quote:Originally posted by ClaudiaTherese: As I said, I have no quibble with that at this time, as it is not the topic I was discussing. Please, do carry on.
That's okay, it appears I've done all I had intended here. Posts: 2804 | Registered: May 2003
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You're right, CT, my post would be more of a comment on the way the cost is handled. I like Publix's better than the government's.
Publix decided they had a good idea, and they figured out how to pay for it. Maybe the cost of some items went up a little. Maybe they just made less elaborate tv commercials this year. We'll see when we get to the holidays if they rerun the CGI pilgrims and tree full of doves.
Medicare, on the other hand, is a giant sucking hole in the budget. Government knows they have to pay for it and that it will come out of the budget, but they don't seem to think of it beyond that. There never seems to be discussions of decreasing other costs or paring things down to the essentials. Obviously, it's a hard discussion to have here in Florida with all the retirees, but it still ends up looking amazingly irresponsible.
Businesses are never perfect, but on this particular issue, Walmart and Publix seem to have the government beat hands down.
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Madicaid vs Medicare- aren't they different? Which is also different from CHIP- I have to pay some money for CHIP- just not the $300 a month private would cost.
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Medicaid is different from Medicare. Medicare and Medicaid have separate budgets, separate classes of recipients, and Medicare is more "permanent" while Medicaid is generally shorter-term (although some people will qualify forever.) Some things may not be covered for some people on Medicare that may be covered on Medicaid, and vice versa.
Posts: 21182 | Registered: Sep 2004
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Roughly speaking, Medicare is a federal program that covers the elderly and disabled. Medicaid is a federal program that provides money to state programs for people living in poverty. SCHIP is a federal program that provides money to state programs for children. Because Medicaid and SCHIP are state-administered, eligibility requirements and benefits differ from state to state.
AvidReader - What Walmart and Publix have done, while commendable, falls far short of what Medicare has accomplished. Comparing two companies providing some medicines at low costs to a program that provides health insurance to a huge segment of the population (that generally requires more care than the population as a whole) isn't just apples and oranges, it's peas and watermelons.
Posts: 2149 | Registered: Aug 2000
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Wow, your wireless adapter goes out, and you get quoted ten thousand times in a couple days! Cool!
Had I come back quickly I would have clarified my statement to say that yes, I do realize the drugs Publix is giving away free to consumers are not "free". But I see a big, big difference in a private entity choosing to take a loss on a product as a way of enticing customers, and government aid.
Publix is not hurting for money or business, and indeed I do get all my prescriptions filled there, though I did before they started giving away antibiotics, mainly because of convenience. It's located between my pediatrician's office and my home, so it's the best and most convenient place for me to get prescriptions filled. I appreciate their giving me free antibiotics, but I was already a customer.
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I understand the government programs are bigger and harder to deal with. But that doesn't mean we should keep throwing money at them without evaluating what we're doing. Free comes from somewhere in both cases, but the Medis cover a whole lot more money.
I'd like to see government be as responsible with their aid as these businesses are. I'd like them to think about where the money is coming from - preferably before the boomers all retire - and what can reasonably be funded every year with a growing black hole in the budget.
I'm not saying it's not a noble cause. I'm just saying it's expensive, something like a fourth of Florida's budget IIRC. What's our plan for paying for it? What are we giving up in the federal budget, or are we just chalking that up to debt? At some point Congress will have to adress the nation's spending, and the two Medis are going to be a huge piece of that puzzle.
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What makes you think people haven't and aren't evaluating what is being done with the SCHIP program? Do you have any information that suggests it, or is it just an ideological thing?
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SCHIP programs are among the most extensively studied programs out there. This was discussed on a prior page. The evidence is very clear.
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For the sake of curiosity, does anyone have a study on hand on how wasteful Medicare is in comparison to private run health insurance companies? I've always been under the assumption that it's vastly more efficient and far less wasteful, but opponenets of national healthcare like to throw out scare phrases like "huge government beauracracy" and what not.
