Don't any of these assholes realize that if the government is paying for health care NOBODY will ever get the gamma knife treatment?

Or do they just not care?

You get the butter knife treatment -- if they get to you before your head explodes from the brain tumor.

Okay, you have convinced me that socialized medicine is the bad way to go. And that we need to separate health care from government and I'm all for separating it from employers. I would drop my health insurance and buy my own if it wouldn't cost three times as much and am actually (and mind you I don't make a ton of money; if I did, I'd have already bought the separate policy because I don't like having to worry about losing my health insurance if I give two weeks' notice) considering doing that anyway.

But... (and it's a big one)

We do need health care reform in this country. We also need to remove health insurance companies' control of it. All too often, your health insurance, not you, decides just what kind of health care you get. In short, they decide whether or not they will pay for the gamma knife treatment. If they won't or won't until the cheaper is tried, you're screwed. And good luck finding the insurer that doesn't cut corners these days.

We're already seeing rates increased for smokers, drinkers, sometimes overeaters. Insurance companies keep gaining unchecked power, it won't be wrong before they're getting into shit none of us can control -- like family history. Heart disease in your family, pay higher premiums even though you eat right and work out. Who knows what other limits they'll put in one by one when they know they can because their competitors are doing the same.

I don't know the answers but the free market ain't handling this one (you can't buy what ain't available) and what choices we have are being limited by insurers.

I'm already having to resign myself to going to a clinic near my house for primary care because there is absolutely no one on a bus route other than them and some other clinics in the ghetto sections of town that participate in my health insurance. Because they don't allow the going rate for office visits, doctors have dropped out to that degree and we're left with not exactly the cream of the crop; in fact, 3rd rate. I had found someone but went to his office and it was so filthy that I didn't even go through with the visit.

I am so switching insurers next open enrollment if not dropping and buying my own all together.

Still, the problem is that insurance can dictate how you handle a medical problem that arises. Call me crazy but I think that's something the patient should decide with advice from their doctor. I can see not covering elective things like cosmetic surgery but if it's medical, it should be the patient's choice.

Hello, everyone, from the Master Of What Should Be Obvious:

If you want a say, YOU have to pay. You're not getting out of that, no matter what. Don't be fooled by occasional congruence today between your desires and the treatment you get.

That's why I would carry a "Medical VISA card". Such an idea would clear up questions about who's paying, with a buffer in credit for bigger-than-expected expenses.

Life is uniformly fatal. If you think you can get someone else to pay your way, you might be right, but that can't last.

The first thing to do would be get rid of the HMOs. Therein lies the problem. HMOs are only there to make money, they're not there to ensure the patients' best interests; they're there to serve the CEO a huge frakking salary! Do away with the HMOs, that's half the problem gone already. I don't need anybody to monitor my paperwork or decide how much a procedure should cost. That's between me and my doctor. I should be able to call my doctor, make an appointment, pay for the appointment and any medication/procedure/acutrements, done. Why it should be more complicated than that is anyone's guess, but I remember when my mom and I were sick with the flu, the doctor came to the house, flu shot in the butt, done. Mom gave him a check; the following week, dad did some work on his car. No bill, no copay.
Gads, I'm old! o_O

I'm probably going to get burned on this one, but I don't have a lot of empathy for those folks who don't have insurance--it seems like a personal choice to me. Either find a job that pays it or take out your own policy, it's your responsibility, not anyone elses. I think part of this whole national health care thing is propelled by the thought that we have children who don't have health insurance. To that, I'd say what the hell are you doing breeding when you don't have insurance? I think we're all aware that the costs of health care are exhorbitant--wouldn't common sense tell an individual to make health insurance a personal priority? If you drive a car without insurance and get in an accident, is it anyone's fault but your own? Other than regulating the insurance industry like we would any other corporation, the Government has no business interfering with what is a personal decision and a personal responsibility. I think we'd find if we let capitalism do it's thing, that insurance companies would be forced to do what every other business does--compete for our business.

