Free Healthcare

[Elizabeth502]

Even then, someone with low income will never pay off a $200,000 bill if they spend time in ICU, etc. Again the question becomes, who pays for it?

Precisely. That is why I have posted at least 5 times on CAF that if the government (which it now is, espeically with the ACA) is going to validate the insurance company-dominated system of healthcare, the compassionate thing would have been mandating hospital insurance as a stand-alone, universally (thereby dramatically reducing premiums for such coverage), but providing for low-cost, leveled care through expanded clinic services with incentives for physicians to staff them, which costs can now, are now, and could be paid even by those with low incomes.

The reason that most people do not purchase medical insurance – even when they can “afford” to do so (earn an upper-middle-class income) is that they are taking a calculated gamble that they will not need catastrophic care, and because their regular & routine care is minimal, due to excellent health history & often age, and also (even when not in excellent health) due to the exorbitant cost to cover routine care which is 5-10 times the cost of using pay-as-you-go clinics. (Not enough of the latter exist.)

 

[seekerz]

Even then, someone with low income will never pay off a $200,000 bill if they spend time in ICU, etc. Again the question becomes, who pays for it?

Precisely. I get the impression that fairly healthy people on insurance have no idea how quickly medical costs can pile up and how high they can go for people who have neither good health nor adequate/any insurance coverage.

 

[Elizabeth502]

Precisely. I get the impression that fairly healthy people on insurance have no idea how quickly medical costs can pile up and how high they can go for people who have neither good health nor adequate/any insurance coverage.

Wrong. See post # 121. They’re not stupid. They just can’t shell out exorbitant premiums every month, and they haven’t been offered affordable alternatives, and what’s being -]offered/-] mandated is also not the world’s most efficient solution.

Hospital costs =/= routine medical care. Why does no one understand these important distinctions, and how there are indeed solutions for such distinctions, for those who can think Outside the Box.

 

[seekerz]

Precisely. That is why I have posted at least 5 times on CAF that if the government (which it now is, espeically with the ACA) is going to validate the insurance company-dominated system of healthcare, the compassionate thing would have been mandating hospital insurance as a stand-alone, universally (thereby dramatically reducing premiums for such coverage), but providing for low-cost, leveled care through expanded clinic services with incentives for physicians to staff them, which costs can now, are now, and could be paid even by those with low incomes.

The reason that most people do not purchase medical insurance – even when they can “afford” to do so (earn an upper-middle-class income) is that they are taking a calculated gamble that they will not need catastrophic care, and because their regular & routine care is minimal, due to excellent health history & often age, and also (even when not in excellent health) due to the exorbitant cost to cover routine care which is 5-10 times the cost of using pay-as-you-go clinics. (Not enough of the latter exist.)

Expensive care doesn’t just happen in a hospital, nor does it necessarily fall under emergency care either, as many with serious, chronic conditions will tell you.

The trend has been to make as much care outpatient as is practical/feasible. Meaning that much care which is necessary, life-saving, and not optional, is provided on an outpatient basis. The costs add up quickly and many uninsured people have about as much ability to pay those bills, as they have to pay the bills for (name removed by moderator)atient care. Indeed I have heard of providers suggesting to patients what to complain of in the ER so they can get admitted and access care which they can’t afford as outpatients.

 

[seekerz]

Wrong. See post # 121. They’re not stupid. They just can’t shell out exorbitant premiums every month, and they haven’t been offered affordable alternatives, and what’s being -]offered/-] mandated is also not the world’s most efficient solution.

Hospital costs =/= routine medical care. Why does no one understand these important distinctions, and how there are indeed solutions for such distinctions, for those who can think Outside the Box.

I don’t think they’re stupid, I just think they’ve never seen a bill without insurance discounts applied.

Thinking outside the box is great, but there are many degrees of care between “routine medical care” and “hospital” care, for example: the patient with a blood infection sent home to continue IV antibiotics with nursing care at home, the dialysis patient, the leukemic making several trips a month to the Oncology Clinic, the problem pregnancy requiring baby monitoring or ultrasounds at frequent intervals…you get the drift. They’re not sick enough to be kept in a hospital bed, but not well enough to go weeks without a doc - or even to work a regular schedule.

Are we to develop a separate category of insurance for each such degree/duration of required care?

 

[Elizabeth502]

Expensive care doesn’t just happen in a hospital, nor does it necessarily fall under emergency care either, as many with serious, chronic conditions will tell you.

But the posts that followed each other in sequence concerned a $200,000 hospital bill. Someone else generated that discussion, several of us followed with responses.

