What would you do if you had to go to a doctor but had not health insurance?

[PreMD86]

Or the mother****er can cut back a little on his cigarettes and beer (notice I'm not saying he even needs to quit) and buy his own medications. So while he's waiting for his tobacco money that may never come, what should he do in the meantime?

Your problem is that you cannot understand the concept of free will. Homie smokes and drinks because he wants to. He doesn't pay for his medications because he doesn't want to, that is, he has better things to spend his money on.

When I did my one year of family medicine I had lots of patients who wanted to quit smoking but were only held back because they couldn't afford the nicotine patches. Well, duh, the nicotine patches cost about as much per day as a one pack per day habit. Oh the mystified looks I used to get when I explained the simple logic of spending the money on nicotine patches instead of cigarettes.

Don't you folks get it? The majority of the Holy Underserved (PBUTHN) as well as many of you look at medical care like a city utility. Turn on the tap, get water. Turn on the switch, get lights. Go to ED, get health care.

Out of curiousity, how badly were you abused as a medical student to turn you this cynical?

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[Drogba]

Only in the United States would an uninsured citizen or legal immigrant have to declare bankrupcy over the cost of emergency surgery, while an uninsured illegal immigrant gets the government to pay.

The US is one of the only countries (only "developed" country) where anyone would have to declare bankruptcy because of health issues, legal citizen or not.

 

[Drogba]

Whoa. Like someone pointed out, if you pay up front for the visit it will be significantly less than 500 bucks for most doctors. Your PCP sends the bill to the insurance company but do you think any insurance company will reimburse a primary care physician $500 for a simple sore throat? Not on your life. Your doctor probably gets anywhere from nothing to 100 bucks for that visit depending on how accurately it was coded by his office manager and how difficult his insurance company is to deal with. The problem is that you take no initiative to find out how much things cost. Or to say, "Doc, you don't need to do a lab test to diagnose my sore throat." The other problem is that you mentioned you had insurance and made no effort to pay up front, sending the doctor's staff into the automatic insurance billing mode.

I bet most people on SDN think nothing of dropping 50 bucks for a date or paying $300 for and iPOD. It's a question of priorties.

Look at it like this: The cost for health isurance for an average family with a fairly decent insurance plan that has a low deductible and a low co-pay is around $15,000 per year. On the other hand, the average family doesn't really need anything close to $15,000 worth of health care in a year. A couple of pediatrician visits, and annual exam, a few prescriptions here and there, most of which are probably unnecessary (like antibiotics for viral URIs) but since the familiy is not "paying," what the hell and we're not talking a lot of money for most people and especially not for young, basically healthy couples with basically healthy children.

Certainly for a young, healthy, intelligent (because presumably you're going to medical school one day) college student to "cry" because he doesn't have insurance is a complete over-reaction and something for which he should be ashamed.

"Cry." How about get off your ass and stop trying to get other people to pay your way through life. Car wreck? Major surgery" Catastrophic illness? Those are one thing and certainly few people can pay for an ICU stay out of pocket. But a sore throat? A cold? Some bacterial vaginosis? I know for a fact that many of my uninsured patients spend enough on cigarettes and beer in a month to pay for most of their primary care including most of their mostly generic drugs to manage their mostly generic and lifestyle related chronic conditions.

Or haven't you met the asthma patient still smoking two packs a day complaining that he can't afford his albuterol MDI or his advair?

Isn't this the whole concept of insurance whether it is health, car, home or life insurance? You and your kids *probably* won't have any incredibly expensive medical conditions, but what if you do? You are screwed. It really isn't that unlikely either. There is a reason why health related bankruptcy affects 2 million Americans a year. Sad thing is, many times having insurance won't even protect you from this since most of these bankruptcies are declared by full time employees with health insurance. Its truly a perverse system when finding out you have cancer, or some rare incurable disease, or having suffered significant injury is only the beginning of your suffering.

 

[NonTradMed]

If I didn't have health insurance and I need to see a doctor, I guess I would pay for it out of pocket if I felt it was serious enough to warrant a visit. However, I would pray that it doesn't turn out to be something really bad (cancer, long illness etc). There's also the community health clinics available locally.

I don't think simple checkups are out of range for most Americans. Most of us can afford to go see a doctor, even without health insurance. The problem is not having catastrophic insurance. Medical bills is one of the top reasons that people go bankrupt in this country, so obviously, having medical insurance is very, very useful---but even that may not be enough. Even for something like simple surgery, it can get very expensive very fast.

However, I think the people who 'fall through the holes' are those with chronic illnesses. I have a good friend who had cancer while in college. She eventually underwent surgery but afterwards, she required a lot of follow-up care and chronic medications, and an assortment of other illnesses also appeared due to her weakened state (she was always in precarious health).

For people like her, not having health insurance is scary. She's too 'healthy' to qualify for disability or any medicaid programs but she requires hundreds of dollars worth of medication a month, and constant checkups by specialists.

