Universal Health Coverage

[piqaboo]

I already knew that. We get our annual healthcare info roll-out in Nov. I am dreading it, this year.
I'm pushing to get all our annual appts in this quarter, so we can skip next year if we have to.

[Haggis@wk]

Major health insurers to stop offering new child-only policies.

“Some of the country’s most prominent health insurance companies have decided to stop offering new child-only plans, rather than comply with rules in the new health-care law that will require such plans to start accepting children with preexisting medical conditions after Sept. 23.”

Wow. Who could have seen this coming?

[Shapley]

McDonald's May Drop Health Care Plan, Cites New Federal Rules

[Selma in Sandy Eggo]

See? I've said it all along. We do not need mandated universal health coverage.

We need socialized medicine. That'd give us one industry to support, instead of two.

[Haggis@wk]

See? I've said it all along. We do not need mandated universal health coverage.

We need socialized medicine. That'd give us one industry to support, instead of two.

The continued purging of mini-med plans isn’t unexpected but the McDonald’s brand-name puts it in bold. Mickey D’s is a huge employer of the very working poor the Affordable Care Act was ostensibly designed to help most. It’s bad enough that the bill will close the market for affordable coverage to these low-wage hourly workers, and replace it with a sure-to-be-hideously-inefficient, perversely-incentivized set of subsidies for plans some workers may not want or need. It’s worse that it won’t do so until 2014.

What is Jimmy on the fry station supposed to do until then?

That'd give us one industry to support

You seem to forget the only industry we will be supporting will be the government, none of our money will go to the health care industry. We pay the government and they decide how much to pay your doctor; yeah, that'll be as efficent as the VA, the post office and IRS

[Marye]

Just back from the U.S. and witnessed some more of the insurance nightmares that come with your health care. Honestly, if you knew how easy it was up here... you would want it. Yes people whine about line ups and can't get xrays tomorrow, or have to wait in the emergency for hours but really, if a privileged Canadian (and we are with our health care) had to pay $900 a month and still get bills from their insurance companies that are a foot high with some that you already paid and you have to figure it out? They would shut the hell up. How can anyone who is so sick, can no longer work because she is dying look at these bills and not sit and cry that the end of her life is a nightmare. She is not getting the care she would get in Canada. Trust me. I watched my mother die with cancer and we had daily nursing to our home, doctor's coming. My mother died without worrying that her family had a multitude of bills to go through and sort out and pay. She didn't have to worry that the end of her life would be in screaming pain. My sister-in-law had to pay $817 for 10 pills -- antibiotics. WHAT!?!?! That same drug in Canada (because my government subsidizes this) is $162.00.. and with my employment and further drug care (a taxable benefit to me) I might have to pay $20.00 for those 10 pills. Of course, my doctor says when she is writing a prescription: do you have a drug plan? This might be expensive. I am so blessed. If you are over 65... the government picks up the costs of your drugs -- you pay for the dispensing fee. Honestly.. I know you will say, we don't care about Canada and we don't care about you Mary and your progressive socialist ways. We just don't want to pay for everyone. Not everyone is equal here.

Can I say? I worked in a doctor's office in a hospital and I billed OHIP (my provincial health care) for the doctor's practice. All I did was send in a card (provided by OHIP) with the amount ticked off to be paid for the patient's care. At the end of a month OHIP returned with a cheque. The end. Any discrepancies.. well that was what I was paid to sort out. If you are an in-patient? the hospital sent the bill to OHIP.. you, as the patient, paid for your television and telephone.

One more thing. This past weekend I realized how expensive food, at the grocery store, is in the U.S. You pay a lot more for the same item than I do. Scary.

[Shapley]

Insurance only exists because the price of care went up. The government saw that it was good, so they set out to 'regulate' it and make it 'better'. The result is what you see now.

So, with insurance so surely confusing that it makes people cry, the government has mandated that everyone has to buy it.

The simplest system - which existed for over a century in this country, is one in which people receive care and then pay for it.

