» Health Care Reform And "unnecessary" Tests, makes me a little concerned... Options

[Gemini]

I live in Canada, where we have had publicly funded health care for decades. It isn't perfect, but I would much rather have what we have here than what the US has.

We have no for-profit HMOs that decide who gets cared for, and who doesn't, based on a profit motive.

We don't worry about "pre-existing conditions." Everybody is covered to exactly the same extent. The 80-year-old with a heart attack will get the same treatment as a 35-year-old.

Not everything is covered. Drugs are not, whether prescribed or over-the-counter. Dental care is not covered. Routine eye care is not covered, nor are the glasses you may need. For all of these, private insurance is available. But again, the insurers may not disallow a claim due to a "pre-existing condition" (trip cancellation insurance is an exception).

If a test is covered by the public plan (and most are), then it will be done if your doctor deems it necessary. There is no prior review by an insurance administrator--it just gets done.

Drugs are still sold by pharmaceutical companies at a profit, so there is still money to be made by researching and developing new drugs. Private, for-profit, companies make and sell medical supplies and equipment. They are still thriving.

There are waits for many procedures. But I will take that in a moment over not being able to get them at all because I don't have insurance, or because my diabetes or celiac disease is a "pre-existing condition."

I think there are definitely pro's and con's to each side of the fence on this one, Pete. I guess it all depends on which side you sit. However, I have to make a few comments on some misconceptions about American health care. I also have many relatives who have resided in Canada for the past 70 years or so and they have given me an insight into your system. I am in no way saying ours is better because it has it's pitfalls, for sure.

The only time I have ever heard of someone being refused health care here is when the treatment may be experimental and not approved by the FDA. I have never had a doctor refuse me testing, in fact, I have complained they want to do too much testing. In all my sphere of people I know and stories I have heard, the only people who may be refused are those without health insurance and that can be fixed by going on public assistance. There are also many places which will treat, without reimbursement, as evidenced by all the illegal aliens who get free medical care here on a routine basis. Emergency rooms in the US will turn away no one and you will get the best medical care in the world.

The pre-existing condition clause is a huge problem but I strongly think this will go away. If the government wants to get people insured, they will put enormous pressure on the insurance industry
to do so or, I expect, try to shut them down. I feel personally that there are so many people who refuse to take responsibility for their own health, (for example, the obesity problem), that you cannot discriminate against people with real diseases who do take care to follow what they should be doing. There just won't be enough people to cover to generate profit if they keep doing this. It may take time but I think it will go away. That has been a big issue with all the reform ideas bandied about.

My brother is a Type 1 diabetic, a very bad one because I also think he suffers from undiagnosed celiac disease, and he has never been refused treatment for anything. He has an HMO like most people with insurance do and he may actually need a kidney transplant within the next 7 years. The only thing which will prevent him from doing so is if he cannot find a suitable donor. I am not sure if this is true in Canada but I know in the UK, no one after the age of 65, I believe, are allowed transplants. They have age cut-offs because it's government funded. That is not going to fly here in the US. People are used to the best and I know that I would be willing to pay more for health insurance to have the best offered. I know there is a thriving private medical practice in Britain because of all the problems with the government run program. You have to have money, though, to enjoy that option.

I think the US government should stick to providing an option for those who are unemployed. That is what all the fuss has been about. If you lose your job, you may lose your health insurance here and that is not right. No American should be refused health care if they aren't employed because they pay other taxes and contribute in other ways. I would have no problem chipping in my share for them, either. But the coverage of illegals has to go....completely. It is draining our economy and the people who work for a living. They also have to reign in spending, which means cut back on all the ridiculous testing they do when having a physical or surgery here. Certain tests are fine and it should be taylor
made for each person's specific health care history. Screening for colon cancer across the board just because you turn 50 is part of the problem.

There are lots of things which can be done to fine tune our system and make it more affordable for everyone. It takes leaders with the guts to do so and put pressure on those who are taking advantage of the system. However, I do not want the US government providing insurance for everyone here, with no other option, because they have a habit of not getting things right...at our expense. It will be as horrifically expensive as what we have now and with fewer options.
I won't even go into the good doctors we will lose who won't want to work for a lot less pay and have reams of paperwork to do, on top of all that. There will be reams of paperwork also....it's the goverment!