I remember there was a time when she couldn't find a job that gave her health insurance, but luckily her father had good insurance and he covered her by paying extra under some clause under his insurance policy at work.

But for people like my friend, health insurance is a real issue. For people like her, I don't think the current system works very well. If she was to lose her job the next day, and had to work in temp positions with no benefits, her savings would run out pretty quickly just on medications alone, and trying to get gov't insurance could take a long time (and she may not qualify...), during which she would be really pressed to cough up money for the medicine she needs.

For most of us young, healthy adults, it's not as big of an issue, but I don't think health insurance should be underestimated in its importance. Like any other type of insurance, we don't really feel it's absence until we need it. I think it's irresponsible for people not to get insurance if they can afford it, and I'm thankful I have always been covered by health insurance.

 

[8744]

Isn't this the whole concept of insurance whether it is health, car, home or life insurance? You and your kids *probably* won't have any incredibly expensive medical conditions, but what if you do? You are screwed. It really isn't that unlikely either. There is a reason why health related bankruptcy affects 2 million Americans a year. Sad thing is, many times having insurance won't even protect you from this since most of these bankruptcies are declared by full time employees with health insurance. Its truly a perverse system when finding out you have cancer, or some rare incurable disease, or having suffered significant injury is only the beginning of your suffering.

The point is that all most people need, especially in the age group on SDN, is a major medical policy with a very high deductible against the possibility of getting really, really sick. These policies are considerably cheaper than the usual comprehensive health insurance that people expect from their employer.

As for bankruptcies, suppose you have a job with insurance and are over-extended on your credit and living a little bit beyond your means like most Americans. Now suppose you get sick and are no longer able to work. Even if you have health insurance you can still go bankrupt because, and this seems obvious, most health insurance doesn't pay for groceries or make your car payment for you. So this is a "health care related" bankruptcy but hardly an ringing endorsement of socialized medicine. In fact, many people use bankruptcy to get out of all kinds of trouble. We no longer have debtor prisons after all so the only consequence, realistically, for most people is that their credit is shot. In exchange you are not required to pay your debts as you promised when you incurrred them. They can of course repo your car but money you owe can realitically almost never be recovered.

 

[foreverLaur]

At my dad's work (Lockheed Martin), he pays around $420 a month for a family insurance plan. Starting in January, the are cutting the benefits in half and it is going to be $950 a month. Looks like we're going independent through AARP.

 

[8744]

Out of curiousity, how badly were you abused as a medical student to turn you this cynical?

Cynical has got nothing to do with it. I might as well ask how long you have spent cavorting in the land of gossamer fairies to make you so ignorant of the way things are as opposed to how you want them to be.

Why we should subsidize luxuries for the the so-called underserved (for surely money spent on beer, cigarettes, weed, cell phones, tatoos that does not have to be spent on health care is a subsidy) is a legitimate topic of debate.

And I'm a cynic from way, way back. Long before I went to medical school. Cynicism is a function of skepticism. Is your generation the one that believes everything The Man tells you? My, my, how the pendulum swings.

 

[Omyss]

Cynical has got nothing to do with it. I might as well ask how long you have spent cavorting in the land of gossamer fairies to make you so ignorant of the way things are as opposed to how you want them to be.

Why we should subsidize luxuries for the the so-called underserved (for surely money spent on beer, cigarettes, weed, cell phones, tatoos that does not have to be spent on health care is a subsidy) is a legitimate topic of debate.

And I'm a cynic from way, way back. Long before I went to medical school. Cynicism is a function of skepticism. Is your generation the one that believes everything The Man tells you? My, my, how the pendulum swings.

But for every "leacher" out there, there will be somone with a severe chornic illness who can't even hold a full time job (let alone Health Insurance). Not to mention that it benefits everyone as whole (ie you and me).

 

[limpkitty]

Cynical has got nothing to do with it. I might as well ask how long you have spent cavorting in the land of gossamer fairies to make you so ignorant of the way things are as opposed to how you want them to be.

Why we should subsidize luxuries for the the so-called underserved (for surely money spent on beer, cigarettes, weed, cell phones, tatoos that does not have to be spent on health care is a subsidy) is a legitimate topic of debate.

And I'm a cynic from way, way back. Long before I went to medical school. Cynicism is a function of skepticism. Is your generation the one that believes everything The Man tells you? My, my, how the pendulum swings.

No, we're the generation that believes in human rights and dignity. What is wrong with you man? This is the only country in the world where people don't believe they have the right to ask the government for services they are owed. Meanwhile, I guarantee that panda bear doesn't balk about spending 400 billion dollars a year on the military with another 3 billion a week in Iraq on top of that.

Wake up people! Who profits off of the current system? Not doctors and nurses, not patients, certainly not the uninsured. No, the winners are the health insurance and the pharmaceutical companies that make out like bandits by denying people coverage and overcharging them for medicine.

