow any health care provider, anywhere, to access a patient’s complete medical history. It’s roughly analogous to a credit report. This would make it much easier for a patient to switch providers, and provide potentially life-saving information should the patient need medical care away from his or her hometown. Will such a system ever be feasible, or will privacy concerns and greed on the part of HMOs and other providers present such formidable obstacles that no enterprise would be willing to undertake the risk of bringing it online?

    posted by Roger on 9-13-2007 at 1:46 pm

24. How can the dichotomy between for profit health insurers making profits for shareholders and the idea of keeping the patient’s needs first really work in the long run?

    In countries where there is state-run insurance, is the cost rising as fast as it does here with for-profit insurance companies.

    If we just switched to a single payer system and cut out insurance companies, what effect would that have on the economy. There is a whole industry that provides services and products to health carriers, not to mention brokers and industries that get revenue from health insurers.

    Another thing to look into is how non-profit insurance companies are really run, i.e. they run for-profit subsidiaries, executive pay comparable to for-profit companies, ect.

    What impact does AHIP really have in legislation (the health insurance lobbying group). And a larger issue is why is corporate lobbying even legal and not looked at as bribery.

    posted by al on 9-13-2007 at 1:53 pm

25. My questions deals with the insurance company. My current insurance provider allows me to get prescriptions at a local pharmacy only one month at a time for a copay of $40.00 or if I choose to use the mail order company they have selected I can get 3 months worth for the same or less money. I always wonder is the mail order co (medco)owned by the insurance company also why don’t the single store and pharmacy chains challenge this?

    posted by Dean on 9-13-2007 at 1:54 pm

26. You’re trying to cover a topic of great complexity and overlapping issues, and with a large amount of academic and public policy controversy. Good luck.

    My 2 cents: to some extent, I think the problems we see in the US health care system has a lot to do with insurance/delivery policies and methods that were developed before a time of rapid and extensive medical technology changes. For the average middle class family, health insurance comes from the employer, because of a quirk in tax policy during World War 2. Insurance was seen as a cheap fringe benefit because health care at that time was relatively cheap: you either got better on your own or you died, and there wasn’t that much that physicians actually could do about that. Dwight Eisenhower had a heart attack when he was president, and he was basically prescribed bed rest. That was the state of the art, and it was incredibly cheap.

    Nowadays, a homeless guy having a heart attack (assuming that someone notices and calls 911, which is a different question from health technology) will probably receive massive and costly intervention. Whether he lives or dies doesn’t depend solely on his constitution. This is just one example of the change in typically available health care technology, and this change has occurred within living memory and during the time our insurance practices were established.

    So, we have a difference between spending basically zip on health care in, say, 1950, and spending hundreds of thousands of dollars today. Health care costs have increased astronomically, but are we better off? I’d say yes, in this case.

    How does this change in costs affect insurance? What was once a cheap fringe benefit provided by employers has now become a large expense. If employers are forced to disproportionately bear this cost, you’ll see less insurance coverage. Which may also lead to labor market friction, because people will be afraid to switch jobs. This is an argument for separating insurance from employment, and we can start talking about private insurance, government insurance, or some mix of the two.

    We should bear in mind, though, that providing health insurance coverage to everyone won’t necessarily bring down the amount of spending on health care. The technological change example above suggests that health care costs will rise, and in general we’ll get more benefits from our extra spending.

    As said, “health care” as a policy topic is not something you’re going to spend an afternoon on to come up with a worthwhile blog article. Good luck.

    posted by Cheng-Jih Chen on 9-13-2007 at 1:56 pm

27. Many countries have it set up so doctors receive bonuses for their patients who get healthier each year. Why is the health care industry simply treating symptoms when its focus should be on healthy individuals? Isnt that what health care should be?

    Also, why do we allow pharmaceutical companies any legislation in health care. We’re being overmedicated because more money is being put into pills instead of cures?

    posted by Alicia on 9-13-2007 at 2:11 pm

28. whom becomes the gatekeeper in a govt run system?

    posted by les on 9-13-2007 at 2:19 pm

29. Why does an asprin cost $32 each and why does it cost so much different if you pay for yourself, with different insurances and medicare/medicad?

    Why do health care fees (in general) jump up 10%+ a year?

    If hospitals aren’t making money who is in the health care system?

