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8 years ago  ::  Jun 26, 2010 - 11:59AM #31
Erey
Posts: 21,730

Well if it is the insurance companies fault then how does the bill get to be $675 before any insurance deduction is factored? 


How much can the insurance company take on of that 675 and still keep the lights on? 


We are simply charged more for the same medical services.


 


Note- not saying the insurance company is untouchable or not an issue but without insurance the bill is 675  - why so much?

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8 years ago  ::  Jun 26, 2010 - 12:57PM #32
Ebon
Posts: 10,148

We have universal care here, funded out of taxes. Now, before I say anything else, I have to point out that the NHS is not perfect and no-one should ever claim it is. That said, it is a lot better than the scandals that the right-wing tabloids present as normal would have you believe.


Operating budget of the NHS amounts to about $2000 per citizen, per year. Administration accounts for about 6.8% of the budget (including pensions and benefits). Your out-of-pocket expenses amount to a £7 contribution to drug cost for each prescription you get filled and the young, old and poor are exempt from that. It's paid out of taxes. Income tax averages 22% for most (plus another 8-10% National Insurance, our version of Social Security). Personally, I pay a lot more because I smoke. A pack of Marlboros here costs just over £6 (about $9), three-quarters of which is tax. Personally, I've got no problem paying that. I have a habit which may well damage my health, I pay more to cover for that damage, seems fair to me. The state swipes a couple of pence off a pint of beer for the same reason (it should probably be more, we have a real problem with binge drinking here).


Yes, there are sometimes waiting lists for non-essential surgery. They are rarely very long (the occasional tabloid fodder of the person waiting months is a scandal caused by admin screwing-up, not normal at all) and, if you have the money, you can just call up BUPA or one of the other private medical firms and by-pass the list. Some companies offer private coverage as a perk for their high-level employees. No, you do not have a government beurocrat between you and your doctor. The beurocrats (we prefer the term "civil servant") just direct the resources where they need to go quickly, quietly and with a minimum of fuss. Besides which, an insurance company really does have beurocrats between you and your doctor. At least the civil servants don't have a profit motive. Yes, there is a board (called NICE) which decides which drugs are available on the NHS. However, they're strictly evidence-led and if there's a hold-up, it's always because they're unconvinced of the effectiveness of a drug (they function much like the FDA) and, again, if they won't approve a drug, you have the option of going private. Yes, a couple of people were once left to die in a corridor. That's a scandal, obviously, but malpractice happens the world over and we're not immune from it. No, there are no waiting list to see your doctor. Most will see their doctor the same day they ring them or, at worst, the following day. Yes, everyone is covered, including students, the unemployed and even foreigners (although the E111 scheme means their home country is billed for their care). Drug users and alcoholics are covered, in the sense that they are given as much help as possible to get off the drugs (much cheaper than jailing them).


I see my doctor every two weeks and my shrink between every two weeks and every month. Were it not for the NHS, I would probably be dead because I almost certainly wouldn't be getting treatment for my MDD. During the healthcare debate, your tabloids fed you a lot of scare stories about our health system and our more right-wing tabloids (most of which hate the NHS) did the same. While some of them were true, none were widespread and all were rare outrages that we try to correct for. The NHS isn't perfect but it's not bad either.

He who oppresses the poor shows contempt for their Maker, but whoever is kind to the needy honors God. ~ Proverbs 14:31

Fiat justitia, ruat caelum

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8 years ago  ::  Jun 26, 2010 - 1:25PM #33
Ebon
Posts: 10,148

Jun 26, 2010 -- 11:59AM, Erey wrote:

Well if it is the insurance companies fault then how does the bill get to be $675 before any insurance deduction is factored? 


How much can the insurance company take on of that 675 and still keep the lights on? 


We are simply charged more for the same medical services.


Note- not saying the insurance company is untouchable or not an issue but without insurance the bill is 675  - why so much?