 

[8744]

But for every "leacher" out there, there will be somone with a severe chornic illness who can't even hold a full time job (let alone Health Insurance). Not to mention that it benefits everyone as whole (ie you and me).

Is it one to one? What if for every person who truly needs a hand there are five free-loaders? Ten? Two? Before you go spend money something wouldn't you like to know on who you were spending it and whether they needed it or not.

 

[8744]

No, we're the generation that believes in human rights and dignity. What is wrong with you man? This is the only country in the world where people don't believe they have the right to ask the government for services they are owed. Meanwhile, I guarantee that panda bear doesn't balk about spending 400 billion dollars a year on the military with another 3 billion a week in Iraq on top of that.

Wake up people! Who profits off of the current system? Not doctors and nurses, not patients, certainly not the uninsured. No, the winners are the health insurance and the pharmaceutical companies that make out like bandits by denying people coverage and overcharging them for medicine.

Human rights and free medical care have nothing to do with each other. And I fail to see how my asthmatic patient, the one spending $300 per month on cigarettes, not to mention anybody else, is owed anything by anybody. "Owed" implies "earned." Which is a stretch. What you are really saying is that everybody and his brother has the right to haul you out of bed, force you to the clinic or the OR, and to make you work for free plying your particular trade which in this case is going to be medicine. I mean, if medical care is a right than it's not like we can charge for it.

As long as somebody has to produce it for somebody else, health care cannot be a right, human or otherwise. Or are you saying that when a family medicine physician discharges a patient from his clinic for non-payment (which happens) the patient's rights are being violated. Or, what if you get your wish and the government subsidises health insurance for everyone but most of the physicians in practice decide to only take private insurance or cash? Surely you know how hard it is in most cities to find a primary care doctor who accepts medicaid? Will the government, in the name of human rights, force doctors to take less than what they can make on their own in a free market by outlawing said free market?

Or is economic freedom not a human right?

Again, the problem is that many of you think that medical care flows out of a tap and that it can be had by the ton for a nominal charge if it were only free

Reminds me of the habitual drunks we get who come in under police custody extremely combative threatening to sue everybody and yelling loudly, "I pay yer' salary!"

Not hardly. This kind of patient wouldn't dream of contributing a dime to his own medical care.

I'd most certainly rather have my tax dollars go to the construction of a carrier battle group. Funding the military is a legitimate government function, something that libertarians, liberals, communists, coinservatives, Republicans, and Democrats can agree on. The difference between miltary spending and welfare spending is that while military spending can be cut, undergoing various up and down cycles, once you give people a freebie no matter how the costs explode or no matter what the unintended consequences you are stuck with it for the rest of history.

 

[8744]

No, we're the generation that believes in human rights and dignity. What is wrong with you man? This is the only country in the world where people don't believe they have the right to ask the government for services they are owed. Meanwhile, I guarantee that panda bear doesn't balk about spending 400 billion dollars a year on the military with another 3 billion a week in Iraq on top of that.

Wake up people! Who profits off of the current system? Not doctors and nurses, not patients, certainly not the uninsured. No, the winners are the health insurance and the pharmaceutical companies that make out like bandits by denying people coverage and overcharging them for medicine.

Hey, I hear that both Germany and France are considering reducing health benefits. Is that a human rights violation?

 

[8744]

http://www.bmj.com/cgi/content/full/325/7363/514

Uh huh.

 

[PreMD86]

Human rights and free medical care have nothing to do with each other. And I fail to see how my asthmatic patient, the one spending $300 per month on cigarettes, not to mention anybody else, is owed anything by anybody. "Owed" implies "earned." Which is a stretch. What you are really saying is that everybody and his brother has the right to haul you out of bed, force you to the clinic or the OR, and to make you work for free plying your particular trade which in this case is going to be medicine. I mean, if medical care is a right than it's not like we can charge for it.

As long as somebody has to produce it for somebody else, health care cannot be a right, human or otherwise. Or are you saying that when a family medicine physician discharges a patient from his clinic for non-payment (which happens) the patient's rights are being violated. Or, what if you get your wish and the government subsidises health insurance for everyone but most of the physicians in practice decide to only take private insurance or cash? Surely you know how hard it is in most cities to find a primary care doctor who accepts medicaid? Will the government, in the name of human rights, force doctors to take less than what they can make on their own in a free market by outlawing said free market?

Or is economic freedom not a human right?

Again, the problem is that many of you think that medical care flows out of a tap and that it can be had by the ton for a nominal charge if it were only free

Reminds me of the habitual drunks we get who come in under police custody extremely combative threatening to sue everybody and yelling loudly, "I pay yer' salary!"

Not hardly. This kind of patient wouldn't dream of contributing a dime to his own medical care.