    If most non-health care related businesses, most citizens and at least some politicans see at minimum a need to overhale the health care system who is holding the change up?

    posted by Kelly on 9-13-2007 at 2:34 pm

30. Why is there so little focus on preventative health care? And if we move to a universal health care system, what measures, if any, will be taken to increase access to preventative care? How will genetic testing change our views of preventative care?

    posted by Alexandra on 9-13-2007 at 2:39 pm

31. My question is simple. Why do most insurance companies NOT cover the cost of prescription glasses and hearing aids?

    It’s not like they are optional for me.

    posted by KJ on 9-13-2007 at 2:41 pm

32. Cheng-Jih Chen hit several nails on the head in the comments above. Well said.

    > They say that doctors hate HMOs.

    Who is “they”? I’m not disagreeing, I just get this red flag whenever someone says that some unknown “they” is involved in something.

    > How does the American healthcare system compare to those of other countries?

    I think a good gauge of this is to see where people go for healthcare when they have the means to afford something other than whatever their home country offers. How many US citizens go abroad for healthcare? Compare that to the number of individuals from other countries that come here for it.

    posted by Dave on 9-13-2007 at 2:45 pm

33. What’s a single payer health care system?

    posted by Scott Mahler on 9-13-2007 at 2:52 pm

34. Thanks for the good wishes, Cheng-Jih… just to clarify, though, this will actually be a 4-6 page article in our print magazine (2 months of heavy research, editing and rewriting before it hits stands). It’s definitely a weighty topic, and something we want to get right (mainly because so many people want a better grasp of it), so we’re going to take our time on it, and try our best!

    posted by Mangesh on 9-13-2007 at 2:53 pm

35. It seems to me that “insurance” is something you have in case something goes wrong — it’s a collective hedge against catastrophe. Our health “insurance” is so much more than that. Imagine what car insurance would cost if it had to cover routine maintenance. Shouldn’t we change our system so that catastrophic care coverage can be separated from routine maintenance? Many people can afford Dr. visits, and don’t need insurance for that. What they can’t afford is surgery, chemotheraphy, acute nursing care, physical therapy, etc. Wouldn’t insurance be so much cheaper if they only intervened when you really needed them?

    posted by Bob on 9-13-2007 at 2:55 pm

36. Why does my treatment provider bill different costs of treatment depending upon which insurance provider I use?

    posted by Carol Davis on 9-13-2007 at 3:30 pm

37. I’d like to know more about why the U.S. is one of only two countries left in the world (New Zealand is the other) that allows pharmaceutical companies to advertise. Doctors are the ones who should determine the best medicine for an individual, not an individual who has seen a 30 second clip on TV. How much are our lawmakers getting paid to keep legislation in favor of big pharma?

    Also, family doctors make good money but far less than other specialty doctors, so there are much fewer people choosing to go into family care these days (plastic surgeons, others, make WAY more). How is this affecting/overburdening our healthcare system?

    Having one doctor who knows your health history is important to preventative care, but so many people in the younger generation just go to health clinics for ‘quick fixes’ and never have one primary care physician. Is this because our younger generation is simply not educated on the importance of this issue or because of having to change health insurance companies a lot (due to changing jobs, moving), or something else? What can be done about continuity of care?

    posted by Jennifer on 9-13-2007 at 3:31 pm

38. I earn $15,000 a year and pay 3,$600 for catastrophic only medical coverage. My deductible is $5000. These numbers do not work!! I am 55 and need to manage the next few years till I’m eligible for Medicare.
    By that time, who knows what it will cost and if it’s any good?

    posted by 4k on 9-13-2007 at 3:49 pm

39. This might be really simple, but has always puzzled me. Why does the health care system work on a M-F 8-5 week? Even in the hospitals, a lot of the labs are closed on the weekends. I know I don’t get sick only M-F 8-5.

    I have heard that they want time off too. But for the millions of people that work in the hospitality and tourism sector, their peek times are weekends.

    posted by Elizabeth on 9-13-2007 at 4:01 pm

40. Is malpractice insurance the real reason why medical care is so expensive?

    How are drugs priced? Ingredients and manufacture doesn’t account for a $20 pill even at a 900% mark-up.

    posted by J2daQ on 9-13-2007 at 4:09 pm

41. I’ve heard that the U.S. spends more money than any other developed country in the world on health care and health related services, however, our health care system is worse than many of those other countries. Also the rate of expenditures has been increasing steadily since the 1960s yet in general our health hasn’t been declining, so there has really been no need to increase the amount of expenditures. I’m interested to read what you can dig up on that subject.

