Can someone explain the health care 'crisis' to me?

[Copernicus]

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Don't employers have open enrollment for one month out of the year, when you can get insurance or change policies at your job without any background check or anything? Is that just in my state or something?

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I'm not sure if that is a state or federal law or just courtesy by the employer, but open enrollment once a year is very common. You usually can change not just health insurance coverage, but also disability and life insurance coverage, your 401(k) plan, and other benefit plans offered.

And obviously you can change benefit plans on marriage (or divorce) having children, etc.

-Zeno

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Federal law on any tax favored benefits. You have to elect to defer taxes before the income is earned, so elections are usually made in advance of the tax year. On non-tax favored benefits its just an administrative rule to keep expenses down.

[Bill Haywood]

Come my son, and listen.

Since you've been healthy enough not to find out on your own, here's what to expect, from my own family's experience.

You are charged $800 for a $200 procedure. You haven't met your yearly deductible yet, so the anesthesiologist bills you instead of your insurance company. Insurance company is charged only $200 for that particular procedure, but you get stuck with an $800 bill for being you.

Children's health insurance is canceled without notice. When queried, the company claims that photocopied forms you sent were illegible. You know this isn't true because this is the second time they've pulled this. Repeat three times with more inventive excuses.

You wait 3 months for an appointment with what turns out to be a nurse who is screening things for a doctor. You persuade her you have something that really needs to be seen. NOW you make an appointment with the doctor -- in three months.

A doctor you finally develop rapport with gets transferred to another county. Medical conglomerates do that sort of thing.

Your father (a retired physician) waits in an emergency room for 6 hours with chest pains before being closely examined. By this time, the heart muscle is badly damaged. He dies.

A prescription you've been taking for years is rejected by the new insurance company. Why? That drug is not in the list in their manual. (Real issue: no generic version available.) You must pay a monthly $50 CO-payment. This is name-brand insurance, Blue Cross!

Insurance refuses to pay for a surgical procedure. You spend TWO DAYS on the phone attempting to reach higher ups, who eventually confirm that yes, it's supposed to be covered.

A doctor charges a friend $800 for a five minute visual/hand examination of a child's arm. No lab work or x-rays or casts of any kind are involved. You need to see a doctor of that same specialization. You beg the insurance company not to send you to a proven crook. Sorry, only in-network doctors will be paid for.

A doctor under pressure to shorten his per patient time informs you of a new condition that you have. He gives 30 seconds of generic boilerplate explanation, then vanishes. You ask a nurse if you are supposed to leave now, or wait for something else.

Your sister is a doctor at Mayo. One after another, her colleagues are driven out of the company -- replaced in one case by a doctor who had not worked in a year due to substance abuse problems. Why? The new hires would not challenge the corporate bean counters.

And we are a basically healthy, highly educated Caucasian family adept at pressing bureaucrats. Imagine what it is like for everyone else.

Here is the underlying problem with our HMO/ private insurance system. The way the companies cut costs and boost profits is by denying coverage, not through efficiencies or expanded services. A large portion of every health care dollar (30% is what comes to mind, Paul Krugman wrote about this) is spent on the bureaucracy whose job it is to invent regulations that deny coverage. As one outfit's profits go up, its competitors must develop more byzantine ways of restricting coverage.

Years ago, the complaint was that arrogant, unapproachable doctors thought they're god. Now we find out that an overbearing individual is far preferable to a corporate bureaucracy, which offers no face to challenge. The doctors are degraded by corporate even more than the patients.

Your grandparent's life skills included learning to fix farm machinery. You will learn to pour through coverage manuals like a lawyer, in order to force action out of institutions whose job is to not do their job.

But at least we don't have a single-payer health system. I hear that destroys freedom.

[vhawk01]

Anyone wanna give me a quick synopsis of what some of these proposed solutions would do to physicians salaries? I am really, really uneducated wrt economics.

[Copernicus]

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Come my son, and listen.

Since you've been healthy enough not to find out on your own, here's what to expect, from my own family's experience.

You are charged $800 for a $200 procedure. You haven't met your yearly deductible yet, so the anesthesiologist bills you instead of your insurance company. Insurance company is charged only $200 for that particular procedure, but you get stuck with an $800 bill for being you.

