People from the rest of the world may have noticed that we're having arguments about health care in this country. Some people say the current system is broken. Others are afraid to lose what health care they have. Some say that providing health care for the uninsured will be too expensive. Others say that we already are providing health care for the uninsured, but doing it in the most expensive way possible.

People outside of the U.S. probably don't understand what the difficulty is. So I'll provide a little analogy. Here's what fire insurance would be like if it ran like the U.S. health care system. I am basing this on my experiences with my own health insurance, which is considered to be a very good insurance plan.

Under this system fire insurance is provided by your employer, who gets a group discount from the insurance companies. Neither your employer nor the insurance company is allowed to disclose how much the insurance costs, because they both consider it a trade secret. Once a year, in November, you get the chance to change your fire insurance company if you are unhappy with them. But since you probably haven't had a fire, what is there to be unhappy about?

If you lose your job, you lose your fire insurance but the insurance company is required by law to allow you to pay an exorbitant sum to continue your insurance for 6 months. They will also allow you to buy a cheaper plan, which will replace your house with a tent if it burns down. By the way, the most common way to lose your job is to have a house fire.

If you are self employed or unemployed, you might be able to buy insurance. It will be much more expensive than the group plans that employers get. You will also be disqualified if you have had a fire in the past, smoke, or have been seen with matches or a cigarette lighter.

The way the fire insurance system works is that your insurance company will provide you a list of twenty fire inspectors. You are required to have a fire inspector in order to get access to a fire station. You will call all twenty and their secretaries will tell you that they aren't taking any new clients. You will eventually get taken on by one of them because your mother is one of his clients.

The inspector is paid a flat fee per year per client by the insurance company. He gets paid this amount whether he inspects your home or not. Each time he does inspect your home he might get a small payment from the insurance company, but you need to give him a $20 additional payment. This is to encourage you not to get your home inspected. If your home has apparent problems that need further investigation, the inspector does not get additional payments from the insurance company. If your home needs repairs to prevent a fire, the insurance company will pay for them, but the inspector might get charged a fee for referring you to a contractor. This is to encourage your fire inspector not to refer you to a contractor to perform repairs.

The fire inspector contracts with a fire station to handle emergencies. It might not be the closest fire station to your home. None of the firefighters working at the fire station are employees of the fire station. They are all independent contractors who are paid by the person who has a fire, or by the insurance company. The only employees at the fire station are the 35 people they have on staff to handle billing the 65 insurance companies that they contract with.

If you have a fire, the first thing you do is call your fire inspector. If he agrees that there is a fire, he will call the insurance company to get authorization to call the fire station. Some fraction of the time these authorizations will be denied.

When the fire station gets the call they will also call the insurance company for authorization. When each fireman gets to the house, they will ask for a copy of your insurance card before putting out the fire. If any of the people involved forgets to get authorization, they won't be paid by the insurance company. They will either bill you, or eat the expenses.

Fortunately it was just a minor fire entirely contained in a frying pan. After the fire has been put out, and a contractor has started repairs, you will receive a bunch of bills that have "THIS IS NOT A BILL" written on them. You will get one from each fireman, one from the fire station, one from your fire inspector, one from the contractor who is repairing your house and one from each of the construction workers the contractor has hired. They will come with a reply envelope for sending in a payment. This is to encourage you to accidentally pay them. The bills will be for outrageous amounts that represent several years of your salary. Even the construction workers will be billing you several hundred dollars per hour. The fire station will be billing you ten thousand dollars for the water that came out of the fire hose from the public fire hydrant and a thousand dollars for the initial phone call.

If you belong to one of the group fire insurance plans offered by your employer, you are lucky. After about 6 months you will get notice that they have paid all of the bills for about 30% of the billed amount. Some items they will disallow, like the bill for fire hydrant water. You aren't responsible for paying those, either. Some of the time, the insurance company will decide to de-authorize the fire fighting. Usually it involves the insurance company not having evidence that the fire wasn't caused by an alien death ray. Alien death rays are not a covered benefit.