Lots of people think that the government is productive, but it isn't. Everything in possession of the government was made by someone else and either confiscated by taxation or paid for by money confiscated by taxation. The government doesn't produce wealth or medical care or anything else - it just takes from one to gives to another.

There is an ongoing Conflict of Visions in America.

On the one had, we have the traditional American idea of liberty and human rights, an entirely negative conception. It is a unique and radical idea. On this view, human rights are things the government can't do to you. You have free speech because the government can't interfere with it.

On the other hand, we have the imported Progressive idea of human rights, based on socialist ideas taught in European universities in the early part of the 20th century. On this account, human rights are positive duties of government. You have free speech only insofar as someone provides you with a forum and something to say in it.

On the traditional view, you have a right to medical care because the government can't interfere with your efforts to obtain it by voluntary means. On the Progressive view, government has a duty to provide medical care to you.

To me, the Progressive view is illogical. If the government has a duty to provide medical care, then it has the duty to coerce doctors to provide it to you. Or worse, to confiscate wealth from others to bribe a doctor into providing services "voluntarily." The Progressive vision always strikes me as an attempt to use coercion to secure a society without coercion. Huh?

When you recognize what the philosophical dispute is really about, you come to see that the Progressive view of liberty and human rights is anti-American in all senses, cultural, historical and constitutional. One of my undergraduate professors has written extensively on the subject.

Disputes over health care and the like are surface phenomena of a much wider, and much more dangerous, political struggle.

I have to dissagree with you Flynne. I was born and raised in the kaiser system. As a relatively young relatively healthy person an HMO is exactly what i want. I don't want to personally take on the overhead of managing my care and I don't want any financial liability beyond the premiums.

I'm not a fan of one size fits all solutions.

"the problem is that insurance can dictate how you handle a medical problem that arises. Call me crazy but I think that's something the patient should decide with advice from their doctor."

Call me pragmatic but I think that's something the patient should decide with the advice of his accountant.

The thought of national healthcare terrorizes me. My husband works a job that ain't exactly his dream job, but it pays consistently, and the insurance it provided was a big factor when he choose to take it. I don't see why others think they should be handed healthcare no matter what they do for a living.

If you do away with insurance, the only people getting the gamma knife will be millionares. That's free market. Not necessarily bad, but unpopular.

I like good insurance. My daughter gets a lot of ear/throat/sinus infections. I took her to an ENT. He said tonsils out, I said ok, we scheduled it, insurance paid. Now, if the government was involved, it would have been months and months to see the specialist, government deciding after the recommendation if DD really needed the surgery, then months and months of waiting for it. Just like canada.

And heck yeah smokers, heavy drinkers, and obese people should pay more, they cost more. Just like people who get lots of tickets should pay more in auto insurance. I choose not to eat like a pig and be a fatass, I shouldn't have to pay more because others are fat. And don't even get me started on people who literally pay to be given cancer. Your right, yes, but don't expect me to pay for the treatment.

Do you ever read my entire post mof3 or just what you choose to prejudice it with?

"And heck yeah smokers, heavy drinkers, and obese people should pay more, they cost more"

This is why health care as a for-profit enterprise doesn't make sense to me. How sensible is it, in the long run, to make it more difficult to be insured for those who are more likely to become ill and require medical care? They'll probably need care at an ER department that must provide that care regardless of whether you can pay. Would you really want that to change?

Nicely said, Jeff. Now let me ask everyone two questions:

1) What makes you think that you are obliged to get health insurance ?

2) What do you think "health insurance" really is?

These questions are designed to make you notice the enormous difference between what you are thinking about health insurance and other forms of insurance.

Reform starts with public knowledge and demand. That's why I'm asking.

