Don't get ill in America

[Ugly Betty]

I guess it all boils down to whether you believe basic healthcare to be a right, Mrp. There are 50 million people in this country with no health coverage, and eventually, we all end up paying.

While public healthcare is costly, private insurance is even more so and adds greatly to the cost of doing business for both small firms and large corporations. Surely, between the private and public sectors, we can find a way to cover all of our citizens and reduce the combined costs.

[mrp]

1. You can't have a right to something which is an unfunded liability. How is the healthcare of Ethiopians? (They would be better off if their tax system didn't impose 89% personal income tax on incomes over 4000 USD).

2. Why do you keep on saying that private healthcare is more expensive? Clearly public healthcare makes private insurance unaffordable as above. In Australia for example, we pay an additional 1.5 % on income tax as a medicare levy. The cost is closer to 8% of taxable income (in aggregate). So you are forcing people into a more expensive system.

[Ugly Betty]

1. You can't have a right to something which is an unfunded liability. How is the healthcare of Ethiopians? (They would be better off if their tax system didn't impose 89% personal income tax on incomes over 4000 USD).

2. Why do you keep on saying that private healthcare is more expensive? Clearly public healthcare makes private insurance unaffordable as above. In Australia for example, we pay an additional 1.5 % on income tax as a medicare levy. The cost is closer to 8% of taxable income (in aggregate). So you are forcing people into a more expensive system.

Mrp, well, the war is an unfunded liability at this point...to the tune of about half a trillion dollars. Any idea how much could have been done at home with that kind of money? And this ain't exactly Ethiopia.

Private healthcare costs have risen here an average of 10% per year for the last 6 years, well over the rate of inflation. In contrast, Medicare operates at a 3% overhead or administrative cost - a very efficient system, I would say. Meanwhile, the average health insurer here costs its members an average of 18-20% for administrative costs alone. You decide...which is cheaper? And I remind you, Medicare is a program for seniors, whose medical costs far outweigh those of the average worker covered by private health insurance.

[mrp]

Administrative cost might mean someting. It is simply a ratio. How are you defining administrative cost? How complex are the services that private healthcare provides? Are you counting profit as part of administrative cost? Are you considering by how much medicare, medicaid etc cost in taxes over the specific levies? Are you considering crowding out?

A far better measure is simply worker productivity or return on investment.

So what if America is wealthy - if I become wealthy, does that mean you have a right to my wealth? What if I prefer to be less wealthy or go elsewhere?

Having a right to healthcare in a wealthy society is not really necessary. Everyone already has access to it. How people spend their money shouldn't be up to you or me. This is just a ponzi scheme - that by taxing themselves, they can afford more services. Why would you tax yourself to have a higher income by subsidies when each dollar the Government spends costs society roughly $1.40?

In other words, medicare etc need a rate of return on their services greater than 40% + whatever private healthcare provides just to make someone indifferent to the two. Can medicare really claim such a high level of benefits?

If you really care about the poor and insist they need assistance, a flat tax system and direct cash payments works much better than socialising production of goods and services and punishing overtime. Even a voucher system for medical expenses would be better. Some people don't need medical insurance, some do. Medicare is an unfunded pool of losses, whereas a voucher scheme would cost less as poeple could buy their own insurance at the cost of the premium, not have someone else pay for their unfunded liabilities through taxes.

[mrp]

http://healthcare-economist.com/2006/07 ... ive-costs/

A common justification for Medicare is that the public health insurance system has an overhead cost which is about 2% of claims, while the private sector has administrative costs between 20%-25% of claims. This tells us that Medicare is the best system for America…right?

Merrill Mathew’s of the Council for Affordable Health Insurance (CAFI) summarizes the findings of Mark Litow’s paper “Medicare’s Hidden Administrative Costs.” Litow finds that taking into account extra legal costs from Medicare adjudication and CMS salaries, the administrative cost ratio increases to 5.2%.

Private Insurance on average has administrative costs of 16.7% (varying between 30% for individual policies to 12.5% for large group policies). Yet these figures are inflated. If we exclude taxes and profits, as well as sales commissions, then the total administrative costs decrease to 8.9% overall and 8.0% for large group policies. I do not agree that commissions should be deducted from this this figure but profits and taxes certainly should. Medicare does not pay taxes and does not make a profit so any fair comparison should exclude these items. Further, tax revenue from insurance companies adds to the public’s coffers; profits should be seen as a cost of capital.

