I made a proposal in GregR's diary reporting on the role professional debt collectors played inelecting Scott Brown. He asked “does Scott Brown like it when people cannot pay their medical bills?” My proposal was to have insurers pay all the bills in full, and then, if the patient's chosen coverage level doesn't cover them fully, to then bill the patient for the difference. On most procedures for most illnesses, though, I think the insurance should cover the whole amount, there should be no cost to the patient. Only super expensive and unethical procedures should not be paid in full by the insurer (iow, by the premiums from the entire pool of insured people), and if a patient wants such a procedure, he can either pay out of pocket or buy supplemental private plans that would cover it.
Do people here share my view that there should be no cost to the patient for health care, especially for basic medicine? Or should people ever have to sell their car to pay for a surgery?
stomv responded to the suggestion (but only with his usual one “all there is to say about that” comment, hrmph), and brought up what seems to be a basic assumption, that people always will and indeed should have to go broke if they get sick, that they have a choice about paying back hospitals and labs or having their credit destroyed.
It's true that the gov't has more efficient repo skills than collections agencies, but it's a bit trickier for Uncle Sam to repo someone's car/house/whatevs to pay for surgery as opposed to a private faceless agency.
What's the consensus here?
Routine physicals, dental hygene appointments, and eye exams
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p>Vaccinations
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p>ER visits (for true emergencies) and follow-up treatment
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p>Treatment of terminal illness such as cancer
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p>Medicine prescribed in pursuance of any of the above
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p>This list isn’t necessarily exhaustive, but what I can think of off the top of my head.
ER visits for true emergencies.
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p>Hm.
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p>What’s a “true” emergency? I see people all the time who have things they are convinced are true emergencies. Including:
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p>”My kid has a fever”
“I have chest pain”
“I have belly pain”
“I’m vomiting” (Maybe once, maybe more than once…)
“I cut my finger”
“I have a sunburn” (Yes, a real patient. More than one, in fact)
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p>Which of these are “true” emergencies? Well, I can tell you, ex post facto, whether something was an emergency or not. But I went to school for a long time to be able to do that, and even then I’m not sure sometimes.
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p>The problem is that “true” emergencies are in the eye of the beholder. Remember that time you had [whatever it was], and you were “rushed” (no one proceeds to the ED at a stately pace; it’s always “rushed”) to the ED, only to find out it was something harmless? Or when it happened to a relative? Did you know it was not an emergency? A lot of times you do, but sometimes you don’t. An 8 month old with a fever is really an emergency. An 18 year old with a fever is an annoyance (most of the time; sometimes they’re an emergency). An 80 year old with a fever may be back to an emergency again, it depends on the 80 year old.
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p>So before you get to not paying for things which aren’t “true” emergencies, bear in mind that it’s not as easy as all of that; you’re making judgments after the fact about things which weren’t clear before the visit to the ED. I have a long essay on how to handle “emergencies” which aren’t, but not here, and not now.
…if an ambulance is required, so of your list above only the second one (chest pain) definitely applies. I can’t think of any circumstance where the last two (cut finger, sunburn) apply. The other things can usually be taken care of by calling a PCP to get it checked out. Yes, there’s going to have to be some judgement involved, but I think there can be a reasonable standard. I’m not suggesting that everything else be paid for completely out of pocket. There’s nothing wrong with a scale of copayments. The things I listed are either preventative or potentially life-saving, which IMO should be the top priorities if resources are limited.
my girlfriend got in a car accident a couple years ago, and had a very minor injury, but they still made her take a ride in the bus, and are now trying to get her to pay 400+ bucks for it. There was no reason she needed an ambulance ride for a small cut and fat lip. Not a serious emergency.
that if you are sick Mon-Fri from 9-5 you’re golden (if your doctor can squeeze you in) Get sick on a Friday night though and you’re out of luck til Monday morning(if your doctor can squeeze you in). Years ago, my daughter came down with a sore throat and fever on a Friday night.
By Sunday, her fever was still high, sore throat worse, and I thought it might be strep throat. Now strep throat is not life threatening if treated promptly, but if it’s let go it can affect the heart and the entire body. So on Sunday night I’m wondering do I wait until Monday morning and risk Scarlet fever or other serious complications, or do I take my daughter to the emergency room with a sore throat and fever. I took her to the emergency room.
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p>What about fractures, torn ligaments, and other injuries. Certainly you could probably take mega doses of advil and wait till Monday. But such injuries can cause permanent damage if left untreated. Although not considered life threatening, some injuries left untreated could end up costing more in quality of life and in overall costs if you wait.
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p>I think it’s high time for a clinic to run (adjacent to the ER maybe) around the clock. It can be staffed by a Nurse Practitioner who can decide if the injury/illness merits a trip to the emergency room, or if it could be treated in the clinic. This alone would cut the cost of healthcare tremendously. An office visit charge with a Nurse Practioner is far cheaper than a work up in an ER. I’ve seen “walk-in clinics” spring up from time to time, but they often run on the same 9-5 weekday schedule as regular doctor offices. This may help to pick up the overrun from the regular doctor offices, but it doesn’t address the fact that people get sick at night and on weekends too.
