Health care problems and solutions in politics

[Occams Barber]

What is a heavy subsidy? How do people get it fpr hearing aids?

I'm not that familiar with the details but I understand that the more basic hearing aids are provided free but if you want the bells and whistles model you'll get a subsidy equivalent to the cost of the basic model.

Eligible people would typically include Age Pensioners, Veteran Pensioners or people with a relevant disability.
(note: in Australia people with a disability are provided with specific funding which they use to purchase approved forms of assistance. In the link below it's referred to as the NDIS - National Disability Insurance Scheme. There's also a similar scheme aimed at older Australians.)

This booklet has more detail although it will not give you a specific % or $ value.
Client Information Booklet
OB

 

[Occams Barber]

What do you do with people who can't afford the deductibles?

I had to look "deductible" up in Google. Turns out it's US specific terminology for what I know as an 'excess'

North American
noun: deductible; plural noun: deductibles
the part of an insurance claim to be paid by the insured; an excess.​

Short answer - there is no "deductible". There may sometimes be a 'gap payment' - a small payment to cover the difference between the doctor's/specialist's fee and the Medicare refund they receive. Many doctor's forgo this particularly for older or low income clients. There is no 'gap payment' for hospital services.
OB

 

[jayem]

I am not aware of any health insurance companies paying for abortions.

Some insurers do. It's complicated. Pursuant to the Hyde Amendment, ACA plans that are eligible for federal premium subsidies do not cover elective abortion. Abortion coverage in other private health insurance depends on the state. Group health plans that are bought by employers (known as "fully-funded" health plans) are under state regulation. IIRC, about 11 states flatly prohibit coverage for elective abortion. Other states allow it. (I know that CA, NY, OR, and WA require fully-funded plans to cover termination.) And it also depends on the employer. Some employers won't cover elective abortions--others will. Most large companies, i.e., Fortune 500 size, are self-insured. They pay employee medical bill directly, usually hiring an insurance company to handle claims as a TPA (third party administrator.) Self-insured plans are exempt from state regulation. So such plans can, and do cover elective abortion even, if the state prohibits abortion coverage in fully-funded plans. I worked for a large private hospital system with >25,000 employees. My health coverage was self-insured. Elective abortion was a covered benefit.

To be honest, the dirty little secret is that most private health insurers would have little problem covering abortion. It's much cheaper to pay for a 1st trimester termination than to cover 9 months of prenatal care, labor, and delivery.

The ACA excludes contraceptives because Republicans balked at the idea to include them. (FYI that is the law commonly called Obamacare in the United States. Its official name is the Affordable Care Act.)

Also not quite true. ACA plans sold to individuals on the exchanges must cover contraceptives without cost-sharing. This is still in force. ACA also required employer group plans to provide the same benefit. This was challenged in the Hobby Lobby case. SCOTUS ruled that an employer whose religious convictions prohibited such coverage was exempt. Actually, Hobby Lobby didn't object to all contraceptives. Only to several emergency contraceptives ("morning after" pills) which they believed induced abortion if fertilization has already occurred. A view that was not shared by mainstream gynecologic opinion. But that's off topic.

 

[Tanj]

I would sure like to see the details behind this.

Your clicking finger not working?

New study finds 45,000 deaths annually linked to lack of health coverage

Who exactly are the people that are saying because they don't have health insurance.

The people that did the study. See above link.

What are they dying from

Anything, everything. Turns out "being dead" . is pretty easy to measure.

and what would have health insurance done for them.

Not have them being dead, as was found for the group of people that did have insurance.

Why don't they have health insurance?

Because your system sux0rs.

Too many questions for me.

What's the limit on questions you can handle?

