Two healthcare systems

[bandaidwoman]

Here is a copy of the proposal for the organization for national health insurance promoted by physicians

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance
To View the Proposal As Published in JAMA Please click on the Link to the left
Executive Summary

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet over 39 million Americans have no health insurance whatsoever, and most others are underinsured, in the sense that they lack adequate coverage for all contingencies (e.g., long-term care and prescription drug costs).

Why is the U. S. so different? The short answer is that we alone treat health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In our market-driven system, investor-owned firms compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs, which, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar.

We endorse a fundamental change in America's health care - the creation of a comprehensive National Health Insurance (NHI) Program. Such a program - which in essence would be an expanded and improved version of Medicare - would cover every American for all necessary medical care. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Investor-owned facilities would be converted to not-for-profit status, and their former owners compensated for past investments. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules - often rules designed to avoid payment. During the transition to an NHI, the savings on administration and profits would fully offset the costs of expanded and improved coverage. NHI would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run.

A National Health Insurance Program is the only affordable option for universal, comprehensive coverage. Under the current system, expanding access to health care inevitably means increasing costs, and reducing costs inevitably means limiting access. But an NHI could both expand access and reduce costs. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine.

 

[Synch]

The time has come when most of the real working class, the white collar workers, have become victim to utopian loonies like LeftyHenry and the policitians he support. A NHS system will crumble America's middle class, degrade the health care quality of the upper proletariats, the same people who actually produce the most tangible wealth going by your own opinion LeftyHenry. It's the engineers tiring away at a cubicle making $150,000 you'll hurt with NHS. This same people who pioneered technology that significantly improved the lives of the very poor. We're not living in the 19th century where 99% of workers toiled without skills.

I don't even like the idea of health insurance. The problem was created by a Roosevelt. In the old days your health bills weren't paid by a third party. The PHS isn't perfect, far from it, but this problem grew out of problems caused by government policies.

During World War II, the government imposed wage and price controls. This meant that employers who wanted to hire more workers were forbidden to offer higher wages to attract them. So employers started offering various benefits instead. One of these benefits was employer-paid health insurance.

 

[Awesome!]

Private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment though a single nonprofit payer would save more than $150 to $350 billion per year,(depending on who you aske) enough to provide comprehensive, high-quality coverage for all Americans.

I have a practice of four physicians. We hire nine ( more than double the physicians ) of non medical personell with full benefits, workmans comp, health insurance, retiremnt benefits etc to deal with the morass of paperwork. I have a full time nurse who spends 8 hours a day, (no patient contact) getting precertifications and prior approvals for all the patients. Of that nine only one is a full time medicare insurance specialist. ( oh yeah, and we also need a full time coder discern the different codes that get things paid.) Medicare is not the highest payor to physicians but neither is it the lowest (numerous HMOs have them beat.) but the rules are the same and ther is no second guessing and no quarterly about face rules that change reimbursement from one month to the next.

If we had a single payor system, I would save half a million on staffing alone. (including their corresponding insurance benefits, retirement benefits, workmans comp, disability benefits, unemployment tax etc. etc.) Am I willing to give a thrid of that up in terms of taxes? You bet your bippy I would!


And guess what, medicare and medicaid don't disqualify you based on an preexisting condition.

Also, the unisnured comprise the largest section of those who sue for malpractice and jack up the medical inflation (due to hospitals having to recover their costs from the insured.) . That raises the price across the board from what hospitals charge to recover their costs providing free care to these unisured ( so your insurance pays the hosptial 10 dollars for an asprin pill when you get hospitalized ) to malpractice premiums, insurance premiums etc.

Also, national health insurance does not necessarily mean socialized medicine. And if you think having national health means curtailement of services, think again. Your private carriers are already doing so. I have a easier time getting medicaid and medicare to pay for a PET scan ( average cost over thousand dollars and the best way to evaluate potential metastisis over cat scans ) to monitor cancer patients than some of the private insureres. ( blue cross and kaiser being the worst...ie my medicare patients get better , advanced state of the art services than some private party payors do.)

I not only speak as a physician, as owner and partner to my husband of a commercial property leasing company, I also understand the pure non medical perspective of running a non medical related business.

Wow, can I work for you? You really take care of your employees! I don't know too much about medical related business, however I can see your point relating to all the staffing you need to deal with all the payor's red tape etc. Maybe the government does have to get involved with some of the b.s. that the payor's are putting the medical business through, but do we need to nationalize to do that?