Children's health insurance is canceled without notice. When queried, the company claims that photocopied forms you sent were illegible. You know this isn't true because this is the second time they've pulled this. Repeat three times with more inventive excuses.

You wait 3 months for an appointment with what turns out to be a nurse who is screening things for a doctor. You persuade her you have something that really needs to be seen. NOW you make an appointment with the doctor -- in three months.

A doctor you finally develop rapport with gets transferred to another county. Medical conglomerates do that sort of thing.

Your father (a retired physician) waits in an emergency room for 6 hours with chest pains before being closely examined. By this time, the heart muscle is badly damaged. He dies.

A prescription you've been taking for years is rejected by the new insurance company. Why? That drug is not in the list in their manual. (Real issue: no generic version available.) You must pay a monthly $50 CO-payment. This is name-brand insurance, Blue Cross!

Insurance refuses to pay for a surgical procedure. You spend TWO DAYS on the phone attempting to reach higher ups, who eventually confirm that yes, it's supposed to be covered.

A doctor charges a friend $800 for a five minute visual/hand examination of a child's arm. No lab work or x-rays or casts of any kind are involved. You need to see a doctor of that same specialization. You beg the insurance company not to send you to a proven crook. Sorry, only in-network doctors will be paid for.

A doctor under pressure to shorten his per patient time informs you of a new condition that you have. He gives 30 seconds of generic boilerplate explanation, then vanishes. You ask a nurse if you are supposed to leave now, or wait for something else.

Your sister is a doctor at Mayo. One after another, her colleagues are driven out of the company -- replaced in one case by a doctor who had not worked in a year due to substance abuse problems. Why? The new hires would not challenge the corporate bean counters.

And we are a basically healthy, highly educated Caucasian family adept at pressing bureaucrats. Imagine what it is like for everyone else.

Here is the underlying problem with our HMO/ private insurance system. The way the companies cut costs and boost profits is by denying coverage, not through efficiencies or expanded services. A large portion of every health care dollar (30% is what comes to mind, Paul Krugman wrote about this) is spent on the bureaucracy whose job it is to invent regulations that deny coverage. As one outfit's profits go up, its competitors must develop more byzantine ways of restricting coverage.

Years ago, the complaint was that arrogant, unapproachable doctors thought they're god. Now we find out that an overbearing individual is far preferable to a corporate bureaucracy, which offers no face to challenge. The doctors are degraded by corporate even more than the patients.

Your grandparent's life skills included learning to fix farm machinery. You will learn to pour through coverage manuals like a lawyer, in order to force action out of institutions whose job is to not do their job.

But at least we don't have a single-payer health system. I hear that destroys freedom.

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What you are describing fits Canada to a T...a single payer health system that is failing. Read the above linked article about Canada if you think single payers is the answer.

[Case Closed]

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Great analogy ... if not having a pony means a death sentence to many.

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Have any of you liberals ever taken a minute to think about just who is going to die if we de-regulate health care?

Most of America is insured as it is, and the status quo isn't making a whole lot of money. Now let's do the following:

- Stop forcing all these Americans to pay the Medicare/aid taxes that they're getting nothing for. Their bills will also be lower, because they're not picking up the slack for treatments that medicare/aid only partially paid for.

- Deregulate the insurance carriers so that the customers can actually choose what they do and do not want to be covered for.

- End the war on drugs, and thus make all the drugs cheaper.

- Reform the tort system so that doctors don't have to pay six figures in malpractice insurance every year.

Insurance will become very, very affordable, and many more Americans will have it.

The only people that won't have it under such conditions are the dregs of society. Drug addicts, lazy bums, criminals, those with horribly untreatable physical conditions...these are the people who are going to die. You know good ol' middle class hard-working Joe? Joe is going to benefit from this system. He's not going to get hurt. You know that perennially unemployed pothead friend-of-a-friend of yours who sleeps on the couch all the time? He's going to be screwed.

It is so freaking easy to succeed in a free market. The only people that are going to get the shaft are going to be the losers that frankly most of us do not want in society anyway. That is who socialism helps.