The Japanese system works...here's a link with an outline of the system-

http://www.pref.osaka.jp/iryo/medicalinfo/
insurance_e_j.htm

The other half of the equation is not outlined in the link, I can't find info online on it, but there are price caps on all procedures and drug prices, and the prices are uniform all over the nation. Even if you don't have insurance it is still possible to pay your bills, something that is nearly impossible in the US, where an emergency room visit can cost thousands of dollars in some cases.

When my father had cancer I went to the US to help take care of him. Some of his anti-emetics were $1500 per prescription, that's outrageous. It seems there is no upper limit to what can be charged. That is one thing that is breaking the back of the American system.

In addition, America has the problem of taxpayers having to pick up the slack for the uninsured and illegal aliens who use emergency rooms for clinics (what else can they do I suppose?), which drives up prices.

Japan is facing tough times as the elderly population increases rapidly. The system is not faultless, but it is one example of socialized (nationalized?) medicine that works well.

Rad, I'll fess up to ignorance but I do know this, I think it's pretty well a scam as set up.

As for should those in danger of being ill -- the smokers, drinkers, overeaters, etc. be charged more, that can be argued both ways. But what about things you cannot control, such as family genetics that give predisposition to things such as diabetes, mental illness, and -- for the record -- obesity (yes, I know overreating causes this but your genes determine how easily you gain weight)? That was the point I was trying to make above.

I'm not sure what the answer is but I think we need some kind of other solution than health insurers determining what kind of care we get. Socialized medicine obviously also won't work. A health visa card will only work if you don't exceed the amount you can borrow. One operation or illness, yes, can be borrowed but if you have something ongoing for the rest of your life (short or long) that's not gonna work out, especially as your ability to earn will decrease with the illness.

So, yeah, it's a difficult question and it's no wonder it hasn't been solved as to how best to address it.

Crella, the link led me to something only in Japanese even when I clicked on English but sounds intriguing too. Perhaps we will eventually have to eventually resort to price caps. However, the AMA is a powerful lobby and will probably fight that -- forever. Sad but true.

Grammy, just don't let up on the questions. Ask others. The Medical VISA idea will free up 100% of routine visits and lab work. There's your immediate savings. An interest rate can be charged to do two things: pay for the administration of the network, itself just an extension of current banking practice but restricted to licensed doctors and pharmacies, and build a fund for catastrophic illness.

Please note that the hard questions will remain. You don't get a pass to demand millions of dollars for a loved one's treatment today, and you're not going to. But nobody builds tall buildings in Jacksonville and Chicago with your medical premiums.

Maybe somebody ought to look into that now.

"Do you ever read my entire post mof3 or just what you choose to prejudice it with?"

Does my every post have to do with you? I was stating my opinion on the topic at hand. Including the fact that I don't think I should have to pay for those who choose to kill themselves slowly and expensively, whatever their method of choice. I don't think I should have to pay for illegals to get their sore throat checked either, guess I should have tossed that in there. Immediate life-saving treatment sure, I'm not heartless, but then ship them straight from the hospital back over the border. That right there would save hospitals billions a year, lowering all our costs substantially.

I'm not a fan of one size fits all solutions.

Nor am I smurfy, but there was health insurance BEFORE there were HMOs. Health insurance that was available through employers for individuals and families. Health insurance that could be bought individually, also. Blue Cross Blue Shield was one of them. There weren't an HMO as much as they were a clearing house for billing, etc. This was in the 60s. HMOs came along in the late 80s, early 90s, when some people realized there was money to be made redirecting premuims paid by relatively healthy people who used only some of their benefits.

They not 'There' were...

Will this work?

http://tinyurl.com/5advmg

I'm sorry about that! This should work...

Here's a pretty good summary in English...

http://tinyurl.com/5ophm4

It's not a perfect system, but I sometimes think that a little cost control wouldn't hurt the US system.

Thanks, Crella!

I am impressed. It seems the most workable of all the suggestions and systems I've seen so far.

One thing that makes me wary about mandatory insurance coming from poverty and only rising to lower middle class as an adult is that it may be difficult for some to afford. The percentage of income (basically making it a sliding fee scale) takes care of that.

