What would it take to shake off the health care handcuffs?

People need to realize what health care costs. What the insurance costs or costs their employer sees, what the true price of prescriptions cost, what the true price an office visit costs and what a major illness costs. The further away the consumer of the product is away from realizing it's true costs the more they will consume. When stuff is free, people want more, its that simple. If we have a goverment run system, people will consume more health care because someone else is paying for it.

There is no risk or reward for people to live healthy and take personal responsibilty in their life. The more people are removed from the financial responsibilty of the actual costs of not taking care of themselves the worse our country's health is.

Here we go again… that's right lets blame the Health care consumer for wanting affordable health insurance. After all they have the audacity to get sick and to expect quality health care at a reasonable price.
Let's look at some of the actual costs incurred when one has the poor taste to get ill, elderly or infirm.
Look at the costs of supplies......... much like the old tale of the Army paying $300.00 for a plain old hammer, hospitals often spend inflated prices for needed supplies. When an insurance company is billed,
if the hospital knows that the Insurance will cover 80% of costs then they may tack on an extra 10-20%
on the actual price of services so that ultimately they are paid the same amount of money that they would have required the patient to pay out of pocket.
Medical supplies is a highly profitable business, just ask Abbott or Baxter or any of the major medical supply manufacturers. For example to purchase one of the new 'fancy' breed of Walkers, you know the ones with brakes and a seat, if you get it from a Durable Medical Equipment Company you could pay or
your insurance could be billed up to $250.00.......go to Walmart and you can buy the same thing for
$110-125!!! A cane? Purchased through a medical supply company your insurance is billed or you pay any where from $50-$100 for an item that I've seen at my local supermarket for under $20!
Please note that not one of our elected officials has to my knowledge investigated the actual cost of health care supplies and services versus what's billed to the insurance. Also no one has actually questioned the profit margins in the Health Insurance racket? Why should they care about the cost of health insurance?
After all don't our elected officials get guaranteed health insurance for the rest of their lives as well as a kick-ass pension so that they don't have to worry about Social Security being available when THEY retire.

Whew, stepping down from my soap box now !!

When an insurance company is billed,
if the hospital knows that the Insurance will cover 80% of costs then they may tack on an extra 10-20%

Well, actually it doesn't work like that. Most people use a contracted provider network to keep costs down. There is a negotiated fee schedule that determines how much the provider will be reimbursed for a particular item. The provider can bill $10,000 for an item, but if his negotiated fee for the item is only $125, that's the most he will be paid for it. The rest is a write-off, per the contract agreement with the insurance carrier.

The people who really get screwed are the uninsured, who have no powerful insurance company negotiating provider discounts of 25%-50% for them.

Hello all. When I get my hands on details from the event itself (my schedule wouldn't budge any room for it) I'll provide an update.

Gary, I'm not sure what to make of your point. How then, do you think the healthcare system could be revamped? Can you share examples of other, successful experiments in healthcare? Bear in mind most doctors don't seem to accept bartered goods/services in exhange *grin*

That's an interesting point to consider Kathleen. If the structure of healthcare itself were to change, what would be the implications for medical supply profit margins? Which change comes first?

Auntie, I believe we've discussed this in other forums, but can you share your perspective of how a state-managed healthcare system would affect us all?

The government already pays for 60% of health care services in the U.S. because the government is the largest employer and it pays for medicare and medicaid. HMO's cost an extra 15-30% over the cost of actual health care, because of the high overhead for administration of health care plans. If we cut out the expense of paying for HMO's, we would already be spending almost enough to cover everyone. Universal health care with a single government payer would not be very expensive. Many of the highest bills unpaid at hospitals are the result of poor prevention. People delay care because it is too expensive. Our health statistics in the U. S. are not very good compared to other developed nations. We should be ashamed.

Yet Gary, the other industrialized countries with single payer plans spend less and have better results than us. They aren't paying for the profits of the Frist family ( HCA) or the CEO of United healthcare's billion dollar bonanza. We are paying for someone else's wealth collection system for health care...and not covering people at the same time.

Hey everyone, the audio is available for Policy and a Pint: Health Care Handcuffs now! I'm firing it up now.

Interesting perspective Melinda. I know of a dental "volunteer" service that offers low/no cost service for those that need care & can prove need - it usually ends up being very basic stuff: some preventative for kids, tooth removal for much older adults... Can't speak for other people but I'm VERY glad I don't need to rely on this type of service. How would one go about making this mandatory? Wouldn't medical supply/drug costs simply be redistributed in another way?

Guess I best listen to the audio and get back to this...

Welcome to the conversation, sorry we were cross-commenting.