My point is that the federal government should give us tax cuts, just give me 3-5% and then people like me wouldn't need to depend on my company, or the federal government to pay for my healthcare. My assumption is that there is a ton of waste by the federal government similar to the red tape waste of the private system that you speak of. Fine, but if your employees did have a 3-5% tax break from the federal government, same with you, you wouldn't need to be in this position to ask for more federal government for help, we could all do just fine an individual basis. I don't think I'm being unrealistic, tax cuts are still possible, aren't they?

 

[bandaidwoman]

For those who don't like the national health insurance model there is a problem with our country solely relying on employer based insurance coverage for two reasons: many employers are opting out of this benefit and two, it makes it all but impossible to get decent individual insurance coverage when you are trying to compete against group rates.


As you stated Awesome, is there another alternative that means not nationalizing? The current Health savings account is a tax break I guess. So you may want to look into that.

In additon, the obvious is why can't we make individual insurance affordable so we don't have to rely on our employers for health care?


Kerry had a good idea ( in theory) " let people buy in (at full “group rate” cost) to the same programs offered to federal (or better, state and federal) employees. ".


Kerry's idea is excellent, it sure would let us employers off the hook. At least make inferior insurance coverage more affordable, it’s a step in the right direction. Those who want (or need) decent comprehensive coverage can get it, those who want bare bones coverage can get it, and those insurance companies that want to price themselves in the middle will have to provide a set of benefits which justifies their price point.



But Kerry's proposal doesn’t appear to address one of the biggest problems with non-group insurance now, the indiscriminate exclusion of care based on medical history.

Thus, with free market forces playing a greater role in individual health care, the young and healthy will out price the sick who need health insurance the most and you can bet every insurance company is going to find as many "medical exclusions" when they insure you. I was almost priced out of cigna with a history or a head scan I had at age 20 for a head inury after a mountain bike race! I found Humana who didn't , so I was lucky


Also, you can bet your cap on how much health care dollars you can spend in your lifetime will go down.
I have a 38 year old female who used up her 5 million lifetime cap on fighting Cutaneous T Cell Lymphoma. She has done well but needs expensive treatment to maintain her health. She was basically operating as a non insured patient everytime she went to the hosptial for treatment since her insurance no longer paid. I told her to go on disabilty and now medicare pays for all her treatments (80%) at least for the rest of her life. She had to quit working as a software engineer , become a burdern on taxpayors so she could recieve her life saving treatment If she switched insurance companies...oh, yeah, prexisting health problem, sorry!.


In addition, insurance companies primary goal is to make money, not to improve health care. They respond to share holders.

If Congress were to pass a bill which takes all the problems into consideration, then the insurance market would likely become less profitable. Were that to happen, many insurers would look to other types of insurance to sell rather than health insurance.

In summary, I like the initial thrust of the concept but I worry about the details. To allow medical insurance to operate under a pure free market system means healthy individuals price out the the less healthy who need the insurance the most. This is already happening. Thus, the concept of national health insurances should receive honest scrutiny as an option for making health insurance available to our citizens.

 

[Awesome!]

For those who don't like the national health insurance model there is a problem with our country solely relying on employer based insurance coverage for two reasons: many employers are opting out of this benefit and two, it makes it all but impossible to get decent individual insurance coverage when you are trying to compete against group rates.


As you stated Awesome, is there another alternative that means not nationalizing? The current Health savings account is a tax break I guess. So you may want to look into that.

In additon, the obvious is why can't we make individual insurance affordable so we don't have to rely on our employers for health care?


Kerry had a good idea ( in theory) " let people buy in (at full “group rate” cost) to the same programs offered to federal (or better, state and federal) employees. ".


Kerry's idea is excellent, it sure would let us employers off the hook. At least make inferior insurance coverage more affordable, it’s a step in the right direction. Those who want (or need) decent comprehensive coverage can get it, those who want bare bones coverage can get it, and those insurance companies that want to price themselves in the middle will have to provide a set of benefits which justifies their price point.




But Kerry's proposal doesn’t appear to address one of the biggest problems with non-group insurance now, the indiscriminate exclusion of care based on medical history.

