National Health Care - Copays/Deductibles vs 100% covered

[Bread and Circus]

It seems apparent that a good percentage of DU'ers prefer a
single payer National Health Care system. Poof. Shazam. You
got it.

Now the question is:

Should the system have Copays/Deductible for services/meds/goods
that are based on ability to pay or should the tab be 100% covered
by the goverment

[BlueJazz]

1. I suppose that if we, as a nation, can go....

gallivanting all over the world, started phony "wars", and spending
money like proverbial water, we can damn sure afford to have national health care for everybody.

[sendero]

2. I hafta vote for copays....

... based on the theory that if there is no cost to the consumer for medical care some people will abuse it to no end, going to doctors for all kinds of trivial reasons.

My own Dr. and I have discussed this at length, and he's convinced he sees it all the time.

[davekriss]

14. If your doc sees it all the time now...

...and we don't have 100% pay for medical care (very few PPO or Fee for Service insurance plans today don't have a co-pay and deductible), then the reason for frivolous use of healthcare has nothing to do with a lack of placing a cost on the consumer.

Next?

[sendero]

23. Nice try...

.... but there large segments of society who do pay no incremental costs for increased care, and those are the people he is talking about and what drove him to his conclusion.

Next indeed.

[davekriss]

25. Have a link?

I would like to learn more about this abuse of the system -- and learn how I can get into one of these "large segments" myself! -- before I cede the point.

[Bread and Circus]

26. Yeah, just link to my office....

Look, I don't need a link. I see it first hand everyday..

With insurance

"Hey doc, I gotta headache, worst headache of my life...."

"Hey, you need a head scan"

"Sure doc"

----

Without insurance

"Hey doc, I gotta headache, worst headache of my life...."

"Hey, you need a head scan"

"Hey doc, how much does that cost"

"$1200"

"Hey, well, it's not the worst headache of my life...uh,
do I really need that head scan?"

---

This is a simplistic example but it really happens very similar
to this everyday.

[davekriss]

30. Compelling argument

:P

Fortunately most of us will be too busy living our lives for such abuse to be much more than background noise. Unless you have a definitive study to prove otherwise?

(I'm not trying to be argumentative, but it appears the claim that co-pays are necessary to eliminate abuse seems based on assumption -- more akin to one of those tired old conservative memes, like that funny one about a "liberal media". I'll be happy to cede the point if you can raise factual evidence.)

[Bread and Circus]

38. doctors are as much to blame (with the help of lawyers....)

because we order $80 billion dollars of un-necessary
tests each year just to cover our asses against the runaway
lotto like litigation in this country.

Take away bullshit litigation and I will happily gamble being
"owned" by the government.

Frankly, a lot of us would like a better quality of life,
less paperwork, the malpractice monkey off of our backs, and
better connection with our patients. We don't want to see 4
patients per hour with our hand on the doorhandle. We really
do want a better system.

[Cleita]

27. I think doctors encourage this.

They really need to decide who gets treated and who gets a lollipop. Many doctors enable hypocondriac behavior because the patient has good insurance and it sure beats time spent on that low paying medicaid patient. Other abuses are unnecessary surgeries and other procedures that also generate income.

I think if a doctor has a waiting room full of patients all of whom, he will be reimbursed for equally, chances are that he will treat the sicker ones and send the malingerers home.

I would be interested, myself, in knowing how this works in countries with single-payer systems. Do the most needy patients get taken care of first if re-imbursement is assured? Or, do the well-insured malingerers get coddled like they do in our system?

Maybe this explains the complaints about long waits. It could be those who could take care of their problem out of the medicine cabinet are the complainers.

[Bread and Circus]

40. deleted by familydoctor...

[Bread and Circus]

44. There are many good and accurate observations in your post.

[BattyDem]

3. 100% coverage

This country is rich enough to offer healthcare as a basic right. There's always plenty of money for phony wars and tax breaks for the rich, so let's "find" the money for something that benefits everyone. If the big corporations would start paying their fair share of taxes instead of putting their "headquarters" in the (tax-exempt) Cayman Islands, we would have more than enough money.