    posted by becky on 9-13-2007 at 5:00 pm

42. Tying into your piece on immigration, I’m curious to know how much (monetarily) illegal immigration affects health care costs that are passed along to taxpayers. Are associated, unpaid costs divided amongst taxpayers on the local, state, or national level? Are there organizations who raise funds to help pay for the medical bills of illegal immigrants?

    posted by James on 9-13-2007 at 5:05 pm

43. No third-party payee system is sustainable in the long run. Human nature being what it is, I want all I can get of something when its cost to me is less than its perceived value. Therefore, I can be as overweight as I am comfortable with, because the perceived cost of my medical care for high blood pressure, high cholesterol, Type II diabetes, and coronary problems will be paid by the insurance company – it’s practically free!

    So my question isn’t about socialized medicine, HMOs, or any other third-party payee system. Rather, I would like to know how we can get off this bandwagon.

    How can we as a society get back to a system where cost of services such as medical care is borne directly and immediately by the user of the service? Health savings plans are a start, but how can we push (or pull, or even drag) people into bring medicine back to a two-party transaction?

    posted by DaveR on 9-13-2007 at 5:58 pm

44. What does it really mean that we spend 12-14% (depending on what data you look at) of our GDP on healthcare, the most of any country in the world?

    Why is medical school so expensive and shouldn’t it be better subsidized to insure there will be a supply of doctors?

    I think we can all agree we aren’t getting what we pay for.

    posted by al on 9-13-2007 at 7:11 pm

45. How can medicinal marijuana be legal by state? Are other drugs governed at the state level? Are all? What other lines are drawn in health care between state and federal governments?

    posted by E on 9-13-2007 at 8:14 pm

46. More to the point is how much is the administration of insurance costing us? Medicare insures that the least healthy of the American population is given health care at the lowest administration cost. Imagine if the government was to add the healthiest population to Medicare; how the administration costs would lower. Not only for the “insurance” but also to doctors who would benefit from having to staff less administrators and again concentrate on practicing medicine.

    posted by Elizabeth Gilchrist on 9-13-2007 at 8:55 pm

47. Why won’t the Insurance Companies embrace Capitalism?
    The reason private insurance is not working is that the system is not capitalistic. A key component of Capitalism is competition.
    1. If I do not like McDonalds I can go to Burger King. If I do not like the insurance at my company I can only change one time a year and I only have two choices. I cannot buy other policies. If I cannot go to a competitor the system is not capitalistic.
    2. Insurance companies can deny you for having pre-existing health conditions. Which means even if I choose a competitor they can refuse my money as a customer. Somehow the “ALL YOU CAN EAT” resturants can serve hungry fat people and picky old ladies. How many businesses in the world will turn away paying customers?
    3. Insurance is based on the well people paying for the sick people. Who are the most healthly people? Young people. Who are the people most likely to be uninsured? Young people, those 20 somethings at their first job have no insurance but have low health care costs. This is how the insurance companies will make their money.

    Try to imagine the Geico Gecko selling health insurance.

    posted by Dr Howard on 9-13-2007 at 9:16 pm

48. When comparing the US healthcare system to those of other countries, the demographics of the countries have to be considered. Cheng-Jhi mentioned the homeless man having a heart attack and the extensive cost of healthcare for him. Well, as a practical matter, this homeless man is not contributing to health insurance premiums OR taxes that might fund national health insurance. Don’t miss my point – I’m not saying he doesn’t deserve healthcare. I’m only saying that those of us who contribute to the healthcare system through insurance premiums, co-pays or out-of-pocket costs as well as income taxes are paying, indirectly, for this homeless man’s healthcare as well as all the other indigent patients. I never see the issue of demographics and the related economic issues addressed when the topic of nationalized healthcare arises, but I think it is a huge consideration. The US has very different demographics from Canada. I, too, am frustrated by my healthcare costs, but I want the best healthcare available (and we have it here in the US), and am willing to pay for it. I don’t trust our government to efficiently administer a nationalized healthcare system.

    posted by cm on 9-13-2007 at 9:37 pm

49. I would like to understand more of why hospitals will charge a patient one amount but will charge the insurance company less for the same procedure. How does this work in anyone’s favor?

    posted by Chris on 9-13-2007 at 10:31 pm

50. I have Kaiser. Henry J. Kaiser provided an entire health care system for his employees, which then expanded to a broader base. The basic premise is preventive medicine, with vaccines, etc. provided at no charge. It’s not perfect, but it’s good, reliable care for a reasonable amount of money.

