Rants/Raves about health insurance?

no raves. none.

I've lived in Australia and now live in NY. In Australia Medicare pays a percentage of the recognized charge for doctor services and state governments provide free treatment in public hospitals by doctors they nominate. If you want to choose your doctor in a public hospital or have treatment in a private hospital, you are responsible for any difference between what the doctor charges and what Medicare reimburses, plus the hospital charges. You can insure for private treatment. Drugs are provided under a separate scheme and there are copays for almost everyone. There is no discernible difference in the quality of the treatment I've received in Australia and NYC. In NY I have excellent coverage provided by my employer, although they routinely find some error in my claim for gym fees and refuse to pay. My copays in NY are lower for doctor visits, but significantly higher for prescriptions.

The major difference I find in NY is that my doctor's office employs four people to do the admin work dealing with the different insurance companies. This is not necessary in Australia because there is only one insurer - Medicare. I've also found that for identical treaments in similarly appointed facilities, the fees doctors charge here is four to five times that charged in Australia. I had a colonoscopy recently, the doctor did it in his clinic and charge $2500, the anesthesiologist charge $1800. In Australia I paid $500 and $350 for these fees.

Universal health coverage in Australia also means that bad debts are an insignificant issue for doctors, and I've never heard of anyone in Australia declaring bankruptcy due to unpaid medical bills.

That is not to say that there aren't issues with Medicare in Aus. There are waiting lists for elective surgery (if you want to be treated as a public patient) and there can be situations where the patient thinks they need one treatment and the public hospital disagrees. I think that the advantages of universal coverage outweigh the costs. Nobody has to have a chronic condition go untreated because they can't access health care. Generally, Australians can also ask their local Member of Parliament to lobby with Medicare on their behalf - try that with an insurance company. At least a government agency is ultimately accountable to the elected officials.

Australia would indeed be an excellent model for the US to copy; longer lifespans, less paperwork, little or no burden on employers, less burden on doctors, no chance of being refused coverage for a preexisting condition or because a faceless drone or corrupt consultant decides after the fact that a procedure wasn't covered, much less litigation, all at a lower overall cost to the individual and to the public, and without sacrificing public/private competition and choice. The Pharmaceutical Benefits Scheme where the government negotiates down the prices of drugs directly with pharmaceutical companies who compete to get their parallel products on the subsidized list is genius. Bulk-billing walk-in clinics are a godsend, especially for the young.

But I've tried a number of OECD nations, read about others, and nearly all of them seem to be better-functioning for the middle class than the US, so copying just about any other model would be an improvement. I've supposedly got excellent health insurance by US standards, and had much worse, more complicated, and more expensive experiences here than in other countries. Even finding a doctor to see is way more of a struggle here. Either Obama fixes the system here in a big way, or I won't be staying long term -- the risk to me and my family's health and my finances of supposedly top-notch private health insurance is too great, not to mention all the stress and wasted time with endless paperwork, when I can pick one of several other countries where I know we'll be taken care of as needed for life, no questions asked, regardless of employer. So many great things about living in America, but sadly healthcare is the dealbreaker.

Here's a rave: my wife's COBRA coverage ran out last October, so she signed on with Atlantis Health Care for about $355/month, with a sizable ($2800/yr) deductible.

Two weeks later she tripped on a Con Ed installation by New York Public Library on 42nd Street, fell on her face and broke her hip. She was taken to the emergency room by ambulance, and spent three weeks in the hospital. Her bill came to some $80,000, and the insurance company paid every single cent, without argument!

Never before have we felt so satisfied with a health insurer!

wow...that IS impressive, booklaw.

I hope she's feeling better (and why not have ConEd foot the bill???)

We have retained counsel who will sue Con Ed. She is better, but she still limps and still uses a cane.

a rave for empire plan united -- i haven't really put it through its paces like mrs. booklaw, but so far i'm pleasantly surprised by how much it covers (and how cheap it is for me through my employer, the state). it's an hmo, but i don't actually need referrals to see specialists. at a clinic the other day, the nurse taking my blood told me never to lose that insurance, because she thinks it's really good.

a rant: what the hell is up with all the stuff when you call about how telling you something is covered is no guarantee that they'll cover it, that the only way to find out is to submit a claim??? so i can't find out if you'll cover a procedure until it's already done and i might be on the hook for the bill? what the hell?

Many insurers will routinely reject some completely valid claims assuming that some people won't bother to contest it. They are scum and absolutely parasites on our society.

National health insurance now!

sweet tea wrote: hey carny, did you read the atul gawande piece in the last (not current) new yorker about health care costs? it's really interesting stuff.

In case you missed it

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Of course, he's a Brooklyn boy!

When it comes to keeping costs down, I think the key is to keep perverse financial incentives out of the healthcare equation as much as possible, and especially insulate doctors. It starts with government paying for most of the cost of tertiary education at public institutions (supplemented with interest free loans paid through a graduate tax) so doctors don't start with a huge student debt. Publicly funded not-for-profit hospitals, where the total funding is based on needs and outcomes and calculated per patient-type/bed rather than per procedure. Doctors on salaries (with a private practice on the side if they want). Publicly funded universal preventative measures. Tort reform by way of no-fault insurance. Relegate private insurance and private hospitals to a luxury for the rich, because when the public system is functioning well (lean and mean), all the private system has going for it ends up being somewhat shorter waiting lists for elective procedures, and nicer rooms and more nurses and TVs, but not better healthcare outcomes.

I've done hospital stays in 3 countries. Country 1 was private/public competition, country 2 was public only, country 3 was private only (US). Country 1's public system wanted me in and out in 1 day, everything was high tech, checks and balances at every step, pack them into wards and get them out asap fixed up and without complications. Country two kept me 3 days for the same procedure, gave me a huge private room and personal nurse, there was free beer in the fridge and a smoking lounge, the tech was creaking, same outcome higher taxes. Country 3 was just scary; dirty, constant snafus and chaos and incompetence, keep me in as long as possible to inflate the bill (I eventually told them it was ridiculous and I was going home), run as many tests as possible all negative, and leave me with half a dozen fights with the insurance company to sort out.

Some info for the ladies and some guys. Planned Parenthood provides free female exams and health check ups plus other services for the unemployed or just plain poor-ass people.

http://www.plannedparenthood.org/health-center/findCenter.asp

Eyeglasses make me sick, just paid $325 for a pair and that was with a 30% discount! WTF?

Anastasia Beaverhausen wrote: Also, if I leave my job I can be denied health care due to a "pre-existing condition."

Not in New York State.

http://www.nysegov.com/citGuide.cfm?ques_id=645&superCat=106&cat=110&content=relatedfaqs