Even with Litow’s manipulation of the numbers, Medicare seems like a better deal. Let’s see why:

Economies of scale: There are large economies of scale in the insurance business; however ,large insurance companies can certainly replicate the majority of the scale economies Medicare enjoys.

Cost of Capital: Medicare incorrectly counts its cost of capital as 0. The true cost would take into account the direct cost of hiring IRS workers to collect the taxes which pay for Medicare as well as taking into account the distortionary effects of income taxation on workers labor supply decisions. For the private sector, the costs of capital is transparent: it is simply the interest rate.

Demographics: Medicare serves the elderly population and thus has a high cost per enrollee. In 2003, the average medical cost for Medicare was $6,600 per person per year, while the same figure for private insurance was $2,700. Thus, if public and private health insurance had the same administrative cost per person, Medicare would still be seen as ‘more efficient’ since Medicare’s administrative cost ratio would be less than half the size of the private insurance’s cost ratio.

Finally, we need to realize that administrative costs are like people: some are good, and some are bad. What if a private insurance company raised its administrative costs by 1% , but was able to reduce fraudulent claims by 10% and reduce the premium charged to customers by 8%. This is an example of how an increase in the administrative cost ratio can add value. It is likely that private companies try to avoid paying for unnecessary medical treatment and are more vigilant to detect fraudulent claims then Medicare.

[Ugly Betty]

Mrp, if you read the article you posted, I think you would see that Medicare's efficiency is superior to private insurers. If you want to take out profit and taxes from the private, which is a farce as those costs are real to the premium payer, you still can't match Medicare for efficiency. And including the IRS into Medicare costs is nonsensical, as they collect taxes for the entire nation. It seems a bit more than unfair to heap their costs onto Medicare alone for the sake of an argument.

As far as comparing administrative costs, that is for all services and a reasonable comparison for those offered by both Medicare and private insurers. Both basically offer the same thing.

As far as measuring based on worker productivity and return on investment, you seem to be weighing this all up as a business venture. I thought we were talking about healthcare, or is that only valuable insofar as someone makes a tidy profit?

And as far as access to it is concerned, you will find that the uninsured (as indicated in earlier posts) don't seek medical care unless and until it's an emergency, in which case the costs increase many fold because they waited so long to seek care. The studies will prove me out on this, I assure you.

Finally, you assert that Medicare costs the taxpayers 140% of what they pay into it. Wrong! Check the facts. It costs 103% roughly of what is paid in, at least until Bush and his cronies got to it.

I suppose we will not come to agreement on this, but again, I believe there is a happy medium between private and public healthcare systems.

[mrp]

It is not a farce.

READ THE ARTICLE I POSTED TOO

Medicare costs 6 600 USD per paitient, private costs 2 700 USD

Medicare literally counts cost of capital as zero. Can you imagine a private firm never paying interest?

Medicare doesn't count the cost of gathering funds from the IRS, excluding deadweight losses (social costs of lower production due to choices altered by taxation). Yes they do collect taxes for the whole nation. Which means the cost to medicare is actually cheap (but they don't count). Medicare doesn't cost "three per cent", it's administrative costs are cloder to 5.5% and it doesn't account for fraud very well.

Private health insurance has higher admin costs to cut down on fraud.

Why is overhead cost a superior measure of efficiency? Medicare explicitly doesn't include many costs, and fails to properly investigate fraud. This doesn't measure anything useful. This is just another measure of business performance, which medicare fudges. Why is return on investment a terrible measure of project evaluation or business performance?

"I suppose we will not come to agreement on this, but again, I believe there is a happy medium between private and public healthcare systems."

There ain't. 6 600 USD per paitient versus 2 700 USD. Combine deadweight losses, crowding, unpoliced fraud and moral hazard. Private wins hands down. If you really were concerned that people could not afford it, you would offer them non means-tested cash or a voucher system.

"studies show"...I showed you a study which points out that Medicare is about 2.5 times more expensive per paitient than private, but you've just ignored it.

[Ugly Betty]

Mrp, your source for the $2,700 for private insurance is a fantasy. For a single person - not married and no kids - the average monthly premium for BASIC coverage is now about $450 per month. That's double what you are citing. I know, as I had to pay it not that long ago.

