Originally Posted by The Wonkette

Sadly, money is an issue. With the savings in funds from futile care, think of all the good preventive primary care could be accomplished.

Yeah, I understand futile care. It's the discerning when and if it falls under that category is the huge dilemma. Maybe this whole issue is taking us down a slippery slope.

If we had a single payer system, this issue might be more about people's choices, not ways to save money. There sure is a lot of gray matter in the decisions of when and when not to attempt a potential life saving procedure. I say this from the past two years of experience with my mother's care.

Originally Posted by The Rani

It's true that most doctors would rather end up dead than in a hospital, and I know a chief trauma surgeon who also believes that CPR is worthless.
I was thinking the other day that a return to in-home care, as opposed to hospital treatment, wouldn't be a bad thing.

I have been on the lookout for an old-fashioned Red Cross handbook of home nursing, like the one my mother used to have. In fact, if I could get several copies, I'd give them to my children - both of whom are married to doctors and one of whom is a doctor herself. My grandson Caden's asthma attacks mean many a night spent in the hospital for him, poor little guy and there has got to be a better way. Let alone this is not a solution open to most people!

Originally Posted by The Grey Badger

I have been on the lookout for an old-fashioned Red Cross handbook of home nursing, like the one my mother used to have. In fact, if I could get several copies, I'd give them to my children - both of whom are married to doctors and one of whom is a doctor herself. My grandson Caden's asthma attacks mean many a night spent in the hospital for him, poor little guy and there has got to be a better way. Let alone this is not a solution open to most people!

P.S. I think there are many people now in nursing homes who would not be if they could afford an in-home attendant.

Originally Posted by The Grey Badger

P.S. I think there are many people now in nursing homes who would not be if they could afford an in-home attendant.

Definitely. A friend of mine had 4 (paid for by her) attendants for her 97 year old mother. It was, no kidding, $10,000 a month.

My mother was with us for 16 months until her care became a 24/7 exhausting experience. If I had more outside help for in home care, I think I could have managed keeping her with us. But sadly.......

I think it's in one of the Nordic countries that provide some in home care.

Originally Posted by The Rani

I helped keep my asthmatic nephew out of the hospital one night, because I happened to be there and I know what the proper "panic" threshold is.
Most people can't figure those things out on their own, but they probably could learn to do so.

Which is? His mother has an MD herself and she takes him into the hospital!

Naw, Obama doesn't cave, he just compromises. Hmmmm..............


Administration Announces States Can Decide Their Own Minimum Health Care Benefits

Originally Posted by The Rani

It's true that most doctors would rather end up dead than in a hospital, and I know a chief trauma surgeon who also believes that CPR is worthless.
I was thinking the other day that a return to in-home care, as opposed to hospital treatment, wouldn't be a bad thing.

Obviously, home care is a lot more labor-intensive, but there are cost-savings galore as well. Less MRSA, C-Diff, VRE, etc., along with less trauma to the patient in just being admitted, re-admitted, discharged, etc, over and over. Plus the inevitable tests, treatments, imaging by a parade of different clinicians, and all the repetitive bs that goes with it.

CPR isn't "worthless," but its usefulness is certainly limited to some specific situations. For example, a witnessed cardiac arrest that occurs for a "relatively" benign reason (seems like a contradiction in terms, eh?!). If someone immediately begins effective chest compressions, and a shockable rhythm is present, and an AED is handy, the patient can be revived pretty well.

After electrocution that stops the heart but does little or no damage to internal tissues, immediate, effective CPR can make a big difference.

On the other hand, from your trauma surgeon's perspective, he/she is probably right. Trauma codes are terrible, they're messy and they rarely turn out with survival for the patients.

My limited experience in medicine suggests that statisitics are fine for showing us the general case, but when something happens to an individual patient, it's pretty much happening to him/her at the 100% "statistical" level!

IMHO, the following is a fine explanation of why we need a single payer system. It appears that as the current system stands, everyone is supposed to bow and accommodate the insurance industry.

I offer two excerpts from:

Our healthcare system is unfair and unbalanced

We need to fix our system to make sure that meaningful, necessary, and prompt access will be available to all, whenever they need it. The system needs to be truly patient-centered.