Thus, with free market forces playing a greater role in individual health care, the young and healthy will out price the sick who need health insurance the most and you can bet every insurance company is going to find as many "medical exclusions" when they insure you. I was almost priced out of cigna with a history or a head scan I had at age 20 for a head inury after a mountain bike race! I found Humana who didn't , so I was lucky


Also, you can bet your cap on how much health care dollars you can spend in your lifetime will go down.
I have a 38 year old female who used up her 5 million lifetime cap on fighting Cutaneous T Cell Lymphoma. She has done well but needs expensive treatment to maintain her health. She was basically operating as a non insured patient everytime she went to the hosptial for treatment since her insurance no longer paid. I told her to go on disabilty and now medicare pays for all her treatments (80%) at least for the rest of her life. She had to quit working as a software engineer , become a burdern on taxpayors so she could recieve her life saving treatment If she switched insurance companies...oh, yeah, prexisting health problem, sorry!.


In addition, insurance companies primary goal is to make money, not to improve health care. They respond to share holders.

If Congress were to pass a bill which takes all the problems into consideration, then the insurance market would likely become less profitable. Were that to happen, many insurers would look to other types of insurance to sell rather than health insurance.

In summary, I like the initial thrust of the concept but I worry about the details. To allow medical insurance to operate under a pure free market system means healthy individuals price out the the less healthy who need the insurance the most. This is already happening. Thus, the concept of national health insurances should receive honest scrutiny as an option for making health insurance available to our citizens.

I think the arguments that you have presented regarding your practice, should require some government intervention due to all of the red tape, follow up, time consuming b.s. that the payor's are putting you through. Sounds like their shareholders and accountants have it all figured out to maximize profits etc.

Regarding my tax cut, I'm talking about a no-strings attached tax cut, my money. I think if we had a tax break from the government in theory, the government would have to manage better, just like we have to do everyday with our budgets, get creative, at the same time with the extra money we would be able to get group plans with our employeers etc. I just cringe at the idea of more government.

 

[taxedout]

Remove the government from medicine and the cost will go down.

They created the nightmare, what makes anyone think they can fix it ?

 

[BWG]

Remove the government from medicine and the cost will go down.

Yeah, like tort reform.

The winners?
Doctors
(lower malpractice insurance)
Insurance Conglomerates
(more Doctors can afford MI = more profits)
(less claims payed out = more profits)

The losers?
Us (higher medical insurance premiums)
:lol:

 

[taxedout]

Remove government regulation and introduce competition into the insurance industry.

less claims paid out equals higher premiums ?

 

[taxedout]

Here is a copy of the proposal for the organization for national health insurance promoted by physicians

What is this Physicians Working group for Single-Payer National Health Insurance ?

Why do they think they speak for physicians as a group ?
Just another bunch of academic heads, too inefficient to compete in the real world, trying to ruin it for the rest of us.

 

[bandaidwoman]

What is this Physicians Working group for Single-Payer National Health Insurance ?

About PNHP

Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 14,000 members and chapters across the United States.

Since 1987, we've advocated for reform in the U.S. health care system. A large part of our work involves educating health professionals about the benefits of a single-payer system--including fewer administrative costs and affording health insurance for the 46 million Americans who have none.

Our members and physician activists work toward a single-payer national health program in their communities. PNHP organizes rallies, town hall meetings, and debates; coordinates speakers and forum discussions; contributes Op-Eds and articles to the nation's top newspapers, medical journals and magazines;and appears regularly on national television and news programs advocating for a single-payer system.

PNHP is the only organization in the United States dedicated to implementing a single-payer national health program.

Why do they think they speak for physicians as a group ? For those of us who support it, yes.

Just another bunch of academic heads, too inefficient to compete in the real world, trying to ruin it for the rest of us.

Not true, I am a senior partner of a very successful private Internal Medicine group comprising 4 physicians and two PAs and one NP and over 25 non medical personell whose sole purpose is to deal with all the competing insurances who each set their own rules and regulations on how I should practice medicine. Our business practices are very sound and healthy but I have had to be creative as our payors (many of the private carrieers) continue their price cuts (ie: I have established an in house lab, echo, stress tests etc so we can recover lost revenue.) We are so popular three of us have not taken new patients in six years. My public profile has a direct link to my web page.(sponsered by the AMA)

 

[taxedout]

Why do they think they speak for physicians as a group ? For those of us who support it, yes.

They speak for a subset of the group.

