Request critique on universal health insurance plan

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coaster
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Request critique on universal health insurance plan

Post by coaster »

Hello, fellow twitchers (I can say that, can't I? I have RLS, too) ;)

I haven't posted much here, my RLS is pretty well-controlled by Mirapex and Lyrica, at the moment anyway my other health issues are of greater concern. But my greatest health concern is the soaring cost of health care. I've put together a plan for universal health insurance (NOT "socialized medicine) that I think should help. I'll like your input.

There’s plenty of discussion elsewhere online (and here, I'm sure) about the problems of health care in the U.S. This is my plan for a solution. I’d like constructive criticism. What are the weak points and how should I fix them? What are my omissions? What do you object to? Where is my rationale weak? It’s rather lengthy, but please take the time to read all the points and understand it, then give me your thoughts. Thanks for your input!!


The Problem

The rapidly escalating cost of healthcare and health insurance; the growing lack of coverage and reduction of benefits; the growing numbers of uninsured; the detrimental effects on the nation’s overall health.


The Solution: Universal Health Insurance

A public-private partnership to provide health care to everyone regardless of income or employment. The principal features of the plan:

1. Every person in the country covered by health insurance consisting of two programs: Basic coverage and Catastrophic coverage.

2. The private sector providing health care much the same as currently.

3. The government as sole payer for catastrophic health care expenses, and for basic health screening and pre-natal screening.

4. Insurance companies providing Basic health insurance to cover the risk up to the catastrophic limit.

5. Subsidized Basic coverage for those unable to pay.

6. Everyone is required to be insured.

7. Everyone is required to have annual health screening.

8. Regional claims processing subcontractors to coordinate claims and payments.

9. Federal government as the malpractice insurer.

10. Reduce duration of patent protection on new pharmaceuticals.


About this Plan for Universal Insurance

Catastrophic Coverage

The Federal government will be sole payer for catastrophic health care expenses. For example, expenses over a per person per year cap will be paid in full by the government.

Basic Coverage

Private insurance will be the payer for health care expenses less than the catastrophic cap. Insurance companies will bid for a contract to be single payer for a given region. They’ll compete on the basis of best service and best payments to providers, and least expense to the insured. They’ll contract for a schedule of fees paid to providers and for premiums, copays, and deductibles to the insured. They may or may not offer dental and/or vision insurance as part of the Basic program, or as add-ons. Contracts will run on a yearly basis. Since the insurance companies won’t do their own claims processing, substituting one company for another will be fairly easy. The need to compete annually will keep this a competitive market.

Health Screening

The Federal government will pay for one basic health screening exam per person per year, and one pre-natal health screening for a pregnant woman. Perhaps basic vision and dental exams could be included, since they can escalate into significant health problems.

Fees for Services

A Regional Medical Board will set a fee range for every medical service. The actual payment to the provider will be somewhere in that range depending on their contract with private insurance. Those same fees as contracted for will apply to claims over the catastrophic limit. The fee schedules will be posted on the internet for public access.

Mandated Coverage

Every person is required to participate. A person who isn’t participating will be denied medical service. Any provider providing service to a non-participant will do so either at their own expense or on the basis of a cash arrangement with the patient.

Subsidies

Those who are unable to pay for the Basic health insurance may be subsidized by the public sector through a means-test program and direct payments of insurance premiums to the insurance company, and copays and deductibles to the providers.

Federal Malpractice Insurance

Providers will be insured against malpractice by Federal malpractice for a modest no-profit premium. Perhaps there could be a provision to assess physicians a penalty for multiple malpractice judgments. Tracking malpractice claims centrally should also deter doctors with high numbers of claims from picking up and beginning a new practice in another state. Since the risk is shared over a wider base and since it’s expected judgments will be limited in size and reduced in number, the premiums will be much less.

Patent Protection

Reducing the time a drug company can patent their new products will lower the cost of prescriptions and new medical devices. They will also not be allowed to renew patents on minor or superficial improvements.

Adverse Selection & Pre-existing Conditions

Adverse selection is an insurance term which refers to people who are sick buy insurance but those who are healthy don’t. Insurers contend with this by refusing insurance to those with “pre-existing conditions.” Since the risk will be borne by the entire population, as well as the cost, these two terms may be stricken from the health insurance lexicon.