If you are unlucky enough to have an individual plan and it's not a bad fire, that will probably happen as well. If it's a bad fire, the insurance company will claim you were never insured, that the fire call wasn't pre-authorized, or that on your "fire history" form you forgot to mention that your grandfather smoked.

If you are uninsured, or if your insurance company refuses to pay, you'll have to pay those exorbitant bills, skip town and use an alias, or go bankrupt.

Why were the bills so high to begin with? There are a few reasons for that. There's a lot of overhead to running a fire station. You need to pay those 35 people who handle billing. Since there are 65 contracts each with different rates of payment, you need 35 people to handle billing. Every firefighter is also paying two or more people to handle billing. It's important to have these people since the insurance companies are trying to underpay you and you are trying to get them to overpay. Every dollar they save is a dollar in profit for them. Every extra dollar they pay is a profit for the fire station. In addition the fire fighters salary comes out of charge, so if they handle 50 fires a year and want a $200k income, that's $4000 per fire in salary alone. Add another $3000 for a secretary and two billing clerks, and that's $7000 per fire before overhead.

By law, a fire station needs to respond to fires of the uninsured. Most of those bills don't get paid, so the unpaid charges are worked into the billing rates. That boost the bills further. The amounts billed might even be different depending upon your insurance company. How much it really costs to provide these services is considered a trade secret by the fire station. The amounts the insurance company pays is considered to be a trade secret by both the insurance company and by the fire station.

So now there is talk of reforming the fire insurance system because it's gotten more expensive to buy the insurance than it is to buy the house it protects. Of course huge profits are made in fire insurance, so the insurance companies don't want that. The opponents are raising the usual talk about not being able to choose your fire inspector, and how we wouldn't want fire departments run by the government because government can't do anything right. That would be socialism, and we all know socialism leads to totalitarianism. We wouldn't want the government telling us how to fight fires and what construction materials were safe to use. Of course, the U.S. fire fighting system is the best in the world and there's no need for improvement. And it would be too expensive to provide fire fighting services to everyone. It's not like a government mandate to have fire insurance before you could buy a house would ever be practical. And people wouldn't be able to contract with fire stations that put out fires with xenon gas to avoid water damage because the government will think it's too expensive.

But somehow the rest of the world is able to provide low cost fire fighting at reasonable cost without slipping into totalitarianism. The major problem the opponents of government sponsored fire fighting have is that it might work. And if it works, it will necessarily cut the profits of the insurance companies, the fire stations, and firefighters might have to become salaried employees rather than contractors.

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@SETIEric@qoto.org (Mastodon)

Well, if you're going to put it THAT way, of course it all sounds silly. (Just kidding.)

At the risk of upsetting some Americans and some Canadians, let me point out the good and the bad of the Canadian medical system. According to CNN, some of you Yanks seem to have an interest in it.

Our doctors still make way too much, and are mostly private contractors. So are many other medical specialists. Still, many want to move to the US because they are in it to make money first, and to help people second. You are welcome to them.

Most nurses, and most technicians, are civil servants, who work for a large, slow moving bureaucracy, and make just above minimum wage. Many of them want to move to the US too, and they have my sympathy.

Health care care is still a huge, fragmented industry: part government, part not for profit, and part for profit. Like any large organization run by humans, it can be slow, it makes mistakes, and it can be frustrating to deal with. (Except for SETI, of course.)

Having said all that, my minimum government health care insurance has been in effect through several layoffs, going back to grad school, and several years of self-employment. Most years I paid nothing, now I pay a sliding fee based on my salary. That's our province's recent answer to rising costs, other provinces are allowed to make other decisions. Prescription drugs are a kicker for the self employed: I make just enough that I don't get any government assistance with them. It's a pain right now, but I know that if my income stops for some reason, I have something to fall back on.

This large, clumsy, slow moving, infuriating system saved my life a few years ago. It has saved several friends and relatives. It has saved a few friends and relatives from a live of lowered standard of living, just because they had the misfortune to have children that needed long term medical care. All for free, except for our high tax rates, but that's OK with me. Them that's got pay, them that don't are looked after anyway. They are all my brothers and sisters, after all.