Anne Ness, R.N., I'm glad you joined the discussion. R.N. is on my list of tough jobs that don't get enough credit. Some of the R.N.s I know have told me the same thing about delayed care - people hedge their bets and instead of getting treatment up front they get a spendy trip to the ER. For the sake of this topic, can you cite some of the reasons HMO administration costs are so high?

Good to see you, Paul. I imagine Gary will be back to respond *grin* Do you have specific countries/structures in mind?

More goverment, right?

So if I'm not happy with the service I'm given, what do I do? What happens if I want a second opinion? How long will I wait for a specialist? There is no competing health care provider. I'm stuck with what some goverment worker sticks me with. If I don't fit into their predetermined catagory for some service or illness, I'm screwed! Will it be run by life time employed unionized government workers who could never get fired or repremanded for not doing their job? If so, they have no right to strike. If there is no competition, what incentive will there be to give good service?

When something is free people want more. Who makes the determination of who gets what?

Or Matt Entenza's wife Lois Quam! Matt and Lois were big winners in that bonanza! But's that OK, the standards are different for big DFL contributors!

That's a good question, Gary. Sadly, that question applies on some level for many of us already, even those with health insurance. Sounds like you and I both have it so we have some options... but ultimately, how often do we have to make health decisions based on money?

It would be really interesting if you presented a way to fix the existing system or incorporate your concerns into a solution.

The current "health care" system is really a sick care cartel. Doctors take care of the sick not the healthy. What would happen if doctors got paid to maintain their customer's health? If they fail, then they do not get paid but must bring that customer back to health.
Will this happen in our lifetime? Probably not, the drug pushers have too much influence. Read the book Selling Sickness to learn how the drug companies get the public hooked. I picked it up today at the library.
The top priority of a health care system must be to maintain the public's health, easy to say but politically charged, so far no politician has stepped up to the plate.
With a healthier population the demand for medical services will go down, lower demand = lower prices, this is after all a market economy.

I still don't see how health care be reformed, in any meaningful way, without slashing the number of specialists, adding nurses, cutting administration costs, standardizing electronic forms, geographic reapportioning of specialized care, and last but not least, an actual paycut to reduce costs.

The paycut is not any more, or less important, than any other aspect, but it needs to be done. Estimates are that we spend 30% more on administration, and 20% more on salaries than we should. Nurses are already downsized, as having fewer workers is one way to downsize.

The biggest imbalance in the system is the enormous overpopulation of specialists in this country. Med schools need to be regulated, as odd as that sounds. If med students continue to reach for the top shelf paycheck, and the medical establishment continues to find room for them, the turnstile treatment factories will only get worse.

Most of the cost in administration is due to multiple private sector systems. The most efficient administrative systems are from the government, medicare and social security. Private sector systems attempt to extract wealth. One of the most efficient is Australia, and in reality all the single payer systems are much more cost efficient than the American system, and they cover everyone...again they cover everyone, the fake anecdotal,horror stories notwithstanding. There is a direct relation between the CEO of United Health Care getting an over billion dollar payout and millions not having health care. Gary, you obviously have no clue how a single payer system works, so don't even comment. Learn something before you comment. Guess what; your care is limited here, and especially 46 million who have no coverage at all. Right now we ration, we will always ration; but it is a decision over breast augmentation and facelifts or health care coverage .

I'm uninsured and when I go to the emergency room, I get an itemized bill. I know some of that stuff they list can be found a lot cheaper. It's ridiculous. Also, the whole malpractice system is totally a mess. I'm not saying that those people who sue should get nothing. And, I think doctors should be held accountable for negligence, but our society is too litigious. Something needs to be done there.

I seem to remember, or at least heard about from older people, a time when you didn't need insurance. You could just go to the doctor and pay cash. And, most procedures were affordable. You perhaps needed insurance for the big items.

Here's what I know. I live in California. I have Medi-Cal (state insurance), rather than provide good available dental care to people on Medi-Cal right from the start, allowing American citizens a little dignity in their health care choices, they waited and fought through not one but THREE court battles and then sent a notice to all insured stating that they would now pay all back claims from I believe it was 1995, possibly back further. Providing you had kept all bills and such of course.

When I got that notice a week or so ago, I sat with my mouth of rotten teeth and just sobbed. Why couldn't they just be decent and pay up front??? Why was that such a tough governmental decision to make?? I just don't understand this.

I had such a beautiful smile. And it's gone because I became disabled in 1995 and couldn't afford to pay for my own dental care (as I had done before in $$$ let me tell you!) all because some govmnt legislator decided I didn't deserve dental coverage that was worth a damn?

Something is just not right.