Try to follow, please.

 

[seekerz]

There is a difference between getting health insurance which covers certain immoral services you would never use and *which you do not have the authority to decide on, *and offering and paying for those services, which is what the HHS mandate is all about.

People say, oh, it covers abc, no big deal, doesn’t cost much. But the HHS is mandating coverage of abortifacient drugs as well as abortifacient abc, *and *sterilization, which is not cheap. They want Catholic institutions to pay insurance to cover this for people–whether the cost shows up officially or not, and it will have to show up for those Catholic institutions which are self-insured.

I don’t agree with the ‘contraceptive’ mandate because I think it unnecessarily challenges well-known Catholic beliefs, when the real problem lies with the link between employment and insurance coverage. It is not essential to the law and will likely be struck down. There have to be other ways that the benefits of group insurance can be made available to people, without their employers being part of the equation.

 

[seekerz]

But the posts that followed each other in sequence concerned a $200,000 hospital bill. Someone else generated that discussion, several of us followed with responses.

Try to follow, please.

I am following. What I fail to see is how/where expensive outpatient care, that is not necessarily emergent in nature, is being taken into account. So we have ‘hospital insurance’ and pay out of pocket for routine care. Where does that leave the millions with chronic conditions requiring myriad, frequent contacts with doctors/labs/testing facilities?

The world is now facing a coming storm: a chronic disease epidemic which will only be made worse if people can’t get regular treatment before they develop disabling complications.

 

[Nimzovik]

These days, good health Care is unaffordable to even the (middle) middle class.

From what I have seen, the homes of Doctors (and of many nurses) far exceeds the home values of most people. Hmmmmmm…

 

[Elizabeth502]

Are we to develop a separate category of insurance for each such degree/duration of required care?

That’s what leveled care is. And yes, I think that broadly that is one way of addressing healthcare, if the country/gov’t, and its voters want to prioritize the delivery of healthcare through private medical insurance. The people who need preventive care the most are those with chronic conditions (diabetes, heart, cholesterol, blood pressure, obesity, and more). They should be in one or more insurance pools with premiums appropriate to their level of need and with discounts/reductions for patient initiative in health maintenance & doctor cooperation in that maintenance.

 

[seekerz]

That’s what leveled care is. And yes, I think that broadly that is one way of addressing healthcare, if the country/gov’t, and its voters want to prioritize the delivery of healthcare through private medical insurance. The people who need preventive care the most are those with chronic conditions (diabetes, heart, cholesterol, blood pressure, obesity, and more). They should be in one or more insurance pools with premiums appropriate to their level of need and with discounts/reductions for patient initiative in health maintenance & doctor cooperation in that maintenance.

For the record, I favor single payer but even more importantly, I favor a system devoid of fee-for-service, so that the recommended care depends totally on what the patient needs, and is not impacted by whether or not the practice is in the red or the provider has student loans to pay off.

However, if we are going with insurance for now, I can’t see how such a model would be practical. To my knowledge, the way insurance works is that premiums are pooled and the contributions of the healthy covers those of the sick based on the prediction that at some point, everyone is going to get sick and need care. If you parcel out all the sick according to how sick they are, how will those least able to maintain steady employment be able to afford their premiums?

But that’s hardly my only question: how will people get onto such insurance? At diagnosis? If so, there’d have to be open enrollment year round - could insurance companies even function in that manner? What of the expensive care of short duration, such as post-hospitalization or pregnancy complications? Is it really feasible to get on and off insurance in a few short weeks or months?

I fully agree that there are alternative solutions which can be proposed, outside of the ACA. Aside from the obvious question as to why they have not been tried prior to the ACA, how does the existence of alternatives make the act the wrong solution? Different people have different approaches to the same problem - but we can’t know what works unless we try one or other approach.

 

[Elizabeth502]

I don’t think they’re stupid, I just think they’ve never seen a bill without insurance discounts applied.

They have, but most of those bills are insufficiently discounted for the average middle class person, and often are never discounted because of deductibles most non-chronically-unhealthy people will never reach in any given year.

 

[seekerz]

They have, but most of those bills are insufficiently discounted for the average middle class person, and often are never discounted because of deductibles most non-chronically-unhealthy people will never reach in any given year.

All insurance bills receive a basic discount (it’s called the allowable amount). That is the big, big advantage of having insurance. Even if you have not met your deductible, you’ll be charged, say $450 (ballpark figure, it may be more) for that MRI (as opposed to the uninsured person who faces a bills of $4000-$5000). If you have met your deductible, your insurance may pay $350-$400 and leave the remainder to you.

