Health care problems and solutions in politics

[stevil]

Stevil, I brought this up in the Abortion Dabates section and got this message for everyone else: It would be the same as killing a two-year old because you don't have insurance.

We can just disagree on this.

A good question would be how early in life should "childcare" begin?

Once it's born it would be childcare. Prior to that it would be healthcare of the woman.

Neonatal care absolutely needs to be covered in any children's health insurance plan. But then you come across the ethical questions about the age of viability. Should babies be born and taken to the NICU (neonatal intensive care unit) or stay in the uterus until their due date while the mom pays for pregnancy-related issues?

The doctors should consult with the parents with regards to making core decisions regarding health. Govt should cover the costs. Shouldn't need health insurance for this.

This is why I suggested the government could create a plan for women who think they may be, definitely are, or just were, pregnant. My fear is that many women have abortions because they lack the necessary health care coverage for the next several months (up to nine) so I want to see what the govenrment can do to give pregnant women a full range of health services that will drastically decrease the costs out of her pocket to deliver a baby.

Govt should cover costs, should at least provide ultrasound twice, should at least provide a mid-wife, and maybe anti-natel classes. Should at least provide hospital services for the birth, should at least provide post-natel care, and support, to help mothers progress on their journey with the new born.

The goal isn't to reduce abortions, but it is to support mothers and babies in these difficult times.
Of course being pregnant and giving birth and getting vaccinations and the like shouldn't make the family poor. Govt should provide these basic services free.

 

[GodLovesCats]

My thinking is a good side effect of more health care coverage for pregnant women and new moms is the number of abortions going down.

What do you mean by "antinatal" care?

 

[rjs330]

Actually a copay and deductible are totally different. A deductibe is how much money you must pay for a treatment to be insured for it. For example, I could be insured for a certain medication after spending a $600 deductible. A copay is what you pay a receptionist for a therapy or doctor appointment.

Right I know that. That's why I clarified. I was trying to get a grasp on what the Aussies do and how they do it. I understand how it works here. I've had insurance for 34 years.

 

[GodLovesCats]

OK I thought you said it wrong.

 

[rjs330]

RJ, the biggest flaw in the ACA (for me personally) is it does not require insurance companies to keep the same prices for extended release verions of drugs when someone needs to switch. Mom could pay just $5 for 3 months of a regular medication but I must take the XR version and it costs hundreds of dollars even though they are exactly the same drug. The only way I can get it is free from the manufacturer, based on my low income level by filling out a form the doctors gives me every year. And this is a drug I can't live a single day without. At the bare minimum there needs to be a very low price cap on prescription drugs.

That sounds good in theory. But how do companies recoup the cost of drug development? I suppose during the patent process the companies could submit paperwork outlining the cost and the patent office could give them a patent based on the time they would need to recoup the cost plus profit before anyone else can produce the drug.

The unintended consequences of forcing price control is lack of development. It would slow drug development down. I've read that America is the leader on developing drugs. And I hate to say it, but companies are not in the business just to make drugs to help people. They are in it to make money. So to cost control would slow beneficial drug development.

Just as an aside in your case it doesn't sound like it's the exact same drug. There has got to be some difference if you can't take one but can take the other. There's got to be something different in the drug.

 

[GodLovesCats]

The only difference is the letters XR. This means instead of all 100 mg of each pill coming out together, it trickles out at a slower rate. This keeps me seizure-free all day with one dose. A lot of drugs are like this, includig my sleeping pill, which also was nearly impossible to get in the XR form for the same reason.

 

[rjs330]

If you look at the graph below you'll see two things:
1. The US has the highest healthcare cost in the OECD (actually the highest in the world)
2. Most of the extra cost comes out of your (private) pocket (the red section of the bar chart)
Considering the standard of US healthcare is generally rated below that of comparable countries it appears the extra cost is not achieving anything useful.

List of countries by total health expenditure per capita - Wikipedia

OB

The ratings of healthcare are generally biased. Our healthcare is second to none when it come to the actual care itself. We have fast and excellent care. The ratings are biased in that "national healthcare" is used as a measuring stick. So it's not an accurate depiction of the care itself.

When you have insurance, which includes Medicare or money you get great care! Best in the world! The other thing they rate is life expectancy. That is also often biased. It's not based upon whether the doctors are taking care of you properly. It's an overall view. And in America we have very high rates of death by accidents, homicides, and poor eating habits etc. That has nothing to do with the care people receive medically.

