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View Diary: Why can't we start our OWN Public Option? (215 comments)

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  •  this is the real obstacle to (10+ / 0-)

    medicare for all.  they won't take medicare reimbursement rates, even though those rates are generous by international standards.

    Doctors on the site flame me when I say it, but it is the truth.

    •  Well, but don't most doctors in other countries (20+ / 0-)

      have much less if anything to pay back in student loans?

      •  Education in other countries, (21+ / 0-)

        even university, is either free or much cheaper and therefore no need for high student loans.

        Some men see things as they are and ask, "Why?" I dream things that never were and ask, "Why not?" --R.F. Kennedy

        by farbuska on Sat Dec 19, 2009 at 06:28:55 PM PST

        [ Parent ]

        •  Yes, this is why we have many Asian doctors (2+ / 0-)
          Recommended by:
          ems97007, CKendall

          in part. Many friends here are Asian doctors who studied there but then came here. I must say, they really are top notch. My last surgery was by a wonderful Indian doctor who had the best bedside manner and smarts of any doctor I'd seen over the year we were trying to figure out what was wrong.

        •  Sadly this is changing in Europe (3+ / 0-)
          Recommended by:
          Angie in WA State, ems97007, CKendall

          and very few developing nations have free universities. I don't know if it is part of the Bologna Process (this is a project to standardise higher education in Europe, allowing students to choose more freely where they will attend university, exchange credits, get credits for past work etc.--but has many negative points also) or due to the several international accords that are forcing privatisation and marketisation on education worldwide, but several European countries are in the process of ending free university education, and/or limiting the amount of time students can spend at university, removing financial support for students' living expenses, and permitting the growth of a private university sector. These policies were already imposed on most eastern European countries as part of the deal for IMF and other financial support some years ago.

          This is one of the reasons students have been protesting and on strike in Germanyand Italy recently.

          Here in the UK, negotiations are underway to lift the cap on tuition fees (currently £3000/year, all but one university here charges the full fee and that one will be from next year). I'm sorry to say that the head of the university where I work is part of the panel making this decision, and it is likely that fees will be increased to £7000=£10000/year. That is actually higher than many American state universities.

          Medical students here are currently semi-subsidised by the NHS, but it is likely that the NHS will not be able to afford to subsidise as many at these rates, so cost-sharing will come in and further restrict access to the professions to those who are already wealthy. Alternatively, the NHS could impose further restictions on the employment of the students it subsidises (i.e try to force them to remain within the NHS system) but I doubt this would stand up to legal challenges unless it was done in a very crafty way.

          Political Compass says: -8.88, -8.67
          "We never sold out cos no one would buy."--J Neo Marvin

          by expatyank on Sun Dec 20, 2009 at 12:26:43 AM PST

          [ Parent ]

      •  yeah, and I don't think they should (11+ / 0-)

        have to pay what they do here either.  but whenever anyone floats the idea of paying off their student loans in exchange for them taking lower rates, they don't like that idea.

      •  That's just one of the costs (7+ / 0-)

        There's also the insane cost of malpractice insurance, and how much they spend trying to get insurance companies to cough up the money they owe.

        Nothing brings people together more than mutual hatred.

        by Hannibal on Sat Dec 19, 2009 at 09:06:07 PM PST

        [ Parent ]

        •  i agree with this (1+ / 0-)
          Recommended by:

          i am for taking a pretty hard line on frivolous malpractice lawsuits...and I also think that if providers really thought about how much of a headache they would save on billing with single payer, they might think about it...

          but I doubt it...

          •  Many doctors would welcome single-payer (7+ / 0-)

            most the family practice/internists. Many specialists and surgeons oppose it. Trouble is, we have too few of the former and too many of the latter.

            "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

            by Alice in Florida on Sat Dec 19, 2009 at 09:43:53 PM PST

            [ Parent ]

            •  interesting...i wonder if we could go (1+ / 0-)
              Recommended by:

              single payer for all routine care, and then have some other reimbursement mechanism for the surgeons.

              probably not...

            •  OB/GYNs might surprise you (0+ / 0-)

              and welcome it, even those who do a lot of surgery.  That's the talk I hear in the doctor's lounge.  Single payer would be wonderful since our billing staffs would only have one set of rules to figure out.  We would even take a bit less money if we could count on getting paid on time according to set rules.

              Contrary to the attitude of many on this site doctors are not your enemy here.

