Author Topic: Politics  (Read 226343 times)

ˇKeith!

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Re: US Politics (and Transition)
« Reply #1310 on: August 19, 2009, 10:31:55 AM »
no thats the way it happens now (with the walker).  the govt here isn't looking to own/run the hospitals but to insure the populous.  there will still be for-profit hospitals.

smirnoff

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Re: US Politics (and Transition)
« Reply #1311 on: August 19, 2009, 10:40:41 AM »
Oh ok. Yeah, that stinks if that's really what ends up happening.

Colleen

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Re: US Politics (and Transition)
« Reply #1312 on: August 19, 2009, 10:44:26 AM »
One of the things about the current system that makes me nuts is that the people least able to afford it--the uninsured or barely insured (people who have catastrophic coverage only) subsidize the cozy relationship between insurance companies and healthcare providers.

Here's how it works:  JoeBob Health Insurance is the employer healthcare plan for 250,000 working stiffs in a metropolitan area.  JoeBob goes to St. Harry's Hospital and says, if you are in our network and we list you as a preferred provider, you have a guaranteed customer base of at least 250,000.  In return, you will give us a 95% discount on the services you provide. If you won't give us that, that's 250,000 customers removed from your potential pool, going to a competing hospital"  St. Harry's makes the deal.

This means that if Jimbo, who has JoeBob health insurance, goes to the Emergency Room and is assessed for a $10,000 visit according to the invoice, JoeBob pays an actual payment to St. Harry's of $500.00 or thereabouts.  Seriously.

But, if Bubba, who got laid off and doesn't have health insurance, goes to St. Harry's and receives the identical treatment at the $10,000 price, he is billed for the whole $10,000 by the hospital, who will work hard to collect it just as any other debtor will--letters, phone calls, referrals to collection agencies, destroying your credit if they have to write off the debt.

That's the reason why you'll look at a hospital bill and see that a bandage is priced at $75.00; the hospital knows that the actual cost of the bandage to them is 50 cents, and the labor involved in stocking and using it is around $1.00.  If they bill it at $75.00, insurance plans will pay them $3.00, which gives the hospital $1.50 cushion.  That either becomes profit or a subsidy for more expensive treatments where the discounted insurance plans don't cover the cost to the hospital (for, say, a major surgery with a 6-person surgical team for 3 hours).

But the shmo who has no insurance will be billed $75.00 for the bandage.  This is why if you negotiate with the hospital on a bill that you have to pay yourself, they will quickly discount it 30-40 percent or more.  They are still getting paid a LOT more than they get from the insurance company.

In the past the hospitals were able to make up the difference between their costs and the deep discounts given to managed care plans by having a client base who has the so called "Cadillac plans" or "fee for service" plans where the insurance just pays the hospital bill, no questions asked.  However, as the cost of insurance has skyrocketed, there are fewer and fewer people on fee for service plans and more on the managed care plans.  That means the hospitals have to lean even more on the people forced to pay full freight out of pocket due to lack of insurance, or lack of enough insurance.

Here's a real world example:  http://andrewsullivan.theatlantic.com/the_daily_dish/2009/08/the-view-from-your-sickbed-1.html#more



 

Clovis8

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Re: US Politics (and Transition)
« Reply #1313 on: August 19, 2009, 10:51:39 AM »
I find this very true. There are a lot of nutso liberals, but none of them can touch people like Glenn Beck, and those who take him seriously.

Michael Moore and his legions of fans say hello.


HAHAHA, ya that's the same thing. OK!

smirnoff

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Re: US Politics (and Transition)
« Reply #1314 on: August 19, 2009, 10:58:26 AM »
Hmm interesting article Colleen. Tricky stuff...

FroHam X

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Re: US Politics (and Transition)
« Reply #1315 on: August 19, 2009, 11:01:14 AM »
I find this very true. There are a lot of nutso liberals, but none of them can touch people like Glenn Beck, and those who take him seriously.

Michael Moore and his legions of fans say hello.

Yeah, they're crazy, but have you SEEN Glenn Beck?


The sad thing is that this shouldn't be a politicized issue - making sure EVERYONE has access to affordable health care should be a priority. No one is talking about going to a much more efficient single payer (govmt sponsored) health plan - weigh in at any time Canadian and UK filmspotters - but it is time that we, at least, take our health care out of the hand of insurance companies who pay doctors for disease management and put the decisions back into our hands and let doctors get back to preventative medicine.

Affordable health care should be right not a luxury.
A lot of those people worrying about the label: socialized medicine are on medicare and medicaid and they don't even see their own hypocrisy...


Yeah, the thing that gets me is how people are so mistrustful of the government, and thinking that the government wants to decide people's health plans for them. Since when has the government been less trustworthy than a corporation looking only for profits?