Sliding Catastrophic Cap

Obviously people require more health care as they grow older. The flip side is young people who are healthy don’t use much health care. But to go along with this, young people starting out in life usually can’t afford to spend a lot on health care, either, and a major medical issue could burden them for a very long time. This situation would typically be addressed by graduated insurance premiums; greater for the higher risk. But since the risk is set by the cap, perhaps another way to address this would be a sliding catastrophic cap: lower for young people, higher for older people. The thinking here is that the sliding cap would compensate for the age-related cost of care; the Basic plan premiums for older people will be higher because of the higher cap, but the catastrophic costs will still be shared equally by the entire risk pool.

Health-Care Consumer

By paying for their own insurance, by publishing the costs of their care, by being offered Health Savings Accounts, it’s expected the patients will behave more like consumers: seeking the best service at the lowest cost, and not using more service than they need.

Shared Risk

Universal insurance will accomplish what insurance is supposed to accomplish: reducing the risk for any one particular party by spreading that risk over all parties. Pre-existing conditions, adverse selection, denied benefits, exhorbitant premiums, and cost-shifting will all disappear.


The Players

Federal Government

Primary and only payor for Catastrophic Plan claims. Subsidize insurance premiums, deductibles and copays for those unable to pay.

State & Local Governments

Relieved of current obligations to Medicare and Medicaid states and localities will be able to reduce state income taxes and local property taxes to the extent they’re now required to pay the states’ shares of these programs.

Insurance Companies

Primary payor for the Basic Plan. Contract with providers for service fee schedule and with insured for premiums.

Claims Processors

Regional claims process services receive claims from providers and are responsible for verifying the claim and services rendered, forwarding claim to insurance company, receiving payment from insurance company, and remitting payment to providers. The insurance company with the regional contract may NOT also be the claims processor for the same region (but may for a different region with a different insurer).

Providers

No change. Except: back-office and malpractice expenses will be greatly reduced. And physicians will actually be able to practice medicine instead of jumping through hoops to satisfy insurance company requirements or government Medicare requirements. They’ll be paid rapidly and a rate they agreed to be paid.

Employers

Employers will no longer offer insurance as a standard employee benefit, but may offer Health Savings Accounts with which employees can accrue funds to pay for their basic health insurance and copayments and deductibles, also other medical services not offered or paid for under the local Basic plan contract.

Patients

Responsible for purchasing Basic Plan insurance, getting annual screening, and paying copayments and deductibles (if able to pay).


Advantages of this Plan

1. Providing health care for everyone will improve the overall health of the nation.

2. The private sector continues to provide health care service, as that’s something they’re already doing well.

3. Competition for the Basic plan should foster good service and low cost.

4. Limited risk will dramatically reduce insurance company costs and thus premiums.

5. No uninsured will dramatically reduce provider costs and they won’t have to pass on these costs.

6. Federal malpractice insurance will dramatically reduce provider costs. Doctors who get too many judgments will lose their license to practice in all states.

7. Required health screening should catch health issues before they become expensive.

8. The Medicare, Medicaid, and Veterans Administration health care systems will be terminated since they have no purpose under universal coverage. The payroll withholding tax current assessed for these purposes may be eliminated.

9. Reduced patent protection retains a profit motive for new drug development but without excessively long periods of being able to price the product at non-competitive levels. Perhaps patent protection can be on a sliding term such that the protection is in place until the company has recovered the cost of development plus a modest margin.

10. A single regional claims processor will dramatically reduce paperwork for all system participants and thus the cost of filing claims and speeding payment, and taking out all the middle-men takes out each entity’s profit margin. Also divorcing processing from insuring removes conflict of interest.

11. The Regional Medical Board, consisting of a mix of providers, will be familiar with health care costs in their area and be able to set fee schedules realistically.

12. Requiring patient participation through insurance premiums, copays and deductibles, and publishing fees will get the patient involved as a medical consumer, fostering an awareness of the cost and competing for the best service at the lowest cost.


How this Plan Will Be Paid For

Because payroll withholding for Medicare will be eliminated for both employees and employers, there should be more take-home pay for employees . Those who are able will pay for the full cost of the Basic insurance plus their copays and deductibles. Employers may provide Health Savings Accounts as an employee benefit. The subsidies plus the catastophic expenses plus malpractice awards plus claims processing will be paid through additional tax levies to be determined.

Basic Plan – insurance premiums assessed against the insured. Those who can pay will be required to pay the full amount, plus their deductibles and copays (except for the free annual screening). Those who aren’t able to pay, or are only able to pay a portion, will be subsidized by the Federal government.