    When I had PPO coverage, my doctors complained about insurance companies telling them what to prescribe, ridiculous abounts of paper work, etc.

    posted by Barbara on 9-13-2007 at 10:43 pm

51. Dr. Howard, I loved the restaurant analogy. Very well put!

    Some very good questions and comments have been written. I have one now.

    I’m inclined to hope for a health care system like what was mentioned above for Canada. I’m assuming that it is the same as Europe in general. I’d like to know more about the US government’s own health care system. It has to be far better than what the common people who pay the bills have available to them. Just what are folks supposed to do who do not have health insurance? Unemployment, not by choice I might add, causes you to make drastic choices. Too young for Medicare, not qualified for Medicaid and and then you have to decide whether you buy food and pay bills (house, utilities, etc) or go to any place that will take you so that you can get the medicine that you need because of health conditions you already have. But then, assuming you can get a perscription, just how are you supposed to pay the prices? Drug companies are gouging us and we stand by and let them? How smart does that make us? Emergency room? Sure if you want to take the chance. What constitutes an emergency by their standards? Personally, I have HBP but no meds for months. I know I’m in trouble, but can’t afford the ER bill if they decide I don’t fit whatever criteria they have in place. So, I wait and hope that I don’t have a stroke, literally. And yes, I know that’s an emergency then. But at least I’ll get care.

    I’d be willing to pay higher taxes in order to guarantee health coverage for everyone. It would sure beat what we are paying taxes for now in some cases.

    posted by debbi on 9-13-2007 at 10:48 pm

52. I live in the UK (born American) and we have a national health service. When I did the math I realised that I pay more in taxes for the NHS than I did for health insurance in the USA. Public healthcare isn’t all marshmallows and bunnies. The hospitals and doctor’s surgeries are usually very old and rundown, almost to third world standard. It takes months, sometimes years to get an appointment for an operation and with nasty bugs like MRSA rampant using NHS healthcare isn’t a nice experience. I can get private healthcare which would be on par with American standards but I would still have to pay for the NHS. Whichever way you look at it healthcare will never be free.

    posted by Ari on 9-14-2007 at 2:49 am

53. …forgot to add my question.

    Would it actually be the same standard of health care in the USA if it did turn into a national health service? If so, would we actually end up paying more in taxes than we do in insurance?

    posted by Ari on 9-14-2007 at 2:55 am

54. How much is enough? The life expectancy has increased from (what to what?) significantly. At what point do we say as a society that the life expectancy in about right. Is there a point when we should stop trying to extend life?

    posted by Bob on 9-14-2007 at 6:30 am

55. I want to know how we can expect health care coverage to be affordable when insurance companies, drug companies, and even some health care providers have to answer to investors who want a return on their investment? If you are acting in the best interest of your investors how can you act in the best interest of the patients you are serving?

    I want to know at what point we will stop and realize that there is a basic conflict between the ideas that health care and insurance are a commodity to invest in and that they are also a basic right that all people should have access to.

    posted by Sabrina on 9-14-2007 at 7:39 am

56. Another question – I’d heard that either the threat of medical malpractice suits, or maybe it was just the insurance costs for it, were driving physicians into other lines of work. What’s the story there? What impact is it having?

    posted by E on 9-14-2007 at 8:09 am

57. How does the American healthcare system compare to those of other countries? Is there a better model we can follow?

    I think the more important question is:

    How can we ensure that every American has access to health care?

    Right now emergency rooms are being used as primary health care, when that is not only more expensive, but by the time someone is going to the emergency room whatever is wrong may already be beyond help.

    Most Americans don’t even have access to preventive tests because they do not have insurance.

    For example, simple preventive tests so as a mammogram or a colonoscopy (which would detect breast cancer and colorectal cancer, respectively). By the time most people have these tests done, it is too late and the cancer is in the later stages of the disease.

    If all Americans had access to these and other preventive tests, ultimately, the price of health care would go down. People wouldn’t need to be receiving expensive treatments and surgeries for diseases or other problems that could have been prevented by a test.

    We need to make health care accessible to all Americans. Rich, poor, black, white…it shouldn’t matter. Unfortunately, within our current health care system, those do factor into a person’s access to health care.

    Most people cannot afford health care. Especially if someone is unable to or not working. Health care is expensive.