 

[jayem]

These are only my proposals and not based on what would be realistic with a Republican Senate majority. For the purposes of this topic only I am assuming both sides of Congress will be controlled by Democrats. In no particular order of importance:

1. Require all employers with at least 25 employees to include health insurance benefits to part and full time workers.

I generally agree with your points, except for that. The linkage of health insurance and employment is an obsolete relic of the WW2 era that must be terminated. It serves no one's benefit. If you're an employee, why would you rent your health insurance from your job? Because that's what you're doing. It's absurd. If you lose your job, or want to change jobs, you lose your coverage. (Except for 18 months of COBRA, which can cost you 101% of the full premium.) Your and your family's coverage should belong to YOU--not to your employer. And providing health benefits to workers is an enormous and continually increasing expense for employers. I worked 18 years in the occupational health division of a large hospital system. One of our clients was a national manufacturing company with about 17,000 employees at the local facility. Like most big businesses, they were self-insured. They paid employee, dependent, and some retiree medical costs from operating revenue. This company's largest single line-item expense was health care. Bigger than payroll, raw materials, R & D, daily operating costs, utilities and plant maintenance, marketing, taxes, and admin. It's crazy that a company in the manufacturing business spends more on employee (and retiree) medical bills than any other item. And these costs are always rising. So the prices the company charges must also rise. Coupling health coverage with employment puts all of our businesses at a disadvantage vis-a-vis their foreign competitors operating in countries with nationalized health systems. This unholy union has to end. Politicians and political parties claim to be pro-business and pro-jobs. I can think of nothing that will aid existing businesses, stimulate new business creation, and promote job growth more than getting the health benefits monkey off the backs of our employers.

 

[Hank77]

That attitude murders your countrymen.

Study: 45,000 Deaths Per Year Due to Lack of Health Insurance




Nice strawman you built there, nicely knocked down too. What the heck is "regular wellness exams and disease testing"? Seriously? My single payer system diagnosed and paid for my kidney cancer. Is that different enough for you?

If you don't mind would you share how much you pay for your insurance?
I don't understand Australia's health coverage system at all, everything I have read is confusing.

 

[Hank77]

I am not aware of any health insurance companies paying for abortions. The ACA excludes contraceptives because Republicans balked at the idea to include them. (FYI that is the law commonly called Obamacare in the United States. Its official name is the Affordable Care Act.)

Contraceptive Coverage Under the Affordable Care Act. ... The ACA mandates that private health plans require coverage for 18 methods of contraception used by women, including female sterilization, along with related counseling and services. It also requires this coverage to be provided with no patient out-of-pocket costs.

Remember this case that went all the way to the SCOTUS, the Little Sisters of the Poor? This is a fun read, it made my heart smile.
Little Sisters of the Poor v. Azar - Becket

 

[Occams Barber]

If you don't mind would you share how much you pay for your insurance?
I don't understand Australia's health coverage system at all, everything I have read is confusing.

First of all forget about private insurance.

Australian healthcare is financed through the tax system. A combination of a 10% Goods & Services tax (GST), combined with a 2% levy on high income earners, pays for the system (along with schools). The Federal government collects the money and returns it to the states to use in building and running hospitals. Most hospitals are publicly funded from this tax. Since they are publicly funded they are not-for-profit. No-one who uses the public hospital system is charged. Everyone has access.

Fees for medical services outside of hospitals are based on a standard fee for service set periodically by the federal government. Doctors etc. may charge patients what they wish however the federal government will only reimburse a standard amount per consultation. Some doctors charge at the government rate; others may charge more. Where a doctor charges more than the set rate patients will be charged (by the doctor) a 'gap payment (a 'co-payment'). While doctors will often charge a gap payment this does not usually apply to low income patients or older patients.

Pharmaceutical products are also heavily subsidised.

Some people may also choose to buy private health insurance. This may help with early access to non-critical surgery or a higher level of hospital accommodation in a privately run, for-profit, hospital. Broadly speaking younger people avoid private insurance while older folks use it since they are more likely to need hospital services.

The take home message is that EVERONE regardless of income, lack of income or medical status has a right to free ongoing hospital care and subsidised (or free) doctor consultations, pathology, X rays etc.

There is also a heavy emphasis on preventative medicine through free vaccination, various cancer screenings and campaigns on public health issues.

OB

 

[Hank77]

First of all forget about private insurance.