So, bottom line? Is it perfect? Of course not, people run it. There are still huge problems with the painfully slow speed that new treatments and new equipment gets approved for government funding, and this is mostly what we hear about in our press. But for the 99+% of us that don't need the new stuff, it keeps us alive. And it keeps me from choosing between poverty or watching my loved ones die long painful deaths.

My message to any Americans who are interested - your health care will have to change, because people are changing, the world is changing, and people's expectations are changing. You will have to watch this change like a hawk, or a small percentage of you will get very rich screwing the rest of you.

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here's one for you:

My psychology teacher/professor(2 yr col) is a sex therapist the other half of the year, her Mal practice insurance minimum is 1,000,000 $ or 1 mil. thats the minimum for her to practice in LaGrange, GA. i won't name school or teacher and what age group she specializes in. but lets just say it's tough on her.

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I recommend Secunia PSI: http://secunia.com/vulnerability_scanning/personal/
Go Georgia Tech.

And in the end her clients pay the insurance premiums, through their fees. Same in this country, except I pay my doctor's insurance premium through my taxes.

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Well, what's being proposed here is really that. A less than half solution that isn't going to solve the problem and is going to make insurance companies rich. We're going to mandate that everyone have insurance. We're going to have a public plan to compete with private insurance, but only a small number of impoverished people will be eligible for that plan. Sounds like it's time to raise insurance rates to me!

The only hope is that it will eventually morph into something that can solve the problems. And in case I wasn't clear enough in my analogy the problems are:

1. There is no fair market for health insurance. Your choice of insurance is limited to those your employer contracts with, and (if self-employed) those that will accept you into their plan. Rather than creating a shared risk pool, the insurance companies create a pool of low risk applicants and charge them as if they were in a shared risk pool. If an applicants risk changes they are expelled into the ranks of the uninsured. In the future they will be expelled into the "public plan."

2. There is no fair market for hospital services. Doctors are locked by contract into getting services from a single provider. Hospitals do not advertise their charges, not do they advertise what rates the insurers are paying. The only way to find out what a hospital charges is to get billed.

3. There is no fair market for doctors. The insurers dictate which doctor you see. They artificially limit the pool of eligible doctors to in order to reduce the rates they pay. That's why it's impossible to find a specialist or even a primary care physician who is taking on new patients.

4. People don't know how much they are currently paying for insurance. Employers don't put it on your pay stub. The cost should be mandated to be on the paycheck. When people opt out* their gross pay should be increased by that amount. When people see how much they are already "taxed" for their health care they might not be so happy with their current plan.

* I am currently opted out of the UC's health insurance because I am covered under Angela's. It saves the project money. But beyond that, I get no benefit for refusing coverage.

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@SETIEric@qoto.org (Mastodon)

Angela also has millions in "professional liability" insurance. But since it's hard for a Speech Pathologist to kill anyone by trying to fix a lisp, the rates aren't that bad.

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@SETIEric@qoto.org (Mastodon)

i as a full-time student(20); getting insurance(some medical and prescription meds) through my step-dad whose in Iraq as a Private contractor for 500 $ a month added... and lets not forget that auto-insurance is the same way.. being 20, a male and even with a 15% defensive drivers ed; my insurance on a '65 Malibu which is the oldest car in the family 125 bucks a month..

my former employer(i'm glad) doesn't allow part-time employees to get medical ins.

now; there are alot of part-time employees in the U.S. which don't get medical ins. which leads to this problem... oh, if your employer does allow part-time employess to get insurance though them, you have to pay your way.

One of the first questions you have to answer: do you WANT a fair market for health services?

To use an Ericesque analogy - you have, in North America, a fair market for cars. At one end of the spectrum, a few people drive Ferraris and Rolls Royces. In the middle, most of us drive Fords and Toyotas and such. At the other end, some people take the bus, or just walk. Do you want health care to be like that?

The alternative, as in Canada, is an even level of health care dictated by a faceless grey bureaucracy. It is NOT the best health care money can buy. It is probably more or less the best health care we can, on average, afford.

