After all, the insurance companies are rich--they can afford it.  So why shouldn't they pay their fair share?

As long as the insurance companies are involved in it... there will be no affordable health care. They just had a scandal concerning a nationally known health insurer here in Connecticut. The various payment plans were supposed to be determined by an disinterested independent third party. The rates were sky high. It was determined that the third party was owned by the insurer in question. The insurer was required to sell off the third party.

Two years ago there was another well known health insurer that provided health insurance to a woman on the West Coast. She was diagnosed with breast cancer. She was scheduled for mastectomy. On or about the eve of surgery her insurance was canceled. An investigation disclosed an internal memo congratulating the employee who denied the claim because it saved the company money.

The doctors are not completely happy with the system either. I have had doctors tell me to get another health care insurer, or they would not treat me. It seems they were having trouble getting paid by the insurance company. Makes you wonder where all those premium payments went.

If as you say doctors/hospitals are charging more for procedures if a patient is insured...they are part of the problem that needs to be fixed. It fuels the insurance industry's argument about rising health care costs when raising premiums.

I love suing insurance companies, and during depositions listening to their BS explanations for denial of claims. They don't get serious about settlement until the jury is empaneled two or three years after the denial of the claim. Then its a matter of " Hey, wanna talk about settlement?"  Very often the plaintiff is dead by that time, and his/her estate has been substituted as plaintiff.  If you have ever seen that movie "The Rain Maker" ...it is a very accurate portrayal of how insurance companies work.

There is no need to have one monolithic health care plan provided by the government...so that should keep all the right wingers happy, and no need for them to scream socialized medicine. All that is needed is a government sponsored plan of affordable health insurance with the government acting as a competitive market participant. If the government sponsored plan works it may serve to force the insurance carriers to reduce premiums to a competitive level. The insurers are not going to offer competitive rates unless they are forced to do so.

The rich can afford good health care. The poor have Medicaid. Unless something is done soon the middle class will have no health care coverage because it will be beyond their reach financially.

Brilliant Kevin - You've just described the health insurance equivalent of FannieMae.

And you're point that it will not be socialized medicine because the doctors are being paid not by the government but by an entity funded by the government, who could disagree?

The reason for the dysfunction in the market mechanism of health insurance is similar to the one in title insurance.  The people paying for the service are not customers.  In title insurance, the customers are the realtors, builders, and lenders.  In the health care system the doctor's customers are not its patients but the health insurance companies.  Doctor's make or break their practice in bargaining over reimbursements with the health insurance companies and being placed on their approved provider lists, not because they offer the best service or prices directly to patients.

If we set up some sort of FannieMED to provide health care, it will still have to go through the same price negotations with health care providers that the insurance companies do now, but it will go one of three ways.  (a) They will charge low premiums that everyone can afford and tell the doctors to name their price, in which case it will be bankrupt in two years and require a bailout; (b) They will charge low premiums that everyone can afford and drive the same hard bargains that insurance companies do now.  People on the governement plan will be relegated to the list of approved providers like any other insurance company (and the harder the bargain it drives, the smaller the list will be).  On the upside it will take almost 10 years to be bankrupt; or (c) (the most likely scenario) They will charge low premiums that everyone can afford and have laws passed requiring doctors to take any patients with their insurance and only pay doctors what the government regulators determine are "fair" prices for those services.

In this last scenariou the doctors will initially subsidize lost revenue by soaking the private insurance carriers and walk-in customers more for the same services.  Eventually most of the private insurance carriers will lose business and fold because they can't compete with a government-sponsored entity that has its advertising budget and losses footed by taxpayers.  The remaining doctors will then deal with their significantly lower revenue streams by cutting staff and decreasing quality until the average doctor's office resembles the NHS in England.  As more doctors leave the practice and fewer enter the field because of the perceived drop in income, the doctor's offices will have a waiting list to match the NHS as well.  There will undoubtedly be exemptions for high dollar private clinics for the 10% of the country with the money to pay for them.  In the meantime, to stave off bankruptcy, the government system, eventually rife with fraud and unaccountable doctors, will eventually have to up the premiums.  The rest of us will go from spending a lot of money on really high quality health care to spending slightly less money on really poor quality health care.

Well...that sounds like quite a forecast for doom. Have you checked today to see if the sky is falling?

The truth of the matter is that the insurance industry and pharmaceutical firms have a strangle hold on health care...always claiming that their revenues are driven by the escalating cost of health care. There was an interesting item on 60 Minutes shortly after the Medicare prescription drug package was enacted. It seems that the pharmaceutical industry had a large hand in influencing the bill. In its final version Medicare was foreclosed from using its superior buying power to negotiate lower prices for its recipients. The VA has this ability. When the cost of prices between Medicare and the VA were compared...the VA pricing was far lower. There was arm twisting in the House and Senate to get the Bill passed in its current form. One congressmen interviewed indicated that he was nearing retirement, and that his son wanted to run for his seat. He was told that if he did not vote in favor of the bill his son would not get the party nomination.  A number of congressmen went on to take lucrative jobs in the pharmaceutical industry not long after leaving office. One former congressman and now pharmaceutical industry employee  who was interviewed was instrumental in the bill's enactment. When he was asked about the arm twisting he sloughed it off as "just Washington politics".  One has to ask if his constituents felt the same way, or did they even know about it.