Insurance was a nicety, a luxury if you will, to help ease the burden of unexpected expenses. It only became an expensive necessity when the government decided to make it affordable.

[dai bread]

I read Marye's post with interest. I still shake my head in wonder at the convoluted tangle that the U.S. health system appears to be. I don't have the experience she has of a health system other than as a patient, but ours is a piece of cake compared to what I read of the U.S. system, both on this board and elsewhere.

My doctor has put his fee up, though. The last visit cost me $35.00 instead of $30. The medicines cost me $3.00 an item, but as a pensioner I get discount, so the standard price is higher.

[Marye]

The insurance my family member has she has always had since the beginning of her terminal illness seven years ago! It is not new, Shap, unless of course when you can no longer work then the insurer and coverage changes or you are dropped. That doesn't happen here. She was charged $25,000 by the doctor to do her surgery as her insurance did not cover the doctor fee for the type of surgery she had. She would not have had that charge here.

The cost of a consultation to a oncologist is $148.95 (30 years ago it was $90.00 -- hasn't even doubled!) and that fee you can charge only once a year to each patient. You can, if you see the patient again, charge a limited consultation and a repeat consultation though the fees are less maybe 95.00. These two fees are charged once a calendar year per patient. Then all the other times you see the same specialist it is 50.00 or less. See another specialist? Same charge. Different specialist? Same fee roughly. This charge is to my government plan. You cannot overcharge as the plan will reject it. Family doctor fees are much less. If you are an in-patient the doctor may bill OHIP daily in the amount of $30.00 for seeing you (30 years ago it was $15). No matter how sick your patient is and even if you see them twice or more times a day, you can only charge the one fee that day. Patient still in hospital after 4 weeks? you can only charge daily at $9.00 per visit Longer? You can bill three times a week. REALLY LONG (after 8 weeks) Once a week. This is what the doctor makes.

Some family doctors are now asking their patients if they would like to pay a yearly fee like $150.00, to cover the cost of telephone advice (if I choose not to go to the doctor but want to ask a question) or getting a prescription over the telephone (if I could not got to see the doctor) or if I need forms filled in for some executive physical (executive.. hahahah.. not me)... My family doctor charges this sort of yearly fee to cover if you think you are likely to use them frequently. But I do not pay the yearly fee as I go see my doctor. I will happily pay $15.00 to get a prescription over the telephone, if I need one but I make the trip to see my doctor. OHIP does not cover everything. Cosmetic surgery, invitro fertilization to name two medical events they do not cover unless that breast reduction you need is for back pain, or unless the droopy eyelid you have needs lifting because you would like to see better. They will cover the cost then. My government health care plan is not there for profit or the consultation fees would be $500.00 and the cost of hospital visits would be $100 a day. I only need to show my health card ANYWHERE in Canada and I am covered for so many services. One province will bill the other if I am sick in B.C. or if I am unwell in the Yukon. If I am unwell in the U.S. my health care provider and my employer (part of my taxable benefits) will pay some fees but mostly they will help pay to get me home to be looked after.

[Marye]

The insurance my family member has she has always had since the beginning of her terminal illness seven years ago! It is not new, Shap, unless of course when you can no longer work then the insurer and coverage changes or you are dropped. That doesn't happen here. She was charged $25,000 by the doctor to do her surgery as her insurance did not cover the doctor fee for the type of surgery she had. She would not have had that charge here.

The cost of a consultation to a oncologist is $148.95 (30 years ago it was $90.00 -- hasn't even doubled!) and that fee you can charge only once a year to each patient. You can, if you see the patient again, charge a limited consultation and a repeat consultation though the fees are less maybe 95.00. These two fees are charged once a calendar year per patient. Then all the other times you see the same specialist it is 50.00 or less. See another specialist? Same charge. Different specialist? Same fee roughly. This charge is to my government plan. You cannot overcharge as the plan will reject it. Family doctor fees are much less. If you are an in-patient the doctor may bill OHIP daily in the amount of $30.00 for seeing you (30 years ago it was $15). No matter how sick your patient is and even if you see them twice or more times a day, you can only charge the one fee that day. Patient still in hospital after 4 weeks? you can only charge daily at $9.00 per visit Longer? You can bill three times a week. REALLY LONG (after 8 weeks) Once a week. This is what the doctor makes.