Several reasons. Firstly, the very existence of the insurance business distorts the prices. Your doctor has to factor in the time taken to actually get a payment out of the insurance company, he may well have to fund a person or department specifically for dealing with that. He has to factor in teh time he or someone will take dealing with the insurance companies morass of paperwork. In many areas, he is required to have malpractice insurance, the premiums for which just keep rising despite the fact that actual malpractice payouts have been stagnant for years (i.e. the insurance company keeps pushing up the premiums for the simple reason that they can)

Secondly, because healthcare in the US is a for-profit business. Mystical mumbo-jumbo about the "magic of the market" aside, it's basic logic that a for-profit service will cost more than a non-profit one for the same service. The free market works fine for hamburgers or running shoes because you can just walk away if the price gets too high. But because we all need healthcare (or the option of it anyway) and we need it all the time, it forms a captive market, you can't walk away. And that means there is no mechanism keeping prices under control except competition and healthcare, at the level of your local doctor, isn't a very competative business. Because doctors, like any sane person, like making money, there is every incentive to keep prices to within a few dollars of their nearest competitor (who may well be miles away anyway). The pressure in any private business is always to make more money. That means that, absent some outside force (such as external competition or governmental regulation), prices will always rise.


Finally, you have been sold a bill of goods about your healthcare. A lot of people, mainly politicians, like to talk about the US having "the best healthcare in the world". It is, if you'll forgive the vulgarity, bullcrap. You may well have the best doctors in the world but your actual healthcare outcomes are fairly pitiful. In measurable outcomes like child mortality, life expectancy, standard of care and so on, the US is not all that great. Partly, that's for non-medical reasons (such as the fact that most Americans and most Brits, including me, eat crap) but much of it is to do with the way you deliver healthcare. However, because you have had a lot of smoke blown up your collective asses about how wonderful your healthcare is, because the US will never admit to being less than the best in anything (and, without wishing to get into foreign policy, that attitude is probably the number one reason for international exasperation with the US) and because Americans always associate quality with cost, you will pay the exhorbitant fees. There is no incentive for doctors to lower prices and every incetive to raise them, both for the reasons I covered above and because Americans, raised on the idea that the best care costs most, will continue to pay those fees.

He who oppresses the poor shows contempt for their Maker, but whoever is kind to the needy honors God. ~ Proverbs 14:31

Fiat justitia, ruat caelum

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8 years ago  ::  Jun 26, 2010 - 6:43PM #34
solfeggio
Posts: 10,753

Ebon -


I liked your posts!  Your explanation of the NHS should be required reading for every American.  What you've been saying about the American health system is basically what I've said in some of my posts, and which has resulsted in people calling me an America-hater (which I'm not.)  


Your point about Americans and Brits (and Kiwis!) mostly eating crap was well taken.  We here in NZ have a very high rate of coronary artery disease and cancer, and I'm sure a lot of that can be traced back to the high consumption of lamb, pork, and beef, and processed meats as well.  Sausage rolls are a big favourite here, for instance, as are blood pudding and sheep meat.


But that's all cultural, and culture has got to be one of the hardest things to change. 

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8 years ago  ::  Jun 26, 2010 - 8:32PM #35
jane2
Posts: 14,295

Jun 26, 2010 -- 6:43PM, solfeggio wrote:


Ebon -


 


I liked your posts!  Your explanation of the NHS should be required reading for every American.  What you've been saying about the American health system is basically what I've said in some of my posts, and which has resulsted in people calling me an America-hater (which I'm not.)  


 


Your point about Americans and Brits (and Kiwis!) mostly eating crap was well taken.  We here in NZ have a very high rate of coronary artery disease and cancer, and I'm sure a lot of that can be traced back to the high consumption of lamb, pork, and beef, and processed meats as well.  Sausage rolls are a big favourite here, for instance, as are blood pudding and sheep meat.


 


But that's all cultural, and culture has got to be one of the hardest things to change. 






Interesting about food. When I was young and long into my married life we had a moderate portion 3-6 oz of beef, lamb or pork along with a starch, usually potato and a veggie for dinner. Most meat was broiled or grilled or baked or roasted. It was not an unhealthy diet. We never ate sausage and just a bit of bacon and eggs on the week-end.


A certain med made me gain 35 pounds, but I have lost that in the two years since I quit that med. I've also learned that southern farm families had fat-back in their greenbeans because little meat was served : I first learned about veggie plates at restaurants here in the south.