[Jestgar]

Some stories from doctors

http://www.drsforamerica.org/stories.php?id=s7

The text of the bill under consideration

http://www.opencongress.org/bill/111-h3200/text

physicians' opinion

http://www.healthcarefinancenews.com/news/...surance-options

another physician site

http://www.pnhp.org/

[Jestgar]

I just went to a talk about the health care reform situation. I heard some interesting numbers which, unfortunately I can't back up with sites, but I suspect you could research them yourself.

The talk was given by two physicians.

30% of Americans are (already) covered by a government health care plan (medicare/medicaid)
50% have health care paid for by their employer
5% pay for private insurance
15% are uninsured

80% of the uninsured are employed

93% of voters are insured

Insurance companies are paying 1.4 MILLION dollars PER congressperson to influence the decision (and $400,000 on advertising to influence the public).

Government programs cover women, children and trauma. An underemployed male is not eligible.

The structure of insurance companies is such that they can cancel your insurance, without penalty (to them), without repaying your premiums, if you forgot to check, initial, date, or otherwise "incorrectly" filled out any of your insurance forms.

With no notice.


As a nation we have decided that everyone deserves the assistance of firefighters if their house is on fire.
As a nation we have decided that everyone deserves the protection of the police force.
As a nation we have decided that every child deserves an education.

Why not health care?

[Lisa]

My daughter is a full time chemist, doing full time work for a large company. They hired her as a temporary employee, with permanent status in three months. She has worked there for four years, full time-temp. They do not pay her any benefits what so ever, and not required too.

She can't afford a personal plan. Is that the right thing to do?

My husband is a retiree from a major international company and just a letter away from no health insurance, or one day late in a premium or one form overlooked. Private pay at our age, yeah right!

Yes, I do think that reform is in order.

[Gemini]

I just went to a talk about the health care reform situation. I heard some interesting numbers which, unfortunately I can't back up with sites, but I suspect you could research them yourself.

The talk was given by two physicians.

30% of Americans are (already) covered by a government health care plan (medicare/medicaid)
50% have health care paid for by their employer
5% pay for private insurance
15% are uninsured

80% of the uninsured are employed

93% of voters are insured

Insurance companies are paying 1.4 MILLION dollars PER congressperson to influence the decision (and $400,000 on advertising to influence the public).

Government programs cover women, children and trauma. An underemployed male is not eligible.

The structure of insurance companies is such that they can cancel your insurance, without penalty (to them), without repaying your premiums, if you forgot to check, initial, date, or otherwise "incorrectly" filled out any of your insurance forms.

With no notice.


As a nation we have decided that everyone deserves the assistance of firefighters if their house is on fire.
As a nation we have decided that everyone deserves the protection of the police force.
As a nation we have decided that every child deserves an education.

Why not health care?

I agree that all American citizens should have health care available to them. However, my position is that if you sneak into my country, you're not entitled to anything. Legal immigrants can buy insurance like everyone else can so they fall into the same category as a citizen...but they have to pay something for what they are given. I would never go to a foreign country and expect to have my health care paid for by the citizens of that country.
I work for what I have and do not take from others what I am not entitled to.

If you are in a group plan, the insurance company cannot refuse to cover you. It's a totally different ball game if you apply for private insurance. Maybe this differs from state to state or insurance carrier to carrier but where I live and work, if you apply for insurance under your employer, you are covered, period.
We have disabled people here, cancer survivors and many others at work with serious medical conditions and they all have insurance. None have been canceled but it's group insurance so there's the difference. I don't agree with the policy with private insurance of canceling people without notice and not refunding money spent but it is, after all, private insurance and they can cover who they chose. I think this is why the majority of people rely on group policies.
Perhaps the government can come up with a group policy to cover the unemployed or those who have been treated unfairly by the insurance industry to bridge this gap but I don't want it to negatively affect the rest of it. Once you get rid of competition, we will all have crappy insurance coverage.