I'd most certainly rather have my tax dollars go to the construction of a carrier battle group. Funding the military is a legitimate government function, something that libertarians, liberals, communists, coinservatives, Republicans, and Democrats can agree on. The difference between miltary spending and welfare spending is that while military spending can be cut, undergoing various up and down cycles, once you give people a freebie no matter how the costs explode or no matter what the unintended consequences you are stuck with it for the rest of history.

Panda- You have no idea how many times I've wondered whether the lung transplant patients at the thoracic ICU I work at really deserve treatment. As cynical as you are, I really do hear you. As far as your asthmatic patient goes, I believe he deserves treatment because he needs it. period. Your job as a physician is to treat. Whether it's a convicted murderer, an obese person that considers every option but dieting, or someone who attempted suicide. It's not your place to tell the working poor what they are allowed to spend their money on.

And yea, I do believe some sort of basic health care is a fundamental human right. Yea, I even believe that discharging a patient with knowledge that the treatment isn't complete is a human right violation- one that should weigh heavily on your conscience. Just because a right has to be produced by someone else doesn't mean it's not a viable right. We rely on our government for infrastructure, protection, education, and sometimes even freedom- all of which are expensive, but nontheless rights we hold dear. I'm also extremely baffled by "if medical care is a right than it's not like we can charge for it." We pay for every right we expect from our government via our taxes- medicine should be no exception.

I'm sure I'm optimistic and that medical school would inevitably make me jaded, but I'll always believe it's deeply unethical to withold basic medical treatment from anybody in need of it. When time comes for me to do such a horrible thing, I hope I don't take it lightly and brush it off as a feature of society that is set in stone.

 

[ufgrad00]

I am agreeing with Panda. I currently work at a large oncology/radiology practice, and when patients can't pay their bill, which is easily 40% of them, they are never denied treatment or meds.

The reason is that the altruism of the physicians and associations like American Cancer Society and other non-profit groups allow for these patients to have their medications at no-cost or co-pays at 10$. Also the pratice is making enough from private insurance to pay the staff well, physicians have 200K+ salaries, and to treat a lot of people who are making ends meet with social security or other fixed income payments.

Also, I believe that there is no current precedence for the government to run a beauracracy at the scale some are proposing. Running the beauracracies itself would consume too much of the budget. How long would it be till the beauracracy, US government, started to mandate your treatment and care the physician can provide. I have a concern that our own government may say it is more profitable to manage your condition than cure it.

 

[PreMD86]

http://www.bmj.com/cgi/content/full/325/7363/514

Uh huh.

I'm pretty sure I'd prefer being transferred to a hospital in Belgium than being denied outright. Any day.

 

[ghostfoot]

No, we're the generation that believes in human rights and dignity. What is wrong with you man? This is the only country in the world where people don't believe they have the right to ask the government for services they are owed. Meanwhile, I guarantee that panda bear doesn't balk about spending 400 billion dollars a year on the military with another 3 billion a week in Iraq on top of that.

Wake up people! Who profits off of the current system? Not doctors and nurses, not patients, certainly not the uninsured. No, the winners are the health insurance and the pharmaceutical companies that make out like bandits by denying people coverage and overcharging them for medicine.

I have some issues with this statement you make: "This is the only country in the world where people don't believe they have the right to ask the government for services they are owed".

What did you do for the government to "owe" you medical services? People are always talking about their "rights" and what they're "owed", but very rarely does anyone cite any source for these "rights".

No one owes you a house or food or health care unless you paid for it. If you've paid for it, then it's owed to you.

Do you have a receipt for all of these services that you're owed?

 

[ghostfoot]

... and "This is the only country in the world where ___" statements, are categorically BS.

 

[PreMD86]

I have some issues with this statement you make: "This is the only country in the world where people don't believe they have the right to ask the government for services they are owed".

What did you do for the government to "owe" you medical services? People are always talking about their "rights" and what they're "owed", but very rarely does anyone cite any source for these "rights".

No one owes you a house or food or health care unless you paid for it. If you've paid for it, then it's owed to you.

Do you have a receipt for all of these services that you're owed?

Do you have a recipt for your right to be protected from terrorism? A right to clean air? Safe food and water? We pay taxes for our government to protect us from harm, in every sense of the word- sometime even from ourselves. Whether it takes a higher amount of tax for us to receive this basic right can be debated, but it in no way takes away from the legitimacy of that right.

 

[08675309]

Panda- You have no idea how many times I've wondered whether the lung transplant patients at the thoracic ICU I work at really deserve treatment. As cynical as you are, I really do hear you. As far as your asthmatic patient goes, I believe he deserves treatment because he needs it. period. Your job as a physician is to treat. Whether it's a convicted murderer, an obese person that considers every option but dieting, or someone who attempted suicide. It's not your place to tell the working poor what they are allowed to spend their money on.

