Things missing from the health care debate

[Louis of PA]

1. The health care bill does not yet exist. Yet the left fully supports "it".

2. There has been no information provided on how many new government employees will be needed to handle "universal health care".

Our government is already the largest employer in the world; does anyone think they should add more employees?

And here's what happens when you get politicians involved with what should be left to free enterprise:

from the New York Post:

State Slaps Dr. Do-Good
Author: Webby Category: NYC News Published: March 04 2009
NY Post


Dr. John Muney's unlimited office care for uninsured patients got the thumbsdown from the state. The state is trying to shut down a New York City doctor's ambitious plan to treat uninsured patients for around $1,000 a year.

Dr. John Muney offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs.

“I'm trying to help uninsured people here,” he said.

His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.

But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan - which it claims is equivalent to an insurance policy.

Muney insists it is not insurance because it doesn't cover anything that he can't do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can't function like emergency rooms.

“I'm not doing an insurance business,” he said. “I'm just providing my services at my place during certain hours.”

He says he can afford to charge such a small amount because he doesn't have to process mountains of paperwork and spend hours on billing.

“If they leave me alone, I can serve thousands of patients,” he said.

The state believes his plan runs afoul of the law because it promises to cover unplanned procedures - like treating a sudden ear infection - under a fixed rate. That's something only a licensed insurance company can do.

“The law is strict on how insurance is defined,” said an Insurance Department spokesman.

A possible solution that Muney's lawyer crafted would force patients to pay more than $10 for unplanned procedures.

They are waiting to see if the state will accept the compromise. Still, Muney is unhappy because, he said, “I really don't want to charge more. They're forcing me.”

One of his patients, Matthew Robinson, 52, was furious to learn the state was interfering with the plan.

“The whole point is, he [Muney] found a way of paying his rent, paying his workers, and getting to see patients for the price,” said Robinson.

“How can the state dictate you've got to charge more?”

Louis' note: I strongly suspect that the laws preventing this man from doing what he wants were crafted by the existing insurance companies in collusion with legislators they donate to. The intent being to limit competition. I think it's obscene and corrupt.

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[Neal Myers]

You are right; as usually, the extremists on the left are fast to say "It's great!" before the details are announced, just as they did with the insurance & bank bailout.

But Louis, dumping on Federal employees is the same shortsightedness shown by Sean Hannity. In fact, Feds have run the Social Security & Medicare programs quite efficiently for many years; their impending collapse is due to the meddling of our Congressmen over the last 40 years, & their use of extravagant increases to garner votes, not the failure of the workers who make the system run.

Leave health insurance to private industry? If you think that's efficient, you haven't been looking. There are over 3,000 private health insurers in the US, with > 300,000 employees plus real estate, computer systems, & contractors who eat up 25% of the money we contribute for premiums. Here in Maryland the largest health insurer is Carefirst BC BS; for 14 years the CEO was William Jews, who earned 6-8 million $ a year for most of his stay. He tried to engineer a sellout to a for-profit company (with a 39 million $ payout to himself). The legislature nixed that, so he retired (with a 19 million $ payout) that the state is trying to reduce to only 9 million $. How much "skin" did he have in the company? NOTHING, he was a hired hand. Plus, other executives & board members also had huge payouts. Contrast this with the head of Medicare for the entire country, who earns < $250,000 per year. Multiply this by thousands of other private insurers, including those in PA, & you can see that there is a lot of money at stake.

A single payer system run by the federal government (NOT socialized medicine) would greatly reduce the cost of health insurance, & make it available to more low income folks. But, it will never happen. This is too great a threat to Congressional contributions for them to let it happen.