[Bread and Circus]

4. Bump

[quinnox]

5. Full coverage with caveats

It would have to be paid for with higher taxes acroos the board, and reductions in wasteful government spending. Can't run it on deficits.

That done, then also people would have to have certain restrictions if they abused the system, or penalties like they would have to pay if they kept going for no good reasons, like hypochondriacs or people just going for silly reasons.

Also, no plastic surgery would be covered, only medically necessary things.

[Kanary]

6. Actually, quinnox, there may not be need for more taxes

I say this because I think that's going to be one of the scare tactics of the reich wing.

Are you aware that the US spends more on health care than any other country?

So much of it goes for paying rich CEO's and doing paperwork. If that was cut out, there would be plenty of $$ to provide care for *everyone*.

As for the "hypochondriacs", I know that has been discussed here before, but I don't remember all the replies. What I *know* is that most other countries provide universal coverage, and have obviously dealt with this problem. It certainly shouldn't be a barrier to much needed care.

Kanary

[quinnox]

8. Maybe so

If it can be funded without raising the taxes, then all the better. You make a good point, it is being done in other countries so we can learn from them and see the best way to go about it.

[Kanary]

12. Absolutely, there are plenty of models to go by, quinnox

We don't even have to reinvent the wheel. :)

Have you, by any chance, read Dennis Kucinich's proposal on Universal single payer health care? He covers this pretty well. I wrote a Resolution for my caucus that opened people's eyes. Most US citizens really don't realize what it is we're paying for, and what the rest of the world does.

For instance, the US pays more for health care than any other nation, yet ranks 37th (WHO) in health standards. Now, that's pretty pathetic. That's what for-profit health "care" does.

I really think that if people were actually shown the facts, and what we COULD have, they would rise up and fight for it. We've been sold a billl of goods. To our own detriment.

Kanary

[quinnox]

16. No, I haven't but

I think Kucinich is on the right track about taking the profit out of the system when he talked about this during debates.

Yea, I agree if it was sold in the right way then the people could be convinced to go for it, but of course the right wing will try to scream socialism and communism and all that nonsense as a scare tactic like you mentioned.

Maybe one day it will be done, it is a long shot but you never know.

[Kanary]

18. Insurance is "socialism", too

It is only a long shot if we keep saying it is.

If we decide, as a people, that this is what we want, and put forth the effort, then it will happen.

It's up to us.

Kanary

[corporatewhore]

10. sometimes plastic surgery is i think nesscary in case of

little kids getting disfigured from burns or accidents.My grandfather told me that in his hometown (outside of reynosa) there was ahorribly disfigured woman and she had rocks thrown at her cause she was so "ugly"

[quinnox]

13. That's true, in those cases

where it is done because of disfigurement or accident or burns then I would say it would be covered.

But I would say no plastic surgery covered that is done for purely cosmetic reasons, in other words where the people are normal and they are just trying to look beautiful.

[Kanary]

15. You're absolutely correct!

We are certainly a rich enough country that we don't have to withhold that sort of thing! There is NO reason for people to suffer, when it could be fixed, if they wish it.

I remember an episode of Judging Amy where the resident dr was treating a young woman who was disfigured from being in an accident. The assinine dr on duty wouldn't do anything about it, so the resident found a way around it, and got her face fixed. Things like that make a huge difference in how life goes.

I'm very glad you brought this up. There is no reason for a country like ours to be so hard-nosed about it.

Kanary

[davekriss]

20. Not necessarily

Review this proposal, here...

http://www.pnhp.org/publications/a_national_health_program_for_the_united_states.php

The idea behind this full-coverage single payer plan is that we can have a full coverage plan -- health, prescription drugs, mental health -- at exactly the same proportion of GNP healthcare expenditure by (i) eliminating the 6% to 9% revenue captured as profit and admin fees by the insurance industry, (ii) reduce the 10% revenue of physician's fees that go to their admin staff to process insurance, and (iii) capturing the fees that today go to paying insurance premiums.

Don't believe the Repug hype, we can collectively grant ourselves the right to decent healthcare.