And yea, I do believe some sort of basic health care is a fundamental human right. Yea, I even believe that discharging a patient with knowledge that the treatment isn't complete is a human right violation- one that should weigh heavily on your conscience. Just because a right has to be produced by someone else doesn't mean it's not a viable right. We rely on our government for infrastructure, protection, education, and sometimes even freedom- all of which are expensive, but nontheless rights we hold dear. I'm also extremely baffled by "if medical care is a right than it's not like we can charge for it." We pay for every right we expect from our government via our taxes- medicine should be no exception.

I'm sure I'm optimistic and that medical school would inevitably make me jaded, but I'll always believe it's deeply unethical to withold basic medical treatment from anybody in need of it. When time comes for me to do such a horrible thing, I hope I don't take it lightly and brush it off as a feature of society that is set in stone.

I like this post.

 

[ghostfoot]

Do you have a recipt for your right to be protected from terrorism? A right to clean air? Safe food and water? We pay taxes for our government to protect us from harm, in every sense of the word- sometime even from ourselves. Whether it takes a higher amount of tax for us to receive this basic right can be debated, but it in no way takes away from the legitimacy of that right.

You're making stuff up. What makes health care a "basic right"? I pay taxes so I can earn money in this country legally and I accept the benefits that paying taxes affords me.

So again, how did you determine that you have a basic right to these things?

 

[167649]

Also, I believe that there is no current precedence for the government to run a beauracracy at the scale some are proposing. Running the beauracracies itself would consume too much of the budget. How long would it be till the beauracracy, US government, started to mandate your treatment and care the physician can provide. I have a concern that our own government may say it is more profitable to manage your condition than cure it.

I agree. Although I am for a universal coverage system (not because it is somebody's right, but because I belive it would be much better for our economy), the absolute last thing we need is a federalized, government monopoly on health care.

 

[Despina]

Well, I havent had health insurance so I was fifteen.....so I guess I dont run to the doctor for every case of the sniffles I get. I have only had to go maybe twice in that amount of time, both times just for infections that wouldnt clear up on their own (I am a firm believer in wait it out, see if it goes away in a couple weeks' time). The docs, knowing that I didnt have insurance, gave me free samples instead of making me fill a script. The only expenses I had were the office visits (round about 100 each, not crazy expensive when factored over the course of 7 years). All in all, me not having insurance has saved me $$$ so far, as I dont have to pay any premiums and only utilize a doctor when absolutely necessary.

EDIT: I guess I should have added that as a student, I absolutely cant pay for insurance in the off chance that something tragic happens to me. Neither of my parents have insurance either, which is a major concern of mine, but as a generally healthy 22 year old dont have health insurance on the top of my priority list (food is waaaaay more important!!!).

Did you ever think of getting insurance with a super high premium (like $5000). My grandfather forced my Aunt to do that when she was without a job for a while. You can get some of those for about $10 a month. A $5000 premium won't destroy you financially for life, but several hundreds of thousands of dollars will.

 

[PreMD86]

You're making stuff up. What makes health care a "basic right"? I pay taxes so I can earn money in this country legally and I accept the benefits that paying taxes affords me.

So again, how did you determine that you have a basic right to these things?

How did people determine that slaves deserve freedom, that women deserve to vote, or that people should have equal access to education? Some rights are hard to articulate, but I believe they generally survive the test of time once instituted. Just because medicine is not part of the benefits currently provided to you for you ability to earn money legally doesn't mean it's not a basic human right.
If you ask me why I believe health care is a basic right, I'll have to say that I believe it's part of the right to equality and pursuit of happiness. But that's getting way too philosophical. Just enjoy your right to legally earn money for now...

 

[ghostfoot]

Just enjoy your right to legally earn money for now...

And you enjoy your (self-declared) right to declare what people's rights are.

Just don't ask me to pay for it.

 

[limpkitty]

I am agreeing with Panda. I currently work at a large oncology/radiology practice, and when patients can't pay their bill, which is easily 40% of them, they are never denied treatment or meds.

The reason is that the altruism of the physicians and associations like American Cancer Society and other non-profit groups allow for these patients to have their medications at no-cost or co-pays at 10$. Also the pratice is making enough from private insurance to pay the staff well, physicians have 200K+ salaries, and to treat a lot of people who are making ends meet with social security or other fixed income payments.

Also, I believe that there is no current precedence for the government to run a beauracracy at the scale some are proposing. Running the beauracracies itself would consume too much of the budget. How long would it be till the beauracracy, US government, started to mandate your treatment and care the physician can provide. I have a concern that our own government may say it is more profitable to manage your condition than cure it.

No precendence for running such a large beuracracy????

Have you heard of MEDICARE, yeah you know, that health insurance thingy for old people. That's all people on the left are proposing--medicare for all. It'd be a helluva lot simpler than the current system. And, this is the good part actually--the part where we find out that we'd save money AND do good for people--Medicare has much LOWER administrative costs than private insurances.