[Mark in Ottawa]

Let me out some Canadian experience into the mix. As I am sure you know, we have had "socialized medicine" here for about 40 years. The bottom line is that it is imperfect and needs improvement but by and large there is no strong constituency for eliminating it. In fact, even those of us who favour a mixed public-private system would not want to see it eliminated. On the positive side, after a 3 month waiting period, it is universal and it covers most procedures (cosmetic surgery and very new procedures are typically not covered, nor is dental work or drugs for other than the elderly). On the down side, there is a serious shortage of advanced diagnostic equipment such as MRI machines and there are very long waits for elective surgery such as knee and hip replacements. There are some differences among what is covered in various provinces and in Quebec there is far more use of private sector suppliers for such things as diagnostics. By contrast, in Ontario, the left leaning government preferred to buy up the private sector machines rather than use the available money to increase the number available - a typical socialist approach that lets us all literally share the pain instead of improving the service. Another problem that we have in Ontario is a shortage of doctors - but this was fomented by the Conservative government who thought they could reduce costs by decreasing the number of physicians and nurses- this proving that the problem is one of imbecilic politicians rather than of politicans of the left or the right.

Having said all that, when my daugher was born, the cost was about $5 and that was to rent a TV for my wife.

[PhillipM]

Let me out some Canadian experience into the mix. As I am sure you know, we have had "socialized medicine" here for about 40 years. The bottom line is that it is imperfect and needs improvement but by and large there is no strong constituency for eliminating it. In fact, even those of us who favour a mixed public-private system would not want to see it eliminated. On the positive side, after a 3 month waiting period, it is universal and it covers most procedures (cosmetic surgery and very new procedures are typically not covered, nor is dental work or drugs for other than the elderly). On the down side, there is a serious shortage of advanced diagnostic equipment such as MRI machines and there are very long waits for elective surgery such as knee and hip replacements. There are some differences among what is covered in various provinces and in Quebec there is far more use of private sector suppliers for such things as diagnostics. By contrast, in Ontario, the left leaning government preferred to buy up the private sector machines rather than use the available money to increase the number available - a typical socialist approach that lets us all literally share the pain instead of improving the service. Another problem that we have in Ontario is a shortage of doctors - but this was fomented by the Conservative government who thought they could reduce costs by decreasing the number of physicians and nurses- this proving that the problem is one of imbecilic politicians rather than of politicans of the left or the right.

Having said all that, when my daugher was born, the cost was about $5 and that was to rent a TV for my wife.

Just curious, what percentage of your income goes to taxes?

[Louis of PA]

Let me out some Canadian experience into the mix. As I am sure you know, we have had "socialized medicine" here for about 40 years .....On the down side, there is a serious shortage of advanced diagnostic equipment such as MRI machines and there are very long waits for elective surgery such as knee and hip replacements. There are some differences among what is covered in various provinces and in Quebec there is far more use of private sector suppliers for such things as diagnostics.

By contrast, in Ontario, the left leaning government preferred to buy up the private sector machines rather than use the available money to increase the number available - a typical socialist approach that lets us all literally share the pain instead of improving the service. Another problem that we have in Ontario is a shortage of doctors - but this was fomented by the Conservative government who thought they could reduce costs by decreasing the number of physicians and nurses- this proving that the problem is one of imbecilic politicians rather than of politicans of the left or the right.

Having said all that, when my daugher was born, the cost was about $5 and that was to rent a TV for my wife.

Mark - It's nice to hear from our Canadian neighbors.

As I mentioned in a recent post, I've seen statistics that only about 25 percent of Canadians of the appropriate age have been given even one colonoscopy. Here in the U.S. it's around 75 percent.

Why so high here? Because doctors understand their importance and the hospitals and doctor's practices have made the investment in the equipment without needing an OK from some faceless, nameless bureaucrat in Washington.

That innocent statistic is meaningful for me, because perhaps under the Canadian rationing system, I could be dead now, from colon cancer. Fortunately I live here, was given regular colonoscopies (truly a pain in the azz), and, at the last one, diagnosed at an early stage and treated immediately, with excellent results (I'm still alive).

One of our senators, a doctor, recently stated that, in Canada, no joint surgeries are performed after Halloween of each year, until the beginning of the next year.

It's human nature to adjust as best we can to the circumstances thrust upon us and to accept, "that's the way it is" when there are no other choices. Other than your national health system, what other choices do you have in Canada?

I shopped for my Medigap insurance, found a company in Tennessee that provides superb coverage at about half the cost of the big name insurance companies in this Pennsylvania region, and the same goes for AARP rates.

