Tru' dat.

We have medicare/medicaid for poor people. But you have to be very poor or elderly to get care under those plans. Otherwise you are expected to take care of yourself and get health insurance to protect your life and assets.

The first thing that needs to be done is to fix the abuse, and yes there is plenty of abuse in Medicaid/Medicare. Currently there is no real co-pay attached to Medicaid/Medicare there is a $135 annual amount, but usually the co-pay for a Visit for Outpatient services is $3.00.

Why is this a problem. First many on Medicaid abuse the system. Rather than going to a doctor for routine care, they will instead utilize the Emergency Room. A doctor's visit usually costs around $150 plus the cost of tests and other services. Under M&M lab tests and X-rays are covered completely. So a patient covers the $3 copay and the government covers the remaining $147 and costs of lab and x-ray. Now, as soon as you walk into an Emergency room anywhere, you must know the visit is going to cost you $500. That means the government is now covering the $497 cost. A 300% increase. Since the persons on M&M do not have a vested interest in being responsible and can continue to use the Emergency Room without any consequence, why should they worry about making an appointment or waiting a day to visit the Doctor???

The quick fix is easy, increase the copay for Emergency visits. Raise it from $3 to $25. Also, make this an upfront payment. Put a financial incentive not to abuse the system into place. Many will complain that sometime those on M&M do not have the financial resources to pay, that is also an easy fix. Allow the person to sign a form that will allow the provider to bill the copay and the copay only against the government benefits the individual receives.

Working in a hospital I see people who use the Emergency Department for colds, sore throats, and a variety of other non-emergent complaints. The savings created by this alone would allow M&M to increase benefits for current enrollees but also allow for the increase of who can be covered.

dmk

You're right, PN. The DTT board is not just about gay issues, but any issues worth discussing in the news of the world, recipes we share, jokes, games, talking with friends, expressing sympathies, offering support, etc.

This thread here is very valid in regards to how the health insurance industry should be dealt with, as Sgtdmk talks about. We all have ideas on how it should be fixed and how the cheaters can be flushed out.

I totally agree with you on those kinds of abuse. I see it all the time.

I'm trying to get care for everyone though. For that we are gonna have to make more changes. Additionally, basic insurance costs are out of hand. My plan covers basic health, including pregnancy. Kids and everybody. If we inact my plan, medicare will have more funds as well.
But even under my plan, I'll agree to a co-pay for the reasons you gave. To control the abuse.

On movie after movie we see the evil of HMOs and the insurance companies. Limit what is covered, denying benefits, denying services, etc. Well folks, oftentimes it is not the fault of the HMOs or the insurance companies, but rather the government. The government has placed restrictions on what a company can or cannot cover. Insurance companies cannot legally develop a plan for an individual. They must instead provide coverage for a predetermined group of benefits. What does that mean??? Well if your are a single individual the premiums you pay cover the cost of these benefits which include, prenatal and pediatric care.

Rather than putting together a package to cover the services I may need, instead because of government regulation, I am paying a premium the covers the cost of services I may never need.

Allow the companies to make individual based coverages, that individuals can choose. Not only will this lower the cost of premiums, but will make insurance more affordable for everyone.

Second, allow insurance companies to operate nationally. There are several states that only allow insurance to be purchased and used in said state. This again causes prices to rise.

Third, pass legislation that places limits on the awards that can be awarded against Doctors and other providers under pain and suffering in civil litigation.

Current Presidential Candidate Edwards made a fortune in civil litigation against OB/GYN doctors in cases regarding Cystic Fibrosis. In one highly covered case in closing arguments Mr Edwards channeled the child in the womb, telling the jury that as the baby was being delivered and a C-Section not performed that fetus was saying help me I am in trouble here, well the jury bought it and brought back a large settlement against a doctor for not performing a C-Section and claiming that this was the reason the child in question has Cystic Fibrosis. One small problem. With all science, it is a never ending learning experience, modern science has now proven that delays in child birth, do not cause CF. BTW has Mr Edwards ever offered to return the money he received???? I think not. Decisions like this have made the cost of insurance for hospitals and doctors sky-rocket. Guess who pays the brunt of this cost?????

