a thought about what is fair and what is convenient

[58limited]

Shane,

I'm going to shop around for new insurance, your plan looks pretty good. My current plan is through the American Veterinary Medical Association. When I signed up it was a good deal - a pool of about 40,000 veterinarians had a lot of negotiating power to get a good insurance deal. This seems to have changed in less than 10 years, and my rates just went up 11% according to a letter they sent me this month.

Nathan and Keven,

Thanks for the description of Australia's and Germany's systems. This is a very interesting topic and I think the U.S. system definitely needs to be reformed. I just think their is currently too much partisan politics going on to have any meaningful reforms.

 

[gizmo]

Another Australian view:

Nat has summed up the Aussie situation very well. I would like to add a few extra points.

1. Pharmaceutical - All prescription drugs go through an approval process called PBS - Pharmaceutical Benefits Scheme. Drugs which are approved under the scheme are heavily subsidised, if your income is below a certain level you get a Health Care card which entitles you to pay no more than (approx) $5 per item, otherwise you pay no more than about $28 per item. Even several expensive drugs which cost hundreds of dollars per course, are only charged at $28 or whatever the cap is now. Drugs which have not yet passed the PBS process are still available, but are not so heavily subsidised. There is also an annual cap per person or per family - I think it's about $200 per year now. Beyond that cap, prescription meds are free. Because of this system, Australia has among the cheapest medications in the "first world".

2. The system is paid for through the federal tax system. There is a medicare levy of about 2.5% or 3% on your taxable income, after deductions. There is a threshold income below which you don't pay the levy, though I don't know the threshold.

3. Community Health centres - these are a more local model which get some funding from each of Federal, State and local government. They vary in what services they offer and whether they provide for all their community or only for people on low incomes (with Health Care card.) A couple of years ago I had a rough time emotionally and had counselling by someone who came to my house weekly for six months, plus an intensive course on coping with anxiety and depression, plus a few sessions with a psychologist, plus medication for a few weeks before I got going with the other stuff, plus about every 6 months there is a "SHADES" graduates' course, follow up sessions for those of us who have completed the Self Help Anxiety Depression Education Sessions. (It works, I am 100% fine now.)
All this valuable help - I had to swipe my medicare card once at the beginning, no charge for any of it at all. Not one cent.

I don't recall the actual figures now, but the following is approximately correct - health care in the US consumes about 10% of the US GDP. In Australia it is about 4%. Yet our health outcomes are demonstrably better.

And if you don't like to use the medicare system, we also have a full private system too. Unlike Canada, we also have private hospitals, run by companies for profit.
If you have low income, you will probably rely entirely on the Medicare system.
If you have middle income, you can either remain on Medicare, or choose to pay for private health insurance for which there is a partial tax benefit.
If you have a high income there is a strong tax incentive to takeout private health insurance, though it is not compulsory, you can stay with medicare if you wish.

Having said that, the really top level emergency health care is in the public hospitals paid for by medicare. If you are seriously injured in a car accident, you will be treated in a public hospital, by public doctors in the acute phase, though if you have health insurance the after care may include your own doctor visiting the hospital, or you may be transferred to a private hospital when you are well enough. If you have private insurance, it will conribute some funding to the public hospital.

It works.

Chris.

 

[panthera]

Thanks, Chris.

"It works."
That is it, exactly. It works. In Western Europe. In Canada. Down Under.
No reason why it can't work in the US...the Americans just have to open their eyes, look at what is really going on and then reject the lies and deceptions which the christianists and republicans feed them.
Let's hope things get better, soon.

 

[petek]

Chris it's often brought up here in Canada by some, usually the wealthy that we (Canada) should allow for profit hospitals to operate. The fear of most people is that these for profit hospitals will siphon off the good doctors with higher wages etc. My question to you is...since Australia and the UK etc operate both systems, what is the incentive for anyone to bother going to a "for profit" hospital and pay added insurance for it. In other words what are they giving people that the regular public hospitals aren't?