    The current system needs to be reformed if we ever have any hope to stop people from dying needlessly.

    posted by amanda on 9-14-2007 at 8:46 am

58. One thing that HMO subscribers should know is that due to a loophole in the ERISA law, they cannot sue a physician or hospital for malpractice.

    posted by Kara on 9-14-2007 at 1:26 pm

59. I have worked for a health insurance company for the past 25 years. And twenty-five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could self-refer to any doctor, specialist or hospital and be billed for the service provided. The insurance company and the patient would each review the bill and contribute to the cost.

    Unfortunately, rising health care costs made it difficult for the average American to continue to pay for their out-of-pocket fees for indemnity coverage. So, people turned to HMO’s and managed care as a solution for affordable coverage.

    This changed healthcare dynamics in this country and several factors that have and will continue to contribute to rising health care costs. These include:

    New technology in medical procedures, testing and treatment such as MRI, Chemotherapy and new medications which continue to drive up the cost of health care. Additionally, access to medical information is becoming vital to the future of healthcare requiring many providers to upgrade their computer systems to assure rapid and secure access to patient information.

    State and Federal Regulations, Benefit Mandates and Litigation are adding to the costs of administration for both medical plans and providers. Another contributor is the growing number of legal cases regarding medical treatment and outcomes, which increase malpractice rates and medical review.

    Our aging population is also adding to medical demands as baby-boomers join the ranks of seniors and increase their needs for treatment and care. The growing number of patients with conditions such as heart disease, cancer and diabetes have helped to drive the development of more effective forms of treatment, but at a greater cost.

    One of the biggest is: Americans Want More
    Social expectations continue to rise and the demand for more technology and advanced medical treatment also drives the cost of medical care.

    Pharmaceutical companies and direct to consumer advertising drive consumer demands for the latest medical options. This contributes to the cost of care,but not always to the effectiveness of these treatments or the quality of care that is needed to balance today’s healthcare environment.

    So over the past 25 years, health care costs have continued to rise, along with the American consumer demand for both the latest and most advanced technology.

    Unfortunately, as these cost trends for products and services have continued to rise, consumers have been shielded from the actual costs of health care. As with many HMO plans the member never sees a bill, so they have no idea what the real charges were for their treatment.

    Surprisingly, health care is one area where consumer tolerance for cost increases, regardless of the value of the service provided in comparison to other products and services, has gone down:

    Service 1982 1992 2002 2007

    Bread $0.65 $0.85 $1.10 $1.20
    Gas $.91 $1.05 $1.55 $2.95
    CarWash $5.99 $10.99 $15.00 $18.00
    Milk $2.19 $2.85 $3.99 $4.50
    Coffee $0.50 $1.00 $3.50 $4.15
    Dr. apt $3.00 $5.00 $10.00 $20.00

    With the introduction of the HMO copay in the early 80’s consumers began to expect to pay a lower out of pocket cost for their healthcare services with greater expectations for covered services.

    I find it surprizing that in America today, no one bats an eye to paying $20 for 4 cups of coffee, a car wash or 2 movie tickets. But many people seem to think it is unfair to pay $20 for a physician visit or surgical procedure!

    Before we can change the healthcare system in this country, we will need to address consumer expectations and the continuing trends that impact health care costs.

    posted by Kathie on 9-14-2007 at 3:56 pm

60. Healthcare costs are skyrocketing (with children, for example, getting sicker, younger) and people having old age types of health considerations much earlier in their working lives (like diabetes and heart disease).

    Stockholders are demanding more return on their investment and, to increase stock performance, firms have been downsizing and raiding the healthcare piggybank. They have also demanded that companies require their staffers to pay more for their benefits or institute a tiered system with different payment levels depending on the wellness of the covered employees.

    We’re getting fatter and lazier as a nation with no end in sight. Schools are getting rid of phys ed and recess and children are more sedentary than at any other time in history. Foods are fattening and the hormones in meats are fattening up our children and ourselve (like the livestock they were designed to chubb-up).

    Entire city operating budgets will be taken up by healthcare premiums for active and retired city workers and their families. I think it’s the city of Madison or Milwaukee that will spend its entire budget on healthcare costs in the next 5 years–with no money left ot keep the lights on.