I completely agree that health care, especially in a developed country where there are resources to implement it, should be a right. It shouldn't depend on how much you make or how much you can afford. If you are sick you should receive care. In the US it's unfortunately complicated by the sheer size of the population. Canada does relatively fine, but we only have 30 million people, and even WE need to step things up and figure out a lot of elements within our system that are not working.


One of the things about the current system that makes me nuts is that the people least able to afford it--the uninsured or barely insured (people who have catastrophic coverage only) subsidize the cozy relationship between insurance companies and healthcare providers.

Here's how it works:  JoeBob Health Insurance is the employer healthcare plan for 250,000 working stiffs in a metropolitan area.  JoeBob goes to St. Harry's Hospital and says, if you are in our network and we list you as a preferred provider, you have a guaranteed customer base of at least 250,000.  In return, you will give us a 95% discount on the services you provide. If you won't give us that, that's 250,000 customers removed from your potential pool, going to a competing hospital"  St. Harry's makes the deal.

This means that if Jimbo, who has JoeBob health insurance, goes to the Emergency Room and is assessed for a $10,000 visit according to the invoice, JoeBob pays an actual payment to St. Harry's of $500.00 or thereabouts.  Seriously.

But, if Bubba, who got laid off and doesn't have health insurance, goes to St. Harry's and receives the identical treatment at the $10,000 price, he is billed for the whole $10,000 by the hospital, who will work hard to collect it just as any other debtor will--letters, phone calls, referrals to collection agencies, destroying your credit if they have to write off the debt.

That's the reason why you'll look at a hospital bill and see that a bandage is priced at $75.00; the hospital knows that the actual cost of the bandage to them is 50 cents, and the labor involved in stocking and using it is around $1.00.  If they bill it at $75.00, insurance plans will pay them $3.00, which gives the hospital $1.50 cushion.  That either becomes profit or a subsidy for more expensive treatments where the discounted insurance plans don't cover the cost to the hospital (for, say, a major surgery with a 6-person surgical team for 3 hours).

But the shmo who has no insurance will be billed $75.00 for the bandage.  This is why if you negotiate with the hospital on a bill that you have to pay yourself, they will quickly discount it 30-40 percent or more.  They are still getting paid a LOT more than they get from the insurance company.

In the past the hospitals were able to make up the difference between their costs and the deep discounts given to managed care plans by having a client base who has the so called "Cadillac plans" or "fee for service" plans where the insurance just pays the hospital bill, no questions asked.  However, as the cost of insurance has skyrocketed, there are fewer and fewer people on fee for service plans and more on the managed care plans.  That means the hospitals have to lean even more on the people forced to pay full freight out of pocket due to lack of insurance, or lack of enough insurance.

Here's a real world example:  http://andrewsullivan.theatlantic.com/the_daily_dish/2009/08/the-view-from-your-sickbed-1.html#more

And that's why I do love single-payer health care. In Ontario we have the Ontario Health Insurance Plan. Every legal resident and citizen gets it. I have an OHIP card. I walk into a hospital, or even a private clinic, I ask to be seen, and so long as it's for covered care (dental and eyecare and a few other things are not covered) I can see a doctor as soon as one is available. I show them my OHIP card and I don't even have see or think or care about what my visit technically costs.

Same goes for if I've got to get an operation for something like a kidney stone. They somehow see my OHIP card and I get operated on. Hell, they'll operate on me if they don't see my card, under the assumption that I do have one and they'll get it verified later. I cannot say the same for American care. I was in the States with my dad and he started feeling some severe pain from a kidney stone. We went to a hospital, and though it was a good experience they still wouldn't do anything for him until he proved that he had health insurance to cover anything they might do.

A lot of people you ask in Canada will say that our system isn't great, or that it's broken, or that they might not even like socialized medicine. Ask those people "Would you be willing to give up your OHIP (or equivalent) card?" and none of them will want to.
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Colleen

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Re: US Politics (and Transition)
« Reply #1316 on: August 19, 2009, 11:03:36 AM »
Another case that has been on my mind a LOT lately happened a few months ago.  I was the responding investigator on a natural death that literally occurred due to lack of insurance.  

This was in late May or June when around here we are already having frequent 90 degree days.  The victim was a 58-year-old woman with a history of COPD (AKA emphysema), heart disease and poor circulation.  She had been on disability for several years because she was unable to work.  Up til then she had worked full time at cleaning and food service jobs, raising her children as a single mom and providing for them, even as her health started going downhill in her 40s.  Over the past 6 months her condition had worsened and she was bedridden.  Her only caretaker was her adult son who lived with her, who seemed to be a little "slow" (he didn't understand typical questions we would ask and we would have to re-word more simply, he literally answered very slowly and with a lot of thought on simple questions, and repeated himself a lot).  