Is this just one of those scare tactic assumptions? That government by its very nature can't do ANYTHING right, so let's not even bother looking up the facts and just assume that we're throwing money at a wasteful system?
I don't have any facts or figures the other way either, but I haven't seen anything against Medicare. My opinion on the matter is that healthcare is probably the one thing government can do better than private health insurance, because they don't spend on advertising, they are more interested in keeping you healthy than in making a buck, they aren't working in partnership with the drug companies, and they are more efficient administratively.
I understand where this negative assumption comes from, but I've yet to ever see any facts back it up.
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(You might -- or might not! -- be meaning "Medicaid" instead of "Medicare," or perhaps both.)
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Medicare is what senior citizens are on right? National healthcare for the elderly? Whichever one that is, is the one I'm referring to.
To be fair, I'm not even sure really what the other one does, so I don't even have a clue as to the efficiency or wastefulness of it.
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There was an issue with Medicaid and the government pandering to prescription drug companies (I am sure that is an oversimplification of the issue).
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It would be hard to compare directly, since private health insurance companies spread the risk over people of all ages and all health-statuses. Folks on Medicare are higher-cost, pretty much by definition.
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What dkw said. I didn't think you were going for Medicare, since it it is really difficult to assess cost-effectiveness there -- something like (don't quote me -- I'd have to dig it back up) 70% of a current typical US person's medical costs are incurred in the last 3 months of his or her life.
The comparisons can be made, it's just more difficult. Most of the complaining I've read has been about the cost-effectiveness of Medicaid.
Then again, we likely read different things and talk to different people.
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AvidReader - I'll grant you that more needs to be done to ensure that the money for these programs is there and will be there in the future. Still, I don't agree with your comparison. WalMart and Publix can pick and choose what drugs and services they supply. If something isn't cost-effective, they have no obligation to provide it. The US and state governments do have obligations to their citizens even when it's expensive.
Lyrhawn - I'll ask my mother for specifics and get back to you. She's done a lot of research in this area.
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I actually think the Medis are one of the few times government didn't ruin what makes the free market work. You don't have to go where the government says and put up with a bad doctor. You go to the best doctor who takes the program. As long as they keep the rules bearable for the doctors so they keep a lot of doctors in the program, they've got the best of both worlds.
My problem is the assumption that the government is where you go to get health insurance after you retire. We've got a lot of retirees already and more getting ready. That money has to come from somewhere and I think the government needs to make an effort to figure out where.
There's only three options. Raise taxes, cut services, or cut other items in the budget to make up the difference. At the moment, Congress seems to prefer not addressing it at all and putting us in debt. Except we're already in debt. At some point, I'd like to see us with a surplus again, and we can't do that if we're constantly expanding programs, even good and noble programs, without looking at what the budget can support.
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As for the factcheck numbers, Florida's looks great. $40,000 is enough for two people if they're careful with their money. It wouldn't be enough for kids. $50,000 in states with more taxes makes sense, but what's the cost of living in NJ that families making $70,000 a year qualify?
Is that $70,000 when they have a kid with a birth defect insurance won't cover, or is that anyone? Cause I'd think you could reasonably afford decent insurance on your own. I'm even leery of the $60,000 amounts in most states. I just have a hard time seeing that as low-income.
Looking at my insurance, for a family of four, health insurance would cost a $1000 a month. Other people have told me this is about what theirs charge as well. My insurance has a $250 deductible on dr visits, $100 on prescriptions. So, before that health insurance pays a dime, a family of four could pay as much as $1400. So, we are at $13,400 a year (with health insurance paying nothing). When they finally pay, they pay 70%, but only after you have fought with them for about a year (these are the people who claimed my pregnancy was a pre-existing condition from 18 months prior- yup, I'm an elephant). A family of four making $60,000 a year could easily have problems with paying 20% of their salary. I think the real question in this debate needs to be why is insurance so expensive that a family of four making 60,000 can't afford it.