We Americans are accustomed to choices, whether with car insurance or automobile brands ... and with health insurance. If we go the single payer route, we avoid paying insurance companies but in their place we pay for a bureaucracy of untold numbers.

How many people are employed in Canada in your national health services, and what is the payroll for them? And what is your tax rate?

To ask it another way, what is the tax burden per taxpayer to support your system up there?

Understand, our demographics here create a situation where it's tough to make an apples to apples comparison between our two systems.

Finally, you state that your cost for your wife's hospital stay was only $5.00. But tell me, what was the actual cost of her pregnancy and delivery to your fellow Canadians?

Regards,

Louis of PA

[jon_norstog]

Hey, guys,

I didn't mean to start anything. I was just trying to think how we could make the system we've got work a little better, 'cause I know a comprehensive health care system is something that people will be fighting over for years.

Before I had regular employment, it was reassuring to know that VA was there, fortunately I didn't need it. My daughter, I delivered at home, we just got good pre-natal care from a GP. No fuss, no muss.

My son was lucky to be born just before I got downsized out of CH2M Hill. Good, healthy kid. Then a year later I got picked up by Navajo Nation, health, dental and vision insurance from a variety of "providers" who spent all their time figuring out reasons to not pay a claim. They always paid eventually, but they held the $ for 6 months or so and collected the interest.

Thailand, I lived there a couple years. They had universl health care in government clinics, also a lot of private clinics in the cities. I used to go to the "Mayo Clinic" on Thanon Phahonyothin. They had US-educATED doctors and nurses who could speak english, and everything. They were really good on injuries, cuts, fractures, burns, bullet wounds. Everything else they just prescribed penicillin and opiate pain killers. $100 baht ($8.50, then) per visit, cash an carry.

Traveling, I was always envious of the Canadians. Their system covers them even in foreign countries. It is really tough being broke and sick or injured in a foreign country.

But my favorite health plan is to stay healthy and avoid taking any medicine that doesn't come out of the ground.

Well, I really can appreciate this list for proving space for this kind of topic!

jn

[Louis of PA]

Thailand, I lived there a couple years. They had universl health care in government clinics, also a lot of private clinics in the cities. I used to go to the "Mayo Clinic" on Thanon Phahonyothin. They had US-educATED doctors and nurses who could speak english, and everything. They were really good on injuries, cuts, fractures, burns, bullet wounds. Everything else they just prescribed penicillin and opiate pain killers. $100 baht ($8.50, then) per visit, cash an carry.

jn

Jon,
I lived in Bangkok, in a home off Sukumit at Soi 21 (eesipet), for two years while with the U.S. Army.

I brought my wife over, unauthorized, and our medical care was via local doctors. My eye doctor was Chinese, her obstetrician was a Thai but educated at Johns Hopkins. Lucky we didn't choose a German-trained doctor; that was the era that European medicine prescribed Thaladomide for morning sickness, resulting in enormous numbers of horribly deformed children. The U.S. had not approved that medicine for use in the states.

The Baht then was very stable at a nickel; 100 Baht was worth $5 dollars. I learned to negotiate for everything I bought.

The medical treatment available in the country is the best in the world, and has been for decades. I see no excuse to exchange it for any other system, especially one managed and controlled by the kind of folks who helped give us this recession.

Louis of PA

P.S. Here's another comment from a doctor in my state

From Dr. S. in PA:

Hugh,

I read the email you posted from Dr. L and had to echo his comments. I'm a urologist in Pennsylvania in a four man group. One is retiring soon, at age 64. I have 2 partners in their 50's, and I'm in my late 30's. My partners in their 50's constantly refer to their desire to retire early. I like to think right now I'm going to practice as long as I can.

However, there seems to be a growing recognition among everyone that I speak to that the "goose that laid the golden egg" is dead already. Very few urologists locally are doing well financially. The unreimbursed costs related to such as prior authrorizations, electronic medical records, massive amounts of phone calls/prescription requests are eating away at our bottom line. Our income is at lower levels now than 10 years ago, and the burden of practice is increasing yearly.