I'm not sure which is best, you have to make that choice yourself.

Another thought, about Eric's third point (doctor shortage). We have exactly the same kind of shortages here in Ontario, and there is a huge debate over the reasons for this. One theory is that the government (who also funds the health system) has artifically created the shortage (through university funding, mostly) to control the costs of the government funded health care. If you can't see a doctor, you're not costing the system anything (at least until you die, but then that's another department). So (maybe) it's not about private enterprise versus government intervention, but just about human nature.

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Well the powers that be have already decided that we are going to have a market for health care. Single payer wasn't even invited to this party. But without the ability to choose a doctor or hospital or insurance company based upon real price and quality information and without the ability to change your choice at any time, it certainly won't be a fair one.

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@SETIEric@qoto.org (Mastodon)

The alternative, as in Canada, is an even level of health care dictated by a faceless grey bureaucracy. It is NOT the best health care money can buy. It is probably more or less the best health care we can, on average, afford.

I'm not sure which is best, you have to make that choice yourself.

I live in Australia, we have a combination of public / private health care, you can pay for private insurance if you want access to a private hospital. The public health care system sets the bar so to speak. It isn't perfect, there are waiting periods for elective surgery (cosmetics and the like) and there's a lot of stories in NSW (our largest state) about bungles which have left patients without care.

But it works. And although you'll hear "horror" stories about any country that has a health care system run by people (ie all of them), what you never often hear about is the untold masses of people for which the system works and does not push them into bankruptcy.

My brother recently collapsed at University, his heart was trying to shut down because of a rare nerve problem that can happen randomly to anyone. They called an ambulance and he went directly to the nearest hospital (not the private one we pay private insurance for) a public one, as it was the closest. The waiting periods are long at public ones for people who use emergency as a free doctors appointment ie. people with the flu or just minor cuts and bruises.

My brother was admitted straight away although his condition had slightly improved. I was contacted immediately by the Uni since my parents were listed as out of the country (they were in the US at the time). My aunty was also called. Two doctors and a specialist came down to see him even though his situation was now stable and non life threatening, they identified the problem immediately and gave him a dose of a drug whose name i cannot remember which had him up and talking normally within 30 minutes. This is all before i arrive and fill in his details, including our insurance information. He was later given some anti nausea pills (apparently it had something to do with blood regulation to the stomach) and we went home. It isn't a recurring problem. A few weeks later we got a bill in the mail for $0. Paid for by the government.

Health care should never be completely private. It has an inelastic price curve, ie one where the consumer will pay any price for the smallest quantity. This leads to endless hyperinflation. Simply put, people will pay anything to live. Public health care is also more then about pricing. Its about our personal and private success as individuals and the survival of our community. If a portion of society are paying massive medical fees on low paying jobs for illness they had no control over then the economy looses that productive capacity. Its sort of a shout out to the parable of the broken window:

http://en.wikipedia.org/wiki/Parable_of_the_broken_window

As individuals have an increased chance of survival as part of a successful group. In order for us to succeed we must all succeed. Im not saying socialism or anything. People should reap the rewards of their hard work, and conversely people should pay for their mistakes and laziness. But illness is something we rarely have control over (excluding things like cigarette lung cancer and obesity). Im reminded loosely of a quote from the movie A Beautiful Mind:

"If we all go for the blonde and block each other, not a single one of us is going to get her. So then we go for her friends, but they will all give us the cold shoulder because no one likes to be second choice. But what if none of us goes for the blonde? We won't get in each other's way and we won't insult the other girls. It's the only way to win. It's the only way we all get laid."

Many ultraconservative Americans seem to be opposed to US health care reform on the basis of cost and increased tax on the wealthy. Just as i would pay anything to have my brother treated with care and speed at the closest hospital, even go into bankruptcy, i think Americans, especially lower and middle class, are paying very high insurance premiums. How about this for a New Rule: Not everything in America has to make a profit. It used to be that there were some services and institutions so vital to a nation that they were exempt from market pressures. Some things we just didn't do for money. The United States always defined capitalism. But now it's becoming all that it is.

