Which of the current crop of Presidential candidates has a healthcare plan that is workable and desirable? What do you like about it, and what improvements would you like to see?

Mitt Romney had a good plan for Massachusetts when he was governor. (He seems to have changed his mind now, though, a habit he has developed lately.) If I understand things, it is about the same as what Hillary's plan is now. It's not what I'd like to see, but it works, again, from what I have read.

Frankly, what I would like to see won't happen for a long time, and it is too detailed to explain here. Besides, Scotty would start yelling and calling me names again.

According to this site, Clinton, Edwards and Obama are offering pretty similar ideas, while the Republican candidates aren't talking much about the issue. That was back in May, though.

Ah. From the same site this month - McCain's health plan. Others are discussed, too.

Has anyone suggested the obvious answer to one big question? It is clear that insurers are allowed 1) to ask for very high premiums from those who might be very expensive to treat or are otherwise high risk 2) to refuse to insure somebody.

The obvious answer is to compel all insurers to insure everyone who seeks insurance, regardless of health history, cost or risk 2) to compel insurers to charge exactly the same premium to everyone. The only permissible variations are 1) that the premium can be adjusted for age but remains the same for all in each age group 2)that the premium may vary according to the postcode (zipcode) of the insured. That is to accommodate the fact that healthcare will inevitably be more expensive in some areas than it is in others.

How does that sound?

Has anyone suggested that the obviouus answer to the questions Fred has raised is a single payer system? Heavens forfend! Filthy Socialist idea, one step removed from communist dictatorship. We already have the best health care system in the world, don't we? Are we going to be influenced by 47 million deadbeats who refuse to get off their dead asses and raise themselves to the same lofty heights we hardworkers have attained? So long as 253 million of us are either satisfied, afraid to shake the boat, or convinced that we already enjoy the best of all worlds - just bugger off and stop trying to import your foreign ideas, by jingo!

Seriously, why don't we try to listen to what the World Health Organization, Fred Puli, dancegirl, babthrower, newnickname, and some of these other AP members with personal experience and knowledge of UK, Canadian, and French systems have to tell us ? Is our system so indefensible that we have to resort to comparison with that of the Castro regime??? Are we really uneducable? Already perfect?

Fred, in the UK or in France, are there actual insurance companies involved, or does the government just make the payments?

A while back, I gave my ideas on my blog,

here,

and here.

Written with an eye toward issues regarding providers, but general as well. Each post generated lots of comments, not all of them positive!

quote:

Originally posted by DorianGreyed:
Fred, in the UK or in France, are there actual insurance companies involved, or does the government just make the payments?

Not sure what you mean by 'payments' in the plural. In Britain the service is free at point of delivery. Nobody parts with any cash at all. The only 'payment' would be the payment for a prescription as an outpatient. This currently about £6-50 ($13) but is not payable by people of sixty up nor by various others.No insurance companies are involved in the National Health Service at all.(Except that any injured claimant is certain to be treated in a National Health Service hospital, which must save the insurers a lot of money )

France prompted my question. In France insurance companies are nearly always involved. The French system is quite different.It usually involves insurers to a degree, though in practice the amount insurers are called upon to pay are modest, for reasons which are plain if you read the folowing link. This link is meant for foreigners who intend to settle permanently in France but it explains the system fairly well:

French Healthcare

Insurers don't ask what your health is !Being French they ask all about your marital status (very important in French records) and your address and postcode but not whether you are ill or likely to be They quote a premium based on age and postcode (where you live may mean that the local doctors are entitled to charge a permitted bit over the tariff paid by the state, as explained in the link) and it's the same premium whatever your history.There is fierce competition for this business. Insurers try to outdo one another all the time. With families most, if not all, insure the first child for a modest premium but insure all other children free.

By payment, I meant doctor's fees, meds, hospital charges, etc. Someone pays these.

quote:

Originally posted by DorianGreyed:
By payment, I meant doctor's fees, meds, hospital charges, etc. Someone pays these.

We are not talking the same language

What doctors' fees? What meds? What hospital charges? No patient 'pays' these.No insurance company pays them either, unless the insured is placed with a private hospital or takes private care.