          •  Malpractice rates aren't linked to lawsuits (2+ / 0-)
            Recommended by:
            mrkvica, CKendall

            They're linked to financial markets. I'll try to dig up the article showing the linkage -- it was quite stunning.

            Member, The Angry Left

            by nosleep4u on Sat Dec 19, 2009 at 10:23:37 PM PST

            [ Parent ]

          •  one reason for malpractice suits in the US (1+ / 0-)
            Recommended by:
            Angie in WA State

            is the lack of universal health care though--if something goes wrong, the person becomesw uninsurable and pretty much the only way to ensure they will get medical care in future is to sue for a chunk of money to pay outright.

            For example, if your child has cerebral palsy due to lack of oxygen at birth and you can show this could have been prevented, you can sue to get an amount to cover future costs of providing private health care and living costs.

            Here in the UK these lawsuits are less common as the child is entitled to healthcare, social care, housing etc. So even when people do sue, the payouts tend to be smaller because all of that is taken into account in deciding the sum that will be needed.

            The NHS itself carries insurance to cover negligence by all of its practitioners other than GPs, pharmacists and independent midwives, all of whom carry insurance through their trade unions. This is all changing however as the UK government turns local halthcare units within the UK into semi-independent Trusts, I believe part of that process is also transferring the malpractice risk.

            Political Compass says: -8.88, -8.67
            "We never sold out cos no one would buy."--J Neo Marvin

            by expatyank on Sun Dec 20, 2009 at 12:33:44 AM PST

            [ Parent ]

        •  no bookkeepers, for example (2+ / 0-)
          Recommended by:
          Creosote, mrkvica

          In France, the billing amounts to pressing one button on a keyboard.

          No bookkeeper to fight insurance companies, no dunning the patient, no forms for the doctor to sign to say that "yes, really, the test was needed", etc.

          And remember that each employee costs 2 to 3 times their salary once you add overhead...

        •  these are two separate issues (4+ / 0-)
          Recommended by:
          Odysseus, mrkvica, koNko, nosleep4u

          malpractice is, in the scheme of things, very small potatoes.  The real costs are in coverage litigation.  Not only do patients often have to litigate bad faith claims, but insurers spend enormous amounts of money fighting with each other over who has primary responsibility for payment of claims.  

          A few years ago, I broke my foot when I stepped off a curb.  I had medical insurance at the time (yeah me!), but my HMO spent two years litigating with my employer's worker's comp carrier over whether the injury was work related since I was walking to lunch with co-workers when the accident happened.  

          It wasn't even a huge bill.  A clinic visit, an xray, a cam walker, some vicodin, and a follow-up Doctor visit just to make sure it healed right.  

          "Rules must be binding. Violations must be punished. Words must mean something." President Obama in Prague on April 5

          by jlynne on Sat Dec 19, 2009 at 10:09:17 PM PST

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          •  If you mean the entire (4+ / 0-)
            Recommended by:
            mrkvica, jlynne, expatyank, scotths

            cost of the health care system, then yeah, malpractice insurance is small potatoes. But as a proportion just of doctors costs, its quite large.

            You are spot on with this:

            The real costs are in coverage litigation.  Not only do patients often have to litigate bad faith claims, but insurers spend enormous amounts of money fighting with each other over who has primary responsibility for payment of claims.  

            The MSM never discusses this.

            Member, The Angry Left

            by nosleep4u on Sat Dec 19, 2009 at 10:28:34 PM PST

            [ Parent ]

    •  Depends On Where You Are-- (8+ / 0-)

      It's easy for us to find Medicare docs here in the urban rustbelt. Much harder in rural Puget Sound over the past 10 years.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Sat Dec 19, 2009 at 07:14:57 PM PST

      [ Parent ]

      •  Medicare doctors have been hard to find (0+ / 0-)

        in my  county.  Bad news, especially for the growing retirement community industry that has been expanding properties and facilities here.  Supposedly things have improved recently.

        "Don't let what you cannot do interfere with what you can do." John Wooden

        by CKendall on Sun Dec 20, 2009 at 12:56:03 AM PST

        [ Parent ]

    •  doctors and hospitals, not insurance companies, (2+ / 0-)
      Recommended by:
      Alice in Florida, evangeline135

      are also the main reason for high costs.

      but unlike doctors and hospitals, insurance companies do not add anything.