Let us not also forget the famous "Dough-nut Hole" provision in which the first $5,000.00 of coverage is provided. After that cap is reached the recipient is on his/her own until the end of the year. Many of the elderly are in the position of having to choose between food and medications under the current system. I recently spoke to the wife of a terminally ill cancer patient. She said her husband's medications are running at approximately $2,000.00 for a two week supply.

I would never advocate buying prescription drugs over the internet because of counterfeit drugs being sold by some sources. However, some residing near the Canadian border tried to buy drugs less expensively from Canadian pharmacies. Canada has price controls. In retaliation the pharmaceutical industry threatened to boycott Canadian pharmacies which sold to Americans. I spoke to a doctor recently about the quality of the drugs sold in Canadian pharmacies. He said they are the same drugs sold to American pharmacies but less expensively.

Somehow Canada, Great Britain and the Scandinavian countries all have national health care coverage that works.  Please don't try to argue that the British are on waiting lines for medical attention. They use a triage system similar to that used in American emergency rooms. Those that require immediate attention go to the top of the list. Those cases of elective or cosmetic surgery may have to wait a while. With respect to your view of availability of doctors...its medical staffing is the third to fifth largest work force in the world as of the last survey I have seen. It co-exists with a more expensive private health care insurance industry. While you seem to hold up Great Britain's National Health Service as a failure...The NHS seems to be the system preferred by the majority of the people. If your opinion were true...one would have to ask why. It has been around since l948. They must be doing something right.

In response to your concern for doctor's incomes declining, I just saw an interesting item on today's news. The state of Connecticut published the annual incomes of its top earners. The highest paid were several college basketball coaches coming in at over $1,000,000.00 per year. There were several doctors working for a state health care facility with reported earnings of approximately $1,000,000.00 per year. How magnanimous of them. It was reported that these doctors could earn more in private practice.

Insofar as your forecast of doom for the quality of medicine and research and development are concerned... information for new procedures is shared on an international network and through conferences. There is a new treatment available for kidney cancer which is available in the European Union but not in the U. S. There is a new treatment foe alzheimer's disease available in Russia, but not in the U. S.  There was a new anesthetic to make a very painful procedure less painful developed in Denmark. It is now an accepted procedure in the U.S.

In the course of litigation I have witnessed a lot of deceit and protectionism in the insurance industry. I recall taking the deposition of an insurance agent in a worker's compensation related case. My client was a putative employer that had offered a self insured plan for health care and workers compensation insurance to its employees under ERISA. The insurance industry took issue with it. A regional insurance trade organization had published some negative comments about my client. We sued for defamation.

When I made inquiry as to the insurance agent's practices for the sale of worker's comp insurance he testified that he really had no motivation to perpetrate any impropriety because he did not generate a significant commission from its sale. I continued the deposition to a later date and subpoenaed his bookkeeping/accounting records. They disclosed that his small agency was gaining $50,000.00 per year in commissions from worker's comp insurance alone. That was on top of his other products...auto, homeowners, life, casualty, etc.  Multiply that $50,000.00 by the number of agencies offering it. It is a mandated insurance which employer's are required to carry in order to avoid more severe damages.

The current system of health care is becoming unworkable. In my case the cost of health care is $16,000.00 per year, and it goes up 25% to 30% each year. I am sure that most if not everybody in the middle class is in the same boat. The choice offered by the insurance companies is to pay them more or take a higher deductible and pay the hospitals more. What good does it do to have a system that no one can afford? It is the same as having no system at all.

You seem to prefer a more expensively priced private insurance coverage to one more moderately priced with the government as a market participant. Why...I can not imagine, but the same choice would be available to you since the private insurance industry would co-exist in much the fashion of the British system. As I understand Obama' proposed plan it is to be an extension of the plan offered to Federal law makers. If so, the plan has been tried, and withstood the test of time. Coverage would simply be extended to a greater number of participants. 

I experienced a similar phenomenon to what Robert mentions in his post, and I asked my physician why prices seemed so high. He explained that he had to charge prices higher than the service actually cost to all his patients in order to honestly report those prices to the government, which in turn ensured that Medicare and Medicaid paid for the actual costs of services rendered to patients who were so covered.

This is even more insidious than what Robert reports, because it forces physicians to charge higher prices in order to cover the shortfalls in Medicare and Medicaid coverage that would otherwise exist. In areas of the country where a greater proportion of patients take advantage of these government programs -- rural communities and areas with a high concentration of elderly and poor -- healthcare costs are disproportionately high as a result.

I agree with Robert on one thing -- national, government-subsidized healthcare is not the answer. But the physicians and insurance companies are not solely, or even majorly, to blame for this state of affairs either.

It is a difficult puzzle to solve, to be sure, but the path forward seems to be in the cessation of government intervention in the healthcare system altogether. If doctors could charge on a sliding scale -- which is strictly prohibited by law for any physician that sees patients covered by Medicare or Medicaid -- much of the inflated cost of healthcare would go away through simple competition in the marketplace.