That's right children, look it up--I'm not making this stuff up. It's not exactly communism, it's just expanding medicare, a system already in place that reciepients love. And doctors would do just as good as they do now, they wouldn't even have to deal with all the billing hassles that they do know. Talk to doctors in practice--it's EASY to get paid from medicare, in contrast to private companies.

 

[167649]

And you enjoy your (self-declared) right to declare what people's rights are.

Just don't ask me to pay for it.

You already do. This is something a lot of people do not understand. Our consumer market and the american economy in general pays very, very heavily for uninsured patients. It is not as simple as "don't tax me because I don't want to pay for them."

 

[167649]

No precendence for running such a large beuracracy????

Have you heard of MEDICARE, yeah you know, that health insurance thingy for old people. That's all people on the left are proposing--medicare for all. It'd be a helluva lot simpler than the current system. And, this is the good part actually--the part where we find out that we'd save money AND do good for people--Medicare has much LOWER administrative costs than private insurances.

That's right children, look it up--I'm not making this stuff up. It's not exactly communism, it's just expanding medicare, a system already in place that reciepients love. And doctors would do just as good as they do now, they wouldn't even have to deal with all the billing hassles that they do know. Talk to doctors in practice--it's EASY to get paid from medicare, in contrast to private companies.

Where are you getting your information on Medicare? Medicare is a failing program. It will run out of funds in a decade.

Sure, I will look it up:

http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2006.pdf

http://www.gao.gov/new.items/d02546.pdf

Medicare fraud costs us billions. And it is on the current train to collapse within 10 years. I sure hope you are not saying that we should ensure everyone with a system that is prone to fraud and is financially exposed. A massive, federalized healtcare system would be just as inaccountable and financially flawed as medicare.

 

[ghostfoot]

You already do. This is something a lot of people do not understand. Our consumer market and the american economy in general pays very, very heavily for uninsured patients. It is not as simple as "don't tax me because I don't want to pay for them."

I guess I should have said "don't ask me to pay even more for it".

 

[167649]

I guess I should have said "don't ask me to pay even more for it".

More? You would save a lot of money. With a partially subsidized health care program to insure the currently uninsured, our economy would recover the cost in two years.

 

[45408]

... and "This is the only country in the world where ___" statements, are categorically BS.

This is the only country in the world where we fought a war against the British starting in 1776 for freedom.

My exception disproves your rule.

 

[45408]

More? You would save a lot of money. With a partially subsidized health care program to insure the currently uninsured, our economy would recover the cost in two years.

Proof?

 

[luv2sd]

die

 

[BlackSails]

I have no problem with my tax money going to pay for medical costs for the kid born with cystic fibrosis, or the poor teenager beaten by a gang. The government can give all the free care it wants to the poor old lady who, despite knowing better, didnt save any money, and now cannot afford her chemotherapy. What I have a problem with, is when the government wants to give free health to the people who brought their problems on themselves. The criminal involved in a gang shoot out will never even see a bill for his emergency surgery, follow up care, etc. The 25 year old who has completey f**** his heart up with drugs, gets a free mitral valve replacement. The person with GERD, who rather than spending money on drugs that could easily control his condition, spends it on foods that exacerbate his condition, gets a free nissen fundoplication. Americans need to take responsiblity for things that are they own fault. You are not big boned, you are obese, and this is because you eat too much and dont exercise. You have diabetes for the same reason. You have emphasema because you smoke, not because God, or anyone gave it to you. Its your own damn fault.

 

[Doctor Bagel]

I have no problem with my tax money going to pay for medical costs for the kid born with cystic fibrosis, or the poor teenager beaten by a gang. The government can give all the free care it wants to the poor old lady who, despite knowing better, didnt save any money, and now cannot afford her chemotherapy. What I have a problem with, is when the government wants to give free health to the people who brought their problems on themselves. The criminal involved in a gang shoot out will never even see a bill for his emergency surgery, follow up care, etc. The 25 year old who has completey f**** his heart up with drugs, gets a free mitral valve replacement. The person with GERD, who rather than spending money on drugs that could easily control his condition, spends it on foods that exacerbate his condition, gets a free nissen fundoplication. Americans need to take responsiblity for things that are they own fault. You are not big boned, you are obese, and this is because you eat too much and dont exercise. You have diabetes for the same reason. You have emphasema because you smoke, not because God, or anyone gave it to you. Its your own damn fault.

If you follow this model too closely, you'd wind up with nobody getting anything paid for. Americans who eat what they think is a fairly OK diet still develop heart disease as a result of their diet. Having sex even with protection can cause cervical cancer. Did they still bring is upon themselves? And what about the person who got in a car accident because he was talking on his cell phone while driving?

I admit the sentiment is appealing, but most of us our harming our health every day.

As for the original question, been there. I have paid out of pocket for care, but I definitely went to the doctor less.

 

[limpkitty]

Where are you getting your information on Medicare? Medicare is a failing program. It will run out of funds in a decade.

