Is the American healthcare system really so broken?

Originally posted by sh76
Fair point. I'm using anecdotal evidence too much, perhaps.

However, given that my experience is probably shared by many people across the country, I can see why people are reluctant to change to the unknown when most people probably don't feel like their system is broken.

Those same people are going to be upset when the cost of their premiums keep rising or when the company they work for stops providing health insurance. I suppose they'll blame that on "Big Government".

Originally posted by sh76
I'm not sure if you meant my uncle being a "personal connection." But that had nothing to do with it. My GP could have given me the exact same prescription (for another small co-pay, of course). It's now 1:30 PM. I guarantee you I could see my GP this afternoon if I wanted to.

I think the thing is that the tests you're asking for are sort of routine, relatively cheap tests. If you ask for something a little more costly like an ultrasound or a CT scan you'll run into a little more resistance. Or at least, that's been my experience. My wife has had a lot of trouble getting these sorts of tests approved from her insurance company. She's often gotten these rejected until she muscles her doctors or specialists into fighting for her with the insurance companies. In more than one case, the doctors have told her straight out "You need XYZ, but the insurance companies won't cover it with your policy".

I've also noticed that, for whatever reason, the doctors need confirmation that pain is one of her symptoms before the insurance company will grant it. And they routinely reject anything until the doctors start talking about pain an suffering. Which is retarded, to me. If you've got a disease, it needs to be treated whether or not you're suffering, before you do begin to suffer. What happened to treating diseases early? Luckily, in my wife's cases pain was included anyway.

I guess it does come down to anecdotal experience, but my own anecdotal experiences haven't painted as rosy a picture.

Originally posted by no1marauder
Those same people are going to be upset when the cost of their premiums keep rising or when the company they work for stops providing health insurance. I suppose they'll blame that on "Big Government".

Maybe then there will be enough impetus to change the system.

Now, apparently, there is not.

Originally posted by Melanerpes
The problem when insurers have to accept anyone, is that if they end up with too many chronically sick people in the pool, the only way to make a profit is to charge premiums that are so high that the healthy people will flee. But if too many healthy people flee, the insurer has to charge even HIGHER premiums -- or else they have to greatly restrict the a ...[text shortened]... pool, while keeping benefits high enough to allow all the sick people to get the care they need.

Or just use risk pooling like I said before.

Originally posted by joneschr
I think the thing is that the tests you're asking for are sort of routine, relatively cheap tests. If you ask for something a little more costly like an ultrasound or a CT scan you'll run into a little more resistance. Or at least, that's been my experience. My wife has had a lot of trouble getting these sorts of tests approved from her insurance company ...[text shortened]... otal experience, but my own anecdotal experiences haven't painted as rosy a picture.

the irony is that the insurance system has become totally backwards.

the insurance companies cover all the routine, relatively cheap tests, but when it comes to the really costly stuff, then you're probably on your own.

it should be the other way around. The insurance companies should be covering all the really costly stuff, and when it comes to the rountine, relatively cheap tests, you should probably be on your own.

Originally posted by KazetNagorra
Or just use risk pooling like I said before.

But how do you keep all the healthy people from jumping out of the pool?

Originally posted by Melanerpes
But how do you keep all the healthy people from jumping out of the pool?

That won't be possible. A risk pooling system is a fund that insurers have to pay to if they insure a low risk patient, and get paid from if they insure a high risk patient. If all insurers have to join the fund, then healthy people cannot avoid it.

Originally posted by KazetNagorra
That won't be possible. A risk pooling system is a fund that insurers have to pay to if they insure a low risk patient, and get paid from if they insure a high risk patient. If all insurers have to join the fund, then healthy people cannot avoid it.

The healthy people can avoid it by just not buying insurance and paying for all of their own healthcare costs out of pocket.

And if the healthy people don't buy insurance, there isn't going to be much money in the pool to help cover the sick people.