Australian healthcare is financed through the tax system. A combination of a 10% Goods & Services tax (GST), combined with a 2% levy on high income earners, pays for the system (along with schools). The Federal government collects the money and returns it to the states to use in building and running hospitals. Most hospitals are publicly funded from this tax. Since they are publicly funded they are not-for-profit. No-one who uses the public hospital system is charged. Everyone has access.

Fees for medical services outside of hospitals are based on a standard fee for service set periodically by the federal government. Doctors etc. may charge patients what they wish however the federal government will only reimburse a standard amount per consultation. Some doctors charge at the government rate; others may charge more. Where a doctor charges more than the set rate patients will be charged (by the doctor) a 'gap payment (a 'co-payment'). While doctors will often charge a gap payment this does not usually apply to low income patients or older patients.

Pharmaceutical products are also heavily subsidised.

Some people may also choose to buy private health insurance. This may help with early access to non-critical surgery or a higher level of hospital accommodation in a privately run, for-profit, hospital. Broadly speaking younger people avoid private insurance while older folks use it since they are more likely to need hospital services.

The take home message is that EVERONE regardless of income, lack of income or medical status has a right to free ongoing hospital care and subsidised (or free) doctor consultations, pathology, X rays etc.

There is also a heavy emphasis on preventative medicine through free vaccination, various cancer screenings and campaigns on public health issues.

OB

Thank you very much, that sounds simple enough. One more question. When you say including 'schools' do you mean medical schools or the public school system.

10% on my salary, at my last job before retiring, would be approx. $200 a month less than I was paying for my share of my employer group ins. with Anthem Blue Cross/Blue Shield.

 

[Occams Barber]

Thank you very much, that sounds simple enough. One more question. When you say including 'schools' do you mean medical schools or the public school system.

You're welcome. The school component of the GST pays for public schools. We also subsidise private schools on a $$$ per student basis.

10% on my salary, at my last job before retiring, would be approx. $200 a month less than I was paying for my share of my employer group ins. with Anthem Blue Cross/Blue Shield.

It's effectively a little less than 10% since you only pay GST on the goods and services you actually purchase. Remember there is no "deductible", no limitation based on prior condition and no time limits on treatment.

Over and above this there are special schemes designed to assist people with a disability and older Australians. These schemes basically provide funds which can be used to purchase approved support services.

I would never claim that Australia has the best healthcare system but...compared to the USA...
OB

 

[Silverback]

It's not about waiting - Its about managing health at the most appropriate point - So to use your example - Going straight to a Dermatologist may be unnecessary. In a well designed health structure, your local General Practitioner may be more than adequate; OR your systems could set up skin check clinics etc so that your suspicious mole or your flare up of psoriasis can be checked, before the need to go in the expensive direction of a Dermatologist. Its about using the health dollar more wisely, and for the objective of wellness ie treating the population before its a serious problem.

Primary Care is the best value for money. The USA suffers from an epidemic of Type Two diabetes and a dependency on joint replacement - higher than any other country in the OECD - Of course one of the major factors is the high obesity rate there.

Where few dollars are spent on primary care, the population is sicker, less fit, and more dependent on expensive care options - which if your poor, is a disastrous situation.

I know people are resistant to change - But really there's some fantastic benchmarks in health systems around the world - and change is needed or the USA wouldn't have such a poor individual health status compared to other OECD nations.

I'm not saying your wrong, I'm just saying Americans are use to going straight to a specialists if they have that opportunity, and there would be major pushback at the polls, if that was taken away.

 

[Silverback]

The problem with having employers pay for health care is that
1. Not everyone is employed
2. In USA (it seems) that you have a lot of people with strong religious views, especially with regards to family planning, such as contraceptives, abortions, the morning after pill etc. This is fine if people are choosing to buy their own healthcare insurance, but if they are buying it for others i.e. employees, then they might have "moral" conflicts with regards to buying things which other people would call bare necessities.

I have no problems for employers to optionally offer medical coverage as an added extra, But I do have problems if employees need medical insurance and need employers to pay for it.