 

[TheRealJuliane]

These days, good health Care is unaffordable to even the (middle) middle class.

From what I have seen, the homes of Doctors (and of many nurses) far exceeds the home values of most people. Hmmmmmm…

Oh, we’re back to envy again? Doctors also have a much larger student debt load than the average person as well as malpractice insurance. What would you do, pay doctors the same as janitors? Do you think just anyone should be able to perform surgery? Yes, we reward doctors for their skills. The ones who perform complicated surgery, we pay the most. Family practice doctors don’t earn millions of dollars. And whose business is it if anyone’s house is large, or not? There will always be someone with more money than you, and someone with less money. How about if you pay attention to your own life instead of coveting someone else’s life?

 

[TheRealJuliane]

They have, but most of those bills are insufficiently discounted for the average middle class person, and often are never discounted because of deductibles most non-chronically-unhealthy people will never reach in any given year.

That’s a convoluted way of saying “an average, healthy person.”

 

[seekerz]

Oh, we’re back to envy again? Doctors also have a much larger student debt load than the average person as well as malpractice insurance. What would you do, pay doctors the same as janitors? Do you think just anyone should be able to perform surgery? Yes, we reward doctors for their skills. The ones who perform complicated surgery, we pay the most. Family practice doctors don’t earn millions of dollars. And whose business is it if anyone’s house is large, or not? There will always be someone with more money than you, and someone with less money. How about if you pay attention to your own life instead of coveting someone else’s life?

Generalizations of this sort tend to be inaccurate on either side.

First of all, it’s not the patients’ fault that medical education is, like everything else in medicine and indeed in education, seriously overpriced. Some might object that overpriced is not the word in a free market because demand is what controls price. I might agree, except that sickness is not really optional and neither is the need for its treatment. So how does one curb ‘demand’ for care? By opting out of humanity?

Secondly, all doctors are not equal. The highest paid ones are usually the most specialized and the services they provide are accordingly highly priced too. Your average primary care physician does not command nearly as much income, which is why a rift exists between these groups similar to the rift between your post and Nimzovik’s.

The sad reality is that we cannot have the best of all worlds: costs must be contained otherwise they might overtake our capacity to pay - and then not only the sick, but even their docs could not survive financially.

 

[TheRealJuliane]

Generalizations of this sort tend to be inaccurate on either side.

First of all, it’s not the patients’ fault that medical education is, like everything else in medicine and indeed in education, seriously overpriced. Some might object that overpriced is not the word in a free market because demand is what controls price. I might agree, except that sickness is not really optional and neither is the need for its treatment. So how does one curb ‘demand’ for care? By opting out of humanity?

Secondly, all doctors are not equal. The highest paid ones are usually the most specialized and the services they provide are accordingly highly priced too. Your average primary care physician does not command nearly as much income, which is why a rift exists between these groups similar to the rift between your post and Nimzovik’s.

The sad reality is that we cannot have the best of all worlds: costs must be contained otherwise they might overtake our capacity to pay - and then not only the sick, but even their docs could not survive financially.

And neither is it the doctor’s fault. The reason they come out with more student debt is that they have to go to school for MUCH longer than most college students. It’s not merely the cost which is too high for all college students, it’s that they add another 8 years plus, depending on their specialty.

I already said that primary care docs don’t earn as much; why do you think you need to repeat it?

Why does this sort of debate return again and again to the salary someone ELSE makes?? It’s envy and covetousness.

 

[Elizabeth502]

That’s a convoluted way of saying “an average, healthy person.”

It’s “convoluted,” Julianne, because she keeps on bringing up chronically unhealthy. That’s why.

Again, it’s helpful when people follow the dialogue.

 

[seekerz]

Why does this sort of debate return again and again to the salary someone ELSE makes?? It’s envy and covetousness.

Or it’s basic economics (I find it a good practice to at least initially, attribute the best - rather than the worst motives - to people).

Part of what drives the increase in health costs are the earnings of providers. By virtue of their specialized knowledge, they can - if they choose - try to match the services they render or recommend, to the income they seek for themselves (Kind of the same way lawyers’ honesty is what determines how many hours they bill us for).

 

[seekerz]

It’s “convoluted,” Julianne, because she keeps on bringing up chronically unhealthy. That’s why.

Again, it’s helpful when people follow the dialogue.

Why should I not bring them up? If we are talking health care costs and solutions, they lie smack, dab in the center of the problem.