Catastrophic Plan – will need to be paid for by taxes. Since there won’t be any more payroll withholding for Medicare there will be almost three percent more take-home pay in an employee’s paycheck, assuming the employer passes on their half of the tax. Since the government is only picking up the health-care expenses over the cap, plus subsidies, and is no longer in the business of providing Medicare funding, hopefully the net tax increase (as there probably will be) will be small.

Note: About Non-participants

There will always be some who refused to participate. Do we deny them access to the medical system? If we say no, then we destroy the whole concept of universal shared risk. My response is we do deny them because they have no insurance. If they want to work out some cash or barter arrangement, let’s look the other way when providers are willing to provide service under these arrangements. There will always be some willing to do that, so non-participants won’t be going without health care.

Final Note: Illegal Aliens

I know this question is going to come up: will illegal aliens be covered? My answer is yes, and my reasoning is this: they’re already here in the country and they’re already getting public assistance and health care. Under this plan they’ll at least be paying into the system through premiums for the Basic plan, and they won’t be taking services out of the system as uninsured patients. Perhaps we’ll need a provision that they don’t get any services until they’ve been working and paying their taxes for a certain number of months. The secondary option is the same as outlined under non-participants.
~ Tim ~
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woodsie357
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Post by woodsie357 »

wow! you've put a lot of work into this, I commend you.

I can't really comment myself because my RLS is bad enough that I've slept 3hours in the last 4 days and my brain can't function enough to put it all together.

I will say what you've done is pretty amazing.
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Aiken
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Post by Aiken »

I've lived in Canada. I'll never voluntarily go back to universal health "care".

If you don't pay someone yourself, either through your insurance or your pocketbook, they treat you like an inconvenience and not like a patient. If the government is paying, the government is the one to be kept happy, not you.

Don't do it. You only think you want this.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

coaster
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Post by coaster »

Remember, it's not universal care it's universal insurance. The universal is that everybody is covered by insurance. The providing of services remains in the private sector, same as now, but without the extra expenses and hastles of malpractice, Medicare, dancing a jig for insurance company to get their patient's claim approved, etc etc. IMO the service should be better at a lower cost if you get the insurance companies off the doctors' backs.

I wonder how many members here have had to go through several different medications before they got to one that worked for them NOT because the doctor didn't know which was the best, but because the insurance company required they try the others before they'd pay for the one that works.
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Neco
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Post by Neco »

I don't think this plan resolves the main problem though...

Rising health care costs - period.. Under this plan people still have to do a song and dance to get the insurance company to pay, because the insurance company is still paying for basic non-catastrophic services, which is where most people get screwed.

The government paying instead of you doesn't change anything on the insurance side. They may have a little more leverage to stop the abusing denials of payments for treatments that are needed ("The Rainmaker" syndrome) or what medications someone has to try before they get the one they really want.. But the government paying for you just makes sure you have an insurance company to fight with.. Nothing more.

Since their client is the gov't they will also do everything they can to jack up the prices even more, because they can and will get away with such things. Also even if everyone is covered, it won't necesarrily lower costs for everyone, because you will still have people that were not covered before, now getting coverage that requires expensive payouts for treatments, where before they would have been denied insurance at all, or the company would have denied payment anyway.

Some doctors are obscenely rich for what they do, especially compared to the Nurses.. And hell Dentists are obscenely rich compared to doctors too. They all need to be brought into line when necesarry, Insurance companies, Doctors, Dentists, etc.. The health care industry is full of bloated charges and expenses because, hey, the insurance company is paying for it - not the patient... Ever wonder why those of us who pay out of pocket usually get a "10% cash discount" ?

I mean lets be honest... why does it cost $90 for me to have a 15 minute discussion with a doctor, that results in a medication change?

Yes, that is what I paid because the first time I was prescribed Oxycodone I DID NOT like it, and my doctor was not in that day. I sat in a room with a doctor who had a cold demeanor, and others have called a *****, and felt totally scared I wasn't gonna get any medication at all, for a about 15 minutes. And she charged me that much money..

Why does an operation cost $30k ? $100k? Why ARE they so special, really? ANYONE with an interest can be trained to do their job, as many who have made it out of the Ghetto's of America can attest to. They are NOT that important OR irreplaceable.