Finally, pass legislation that allows Health Savings Accounts that belong to the individual that they can use to pay the cost of medical care. Make this money tax deductible and allow the accounts to roll-over year in and year out. A young person establishing an account like this will be able to save money in the accounts while they are young and healthy and then be able to use it as they age and begin having medical problems. Allow the individuals to use these accounts to pay insurance premiums as well. Yes make medical insurance premiums tax-deductible.

dmk

Didn't Michael Moore make a movie on health care issues?

I agree with you Sgt. That would probably be the easiest way to fix the system that we currently have. Your solution is a mix of my "legal" and "regulatory" fixes I was gonna post. The reason I started with "fair" though is that it automatically covers everyone for basic care. The thing we keep hearing is that there are "x" number of people with no insurance. My plan forces everyone to pay for their basic care. But also forces anyone who wants the optional improved coverage to pay for that too or prove disability or poverty.
Any insurance based plan will leave some people behind.

Here's an even bigger problem than the UNinsured

The UNDER-insured

It’s Not Just the Uninsured
By BOB HERBERT Published: NY Times November 17, 2007
http://www.nytimes.com/2007/11/17/op...html?th&emc=th

Sandra Hightower never thought of herself as particularly political. She worked, and much of her free time revolved around her daughter, Brittney, a fiercely outgoing teenager with a passion for cheerleading at her high school in Nacogdoches, Tex.

But “after getting slapped in the face with reality,” Ms. Hightower said she’s ready to go to Washington herself if that would help get Congress to do something about the health insurance crisis that is responsible for so much unnecessary suffering and death in the U.S.

The tedious, hair-splitting debates over health care that we’re getting from the presidential candidates — those who talk about health care at all — seem out of sync with the enormity of the problem. For families without the protection of health insurance, the devastating combination of serious illness and imminent financial ruin can be absolutely mind-numbing, stunning in its tragic intensity.

For Sandra Hightower, the nightmare began in the summer of 2005 when Brittney had to have a cyst on an ovary removed. More cysts developed and in early 2006 doctors found that Brittney had cancer. She underwent surgery in Houston and the prognosis, according to Ms. Hightower, was good. “Everything was fine,” she said. “All results came back clear.”

Ms. Hightower did not think at the time that she would take too much of a financial hit because she had health insurance at her job, and the policy covered Brittney.

The cancer recurred three or four months later and more surgery was required, followed by chemotherapy. The 15-year-old who loved to dance, and who wasn’t sure whether she wanted to be a model or a pediatric nurse, was now having to battle for her life like a warrior in combat.

The next round of bad news came in a double dose. One night, after coming home from school, Brittney suddenly found that she couldn’t walk. The cancer had attacked her spinal cord. As the doctors geared up to treat this new disaster, Ms. Hightower received word that her insurance policy had maxed out. The company would not pay for any further treatment.

Ms. Hightower was aghast: “I said, ‘What do you mean? It was supposed to be a $3 million policy.’ ”

She hadn’t understood that there was an annual limit of $75,000 on benefits. “It was just devastating when they told me that,” she said.

Most of the debate about access to health care has centered on people without insurance. But there are cases like this one all over the country in which individuals are working and paying for coverage that, perversely, kicks out when a devastating illness kicks in.

Americans with inadequate health coverage — the underinsured — are a major component of the national health care crisis. Like the uninsured, they can be denied desperately needed treatment for financial reasons; they often suffer financial ruin; and in many cases they die unnecessarily.

“This is a very significant problem,” said Daniel Smith, president of the American Cancer Society’s Cancer Action Network. “We want to help educate Americans more broadly about the idea that while they think they might be insured, when they’re diagnosed with something as devastating as cancer their policies may not give them the coverage they need.”

Sandra Hightower became almost frantic with the combined tasks of caring for her daughter and trying to figure out how to pay for the increasingly expensive treatments.

“Her back surgery, with the reconstruction and all that, was over three hundred and some thousand dollars,” she said. “I had to start doing fund-raisers, bake sales. And the community kicked in, my community here in Nacogdoches. Definitely the high school. And people donated to a benefit fund at the bank.”

After several months, Brittney was declared eligible for federal disability benefits, which enabled her to qualify for Medicaid. “But we still owed for everything before that,” said Ms. Hightower.

Brittney fought like crazy to survive, her mother said. But in the end, she didn’t make it. She died, at age 16, on June 5.

To be honest Gary that belonged in the other thread, we are working on a cure over here. We already know there is a problem.