And ask any employer here. Health care adds 20-40% to an employee's compensation package.

As for fraud, yes, I agree, that's a fact of life, and not just for Medicare but for ALL insurers, health, vehicle, home, name it. They all investigate it, but it's not always a win.

In the matter of overhead costs, I am comparing a government run program (Medicare) at 3% vs. private insurers which, as you cite yourself, can be as much as 25%. At least the government programs don't make a bunch of rich people richer. More people get care, and most of them are poor who wouldn't get it otherwise.

At least Medicare doesn't cut you off when you get sick because it might cost them, which is sadly not the case with many private insurers.

[mrp]

No, it is fact, properly researched data.

Deal with it.

Who cares about overhead? The fact is that private healthcare is 2.44 times cheaper per patient. If you can cut down overheads, start your own insurance firm.

[mrp]

Ahem. Even if you are right, the private sector is still 22% cheaper.

[mrp]

A healthy 25 year old with no family and has finished their education can spend as little as $25 US per month.

Preferred-Care Blue Rate Saver PPO

THIS IS BASIC COVERAGE

The most expensive plan cost $231.63 US per month.

Blue Care HMO

THIS IS EXTENSIVE COVERAGE

https://www.ehealthinsurance.com/

I said was from Kansas City (just random).

The maximum costs are half of what you said they were.

Insurance costs don't match health cover costs as insurance covers risk and non-patients do not incur health costs as such. Insurance companies also invest in capital markets such as property, shares and bonds to fund liabilities and dividends to shareholders. Public healthcare doesn't insure against losses, it subsidises losses out of taxation, which costs 140% of whatever revenue is raised.

[Ugly Betty]

Mrp, if you can find rates like that, knock yourself out. It's just not reality, at least not around here. $25 a month for health coverage? Pllllllease!

I ran my own info on that site, (not as a 25 year old college student, either and not as a smoker, which I am) and got rates from $138 per month with a $2500 deductible and 30% co-insurance and no coverage for office visits to $297 per month with a $1500 deductible, 30% co-insurance and office visit coverage only after the deductible had been met. The first plan would cost $4156 for a year and that assumes I never get sick. The second would run $5064, again, assuming I never get sick. Just how do you suppose a minimum wage person might pay that?

Some of those companies listed, well, I wouldn't insure my pets with them. If you have pre-existing conditions, they won't accept you, or require up front payments of deductibles. Others there are just thieves and end coverage once you've been diagnosed with a serious illness or won't cover certain forms of treatment at all. Also, they include no dental or vision coverage.

Finally, if you don't think overhead costs are a factor, you're in denial. Those are real costs and add to the premiums people are forced to pay.

[mrp]

Run it again and sort by price.

What is the cheapest? By how much cheaper is it than Medicare?

How many firms can you use before it becomes as expensive as Medicare?

Both of what you listed were still cheaper than medicare.

"Finally, if you don't think overhead costs are a factor, you're in denial. Those are real costs and add to the premiums people are forced to pay."

No s**t! On average, Medicare, $6 600 per paitient, private, $2 700. So overheads contribute to the cheaper system. What is your point? If you can reduce overheads, start your own insurance company.

I ran that thing as a couple from Miami-Dade county, both 64 and both smokers. The cheapest was $64 per week per person, $678 per month.

The most expensive was about $2500 per month.

No smoking and it falls to $514 up to $2037 per month.

You're still forgetting the deadweight loss of taxation - each dollar spent by Governemnt costs about $1.40 in lost production.

If you don't like some of the companies, why be so enthusiastic about a NHS scheme? Look at the waiting periods:

http://www.adamsmith.org/cissues/waiting-list.htm

What do waiting lists measure?

The newspaper headlines which tell us there are now a million people on NHS waiting lists are rightly shocking. The figure means that one in sixty of us are now waiting for medical treatment. And by no means all of us are even ill. Of those who actually need the NHS to do something for them, it is more like one in six who are condemned to wait.

Waiting lists are the inevitable consequence of a politically-driven, tax-funded, centrally-run health service. Users have no customer power over the system. Since the amount which people pay (through taxation) is unrelated to the volume of services they use, they have every incentive to demand as much service they can get, however marginal or even unnecessary. And because - unlike almost all other goods and services - there is no price mechanism to inhibit the over-demand, the central authorities have to resort to the only other strategy open to them, that of rationing.