      •  and also pharma and medical device manufact (3+ / 0-)

        urers...are a LOT of the problem

        when i read in article in huffpo a while ago and all the people were complaining, rightly, about an insurance company that dumped a kid who needed  prosthetic arm that cost thousands of dollars (and it would only last a year because the kid was growing)...but nobody was asking WHY IS THIS PLASTIC AND METAL PROSTHESIS THAT ONLY LASTS A YEAR COSTING THOUSANDS OF DOLLARS???

        in europe it is probably, like, 20 bucks or something...

        •  When you have to keep full time staffers (7+ / 0-)

          to fight with insurance companies, well the $s have to come from somewhere.

          Pretty much every doctor's office has at least one full time employee whose sole job is to fight with insurance companies. One dentist office I went to had two dentists, two hygenists, and FIVE paper-pushers. Now that, dear ones, is insanity!

          Member, The Angry Left

          by nosleep4u on Sat Dec 19, 2009 at 10:38:46 PM PST

          [ Parent ]

          •  My doctor has a staff of one (2+ / 0-)
            Recommended by:
            Angie in WA State, evangeline135

            His receptionist.

            Because he takes no health insurance (if you have it, you can duke it out yourself). He charges the same rate as any other doctor I'd seen... $80 a visit.

            He draws blood in office.

            He's from out of country and very political and very against the way health care is set up in the U.S.

            I've zero gripes with him, except that I have to use free clinics when he's out of town.

            And also, I get better care because he doesn't have quotas to exceed that will "ding" him through the health insurance system.

            And as a good man, if I can't pay him, he'll just see me anyways. He has to be careful of malpractice and does pay insurance, and so keeps scrupulous charts. But he doesn't always charge when I've been short on cash. And we all got the swine flu and flu vaccine for free.

        •  You're my hero! (5+ / 0-)

          Thanks for bringing up this point. One of my biggest concerns in the whole healthcare "reform" debate is why medicines & medical devices cost so damn much.  The other is the "punishment" of people with pre-existing conditions, but that's for another rant...

          Blood glucose testing strips are grossly overpriced. They're just plastic, a little metal & some chemicals, but they're at least $1 each. Box of 100 strips costs >$100. I have to test at least 4x/day, so a box that size lasts less than a month.

          Insulin too is overpriced. It's all lab synthesized now & has been for years, yet it too is over $100 a bottle w/out prescrip coverage. I actually wrote a letter to the director of manufacturing at Lilly asking her what the cost per unit is to manufacture a bottle of insulin. Haven't heard back, naturally..

          The insulin pump I use has "pods" that I fill with insulin & adhere to myself. I have to change the pod every 3 days (to reduce risk of infection at the site). Each pod is roughly $45, so for a box of 10 (a months' worth) I would pay $450. My insurance helps some but I have to meet my deductible first since they classify the insulin pump & supplies as "durable" medical equipment. Yeah, something lasting 3 days is durable. Some may argue that I should just go back to injections, but being on a pump provides me with far more precise control of my blood sugar, which in turn reduces my risk of typical complications such as blindness, amputation, kidney failure, heart disease.

          I've bitched about this in the comments of enough other diaries that I probably just need to do some research on the topic of overpriced meds & do my own diary. Someday when I work up the courage to post it, I guess...

          •  definitely worth a diary... (2+ / 0-)
            Recommended by:
            mahakali overdrive, CKendall

            they are sort of a part of pharma, so I think they are probably benefitting in the same way from reform, i.e. the bill promises that they won't face price controls...

            i think evan bayh has gotten some taxes that were going to be put on them taken off the table...i think there are a lot of these companies located in indiana or something...that is what i heard anyway

          •  The cost looks to be rather less in the UK (0+ / 0-)

            The cheapest box of 50 I could find online was £19. Maybe mail order would be worthwhile!

            However, you can get these on prescription here, and since you use them daily you could then cap your totaol costs at around £90/year using a PPC (Prescription Pricing Certificate). My husband is on loads of meds so he has one of these, we make monthly payments to cover the cost of the PPC by direct debit, and his prescription meds are "free" at any pharmacy. BTW, docs here will often prescribe OTC meds as well if you need them, i.e. cough syrup, paracetemol etc., if they are concerned that you may not take things they recommend due to cost.

            This is not to say that all is rosy. See here for info on dificulties diabetics may have getting the NHS to prescribe enough glucose test strips.