Just my $0.02.

The reason there is a difference in cost of a service is due entirely to the insurance companies. For example: If I go to the chiropractor and use my insurance then I have to pay out of pocket the $500 deductable each year and then 50% of the amount billed to the insurance which in this case is $55. If I don't elect to use my insurance then it costs me $38 a visit. Now you say that this isn't fair. However, take a good look at the statement that your insurance company sends you after the doctor has billed them. If the doctor billed say $110.00 for the visit, then right off the top the insurance company disallows a certain amount of that billing. For this example let's say they disallow (Sometimes noted as a discount) $55.00 (which is closer to the truth tham most people realize) then the insurance is looking at a $55.00 billed amount. Now remember that they only pay 50% of that bill and I have to pay the rest. Which sounds good on the surface, but I am getting charged at 50% of the $110 NOT the $55. So now the insurance company says it is my responsibility to pay the doctor $55.00. Now if I am a hard working low paid consumer- which one do you think I am going to pay??????? People need to realy investigate what the insurance companies are up to. Sure I use my insurance for hospital bills annual checkups etc..... But when everything is said and done I still get stuck with a highter percentage of the bill then what they told me I would pay and more importantly the doctor or hospital has to eat a discount they didn't agree to in the first place. If the bill is $1000 dollars and I am supposed to pay 20% of the bill (this assumes that I have already paid my deductable for the year) then the insurance company shouild be paying the other $800. But I can guarantee you that they will probably only pay about half that amount and most hospitals and doctors will bill you for all or part of that difference. This all started with the HMO's and the medical community and we the people have suffered ever since.

ENOUGH SAID.   Our system is the worst in the world!!!  When ladies lay on the floor at the hospital and die because the doctors and nurses thought she wasn't good enough you know we have a serious problem - that isn't even in the movie - just plain fact.  When you get refused treatment because you don't have the right health card and might not be able to pay it sickens me.  I thought doctors took an oath but I guess that only matters when you have the green to payfor it.

Now, I will go back and read the rest and the other comments.....more to follow. :)

...just wait until it's "free"!

Our system is the "worst in the world"?  I guess that's why most Canadians travel to the US for any major medical procedures.  Sure, in Canada your treatment is free, but you have to wait at least six months to a year before you can even get an appointment to be treated, and that's AFTER having waited weeks or months to see a doctor.  Our system may have its problems, but Michael Moore sure as heck ain't the guy to fix them.  Ninety-nine and forty-four one-hundredths percent of everything in that movie has been proven to be absolute crap.

"Refused treatment because you don't have the right health card"?  I can speak from personal experience on this one.  My wife was recently in hospital for several days after presenting all the classic symptoms of cardiac problems.  Even after it was determined that we didn't have insurance sufficient to cover all of her expenses, she was never refused testing nor treatment for her condition.  It may take us a while to pay down the balance, but the fact that my wife got the care she needed was the main concern for me.

The reason healthcare costs are so out-of-whack is that the healthcare industry is not consumer-driven.  As long as someone else is paying, who cares how much it costs?  The only way to make healthcare affordable is to give consumers an incentive to shop around for the best deal.

Although she has stated her case in rather extreme terms...possibly a hyperbole...I think her point is well made. The hospitals are required to do one of two things. Either admit the patient or stabilize the patient's condition for transport to another hospital which will admit him/her. I know of one hospital in my area that has a publicly stated policy of not turning away patients for an inability to pay. I have been told by EMT's of others that do not take that position. 

The entire system is out of control. The insurance industry is used to operating in an atmosphere of doing as they damn well please, filing rate increases with the state governments, and having them receive rubber stamped approval.

AIG is a prime example of the insurance industries bloated self indulgence. After receiving the first bail out funds it threw lavish parties for its agents on the West Coast. It then gave huge bonuses to its executives in certain of its divisions. When challenged on these points AIG argued that it had to pay these bonuses in order to retain top executives in divisions it was trying to sell to pay the government back. The problem was that the buyers could not obtain sufficient credit for the purchases to culminate. Did these executives give their bonuses back? I don't think so. Here we are this week, and AIG has its hand out again.... seeking further reward for failure.

The same tired old reasons for escalating costs given by the insurance industry do not impress me. Their claimed heightened exposure from malpractice claims is easily remedied through self help. All they need to do is limit the amount of their exposure by limiting the amount of the coverage under insurance policies made available to a physicians. This is currently done with the malpractice insurance policies extended to attorneys. In the event that the physician is sued for malpractice the insurance company is exposed for no more than the limits of the policy. The physician would be liable for anything in excess of the policy limits, and he can discharge the excess in a bankruptcy.

With respect to your analysis of Canadian health care  I would have to disagree with you. If your position were true we would have people dropping dead in the streets of Ottawa . If it is patterned like the British or Scandinavian systems...those with immediate need get the required medical treatment. I just did a closing yesterday with a former Canadian (Now American ) citizen. He had no trouble whatsoever in obtaining the treatment he needed from the Canadian system.

