posted
I don't know how it is in your city, but in Salt Lake, as far as I can tell, the majority of healthcare facilities are on the east side. (I'm still in Baltimore, but I haven't really looked at our distribution of facilities- and we're a bit odd with Johns Hopkins here). If you have a heart attack or a traumatic accident, you are more likely to wind up dead just because of the quality of neighborhood you live in.
You can try to set up everyone on GEHA (Gov't Employee Health Association - which I believe is what Obama is talking about by "the same plan Congress has") but if there are no doctors in their neighborhood, who is going to provide all this lovely preventative care?
If you don't have a job that allows much paid time off, when are you going to go to the doctor before it's a crisis?
And GEHA has copayments. If you're one of these folks that is being discussed (re: Gas tax) for whom $30 is a lot of money, that's going to be another reason you don't go. Actually, I think that's one of the main reasons they keep copayments, so people only come in when they really need it.
I'm hopeful that when I get through with becoming a nurse practitioner I remember that one reason I wanted to do it was to be able to practice in an underserved area. I suppose if we go to universal coverage, I should be better able to do so in confidence that I will be able to make it without a comfortable clientele.
Something that has come up in my scripture reading this week is something you may remember if you've read The Worthing Saga, the part about fat people eating in the presence of starving people. I agree that healthcare should not be a matter of priviledge. But adding the government as the last great payor is unlikely to change that.
posted
I agree, pooka. I don't think the universal health care debate has ever been about the poor. There's another agenda there, and that makes me nervous.
If the government were really looking to give everyone basic care, they'd go back to funding the health departments as primary care providers. They already have the facilities and the staff. They'd need to expand both, but it solves the problem of luring doctors to the other side of town.
Posts: 2283 | Registered: Dec 2003
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posted
Yeah, I don't know enough about the health care business prior to the rise of the HMO's. The strange thing is I worked for a health coverage broker for a summer in college, when they were bringing the Pepsico account on board. (As an aside, the stuck me with someone else's clerical error as I was leaving, because I was a temp and they had to blame someone, and then they wouldn't hire me when I finished school. Jerks.)
But the idea that there is room for a 400 person bureaucracy between the HMO and the corporation to be profitable is troubling. I also worked for a surgical device manufacturer when I got out of college, in the marketing department. There's nothing like tracking the profit margins on cancer treatment crap.
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posted
It's a little ironic complaining about the profit margin in medical equipment when you have a job tracking said margin. Their ability to pay you to work there was tied directly into the profit you seemed to have a problem with.
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posted
And I for one am glad that "cancer treatment crap" is available at all - and thank God for a medical system like the one here in the US that saved my life.
I'm not ever going to be the Big Pharma apologist, but if there were no profit to be found, then it's highly unlikely companies would spend the millions of dollars necessary to bring "cancer treatment crap" to the market.
Certainly I don't condone price gouging or unfair pricing, but for new treatments and drugs to be developed, there has to be incentive for a company to invest that type of capital and take that type of risk. In other words, some profit to the drug company is not a bad thing. It encourages them to develop new drugs, and provides the capital to fund the outrageously expensive R&D part of drug production.
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quote:But the idea that there is room for a 400 person bureaucracy between the HMO and the corporation to be profitable is troubling.
Not necessarily, if they work the way they are supposed to. Let me give you an example.
My company is currently laying off techs who make $50 an hour and contracting out their work to a company who charges us $85 an hour. The techs, of course, are questioning how that makes sense. The answer is that they cost us a lot more than $50/hour. First, there's their benefits and pension, which is about a third again of their wage. So call it $16/hour. We provide each of them with a laptop and pager. And if we employ techs, we have to employ people to manage them, and pay for their laptops and cellphones and rent for places for them to sit. And HR people to manage their benefits packages, and accountants to get them paid on time. And we pay all that 40 hours a week, even if we don't have 40 hours worth of work for every week. It is a LOT cheaper to pay $85/hour for the hours we need worked than pay $50/hour plus overhead to have someone there all the time. The $85 covers all of the contractor's overhead, of course, but they work for a lot of different companies, so they are busy 40 (or more) hours a week even if we only have work for them for 30, so we're not paying the entire overhead.
So, in your example, pooka, how many companies did that 400 person company work with in a year? If they broked new insurance contracts for 10 companies who each would have had to employ 50 people in-house to do the job themselves, that's a savings of 100 wage and benefit packages. Plenty of room for profit.
If the system works the way it's supposed to, specialization makes sense. Our system doesn't work the way it's supposed to, but that doesn't mean that every company in the health care field is profiteering.
Posts: 7954 | Registered: Mar 2004
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posted
Belle, you bring up a good point. If there was no profit for the companies to create their cancer drugs, they wouldn't do so.
But what is the use of them creating the drug to someone who can't afford it?
What happens when the need for the company to make a profit over reaches the need for their customers to remain healthy?
What do you do with a Pharmacuetical company who discovers there is more profit in paying kickbacks to doctors than to develop a new, better cure?
What do you do with a company that discovers there is more profits in burying bad test results about their cures than in insuring those cures are not bad?
What do you do with a company that discovers there is great profit to be had, legally, by buying out generic competitors after the legal monopoly on the drug has expired?
Obviously you fight these abuses, through new law or through the enforcement of old laws.
So what do you do when the company discovers its much, much more profitable to buy off the lawful enforcement of those laws than to obey them?
This has occurred repeatedly in the past, yet whenever something is suggested to improve the "health care system" screams are heard that this will kill the profit motivation of these fine upstanding protectors of our health.
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posted
I'm sure insurance brokers saved the clients money. They did it by consolidating the client's buying power to leverage HMO's nationwide to give them better rates. I'm not sure it was good for the insureds in the end (Pepsico's employees) because their level of coverage was often compromised.
Posts: 11017 | Registered: Apr 2003
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posted
pooka, I agree that provided care isn't useful if people cannot access it. I can't see the connection between that point in your original post and the argument against universal coverage:
quote:You can try to set up everyone on GEHA (Gov't Employee Health Association - which I believe is what Obama is talking about by "the same plan Congress has") but if there are no doctors in their neighborhood, who is going to provide all this lovely preventative care?
If you don't have a job that allows much paid time off, when are you going to go to the doctor before it's a crisis?
These seem to me to be important -- but seperate -- issues. Regardless of who funds the care, geographic and temporal access will be issues. That doesn't seem (to me) to lead one either toward or away from universal insurance.
Or were you making three different points? (I could well have misread you.)
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Edited to add: from the thread title, I was expecting that these would be additional concerns that went above and beyond the realm of insurance coverage. But I'm reading the text as also an argument against universal coverage. (?) I'd have agreed that universal coverage would not be a panacea, but not that its lack of panacea-level qualities was a reason to avoid pursuing it. I still think it helps, based on the morbidity and mortality data from other industrialized countries, and I think that geographic and temporal access solutions would be another key issue to address alongside coverage.
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