Sure, I will look it up:

http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2006.pdf

http://www.gao.gov/new.items/d02546.pdf

Medicare fraud costs us billions. And it is on the current train to collapse within 10 years. I sure hope you are not saying that we should ensure everyone with a system that is prone to fraud and is financially exposed. A massive, federalized healtcare system would be just as inaccountable and financially flawed as medicare.

You're argument has nothing to do with mine. Medicare is running out of money because it is inadequetely funded, due to the rapidly rising cost of healthcare (and the increasing lifespans that healthcare has resulted in). This doesn't negate the fact that medicare, as a system, has vastly lower administrative costs than private insurance (because they spend so much combating "fraud" and denying people care, not to mention their obscene levels of profit).

HillaryCare, which it seems you are a supporter of (sames as EdwardsCare and ObamaFoYoMamaCare) is going to result in a huge increase in expenditures with no savings or cost-control mechanisms.

 

[Drogba]

I have no problem with my tax money going to pay for medical costs for the kid born with cystic fibrosis, or the poor teenager beaten by a gang. The government can give all the free care it wants to the poor old lady who, despite knowing better, didnt save any money, and now cannot afford her chemotherapy. What I have a problem with, is when the government wants to give free health to the people who brought their problems on themselves. The criminal involved in a gang shoot out will never even see a bill for his emergency surgery, follow up care, etc. The 25 year old who has completey f**** his heart up with drugs, gets a free mitral valve replacement. The person with GERD, who rather than spending money on drugs that could easily control his condition, spends it on foods that exacerbate his condition, gets a free nissen fundoplication. Americans need to take responsiblity for things that are they own fault. You are not big boned, you are obese, and this is because you eat too much and dont exercise. You have diabetes for the same reason. You have emphasema because you smoke, not because God, or anyone gave it to you. Its your own damn fault.

What I wouldn't give to live in a world where things were so black and white...

 

[167649]

Whoa, my argument has nothing to do with yours? Lets take a step back here:

Have you heard of MEDICARE.......that's all people on the left are proposing--medicare for all.

And then you even said in your next post:

Medicare is running out of money because it is inadequetely funded, due to the rapidly rising cost of healthcare

All you have said is that we should simply expand medicare for all. But then you admit that medicare is running out of money as it is.

My point: it is not as simple as simply expanding medicare to cover everybody. You would need to increase federal taxes very substantially to do this (we need to do this already with just the seniors) and this involves raising federal income and payroll taxes. And don't think for one minute that these funds won't be pulled apart by capitol hill. Funding a nationalized health care system solely with general taxes would be a disaster, the politicians would rip this money apart and ration (as they already do) without any competition presenting another choice to americans. Which is one of the reasons why I do not think our federal government should run health care.

And private insurance/drug/hmo companies are huge lobbiers. Do you think that they would just step aside? Say, ohh, ok, we'll just find something else to do. Of course not, they would never let it happen, and big corporations like these have the country by the balls. As idealist as one is about government, thats just how it works today.

HillaryCare, which it seems you are a supporter of (sames as EdwardsCare and ObamaFoYoMamaCare) is going to result in a huge increase in expenditures with no savings or cost-control mechanisms.

Hell no, her plan is crazy. I agree that it would drive up inefficiencies. I am not for hillary care.

What I am for is an economically feasible plan which covers everybody, but I am not for a federalized monopoly without any competition. And you can't simply transplant the Canadian or British model into this country, our extremenly capitalist, every-man for himself culture would reject it like a mismatched organ.

 

[cardboardearrin]

A lot of states have state programs that are free or nearly free.

 

[acrunchyfrog]

To the OP, I'd do what I have done in times that I didn't have insurance: live below my means (sorry, no pizza this week) and pay for the visit with cash. On top of that, exercise a modicum of self control and keep a couple hundred bucks stashed in savings for unforseen dr visits and other SHTF moments.

At that time in my life I was hard working and resourceful enough to find a job that had insurance. Right now we're talking about changing plans. I'd prefer one with better bennies but a really high deductible, and I'm looking into whether I qualifiy for a Health Savings Account.

Funny thing but my college requires that everyone have insurance better than what they provide, or they charge you 500 dollars a semester for their plan. Does anyone else's college do that?

 

[GreenShirt]

Go to a community health center. It is completely free and generally very high quality.

I second this post. The National Association of Community Health Centers serves millions of underserved people a year on a sliding scale. Their level of care exceeds that of the private sector in some areas (particularly diabetes care). In areas that have a CHC, ER visits are cut drastically because people have a place to go to receive good care. It is one of the most successful government programs, has bi-partisan support, and in an age of decreased healthcare spending has actually received additional funding.

Check it out: http://www.nachc.com/

 

[Bacchus]

It is one of the most successful government programs...

Been to west Philly lately? HUP is swamped.

 

[BlackSails]

What I wouldn't give to live in a world where things were so black and white...