Over the course of the next few weeks, I began to get my explanation of benefits (EOB) forms from my insurance. These EOB forms highlight how much the hospital charged, what my insurance wrote off (or “discounted”), and what I needed to pay. I am unable to list the costs here due to our system’s insurance contracts, concerns about anti-competitive activities, etc. This is unfortunate, because they expose another area where our system is unfair and unbalanced: if you are uninsured, you will be expected to pay more than if you are insured. This is because insurance companies negotiate with hospitals on their patients’ behalf, and reduce the costs for which patients are responsible. If you are uninsured, and if you don’t know how to seek financial assistance, you pay the full (non-discounted cost) of your medical services. That cost is usually set high enough to ensure your healthcare provider will get the maximum payment possible from insurers…so the uninsured face the full burden of this increased cost.

SNIP

Why do we have healthcare systems that charge so much? Because they feel they need to in order to be able to accommodate insurance companies’ demands for discounted services and still turn a profit–if systems charged the actual cost of the procedure, then they would take a “discount” on that amount and end up losing money. Why do insurance companies expect/demand discounts? Because it helps justify their existence: if that “discount” were the actual price people were charged, there might be less need for insurance. Why was my co-pay a small fraction of the total charges? Because I am fortunate to have really good insurance coverage.

http://www.kevinmd.com/blog/2012/01/...nbalanced.html

Health Insurance Law Results in Big Profits for the Insurance Industry.

January 9, 2012

"Despite the headline from Bloomberg below, the fact is the law was written by Liz Fowler, a former Well Point executive who worked for the Finance Committee. After writing a law that entrenched the industry further she was hired by President Obama to work at HHS to implement the law. This law was written and implemented by the insurance industry so no one should be surprised that the insurance industries profits are up. The money spent by the insurance industry was to get as much as they could out of a law that always favored them. That is the way it works, get as much as you can and fight for more. Profits before patient care is the American health care system. And it is also not surprising to see the corporate media mis-report the situation. They did a very poor job throughout the debate on the health care law and continue to do so." ........... Kevin Zeese

http://itsoureconomy.us/2012/01/heal...ance-industry/

I personally see insurance as something obsolete. It also runs on the idea of scaring people into buying something they do not need.

It screws over those of us who actually need health insurance and can't get it for a reasonable price. I have epilepsy and need medication to control my seizures, but I doubt I'll find anything reasonably priced. There was a kid in my class who used to have epilepsy and he'd just have seizures in the middle of class because his mother couldn't afford health insurance. I believe the school I went to (Catholic) ended up paying for insurance until she got on her feet (she was fleeing an abusive drug addict)

When the Catholic church shows more kindness than your own government, you know no one gives a shit about you.

Originally Posted by Felix5

I personally see insurance as something obsolete. It also runs on the idea of scaring people into buying something they do not need.

It screws over those of us who actually need health insurance and can't get it for a reasonable price. I have epilepsy and need medication to control my seizures, but I doubt I'll find anything reasonably priced. There was a kid in my class who used to have epilepsy and he'd just have seizures in the middle of class because his mother couldn't afford health insurance. I believe the school I went to (Catholic) ended up paying for insurance until she got on her feet (she was fleeing an abusive drug addict)

When the Catholic church shows more kindness than your own government, you know no one gives a shit about you.

This is why we need a more compassionate health care system. Since there are` increasing numbers of people who have lost jobs, there are now more without health insurance. Like you indicated, having a pre-existing medical condition, they're up the creek without a paddle or the money to buy one.

This is why we need a more compassionate health care system. Since there are` increasing numbers of people who have lost jobs, there are now more without health insurance. Like you indicated, having a pre-existing medical condition, they're up the creek without a paddle or the money to buy one.

I have a pre existing condition and I know I'm fucked. Which is why I'm just going to join something like the peace corps. They give you health care for awhile, maybe I'll just stay there until the economy gets better or something.

As for everyone else, I honestly don't see this problem getting resolved until the next awakening. I honestly just don't think this crisis period is going to turn out so well.

Originally Posted by Felix5

I have a pre existing condition and I know I'm fucked. Which is why I'm just going to join something like the peace corps. They give you health care for awhile, maybe I'll just stay there until the economy gets better or something.

Felix, pre-existing conditions won't prevent you from getting insurance, it will lengthen the time before some things are covered.

http://en.wikipedia.org/wiki/Pre-existing_condition

I thought Obamacare wiped some of these out altogether.