What we need more of is health provider competition.. Like those urgent care clinics, and clinics popping up in the grocery stores, that handle some pretty basic stuff you usually would have to go to the doctor for. And they do it for a decent fee.

coaster
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Post by coaster »

Zach wrote: Under this plan people still have to do a song and dance to get the insurance company to pay,

No, because the insurance company that pays the bill isn't involved in claims. And claims under this plan isn't a matter of trying to convince the insurance company something is justified and covered. There is no such thing as a denial of a claim. The ins. co. has contracted to pay all claims. It's just a matter of submitting it to the claims processor. The claims processor tells the insurance company to cough up $X and then turns around and remits that to the doctor. If a patient and a doctor cook up a scheme to submit false claims, that's a whole different story. If we start taking away doctors licenses nationally for malpractice and false claims, these abuses would almost disappear.


What we need more of is health provider competition.. .

Yes!! Absolutely. That's why the fee schedules are posted online; to get the health consumer involved in it. My question to you is, under the plan proposed, what would you see added to foster the competitive process? Is the lower copay for seeing a doctor that charges a fee at the low end of the range set by the board enough of an incentive for people to do business with the lower-cost provider? Or is there a better way? Suggestions welcome!!
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coaster
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Post by coaster »

How the Basic Plan Works

I decided to add this because I can see from the responses on the various forums I posted this that there’s a lot of confusion here. I think it’s confusion stemming from our concepts of how health insurance works having been influenced by the way it’s done now. There’s no good reason why it can’t be done a totally different way. And I think it makes more sense when we just cast aside our knowledge of how health care is paid for now and entertain a whole new way of doing things. Surprisingly, I think it’ll be easier for the insurance companies themselves to understand, because they know underwriting risk, and this is just a matter of underwriting risk. Yes, it’ll take a few years for their actuarial tables to get enough data to be able to underwrite the plan properly, and during that time some premiums may be too high, some may be too low. But before I get too far ahead, let’s look at the new way of buying and selling and providing health insurance under the Basic plan:

1. The insurance company has nothing to do with insurability, because everybody gets insured.

2. The insurance company has nothing to do with deciding whether or not to pay a claim, because all claims get paid.

3. The insurance company has nothing to do with deciding how much to pay the doctor because they pay according to the schedule they’ve contracted to pay.

4. The insurance company has nothing to do with deciding how much of a copay the patient pays because the copay is the difference between what the doctor charges and what the insurance company pays the doctor.

5. The insurance company receives the premiums from the insured and pays out the claims as they’re told to by the claims processor. Nothing else. There’s no getting turned down for insurance, there’s no getting a claim denied, there’s no having to do this or do that before paying for this. That’s all between the patient and the doctor.

6. The insured pays the insurance company the premium agreed to in the regional contract for that year, and that’s basically all the contact he/she has with that company.

Let’s take an example:

Insurance companies bid on a contract to provide Basic plan insurance to a region. Company AAA says they’ll insure everyone for a premium schedule of from $500 a year to cover a 25-year-old with a cap of $5,000 to $2,500 a year to cover a 50-year-old with a cap of $50,000 a year. And they’re the low bidder, so they get the contract. For those premiums, they’ll pay 100% of the low end of the fee schedule that the Medical Board for that region has published, the copay will be the difference, and each patient will have a $250 deductible before they pay anything.

The Medical Board’s fee schedule for a standard office visit to a Rheumatologist allows a fee of from $95 to $125. The patient’s doctor has set his fee at $115. The patient pays the doctor $20 on the date of service, the doctor remits the claim to the processor, the processor verifies it’s a valid claim, coded correctly, fee charged correctly, patient has satisfied deductible and is under his cap, and all that, and remits the claim to the insurance company. The insurance company remits $95 to the processor, and the processor sends $95 to the doctor.

Let’s take the above example, but it’s the first office visit of the new year. Everything works the same except that in addition to sending $95 to the doctor, the processor also sends a bill to the patient for $95, since he hasn’t yet met his deductible.

Third example: patient is over his cap. The insurance company drops out of the loop. The processor sends the claim to the government (yes, there’ll have to be some kind of a new bureacracy to handle these over-the-cap claims, but we’re getting rid of Medicare.) Government pays $115 and the processor sends $115 to the doctor. Patient pays nothing.

There’s one thing I haven’t figured out yet and that’s how the processor gets paid. Any ideas? A per-claim fee from the government? A cut of the claim?

One other question: should the doctor be allowed to charge more if the patient is willing to pay the difference? What if the doctor wants to charge more but the patient isn’t willing?
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Post by ViewsAskew »

Tim, I haven't had time to read it all...so I probably shouldn't even be posting yet.