[Kanary]

35. The key word is "collectively", davekriss

We're not going to have this handed to us. Too many vested interests.

We're going to have to decide that this is what we want, and come together to see to it that we get it.

You're correct on the economics.

Kanary

[Tripper11]

7. I said 100%.....

Part of the problem, as I just found out with copays is there can be hidden costs. I went to get my wifes script today and the charge was over $30 for one prescription. I got them anyway and when I told her, she got pissed. Not at me, but the insurance company.
It seems she needed "preauthorization" in order to have only paid what should have been a $10 copay instead of the full prescription amount.
I asked her what the hell that meant, but she didn't know. To me it seems that if your doc gives you a prescription that's the authorization, but apparently there is some little sneaky way charge us the full price.
The person at the insurance company blamed the pharmacy, and the pharmacy said normally these things pop up on their computers when it is needed.
Either way it's totally ridiculous, and we're fighting to get over $45 back in overcharges. It's not the money so much as the priniciple.

[corporatewhore]

9. i went to the docs today i showed them my military id they let me in

the doc looked at my throat looked at my ears prescribed some antibiotics went to pharmacy showed them my card waited fifteen mins and went home my mom on the other hand would wait awhile until she was in very bad pain or until we beg her to go and then she would only fill like a small percentage of her perscription i think everybody should have the kinda health care i have.i have discussed this in school and they said i deserve it cause my dad is serving the country but i believe everybody serves the country in their own unique way.I would even argue that my mama has served the country more than my dad has.You shouldnt have to join the army to get decent medical care

[bleedingheart]

11. As much as I would like to see 100% coverage all the time

I think that a copay system would have to be implemented in order to keep the system from being abused. However that said, I think that income should be a deciding factor in what that copay amount may be or how much the individual taxpayer would pay for the service.

[Kanary]

17. Why would other countries not have the problem, then?

Are US citizens that much more "abusive" than people in other parts of the world?

If that is the case, then WHY? What is it about 'Merkins that we are so dishonest and manipulative? And, shouldn't that be what we would focus on, rather than denying care?

As for basing it on income..... I will tell you that even when it is a $2 copay, (which means that a lot more is spent to process the payment, than is received!!), for people who live on a fixed income like SS or disability, at the end of the month, there is NO $2 available. So, those people would just have to wait until the next month in order to get their medication anyway. No, a copay for those on the edge is just punitive.

Kanary

[Bread and Circus]

28. Actually, Japan applies a form of copayment by the patient...

so don't just assume what you want is done everywhere else
but 'Merrucah

[politicat]

21. Abuse is in the eye of the not-beholder

My dearest friends are both English - this just happened, but there it is. So is my aunt's husband, a couple of close family friends, and several other family/kin types.

I've asked them this question. The answer I get in most cases is "no, the system's not abused. That's what local surgeries (primary care providers) are for." And in my circle, there have been 4 cases of cancer, two of difficult pregnancies, and two of major heart defects.

This makes sense to me. The local PCP acts as the gatekeeper. What does this mean in the long run? That the PCPs will feel a little swamped until people adjust - a year or so into the program? So? In many of the practices in the southwest, where I did my internship, docs schedule a few extra minutes with patients likely to need some extra assistance - like the elderly who don't get out much, new mothers, teens. Why not do the same with people who have never had insurance so you can reassure them that this service isn't going to go away? And why the rush to get everyone out of the office anyway? In a single payer system, the profit motive, and the motive to see lots of patients is reduced. Besides, has anyone actually done a study to see if Medicaid recipients bring "frivolous" complaints in more often than the privately insured? until I see that, I'm not going to believe that it really happens. Hypochondria can affect anyone, no matter their insured status.

Look, not to be mean to doctors, and I've known several good ones. But I've also known a lot of very selfish ones who spent months on vacation, saw few clients, and basically wasted their talents, skills, and training. I'm not interested in forcing anyone to work more than I do - 40 hours a week. But the docs who are complaining that the system will be abused are not likely to be the ones working for $40K, 60 hours a week at the local community clinic or ER, serving the poor who wait until there's no more waiting.