Medicare and medicaid are not that great....at least that's what I hear from seniors around me. If it was so good, no one would need supplemental insurance. So, seniors have to carry 2 insurance policies when they retire because, otherwise, they could still lose their savings if they have a serious illness. I don't hear much complaining about medicaid because it's welfare based. People who go on medicaid have no insurance at all and usually little to no income so anything is better than nothing, in their view. That's fine, but I work and do not want this comparable insurance. If only 15% are uninsured, according to your figures, then why re-do the whole system and possibly make it worse for everyone else? That's progress?

[Jestgar]

80% of the uninsured are employed

Just in case you missed that.

My niece has publicly funded insurance for her and her son. She's a full time student. Unemployed, yes, but with a goal. Doesn't she deserve good health care?

If you read the plan (I posted a link to the text for you), you'll see that they are proposing a public plan option that you could choose, or choose to remain on your own insurance. Is this what you're objecting to?

[Jestgar]

I'm also curious if you have any numbers about what percentage of publicly funded health care is spent on illegal immigrants.

[Jestgar]

A couple articles on insurance companies' ability to cancel your insurance.

http://law.freeadvice.com/insurance_law/he...ncel_policy.htm

http://www.kaiserhealthnews.org/Daily-Repo...rescission.aspx

http://www.healthinsuranceblog.com/archive...ance_compa.html

http://www.washingtonpost.com/wp-dyn/conte...9090702455.html

http://www.darkdaily.com/health-insurers-c...f-sick-patients


I couldn't find any that specifically address private vs paid for by your company

[Jestgar]

I like this one
http://www.huffingtonpost.com/allyson-kapi...e_b_320697.html

• Defending the practice of not covering maternity care, one insurance official called pregnancy a "matter of choice."
• Many insurance companies consider C-Sections a "pre-existing condition." In Colorado, a subsidiary of United Health, one of the biggest insurance companies in the nation, "simply rejects" women who have had C-Sections. Note: Approximately 30% of births are via C-Sections.

And the list goes on. Health Insurance companies also charge women 48% more than men for the same individual (not group) coverage and can deny women coverage if they have been a victim of domestic violence.

• In 2008, 14.5 million American women purchased individual health insurance. These women pay up to 48% more in premiums than men, said Speaker Pelosi in a recent report. This discrepancy is due to an insurance industry practice known as "gender rating," which permits insurance companies in most states to charge men and women different premiums for the same coverage.
• In all but 12 states, insurance companies are completely free to continue the "gender rating" practice.
• In eight states and the District of Columbia, it's perfectly legal for insurance companies to deny coverage to victims of domestic violence.

[Jestgar]

This one has some math, and interesting comments at the bottom

http://tauntermedia.com/2009/07/28/unconscionable-math/

TomK

The other continuous care benefit is reduced employee abuse. I know a guy who has been passed over for raises every year since he had an autistic son. What’s he gonna do, leave? He’s uninsurable anywhere else, so the insurance system has put him in chains to his employer.

[mushroom]

Many people base their employment decisions on the availability of health insurance. I.e., if you can get a job with a good company that has good health insurance options, grab it. I have worked many jobs in the U.S. where there were no health benefits (smaller companies, law firms, etc.--the law firms insured the lawyers but none of the support staff); when I was younger I thought it didn't matter, but the older you get the more it matters. and unfortunately, even if you have good health insurance the company can unilaterally change it to some crappy HMO where you have to go hat in hand begging doctors to accept your insurance, and begging your PCP for referrals. Employer-based insurance ain't what it's cracked up to be. At one firm all the men could have coverage for their spouses, but none of the women could This was when my husband was in college.

And then there were the companies who discriminated because of medical issues. I was once offered what I thought would be a fabulous job for what I thought would be a fabulous company (a big one), only to have the offer withdrawn after my pre-employment physical because I had had cancer and they said they could not provide health insurance coverage because of my pre-existing condition (under a group policy, even)! Well, at that time I had great insurance through my husband, so I offered to waive the health insurance, but they said that was not an option under their company policies. I was flabbergasted. I think it was just pure discrimination but I didn't feel like fighting them. If that's the way they were I didn't want to work for them anyway.

Yes, I know things have improved greatly since those days, but even now employer-based health insurance has multiple problems and sometimes leaves you with no choice, or Hobson's choice, and with some employers, no insurance at all.