What Should We do About Heathcare?

[BlackMagicRose]

There are too many Americans without Heathcare. that is a fact that everyone knows, but what can we do about it? I honsetly am not sure and was wondering what everyone thinks about this.

Here in Austria it is a socialist system. Everyone has healthcare, but it is not free. You have to pay "social insurance" which is a pretty heafty cost (more so if you are self employed like my husband), but we get many benefits from it, including a long term maternity leave.

I do not know if it is the right way to go, but it is certainly better than what the US has now.

[PinkMartini]

Oooh good thread. I see some great suggestions coming from it :)

I am lacking in any ideas (don't know enough about the options) but I do agree there are far too many Americans without healthcare. Hell, I didn't have health insurance for 5 years (after I graduated H.S. and was taken off my dad's policy) and it was horrible. I didn't see a dentist in that time and now that I do have insurance, I'm FINALLY able to get my teeth taken care of. (Speaking of which, my younger brother doesn't have insurance and has had to have 3 teeth pulled in the past 2 years because to get them taken care of would have cost over $500 per tooth) And I had to go on Medi-Cal for the first half of my pregnancy with my DS because I didn't have insurance.

[jennylou]

How much is the "social insurance" tax? I just wonder if it wouldn't be about the same as what we are paying in insurance premiums, deductibles, copays and the amount that our employers are already paying?

[msnicolea]

It should be affordable (free to some) and mandated. All children must be automatically covered at birth.

[ysolde]

Can we do something along the lines of the British/Spanish/French system, where there is a basic healthcare system for everyone who needs it, with the option of private insurance and doctors/hospitals for those who want it/can afford it? I realize this means some of us will be paying twice, but I would be willing to pay twice if it meant the ability to see "my" doctors and basic health coverage for all.

I hate the Canadian concept where no one is given the option of private insurance.

[msnicolea]

I agree, ysolde--I am totally ok with their being additional options, services on demand and from private pay--as long as major coverage extends to all!

[Dally]

I think healthcare should be disassociated from employers. It doesn't work well for the majority of employers (who are small businesses) or all of the employees who work for small (or even medium-sized) businesses, are self-employed, or are employed part time.

Maybe there was a time when that worked, but no more.

I think a combination of private and public health insurance would be great. We could pay for basic insurance with taxes, and then people could choose to pay for additional private insurance. Alternatively, all insurance could be private with a sliding scale of help paying for insurance by the gov via a tax.

I do think everyone should have basic coverage, all children should be covered, and no one should be dropped for getting sick.

[ysolde]

I agree, ysolde--I am totally ok with their being additional options, services on demand and from private pay--as long as major coverage extends to all!


I also think it's going to mean tough choices. Experimental treatments, the latest drugs, etc. may not be available on the "national" system. OTOH, everyone should have access to chemo, heart surgery, asthma meds, heck, a flu shot, without having to decide whether to get treatment or pay rent/for food.

[tandt]

You ladies make some excellent points and I absolutely agree that something has to be done.

While I don't have a solution to offer, I am hesitant to support tax-style dollars going to cover everyone.

I know there are so many families in need of insurance, but having a tax paid by all means there's no incentive for some to seek employment, other options, etc to get healthcare. It can't just be 'free' for some.

I'm sure I'll get flamed by some, but those are my thoughts-- I get frustrated when solutions for most anything include raising taxes and having the federal govt run things.

And yes, we have faced insurance issues-- always had coverage, but also some big out-of-pocket costs after insurance paid their portion. My husband had cancer and we had tremendous bills and currently my parents are facing health troubles with my dad and mounting medical bills.

We could pay for basic insurance with taxes, and then people could choose to pay for additional private insurance.

Interesting compromise!

Tragedy strikes everyone, regardless of income, and there has to be a solution, I agree.

[BlackMagicRose]

To the person who asked how much we pay for social insurance (it is not only for health, but also retirement) 1,200 euros every three months which is exactly $1,756.18.

So yearly: $7,024.72

It is high for us because husband is self employed, if he were employed by someone here, it would not be as expensive.

Still, not cheap. But, how much does everyone pay for insurance a month in the US??

I remember paying $420 a month for blue cross and blue shield so that was about $5,000 a year.

Any way...I do think private health care should be an option and as much as it sucks, we need to give every baby health care no matter what.

[jennylou]

To the person who asked how much we pay for social insurance (it is not only for health, but also retirement) 1,200 euros every three months which is exactly $1,756.18.