The ones likely to complain are the ones who see universal coverage as threatening to their two Lexus lifestyle. And in this case, I have to say, "if you're not in it for the humanitarian reasons, you're probably in the wrong profession."

Pcat, who is a health professional, makes very little because she works in Community mental health, and wishes everyone had access to the basics.

[Kanary]

22. I think you hit the target, politicat!

Everything you have said rings true to me.

I can't speak for everyone, as I really *hate* to go to drs, but I can't imagine there being a run on services, just because "now I can". Except for those who haven't had medical attention for lack of $$$, and those are specifically the ones we should be getting in immediately, anyway! Think of what could be prevented, if all those people could suddenly make appointments, and get in for a basic checkup! It's really obscene that so many are not able to do that simple thing.

Then, I think of all the men who also don't like to go to drs, and only go because their wives finally nag them into it. No, somehow, I think that, on balance, our problem is more of people who can't or won't go to the dr, than of people who would "take advantage of it".

I once knew a woman who seemed to me to have that need for attention and seemed (to me.. who knows...) to seek that attention from drs. I'm sure they exist. But I don't think that's the biggest problem.

As for the "selfish" drs you mention.... there would still be a place for them.... As Tom Lehrer sang so long ago, they would "specialize in diseases of the rich". There would still be rich folk who would seek out drs for other reasons, and would have their own "idle rich" drs. They could talk about their Lexus, or something. :)

Thanks for a well-thought out post!

Kanary

[Kanary]

19. Actually, familydoctor

The whole idea of copays and deductibles kinda defeats the whole idea, doesn't it?

The GOAL is to REDUCE the amount of overhead, which means that all the paperwork is a large part of what keeps our costs high. So, if you continue with the paperwork in order to keep the copays etc, then ..... there go the costs, which means taxes, which means people will scream.

No, a system of coverage for all without all the folderall will be much more manageable, and much more equitable.

As a dr, I'd like to hear you weigh in on this question.

I mean, maybe I'm wrong, but I would *Guess* that you have grown somewhat disenchanted with paperwork... :)

~~gigglesnort~~

Kanary

[Bread and Circus]

29. Yeah, it's the bane of my life....

I hate it.

But the government is no better than the insurance companies.

[Kanary]

32. I understand that. But... wouldn't getting rid of the whole copay system

aleviate that? Isn't that a big part of the problem?

Drs should be able to concentrate on treating patients. What a concept.

Kanary

[Bread and Circus]

37. Yes and no....

but imagine if Uncle Sam decided exactly what you could and
couldn't make for a living. Then imagine Uncle Sam with
Hastert on one shoulder and Delay on the other...

I am not against a Single Health Payer system. I'm just saying
I am damn scared what a mess the asshole politicians would
make it.

I've worked as a medicaid provider. It's been starved to death
by lack of funding (blame the gop). It's hell to be a medicaid
provider.

Again, just put your livelyhood and your children's welfare in
the hands of Delay and Hastert for a moment. It makes you shudder
doesn't it?

[Cleita]

39. They will turn any workable system into garbage.

That's a given. I have really been knocking my head against a brick wall trying to figure out how to neutralize these type of bureaucrats and politicians to where they don't count anymore. With a will, I think it can be done. It's trying to figure out by whom and how. I think the medical profession itself is going to have to stand as a cohesive group along with the people to accomplish this.

[eridani]

24. More money wasted in processing copays than they recover

There are more people around like me that people who 'overutilize' IMO. My eye exam and mammogram are pretty overdue just because I have trouble finding the time to get basic stuff like that taken care of.

[Cleita]

31. I would rather we had our health card that we showed to get

care. I would respect any decisions a doctor would make that my case isn't as dire as I think. If I didn't like it, I would like to be able to get another opinion. This would be ideal to me. However even a system that has affordable co-pays or deductibles would be second best for me as long as it gets me health care and treatment. What I have now isn't doing either because my insurance premium is so high I can't afford the deductible to get the care I need.

[GreenArrow]

33. 100% covered

but covered not by the government, but by we the people. The government serves only as an administrator.