Some family doctors are now asking their patients if they would like to pay a yearly fee like $150.00, to cover the cost of telephone advice (if I choose not to go to the doctor but want to ask a question) or getting a prescription over the telephone (if I could not got to see the doctor) or if I need forms filled in for some executive physical (executive.. hahahah.. not me)... My family doctor charges this sort of yearly fee to cover if you think you are likely to use them frequently. But I do not pay the yearly fee as I go see my doctor. I will happily pay $15.00 to get a prescription over the telephone, if I need one but I make the trip to see my doctor. OHIP does not cover everything. Cosmetic surgery, invitro fertilization to name two medical events they do not cover unless that breast reduction you need is for back pain, or unless the droopy eyelid you have needs lifting because you would like to see better. They will cover the cost then. My government health care plan is not there for profit or the consultation fees would be $500.00 and the cost of hospital visits would be $100 a day. I only need to show my health card ANYWHERE in Canada and I am covered for so many services. One province will bill the other if I am sick in B.C. or if I am unwell in the Yukon. If I am unwell in the U.S. my health care provider and my employer (part of my taxable benefits) will pay some fees but mostly they will help pay to get me home to be looked after.

[Marye]

The insurance my family member has she has always had since the beginning of her terminal illness seven years ago! It is not new, Shap, unless of course when you can no longer work then the insurer and coverage changes or you are dropped. That doesn't happen here. She was charged $25,000 by the doctor to do her surgery as her insurance did not cover the doctor fee for the type of surgery she had. She would not have had that charge here.

The cost of a consultation to a oncologist is $148.95 (30 years ago it was $90.00 -- hasn't even doubled!) and that fee you can charge only once a year to each patient. You can, if you see the patient again, charge a limited consultation and a repeat consultation though the fees are less maybe 95.00. These two fees are charged once a calendar year per patient. Then all the other times you see the same specialist it is 50.00 or less. See another specialist? Same charge. Different specialist? Same fee roughly. This charge is to my government plan. You cannot overcharge as the plan will reject it. Family doctor fees are much less. If you are an in-patient the doctor may bill OHIP daily in the amount of $30.00 for seeing you (30 years ago it was $15). No matter how sick your patient is and even if you see them twice or more times a day, you can only charge the one fee that day. Patient still in hospital after 4 weeks? you can only charge daily at $9.00 per visit Longer? You can bill three times a week. REALLY LONG (after 8 weeks) Once a week. This is what the doctor makes.

Some family doctors are now asking their patients if they would like to pay a yearly fee like $150.00, to cover the cost of telephone advice (if I choose not to go to the doctor but want to ask a question) or getting a prescription over the telephone (if I could not got to see the doctor) or if I need forms filled in for some executive physical (executive.. hahahah.. not me)... My family doctor charges this sort of yearly fee to cover if you think you are likely to use them frequently. But I do not pay the yearly fee as I go see my doctor. I will happily pay $15.00 to get a prescription over the telephone, if I need one but I make the trip to see my doctor. OHIP does not cover everything. Cosmetic surgery, invitro fertilization to name two medical events they do not cover unless that breast reduction you need is for back pain, or unless the droopy eyelid you have needs lifting because you would like to see better. They will cover the cost then. My government health care plan is not there for profit or the consultation fees would be $500.00 and the cost of hospital visits would be $100 a day. I only need to show my health card ANYWHERE in Canada and I am covered for so many services. One province will bill the other if I am sick in B.C. or if I am unwell in the Yukon. If I am unwell in the U.S. my health care provider and my employer (part of my taxable benefits) will pay some fees but mostly they will help pay to get me home to be looked after.