            Political Compass says: -8.88, -8.67
            "We never sold out cos no one would buy."--J Neo Marvin

            by expatyank on Sun Dec 20, 2009 at 12:41:28 AM PST

            [ Parent ]

            •  Thank you very much for that link. My husband & I (0+ / 0-)

              would love to live in the UK (and yes, we may be starry-eyed Anglophiles) but there's so much to think about prior to making a move like that. Aside from finding jobs, of course. But the more info I can find, the better.

              Now, if we could only get more funding for research into a cure..... Then it would be a wonderfully moot point!

          •  Strangely this was also the case in China (0+ / 0-)

            But this year, as part of the medical reform legislation anout 1,000 of the most common medication were put on price controls resulting in a radical reduction in costs. I take a medication that was reduced from about RMB 200 to RMB 16.

            Ask me about my daughter's future - Ko

            by koNko on Sun Dec 20, 2009 at 04:29:45 AM PST

            [ Parent ]

      •  Partly because they are responding to (2+ / 0-)
        Recommended by:
        mrkvica, evangeline135

        pressure from the insurance companies.

        Insurers make more money when the thing they're insuring costs more. 5% of 100K is 10x more than 5% of 10K. Ergo, insurance companies have no interest in reducing the cost of procedures -- essentially, their volume would go down.

        They do have a big interest in not paying for procedures at all, as that's immediate cash in hand.

        Member, The Angry Left

        by nosleep4u on Sat Dec 19, 2009 at 10:35:17 PM PST

        [ Parent ]

    •  Medicare rates (4+ / 0-)

      Physicians always take Medicare rates...they have no choice.

      You forget that Medicare is the 900lb gorilla in reimbursement.

      And Medicare reimbursement rates are generous in some instances, but a joke in others.  In some cases medicare reimbursement can be less than the actual cost of care.  This is a huge problem that seldom gets discussed...the variability of payments for different tests and procedures causes physicians and hospitals to order tests based upon compensation and not on clinical need.

      Now if you are talking about medicaid you would have a point (except for the reimbursement rates...those are joke).  

      •  no, i think many doctors refuse (2+ / 0-)
        Recommended by:
        doinaheckuvanutjob, CKendall

        medicare patients because they think the payment is too low.  that's what they say anyway, and that is what a lot of the senators were saying about the medicare buy in for 55 and up.

        and i guarantee, if we set up a commission to reform medicare rates and make them fairer, the doctors and hospitals would NOT want to expand medicare anyway.  they know that private sector reimbursement rates will rise faster and more dependably than public sector reimbursement rates.  So they would fight tooth and nail against medicare for all.

        also, i don't know what you mean about the 900lb gorilla.

      •  MMmmm not always (2+ / 0-)
        Recommended by:
        CKendall, Square Knot

        I have a lot of colleagues who have closed their panels to new Medicare patients because the poor reimbursement rates.

        One of the problems I can see immediately with a so called self created public option is getting the approval of all the state insurance commissions. But I can see a idea budding. One of the most attractive parts of the public option is that it would be administered by CMS, which administers Medicare, consuming only 4% versus upwards of 30% of the premium dollar. If there was a way to contract out the admin services to CMS, that would be great. Mandating that participating providers follow best practices and evidenced based medicine along with electronic medical record and institution of "medical home" may be achievable if you can get enough participating providers. Perhaps the first step would be to offer this to young people under the age of 40. You could offer bang up preventive services, maternity, and major medical coverage only (big deductible on the front end but picks up say after $5000).

        Folks that say they are willing to "donate" would be shareholders of a not for profit I guess, if there is such an animal, but hey, why not? One of the problems with for profit insurance is the conflict between their core mission (return on investment for shareholders) versus the service provided. It would be really interesting to turn that paradigm on its head.

        It's doable but there are kinks.

        But this much we do know -- no faith justifies these murderous and craven acts; no just and loving God looks upon them with favor. President Barack Obama

        by never forget 2000 on Sat Dec 19, 2009 at 09:55:00 PM PST

        [ Parent ]

    •  it's not just the rates (4+ / 0-)

      it's the overhead involved.  Medicare payments lag months behind service, and even for a small clinic, the paperwork often requires a full time employee to complete it.  

      Streamline the process, and a lot more providers would be willing to accept the rates.

      "Rules must be binding. Violations must be punished. Words must mean something." President Obama in Prague on April 5

      by jlynne on Sat Dec 19, 2009 at 10:02:24 PM PST

      [ Parent ]

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