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Health Care Reform at Last (?)


Well, the House of Representatives narrowly passed the Health Care Reform bill. So now it goes to the Senate. The U.S. may actually have a modern health care system by thr end of Obama's (hopefully first) term. I'm curious to hear from Stormdog, Kaunisto, Morwen and others outside the U.S. how they feel about their country's health care program.
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Re: Health Care Reform at Last (?)


Tim I want to see the details of the new program. Is it a universal healthcare system like the ones in Europe, Canada the UK? Or will people still be allowed to keep their private insurance and will they even so have to contribute towards the national system?
Our government is talking about doing that here, i.e. making companies deduct contributions to a national system rather than our present 'medical aid' system.
We've had private healthcare for decades, much in the same way as the US and we've also had government healthcare, totally funded from the Treasury. In other words it's non-contributory and anyone can use it. Of course if you have private healthcare and want to go to a government hospital, you have to pay but then if you have private funding you wouldn't want to go to a government hospital because they are not very nice because, you can imagine in a country of some 50 million+/- there isn't enough funding to make them work properly, so only the indigent and people who don't have insurance use them.
With a national healthcare system, there will obviously be more money because of the income from contributions and if the contributions are based on each person's income, i.e. the more you earn the more you pay, then it's a way of making higher earners support the indigent and the people who don't earn very much.
I'm in favor of it a lot of people aren't but then I worked in the government system in my youth when the system was extremely well-run and it could work like that again. The idea of private hospitals only emerged in the 1970s and then as they became more popular and medical aids (our health insurance companies are called that) supported them rather than the government-run institutions, the latter deteriorated to the point where if you are hospitalized in one of those now, you have to bring your own linen and food.
So yes, I'd like to see a return to the sort of teaching-hospitals we had up to the 1970s and less of the overcharging type of hospitals we're forced to use now because the government ones are so bad.
It will be interesting to see how it works in the US so that our government can take that as an example.
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Re: Health Care Reform at Last (?)


I've had so little to do with health care personally that it's hard to comment.
But the Finnish public health care has always been much praised, although lately the lines are getting longer (due population aging).

Here's what Wikipedia has to say:
quote:

In Finland, public medical services at clinics and hospitals are run by the municipalities (local government) and are funded 78% by taxation, 20% by patients through access charges, and by others 2%. Patient access charges are subject to annual caps. For example GP visits are (11€ per visit with annual 33€ cap), hospital outpatient treatment (22€ per visit), a hospital stay, including food, medical care and medicines (26€ per 24 hours, or 12€ if in a psychiatric hospital). After a patient has spent 590€ per year on public medical services, all treatment and medications thereafter are free. Taxation funding is partly local and partly nationally based. Patients can claim re-imbursement of part of their prescription costs from KELA (Social Insurance Institution). Finland also has a much smaller private medical sector which accounts for about 14 percent of total health care spending. Only 8% of doctors choose to work in private practice, and some of these also choose to do some work in the public sector. Private sector patients can claim a contribution from KELA towards their private medical costs (including dentistry) if they choose to be treated in the more expensive private sector, or they can join private insurance funds. However, private sector health care is mainly in the primary care sector. There are virtually no private hospitals, the main hospitals being either municipally owned (funded from local taxes) or run by the teaching universities (funded jointly by the municipalities and the national government). In 2005, Finland spent 7.5% of GDP on health care, or US$2,824 per capita. Of that, approximately 78% was government expenditure.



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11/9/2009, 4:21 am Link to this post Send Email to Kaunisto   Send PM to Kaunisto
 
Tim Callahan Profile
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Re: Health Care Reform at Last (?)


Some of the weirdness that has popped up involving the healthcare reform debate involves all kinds of bizarre accusations, probaly fomented by the Insurance industry, regarding what a national healthcare plan would entail. Among these fear-mongering assaults are that the Obama plan would include forced euthanasia for senior ciizens and, on a somewhat less hysterical note, that under the plan you would be assigned a doctor and would have no choice as to who your physician would be.

 Of course, in addition to these accusations there is the usual claim that the government plan would cost us all this money. At the same time, the argument is put forward that physicians will be penalized by the government arbitrarily telling them what they can charge. I'll address costs in my next post.

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Re: Health Care Reform at Last (?)


A few anecdotes from my personal life might serve to inject a bit of reality into the discussion medical costs. In January, a few days after New Year's Day, I had to go to the emergency room becuase of acute gastroenteritis. I've had this problem before. I start vomiting, and it goes on until I'm puking bile. A shot of compazine puts an end to it. So I told this to the emergency room doctor, and he said, "Okay, then we'll give you a shot of compazine, which he did. For this service, over and above the emergency room costs, that doctor charged me $300.00 for, as the bill stated it, a "detailed examination." In fact, there was no examination at all, and I barely took up five minutes of his time. Bear in mind also that the emerency room doctor would be there and be paid a salery, regardles of whether I had shown up or not.