Waiting lists are merely the symptom of this. They represent unmet demand. They are rationing by queuing.

Undoubtedly, this strategy has some success. Some people do not bother to see the doctor because they cannot face a long wait, while others fail to turn up to consultants' appointments because they have simply got fed up waiting. A growing number choose to dip into their own savings and pay directly for their treatment in the private sector. A quarter of cardiac patients actually d*e before it is their turn to be called in, which reduces the burden of demand even more.

But the headline figure for waiting lists conceals a great deal too. There are wide variations in waiting times in different areas, between different doctors and hospitals, or for different kinds of illness. So what is the real story behind the headline figures?

How long are the waiting lists?

What patients are concerned with is not so much the number of other people who are on the waiting list, but the length of time which they themselves will have to wait. Obviously, in principle it is possible for the waiting list to be small, but for each person to have a long wait; or for the waiting lists to be large, but for each person to be seen very quickly.

The National Plan for the NHS published in 2000 states that by 2005 "no one will wait more than 13 weeks for an appointment and 6 months for admission".

That was two years ago, but in fact the position has worsened slightly since then. The slide in performance suggests that, however determined the policy objectives might be, today's centralized control structure cannot in fact deliver even these modest goals.

In-patient waiting lists. Most urgent cases, however, are actually seen quite quickly. Consider in-patient waiting times - the period between a consultation with a senior doctor and admission for treatment. There are roughly ten million admissions for in-patient treatment each year. Just under half (4.3 million, in England) are emergencies and as such are treated quickly. Just over half (5.7 million) are for other sorts of treatment

Taking only the figures for England, the one million people on this waiting list at any moment, it is estimated that: 155,000 are seen within 4 weeks.

However, non-urgent cases can have very long waits indeed. Of the remaining 845,000 who are seen after 4 weeks:
345,000 are seen before 13 weeks, but
500,000 are not seen until after 13 weeks, and of those:
250,000 are not seen until after 26 weeks.
Out-patient attendance. There are around 44 million outpatient attendances each year. These are people waiting to see a consultant. The biggest delays are in getting to see the consultant in the first place: once you have had a first consultation, subsequent attendances tend to follow more quickly.

But of the (roughly) 11 million first attendances with a consultant:
8.4 milllion (78%) are seen within 13 weeks, of whom:
3.8 million (35%) are seen within 4 weeks; but
2.4 million (22%) are not seen until after 13 weeks.
How much time do we waste in waiting?

Of course, we can probably never entirely get rid of waiting time in any service - either in health care or even at the supermarket check-out. But for the population as a whole, today's NHS waiting lists add up to a very long wait indeed. As Professor Richard Feachem showed in the British Medical Journal of 19 January 2002, they compare very unfavourably with waiting times in Kaiser Permanente, a California health plan whose spending per patient is remarkably close to that of the NHS. In Kaiser, though, 90% of in-patients are treated within 13 weeks, and 80% of out-patients are seen within two weeks.

But let us set a more modest target for the NHS and say merely that a wait of over 4 weeks is unsatisfactory - and given the pain and anxiety that people may suffer, it clearly must be. So how much time do NHS patients spend in this 'clearly unsatisfactory' state of waiting more than 4 weeks?

Let us also assume that people reach the top of the waiting lists at a fairly regular rate as indicated by our raw statistics, so that all out-patients are seen within 20 weeks and all in-patients are treated within 36 weeks. (Though as a number of hip-replacement patients will testify, this is perhaps an over-generous assumption.) We can then calculate that, in rough terms:
the in-patients on the NHS waiting list will spend 235,000 years waiting in excess of 4 weeks for their treatments; and
NHS out-patients will wait 830,000 years waiting beyond 4 weeks to be seen.
That is, a total of 1,065,000 years of unsatisfactorily long waiting.

What are the knock-on costs?

Of course, this is not the whole story. Waiting lists cost people a lot more than just time. Dudley Lusted, chief economist at PPP Healthcare, undertook a major exercise on the economic cost of waiting lists. His starting point was to estimate the cost to employers of working days lost - counting the period after the first 4 weeks' absence - where the individual remained too incapacitated to return to work and was awaiting medical treatment.