[Shapley]

I have this terrible feeling of Déjà vu...

[Shapley]

A doctor's office visit here typically costs about $100 to $200 dollars. That's the total billed to the physician, of which the patient pays all or part. Given that most of us don't got that often, it really doesn't make sense to pay for insurance that covers it rather than pay the full cost out-of-pocket, but most people seem to like the idea of paying $25 per visit (co-pay) rather than shelling out $200. Given that many plans require you to pay in to the plan for the co-pay coverage, it usually costs them more than the $400 they would pay for two visits over the course of the year, but they don't notice it as much since they are paying monthly payments. (If they pay $10/wk and make two visits with $25 co-pays, they end up paying $550 for $400 worth of services, but that's their choice.) I'm sure it's higher in the cities.

Many physicians charge a 'new patient' fee, which can run into hundreds of dollars, but was $175 the last time I paid one. This is supposed to cover the cost of setting up an account, gathering the paperwork, etc. Locally, there has been a shift to 'walk-in doctor's offices', which appeal to those who do not want to maintain a regular physician. We have several here, but the more successful ones have been bought by the hospitals and are now run by them. I'm not sure what impact this has on pricing or service, since I have only been a couple of times since the change. I have noticed that they apparently no longer offer in-office pharmacy services, which they had before the change-of-hands.

Hospitals are the big money-grabbers here. As you know, we have both public and private hospitals in the U.S. There seems to be little uniformity to their pricing, and efforts by insurance companies, including Medicare and Medicaid, have met with some resistance.

In the old days, people paid their own bills and then filed with their insurance for re-imbursement. With that system, people could look at the bill and confirm that the services billed were consistent with the services recieved. The shift to 'direct billing' was ripe for fraud and abuse, and the hospitals apparently seized the opportunity. It took several years for the insurance to catch on and then begin to implement programmes to control it. The varieties of such efforts have led to much of the paperwork hassle we see today. If they would just end 'direct billing' and let the people pay their own bills, or at least file their own paperwork, it would reduce some of the fraud, IMHO, but we lazy Americans prefer to have somebody do all of that for us.

I've never paid for 'phone consultation', such as phoning in a prescription, as I suppose that is usually considered an extension of the visit, but I'm sure that is also different in the bigger cities and with less personable physicians.

[dai bread]

Changing from my Auckland GP to my Cambridge one cost me nothing.

My Auckland pharmacist charged $3 for having the doctor fax a prescription through. Once I found that out, I preferred the short walk from the doctor's office to the pharmacy. The doctor charged $15 for writing the prescription. Or rather, signing it. It was the nurse who actually pushed the "print" button on the computer.

I don't know if Cambridge pharmacists also have this charge. My GP works in a medical centre which has a pharmacy, so I go there for my medicines. The centre spent a lot of money putting that pharmacy in when they remodelled their premises last year.

[Shapley]

Wal-Mart was going to add walk-in clinics to some of their superstores. I'm not sure what became of that, whether the did or didn't or put it off because of the economy and/or uncertainty over the health care bill.

[Marye]

Shap -- Going to a cardiologist, hematologist or neurologist only costs $100-$200 in the U.S.-- the consultation? That is a good fee then. What does it cost if you have a follow up visit? Less? Same cost? What if you while seeing the doctor they have found you have coronary artery disease and have to go routinely? Do you pay each and everytime now because you did not buy insurance to cover this before? Same deal if they discover you have Parkinson's disease or Leukemia then? If you didn't buy the insurance before you had the condition, can you now NOT get any insurance?

How does vehicle insurance work in the U.S.? You don't have to buy it because you are a good driver, but if you are in an accident and are at fault then you have to pay for everything out of your own pocket? Including the punitive damages to the tune of whatever-the-injured-party-wants, including their medical bills?