Originally posted by Melanerpes
The healthy people can avoid it by just not buying insurance and paying for all of their own healthcare costs out of pocket.

And if the healthy people don't buy insurance, there isn't going to be much money in the pool to help cover the sick people.

That's why you force everyone to take insurance (although most people will take insurance regardless since people like security).

Originally posted by KazetNagorra
That's why you force everyone to take insurance (although most people will take insurance regardless since people like security).

And this is what makes it politically impossible to do (at least in the US). Many people don't like the concept of being forced to buy something they don't really need.

And you're right - the one thing that keeps this house of cards from falling completely is that many healthy people do buy insurance - or at least a lot more insurance than they really need. But as premiums keep rising, this might change.

Originally posted by Melanerpes
And this is what makes it politically impossible to do (at least in the US). Many people don't like the concept of being forced to buy something they don't really need.

And you're right - the one thing that keeps this house of cards from falling completely is that many healthy people do buy insurance - or at least a lot more insurance than they really need. But as premiums keep rising, this might change.

Health care reform in the US is not politically impossible. At the end of last summer, majorities supported virtually every element of the proposed plans.
http://healthcarereform.nejm.org/?p=1424&query=home

The leaders of the Democratic party botched it by pandering too much to conservative members of their party in the Senate. If they had enforced party discipline on cloture vote or simply used available parliamentary procedures to avoid an effective filibuster, we'd have health care reform enacted into law by now.

Originally posted by no1marauder
Health care reform in the US is not politically impossible. At the end of last summer, majorities supported virtually every element of the proposed plans.
http://healthcarereform.nejm.org/?p=1424&query=home

The leaders of the Democratic party botched it by pandering too much to conservative members of their party in the Senate. If the ...[text shortened]... cedures to avoid an effective filibuster, we'd have health care reform enacted into law by now.

Agreed. So why not offer Scott Brown a cool $300 million for his vote? If so, health care reform is just around the corner!!! 😛

Originally posted by whodey
Agreed. So why not offer Scott Brown a cool $300 million for his vote? If so, health care reform is just around the corner!!! 😛

The partisan hack speaks. Broken record time.

If Brown was willing to do what the people of Massachusetts elected him to do, he'd work with Democrats to pass a health care reform bill. The following question was asked in an exit poll of special election voters:

Thinking specifically about the changes to the country's health care system proposed by Obama and the Democrats, would you prefer that Brown (work with the Democrats on these changes) or (try to stop these changes from happening)?

70% agreed with the first statement i.e. that Brown should work with Dems; 61% of the total strongly agreed with it. http://www.washingtonpost.com/wp-srv/politics/polls/WaPoKaiserHarvard_MassPoll_Jan22.pdf?sid=ST2010012203176

Question 13; Result 13A

Originally posted by no1marauder
Health care reform in the US is not politically impossible. At the end of last summer, majorities supported virtually every element of the proposed plans.
http://healthcarereform.nejm.org/?p=1424&query=home

The leaders of the Democratic party botched it by pandering too much to conservative members of their party in the Senate. If the ...[text shortened]... cedures to avoid an effective filibuster, we'd have health care reform enacted into law by now.

the individual mandate seems like a very hard sell - especially if it means it requires you to spend something like $10,000 or more per year, when a healthy person or family might only expect to spend a few $1000 at worst in any given year. People just don't like the idea of being forced to buy something they don't need.

Now if they put all of the chronically sick people into Medicare and-or Medicaid, created medical savings accounts to encourage everyone to pay out of pocket for all of their routine costs, and reduced the indvidual mandate to buying insurance to cover only the truly catastrophic costs, that might be politically doable.

Originally posted by Melanerpes
And this is what makes it politically impossible to do (at least in the US). Many people don't like the concept of being forced to buy something they don't really need.

And you're right - the one thing that keeps this house of cards from falling completely is that many healthy people do buy insurance - or at least a lot more insurance than they really need. But as premiums keep rising, this might change.

Everyone needs health care.