Averaged across the workforce, Lusted estimated two days being lost per employee per year. With a workforce of about 22 million that suggests 44 million work days lost due to delays in medical treatment. With a weighted average pay of £15,000 the cost is therefore £660,000,000. As a rule of thumb, the consequential cost of lost work time or covering for absence will be the same again, to give a total cost close to £1.5 billion for employers. This does not include the productivity losses of below-par workers or the management costs of dealing with absence.

The cost of anxiety and limitations on activity for the patients themselves has been estimated by Professor Carole Propper of Bristol University. Taking this at £5 a day (the mid-point of her estimated range) then the unseen cost of the 1,065,000 years that people spend waiting beyond 4 weeks is approximately £19.4 billion.

There are, of course, other costs too. A MEDIX survey identified the extra burdens on GPs and their patients. Among the key results were:
Worsening conditions - 66% of GPs had patients waiting as outpatients admitted as emergency because their condition worsened
Increased burden - 90% of GPs had patient consultations arising out of waiting list delays and 70% of GPs dealt with problems arising from that - an estimated 1.5 million extra consultations.
What should be done?

Although all these costs are necessarily estimates, it is clear that the cost of NHS waiting lists - in terms of anxiety, incapacity, time off work, the cost of absence to employers, the extra costs to the NHS whose condition worsens and the cost to GPs of seeing patients who are waiting for treatment - is well over £20 billion.

But rough as they are, these calculations do tell us something about the real human scale of the waiting lists and the costs to individuals and economy. Unfortunately, fewer people are being put on the waiting list, fewer of those are being treated in good time, and the total queue is not getting any shorter. Clearly, productivity is falling, despite a real increase in funding of about £5,000 million in the past two years. The inescapable conclusion is that the current structure simply cannot make the improvements that we all want, and that radical reform is inevitable.

Pumping more money into a failing structure will not deliver the benefits. Importing clinicians or exporting patients is a marginal stop-gap. We need to change the system.

Most healthcare can be delivered locally, and there is a strong case for managing that delivery locally too. More local management, greater diversity of provision, and methods to make the financial rewards come upward from the patient, rather than downwards from Whitehall and through the health bureaucracy, could all produce a more patient-centred system where there was a real downward pressure on waiting times both from patients and providers.

On top of that, the quality of care is much poorer

http://observer.guardian.co.uk/nhs/stor ... 70,00.html

Patients who have major surgery in Britain are four times more likely to d*e than those in America, according to a major new study.
The comparison of care, which reveals a sevenfold difference in mortality rates in one set of patients, concludes that hospital waiting lists, a shortage of specialists and competition for intensive care beds are to blame.

Fresh evidence of a stark contrast between the fate of patients on either side of the Atlantic will re-open the debate over whether NHS reforms are having any impact on survival rates.

Mounting evidence suggests that patients who are most at risk of complications after an operation are not being seen by specialists, and are not reaching intensive care units in time to save them.
This week health Ministers will present the latest figures showing another yearly rise in the number of intensive care beds for those who are critically ill. But Britain lags far behind America and most European countries in its critical care facilities. An authoritative study to be published later this year will demonstrate that the chances of survival after undergoing a major operation are far greater in an American hospital.

The authors conclude that NHS waiting lists, the lack of specialist-led care and the fact that many patients do not go routinely to intensive care contribute largely to the difference.

A team from University College London (UCL) and a team from Columbia University in New York jointly studied the medical fortunes of more than 1,000 patients at the Mount Sinai Hospital in Manhattan and compared them with nearly 1,100 patients who had undergone the same sort of major surgery at the Queen Alexandra Hospital in Portsmouth.

The results, which surprised even the researchers, showed that 2.5 per cent of the American patients died in hospital after major surgery, compared with just under 10 per cent of British patients. They found that there was a sevenfold difference in mortality rates when a subgroup of patients - the most seriously ill - were compared.

Professor Monty Mythen, head of anaesthesia at UCL who oversees the critical care facilities at Great Ormond Street Hospital, led the British side of the research, which will be published in a peer-reviewed medical journal later this year.

'The main difference seems to be in the quality of post-operative care, and who is likely to care for patients in the US, compared with the UK,' Mythen said.