I think the government should subsidise medical care, be that a direct subsidy or via a country wide medical insurance for all. But also it should be allowed that private medial care and private insurance companies also exist for those people who want to buy extra coverage.

Although things are changing here in the US, most people still view Government as a necessary EVIL, and most still would not want the Government telling them "we are ending your chemotherapy" Insurance companies may do that by refusing to cover your Chemotherapy any longer, but it would not be viewed the same as the Government saying "NO" that's why Elizabeth Warren and Bernie Sanders are stagnant, or, dropping in our polls.

When our Government says "we are here to help" most Americans still view that with suspicion.

Maybe within a Generation things may be different. I don't know of any millennial who would say "we trust our healthcare to President Trump"

Many in my Generation would call a National Healthcare System...Tyranny, not all, but many, but we seem to be OK with Medicare, probably because we paid into it for 30 years, or, more.

 

[Occams Barber]

Although things are changing here in the US, most people still view Government as a necessary EVIL, and most still would not want the Government telling them "we are ending your chemotherapy" Insurance companies may do that by refusing to cover your Chemotherapy any longer, but it would not be viewed the same as the Government saying "NO" that's why Elizabeth Warren and Bernie Sanders are stagnant, or, dropping in our polls.

Under the Australian system the government can't say "no". The government has no say in the specific medical treatment you do or do not get. It's not like the private insurance system.

Americans are so fixated on the private insurance driven, for-profit system that I think it's become impossible for them to think outside that system and conceive of better alternatives.

OB

 

[KCfromNC]

Exactly, what you don't have to pay for has no value

Might want to ask the person you're replying to who pays for their health insurance.

 

[Larniavc]

Do you have any evidence to support this assertion that people will abuse publicly funded healthcare?

I routinely drive without seat belts and encourage my passengers to do the same because I lice in the UK and would not have to pay for my treatment.

 

[Larniavc]

AT MINIMUM $3000 per ear. And unless you have a conductive hearing loss, both ears are affected.

It makes no sense at all that the government does not recognize hearing aids as medical devices for health insurance purposes. Don't they reqiure approval from the FDA to exist?

That’s outrageous. My Nan had a one sided hearing aide for decades and she never paid a penny.

Are you in America (I’m guessing by your mention of the FDA).

 

[Larniavc]

With a single payer system, does Australia give people choices on health plans?

In the UK that would be called ‘going private’ and anyone with money can get it without effecting their ability to access the NHS.

 

[98cwitr]

Here's my problems with relying on government for anything healthcare related:

1. Government is inefficient and ineffective by it's very nature. We don't need such a system controlling our health.

2. Giving government control over our labor, the fruits thereof, AND our health is a gigantic step towards us literally being slaves to the state. If they own our labor, and dictate our health, then they control us.

3. Costs will go up with the rise of more regulation.

4. R&D will diminish and medical advancements will be stifled.

5. Free market solutions, driving competition, and unhinging the oligopoly between big insurance and big pharma would be a smarter move. Unfortunately there is too much money bribing politicians to pass certain legislation to undo that. The solution to this is held within the power of the states to call an Article V convention to set the federal government back in it's proper place.

I could continue, but these are the big 5 to me.

 

[98cwitr]

If ALL employers were required to offer health insurance to their employees people would not give up any benefits. They should just have to update their work contact information. The exception is people who get fired; that situation would be avoided if people did everything possible to obey employer rules.

How is that good when there is only one provider and they're awful? I pay $700/mo to BCBS right now and they have horrible copays. I need another option, a more affordable option. Why can I only pick from one provider if another can offer the same service at a lower rate? Because my employer didn't pick them?

 

[98cwitr]

America is a free country. We have the right to choose our lifestyles if our health and money makes doing what we want possible. So why shouldn't we have a choice on health insurance?

What I want more than anything from the government is universal health care. My opposition is to forcing everyone to have the same health insurance plan because we all have different needs beyond the regular wellness exams and disease testing.

I am only 72% free.