If you get a chance, find The Story online - a website for a public radio show. A couple years ago, the interviewer guy (I can't think of his name) interviewed a doctor. It was an amazing piece. The guy STOPPED accepting insurance because of what it cost his patients and his ability to care for them.

It really changed my mind a LOT about what is wrong with our system....

I'll read through the rest in a day or two when I am not so busy, so I can give it good thought.
Ann - Take what you need, leave the rest

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Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Aiken
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Post by Aiken »

Zach wrote:The health care industry is full of bloated charges and expenses because, hey, the insurance company is paying for it - not the patient...

I know some doctors. That's certainly not why. The insurance companies actually force them to accept less than they want to charge. When you get a cash discount, you're very lucky if you're getting as good a discount as the insurance companies get. They often pay 60% or less of a doctor's asked fee, with the contractual understanding that the doctor is NOT allowed to recoup the remainder from you. (The only thing a doctor can bill you for under insurance is the co-pay fee/percentage, or the deductible.)

One reason why doctors do charge a lot of money is because they have to pay obscene amounts of money to insure themselves from the overly-litigious, often fraudulently-litigious, American public. Malpractice insurance is incredibly expensive, since American juries award such giant payouts to plaintiffs.

Another reason why doctors charge a lot of money is because they spend a great deal of their lives, and go deeply into debt, becoming doctors. Are you aware of how many years of ridiculous mental, physical, emotional, and financial pain are required to become a doctor? Acquiring the knowledge and skills is no small task, and commands a high price when you use their services, just as it does when you use the skills of a trained electrician or plumber or a computer consultant. It's just that doctors take longer, and more money, to train.

Heck, if you watched me work, you'd think I'm obscenely overpaid as well, because to watch me work would make you think I barely do anything all day. In fact, while I'm not paid as much as a doctor, I'm willing to believe you would consider my income "obscene" as well. However, the level I've brought my skills to, over a period of time kinda similar to a competent doctor's, is not easily attainable, and so I'm valued much more highly than a typical worker my age.

ANYONE with an interest can be trained to do their job,


Not only is that demonstrably untrue, given the number of unqualified doctors *currently* practicing medicine, but I'm personally not satisfied with just anyone being my doctor. I want the best of the best cracking me open to tickle my guts with a scalpel. I know from long experience that the concepts of skills, dedication, attention to detail, ethics, and so on, lie on a very, very wide spectrum in people, and I don't want the people whose characteristics and skills lie in the weak end of the spectrum.

Even if you can train 95% of the people on the planet to be skilled doctors, which I doubt, I still don't want 95% of them working on me. I want the ones that are undeniably at the pinnacle, that are paragons of doctorhood, because sometimes you only get one chance to get something right, and you don't want to take chances with a cut-rate doctor.

(On the other hand, training more doctors sounds good to me. It's more likely that we'll get more paragons out of the back end that way. But don't begrudge them the rewards for their efforts. They're deserved. You have to disconnect your subjective feelings of distress over the imbalance between their and your fianancial situations from the objective truth of the situation. You can't ignore what came before what you see now, or what you can't see now because you're on the outside looking in)
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Aiken
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Post by Aiken »

coaster wrote:Government pays $115


I wish you would say, "Taxpayers pay $115". The government is not employed and has no income or money of its own. When the government pays for something, it's because it took money from taxpayers to do it.

This is an important distinction, because some day down the road, when someone finally manages to push this sort of nonsense through congress, people will start wondering why Tax Freedom Day isn't in April anymore, but in July, or August, which is when it is in Canada.

---

Oh, and I don't want the government telling anyone how much they're allowed to earn. I saw how well that worked back in Canada. Almost everyone who was better than mediocre either moved to a country that didn't violate their rights, or switched to a career in a field the government didn't mess with. There's a reason why typical health care in Canada is crap, and if you want to see one of the rare specialists who's actually good and didn't jump ship, you will be waiting months or years, because they're so few and far between.

Don't do it!
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

coaster
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Post by coaster »

Ann -- if that's "Cash Doctor" with Dick Gordon interviewing a Dr. Forrest, I found it easy as pie; I'll try to read it soon. Thanks!! :)

Here's a link for everybody else:

http://thestory.org/archive/the_story_2 ... p3/rss.xml
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coaster
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Post by coaster »

Aiken wrote:I wish you would say, "Taxpayers pay $115". The government is not employed and has no income or money of its own. When the government pays for something, it's because it took money from taxpayers to do it.