The problem is the cost is too high. And as noted, there are people who can't get medicare and are to poor for insurance. That has to be fixed as well as the general costs. We could just say, okay, everyone is covered by the government. But we don't really want our government controlling our healthcare. The government would not just pay the doctors bills. Medicare right now often just flat denies the doctors first claim or two. They have to jump through a bunch of hoops to get paid and then it's only 80% of the ALLOWED cost. Hospitals have to jack up the costs really high to cover all the people who don't pay their bills or can't pay them or the bills are paid by Medicare which don't cover the costs.

Cost is the driving factor now. How do we get the costs down?

 

[rjs330]

The only difference is the letters XR. This means instead of all 100 mg of each pill coming out together, it trickles out at a slower rate. This keeps me seizure-free all day with one dose. A lot of drugs are like this, includig my sleeping pill, which also was nearly impossible to get in the XR form for the same reason.

Ahh...I see. Thanks for sharing. Are you unable to stay siezure free on the non XR medication?

 

[GodLovesCats]

Ahh...I see. Thanks for sharing. Are you unable to stay siezure free on the non XR medication?

For me personally, it's a matter of not getting seizures at night as the drug's effect wears off and taking a normally twice-daily drug once a day. I can make up a bunch of hypothetical situations based on what my mom went through trying to get the right pills at Walgreen's.

 

[stevil]

My thinking is a good side effect of more health care coverage for pregnant women and new moms is the number of abortions going down.

What do you mean by "antinatal" care?

My spelling was wrong
Antenatal care

It is care from before the baby is born.
You meet with a midwife, they do some blood tests, they talk to you about vitamin suppliments, they get you to do a 12 week and a 20 week scan, they get you into an antenatal class where you meet with other pregnant people and are told what to expect during labour, and your antenatal class later becomes a coffee group where you meet up regularly and talk about your experiences with a new born. Shortly after a new born arrives and once people come out of hospital we might make a meal for each other, to help out and so the new born's parents don't need to cook for a night.

We have a plunket person arrive at our house and do a checkup, and as the baby gets older we then visit the plunket person at their address, they check to see that the kid is developing nicely and that the parents are coping.

This is all for free

I don't know if this happens in USA.

 

[GodLovesCats]

Cost is the driving factor now. How do we get the costs down?

Doing what every Republican on the planet would balk at: kill the entire health insurance industry outside of public employees. Although my mom insisted it is not Humana driving up prices, because they are who she spent 2-3 months talking to about multiple prescriptions, I can't believe that for one second.

 

[Occams Barber]

The ratings of healthcare are generally biased. Our healthcare is second to none when it come to the actual care itself. We have fast and excellent care. The ratings are biased in that "national healthcare" is used as a measuring stick. So it's not an accurate depiction of the care itself.

Here's a summary of the major international studies of healthcare systems and the USA's ranking. Show me where "national healthcare" is used as a criteria.

The Commonwealth Fund (2017) looked at healthcare system performance in a basket of 11 developed countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK and the USA.) The USA rated last.

Compare the same basket of countries against 4 other major studies of healthcare;

• Legatum (2017); Rankings :: Legatum Prosperity Index 2019
• Lancet (2015); https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30818-8/fulltext
• Bloomberg (2017); Bloomberg. Most efficient health care systems in the workd – Largest-biggest.com
• WHO (2000); http://www.who.int/healthinfo/paper30.pdf

In three of the four studies the USA rated last. In the fourth study (WHO) USA rated second last ahead of New Zealand. Note this is a fairly old (2000) study. New Zealand has since improved.

​

The other thing they rate is life expectancy. That is also often biased. It's not based upon whether the doctors are taking care of you properly. It's an overall view. And in America we have very high rates of death by accidents, homicides, and poor eating habits etc. That has nothing to do with the care people receive medically.

"Healthcare" goes beyond "whether the doctors are taking care of you properly". Managing obesity, suicide, accident rates, addiction, drug use etc. are all considered part of a comprehensive healthcare system.

But if you want to deny the health implications of low life expectancy what's your explanation for high infant mortality ? (The USA's 'highest' ranking is compared to the basket of 11 developed countries mentioned above)

• Infant mortality under 12 months: (CIA World Factbook via Wikipedia) – USA highest
• Infant mortality under 5 years: (World Bank via Wikipedia) - USA highest

All health systems (including mine) have problems, They don't get fixed by sticking your head in the sand and pretending they don't exist.
OB

 

[jardiniere]

I would sure like to see the details behind this. It's easy to throw stuff out like this, the devil's in the details. Who exactly are the people that are saying because they don't have health insurance. What are they dying from and what would have health insurance done for them. Why don't they have health insurance? Too many questions for me.

Got it for you: deaths from lack of health insurance. This is the study cited in the article.

"Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time."


"Replicating the methods of the IOM panel with updated census data24,25 and this hazard ratio, we calculated 27 424 deaths among Americans aged 25 to 64 years in 2000 associated with lack of health insurance. Applying this hazard ratio to census data from 200526 and including all persons aged 18 to 64 years yields an estimated 35 327 deaths annually among the nonelderly associated with lack of health insurance. When we repeated this approach without age stratification, (thought by investigators at the Urban Institute to be an overly conservative approach)23 we calculated approximately 44 789 deaths among Americans aged 18 to 64 years in 2005 associated with lack of health insurance."

 

[MorkandMindy]

...
Who exactly are the people that are saying because they don't have health insurance. What are they dying from and what would have health insurance done for them. Why don't they have health insurance? Too many questions for me.

I am one of those.

I'm in immediate danger from borderline hypertension

I could pay for my meds but government regulations forbid it

I can't get meds without a prescription

I could go to Mexico and a doctor there would prescribe the 5 mg Amlodopine and 20 mg Lisinopril pretty much everybody with borderline hypertension takes to stop the elevated blood pressure from destroying our kidneys and eye retinas.

But it is illegal to bring more than 2 months supply into the US and only a US doctor's prescription can be filled in the US.

They would far rather I die than miss the chance to make money.

 

[MorkandMindy]

I was refused Medicaid because I am now 65 so the state said I am now eligible for Medicare, and they can supply Medicaid only to cover the gaps in Medicare.

The federal government said since I have only 34 credits and need 40 I am not eligible for Medicare.

The state said without Medicare I can not get Medicaid because it can only be used as second cover for someone over 65, so I get neither.

I read lots of regulations, and no, I can not be covered. You would not believe how many regulations there are and how long and convoluted they are. The first sentence in SSA 1905 is three pages long.

Common Law on which the law of the US is based, well British law is, considers void any law which would deprive a person of the right to survive, and a person has a right to oppose it. That applies in many countries, but the medical system here does not acknowledge the right to survive over their right to make money, it is illegal to bring more than your personal supply (2 months) of medication into the US, even if it was US manufactured, that is called 're-importing'.

 

[GodLovesCats]

Mark, I went the opposite direction, getting the same drug I complained about earlier (lamotragine) from, unbelievably, Canada. The ACA was supposed to fix that, but it had already been in effect several years - and other patients were still ordering medications from Canadian pharmacies. The nurse practitioner who prescribed those pills (a neurology specialist I know very well), warned me Canada gets them from India so their quailty is much lower. Naturally I went back to American-made pills ASAP.

 

[GodLovesCats]

I also had a problem with not being allowed to take a medicaiton because of Medicare. Although all health insurance companies prevented me from taking it when Mom initially signed up for their plans, eventually they did start covering it. But when Medicare Part D entered the picture, they said I am in the "doughnut hole." That meant I had to stop taking the drug permanently.

(International posters: A "doughnut hole" is another kind of coverage gap affecting patients who get their drugs through Medicare Part D.)

 

[Allandavid]

because there is no such thing as free, and "free" stuff people tend to abuse.

This thinking is strange to me...

I’m Australian. While I continue in the workforce, a component of my taxes essentially pays for my health care. When I retire, it is covered by those who pay taxes.

Despite the predictions of gloom-and-doom merchants, it has worked quite well for over 45 years...

“Abuse”....?? Do you think I intend to spend all my spare time hanging around a doctor’s office, just to make a nuisance of myself...??

 

[GodLovesCats]

Allan, it is not the doctor appointments, but the medications, you could abuse. America has a HUGE crisis now with opioids. Although heroin is illegal, some other opioids can be prescribed as "controlled drugs" to patients who just need strong painkillers for a few days. Unfortunately, despite their best efforts to take a legal opioid exactly as prescribed, patients develop a tolerance to the drug and are unable to get off it, so they go doctor hopping to get more prescriptions. If opioids were free, everyone who complains Advil and Tylenol don't work would be addicted to them and drain government money for real health care.

 

[dogs4thewin]

Allan, it is not the doctor appointments, but the medications, you could abuse. America has a HUGE crisis now with opioids. Although heroin is illegal, some other opioids can be prescribed as "controlled drugs" to patients who just need strong painkillers for a few days. Unfortunately, despite their best efforts to take a legal opioid exactly as prescribed, patients develop a tolerance to the drug and are unable to get off it, so they go doctor hopping to get more prescriptions. If opioids were free, everyone who complains Advil and Tylenol don't work would be addicted to them and drain government money for real health care.

no I was talking about abusing appointments running to the doctor for every little thing.