'In America, in the Manhattan hospital, the care [after surgery] is delivered largely by a consultant surgeon and an anaesthetist. We know from other research that more than one third of those who d*e after a major operation in Britain are not seen by a similar consultant.'

He also believes that the queue for treatment in the NHS would inevitably mean that British patients were more at risk. 'We would be suspicious that the diseases would be more advanced in the UK, simply because the waiting lists are longer.'

The New York patients had paid through private insurance to go to hospital and were therefore likely to be of a higher social class and healthier, whereas the NHS patients were from all social classes. The researchers attempted to level out social differences by rating each patient according to clinical status.

Each patient was then placed in a mortality-risk category. Those at greatest risk were calculated to have a 36 per cent of dying after surgery, whereas the lowest risk patients had between zero and five per cent chance of dying.

Mythen added: 'We looked at a number of hypotheses, but it does seem to show a difference in the systems of care, rather than a reflection of some other factor. The provision of intensive-care beds is obviously one of the differences. In America, everyone would go into a critical care bed - they go into a highly monitored environment. That doesn't happen routinely in the UK.'

Each year, more than three million operations are carried out on the NHS. Around 350,000 of these are emergencies, which carry a higher risk of complications, but there is no routine triage system in Britain for picking out patients before surgery, to determine who is most at risk.

Previous reports looking at deaths that occur within 28 days of surgery have shown that 36 per cent occurred in patients who went directly into ICU after surgery. But a higher mortality rate - 42 per cent - is seen among patients who had first been sent to a ward, got into difficulties and then had to be transferred to intensive care.

Professor David Bennett, head of intensive care at St George's, after looking at survival rates, said: 'There are substantial number of patients each year who d*e, who might otherwise have survived had they got the appropriate kind of care after surgery.

'There's a crucial six- to eight-hour period when some people need their cardiac output [the amount of blood the heart pumps out each minute] boosted. Even 80-year-olds undergoing heart surgery are far more likely to survive when they receive that care, so why are we not, as a matter of routine, picking out the people most at risk?'

Is there really an insurance crisis?

http://www.nationalreview.com/comment/m ... 190909.asp

A recent study by the Dallas-based National Center for Policy Analysis found that from 1993 to 2002, the number of uninsured people in households with annual incomes above $75,000 increased by 114 percent, while the number of uninsured people in households with incomes under $25,000 fell by 17 percent. The poor are getting more coverage while the comfortably off are choosing to buy less. If rich, young, male software developers working on a contract basis are choosing not to be insured because they reckon the likelihood of them needing insurance is small, then that is an example of labor-market flexibility, not a medical crisis.

Private is cheaper and better. Paying for advertising, investigation of false claims or shareholder dividends does not imply it is inferior.

[Ugly Betty]

Mrp, I don't think you and I will come to agreement on this issue anytime soon, like our lifetimes. lol I did some checking however, and found this helpful site. I believe you are overestimating the annual Medicare premiums by quite a bit. http://www.healthsymphony.com/MedicareInfo.htm


I am not advocating an NHS style system here. I realize it has a great many flaws and those who are very ill often have to wait too long for care, and by then their condition is often worse or it's too late. I am merely arguing that some government systems, like Medicare, can provide needed care at a lower price for those least able to afford it.

[mrp]

That's bollocks. The poor having increasing numbers of policies and the largest group without insurance is single, mobile, male analysts and consultants.

The cost per paitient with medicare is $6 600, private is $2 700.

The cheapest premium I could find was $25 per month, medicare starts at $93.50 just for medical insurance (hospital cover is included, but prescription d*ugs are not).

Come on, stop kidding yourself. The best way to help the poor would be a direct cash subsidy or healthcare vouchers. I don't see the point given the cost differences, cheaper premiums and better care of the private system.