I'm new here but for my money I think that those that have the most have an obligation to help those that have the least. Which translates into doctors giving their free or low cost services to everyone who needs it for so many days a month. People helping people is the only way healthy societies survive. Community involvement has been reduced to clubs not people ddoing the hands on work that is necessary to do the things that need to be done.--I worked in healthcare-in home and on the floor- for 10 yrs. I saw the most waste there and the most overcharging. Doctors with the attitude of Gods over everyone, a situation that we, the people, have created by allowing them to not only overcharge and let them build mansions and live in great style but to have turned personal health over to them instead of our own selves. Everyone says "the dr said this" as if his word was more important, more knowledgeable than our own. The system will only change when we the people change.

Thank you for the book recommendation, Jody Solell. I looked it up and the full title is quite a shock: Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients. Please let us know what you get from reading it.

"Med schools need to be regulated, as odd as that sounds." - Tim Nelson That's a really interesting or peculiar idea, Tim, and I can't decide which it is. Can you elaborate? Frankly, I'm loathe to think of that.

Paul thank you for following up and making the point that our care is limited here, even if we're covered. There will always be limitations.

"Also, the whole malpractice system is totally a mess. I'm not saying that those people who sue should get nothing. And, I think doctors should be held accountable for negligence, but our society is too litigious. Something needs to be done there. - Darlene L." Isn't there a more moderate path, a mediation aspect to the system? I haven't used it so I'm wondering if someone could fill in on this information.

Thank you for sharing your personal experience, Sandy/twilasue S., even though it might be difficult for you. How much do you think they spent fighting those legal battles? Can you point us to a link with more information the history of that story?

Patricia C., maybe that's the question. How can the people change and in effect change the system?

Julia, One thing that stands out in the book "Selling Sickness" is the massive amount of advertising by drug companies. The public has been brain washed into believing it is sick and the only cure is drugs. The problem is that drugs (except antibiotics, and that is a whole problem in itself) only deal with the symptoms, not the root cause of the disease.

Your question on how to shake off the health care handcuffs can be answered very simply: Stay healthy. The question now is how to do that without drugs, high priced specialists, millions going to "sick care" executives and just plain waste.

One answer to staying healthy is to be better educated. Beyond that, the advertising by drug companies, fast food companies, soft drink companies and the others competing to undermine the public health must be either banned (a free speech no no, at least until corporations are no longer viewed as persons) or equally countered with millions, I should say billions of $ in advertising, so it is no longer FASHIONABLE to drink and eat the "bad stuff". We did it with cigarettes.
This is war, the public has been assaulted for a long time by advertising, and it is time to fight back. So will the government pony up the $? Probably when the yellow arches stop selling burgers...

I feel that in order to shake off the health care handcuffs, we need real culture change. In a sense, tying health care to employment has deep roots in American cultural values such as PRODUCTIVITY, INDIVIDUALITY, COMPETITIVENESS, and the awesome work ethic of this country of immigrants. If you don't work, you don't get much, not even health care. Sure, we may give you a little welfare, but not too much.

This, I believe, is partly due to the fact that we're a very young culture, and a culture of immigrants at that. A "we came to work hard, so don't you dare to slack off" sort of attitude. An attitude that allowed us to build an amazing nation state in two centuries. As our cultural norms shift from a focus on DOING to a focus on BEING, we will increasingly take care of all Americans in better ways, including health care. And I feel that this current dialogue is one of the keys to that shift picking up momentum.

Thanks for following up on the book Jody Solell. I'll have to check it out (oh that reading stack is getting higher each day...)

Rico V. when you say, "As our cultural norms shift from a focus on DOING to a focus on BEING, we will increasingly take care of all Americans in better ways, including health care." do you mean to express optimism? That's what I took from your statement.

Reading the replies here I don't see much of that. I sense a desire to improve healthcare and reduce costs but no consensus about how to go about doing so.

Julia: By "the shift from a focus on DOING to a focus on BEING" I mean our overall cultural values and norms. I guess I'm speaking MACRO more than MICRO here. We will arrive at a solution when we, as a society, ascribe value to each individual for who they are (human beings) and not necessarily for what they do or accomplish or contribute in currently measurable ways (in essence, saying that being a "contributing" member of society is a requirement). Sure, we can find some fixes now, but unless we look deep inside and come to terms with how we balance some of our core values, they will just be band-aids. We will still be a society that doesn't take care of its members as other societies around the world do.
Like I said, I'm optimistic. For example, evaluations of Welfare-to-Work programs helped us question some of our assumptions on "productivity" and encouraged us to begin to redefine that key value (it's not the same as "employability," etc.)
I agree with you that on this forum there's a desire to improve things, but the tough decisions will be made based on core values that we must revisit and be open to redefine.

I am self employed. As much as I would like health insurance the cost is just way too much. I would like to see a plan out there that just covers the very basics with a large out of pocket cost on my end for general checkups. The key to the insurance plan would be for major surgery and other major issues would be covered but the stiches or checkups would mostly come out of my pocket.