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Monday, November 15. 2010
In a sense, Krugman is right, and Palin was wrong to demagogue the issue. Why should Medicare (meaning us young folks) pick up the tab for elective, extra, and/or ineffective or marginally effective treatments? If people want those, they can pay for them, themselves. It is still legal, in America, to pay your doctor for his services.
Problem is that God rarely gives deep wisdom to expert panels.
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Problem is: the understanding of the direction health insurance reform was/is headed leads eventually to outlawing cash-for-services outside of the insurance regime.
I guess I'd want to know how "elective, extra, and/or ineffective or marginally effective treatments" are defined. What is ineffective for some patients is not necessarily ineffective in others. I'm living proof of that because most treatments for my iteration of RA does not respond at all to "normal" treatment, but it does respond to a treatment regime that does not work on "most" RA patients.
So I guess if I were on Medicare I would be denied treatment because it is not effective in most cases of RA? Or you, being "young", shouldn't have to pay for them? What if I couldn't afford the treatments - what then? Just suffer? Pump in the good old pain killers and rent a wheel chair - that's pretty "cost effective".
I suppose that some surgeries would be considered "elective" - like, oh I don't know, an otherwise healthy 65 year old who needs a hip replacement - would that be "elective" or should we go the "pain killer/wheelchair" approach because you "youngsters" don't want to pay for it?
I just don't trust bureaucracies! When we adopted our children from Child Protective Services, they were covered by Medicaid. One son needed treatment that wasn't covered by Medicaid, so I said I would pay it myself. I was told, very condescendingly, that it was illegal for me to pay. If Medicaid didn't pay, he wouldn't get the treatment. I persisted beyond this (expletive-deleted) office nurse and he did receive the treatment. I suspect she thought we were on welfare and too well dressed and how could we afford orthodontia for the children and why was I carrying a Coach purse. As soon as the adoption was finalized, we paid for private insurance despite the fact they continued to be eligible for Medicaid until age 18.
I'm about 3 years away from Medicare. I'm starting to study to know what my options are and of course it's somewhat useless because Obamacare throws so many curves into the mix.
I do know that at 65 my current health insurance provider will drop my policy. I do not have the option of continuing the policy. So at least that option of paying for it myself is not available.
As someone who has her 'pull date' stamped on her forehead [both Downs and I are in our 80s and neven supposed to be alive now] I take the death panel threat very seriously. We, of course, would be perfectly willing to pay for expensive treatments not approved by the Big Government weenies who plan to be in charge of our medical future, but there is one sneaky provision in the Obamacare law [located, oh, somewhere around the thousandth page or so] which mandates that doctors can't make private arrangements with their patients to let them pay privately for these off-list treatments. According to the mandate, the doctors who try to accommodate their patients this way will be fined thousands of dollars by the Government for doing so.
Your governmental Busybody Brigade at work, folks.
Typical Big Brotherism.
A little edit is in order:
Problem is that God rarely gives deep wisdom to expert panels.
Given that the drafters of O'Bummercare are great admirers of the British NHS, which makes all privately paid healthcare illegal under the excuse that if the NHS doesn't provide it they can't "guarantee quality" (which is a farce as worse healthcare than provided by the NHS doesn't exist), I'd be surprised if under O'Bummercare a similar provision wouldn't be created.
J. T. Wenting,
Please understand that I am not in any way trying to defend "Obamacare". That said, are you certain of your facts re: NHS and private care or non-NHS payment for medical services?
I have a friend who has been living this side of the pond for approx. 5 years now. He has mentioned NHS and the fact that his insurance and care when he lived in Merry Ol' were outside of NHS. According to him, if you work somewhat upscale for a private employer then health care insurance is a common benefit which, apparently, he always had.
Also, see this company which apparently sells private insurance to, of course, civil service (among others):
And here's another private healthcare insurance seller:
Don't know the ins and outs, just curious.
"[The] British NHS, which makes all privately paid healthcare illegal under the excuse that if the NHS doesn't provide it they can't 'guarantee quality'."
Er, in fact, no.
Private healthcare is freely available in the UK - if you can afford it. BUPA is one of the biggest providers:
Mind you, don't take this as a defence of the NHS - far from it. Most of my British friends who can afford it opt for BUPA; the NHS is where you go when you don't have the means to make a choice.
Perhaps you were thinking of our health care systems up here in Canada? I use the plural "systems" because many Americans don't actually realize that there is no national system: each province operates its own healthcare service. Some provinces allow a teensy bit of private healthcare to exist, others ban it all. Of course, if you're a well-heeled Canadian, the private option has always been - go to the US!*
You might recall that the premier of Newfoundland, Danny Williams, great defender of that province's public healthcare service (our politicians always insist that socialized medicine is a "sacred trust" for Canadians), cheerfully skipped down to Florida for a procedure rather than wait in line at home.
Frankly, I was rather surprised at the Obama initiative. I thought that, as in Canada, health was constitutionally devolved to the states. It would seem to me that it should be up to each of the 50 states, not the US Federal Government, to decide what works best for them.
I always believed that you folks, like us, were big on the devolution of power to the local level. One of those things that makes us different from those centralizing Europeans!
The problem is that insurance drives up the costs so that you can't afford much.
I'd outlaw medical insurance entirely.
Let doctors live on what patients are willing to pay, and charge variable rates like they used to.
The issue is not really the docs - it's the hospital costs if you get seriously sick. An ER visit here starts at $700.
The ambulance ride, if you should need one, costs almost the same - the last time I hurt my back enough to be transported the bill was $900 - for a 3 mile Basic Life Support ride to the ER.
You don't want to know what the final ER bill was. :>)
BD - an ER visit in my neck of the woods probably costs about $1200 for the first hour and $500/hr thereafter. I was in one a few years back and there was some disagreement about whether or not I should be sent home. Needed to wait for some test results but not long enough for admission to be sensible. Then once they were certain and that I really should have a certain interventional procedure but could either go home and come back some days later or wait a few more hours, I waited. Cost a fortunate that insurance paid.
Two things about insurance. One, they don't pay what you'd pay if you didn't have it. Insurance companies, near as I can make it out, get a 50% discount off of MSRP.
Second, what we typically have for "healtcare insurance" is not really "insurance" at all. Most, if not all other, insurance guards us against financial catastrophe should some other form of catastrophe befall us. Typical healthcare insurance today is a sort of combination pre-pay/share-pay thing. We, and/or our employers, pay a bunch of money each month and then the insurance company doles that out to service providers when necessary. If the service being provided costs more than we've payed in the difference is covered by others who are paying in more than is being paid out.
If they want to take cost out of the system they should let us use MSA + major medical (high-deductible) and let people know what health care services cost and take responsibility for paying them. If people actually had to pay their bills they'd be more discerning and demanding.
Off topic yet somewhat similar - I think we taxpayers should receive an itemized tax bill, or at least a statement, showing how each $ of our taxes was spent. Then we might have a whole lot more useful information about what to vote for and against.
You only addressed one part of the problem. I agree that people who want more medical care then is provided are free to pay for it themselves. This is the NEW system because healthcare was socialized. However this new system pay all the health care of people who are in the country illegally. Now think of the irony that a citizen who pays taxes all his life is denied life saving care because he is too old & too disposable, but on the other hand someone who broke the law to come here and steal from the social network gets their medical treatment fully paid for. The citizens are beginning to realize they have been sold out for votes.
So Junkie, what/where is the deep?
Certainly not with Krookmen or Commisions or Medicare.
Msr. Krugman's but a shill.
Expert panels: the 25 yr old 'social worker' down the hall who makes the decisions for the physician.