The NHS pays, but not piecemeal or on a case by case basis .

There are a few family doctors who take only private work.The only one I know of is the in house doctor to an enormous block of apartments in Westminster.Most specialists, obviously, are in NHS hospitals. However, specialists who take private work commonly do both National Health Service work as well as private work.So, the one time I decided to take private medicine I was in a private hospital, attended by an eminent, senior, liver specialist. That man spent two days a week in a National Health Service hospital, as a consultant. The NHS paid his fees for that work. (As explained here in the past, that was for alcoholism.I didn't think it right to take NHS services for such a condition, though they were available to me.If I could afford the cash for a lifetime's booze,I ought to pay the cash price of dealing with the consequences . I paid.)

A GP (family doctor) who takes a contract with the National Health Service is currently paid a basic annual fee of about £128,000 (about $256, 000 ).Most, if not nearly all, of our family doctors have such contracts. Specialists, naturally, are on better money.

There are private hospitals in Britain, generally owned by insurers, but most hospitals in Britain are owned, directly or indirectly, by the state. As I understand it, there is at least one hospital which is privately owned and run but which is used entirely by NHS patients: it's entirely contracted to the NHS and was conceived for that purpose.I was told, by the Member of Parliament in whose constituency it is, that it is American owned (Tony Blair was all for having private enterprise in the Health Service, as in other areas of public services).

In France, as explained in the earlier link and post, there is a system where the patient is reimbursed. So there there is a payment to be made first.

Canada's system is described here. It maybe fits DG's question better. The difference from the UK is that, although the Canadian system is 'often called a socialized-public system it is in fact merely publicly funded. Most services are provided by private enterprises. With rare exceptions, medical doctors are not on a government salary, but operate as independent businesses'.

One problem in the US seems to be (just guessing here) that the insurers inevitably 'cherry-pick' the fit and healthy to insure, so that premiums for those likely to need expensive care are not just high but impossibly high. Yet, if you fix the prices and dictate the customers for insurers (the only way to avoid such cherry-picking?), then why bother with private insurers at all?

Wherever I've gone to a doctor's office, someone dealt with me at a reception area. After the waiting room, I was led by a second person to an examination room. Sometimes, a third person comes in to check my blood pressure and weight. Finally the doctor comes in. When I leave, I make an appointment for my next visit. A fifth person does this. Behind her, I see some of the people that dealt with me before (but not the doctor) and quite a few other people, writing, filing, on the phone, etc. I don't know these people, but I know that they aren't doing all this for me out of the kindness of their hearts. They get paid by the corporation formed by the team of doctors sharing this office.

When I go to the hospital, the situation is similar, except far more people are involved, and I use more supplies. I also get fed three times a day. The hospital pays these people.

In the health care systems of Canada, the UK, and France, unless the situation is really different, don't you have similar people doing things? How do they earn a living? Who pays them? Who pays the company that makes pacemakers? Who pays for the dried out chicken they serve at mealtime?

In the US, the hospital pays for most of the services you get while in. They in turn, bill you and the insurance company. The doctors' corporation pays its employees, and that is firgured in what is billed to you and the insurance company.

How does it work in your system?

NNN, strictly speaking our GPs are not on a government salary. They are on contracts. They are not government employees. Their practices and surgeries are privately owned by the doctors themselves.The village surgery which we use here is just such a partnership and has some twelve or so doctors. A 'small' practice has five or six.Such places may take private patients but their business model is such that they usually do not bother. Efficiency and profit dictate that they run on NHS contracts.It's where the money is These surgeries practice in their own area only. To be registered on their books you have to live within their NHS catchment area but they won't hold a monopoly over it.

That marks doctors and their businesses out from hospitals. Hospitals are almost always owned and funded by the state.

Fred, I don't know if you have seen "Sicko". If you haven't, would you watch this excerpt on French health care, and comment on whether it is a fair representation of the system there.
Out of all the health care systems, Moore looked at, I was the most impressed with that in France.

French Healthcare, "Sicko"

First, we forget the lawyers and we kill the actuaries.