Posts: 1001 | Registered: Mar 2006
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This quote below is from a 2003 NEJM paper. Roughly 1/3 of health care costs go to an enormous bureaucracy. I don't have similar cost breakdowns of paperwork for Medicare and Medicaid, but I'm sure it's less than 1/3. The Canadian single payer system's paperwork overhead is estimated by the study to be 1/9.
quote:Our studies document the enormous administrative waste in U.S. health care. In 1999, our nation spent at least $294 billion on health care bureaucracy. This year[2003], health care bureaucracy will cost at least $399 billion, nearly one out of three health care dollars. On a per capita basis, Canada spends only one-third as much as we do on health care paperwork, and the difference between the U.S. and Canada is widening.
Our research analyzed detailed cost reports submitted by thousands of hospitals, home care agencies and nursing homes in the U.S. and Canada. We analyzed data on practitioners’ overhead from surveys of physicians in the two nations. For figures on insurance overhead we relied on the insurance industry’s own reports of their costs. Finally, we used detailed labor force data from the U.S. and Canadian Census Bureaus to compare the numbers of administrative workers in health institutions and offices over the past 3 decades
Our estimates of administrative costs are conservative. We excluded the administrative costs of health businesses for which reliable administrative cost data were unavailable – for instance, drug firms, pharmacies, and ambulance companies.
Our data are the most detailed and comprehensive analysis of administrative costs ever undertaken. They underwent painstaking review during the editorial process at the New England Journal of Medicine
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America’s Health Insurance Plans, a national association of health insurance companies “representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans” has issued statements firmly in support of the SCHIP reauthorization bill.
They don’t seem to agree with the president’s concern that it will be bad for private insurance.
quote: Press Release FOR IMMEDIATE RELEASEAugust 2, 2007 Contact:Mohit Ghose(202) 778-8494 AHIP Praises Bipartisan Senate Vote on SCHIP
Washington, D.C. – Millions of children will receive health care coverage through the State Children's Health Insurance Program (SCHIP) under the bipartisan legislation passed by the U.S. Senate today. The legislation would raise tobacco taxes to fund the reauthorization of SCHIP. “The Senate has acted to ensure the health security of millions of low-income children,” said Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP). “The Senate also took a strong stand for public health by putting in place a funding mechanism that will discourage children from starting smoking.” AHIP also noted that the Senate came together in a bipartisan fashion to reauthorize SCHIP without putting at risk the health security of the more than eight million seniors who depend on Medicare Advantage. ###
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I live in a country where freely available healthcare is a right, as well as a privilege. Yes, the system has flaws - not every drug is deemed cost effective - and people with money can have health insurance or go the private route if they wish. But most of the time, nobody even thinks about how they're going to afford healthcare, from checkups to heart bypass surgery.
By the way - this has not caused society, family, charity or the economy to break down.
From a economic and a socio-political standpoint, I understand why there is all this resistance to tax funded healthcare in the US. I've also accepted that this resistance is one of those cultural differences that I'll never fully emotionally (perhaps even morally?) comprehend. I understand it. I just don't get it.
In this country if a politician tried to veto something like this, that would be the end of his career.
If there was ever a no-brainer, it's guaranteed healthcare for every child. Even the rich ones. Even the illegal foreign ones. You'd like it if you had it, I promise.
Posts: 1528 | Registered: Nov 2004
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quote:In this country if a politician tried to veto something like this, that would be the end of his career.
Well, Bush doesn't really have to worry about that; it's his second term and he won't have another... Most presidents get done and write books, work for charities, etc. So I don't think Bush is too worried about his political future.
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Yeah, I figure he'll be one of the ones who sits back and takes money as a "consultant" for oil companies or something, not really so much the books (unless they're ghostwritten) or charity work.
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Yeah, I figure he'll be one of the ones who sits back and takes money as a "consultant" for oil companies or something, not really so much the books (unless they're ghostwritten) or charity work.
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quote: I live in a country where freely available healthcare is a right, as well as a privilege.