Insofar as free isurance coverage is concerned...I do not think that anyone expects it to be free...simply that it be reasonably priced. The news coverage of Obama's proposed health insurance plan has indicated the the isurance industry is not happy with the prospect of more reasonably priced competition.

Perhaps the reason my foot doctor charges more if you have insurance is because the insurance companies will not pay the full bill.  (This seems to be spilling over into the title insurance business, too, but that is for another post).  The doctors have to bill the insurance companies at a higher rate because they know that in order to get what they really want to charge they have to "work the system."

On another note, my dad is in the hosptial this week.  He had a mini-stroke.  We believe that he had a similar condition a few years ago. He was in the hospital for about a week and had several test, but they were unable to confirm he actually had a stroke.  He has two insurance policies.  He has been self-employed all of his life and he has the only insurance he could afford.  Unfortunately, after the insurance companies refused to pay for almost everything, he wound up owing $14,000.  He hasn't quite paid everything off and he is back again with a bill running up over $25,000 this time. 

There is something sadly wrong with a system that would allow someone who has been paying insurance premiums for years to get stuck with these kinds of debts after something as serious as a stroke.  The biggest problem we face as a nation isn't the un-insured, they almost always get assistance from the medical providers and the government.  The real problem is the UNDER-insured.  Those who have worked hard and paid into a private health-care system and are still not taken care of are really getting the short end of the stick.

In my dad's case, he doesn't have any paralysis but he is experiencing vision problems and he is so dizzy he can't stand up.  He will not be able to go back to work, so he will not be able to pay off his medical bills this time.  He will be forced onto disability, but that won't pay him enough to pay his medical bills.

I believe he voted for Obama, based on his comments about his health care situation.  Unfortunately for him, there won't be any kind of meaningful reform in this area in time to help him.  While I am not in favor of nationalized health care, something must be done to help those who fall through the cracks of our private system.  If the insurance companies can't offer decent coverage for a premium that a working man can afford, maybe we do need the government to step in and provide it.

Interference by government is what got us to where we are...now you want to fix the problem by doing MORE of what caused it in the first place!  Do you really want something as important as your medical care managed by the same kind of inept bureaucracy that runs the DMV?

On a personal note, I wish your dad the best for his situation and I will definitely be praying for him.

 

It will simply make low-quality care more expensive.

The problem with affordable health care insurance is the result of a lack of uniform regulation. Regulation has been left to the state governments which resulted in a patchwork or confused and often conflicting approaches as to what medical procedures are covered by insurance. A case in point is a colonoscopy to prevent and treat colon cancer. Very often to officials appointed to the office of Insurance Commissioner come from the insurance industry, and are predisposed to the protection of the insurance industry's bottom line of profit...business as usual. In the mean time people are dying because affordable health care coverage is beyond their reach.

The problem is not government intervention , but but failure to regulate an industry that has been permitted to trade off human lives in return for profit.

You just made my argument for me.  What you are proposing would just shift the burden of oversight from a small bureaucracy to a larger one, resulting in a two-tiered system with one standard of care for the "elite" and another for the rest of us peons.

The rest of us peons could not be in a worse case scenario. The deregulation and hands off , unrestrained to regulation approach has earned the insurance industry and pharmaceutical giants billions at the expense of human life. Had the state insurance commissioners done their jobs we would not be at the cross roads of needing one uniform regulation. Under the proposed plan the insurance industry is still free to compete with the government sponsored plan. Hmmmmm....why is it that reasonably priced competition worries them? Could it be that they are worried about the loss of profit on their bottom line?

It took me a while, Scott, but I finally think I get it.  There is a string sticking out of your back and when someone pulls it, Rush Limbaugh's voice comes out of your mouth.  Press your belly and... Glenn Beck.  "Our big government has caused all of our problems."  "If you want to blame someone blame the government."

The fact is the PRIVATE health care industry (including the insurance companies) is failing us... not the government.  I'm seeing it all around me.  My dad has two policies that exclude so many things that they are about worthless.  Do you think they told him when he bought the policy that it wouldn't pay for most of his treatment if he had a stroke?

And here in my office, I try to do the right thing and provide 100% of my employees' health insurance.  I would love to keep doing that, but the private insurance industry is getting so expensive that I'm not sure how much longer I will be able to do that.  How are we supposed to keep health care private if nobody can afford the premiums?

I was talking to a full-time waitress at a large chain restaurant and she is having medical problems.  She told me that she didn't have health insurance.  I was stunned that a business the size of that chain didn't provide health care.  She said, "Oh they do... but I have to pay part of it, and it has gone up so much, I can't afford it anymore."

The point is that a private health care system is worthless if nobody can afford to pay for the treatment they need.  Unless you are saying that only the rich should have access to health care, in which case I would disagree.  This is the United States of America - everyone should have access to affordable health care.

You seem afraid to allow a bureaucracy like the federal government get control of our health care system.... but you fail to realize that there is no bureaucracy like the private insurance industry.  They deny claims as a matter of course and make the insured fight them to get them to pay what they are supposed to.  I hardly think the government could do worse!