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Re: Health Care Reform at Last (?)


Here are two other anecdotes relating to medical costs in the U.S. My medical care is now split between the Veterans Administration and Medicare. Before that, I was covered by Blue Cross under the Motion Picture Health Plan (I was working in the animation industry at the time). That particular policy had a "prudent buyer" clause by which the insurance company could dictate what hospitals, doctor's and labs could charge.

While I had this coverage, I had to get hernia surgery. As part of the hospital admission procedure I had a screening chest x-ray, for which the hospirtal charged $ 250.00. The Prudent buyer clause meant that they had to be satisfied with a payment of only $ 50.00, a fifth of what they wanted to charge.

The prudent buyer clause also forbade a certain lab from charging me $30.00 for "venipuncture," i.e. drawing my blood, which isn't that hard to do and takes all of two minutes.

I have a special perspective, which I will share in my next post, on these two procedures, for which the hospital and the lab wanted to charge me exhorbitant prices.
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Re: Health Care Reform at Last (?)


Okay, here's my special perspective:

I was a hospital corpsman in the U.S. Navy. As a ward corpsman, and later, working in a lab, I drew a lot of blood. Thus, I know from personal experience that it requires very little training and take very little time. The lab's $30.00 charge for "venipuncture" was outrageous.

Part of the time I was in the service I was stationed at Moffat Field Naval Air Station, where there was a dispensary. t that station they only had billits for one laboratory technician, one x-ray technician etc., which meant that we who were ordinary corpsmen got to work in the lab and in x-ray. Thus, with very little training, I took quite a number of chest x-rays. For screening chest x-rays, the doctor would but the x-ray up on an illuminated plate, glance at it and (usually) say, "Okay, that's clear." Screening x-rays require very little imput from the doctor. The $50.00 charge was reasonable. The $250.00 charge was excessive.
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Tim Callahan Profile
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Re: Health Care Reform at Last (?)


My point in the anecdotes I submitted is that perhaps some government regulation would greatly reduce health care costs. Not all insurance plans have the prudent buyer clause, meaning that the hospital I went to for the surgery routinely charged patients five times what was a reasonable charge for screening x-rays, required for admission. So, for every 100 patients admitted, the hospital made $25,000.00 on screening chest x-rays alone, rather than the $5,000.00 that would be reasonable.

Also consider that the lady drawing my blood probably drew blood five to ten times an hour. With two people drawing blood at five times an hour, for an eight hour day, at $30.00 a pop, that is: 2 X 5 X 8 X 30, the lab would make $ 2,400.00 a day, for a service that should be part of the blood test. Multiply that by a 5 day week and you have $12,000.00. Assuming the lab operates 50 weeks a year and that's $600,000.00 extra profit for the lab each year; and this is for one small lab.

Last edited by Tim Callahan, 11/11/2009, 6:03 pm
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Re: Health Care Reform at Last (?)


It's those sorts of charges that a regulated healthcare policy will stop.
Our doctor, a GP in private practice, charges R220 to people who are paying privately for the visit and R440 to the 'medical aid', of which they pay R220 and they take R220 from my savings account (the savings account they hold from my contributions which comes from the money we've paid in (premiums) and not used). At the end of the year whatever is over is carried forward either positive or negative. If we go over what we have saved, then we don't get any of the contributions into that account until the portion the medical aid advanced us the previous year is paid up.
So the result is that we don't go to the doctor unless we simply can't self-medicate. My arm injury is a perfect case in point.
I fell on the sidewalk in Edinburgh, slightly injuring my right arm but not enough to see a doctor. When I returned home I did something stupid and tore the rotator cuff muscle. I know this because I can recognise the symptoms.
If I go to the doctor, he will give me a cortisone shot, a prescription for drugs, send me for an MRI and suggest I have it repaired when anyone who's had the surgery will know, is not guaranteed.
All of this at a cost of thousands of Rands, some of which will be covered but most not, for example a surgeon will charge me R3,000+ for a consult to tell me to have the surgery at a cost of upwards of R75,000 which I have to pay, because only the hospital costs are covered by our insurance.
Instead I chose to treat it with ice packs and rest in a sling and my own anti-inflammatories which I take daily for another problem.
It's taking longer to heal but is getting better every day because I refuse to spend all the money having treatment I've been able to sort out for myself. But just imagine someone who has less knowledge of medicine having to deal with this problem and the financial issues involved.
A general government-run healthcare system would've got me treatment without any cost to myself at all.
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Re: Health Care Reform at Last (?)


While I'm sure there's lots of overcharging, I'd point out one thing.
Hospital has to gather also the money it spend on the x-ray machine, not just charge for the use.
And this goes for most other things too; you're not paying for what you get, but for them having everything possible available - all the time - including what you needed, when you needed.
The costs of equipment, stuff and drugs are not to be underestimated.

It's just a question of whether it's paid by patients or taxpayers in general.

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