Not true, I am a senior partner of a very successful private Internal Medicine group comprising 4 physicians and two PAs and one NP and over 25 non medical personell whose sole purpose is to deal with all the competing insurances who each set their own rules and regulations on how I should practice medicine.

Stop accepting payment from your insurance payers, and start taking payment only from patients. Physicians created this mess by becoming employees of providers in the first place. Let the patients sort out their own reimbursement. Same goes for medicare. Stop taking medicare patients and their reimbursements.

 

[bandaidwoman]

Stop accepting payment from your insurance payers, and start taking payment only from patients. Physicians created this mess by becoming employees of providers in the first place. Let the patients sort out their own reimbursement. Same goes for medicare. Stop taking medicare patients and their reimbursements.

I was waiting for someone to blame the doctors, it always comes down to us as usual , I believe that is called displacement.

We spent years getting paid out of individual's pocket or bartering until big coorporate businessmen thought it was a great way to attract employees by providing health insurance. When that happened, no one was willing to pay out of pocket.


Most people will not pay out of pocket to see a doctor, even the richest. ( I know because I take care of many prominent business owners who argue about paying their 30 dollar copays.)

Its called boutique style medicine, look it up. It does exist. These docotors do not take any insurance.

I have a problem with it on an ethical level. Many doctors are doing this, trimming their practice down to a total of 1500 patients, all of whom pay a yearly retainer fee and complete out of pocket expenses. Guess what, you now have a clientelle of exclusively rich!.

I bet a lot of you middle to upper middle income wage earners don't want to pay a 5000 dollar yearlly retainer fee ( per individual) and each office visit as well as all diagnostic testing. Guess what, if your doctor does not file through your insurance, you can't get it payed for by a third party. (So if your retainer doctor wants a 3,000 dollar MRI and does not file through insurance you got to suck it up or see one of us.) (I refuse to take these patients on just so I can order tests for their doctors., which is pretty much what these retainer docs will try to do since they don't have the personelle to deal with the insurances.)

Here is the catch, what if you get hospitalized? Your doctor does not take any insurance so guess who gets the onus of burden of taking care of his or her patients who are sick enough to have to require hospitalization,? (Usually at two in the morning.) Yup, moi, doctors like us who believe in taking care of patients even when they are sick!

By the way, I do take payments only from the patients if they want to pay without filing through their insurance. That's because I have fired the really bad ones already and I also see uninsured patients who pay out of pocket anyway. (many docs won't see uninsured patients.) W I still accept some bad carriers because the police, firemen and teachers have some of the worst plans. The county hospital next to us has fired Aetna because all their docs fired Aetna. (the insurer for its police and firemen, and paramedics). When they get hurt that have to come to my hospital , the next county over, for us to take care of them. I don't know about you but I believe in taking care of the people who protect me.

 

[bandaidwoman]

They speak for a subset of the group. .

And I suppose the overrated AMA, or American Medical Society speaks for us as a group? How can that be when only 26& of us pay yearly dues to belong to this "political" spokesman of United States physicians? I suppose if I had mentioned the AMA it would have garnered a little more respect? 74% of us have decided against the AMA as our political voice.

Here is some empiric data on physicians attitude about national health insurance if you want concrete hard data. Reported in the reputible Annals of Internal Medicine. http://www.annals.org/cgi/content/full/139/10/795

 

[taxedout]

I also believe in getting properly reimbursed for my level of risk, as well as educational, monetary and time investment.

Who else performs a procedure with a million dollar liability, for a $50 reimbursement ?

 

[taxedout]

Here is some empiric data on physicians attitude about national health insurance if you want concrete hard data. Reported in the reputible Annals of Internal Medicine. http://www.annals.org/cgi/content/full/139/10/795

A cross section of doctors, trapped within the leviathan the government has helped create.

 

[bandaidwoman]

Yeah, like tort reform.

Actually it would help tort reform if we had national health insurance.

The biggest payouts is on pain and suffering for any malpractice suit (not lost wages for how can a 1 yr old child have "lost wages?")

If we provided univeral health insurance coverage, then we could actually say that all future health care costs would be picked up by the health insurance system.

You could sue the doctor for pain and suffering, but the actual cost 50 years from now for a child who is brain injured from malpractice would actually be paid for by the national health insurance system. So, that takes millions of dollars off the table, literally, in a malpractice suit

You can look up how much Canadian ob/gyns, orthopedic surgeons, neurosurgeons - which are the of the most expensive malpractice specialties here . In the Canadian malpractice system there are no caps on pain and suffering, yet, these specialties pay pennies in malpractice compared to us!