 

[Cybrvanr]

wait a minute guys, looks like you all have fallen into the same trap all the media hype has been drumming up...

HEALTH INSURANCE IS *NOT* THE PROBLEM!!!!!

The real problem is that health care costs too much. The reason why some people do not have health insurance is because it costs too much...because of the escalating cost of health care, subsequently the insurance has gotten costlier, and out of reach unless your employer foots the bill for it.

We need to be looking at why the cost of health care has risen exponentially higher than the inflation average. One of these may be malpractice reform, but there are much more. Government regulation is part to blame too, among many issues. Back in the 50's and 60's, people could pay for medical procedures out of their own pocket, and only use insurance for the big issues. Nowadays, just getting the case of the sniffles will set you back over a grand! That is certainly not right!

I am all for the free enterprise system of bringing health care to our citizens we currently have if we can just free it from it's constrictions.

REMEMBER...THE GOVERNMENT SCREWS UP EVERYTHING IT TOUCHES!!! Do you really want them running...or should I say screwing up, your health care even worse than it is now?!?!?! I mean really, think about it, they can't keep our highways moving, can't educate our kids, heck, they cannot even run a mail service efficiently, WHAT IN THE H*LL MAKES YOU THINK THEY CAN GET HEATHCARE RIGHT!!!!

 

[panthera]

Steven,

I live in a country which has a higher return on investment (ROI) for capitalists than yours does.
Our people live longer, healthier lives.
Our women enjoy one of the lowest infant mortality rates in the world.
Our workers are more productive than yours...and work fewer hours with more vacation time than yours.
And our government was mainly designed and set up in 1948 by...
YOURS.

Look, I am not exactly crazy about your current government. But your attitude: "The government screws up eveything it touches" is just not in line with reality. Sure, there is waste. Yes, the US government has made some pretty big mistakes (especially lately.) But, and I say this after having lived and visited many countries in this world, the US government is much better than your give it credit for. Try on of the old communist countries of Eastern Europe. Or nearly any African or Arabian country...then you will see the difference. Heck, just go down south of the border...there is a reason all those Mexicans are trying to come to your "screwed up" country.

Oh, and please - I do remember the 1960's. My grandparents lost their house because they couldn't pay for the cancer treatment for my grandfather and keep it. My parents and the other grandfather all worked two jobs to pay for the medicines and treatments for my mother's mom. All hard working, well educated, upstanding Americans.

One point you raise is partially true. The senseless litigation and the absurd health care system in the US has, indeed, led to these terrible prices.

 

[rapunzel]

To add to Brisnat's earlier comments, there are plenty of mentally ill people about in Australian cities. De-institutionalization has put lots of folk with mental health problems out on the streets. Many of them spend an inordinate amount of time on Australian trains and buses as well. Apart from the poor state of cleanliness, the smells, the constant delays, high ticket costs and other unsavory issues, dealing with unbalanced people and their unsolicited attentions is another reason I NEVER use public transport.

Gizmo is correct in his assertion that most trauma injuries are treated in public hospital emergency rooms. However, most private hospitals do have emergency rooms as well where, for a fee, one can receive emergency treatments. And, yes, they will ask for the money up front. (Not so) Surprisingly, there are a lot of people who prefer to go to a private hospital ER.

Petek is right. The private system is syphoning doctors and nurses from the public system. The level of service in private hospitals is of a much higher standard. The health care system in Australia has become a two-tiered system, one for the haves and another for the have-nots. Certain specialists, such as urologists, will not even process their clients through the public system anymore.

Public hospitals are chronically understaffed and underfunded. Unlike the private system, patients in public hospitals will not receive the same level of diagnostics and are much more likely to be released with underlying health problems remaining undiagnosed during their initial admission. Public hospitals are generally older, less well maintained (flaking paint etc.), dirtier and less attractive than their private counterparts.