Who said things are black and white? There certainly are black and white things, but inbetween, there are certainly greys. Cover them too, with catastrophe insurance, and things that are a public good, like vaccinations.

 

[AmoryBlaine]

Cynical has got nothing to do with it. I might as well ask how long you have spent cavorting in the land of gossamer fairies to make you so ignorant of the way things are as opposed to how you want them to be.

Why we should subsidize luxuries for the the so-called underserved (for surely money spent on beer, cigarettes, weed, cell phones, tatoos that does not have to be spent on health care is a subsidy) is a legitimate topic of debate.

And I'm a cynic from way, way back. Long before I went to medical school. Cynicism is a function of skepticism. Is your generation the one that believes everything The Man tells you? My, my, how the pendulum swings.

Gotten wade in on Panda's side, I'm not quite as hard-line as he is but he does make some valid points.

When we talk about the "underserved" everyone likes to imagine the struggling widow with 3 kids and a few medical problems of her own. The reality is that many, many of the "underserved" are scammers who clog emergency rooms to feed their own needs and addictions.

Is Panda a "cynic?" Sure. Like I said, I'm not quite to his level, but I do appreciate the frustration at seeing our "poor" patients in designer clothes and cigarettes who only stop telling you about how they can't afford their meds to answer their Razr phones.

Methotrexate, Humira, Zosyn -- yeah, pretty expensive, probably need to be subsidized.

HCTZ, toprol, walk around the block, don't drink Coca-Cola -- remarkably cheap.

 

[8744]

You're argument has nothing to do with mine. Medicare is running out of money because it is inadequetely funded, due to the rapidly rising cost of healthcare (and the increasing lifespans that healthcare has resulted in). This doesn't negate the fact that medicare, as a system, has vastly lower administrative costs than private insurance (because they spend so much combating "fraud" and denying people care, not to mention their obscene levels of profit).

HillaryCare, which it seems you are a supporter of (sames as EdwardsCare and ObamaFoYoMamaCare) is going to result in a huge increase in expenditures with no savings or cost-control mechanisms.

Don't forget that the administrative costs of medicare (and medicaid) are passed on to the providor in the form of bureaucratic costs of compliance. This is not a trivial. It's not as if physicians just send in a bill and it is merrily paid by those benevolant little elves in Washington. CMS is a huge bureacracy both at the federal and state level which puts the vigilance of private insurance companies to shame except that the vigilance is mostly directed at health care providors who are expected to both manage and police their end of the system. Not to mention that the government can kick your door down and arrest you, something that Aflak cannot.

If you don't think that Medicare spends money combating "fraud" (although you can say it without the danger quotes) then you don't know how it works.

 

[MDpride]

I would call many doctors offices and ask what their self pay rate was. Choose the cheapest and go.

I do the same

 

[MDpride]

Whoa. Like someone pointed out, if you pay up front for the visit it will be significantly less than 500 bucks for most doctors. Your PCP sends the bill to the insurance company but do you think any insurance company will reimburse a primary care physician $500 for a simple sore throat? Not on your life. Your doctor probably gets anywhere from nothing to 100 bucks for that visit depending on how accurately it was coded by his office manager and how difficult his insurance company is to deal with. The problem is that you take no initiative to find out how much things cost. Or to say, "Doc, you don't need to do a lab test to diagnose my sore throat." The other problem is that you mentioned you had insurance and made no effort to pay up front, sending the doctor's staff into the automatic insurance billing mode.

I bet most people on SDN think nothing of dropping 50 bucks for a date or paying $300 for and iPOD. It's a question of priorties.

Look at it like this: The cost for health isurance for an average family with a fairly decent insurance plan that has a low deductible and a low co-pay is around $15,000 per year. On the other hand, the average family doesn't really need anything close to $15,000 worth of health care in a year. A couple of pediatrician visits, and annual exam, a few prescriptions here and there, most of which are probably unnecessary (like antibiotics for viral URIs) but since the familiy is not "paying," what the hell and we're not talking a lot of money for most people and especially not for young, basically healthy couples with basically healthy children.

Certainly for a young, healthy, intelligent (because presumably you're going to medical school one day) college student to "cry" because he doesn't have insurance is a complete over-reaction and something for which he should be ashamed.

"Cry." How about get off your ass and stop trying to get other people to pay your way through life. Car wreck? Major surgery" Catastrophic illness? Those are one thing and certainly few people can pay for an ICU stay out of pocket. But a sore throat? A cold? Some bacterial vaginosis? I know for a fact that many of my uninsured patients spend enough on cigarettes and beer in a month to pay for most of their primary care including most of their mostly generic drugs to manage their mostly generic and lifestyle related chronic conditions.

Or haven't you met the asthma patient still smoking two packs a day complaining that he can't afford his albuterol MDI or his advair?

Completely agree.
Materialistic desires are the root of all evils.