I am not being a wise ass here, promise. I don't know. How does vehicle insurance work in New Zealand Dai?

[Shapley]

Marye,

I've never been to a cardiologist, except through a hospital physical. It was quite expensive (I don't recall the amount), mostly because it was through the hospital.

I've been to a neurologist and to a gastrointestinolgist. Both were under $200, but that was a few years ago. I usually just go the general practicioner, which is less. I'm sure the specialists are quite a bit higher. Medications are expensive. 'generics' less so, when they are available and if the prescriptions permit them.

The biggest savings are realized by going to the physicians' offices rather than seeing them through the hospital. Some, particularly cancer specialists, all seem to be attached to the hospitals and (apparently, though I have no direct experience, thankfully) cannot be seen outside the hospital system. I have no idea what the costs are for such services.

You do have to realize I live in a low-cost part of the country. Analog can vouch for that, since he lives not far from here. You won't find those kind of costs in New York or California, or even Chicago or St. Louis.

___________

Auto insurance is mandatory in most States if you are driving on the public roadways. The requirements are set by the States, not by the federal government. However, it is not required to cover your own cost, only to cover the cost of liability to others. Those with enough money (usually corporations with large fleets) are 'self-insured', which is to say that pay their own insurance claims without going through commercial insurance companies. There are hoops to jump through to get that permitted by the state (liquidity requirements, minimum asset values, etc.) which vary from State to State. I suppose individuals with sufficient cash could obtain similar exemption, but it probably is not worth the time and paperwork compared to carrying minimum liability coverage.

When you finance an automobile, you are usually required to carry full coverage to protect the collateral of the finance company. This is a contractual agreement between the lender and the purchaser, and is not government mandate. The owner is free to drop the collision and other non-liability coverage once the vehicle is payed for. Many financial experts used to recommend dropping such coverage on older vehicles, because the payments add up to more than the value of the repairs and/or replacement of the vehicle. I am sure that is still the case, although I have not read up on it in several years. They say you are better off putting the money you would otherwise pay in premiums in the bank to save for such costs when or if they occur. You'll generally come out ahead financially.

Americans (and I guess people in general) have an aversion to paying out large sums of cash at one time, preferring to spread that sum over longer periods, even if it costs more (through finance charges). This is usually a result of our unwillingness to accumulate cash as well as our unwillingness to let it go for mundane expenses when we have done so. It's a psychological thing, methinks.

[dai bread]

I am not being a wise ass here, promise. I don't know. How does vehicle insurance work in New Zealand Dai?

For personal injury by motor vehicle, however caused and regardless of fault, the Accident Compensation Corporation picks up the bill, as it does for industrial, sporting and domestic accidents.

For damage to the vehicle and other items not covered by ACC, there are two levels of insurance available. One is Comprehensive, which covers everything apart from ACC. There are limits to public liability payments, but they're pretty high. $1 000 000 at least. Then there is 3rd Party, Fire and Theft. This covers any damage done to someone else's property but not your own, unless the vehicle is stolen or catches fire. Theft is highly likely, so any owner with half the brains he was born with has at least that cover. It's surprising how many have nothing though. The insurance companies have systems in place for dealing with the uninsured. I don't know what they are, but I imagine they involve garnishee orders, summary judgements and things like that. It used to be possible to get straight 3rd Party insurance, but I don't know if anyone still offers it. 3rd Party, Fire and Theft is the standard if you don't want Comprehensive, which is expensive.

If you buy a vehicle on credit, you are required to have Comprehensive insurance. As in the U.S., this is required by the financier, not the Government.

[Haggis@wk]

Radley Balko: An honest question for supporters of Obamacare:

“If your answer is no, that is, that the Constitution puts no real restraints on the federal government at all, why do you suppose they bothered writing and passing one in the first place?”

If the government can force you to buy health insurance, can it force you to buy a gun?

[jamiebk]

If the government can force you to buy health insurance, can it force you to buy a gun?

It can force you to use one (draft)