People with private insurance don't go on waiting lists, but straight to the front of the line. They get better food, nicer rooms and more one on one attention from their nominated doctors and other clinicians.

Using the private system requires research prior to making a commitment to a procedure. Specialists charge their own fees and some private hospitals may not get full coverage from all health funds. There are co and gap payments, which still can leave private patients out of pocket by thousands of dollars, after Medicare and their private health funds have settled their payments.

Our current Liberal Federal Government (Liberal being a misnomer), has been flirting with the American health care system for a very long time. Our current Prime Minister has, by stealth, been chipping away at Medicare, making private insurance almost obligatory. During the early 1980's the Liberals did dismantle Australia's universal health care system - then called Medibank. For a couple of years, until they got booted out of office, there was only private health insurance. Then, the Government put a few checks in place to prevent private insurers from leaving their clients without coverage due to ongoing high cost treatments for chronic and terminal illnesses. As far as I remember, pensioners and folks on welfare still had access to free medical care.

As soon as the Liberal Party was replaced by the (then more liberal) Labor Party in 1983(?)- universal health care was immediately re-instated in the shape of Medicare. A happy end was had by all - hip hip hooray!

Cheers

Rapunzel

 

[brisnat81]

Hi Rapunzel,

Have you been treated in a public hospital recently? Your description of flaking paint etc, may be true in the regional areas (I dont know) But in the last 5 years, I've had my tonsils out, in a private hospital, the level of service was ok, but I was still in a 6 person ward, the doctors and nurses were still short staffed and busy. When I had a bleed 7 days after and had to go back to hospital, it cost $120 to get into emergency, and then it took a full day for the specialist to come and see me. (Where I stayed in bed, in the ward, with blood trickling down my throat for 8 hours)

I compare that to unpacking the dishwasher one morning, when I slipped, stuck a very sharp paring knife into my left index finger, severed the tendon and three of the 4 main nerves. At the PA hospital (Public), I was triaged as soon as I walked in, 40 minutes later examined by a doctor, and then admitted and operated on 3 hours later. Once admitted, I had a single room, there was the same level of care and support, and I ended up walking out with no cost to myself.

Again, I cant comment on the Cairns base hospital, But your comments regarding the public system are unfair. Having attended 4 Public hospitals and 3 private hospitals in the last 5 years, I've never seen any flaking paint etc. The problem with Most South East Qld hospitals is that they're almost brand new, but without all the wards open, rather than being old and run down. Yes there are waiting lists, and yes there can be delays, but that is to be expected with anything that is free.

I travel by Bus, Train and Ferry 3 days a week, and other than occaisional train delays, Most of the services run on time and are pleasant enough to use. In other Australian Cities it can be a different story. In Brisbane, Sydney and Melbourne however I've never experienced the same level of Vagrancy on Public transport as in SF. Again this could be different to regional areas.

My Choice magazines, chronicle the introduction of Medibank in the 1960's and its revision in the 1970's. Both systems required direct payment from the user. The first iteration was similiar to the system we have now, but the user had to make direct payments to the government (Weekly Monthly etc), and depending on how much you paid, affected the costs when you had to be admitted into hospital.

Step Forward to Medibank plus in the 70's and the level of cover was still dependant on how much you paid, there were still safety nets for the low income/unemployed, it just became managed by a government owned entity rather than the government directly. The labour government then came along, made the cost of insurance mandatory through the Medicare levy so it no longer had to be seperately paid. Thus you then have universal health insurance, paid for by the worker.

All 3 systems have always met the following critera:
1) User pays, where user can afford to.
2) A safety net for those who are unemployed or cant afford to pay.

I agree that the system we have now is terrific, yes there are problems, but we are so much better off than most of the world. If there was any attempt to change Medicare from its current form, I would be very angry, and possibley consider voting Labour for the first time ever. However most of the negativity I see in your post, seems to be the retoric that I hear coming from the Labour party in the run up to federal election. The State Labour governements are currently running the Hospitals not the Federal Govt, and having worked for 3 years in Queensland health, the level waste is huge.