Not one physician over 50 I've spoken to thinks medical practice (not income) is as satisfying as it used to be. And most I've come across will admit if asked that they wouldn't recommend it as a profession to their children.

And, with the new emphasis with limiting work hours for residents, most new MD's will admit that participating in family life and developing personal interests take precedence over the identity of being a hardworking, hard-driving productive physician.

I fear for the future of my profession. Physicians have been squeezed for so long that we're just sick as hell. And we won't take it forever.

[RayP.]

I guarantee you that the politicians won't be stuck with the same insuance/coverage and care that they force on us.

RayP.

[JohnMOhio]

I thought I would put in my 2 cents. The doctor charging $79 a month plus $10 co pay per visit seems to me as being no different than having an attorney on retainer. If he can make a go of it and provide the care he wishes to provide I say good for him. It is his practice and should be allowed to run it as he sees fit regarding payment for his service. The attornies have their set fees and percentages and we the client are stuck with it unless we shop for another attorney. These folks shop for a doctor that would work with them. What is the difference? I see none. The state always seems to get their nose into things when it is different than the usual and when it works. Another small business will bite the dust for being different.

[Hal O'Peridol]

OK guys, maybe I can clear up a few things and misconceptions. I am in a unique position to comment on much of the above. First, why I feel I can comment..... I am an RN, currently working at a regional hospital approximately 25 miles south of the US/Canadian border. So I have a good background in both US healthcare and Canadian use of our facilities. My wife is also an RN, she is Canadian, and works in a large Canadian hospital in North Vancouver, and has, in fact, worked as an RN there for almost 25 years. So I also know quite a bit about the Canadian health care system, since she and I have used it also.

So here we go.........

#1. Single payer system. Won't go in America, at least not without significant cultural change. People here in the states complain about it taking 4 hours to see the doctor, what do you think will happen when it takes 4 weeks??? The Canadian system is single payer, and continues to be fraught with long wait times for procedures and treatment, sometimes running into months.

#2. To Mark in Ottawa....... Yes the Canadian system has problems, and so does ours. I do not think we need to exchange our current problems for an entirely new set of problems with the single payer system. Yes, your daughter may have cost 5 bucks to deliver, as did both my daughter and son (both born in Vancouver area hospitals), but that is not the total cost, which brings us to.........

#3. Most Canadians, including my wife, have a total tax withholding from their paycheck at a rate of 50%......that's right, half the paycheck is gone even before it gets into their hands. And that does not include GST and PST (sales taxes that run appx 13-14%) on most retail sales, high taxes on booze and cigs....it is actually much cheaper to buy Canadian beer in the US than it is in Canada....taxes ya know. Most Canadians don't realize that they pay in taxes the equivalent of a very expensive medical insurance policy every month, and only get mediocre care in return. And don't be old and very ill in Canada, your care WILL be rationed, even though the government will not admit it. In BC as in most provinces, there are shortages of doctors, nurses, equipment and hospital beds. Even as costs for health care increase, and the population increases, cost saving measures put in place by the government often result in shutting down of clinics and smaller hospitals, resulting in a diminished supply of both care beds and care givers.

#4. Jon, contrary to popular belief, the Canadian health care payment is NOT portable to other countries. If you get sick or injured in another country, even the US, the Canadian system WILL NOT PAY. In fact, since each province runs its own system, the health care is often NOT portable from provine to provine WITHIN Canada itself!!! All Canadians going out of country are encouraged to purchase travel insurance, and I an my wife have often purchased same through BCAA (British Columbian version of AAA).

#5. One of the major problems facing US hospitals now is that reimbursements for patients that have Medicare or Medicaid are not nearly enough to actually cover the care given. And the reimbursement rate for Medicare/Medicaid just got cut again. So who pays the Medicare/Medicaid reimbursements???? Why the GOVERNMENT of course! If the Gov can't afford to pay the proper price for medical care now, what makes anyone think they will be able to when they control healthcare????? Can you say MORE HIGHER TAXES??

#6. As a final aside, two years ago, my wife asked me if I could put her and our two kids on my US medical insurance. So if a person who has been on the inside of Canadian health care for over 20 years has no faith in the system........why should we have faith in the same type of system??