Like I said, I don't like the idea of nationalized health care, but if the private industry cannot provide it, then it may be necessary.  If something doesn't change so that working people can afford private health insurance, then it may be time to investigate alternatives.

Sorry, but you kind of set yourself up for that one!

You mean you want the same government that brought you "affordable housing" to bring you "affordable healthcare"?  It's government that has created the climate in which insurance companies must charge the rates that they do.  Insurance is just like any other business--they certainly don't do what they do because they think Rob Franco is a nice guy and he needs a break.  They're there to make money, and they will either turn a profit or get out of the business.

I don't need the likes of Limbaugh, Beck, et al. to tell me that government solutions don't work.  All I need to do is read a history book.  Better still, I can see the evidence today.  Just look at Great Britain's National Health Service, which is said to be the worst of any industrialized nation on Earth.  Or the Universal Health System in Sweden, under which a man suffering from multiple sclerosis was unable to get a new drug prescribed by his doctor because the drug was deemed "too expensive".  The man offered to buy the medicine for himself, but was not allowed to because the bureaucracy said it would "set a bad precedent" and lead to "unequal access to medicine."

As Thomas Paine once said, "Society in every state is a blessing, but government, even in its best state, is but a necessary evil; in its worst state an intolerable one."  People these days seem to have forgotten that the Holocaust was a government program.

The thing about Neo-Marxists is that they never think what government does is wrong.  They just think that not enough laws have been passed and not enough money has been spent.

I really would not know what Neo-Marxists think. However, I do think that a health care system motivated by the unrestrained greed of the insurance industry and pharmaceutical firms needs uniform regulation. To date the current system has failed. An estimated 46,000,000 people are without coverage, and many that are covered find themselves in the same circumstances as Robert's father...covered by policies that exclude much, deliver little, but still require payment of exorbitant premiums.

In response to your request for evidence...the evidence abounds and surrounds you if you would care to open your eyes. See my citations above to the woman whose insurance was canceled on the eve of her mastectomy, or the woman whose cost of medications for her terminal husband far outweighed the provisions of Medicare Part B (enactment of which was heavily influenced by the pharmaceutical industry) or the threat of pharmaceutical firms to boycott Canadian pharmacies that sold prescription drugs to American citizens at lower prices. These are actual cases.

Another case came to my attention on last night's news. A woman was a resident of one of the western states. She wanted a preventative colonoscopy to detect cancer. Under the state's law the insurance company was not required to cover her colonoscopy, and her colonoscopy was denied. It was a $3,000.00 procedure. She later moved to a state that did require insurance companies to cover colonoscopies. By the time she was able to have the procedure performed she had third stage colon cancer. Her prognosis is not good. 

You seem to be opposed to federal regulation of the insurance and pharmaceutical firms. The fact remains that the insurance industry is already regulated by the state governments which have failed to provide dependable uniform regulation. It is time for one uniform system of law upon which everyone can rely.

You are actually right on target with part of your post, Scott... and I agree.

Insurance is just like any other business--they certainly don't do what they do because they think Rob Franco is a nice guy and he needs a break.  They're there to make money, and they will either turn a profit or get out of the business.

I would like nothing more than for the private health care industry to thrive.  They are obviously in business to make a profit and if they can't do that, they will get out of the business.  That is exactly the problem we have... they are failing.  Not failing to make a profit, but failing to provide coverage to 46 million people, as Kevin mentioned.  If they cannot provide the coverage the people need, then the people need an alternative.

The only reason they are still in business is that they have something that everyone needs and those who can afford it pay dearly for it.  Those who can't just get shafted.  This is the best country in the world... we should not have 46 million people who can't afford to get medical care.  That is just embarrassing. 

I really don't want the government providing health insurance, but the private health care industry needs to realize that if they don't fix this system, it is going to happen.  And I have no problem with the federal government providing coverage for those who can't get the coverage they need in the private sector.  If you like your private health insurance... keep it.  But, for many that is not an option and there are just too many people without sufficient access to health care.

Ok, from the quick scan of the comments I see I have a great big research project on my hands...see scotts comments.  While I haven't had the time to read thru in detail the comments of scott and the others I will be doing that this weekend as this topic really touches my heart because my mom has recently been cut off her insurance because she got cancer a few too many times and has maxed out the policy.  So, don't give me the song and dance about how your wife was taken in after you found the insurance wouldn't cover.  Lets say this for now, thank god you were in a position to be able to show that you could, albeit in time, pay the balance.  Other wise you would find yourself in a whole other situation.  Right now mommy is in chemo again and one drug alone is over $6000.00.  This is breaking my parents not to mention the other drugs she needs just so she can eat, sleep and not vomit all over herself for the next 6 months while they pump her full of shit that could kill her just as easily. 

Since I am batchin' it this weekend I will have nothing better to than research health care, SICKO facts and other things that might have been brought up here.  I am sure I will find the answers and fix the system myself (hahahaha - my attempt to lighten up....)

This seems to be a hot topic in view of everyone's health problems, and the lack of health care available. I think we should move this discussion over to the main board to explore the matter further.