The simple answer is to do just as Fred says and remove all ability for insurance companies to put factors of risk on people and charge them differently or choose not to cover them. Come up with a minimal list of factors that can govern insurance guidelines and make them universal.

But alas the insurance companies would lose an awful lot of money and that may be a worse fate for America than having millions of uninsured people.

In the hospitals the staff are either working for private contractors or they are directly employed by the NHS itself. A lot of the business of running the hospital itself will be placed with private contractors: the cleaning may be, as will the garbage removal, for example.

The medical equipment is supplied by the makers or specialist suppliers and paid for by the hospital.The 'NHS trust', which runs that hospital (sometimes these run more than one) is allotted a budget to spend as it thinks necessary and best.

A lot else is private business anyway. Obviously a big hospital like Addenbrookes' in Cambridge has many private businesses which are incidental to the hospital: the patients' bedside TV and phone service are supplied and maintained by private contractors and there are the banks, the florists, the newsagents', the shops, the delicatessen, the travel agents (which I find slightly odd: perhaps people book holidays for recuperation or do they do so with Granny's money as soon as she dies there?) the food outlets and so on.

The local GPs practice employs staff in its business [see above]. The staff are employed by the doctors. Not knowing the intricacies of the business I don't know exactly how the business's contract with the NHS works or the details of its terms.The contract with doctors' practices used to be, probably still is, basically calculated on a per capita rate of the number of people they had registered on their books as 'patients' (you register with a local doctor as soon as you start living in any practice's area). So the practice knows its income and so knows what it has to spend on staff,nurses, receptionists, pharmacists etc (our local practice maintains an in house pharmacy). The pharmacy adds to the profits, as well as the efficiency, of the business because the partenership must, at least, get a cut of the prescription charges which would otherwise go to some local pharmacist. The more efficient the practice is the more profit it makes, as with any business.

quote:

Originally posted by coldfuse:
Which of the current crop of Presidential candidates has a healthcare plan that is workable and desirable? What do you like about it, and what improvements would you like to see?

I despair of ever seeing a healthcare plan from any of the candidates that has a snowball-in-Hell's chance of ever being enacted, We see from reading how other countries handle the matter how and where changes might be made, but I have to agree with Dorian; I never expect to see anything similar, here, in my lifetime. I'm afraid that there are 253 million voters who are too little concerned for the 47 million without coverage, compassionate pretensions notwithstanding, and too much concerned with the candidate's race, gender, religion, etc.

quote:

Originally posted by dance girl:
Fred, I don't know if you have seen "Sicko". If you haven't, would you watch this excerpt on French health care, and comment on whether it is a fair representation of the system there.


French Healthcare, "Sicko"

Yes, it seems so.Haven't seen the film, which has only just been released in Britain.

quote:

Originally posted by frankvan:
I'm afraid that there are 253 million voters who are too little concerned for the 47 million without coverage, compassionate pretensions notwithstanding, and too much concerned with the candidate's race, gender, religion, etc.

It's the 253 million who ought to worry, if insurers are refusing to insure, are charging big premiums or are avoiding or reducing their liability by imaginative or fanciful use of exemption clauses and the non-disclosure rule

The last is particularly pernicious and popular with insurers. It has been a big cause of trouble for many years. It is unique to insurance law. It has its own legal Latin name uberrimae fidei, which gives a clue as to how long insurers have been protected by it and also abusing it. They'll claim that any fact, however slight, however remote from the cause in action, and however unlikely to be relevant or thought so by any person and however unlikely to be noticed by the insured, which is not disclosed at the outset or during the course of the policy nullifies the whole policy.Happily we have the National Health Service, so any health insurer who reneged here would not cause mischief to the insured. Someone in a country without such a system is not so fortunate.

Private healthcare by law:The Dutch system is now entirely 'private'. Everyone is insured by private insurance companies. The rates are fixed and insurers cannot refuse anyone insurance for the legally required package. Would that not suit America?
Here's a brief explanation:

Netherlands healthcare

(The rate given in the link, 95 euros, is about $135)