So yearly: $7,024.72

It is high for us because husband is self employed, if he were employed by someone here, it would not be as expensive.

Still, not cheap. But, how much does everyone pay for insurance a month in the US??

I remember paying $420 a month for blue cross and blue shield so that was about $5,000 a year.

Any way...I do think private health care should be an option and as much as it sucks, we need to give every baby health care no matter what.

We pay about $100 per pay, so $200 per month. $2400 per year. My DHs employee pays about $750 (this may be higher, this was last years figures and we just got our new changes now, but we were looking when there was a layoff possibility). So, they pay $9000 per year for us. In addition we have a $500 deductible. Then we have our copays and our 10% co-insurance. So, out of pocket just for the insurance is $2900 (deductible and premium), pluss $9000 from the employer, plus our 10% co-insurance costs and our copays (vary based upon primary, specialist and ER).

[Dally]

We pay $800/month for my husband, daughter, and me. This is just for health insurance--we don't have dental insurance (we pay out of pocket for that). We have $500 deductibles for each of us and copays.

We pay a lot because we are self employed and have to get invidual insurance, not because of any extenuating medical history.

My biggest fear is that if one of us gets cancer, our insurance company will cancel us and we won't be able to get insurance anymore. I hate that I have to be concerned about this.

[numberlady]

I think that health and dental insurance should be mandatory for all, so that the risk would be blended over the entire population. That way the "healthy" couldn't opt out and leave only the sick in the pool. I am curious to see how the Massachusetts plan will work.

I also think that there should be 1 standard plan so that everyone has the same benefits and costs. It should be optional to buy more coverage if that is wanted.

I agree with the pp that said it should not be tied to employment. Dh is self employed, so we basically rely on my employer for our health insurance. We would like other options than we are offered, but there are too many downsides to getting insurance on our own.

[Rosebud]

There were lots of good thoughts on this complicated issue in this thread:

Fixing American Healthcare (http://www.constantchatter.com/forum/showthread.php?t=34782)

I bumped it for reference, but closed it so discussion can continue here.

[gayle]

I am an absolute believer in fully Socialized medicine. Ala Sweden (would be my preferred model).

I don't mind paying taxes, as long as those taxes provide services I support. Public medicine, and education are at the top of my list of importance.

[IrishEyes]

I'm curious about the MA plan, too. I have a friend that works for a very small business (a salon), where the owner does not provide health care. Most of the workers there get health care coverage through their spouses work. My friend is going to pay the penalty (she's uninsured) because she's says that's cheaper than buying private health care. I've encouraged her to seek out an affordable plan, and that paying just a little more than what the penalty is will get her coverage with a private plan, but she isn't going for it.

[BlackMagicRose]

There were lots of good thoughts on this complicated issue in this thread:

Fixing American Healthcare (http://www.constantchatter.com/forum/showthread.php?t=34782)

I bumped it for reference, but closed it so discussion can continue here.

I did a search and it did not come up :( Sorry about that.

[hisdaffodil]

I agree something needs to be done too but I'm not knowledgeable enough to have any suggestions, I think.

DH and I were self-employed, with 2 kids and one on the way, uninsured. It was the scariest on earth. But to get insurance coverage with maternity coverage was going to run us 1200/month !!!!!

Instead DH had to quit doing what he loved and get an employer based job just to get insurance.

It still costs us $7410/yearly, plus a $2000 family deductible. So over $9400 just out of OUR pocket, not including what the employer pays.

And to be honest, it isn't the best insurance. It is a BCBS product and the only one the employer offers.

[jay&erinn]

I could be very wrong about my info but....
In Sweeden, don't they pay approximately 2/3 of their salaries in taxes? I think this is to cover education and health care only. It's been many years since I've heard this info (came from an exchange student from Sweeden). He said people were not happy to pay sooo much to taxes. On a $30,000 salary that would only leave $10,000 a year to cover living expenses and saving for retirement. Doesn't seem like much to cover the cost of a car, house, utilities, food, etc.
I hate the Canadian concept where no one is given the option of private insurance
We have friends in Canada and they said that they do have private insurance on top of the basic government provided coverage. They had commented that most people have private insurance also because the government provided coverage is so poor. Maybe I understood them wrong though.

I obviously don't understand some of the health care problems. In PA it seems that children have pretty good access to free health care. Also there are programs in place for children who's families cannot afford private insurance, but make too much money to qualify for medicaid. I had two friends who had their kids on the program- one was a single mom working full time and one is married, but her husband is disabled. Both made decent money but paying out for family healthcare would have put them in the poor house. They both utilized the program. Now, adults in PA- I see them fall through the cracks all the time.