And I have a couple of things I would like to share. I don't know yet my personal opinion on everyone's posts. They all offer a lot to think on...I just have some thoughts/situations I would like to share with you all...

I work for myself, as all of you do. It's just me, no big company, no corporation. I don't make a ton of money, but I make enough to pay my bills and take care of my 3 foster kids. (Yes, I do get money from the state for the foster kids, but it's not very much, not even enough to cover my house payment). 

I have a disease called PKD (Polycystic Kidney Disease). Lots of people have it, but most don't have many symptoms from it and most don't see it progress very far. My family is quite different. My family (maternal side) is 100% positive for this disease. In my family, this has so far in every person progressed to high blood pressure, diabetes, kidney failure, dialysis, kidney transplants and eventually all of this has caused so much damage to the heart that everyone has died around the age of 65...SO FAR. Now, when I was diagnosed with PKD, I was told, "this is a fatal disease"...do me a favor...call your insurance company and ask what your premiums are if you have a diagnosed "fatal disease". Let me save you the trouble. It is zero. You cannot obtain individual insurance coverage if you have what is considered to be a fatal disease. Were I married, and my husband worked for a large corporation, I could get coverage under him. Were I to work for a company that offered a group plan, I could get coverage because it would be on a 'group' policy. But as an individual, in New Mexico (I don't know about anywhere else), I cannot get health insurance.

New Mexico has a state plan, NMMIP or something like that...I was able to obtain coverage under that for about a year. After that, my income increased to above 26k (I think that was the cut off then), and my insurance premium went from $230/month to almost $700/month. Now I'm sorry, but that was not something I could and still can't afford.  Not to mention, the coverage, to say the least, was extremely minimal. At the time, I think I had a $1500 deductible and then my plan was a 70/30 plan, or something round about there. My parents are insurance agents, and if there was any loop hole, plan, or any possible way for me to get private health insurance coverage, they would have found it. Medicare/Medicaid will not be available to me until my creatnine level reaches 5. Mine is currently at 1.2; by the time it gets to 5, I will be ready for dialysis and a kidney transplant.

Last month, I had one of the cysts on my kidneys become infected. This is just something that happens. It's not preventable or forseeable. It normally requires a week or two in the hospital with tons of IV cipro, and usually they have to aspirate the cyst and cauterize it after they cut it open and scrape it out. Lovely, I know...my point is, after the latest bout in the hospital, I owe somewhere around $30k for this. (And because I'm self-pay, they've discounted this 45% or so according to the bill.) I have to maintain my kidney disease...this requires a visit to a nephrologist every 3 months, which requires lab work every time, as well as visits to a pain management specialist, and regular visits to my family doctor. Believe it or not, this 'upkeep' is still less expensive than paying $700/month for the state's health insurance. Now you're probably saying, yea but $8400/year is a heck of a lot cheaper than $30k...which is true! However, I've only ever had 3 cysts become infected in the last 13 years. So yes, $30k is such a large amount of money I can't even consider when I will have it paid off...but on the other side, I truly don't have $700/ month to pay for insurance.

So, where does that leave me? That leaves me with huge bills from a chance infection, and my regular maintenance costs. I do the best I can with all this, it leaves me in constant worry over the "what next" or "what ifs"...but when you can't afford health insurance, you just have to do the best you can with what you have. On a side note, I can't get life insurance either...

Just thought I'd show you all a little bit of my perspective. Again, I have read everyone's posts, and I have a lot to think about before I post any of my opinions on the subject. I just wanted to give you all something else to mull over. I am secretly hoping someone may have some idea I've yet to come across! 

Well, Scott....you asked for evidence. If my citations do not satisfy you, I think Joyce's comments would be ample proof of why the health care system now in effect is a total failure.

Hi Joyce,

I read your blog. Right now what the insurance companies are required to cover is governed by the laws of individual states. What some states require an insurer to cover may not be required in other states.

You could consider moving to a state that would require coverage for your condition. Connecticut has two programs which you might consider. One is the new Charter Oak plan sponsored by the state at affordable rates. However, the down turn in the economy has impacted on the growth of the system. It has gotten off to a slow start. Connecticut also has the state sponsored re-insurance fund. It is very expensive, but it has guaranteed acceptance even with pre-existing conditions.

Hope this helps.

It's not perfect, I admit, but "total failure" is a bit of a stretch.  I seriously doubt that any of the folks here like Joyce or Clanci's mom or Rob's dad would fare much better under a federal government-run program, for a host of reasons.  Actually, Joyce's situation in particular is a classic example of why it's a bad idea.

First of all, price controls have never worked any time they've been tried.  The Code of Hammurabi was basically a set of wage and price controls which eventually led to the fall of the Babylonian Empire.  In ancient Rome, Diocletian attempted to fix prices on commodities like corn and wheat, resulting in widespread shortages and rampant inflation.  More recently, President Nixon tried to combat inflation with his wage and price freeze in the 1970s, with disastrous results.