 

[petek]

Thanks Rapunzel, that's what a lot of folks are afraid of whenever they hear two-tiered. I don't think it will ever happen in Canada because universal healthcare is paramount to us. But then you never know do you.

 

[perc-o-prince]

every other great country on the whole planet has found at l

Sorry, but at least one "great" country with a solution has done my family wrong several times. I've lost a dearly loved aunt, an uncle, and a cousin (at LEAST) to the deficienies in the Canadian system. Before anyone jumps down my throat, know that my father is from Canada (became a US citizen in '61) and, therefore, half my family is Canadian. I lived 20 miles from the border for the first 20-odd years of my life, and spent a lot of time on the other side.

As a single example: when Rich and I heard of my aunt's problems about 5 years ago, the first thing Rich thought of was that she had had a stroke of some sort. BTW- she had been a NURSE in the very hospital she was treated in. The long and short of it is that it wasn't discovered that it was, indeed, a stroke that did the deadly damage to her, until after she passed. The symptoms were all but obvious.

However, there are many factors to healthcare, whether it be private, public, subsidized, or any other type. Follow-up and persistance is the key. Had it not been for Rich catching things the so-called "experts" missed, his grandfather would have been gone long before he went.

I do agree that healthcare reform is sadly needed in the US, and well overdue. Maybe if we stopped sending so many millions of dollars to other countries for their healthcare........ but I digress.

I was about to get into a diatribe about public assistance, immigration, and the like, but I took it out. I think it's safer that way.

Chuck

 

[perc-o-prince]

And that should have been "deficiencies" and not "deficienies" in the first paragraph. Whoops.

 

[gizmo]

I do not agree with most of what Rapunzel said about the difference between the private and public systems in Au, though I do agree with his/her scathing assessment of our current "Liberal" government.
The contrast of dirty, run down, second rate health care in public vs clean, modern, efficient private care - that is a myth created by the private health insurance industry to scare people into taking out private health cover. That is the main reason, in answer to PeteK's question to me above, that people choose to pay for private health cover - it is a triumph of misinformation over fact. The "Liberal" government is ideologically opposed to the medicare system and have been demonising it, underfunding it and amending tax law to bludgeon people into private health cover, then broadcasting how people are switching to private. Surprise surprise!
Fortunately the Aussie population are firmly attached to Medicare and the Libs know they can only wreck medicare so far before they will be thrown from office. Fortunately that time approaches soon...

My last visit to hospital was to a spotlessly clean, brand new ward at St Vincent's hospital in Melbourne. I has severed a tendon in my hand whilst fixing a washing machine.(which I still own...)I was admitted to emergency after a wait of about ten minutes, as it was not urgent. I spent about an hour in emergency, then went up to a two bed ward. I was operated on next morning to have my hand repaired. The facility was spotless and more like a hotel than a hospital. What I ordered for breakfast bore no resemblance to what arrived but it was delicious.
St Vincent's is run by the Sisters of Mercy, but the funding for their operations comes from a mix of Federal & State governments, plus public and religous donations. I was so pleased with my visit there, I donate to the Sisters of Mercy every year even though I am not religious.

A happy customer.

Anyone with an interest in this debate should watch Michael Moore's documentary, Sicko.

Chris.

 

[gizmo]

The other reason people opt for private health insurance is that it can offer extras. You can select various levels of cover from most insurers, the higher levels offer cover for things that are not part of medicare, including dental, chiropractic, massage, and so on.