As I grow older I eat less and less meat, but I am a dairy person who likes yogurt and real cheese in moderation. Old people in the US still drink milk as I do and always have.


Often I wish I had a neighborhood restaurant I could walk to--I love the one Olympia Dukakis visits in MOONSTRUCK. I'd settle for a sandwich shop. But the US has been suburbanized since I was very young.


I'm appauled by the serving sizes at restaurants. My grandkids love the Outback here, but I don't. And we never encourage them to eat all on their plates. I love totake my family out to eat. Since I sold our big house after my husband's death the best I can do is a pizza night at my ranch condo. (Not being a poor, pitiful Pearl, here.)


J.

discuss catholicism
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8 years ago  ::  Jun 26, 2010 - 9:16PM #36
appy20
Posts: 10,165

I think the only people who are under the delusion that we have such great health care are, ironically, the ones on Medicaid (which, yes, is government) and those with administrative jobs in private companies.  Also, people who have never had a health scare have no idea how bad it is.


Another injustice of our system is that adminstrative personnel often get better policies than the rank and file and I find that reprehensible.

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8 years ago  ::  Jun 26, 2010 - 9:41PM #37
mountain_man
Posts: 44,029

Jun 26, 2010 -- 9:16PM, appy20 wrote:

I think the only people who are under the delusion that we have such great health care are, ironically, the ones on Medicaid (which, yes, is government) and those with administrative jobs in private companies.  Also, people who have never had a health scare have no idea how bad it is.


Another injustice of our system is that adminstrative personnel often get better policies than the rank and file and I find that reprehensible.



That means they are worth more than we are. Really! In the civilian world those executives are seen as making more profit for their company, so, therefore, they are worth more. The peons come cheap and are disposable.


Dave - Just a Man in the Mountains.

There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge.   Isaac Asimov
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8 years ago  ::  Jun 26, 2010 - 9:45PM #38
appy20
Posts: 10,165

Jun 26, 2010 -- 9:41PM, mountain_man wrote:


Jun 26, 2010 -- 9:16PM, appy20 wrote:

I think the only people who are under the delusion that we have such great health care are, ironically, the ones on Medicaid (which, yes, is government) and those with administrative jobs in private companies.  Also, people who have never had a health scare have no idea how bad it is.


 


Another injustice of our system is that adminstrative personnel often get better policies than the rank and file and I find that reprehensible.



 


That means they are worth more than we are. Really! In the civilian world those executives are seen as making more profit for their company, so, therefore, they are worth more. The peons come cheap and are disposable.


 





The biggest insult to me about it is that even when the rank and file can afford it, they aren't offered it and so they are't ALLOWED to have it. It is really disgusting.  We are talking about human beings here and that just goes over some people's heads.


 

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8 years ago  ::  Jun 26, 2010 - 9:58PM #39
appy20
Posts: 10,165

There is one area that we are at an advantage.  Once, was about to get into the shower and walked by a mirror.  I saw a huge breast lump. I called the gynecologist mmediately.  I got dressed when to his office. They didn't make me wait in the office.  They took me back saw the lump, were horrified and sent me to the next room for a mammogram and ultrasound.  They drained my lumps and tested the fluid for cancer.  From the time I called to the time I had all test results and saw my doctor was a total of one hour.  Everything was benign. A friend of mine in Canada, coincidentally, found a lump the same week I did.  It was two weeks before she got a mammogram.  Two weeks is a long time when you are scared.

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8 years ago  ::  Jun 26, 2010 - 10:56PM #40
mountain_man
Posts: 44,029

Jun 26, 2010 -- 9:45PM, appy20 wrote:

The biggest insult to me about it is that even when the rank and file can afford it, they aren't offered it and so they are't ALLOWED to have it. It is really disgusting.  We are talking about human beings here and that just goes over some people's heads.



That's part of what's wrong with the USA; money is more important than people. Many companies could offer health insurance to all their employees but that would cut into their profits.


It's not just private businesses; I work for the government and I have no health insurance. I get to work 1039 hours per year (6 months) and the only benefits (other than vacation and sick leave) I get are a paycheck and working in the most beautiful place in the world.

Dave - Just a Man in the Mountains.

There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge.   Isaac Asimov
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