There shouldn’t be any stigma about showing up at the hospital when you’re sick, it shouldn’t cost an arm and a leg just because you made the mistake of going to the hospital instead of trying to make an appointment with your pcp three days later. A clinic next to the emergency room could handle most people without costing $1000 for taking up an emergency room bed. They only stick everyone in an emergency room stall because it makes them $1000 a pop, not because everyone needs to be given that level of care.
I think you could build more than 1 at every hospital (especially if you could suspend prevailing wage laws for the program). Plus you could staff it with Med School/Nursing grads who have gotten a tuition break if they work in these clinics for x years. Why doesn’t this happen????
Could the person who voted “Yes, a portion should be paid by the patient” tell me why they feel that way?
…but one possible argument is to guard against moral hazard. If a patient has to pay even a few dollars for the visit it may prevent him from taking the doctor’s time on something that time or OTC medicine could take care of.
so, you’re saying that the purpose is to discourage people from going to the doctor and accessing health care? Even though surely it will only dissuade people who can’t afford to sell their car or give up their cable. Do you think it dissuades rich people at all, or are all of their health problems serious?
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p>Seems pretty immoral to try to punish people financially for getting sick or to try to get as few poor people to go to the hospital as possible.
I’m talking about relatively small copays; just enough to make people think twice, but not enough to prevent them from getting care. Do you have a different way to guard against hypochondria or Munchausen Syndrome?
Hmm, maybe it could be a crime to harass a hospital or doctor with nuisance requests. Eventually, if someone is abusing free care and being a problem, they’d be told to get lost or be arrested for trespassing, just as if they were showing up at a store every day and making the staff help them but never buying anything. the store can refuse service eventually.
in a place called America, consumers paid a reasonable monthly premium for health insurance. The insurance plan covered services, with some out of pocket expenses:
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p>$15 co-pay for office visit
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p>$5-$10 copay for prescriptions (depending on generic/name brand (patients choice)
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p>Labs, xrays, ekg, other diagnostic tests were covered at 100% and considered included in the cost of the office visit. Office visits were charged according to complexity, so therefore, if you had many services included, the actual cost of the office visit was more.
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p>That was reasonable and affordable healthcare.
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p>Then everything changed:
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p>Monthly premiums for health insurance surpassed the total of one whole paycheck a month, and sometimes took half of another paycheck to meet.
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p>Charges at hospitals were unbundled.
Now you pay a $15 copay for an office visit, but you also pay 20% of the labs, the x-rays, and the EKG associated with that office visit. However, complexity charges did not change. Even though the x-rays etc are billed separately, the cost of the office visit did not decrease in kind. It’s exactly like being double billed.
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p>Prescriptions are $25. $30. $50 based on generic, formulary or non formulary.
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p>I think scenerio one was reasonable affordable health insurance that I would accept proudly as the American way.
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p>The 2nd scenario is corporate greed pillaging patients and redirecting wealth from the American people to corporations. Using such a vulnerable area as health care for people to seek such corporate gains is certainly not something that is to be proud of. That’s why when I hear the Republicans proclaim we have the best health care system in America I could just choke.
I would move the responsibility to pay the premia to government, which I believe is what single-payer is.
The Republicans have not liked the Democrats plan. If we can get a plan put together that addresses COSTS (not insurance company profits but the actual costs) then we should proceed. Your scenario above of the good old days needs to be examined closer. Why does surgery or even diagnostics costs so much more?
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p>WHat are the costs of a VA hospital compared to a private hospital?
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p>Translation: “Partisanship ends when you accept my paternalist condescension and implement what I say is the solution.”
And it didn’t work. They need to come together and Obama has not helped things at all. His remarks are mere window dressing. Even now he is only giving the air of working together for the American airwaves but he is still sending his pit bull (Rahm) do clear out under the hoop.
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p>It has to start sometime or nothing gets done.
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p>Really? You think so? Like when Dems included tax cuts in the stimulus at the insistence of Republicans? Or when Dems decided not to force even larger stimulus because of the oppositions carping?
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p>I think the 2009 Democratic strategy was to hew, very clearly, to the center of all things, at all times bowing not overmuch neither to the right nor the left.
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p>”Window dressing“??
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p>Translation: even if he says all the things I agree with, I’ll still believe he’s trying to undermine my position. Plus Rahm bad. Rahm really bad. Urgle.
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p>You’re in the minority. More people voted for Democrats than for Republicans. Furthermore, your parties demands have been unreasonable. I suggest the onus is on your party to work with the majority. From where I sit, all reasonable efforts to include Republicans in the decisions have been undertaken.
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p>Had I been in Obama’s position I would straight-up make you take it, and like it. You’d see what real partisanship looks like. You have no idea how good you got it right now.