On that particular day, it was over 90 degrees.  The house was steaming hot.  The son explained that he had been out of work and neither of them had had any insurance for about 8 months.  They were in the process of applying for Medicaid for the mother but it is a slow process and she hadn't been approved.  She had had a 3-week stay in the hospital in the previous few months and had a staggering bill from that, and they had declared bankruptcy after she had had a previous health emergency several years ago so they believed they were going to have to somehow pay that huge bill at some point.  Needless to say they were trying to avoid any further debt.  He had just gotten a new job and wasn't on their insurance plan yet.

So on the day we were eventually called there, he had gone to work, leaving some water for his mom.  They did not have the AC on because their inability to pay a previous high electric bill on time had led to them having the power cut off (and then a reconnect fee) so they were doing without air conditioning.  She had open windows in her room and a fan blowing on her.  But the son worried about the fan overheating and catching fire while his mom was alone in the house, so he had turned it off.

She was unresponsive when he left, but he said that she sleeps a lot and deeply so he wasn't too concerned.  She appeared to him to be asleep (based on the amount of rigor we saw when we responded she was probably already deceased at that time but he either didn't realize it or was in denial) and he went to work.  When he got home in the evening and he couldn't rouse her, and realized she was cool to the touch, he called 911.

When we asked if she had been complaining of any pain or new difficulties in the past few days, he said that she had been complaining of pain in her legs, but told him it wasn't very bad and she didn't need to go to the hospital.  This rang alarm bells for me--blood clots in the leg are a very serious potential complication of being bedridden and are an emergency--if a clot breaks loose and goes to the brain or the heart, it's lights out.  The ME investigator who responded was upset b/c he said the pain should have been treated at an ER, plus someone with COPD and poor circulation has much worsened symptoms in heat, particular the oppressive humid heat we have in Georgia.  He said heat literally kills these kinds of patients.  He was furious with the son for turning off the fan and also found some bedsores on her legs indicating that she hadn't been turned often enough.  He felt like the son was possibly neglectful or abusive.

I had spent a long time interviewing the son and I didn't think so.  I just don't think he was equipped to be her only caregiver.  I don't think anyone had told him or stressed enough what were emergency symptoms to watch for, or what conditions could hurt her.  He said he was told to turn her every few hours but it hurt her to turn her and she would cry out or cry, and he said if it was too bad he felt like he was hurting her too much and would wait to turn her til later.

In my heart I think that his mother knew that her leg pain was a serious symptom but felt like she was going to die soon of some complication anyway, and didn't want to cause her son any more debt, and literally laid down and died instead of seeking help.

Whether she consciously did so, or the combination of their lack of knowledge and lack of funds was enough to make them hesitate to seek help, she literally died of lack of insurance.  She is who I think of when people spout off about slackers who don't want to work and want the government to take care of everything.

FLYmeatwad

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Re: US Politics (and Transition)
« Reply #1317 on: August 19, 2009, 11:04:27 AM »
Now theoretically I know they are different, or should be different, but is there really much of a difference between a corporation seeking only profit and a government? Well, aside from one having more power than the other.

Clovis8

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Re: US Politics (and Transition)
« Reply #1318 on: August 19, 2009, 11:11:36 AM »
I am sure some will call me a socialists (which I am fine with btw) but I think Americans look at healthcare in completely the wrong way, and this will almost inevitably stall any progress.

Healthcare is a right, not an option. Americans look at healthcare like cable TV, something you can have if you want to pay for it, but it is not a right. Canadians, and other more socialists countries, view healthcare like highways or waste management. It is a fundamental role of the government to proved the foundations of a working community. One of those foundations is healthcare.

Until, it is viewed in this light, I don't think there will be much progress.

Also, as a non-American, I find it fascinating how Americans can spend $1.6 trillion on two pointless wars and somehow the only aspect of the healthcare debate that everyone focuses on is cost. Even with the Dems in control of the House, Senate, and White House, the Repubs are still framing the debate. It's amazing.  

Colleen

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Re: US Politics (and Transition)
« Reply #1319 on: August 19, 2009, 11:15:23 AM »
Okay sorry for the posting splurge on this thread but just after I had written my last two posts, I read this blog entry from one of my friends, in the form of an open letter to Sarah Palin.  His daughter also has Down syndrome.  Here's a quote:

"So don’t pretend that a national health program would put your son in front of your lovely pejorative “death panel”. Don’t pretend that you would face hardship. Don’t pretend that your America is different from mine. In my America, I’m downright lucky to be a software engineer in Massachusetts and in a position to afford two insurance policies – because under the existing purely private system, faceless bureaucrats have already made the decision that 3 months of PT per year is enough for a girl born with hemiplegia due to a stroke at birth. Our America already made that decision for my daughter."

The whole post is here:  http://www.plinth.org/wordpress/?p=33

I'm joining in with others of his friends and readers to pass this on to raise its visibility.  If you agree with what he's saying, feel free to post or tweet the link and pass it on further.