This way, your daughter's daughter will actually be able to find a obstetrician when the time comes for her to have a baby, Los Angeles can actually afford to have more than one trauma center staffed by neurosurgeons etc!!

By the way, I don't see anyone on this board fighting for insurance reform, the very consumers that have to pay for their premiums are not lobbying at the government for the changes that would make the need for national health insurance obsolete.

Taxed out, when you turn 65 and are unemployed, do you plan on accepting medicare or do you intend to pay at least a couple a grand a month for private health insurance ( let's say 20 yrs from now assuming the status quo exists.?) You can probably plan on using a 1/4 or 1/3 of your retiremnent (if you have any set aside) to pay for health insurance premiums. I'll tell you right now there is not one wealthy medicare beneficiary who has opted for complete private insurance in my 15,000 patient practice because they actually got better services than their previous private payor plan!

 

[BWG]

Remove government regulation and introduce competition into the insurance industry.

less claims paid out equals higher premiums ?

Before tort reform in my state, there was 2 insurers offering malpractice ins.
After tort reform passed, dozens of insurers came in and because of the competition, MI rates were lowered.

Doctors paid less for MI.
Insurers increased the volume of premiums (more doctors opted in with cheaper rates) and reduced their risk of claim payout.


The consumer. OUR premiums skyrocketed.

Health insurance costs have risen even faster. The premiums workers pay for employer-provided health insurance rose an average of 7.7 percent this year - and have increased 84 percent since 2000, according to the Kaiser Family Foundation, a health-issues research center.

Source

Actually it would help tort reform if we had national health insurance.

I agree, as you go on to say, instead of paying the person or family of a person who was harmed, millions of dollars for future medical care, national health care would take care of any future needed care.

I've been reading your posts and I am a strong proponent of a national health care system. I see so many more benefits of a NHC than I can of our present hodge-podge system. ALL Americans should have some level of medical care. It should not depend on who you work for or how much money you make that determines if you and your family has medical care or not.


You are in a unique position of seeing the benefits from an employer's viewpoint, as well as a health giver's point. Therefore, I give your comments a lot of credibility.

 

[taxedout]

Before tort reform in my state, there was 2 insurers offering malpractice ins.
After tort reform passed, dozens of insurers came in and because of the competition, MI rates were lowered.

Doctors paid less for MI.
Insurers increased the volume of premiums (more doctors opted in with cheaper rates) and reduced their risk of claim payout.


The consumer. OUR premiums skyrocketed.

Health insurance costs have risen even faster. The premiums workers pay for employer-provided health insurance rose an average of 7.7 percent this year - and have increased 84 percent since 2000, according to the Kaiser Family Foundation, a health-issues research center.

How much rise without tort reform ? Difficult to say , but I'm sure much greater.

Make reimbursement an issue between the insurance company and the consumer. The general population outnumbers the doctors significantly.
You have more economic and political pull to create competition.

 

[Commonsenser]

New to this site. The PNHP proposal is exactly what I've been advocating for years. It seems they recognize the incredible waste of money we are paying in health insurance premiums. As I stated in another thread, Harvard published a study about a year ago stating that less than 50% of our insurance premiums pay for the actual medical care we get, the rest going to the insur. cos profits and expenses. And only 5% of insureds spend more than $5000 a year in medical care. I'd also read that the average American spends 15% of gross income on health care a year, most of which is in insurance premiums. If that amount is cut in half (paying just for the care), a 7.5% payroll tax makes sense. Only the insurance companies are cut from the equation, and we save half of what we're paying now. "Taxedout" doesn't seem to grasp that this new "tax" is only money he's already paying to the insurance cos. Why would medical care become MORE expensive with UHC? Guaranteeing payments to providers would allow costs to come down, no write-offs being necessary with their accompanying overcharges. The same physicians would be providing the care; the only difference is who pays them.

 

[Commonsenser]

The tax burden there is on the individual,the major burden here is on us small to medium business owners ( and is now affecting the corporate giants) but eventially it will pass on to you in terms of smaller salaries as our overhead for providing health insurance coverage explodes.]


What percentage of your total payroll do you pay out in health insurance premiums and worker's comp? What percentage of her wages is your average employee paying for her premiums?