So Mr Majority, where are the fruits of your majority? Thank God they didn’t spend MORE of our children’s money by going with a bigger Stimulus package… more money down the drain. Do you seriously (I know you can’t answer anything in a non-partisan way but I ask it anyway) think Obama is trying to have a pow-wow with Republicans to fix anything. He’s showboating, plain and simple!
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p>Rahm has hurt your efforts more than any Republican on Capitol Hill. That is the words from lefty and centrists, not just people like me.
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p>We are in the minority for another 9 months. Are we not kowtowing and showing the proper reverence for the lackey majority leadership? Reid will be gone but Pelosi is the one killing any cooperation in the House… she’s evil!
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p>My point exactly: so much time spent trying to get you and your ilk on board.
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p>I said we have a majority. I never said we used it well…
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p>It’s obvious that you don’t believe, a priori, that one side of this debate has anything constructive to offer… yet you still call for me to stop the partisanship. Did your meds change in dosage recently? Forgot to take them? I’m totally serious… you can’t say things like this and then turn around and accuse me of being partisan… and still be considered sane. Seriously. Of the many definition for ‘bi-partisan’ throw around the one that makes the most sense is when both sides take each other seriously. It’s clear that you don’t do that. You think partisanship is mere disagreement with you: that your side is right and mine wrong and that I’m being ‘partisan’ for refusing to see this… It’s quite a leap from, well, reality…
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p>From the DSM IV:
Is there a cure for your HUTAS?
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p>Don’t believe, I don’t even know him…
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p>I believe Blanche Lincoln and Ben Nelson are Democrats. Plus maybe instead of ramming the bill down our throats you could have listened to our ideas. Don’t bother bloviating your response to that, it didn’t happen and “procedural” amendments don’t count.
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p>
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p>I think there could be good debate and good constructive discussions of bills to help Americans. I don’t think the Stimulus Bill was nearly as effective as it could have been. You cannot spend $787 Billion dollars and not put some people back to work (or save unionized government workers jobs). The question is did it have the effect it was suppose to have by keeping unemployment below 8%? Do you remember that line of shite about needing to pass the Stimulus or else … 8%? DIDN’T WORK! How many jobs were created in the private sector which stimulates more jobs vs. more government jobs which do nothing for us?
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p>
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p>No change in meds, but I still hear the voices. The blue ones cured my ED though! Are those the meds you are referring to? You are extremely partisan and I’m sorry your mirror is so fogged.
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p>I agree on whomever’s definition you found. It is working together and I sincerely hope the “adults” we elect to Capitol Hill cooperate for the greater good of the people. We have to stop the polarization. We have to stop the theatrics. We have to stop the sausage factory approach to bills which end up with SHITloads of pork and “wink-wink” deals buried in them and then the outrage when someone votes to take granny’s dinner away because they were really voting to stop the $100 million library buried in the bill. STOP THE BULLSHIT!!! And if someone tries to pull a fast one, then everyone on each side should scream about it and demand answers as to why the buried items was allowed to go through.
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p>Yes. I am. Never denied it. Obama? Not so much. Reid? Not so much. Pelosi? Not so much. The. point. exactly. I even told you straight up what would happen if ever I was in charge. That’s partisanship. I’m specifically and clearly drawing a parallel between what I (the partisan) would do and what Obama (not the partisan), Reid (also not the partisan) and Pelosi (also not the partisan) have done.
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p>duh.
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p>That is what’s happening here, hutas-boy, you’re saying that partisan ship is the problem but the partisans (that would be me) are not in charge. Obama (not partisan) is in charge.
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p>Further, you claim that you are post-partum, partisan, pablum, whatever… when, it’s quite clear that you are as partisan as I, if not more so: To pretend otherwise is clearly, frankly, demonstrably and undeniably insane… or mendacious.
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p>To repeat, I’m a partisan: if I were in Obamas shoes it would be POUTAS before you could say uncle. I would run a public-option so far up your backside you’d be taxed for every time you sneezed. I would go so far left that Grover Norquist would pray for the second coming of FDR as relief.
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p>That’s partisan. What you got now, with Obama et al, not so much… so stop trying to pretend otherwise.
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mendacious. Very good. We should play “words with friends” my handle is BMG-JohnD
In that system there’s a majority party, they’re disciplined to the hilt, and they really do ram things through the Commons. The Lords occasionally whines and delays and the Crown hasn’t vetoed anything in 300 years. Obama is trying, almost too hard, but I’m starting to think if he wants Republicans on board all he has to do is announce that he supports the opposite. The Republicans have been shameless. They even OPPOSE TAX CUTS now because Obama supports them!
from nytimes.com Obama to Offer Health Bill to Ease Impasse as Bipartisan Meeting Approaches
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p>It appears a mandate is included, but no mention of a public option. It’s a plan that could pass through reconciliation. So the question is…..will the public option be presented separately? WE NEED A PUBLIC OPTION!
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p>Obama’s proposal is supposed to be available online on Monday. I think it’s a mandatory read.
if the Dems aren’t so stubborn.
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p>I see this was still there…
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