    With all of this being the case, what systematic changes will the government, industry and individuals need to make?

    posted by Lalita on 9-14-2007 at 8:56 pm

61. I work at a doctor’s office…many years. I was wondering how much money do pharmacutical companies spend to woo doctors to use their drugs? Each week, we’ll have 2 or 3 companies come in with luch for the whole office (7-8 people) with plenty of leftovers. Not just homemade sandwiches, but expensive food from nice restaurants. And, these companies also are constanly giving doctors free note pads, pens, clocks, and other office supplies (with the drug logo in it, of course). This has to add up….big time. All of this doesn’t include the free samples they give doctors to give to patients to try out. How much do these drug companies spend? It just seems wrong.

    posted by Laura C on 9-14-2007 at 11:43 pm

62. Not exactly novel, someone alluded to it earlier in this thread, but I worked in healthcare a few years ago and the Administrative cost ALONE of the American insurance system has got to be ENORMOUS. Different codes, different systems, negotiation of reimbursement rates based on insurer/condition, claims receipt, claims adjudication, actual claim payment & bills based on different reimbursement rates, different co-payments and billing/payment structures from thousands of different providers & dozens of insurers, different statutory requirements for insurance from state-to-state, various federal regulations, all the accountants needed to track this stuff on both the insurer and the provider side, all the IRS folks whose job is to vet deductions for medical expenses, it just goes on and on. Not to mention the computer systems that someone has to develop, install and maintain – I know at my old healthcare company, our entire financial system (outside of the medical billing/payment system) cost about $12K; the medical billing/payment system cost 5x that much because what it had to do was so complex just to keep everything straight, and this was a VERY small practice.

    I imagine the overhead alone has got to be at least 20-25% of the total cost for providing medical care. Anyone else think this is an interesting subject?

    posted by Carey on 9-15-2007 at 2:12 am

63. Addressing Laura C’s comment somewhat: the United States is one of the few industrialized nations that does not have a price cap on prescription medications. As a result, Americans have to pick up the slack for countries that do have price regulations in place. That’s part of why Big Pharma utilizes such aggressive sales techniques – they recoup more money per prescription in the US than anywhere else.

    Many of us wonder why medications are so expensive, but what we don’t keep in mind is that the cost of research and development and testing of new treatments cost millions of dollars, and that expense has to be leveraged out. And while Americans living in border towns trumpet the benefits of buying cheaper drugs in Canada, they don’t know that someone has to pay for their discounted drugs, and right now, that’s us here in the US. It’s a vicious cycle of sorts…everyone wants access to the latest and best drugs, but those drugs only come after many years of very expensive trials, and no one wants to pay for it.

    posted by Kara on 9-15-2007 at 1:26 pm

64. election issues?

    w/o vote accountability/verification, what’s the point?

    blackbox voting must be stopp’d.

    posted by kikz on 9-16-2007 at 5:19 am

65. I have worked at a managed care insurance company and presently work in a physician’s office. I do the billing of charges and the posting of payments. I can tell you why doctors hate HMO, managed care, etc. What other business is there that the business charges $50 for a service and Medicare tells you that if you want their business, you will accept $15 and write off the remaining balance and you will fill out volumes of paperwork so you can accept that $15 and if you make a mistake, we can fine you, take away your business or even throw you in jail. The insurance company will give you a slightly higher rate for now but if we can contract with your competitor at a lower rate, we will then lower the rate we pay you and eventually them.If you don’t accept this new rate, then you won’t have any patients.This is why MD’s are looking at the patient mix, meaning what percentage of your patients are Medicare, Medicaid, commercial or HMO, or non-insurance. A higher Medicare ratio will impact the bottom line. A single physician on his own is a small business, paying employee salaries, work comp ins, liability insurance, malpractice insurance and the usual overhead and don’t forget those taxes. All of the money does not go in the physician’s back pocket.

    Most people are not aware that Medicare payments to MD’s vary depending on what state or even city you live in for the same service. Medicare payments to a MD are not based on what the MD charges. Many insurance companies like to base their fee schedule on Medicare rates because those rates are sometimes slightly raised but because most times they are lowered. The major HMO’s in this state do not pay a cap or stipend for each patient. It’s based on a contracted rate when a patient is seen. Plus in our state, the physician must pay gross receipts tax (ours is 7%) on all income that is not under contract. Thank you Bill Richardson.

    posted by Lynn on 9-17-2007 at 5:06 pm

66. I have an email that CIGNA sent to all of its employees in response to Michael Moore’s recent documentary. I’m sure it’s a little slanted, but it is directly from an insurance company/healthcare provider. pretty interesting that they put this together.

    posted by Rebekka on 9-18-2007 at 12:20 am

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