However Choice magazine has examined the issue many times over the years, and their conclusion is generally that the premiums are so high and cover so patchy and full of fine print, that you would be better off to invest the premium in a good bank account and save up to pay for your own private care, if you ever feel the need to buy more than medicare offers. This may well be different now that the tax system has been amended to encourage private health insurance. Of course if the government funds used to prop up the private health insurers had instead been invested in the medicare funded health system, then the whole community would benefit instead of a few greedy insurers. These tax incentives were introduced because the Australian population was deserting private health insurance in droves, itself a massive vote of confidence in Medicare.

Chris.

 

[petek]

Chuck I can certainly sympathize for the loss of your aunt. But you can't blame a whole country or system. It sounds like she had an incompetant doctor, they do exist everywhere, here, in the US, in the UK. I can round off countless examples of where my family, friends and even myself have all received wonderful treatment. I have never known personally anyone who's opinion differs from mine. My own sister for example since birth with a heart defect has had numerous operations beginning at birth in 1950, stunts, shunts, pacemakers, replacement pacemakers over her 57 years when required and done remarkably well considering no one figured she'd ever live too long back then. Heart attacks, strokes, bypasses you name it and I know plenty of people who have been treated for those and all done well.

 

[petek]

eek. I hope I didn't come off sounding snotty in my reply there Chuck, it certainly wasn't the intent
I should have added that while I said I don't know anyone personally who's opinion differs than mine certainly doesn't mean that our system is perfecto because it certainly is not. There are examples of misdiagnosis, poor response and yes even deaths etc in our hospitals that do get reported in the papers when they happen

 

[dalangdon]

Medical errors happen every day, and in every hospital. I'm pretty sure that's what did my dad in. But then again, he was 84, and had recently completed a pretty horrific regime of both chemo and radiation, so who knows?

Speaking of dad, he was a "trial lawyer", as the reactionary political ads like to say, for an insurance company: He worked for Mutual of Omaha for 37 years. He was convinced that we needed to go to a national system, because the insurance and pharma companies were destroying the healthcare system. After the last year, dealing with Mom's lymphoma, I see the wisdom of his thoughts. If it hadn't been for medicare and the Mutual of Omaha health plan (which they no longer offer to retirees) she would probably be dead, and we would have had to sign the house over to pay for the bills.

Something's gotta give. As a nation, We pay the most for health insurance, but get the least results. And our life expectancy keeps shrinking. And it's killing our competiveness for business.

 

[tomturbomatic]

RE: the fear that government intervention would cap doctors' salaries. My Blue Cross-Blue Shield does that right now, as does my mom's Medicare. With my insurance, there is the fee that the doctor agrees to accept as a preferred provider which is less than if he or she were not a preferred provider, but being a PP is a great advantage in attracting patients. Unfortunately, you can really get hit with unexpected bills if you have surgery and the anesthesiologist or some other medical professional is not a preferred provider.

My mother has not had any service she needed denied to her because she is on Medicare and she does not have a co-pay. Fortunately, she also has a good supplemental insurance policy to pick up what Medicare does not.

"Sadly fear and greed are great human and corporate motivators..." Yet isn't it a shame that these forces are so frequently employed by those claiming to be on the side of "values" as if human life was of no concern except before birth and just before death when the values people will grandstand to the point of calling a special session of Congress to interfere in a tragic family situation.

Insurance companies have not historically been required to report their assetts. In the early 80s, in the really, really ugly early times of the emerging AIDS crisis, insurance companies claimed that they would go bankrupt if forced to cover the expenses of patients with AIDS. For many with AIDS, the best break they could hope for was to be in a teaching/research hospital where their care would be covered if they signed onto the program. Businesses with an employee with AIDS would either be forced to fire the employee or have one of two things happen: The premiums for each employee would sky rocket or the company's coverage would be canceled. Finally the insurance companies were forced to cover treatment and they did not go bankrupt.

There has to be a solution to the problem of access to affordable health care for all citizens of this country, but it will not come about while scare tactics dominate the disussion. Given the interests of the insurance & health care lobbies and their buying of legislators, the solution might be a long time coming.