If you don't mind me asking, Bella, what does that do to your taxes? We already have half our federal budget going to Medicare, Medicaid, and Social Security. I would think we'd need to increase from our system now.
I didn't realize the tax bracket was different from the amount that actually gets paid. This calculator breaks it down; apparently taxes are paid for each bracket as you go. So a person making $100,000 is in the 33% bracket but their total tax is closer to 24% of their income.
Anyway, I was thinking that if a family of 4 needs $1,000 a month to buy health insurance and Medicare is 20% more effective, wouldn't their taxes have to go up by $800 a month to give everyone paid healthcare? I'm just not sure I see where the big savings would come from since the increase in cost would be spread out over all tax payers.
Posts: 2283 | Registered: Dec 2003
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quote:Anyway, I was thinking that if a family of 4 needs $1,000 a month to buy health insurance and Medicare is 20% more effective, wouldn't their taxes have to go up by $800 a month to give everyone paid healthcare?
No. For one thing, a substantial amount of that $1,000 represents profit.
Posts: 37449 | Registered: May 1999
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But if Medicaid or care or whichever is only 20% more effective, wouldn't that negate the savings by eliminating profit? I mean, the doctors and their staffs still have to operate on a profit or they won't do it. Pharmacies need a profit to invest in new medicines. I wouldn't think we could eliminate it entirely.
Posts: 2283 | Registered: Dec 2003
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quote:Originally posted by dkw: CT has explained this in more than one thread, but I don't have the time to go looking for it -- there is a difference between socialized medicine and universal health insurance. In socialized medicine the hospitals, clinics, etc are all run by the government and doctors & other medical workers are government employees. With single-payer health insurance the doctors, hospitals, etc work the same way they do now, but they file their reimbursement claims to a single agency. (Although some of the plans for universal health insurance still have multiple competing insurance agencies too.)
Actually, that's not a bad way of explaining the difference. It makes some sense. I still wonder how such a plan would work. It is often our health insurance plans themselves that limit access to care. So there may still be worse access to doctors and hospitals. Are we talking about an HMO with strict guidelines about which doctors we can see when? Or maybe a needlessly complicated system with so many exceptions that the average genius can't follow?
In Australia, we have government run public hospitals and privately run (usually religious) hospitals. The public hospitals are usually the premier hospitals in each state and territory.
Everyone is entitled to a Medicare card. Your medicare card means you either get free GP visits (if you go to a clinic which "bulk bills") or you get a rebate if you go to a non-bulk billing clinic. The clinics are not government run.
Any treatment at a public hospital is free. Treatment at a private hospital will cost you, but you also get a rebate from Medicare.
Many people chose to have private health cover on top of Medicare.* For us, this costs about $400 pp/year. This includes full dental, optical (all of which is subject to a Medicare rebate if you don't have private health insurance) plus private rooms at hospitals and other benefits (maternity etc).
I think the system works pretty well. It's by no means perfect, but the idea that someone can't afford basic or emergency medical treatment is unthinkable in our system.
*There is a Medicare tax levy surcharge for people earning over $50 000 a year who don't have private health insurance.
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(Oh and our taxes are ok, I think. We have a GST of 10%, a tax free threshold of $6000, then it's 15c in the dollar to $30 000 pa, 30c in the dollar to $75 000 pa, 40c in the dollar to $150 000 and 45c in the dollar over that.)
Edit - And we pay a medicare levy of 1.5% of taxable income (with reductions for low income earners).
Posts: 4393 | Registered: Aug 2003
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quote: If you don't mind me asking, Bella, what does that do to your taxes? We already have half our federal budget going to Medicare, Medicaid, and Social Security. I would think we'd need to increase from our system now.
I'm not Bella, but I'm from the same country.
Our tax rates are - 0% on the first £5225, 22% up to £33,300 and 40% on any income above that.
That means someone on £25,000 (just under $50,000) pays 17.4% income tax and someone on £50,000 (just under $100,000) pays 25.7%.