Cuba has a lower infant mortality rate then the US, which is behind nearly every other western nation in the world. http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

If universal health care saves one child's life, i think its worth sacrificing the profitability of some insurance companies.

I hate straw man arguments, i know my post is full of them. My apologies.

"la sute non si paga" health is not for sale

Pg 149, Blue Mars, by Kim Stanley Robinson.

Live simply so others may simply live

Fridge magnet at a Pastor's house.

While it is important that people can make a living by providing health care, is it necessary that they make such a good living from it?
People dying because they can't afford to get medical help, or even afford the medicine that might help them, just isn't right. IMHO.

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Grant
Darwin NT

"la sute non si paga" health is not for sale

Pg 149, Blue Mars, by Kim Stanley Robinson.

Live simply so others may simply live

Fridge magnet at a Pastor's house.

While it is important that people can make a living by providing health care, is it necessary that they make such a good living from it?
People dying because they can't afford to get medical help, or even afford the medicine that might help them, just isn't right. IMHO.

There are three primary reasons why Doctor's bills are so large:
1. The cost of medical schooling is enormous and needs to be paid off.
2. The cost of malpractice insurance is out of sight. Mainly because jury awards are tens/hundreds of times larger than justified to provide remedial care and a legitimate portion for 'pain and suffering'.
3. Doctors want to have a decent and comfortable income to meet their needs...don't you?

3. Doctors want to have a decent and comfortable income to meet their needs...don't you?

I agree.
But then it would appear that many doctors have a different idea to me as to what constitutes a need, let alone decent & comfortable.

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Grant
Darwin NT

3. Doctors want to have a decent and comfortable income to meet their needs...don't you?

I agree.
But then it would appear that many doctors have a different idea to me as to what constitutes a need, let alone decent & comfortable.

You paint with too broad a stroke. Doctors are people (human) and most are dedicated workers with a love for humanity. They probably range the same spectrum as any other career (excluding lawyers, of course ;) ).

Actually malpractice insurance is a fairly small part of total health care costs. Not that is is negligible, though.

Regarding what doctors earn, it varies greatly depending upon specialty. And if there's one thing I've learned it that people never consider themselves to be rich. In a recent article in Flying magazine, a regular columnist, who is a surgeon that owns an $800k airplane and considered purchasing a $3M airplane, recently complained in an article how much a hospital charged for his wife's appendectomy. I would guess he thinks he's just barely getting by.

Regarding the expense of medical school, I agree, it's too expensive, and that there aren't enough medical schools in the U.S. to train the number of doctors we need. (If you didn't get a 4.0+ GPA and put in a lot of volunteer hours as an undergraduate, you can probably forget medical school in the U.S.). The way around that is the open more medical schools, and maybe even subsidize them.

But even doctor's shouldn't equate "I spent a lot of money on school" to "I deserve at least $NNNk per year in salary." I spent 13 years in college and graduate school, and don't yet make a six figure salary. Nor do I think I'm entitled to one. But then again, if I was in it for the money I would have picked the career track "Fortune 500 CEO". If you don't think that's an easier career track, count the number of SETI Astronomers and compare it to the number of Fortune 500 CEOs.

But I'm going to stop talking about health care now, because I spent the weekend in the hospital.

Eric

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@SETIEric@qoto.org (Mastodon)

But I'm going to stop talking about health care now, because I spent the weekend in the hospital.

Methinks I had a better weekend than you, celebrating the GF's bday.

I do hope everything is OK.

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But I'm going to stop talking about health care now, because I spent the weekend in the hospital.

Eric

jesus... go figure you talk about something and you then have to go see it....

I'm fine, but it took a while to convince me and longer to convince the doctors of that.

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@SETIEric@qoto.org (Mastodon)

But I'm going to stop talking about health care now, because I spent the weekend in the hospital.

Couldn't you buy a fire extinguisher??

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I only had red fire extinguishers. Yellow is apparently required.

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@SETIEric@qoto.org (Mastodon)