[Djinn]

34. can reasons for co-payment and 100% cover

In Australia we have a co-payment - you can either go a Dr's and pay your bill and then claim X amount (I think it's $35 and GP bills range from that to $50ish depending on where you go - prob more in the posh suburbs) or you can go to a bulk billing clinic which only charges the amount the government will pay and bills the govt directly - ie the patient doesn't need cash to be seen by a GP in those clinics. Just a Medicare care (which is an ID verifying you're an Austrlian citizen/permanent resident and entitled to claim on the system)

Unfortunately the bulk billing clinics can be really hard to get an appointment at when you need one and tend to have a high turnover of doctors meaning you generally don't get to see "your" doctor and often they have a bit of an "in and out" attitude.

So what can end up happening with co-payments for those who can afford it is you still end up with two tiered health system with only those who can afford to pay the extra getting high quality care.

That said if we had a total govt pays system every doctor would be FULL to the brim with parents who take their kids to GP for every single head cold and lonely people wanting to chat - it's already a pain to wait for them to finish each time you go to the Doc.

[Jackpine Radical]

36. I think it's an empirical question.

The main purpose for copays in this kind of system would be to curtail abuse of the resources. Copays, if used at all, should be based on ability to pay, and should be adjusted to a level that doesn't discourage people from getting needed care, but does hold down on hypochondriacal attention-seeking behavior.

The system should also have a much stronger preventative and health-oriented approach (e.g. encouragement of appropriate psychological treatment, stress management, health club membership, etc.) to reduce utilization of high-cost, last-ditch services.

[SoCalDem]

41. In a perfect world,

I would like to see a yearly physical, with the basic lab work, and routine tests that are recommended, for every American.. This alone would/could catch many serious conditions BEFORE they became life-threatening(Co$tly)...

and..

maybe... like vouchers.. so many office visits a year (depending on family size and age of children or people)

If you have 3 vouchers, and you have a stuffy nose, you are less likely to "use" that voucher for something insignificant, and are more likely to "save" them for times when you really are sick..
Obviously if someone has a chronic illness that requires "extras", the doctor could issue the patient more..


Emergency room visits would decline dramatically, if parents could take their kids to the doctor when they needed to.

Specialists would still require a referral, but at a certain age, every patient would get a baseline EKG/colonoscopy, etc. so that as they aged and problems cropped up, there would be some basis of what "was normal" at a given age..

Physician assistants could help a lot too, since for routine things they could be the first resource.. This would free up doctors to see to their more ill patients.

[Cleita]

42. Kick

Must go to bed.

:kick:

[shimmergal]

43. Leaning toward co-pays, but. . .

small ones. No $50 like our Australian friend has to pay. I also have some related concerns.

First, a single-payer system that requires one to pay _any_ amount, no matter how small, to get and keep membership is a disaster waiting to happen. Some people won't have the money, and others who may have it are just spacy or disorganized enough that they'll forget to make the payments sometimes.

Second (long story, but question at the end.) I now belong to a Medicare-related HMO. In principle I'm opposed to them, but practically, it's the best arrangement for me at this time. The cheapest supplemental insurance costs almost $200 a month; no way can I afford that. And going without it, the 20% co-pays were eating my budget alive. 20% of a $300 office fee can add up pretty fast.

Now I pay no cash for coverage and only $10 or $20 co-pays for office visits. But the _best_ thing about it, if I need to see someone quickly, I call the network and they'll find an appt. with an appropriate Dr. (GP or specialist) _right away_. Ever try to talk your own way into a speedy appt. with a doctor you haven't seen before (and when you feel awful?) It's nearly impossible, and if you don't feel like the other option--a 4- to 12- hour wait at QuikCare) you're just out of luck.
My question is, is there some way (other than giving HMOs the big bucks) to encourage this sort of service under Single-Payer?

Third question. What about alternative healers and therapies? IMO, they're a valuable supplement to regular medicine (some more valuable than others, of course.) Subjecting them to rigid govt. regulation would probably be a mistake; not having them eligible for any of that health system money presents another bunch of problems. Just wondering.