In addition there is National Insurance (supposed to cover things like unemployment benefit and the state pension). This is complicated but I think it works out at 7.4% for someone on £25,000 and 5.9% for someone on £50,000 (there is a ceiling, above which you do not pay additional National Insurance, so high earners pay less National Insurance as a percentage of their income).
Posts: 169 | Registered: Aug 2005
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Kettricken, in all fairness, I think you need to include the VAT in that kind of equation, too. Sales tax in American is generally considerably lower, and isn't distributed federally.
Posts: 37449 | Registered: May 1999
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5-7% Some states exempt groceries and/or clothing. And some have a "sales tax free" day or weekend right before school starts each fall.
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6.25% in Texas, and cities/counties will add a percent or two. However, there is no state income tax and the necessities are exempted.
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In PA is it 6 percent. Some states don't have sales tax. The highest they reach is 8.5% or so, including local sales taxes. Most are in around 5%, I'd say.
Posts: 433 | Registered: Feb 2005
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In CA the sales tax is generally 8.25%, but some cities add an additional tax, so you can go as high as 9.75% on some items in some cities. Food is the only non-taxed salable item. And food in restaurants and candy are not included in "food."
Posts: 21182 | Registered: Sep 2004
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6% in Michigan. We just raised the tax last week to cover a lot of services that were previously taxed.
Of course, the Republicans wanted to cut almost a billion dollars from the Education budget, and Democrats who wanted to actually raise Education funding now face recall drives across the state because no one wants to pay more in taxes. Pfft. I'll stop now before I go into a major rant on Michigan and politics. Damned Republicans. And damned national Democratic Party.
Posts: 21898 | Registered: Nov 2004
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It's never too late to talk about something that was mentioned earlier in the thread!
Question for other parents of children on CHiP:
Have any of you had this experience? Any time one of my kids gets sick and the doctor finds out they are on CHiP, instead of trying to fit them in they say, "You're on CHiP? Oh, just go on in to the emergency room because we wouldn't be able to see you until [Monday, Thursday, whatever. Three days away.] I've been to the emergency room for something as simple as a sore throat, a mid-grade fever, and diarrhea. It makes me feel stupid for even calling the doctor.
Posts: 6367 | Registered: Aug 2003
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Nope. My kids are treated just like any other Kaiser Permanente patients (except with lower copays and better benefits.)
Posts: 21182 | Registered: Sep 2004
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My kids are on Medicaid, not (as I understand it) CHiP. Still, I would think it would be the same thing. In their case, that is absolutely not my experience. Also, I have never had their pediatrician not be able to see them on the same day I called. Even when I call in the afternoon, it has always been "Come on over and we'll work you in." I seem to have the last doctor who doesn't overbook. The wait times aren't bad either.
Posts: 13680 | Registered: Mar 2002
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I'm still Medicaid (3 more months), but my dr has been really good about seeing my baby whenever we need to. They discourage er visits (don't want baby around all those sick people). If my dr ever replied like that, I would switch drs. We did have a really bad wait time last appt, but my dr's wife had a baby and was still in the hospital, so, he was backlogged from all the patients he had put off while being with his baby. The latest I have called my dr for an appt that day is like 10am, so not sure how well they would handle that.
Posts: 1001 | Registered: Mar 2006
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Yes, you should probably report your doctor to the CHIP people. Just in case. (Although you might want to talk to his other patients first if you know any and find out if they have had the same experience. Maybe he's just really overbooked.)
Once a doctor says they will accept insurance and will accept a patient, I believe they have an obligation to treat that patient like any other (at least to the limits of what the insurance will cover and the patient is able to pay for.)
Posts: 21182 | Registered: Sep 2004
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This doctor used to be amazing. They went from having the office open 7 days a week from 5am to 11pm and getting you in at any time to foisting off everyone on the ER. It never occurred to me that it might be illegal. (Random aside: I love that Firefox checks spelling now.)
Posts: 6367 | Registered: Aug 2003
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