Originally Posted by TeddyR

Felix, pre-existing conditions won't prevent you from getting insurance, it will lengthen the time before some things are covered.

http://en.wikipedia.org/wiki/Pre-existing_condition



I thought Obamacare wiped some of these out altogether.

You can only buy pre-existing condition health insurance through the states. The main plan for pre-existing conditions doesn't go into affect until 2014.

To get pre-existing insurance through the state, you have to be without insurance for 6 months. Then, the price , while it has decreased because it was over the top expensive and few people could afford it, is between $500 to $700 a month. Not many people with a pre-existing condition can be without insurance for 6 months or afford the monthly premium. One major hospitalization could wipe out a person's savings.

Originally Posted by Felix5

I have a pre existing condition and I know I'm fucked. Which is why I'm just going to join something like the peace corps. They give you health care for awhile, maybe I'll just stay there until the economy gets better or something.

As for everyone else, I honestly don't see this problem getting resolved until the next awakening. I honestly just don't think this crisis period is going to turn out so well.

Move to Minnesota. Your epilepsy would qualify you for coverage through our state medical coverage for the disabled and mentally ill.

Australia's health care system is most similar to Canada's, with a federal single payer system (called Medicare) and an extensive state run public hospital system. However we do have private hospitals and health insurance as well. Employees through the Medicare levy and other taxes pay for single payer system federally and the state run hospital system. In Australia employers don't contribute anything to their employees health expenses. Also private health insurance companies here are less regulated than the American ones.

In recent years the whole system has become in an essence a two-tier system with a okay public system and a very good private system (which only those with private health insurance can access). The state hospitals in particular suffer from huge waiting lists for elective surgery, not to mention overly centralized and bureaucratic administrative arrangements for hospitals in some states

Lately when I discovered about the Swiss health care system, I thought that is the sort of health care system Australia should adopt and would help to eliminate the problems which the public hospitals suffer from.

Implementing the Swiss Health Care system in Australia would be the abolition of medicare, pharmaceutical benefits scheme (which fixes the price of pharmaceutical medicines in Australia) and the privatization of the state hospital systems.

Instead people would be required to purchase basic health insurance from the private health insurance companies. These health insurance companies would be required to offer this basic level of insurance to everyone, regardless of age or medical condition. rs also would not be allowed to make a profit off this basic insurance, however can on supplemental plans.

The insured would pay the insurance premium for the basic plan up to a set level of their personal income. If the premium is higher than this, then the government subsides the rest of that person's premium.

However I am proposing this system from an Australian point of view where health insurance is less expensive than it is in the United States. For example; I can buy a basic health insurance plan for as little as $100 per month and up to $200 per month I want a fairly wide range of coverage.

Originally Posted by Tristan

Australia's health care system is most similar to Canada's, with a federal single payer system (called Medicare) and an extensive state run public hospital system. However we do have private hospitals and health insurance as well. Employees through the Medicare levy and other taxes pay for single payer system federally and the state run hospital system. In Australia employers don't contribute anything to their employees health expenses. Also private health insurance companies here are less regulated than the American ones.

In recent years the whole system has become in an essence a two-tier system with a okay public system and a very good private system (which only those with private health insurance can access). The state hospitals in particular suffer from huge waiting lists for elective surgery, not to mention overly centralized and bureaucratic administrative arrangements for hospitals in some states

Lately when I discovered about the Swiss health care system, I thought that is the sort of health care system Australia should adopt and would help to eliminate the problems which the public hospitals suffer from.

Implementing the Swiss Health Care system in Australia would be the abolition of medicare, pharmaceutical benefits scheme (which fixes the price of pharmaceutical medicines in Australia) and the privatization of the state hospital systems.

Instead people would be required to purchase basic health insurance from the private health insurance companies. These health insurance companies would be required to offer this basic level of insurance to everyone, regardless of age or medical condition. rs also would not be allowed to make a profit off this basic insurance, however can on supplemental plans.

The insured would pay the insurance premium for the basic plan up to a set level of their personal income. If the premium is higher than this, then the government subsides the rest of that person's premium.

However I am proposing this system from an Australian point of view where health insurance is less expensive than it is in the United States. For example; I can buy a basic health insurance plan for as little as $100 per month and up to $200 per month I want a fairly wide range of coverage.

The Swiss pay a lot. Here's the list of per capita healthcare costs by country. The US is #1, but Switzerland is third. Arguably the best system in the world is in France at #11. Australia is 16th.