Still sound like a good idea?

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But socialism feeeeeeeeeeeeeeeeeeeels good.

[adios]

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I want to know what is the crisis in US health care. I live in the US and purchase my own health care independantly for a very reasonable price....what am I missing? [img]/images/graemlins/confused.gif[/img]

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Don't know if anyone has mentioned this, apologies if this is a repetition of another post. The issue of health care costs is related to the problems with Social Security. The baby boomers comprise a disproportionate number of people in the U.S. The problems with Social Security are basically about the baby boomers reaching retirement age thus becoming eligible for Social Security benefits. Social Security is running a surplus now because there is more money being contributed by workers than by those receiving benefits. Projections are that Social Security will be running a defecit by I believe 2017 because more people will be drawing benefits and thus the number of workers that contribute to Social Security will not cover the benefits paid. This situation arises due to the disproportionate number of "baby boomers."

What does the above have to do with health care costs? Well those same baby boomers will be eligible to receive medicare benefits as well. I think it's clear that older people require more health care and thus the benefits that the "baby boomers" will receive will cause medicare benefits paid to increase at a much faster rate as the baby boomers age. Also medical costs are on the rise due to a number of other reasons. Here's one point of view (he does mention the baby boomers):

The Top 10 Reasons for Soaring Health-Care Costs

So you have a disproportionate number of people getting older being eligible for government paid benefits as well as rising costs due to various other reasons. The unfunded liability that the federal government has for health care benefits is at best a wild guess IMO.

[Ron Paul]

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Come my son, and listen.

Since you've been healthy enough not to find out on your own, here's what to expect, from my own family's experience.

You are charged $800 for a $200 procedure. You haven't met your yearly deductible yet, so the anesthesiologist bills you instead of your insurance company. Insurance company is charged only $200 for that particular procedure, but you get stuck with an $800 bill for being you.

Children's health insurance is canceled without notice. When queried, the company claims that photocopied forms you sent were illegible. You know this isn't true because this is the second time they've pulled this. Repeat three times with more inventive excuses.

You wait 3 months for an appointment with what turns out to be a nurse who is screening things for a doctor. You persuade her you have something that really needs to be seen. NOW you make an appointment with the doctor -- in three months.

A doctor you finally develop rapport with gets transferred to another county. Medical conglomerates do that sort of thing.

Your father (a retired physician) waits in an emergency room for 6 hours with chest pains before being closely examined. By this time, the heart muscle is badly damaged. He dies.

A prescription you've been taking for years is rejected by the new insurance company. Why? That drug is not in the list in their manual. (Real issue: no generic version available.) You must pay a monthly $50 CO-payment. This is name-brand insurance, Blue Cross!

Insurance refuses to pay for a surgical procedure. You spend TWO DAYS on the phone attempting to reach higher ups, who eventually confirm that yes, it's supposed to be covered.

A doctor charges a friend $800 for a five minute visual/hand examination of a child's arm. No lab work or x-rays or casts of any kind are involved. You need to see a doctor of that same specialization. You beg the insurance company not to send you to a proven crook. Sorry, only in-network doctors will be paid for.

A doctor under pressure to shorten his per patient time informs you of a new condition that you have. He gives 30 seconds of generic boilerplate explanation, then vanishes. You ask a nurse if you are supposed to leave now, or wait for something else.

Your sister is a doctor at Mayo. One after another, her colleagues are driven out of the company -- replaced in one case by a doctor who had not worked in a year due to substance abuse problems. Why? The new hires would not challenge the corporate bean counters.

And we are a basically healthy, highly educated Caucasian family adept at pressing bureaucrats. Imagine what it is like for everyone else.

Here is the underlying problem with our HMO/ private insurance system. The way the companies cut costs and boost profits is by denying coverage, not through efficiencies or expanded services. A large portion of every health care dollar (30% is what comes to mind, Paul Krugman wrote about this) is spent on the bureaucracy whose job it is to invent regulations that deny coverage. As one outfit's profits go up, its competitors must develop more byzantine ways of restricting coverage.

Years ago, the complaint was that arrogant, unapproachable doctors thought they're god. Now we find out that an overbearing individual is far preferable to a corporate bureaucracy, which offers no face to challenge. The doctors are degraded by corporate even more than the patients.