Secondly, the evidence is overwhelming that attempts to control costs in government-sponsored health plans are a dismal failure.  In Germany, according to a 1993 article in the New York Times, the result of price controls on the pharmaceutical industry was supply shortages, patients being denied medications and drug companies scaling back the research and development of new medicines.  In Great Britain, the National Heath Service is notorious for leaving terminally ill patients to die on "waiting lists" due to rationing of care and "allocation of resources".  As many as 15,000 Britons a year are denied chemotherapy for cancer because the bureacracy figures they're going to die anyway.

Here in the US, study after study has shown that financing of government-run health programs like Medicare and Medicaid are responsible for the lion's share of the sharp rise in healthcare costs.  at the same time, the true cost of care is for the most part unknown by the average person who is covered by private health plans, most of which cover even routine doctor visits.  As I said before, who cares what it costs when someone else is footing the bill?  Can you imagine what your car insurance would cost if it covered things like oil changes, tires and tuneups?

Bottom line: interfering with market forces creates more problems than it solves.  After reading some of the stories here, I wish I had the answers, but I don't.  I just know that passing more laws and spending more money will make things worse.  I don't like it any better than anyone else, but as the saying goes, life isn't fair.  And no government on earth will ever be able to change that.

The problem with your analysis is that it exalts money over human life. What you fail to realize is that the current system leaves people such as Joyce and Clanci's mother with no medical treatment at all...or in the case of Robert's father a policy that contains so many exclusions as to be worthless, but still requires huge monthly premiums.

Your comments are governed by a doctrine called "Historical Determinism." It means that because this is the way a system has worked in the past it is cast in stone , and cannot be altered. Given the choice between no treatment at all or treatment under a government sponsored plan...I think I would opt for the government sponsored plan. The more highly priced health care insurance will still be there under the Obama administration as competitors. Hopefully it will create competition that will force the insurance companies to reduce their prices to a competitive level.

I would take issue with your statement about the British National Health Service leaving patients to die on waiting lists. At the very least it is negligent homicide, and at the worst it is murder. The first precept of the Hippocratic oath is... "Do no harm."

The government-run system you advocate would leave more people with "no care at all" than we have now.  My comments are governed not by "Historical Determinism" as you suggest, but by the laws of economics, which are just as immutable as the laws of physics or gravity.

As far as the British NHS is concerned, I didn't make that up.  Take issue with it all you want, but facts are facts.

Hi Kevin,

Thank you for the information. As a matter of fact, I have several family members who lived in Connecticut for many years (off and on) because of their health care system. My grandmother specifically moved there because of it. My aunt and two cousins also continued to live there after being diagnosed because of the health care there, also.

I wish I could move and take advantage of it! Believe you, me! Maybe after my mother gets her transplant and is fully recovered from all that she is going through. Over the Christmas holiday, she had both kidneys removed because they were too large to fit in her body any longer.

I am still reading everyone's blogs and ideas, I really appreciate the input and enjoy reading everything you all have to say on this subject! I am with Clanci, I need to do a lot more research and reading and looking into before I can form an opinion on the matter. Like I said, I don't know much about it, only my specific situation.

I do wonder...Scott's post...his first paragraph, about faring better under a government-run program...my waiting times right now to get into my nephrologist are ridiculous. I have to make my appointments 9 months in advance, which becomes fun trying keep up with 3 month intervals in appointments! But...I wonder, is that any different than what you are talking about Scott? Not a criticism at all, just a question from a gal completely unfamiliar with government-run health care. Like I said, I have a ton of research and reading and getting exposure to the information before I form an opinion, that was just something that caught my eye.

:O)

While SICKO touches on our problems and the success of other countries in their respective plans it is clear to me after a two day research project that was completely overwhelming - sickening and sad - that our health care system is broken and in dire need of repair.  This is not one of those things that fall under "if it ain't broke, don't fix it". 

During my research I checked into Canada vs. US health care mostly.  There are numerous articles and websites but the general over view of the problem in Canada is the wait times.  I found that there are long wait times for "non-emergency" surgeries and things like that especially cosmetic types - circumcisions etc.  Over all they live longer than us, have lower birth mortality rates and rank better than us in health care.  Now, granted they do have a higher heart attack death rate which I found is mainly because they lack the technology and expertise that we have her in the US.  That is because they never really had all that many and really didn't need the technology.  In the last few years Canada has addressed this issue and the survival rate has increased accordingly. 

So, Scott, you may be right in the sense that "Sicko" or Michael Moore is not the answer but given the brillant minds in this country I am sure we can figure out a way to combine the two.  Take the best of what we have - if there is such a thing - and take the best on Canda's, GB's, Frances plans and make one plan. 

Altho, more reasearch is required for me to have a major cataclysmic solving event I did find there are many, many goods in a Nationalized Heath Care program.  This should not be confused with "socialized medicine" as I truely believe there is a difference, a fine line but different in its own right.  The terms are used interchangably and inconsistently so I found it a bit difficult to determine one from the other with out really diggin in deep. 

I will now flip over to the discussion page for the rest of the story. 

Scott, explain to me what "low quality care" is???  Are you serious, do you really believe there should be such a thing.  Next thing you know you'll want seperate hospitals for the rich only....oh, wait a minute, we already have that.