[Elaine H]

Betty - you can argue with mrp until the cows come home hon - it will never make a difference. He is very big on theory, but reality often differs from theory as we all know!
Medical insurance in the USA stinks - unless you are mega-rich and can afford it. Having just gone through breast cancer treatment here in the USA, I can tell you that I am sooo glad that I have a European health insurance policy.
Every day I meet people undergoing cancer treatments who are having to file for bankruptcy - despite having medical insurance. Their deductibles and copays and prescription d*ug costs are so high - that they simply cannot afford them. So as well as being hit by a devastating illness, they are hit by financial ruin too. Not to mention the fact that their insurance companies often won't cover necessary procedures and medications.
When I had US medical insurance, I paid $900 per month! And we had a deductible of $5000 as well as co-pays, etc. etc. When they raised the premium yet again 2 years ago (although we had never made a single claim), we just decided we couldn't afford it any more and took out only catastrophic insurance for a year. Then fortunately, we discovered that as ex-pats, we could actually enroll in a European insurance plan. Boy am I glad we decided to do that - I was diagnosed with breast cancer a few months later, and my insurance covered the cost of all of my treatments, including all prescription medications. What's more- they didn't increase my premium this year either - despite having had to shell out hundreds of thousands of dollars for my treatment.

[Ugly Betty]

Thanks for your post, Elaine. You communicated so much more in one entry than I could in 100 debating with Mrp. You made my point for me and you did so with your own story, which all the articles and discussions of theory could not.

No one should have to lose everything to get the care they need. I'm very happy to hear you were covered as an ex-pat. Thank goodness for your sake!

I hope you are recovering well and never again have to endure what I'm sure you have thus far. All my best to you, and thank you again for adding so much to the debate.

[mrp]

"very big on theory".

You muppet.

What have I shown from EMPIRICAL DATA AND EVIDENCE

American private healthcare is cheaper per paitient

and, private medical insurance premiums are cheaper than medicare

The NHS has a post op mortality rate four-five times higher than UK private hospitals

The waiting lists of the NHS cause more people to be ill simply because they cannot be treated quickly enough, these knock on effects are quite costly.

"Every day I meet people undergoing cancer treatments who are having to file for bankruptcy"

Garbage.

[Elaine H]

mrp - you have now really upset me -and believe me it takes a lot to do that!
Take your theory and so-called empirical data and do whatever you like with it- but DO NOT ever tell me that what I have said is GARBAGE!
Unlike you, I live here in the USA, and thanks to a serious illness - which I didn't ask to get - I have the advantage or rather disadvantage of experiencing the US healthcare system and medical insurance system first hand! The medical treatment is fabulous - if you can afford it.

It is not a matter of whether private insurance is , according to your data, cheaper than medicare! And by the way, the utopic low premiums that you quoted apply to only an exceptionally small percentage of the population and not to the population as a whole. It's about providing AFFORDABLE health care or health insurance for EVERYONE! And as for HMO's - well the least said about them the better !

I am currently helping an elderly lady - who like me has breast cancer. She has medicare - yet is still expected to fork out $700 each month for her treatments, not to mention what she pays for other medications. She lives only from her meagre social security check - and therefore basically has the choice of eating or having her treatment! Well guess what? Last week, when her savings (which Lord knows wasn't much to begin with) ran out, she decided that she simply couldn't afford any more treatments - and because her social security income is just a little higher than the poverty line - she doesn't qualify for any assistance with the costs not covered by medicare. So I guess she will probably d*e sooner rather than later.
Do you want me to go on? I can tell you about sooo many people that I have met just in my area alone who are bankrupt or otherwise unable to pay for much needed treatment ! It is a disgrace that in one of the richtest countries in the world, a large part of the population cannot get even basic healthcare.

OH, the very poor are taken care of - and the rich have no problem, but those inbetween - i.e. the middle classes, and especially the lower middle class often fall into a so-called donut hole when they are suddenly faced with major illness. They have "too much" money to get any assistance but not enough money to pay their medical bills or copays if they have insurance.

Anyway, that's enough from me - getting upset with people like you just isn't worth my energy, which I need for other things.

[gnads]

Pres. you're a naughty boy

You espouse theory & written data

without any factual involvement in the personal situations described.

How have you the right to disbelieve what someone has personally experienced?

That's just being an outright pernicious lil prig .... aint that a mouthful

I've always been in Private health Insurance but I also have to pay for Medicare as well ...... still with the Gun buy back levy in it.

So having no choice about being in Govt. or Private I believe my costs are one third to a half more than they should be .... according to your theory.

As time goes by my out of pocket expenses have increased and there has been the imposition of excesses.

You've been in the workforce 5 bloody mins ..... you haven't walked a mile in anyones shoes.

You're damned lucky no one has called your theoretical waffle .. garbage.