Your grandparent's life skills included learning to fix farm machinery. You will learn to pour through coverage manuals like a lawyer, in order to force action out of institutions whose job is to not do their job.

But at least we don't have a single-payer health system. I hear that destroys freedom.

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I'm unclear. Are you arguing for or against socialism, because all of the problems you described are caused by too much socialism, not a lack of more.

The frightening thing is that the people who advocate socialism never understand that it does not, in fact, increase access to goods and services, which is the stated aim, but instead always reduces the quantity and quality of services available.

[Bill Haywood]

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What you are describing fits Canada to a T...a single payer health system that is failing. Read the above linked article about Canada if you think single payers is the answer.

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Nonsense. Did you actually read the Canada article from the NYT? I did.

It's point was that Canada's system is overcrowded. It treats too many people.

Most of the complaints in my post were about HMO's refusing treatment, not having too many people to treat. And this is a problem for some surgical procedures -- not everything is overcrowded.

That's not a fit to the "T".

Further, note that though you may have to wait two years for a joint replacement operation in Canada, at least you can get it. There are plenty of people in the US who would rather wait 2 years than never get the procedure.

Canada also has an unusual form of single payer health care, where many types of private treatment is actually banned. This naturally shunts everyone into the single payer system, overwhelming it. The article notes that all other single payer systems are in addition to, not replacement of, private care.

So you use Canada to criticize all universal health care by defining its practice as the same as all others. Very sloppy for an astronomer. All ideologically driven by kneejerk free market dogmatism.

[Bill Haywood]

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Are you arguing for or against socialism, because all of the problems you described are caused by too much socialism, not a lack of more.

The frightening thing is that the people who advocate socialism never understand that it does not, in fact, increase access to goods and services, which is the stated aim, but instead always reduces the quantity and quality of services available.

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I'm calling for universal health coverage. Call it what you want.

The frightening thing is that you are arguing from theory, not a comparison of actual health care systems. You start from a theoretical position, that anything you define as socialism is always bad, therefore single payer health care must be bad. But if we compare the systems of Canada and Europe to the US, studies consistently find that they treat more people at lower costs. Yes, new problems may come from trading systems. But the real life experience is that patients in the other countries survive better.

I suspect you will use some sleight of hand and say that the US problem is collectivism, not free market. But that's arguing from theory again, not facts on the ground. In a reality based universe, Canada and Western Europes' collective health care is superior. And if we go to single payer, we would have the advantage of learning from all the past experience; borrowing what works, avoiding Canada's ban on out of network coverage.

A general note. The rhetoric of anarchocapitalists gives me a powerful feeling of deja vu -- to 1983 conversations with Trotskyites. Twenty year olds who had just read the Manifesto had all the answers. Socialism solved everything. Shortages might occur? No, economic democracy would unleash the creative abilities of the masses, and outproduce previous systems. What about the USSR? That isn't real socialism. If you do it the ideologically correct way, all those problems will disappear. Ideology ALWAYS provided a dodge from pesky facts.

Like anarchocapitalists, the Trotskyites had no existing example of successful socialism (they are Trots, so they are critical of China and the USSR). So ALL their arguments were from the pristine, mathematically precise world of ideology.

Eventually, a wing of ACs will start grappling with the problem of reality, and trying to adapt their theories to fit pragmatic conditions. Then another wing will jump on them for "revisionism," abandoning the path to the true heaven. You heard it here first. It's all happened before.

Seek truth from fact. Show me an ideology with all the answers, and I'll show you a burning bush.

[bluesbassman]

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From what I understand, it's basically the same as the pony crisis.

* I want ponies.

* I want someone else to pay for those ponies.

* Nobody is getting off their ass to buy ponies for me.

Hence, crisis. We need decisive action from a bold leader willing to make sacrifices in order to make this happen.

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Correct, pvn. And as any economist will tell you, the best way to make ponies more available and affordable to the masses is to create a government regulated, centrally planned "pony provider" bureaucracy.

That's why countries like North Korea enjoy such a high standard of living with cheap basic necessities, including food and medicine.