Insurance is nothing more than a private form of socialism -- spreading the cost around to a larger pool of people so a few can benefit. Government is not the only form of socialism, you know? Any time you get resources from a large pool of people and give them to a smaller group, you are practicing socialized redistribution. What we have now is a mishmash of private (insurance) socialized medicine with public (Medicaid, Medicare, Vets Care,etc) socialized medicine -- and it is not working. We have far too many people who simply do not get the most effective medical care because they cannot afford to go to the doctor or the hospital or the clinic until symptoms make them too sick to do otherwise.

Try reading _Nickel and Dimed_ by Barbara Ehrenreich to see what it is like to a working poor person in America. Try thinking about all the problems that are made worse because we ignore the health-care basis of them until they blow up in our faces.

I spent a decade involved with the Libertarian Party in several states. I still support the basic philosophy of laissez faire capitalism -- but what we have now is NOT free market capitalism, it is gotcha capitalism, where those who have the capital make the rules that everyone else has to live and die under -- and we are doing far too much of the dying and far too little of the living under the current system.  Elected Republicans who stole libertarian rhetoric (and continue to use it) have zero credibility in this discussion about health care because they failed to do what the rhetoric calls for when they were in power.

Unless you and others who oppose socialized medicine are willing to offer a system that actually takes care of the working poor, the children of the poor and middle classes, and that does not unduly burden the working middle class while adding to the sickening disparity of wealth between the top 10% of American society and the rest of us, I would respectfully ask you to shut up while those who were elected to figure this mess out work up a plan. Once they actually release a plan, then you can see if you have some constructive input to offer.

All, IMHO, of course. (No insults intended.)

to whom are your comments addressed?

Go back and read the post more carefully, Clanci.  I am simply stating that a large federal healthcare bureaucracy will RESULT in lower quality care with a much steeper price tag.

I knew what you meant - i think - I just couldn't help it....hahahaha.  Ya sort of left the door cracked a bit so I could squeeze thru.  Yes, in a way I agree with you about the results altho, keeping the same system isn't good either.  :)

Okay, I don't actually have the solution.  But I've always wanted to say eureka.  I have read all of the comments in this thread, and I am now going to offer my thoughts, notwithstanding Timothy's wish that we wait until the debate is over before we provide our input.

1)  I carry catostrophic health insurance for my son, with a very high deductable.  When I take him for office visits, and they ask about insurance, I simply say I'm paying, and ask "what's it going to cost?"

2)  Although we are not cars, and should not be treated as such, it seems to me that things worked better when health insurance worked like auto insurance, or homeowners insurance, works today.  We don't tend to invoke the insurance in the event of minor damage.  We save it for the expensive stuff, like when we crack that crappy plastic bumper. 

It does occur to me, though, that preventive care was pretty much the point of the HMO.  People were not willing to pay the fifty bucks for a visit to the family practitioner.  So now, since the HMO picks up the tab, we can bring the kids into the emergency room every time they sneeze.  I hate HMOs.  They are an unnecessary layer of bureaucracy, one that is unqualified to make the decisions they are charged with making.

I have a health savings account.  The HSA is one of the good deeds of the Bush administration that never gets any good mention.  When our office insurance rates went up, yet again, I was able to take the difference and contribute to the account.  So, my premium remained the same while I was building up the funds to pay the deductable in the event that I need it.  And if I don't need it, the money is not forfieted.  It is catostrophic insurance with a set-aside to pay the costs that the insurance does not cover.  I like it.

3)  The time for having health insurance controlled by the employer has come and gone.  It was once used as an incentive to gain valuable employees - probably because so much of the potential workforce was killed during WWII. 

Without the pools, there would still be a need for competition in the insurance industry.  Just as there is for auto insurance.  It, too, may be a pain in the neck, but it is not nearly as screwed up as the health insurance industry.  Competition at least keeps the insurance to a tolerable level.

That said, I support a safety net for those who are just in a bad spot and cannot afford any insurance.  The government has my blessing to step in, in those cases, to provide temporary assistance.  Or long term assistance if they got shot up in a war to protect our liberty.

I don't remember insurance being any other way.  Guess I am not old enough.  I hate HMO's too.  Scott said once before that a  few of the downfalls of Nationalized HC (NHC) are long waits and you won't get to choose your doctor.  Well, isn't that basically what we have now.  Every plan I have been on required you pick from the "approved doctor list" or you fall into the other category and can pick your own but you have to pay more deductibles and higher office visit fees.  In essence you get penalized if your doctor isn't on the plan anf forced to switch to one you don't know that gets "paid" by the HMO. 

I bowl with a girl that got e-rays done 2 months ago to see what is going on with her hip and why it keeps locking up.  2 months she waited to get the results, which by the way turned out to be severe arthritis and at some point will need a full hip replacement.  It is just a matter of time.  Who wants to bet her insurance company will find a way to deny the claim by the time she needs it.  Pre-existing condition is what they will claim.

I just spoke to another friend who has to get a bunch of test done on hubby to see if he has dimentia - it will take over 2 months to get him in to see a neuroligist.  It is a crock to think that long waits are the down fall of NHC.  It is the same wait time here in the States.  So, I suppose we ruled that fault out.