Correct, point noted, with one disagreement: technically speaking, the government doesn't take money from the taxpayers; the taxpayers give the money to the government. It's supposedly an honor system. :roll:

Aiken, I wonder what your experiences have been that make you so negative on Canada's health-care system. In general, the Canadians that I've heard talk about or post about Canadian health care have been generally favorable, the only exception being the wait for non-urgent care. And that wouldn't apply in this plan because we keep the service in the private sector AND apply competitive forces to drive best service, best quality, and best price. Unlike Canada or the UK, in this plan the government isn't in the business of providing health care. They just pay for anything over the cap and pay for the premiums for people who can't afford to pay.

As far as the gov't telling people how much they can earn, that doesn't hold either. They give them a range they can CHARGE, the range being set to provide a decent profit margin and if they can better that then, hey, that's the capitalist way. Work harder, work better, make more money. But they make more money by doing their work BETTER, not just by charging more.
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Post by ViewsAskew »

coaster wrote:Ann -- if that's "Cash Doctor" with Dick Gordon interviewing a Dr. Forrest, I found it easy as pie; I'll try to read it soon. Thanks!! :)

Here's a link for everybody else:

http://thestory.org/archive/the_story_2 ... p3/rss.xml


Sounds right - truly fascinating story. But, Dick Gordon almost always has good shows. This one really made me think a lot about what a regular doctor has to do to get and keep patients using the current system.

In my eyes, I'd truly suggest the only solution would be to scrap ALL systems, look at it with completely fresh eyes and start all over. Almost anything using most parts of what we have now seem to be problematic.

But, I haven't put the amount of time in that you have. I will get to read this soon.....
Ann - Take what you need, leave the rest

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Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

coaster
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Post by coaster »

Ann, I agree the BEST solution is to scrap everything and start afresh, but given the influence the insurance industry lobby has on Capitol Hill (well, let's not beat around the bush, they have Congress in their back pockets) then pragmatism is required. There's no way anything that cuts them completely out of the loop has any hope of surviving.
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Aiken
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Post by Aiken »

coaster wrote:Correct, point noted, with one disagreement: technically speaking, the government doesn't take money from the taxpayers; the taxpayers give the money to the government. It's supposedly an honor system. :roll:

Heh, yeah, an honor system where dishonor puts you in jail. :)

Aiken, I wonder what your experiences have been that make you so negative on Canada's health-care system. In general, the Canadians that I've heard talk about or post about Canadian health care have been generally favorable, the only exception being the wait for non-urgent care.

The issue there is the different concept of non-urgent care in Canada. To me, for instance, a leaking blood vessel in the retina, which is causing necrosis around it and damaging vision, is an urgent issue. However, my mother has had it happen twice now, and in both cases she had to wait 8-12 months to get a simple laser cauterization procedure.

That would be one thing. Another would be caregiver attitudes. Almost every nurse I met in Canadian hospitals was gruff and rude, and being in and out of the hospital a great deal as a kid, and also somewhat as an adult, I had a lot of sample data. As I said in an earlier post, when the government is the paying entity, you as a patient become an inconvenience, rather than a paying client to be catered to and satisfied. When I moved to the USA, I avoided hospitals because I was phobic about them. When my wife needed major surgery, I gritted my teeth and stayed with her in the hospital, and I can't tell you how amazing the difference in attitude was. I genuinely couldn't believe how different it is here. I have a completely different attitude towards nurses and hospitals now... but only down here.

Likewise, doctors can be gruff and horrible, though not as bad as nurses. An eye doctor in my home town, for instance, got angry if you deviated even a few words from the assembly-line procedure/script he used to get you through his office in about four minutes flat. I tried to ask him something about how my astigmatism worked, and instead of answering my question, he got cross with me and told me I was messing up his schedule by asking questions (yes, really, he did actually say that). I think he had to get at least N patients a day in order to be profitable under the salary limits imposed by Canadian law, and he wasn't going to let a stupid patient interfere with that.

My wife learned a lot about Canadian and other socialized systems when she was researching for her hysterectomy. She couldn't believe how rudely and horribly a lot of people were treated. You could go peruse the http://www.hystersisters.com forums and look for examples, I guess. It's the same sort of stuff I said above... lack of respect or compassion for the patient, considering them an inconvenience, that sort of thing.

Work harder, work better, make more money. But they make more money by doing their work BETTER, not just by charging more.

Isn't that the way it already works? If you go to a super-expensive doctor who's crappy at his job, and you keep going, you only have yourself to blame. A doctor who charges twice as much as the competition, without the l33t sk1llz to back it up, isn't going to stay in business.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

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