Private insurance and private providers aren't what they are cracked-up to be. They don't have a magic wand to improve efficiency or outcome. There are only two ways to eliminate waiting lists: spend enough to always have excess capacity or eliminate some on the list by makig them ineligible. This can be done better or worse, but typically, the private options are more costly for the same level of care.

Originally Posted by Marx & Lennon

The Swiss pay a lot. Here's the list of per capita healthcare costs by country. The US is #1, but Switzerland is third. Arguably the best system in the world is in France at #11. Australia is 16th.

Private insurance and private providers aren't what they are cracked-up to be. They don't have a magic wand to improve efficiency or outcome. There are only two ways to eliminate waiting lists: spend enough to always have excess capacity or eliminate some on the list by makig them ineligible. This can be done better or worse, but typically, the private options are more costly for the same level of care.

Single payer was the cheapest... it just wasn't very popular. I say "was" because it doesn't really exsist anymore now that Canada, Australia, and England have started opening up options for limited private plans.

The French or Swiss-style systems seem to be a little bit more expensive per capita (still orders of magnitude cheaper than ours), but people are generally more satisfied with what they get and there tends to be better overall outcomes.

Post 2016 we'll have something kinda like Swiss healthcare, but instead of heavily regulated non-profit insurers, our insurers have huge overhead and profit margin baked in.. and 50 different markets of regulation and enforcing on the actual policies! Annual OOP costs after premiums in the US will still be about twice as high as in Switzerland, and the premiums will be 15-20% more expensive after low income subsidies are factored in. I think that is way too generous to the insurers as middle-men, but it could be at least be a step in the right direction.

Personally, I think the French got it right, but I expect America to move closer in line with the models in use in Japan & Switzerland.

You can only buy pre-existing condition health insurance through the states. The main plan for pre-existing conditions doesn't go into affect until 2014.

To get pre-existing insurance through the state, you have to be without insurance for 6 months. Then, the price , while it has decreased because it was over the top expensive and few people could afford it, is between $500 to $700 a month. Not many people with a pre-existing condition can be without insurance for 6 months or afford the monthly premium. One major hospitalization could wipe out a person's savings.

Of course. Insurance legislation always seems to work against people who actually need it.

It may actually be cheaper to simply buy my medication in the long run without insurance.

Originally Posted by Felix5

Of course. Insurance legislation always seems to work against people who actually need it.

It may actually be cheaper to simply buy my medication in the long run without insurance.

The only thing you might want to consider is if you are ever hospitalized. Self pays (people without insurance) are charged the most for their care. Insurance companies are given the best rates. It's totally not fair but that's the crazy game that's being played in this country.

It's totally not fair but that's the crazy game that's being played in this country.

I think it pretty much comes down to this idea, in order for health care to actually work it would require fairness. This is something that is gradually being depleted due to the loss of the silent generation in politics.

Originally Posted by Felix5

Of course. Insurance legislation always seems to work against people who actually need it.

It may actually be cheaper to simply buy my medication in the long run without insurance.

My wife takes a regular series of a very exspensive medicine. Without insurance, the annual cost woud be $32,000 a year - assuming we couldn't bargain it down by ourselves. With our insurance, the copay is about $1,200.

'Nuf said.

Originally Posted by Marx & Lennon

My wife takes a regular series of a very exspensive medicine. Without insurance, the annual cost woud be $32,000 a year - assuming we couldn't bargain it down by ourselves. With our insurance, the copay is about $1,200.

'Nuf said.

Holy Toledo! That's a lot of money for a script. I thought mine would be expensive at $6,000.

It's a darn shame that we are held hostage by the insurance industry. It doesn't have to be this way, does it?

Originally Posted by Deb C

Holy Toledo! That's a lot of money for a script. I thought mine would be expensive at $6,000.

It's a darn shame that we are held hostage by the insurance industry. It doesn't have to be this way, does it?

Actually, it's an infusion, so some of the cost is out-patient service. It's still pricey in my book.

Originally Posted by Marx & Lennon

My wife takes a regular series of a very exspensive medicine. Without insurance, the annual cost woud be $32,000 a year - assuming we couldn't bargain it down by ourselves. With our insurance, the copay is about $1,200.

'Nuf said.

But the real question is: what do you suppose the medicine actually costs to make?