There's a lot of out of pocket but like you said, it's not perfect. And, actually, the problem with out of pocket, if premiums are low enough, is the lower income might not have the cash to go. If you can be billed instead of having to have cash between pay days, most would pay their bills.

And when I read that hospitals are by law non-profit, I could only think one thing: cool! Also, the fees being the same for general practioners and specialists is good too. I think one reason I'm having trouble finding a primary care (to the extent that I'm giving up and am going to go to the urgent care near my house for primary care) is that so many are specialists. Sigh, well, the one benefit is that I can walk in even for a check-up (indeed they're strictly walk-in, first come, first served) when it's convenient for me during their open hours (when I've worked up the nerve) and they are open on weekends.

And, Rad, thanks! I couldn't stop asking questions if my life depended on it. (No pun intended, given that this is a discussion on health care.) My brain just works like that. I always have questions and have never been able to refrain from asking them. Drove my mother crazy when I was a kid. She used to say curiousity killed the cat. The expression horrified me but obviously it didn't stop me. And to tell the truth, I hope I always do have questions and a natural curiousity about everything. Even if I live another half century.

Maybe some combination of the Japanese system where the insurance card works that way. As long as having a poor credit rating doesn't get in the way with getting said card!

That said though, our current system sucks. Let's not forget that a percentage of the uninsured are those considered "uninsurable" for their ongoing health condition. I guess one reason I think about this is because I had a coworker in Denver whose husband was uninsurable. He was born in Canada so he had to travel from Denver to Canada for on-going medical care of the expensive variety (obviously, since they considered the cost of traveling to Canada from Colorado worth it).

Those who can't afford the insurance apply to the government and get a card through the welfare system and the co-pay is waived.

30% sounds like a lot, but with lower prices it's not bad...I get three medications for arthritis and I pay $35 at the counter, $13 for the office visit. Generics are even less.

Government run health care would have the efficiency of the DMV and the compassion of the IRS.

Umm, Crella, people who barely make enough to make ends meet and live pay to pay don't have copays between paydays if they get sick. I hate copays and goddamned doctors who won't let you wait for payday to pay them.

I don't get copays anyway. If the insurance is supposed to cover treatment, what the hell is with the minimal payment demanded of the insured? Their premiums should be the only payment demanded of them.

My aim was not to address insurance costs and their impact on all economic groups...my point about the 'co-pay' being 'not bad' was based on seeing my parent's medical bills and doing my own research into the US HMO system. Considering what the average American pays for health insurance and the cost of the average procedure, and the deductables, the American system works out to be much more expensive.

My health insurance is $75 a month, as a spouse (second member of household to join plan) our son is about $55 per month. Drug costs are low, as are surgical costs. Prices are standardized across the nation-

Office visit $6
Administrative cost $4
Rehab, one visit $6.40
Chest X-ray for example $18.00
Fee for prescription $7.00

So, I go for an office visit, ($10) have rehab, get a prescription, $23.40 of which I pay 30%. Go to the drugstore, get one month's supply of drugs for RA, a stomach med (as many arthritis drugs can cause ulcers) a muscle relaxant, and plasters (6 packs of 10 each) and it's about $33.

Nothing is ever free. Everything has to be paid for somehow. Our system is supported by co-pays and the government. All health care fo r those over 65 has always been free. The insurance premiums arranged through companies are on a sliding scale according to income.

As Japan ages, the bills are mounting and the government can't pay for it all. The elderly are now paying a co-pay for the first time in history....a flat $5 per visit for the first two visits a month, after that nothing. Their insurance premiums were raised a bit as well, but they are still cheap.

If one cannot pay, insurance coverage is provided by your city office, and no co-pay is required.

If your medical expenses total more than $750 in one month (chemo, treatment with monoclonals,hospitalization), you apply to your local city office and get the money back.