[Annette]

I think if we offer some kind of inexpensive preventative care for all, it would help a great deal by freeing up ER's for true emergencies. I read an article on CNN that the ER wait even if you are having a heart attack is close to an hour. Also, people wouldn't wait till they are really sick to go to the doctor, which would end up costing more.

As far as taxes go, add in property and sales tax and I think we rank right up there with Europe.

[Katie1]

I find the Massachusetts plan to be idealistic and a burden to some. It's another case of rich policymakers not really getting what it means to not be able to afford something. Case in point: I worked at a small, independant business that did not offer insurance. Under the Mass plan I had to either buy private insurance that I could not afford, or take the tax penalty- also something I could not afford to do. The new law required the business to start offering insurance but the owners dragged their feet and, knowing the way they do business, I am sure they won't bother until they are caught. None of the employees will report them because all of the employees need their jobs and would be afraid of repercussions. This is reality for many people. It's easy to say just report the business, or find a new job, but for people who are in that situation it's not easy at all.

While this plan was not the main reason we left Massachusetts, I was certainly glad to get away from there with the law in force.

It is hard for me to suggest what should be done because I have a lot of problems with the insurance business in the first place, and feel that health care may be much more affordable to all if insurance companies never existed and began to skew things. At this point I do believe that everyone should have access to affordable health care, but punishing them for not having it seems asinine.

[Rositabean]

I don't have an answer because the system is bad and getting worse but I have some thoughts.

I think the government does a terrible job of providing health coverage. Medicaid products and Medicare provide worse and worse reimbursement to providers and trying to get procedures approved or covered or medications covered that aren't ancient is next to impossible. The thought of having the government expand their reach and workload makes me feel sorry for those who would end up with this coverage. Medical Services for Indigents (coverage in OC for the truly poor) is so awful, you practically have to be dying to have anything covered and you will be hard pressed to find providers.

Good medical practices won't accept the really bad government sponsored plans, or drop them as soon as possible so the system ends up with huge voids in care. For example a couple of years ago one of the medi-cal plans was not able to con a single retinologist to contract with them, so if you had that plan and happened to have a retinal detachment, well, sorry about your retina. For me as a provider it was very stressful to not have anyone to refer to and I am glad not to be in that situation anymore with that plan. Basically the providers that contract with the worst government plans are either brand new and don't know better yet, or are not new and do know better but are otherwise kind of sketchy and can't attract patients with better coverage.

The other issue I have with Free For All care, is that IME people don't value things that are free for them as much as things that they have to pay for. The vast majority of my No-Shows are medi-cal patients and some of the most entitled acting patients are my medi-cal patients. "What do you mean a blepharoplasty/contact lenses/no-line bifocals/designer Gucci frames/Lasik/etc... is not covered?" Sorry, unless the skin is hanging over your entire eye, we are still only looking at a 50/50 chance of getting that medically covered, especially if you are deemed too old to benefit. Your selection of frames include only these ugly abominations (it is interesting to note how quickly these "poor" folks will come up with money to upgrade to nicer frames or lenses when faced with potential fashion faux pas). Seriously, only my elderly Medicare patients seem truly grateful for the coverage they have, the younger medi-cals are just not.

I think it would be best for most people to have catastrophic coverage and then pay out of pocket for routine care. It would surely run less than paying 7-10K per year just to get an annual physical exam out of it. I have a lot of uninsured cash pay patients that do this. They pay cash to see me and for some testing and meds, and even if they pay cash for cataract surgery, it is still going to run less that 7-10K per year. Some private insurers have taken to profiting off of co-pays such that the copays for popular drugs are higher than the cost to buy the drug outright. In cases like this, it is better to pay cash than use insurance.

If we do end up with universal government care there should be incentives for staying healthy or penalties for not. What I mean by this is that you should be able to be excluded from coverage if you smoke, abuse drugs, drink more than socially, or are sedentary or obese. These folks are healthcare train wrecks waiting to happen, and it is not fair to burden the tax base as a whole for some people's poor lifestyle choices. We can have the government enter into a more Big Brother like arrangement and monitor our lifestyles to ensure compliance.

And medical malpractice insurance and litigation is a whole other problem that forces all providers to spend healthcare dollars on unnecessary tests just so we can cover our behinds, not because it is best for patient care or following evidence based medicine. Got a headache? Lets get an MRI. Something needs to be done about lawyers.