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I have a choice and elected to pay the extra money to be in a PPO, rather than an HMO, in California. and generally do not have to wait--except in ER's which can be unbelievable.  though I must admit they do a good job of triaging and handling the most critical cases.

California would be a great example though of what you are talking about.  Doctors are being squeezed by California Medicaid, Medicare, etc.  In fact my urologist just moved back east because he felt the financial situation for him personally is just out of control.  I wouldn't want to defend this statement right now (because I'm hoping to write a diary with a friend on this issue soon), but HMO's have a lot of the practices of a nationalized health care system.  So you may be getting a glimpse of socialized medicine.

Just to finish on this California point however.  The extreme tightening of healthcare mayments by the government, the very cost competitive nature of HMO's in California, are IMO driving down the quality of healthcare for all--even myself as a PPO.  I have an unusual work and travel schedule now, and am able to choose where to have my doctors and main care (obviously not emergency care) and I've moved our doctors and main care providers to Illinois, where personally I've found the care far better.  I know this is an extremely unusual situation (and for me too)--but just mention it because, once again IMHO, I don't think Americans understand the lower quality of care in socialized medicine than they are used too--and HMO's are a glimpse at that care.

IMHO, and obviously all our financial situations are different, but I would recommend people sacrifice on some other area of their spending, and pay the extra for a PPO.  

by wchurchill on Thu Oct 13th, 2005 at 09:02:05 PM EST
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I have several friends in Canada, where there is "socialised medicine."  They are appalled to hear of the quality of care that I receive as an HMO member.  Nothing in their experience matches the disdain w/which the US insurance/HMO cartel treats patients, the opacity and inefficiency of the bureaucracy, etc. Their paperwork is simple and they do not report excessive waits for services.  Nor do they fear that any illness in the family may lead to bankruptcy, as many American families must.  IMHO the HMO experience is a taste of Fully Corporatised Medicine, which is not quite the same thing as socialised. :-)

And what of those who cannot afford the high premiums for "business class" health insurance?  They should just resign themselves to inadequate care, or no care?

I read a while back that an astonishing percentage of health care expenditure -- more than half of the notorious 30 percent admin overhead -- in the US was dedicated to the denial of health care, i.e. gatekeeping, screening out patients, exhaustive analysis of "savings opportunities", etc.  The author of the article (which I will try to find) contended that the money spent on denial and gatekeeping was almost adequate to provide care for the people who were being screened out -- a typical case of "spending a buck in order to save a buck" ...though of course what this really means is diverting an enormous cash flow into the pockets of middle managers, accountants, financial analysts and the elite upper management of private insurance firms, so it's more like "stealing a buck in order to steal a buck" -- that is, if we accept the fundamental premise that the purpose of a health care system is to provide health care, not to enrich elites or provide permanent job security for unproductive paper pushers.

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu Oct 13th, 2005 at 09:22:30 PM EST
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I probably should have commented that I think the American health care system needs significant improvement.  I don't want to be viewed as an apologist for the current state of affairs.

There used to be a survey of opinions on the healthcare systems in the UK, US, and Canada.  I haven't seen it in many years.  I'll have to see if I can find it.  I also have Canadian friends, and hear a little more about the problems.  So for example, they love living so close to the US, because they can just come across the border and pay for a surgical or endovascular procedure (pay since of course they don't have US health insurance), rather than waiting months for the procedures.

By the way, I'm just realizing that I should have recognized that we miscommunicated on our early posts about waiting.  On my original post, I was referring to the practise of having to wait to get a surgery done.  For example for years the average wait in the UK for an elderly person to get a hip replacement was one year.  So you are 75 years old, in pain, in the latter part of your life and wanting to have as high a quality life as possible, and you have to wait a year for the surgery.  I'm not up to date on the waiting list for that procedure today--and I know the UK is raising significantly the money spent on healthcare so maybe they are lower.  But I don't think many Americans are aware of this aspect of nationalized healthcare.

But, just not to be branded a capitalist here, my own solution to this healthcare crisis is a combination of the US and UK type healthcare systems.  they both have +/-'s.  Another minus is when I was familiar with it 10+ years ago, they were 6 to 7 years behind us in adopting new technologies.  But I shouldn't go on here, as I can't yet take the time to really get into this one.

by wchurchill on Thu Oct 13th, 2005 at 10:17:39 PM EST
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This is a wait -- four months without part of your skull while insurance haggles.

http://news.bbc.co.uk/1/hi/health/3706631.stm

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Thu Oct 13th, 2005 at 11:02:21 PM EST
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yes I agree this was total incomptence in this particular case.  But do you think we can't do a review of the UK and France and find similar incompetence?

these individual problems are heart rending and important.  but I dont think we'll fiond beaurocrartic incomptence limited to Americans, english, rrench , etc.

by wchurchill on Fri Oct 14th, 2005 at 05:59:20 AM EST
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Yes, I realize this was sort of a one-off incident and I did use it as sort of a cheap shot for its shock value, but I think the important point of the story was that this was not incompetence -- it was refusal to pay.

Incompetence I can see -- they lost the skull fragment or dropped her off the schedule or something.  This is different from that.

And there actually is a ton of evidence that our system is broken.  My Unbossed colleague, em dash, has writes a lot on the subject.  Here's a sample:

Code Blue!  Stat!

The Healthcare Crisis and Homeland Security

And my favorite:

Give the Gift of Love:  Buy Grandpa a Pill Splitter for Father's Day!

She's got a lot of good posts in there and they're loaded with statistics, studies, and links.


Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Fri Oct 14th, 2005 at 04:02:23 PM EST
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Paul Krugman addressed the question in a NYT op-ed last April, and you may be thinking of this: Passing the Buck.

According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries - but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.

According to the health organization, the higher costs of private insurers are "mainly due to the extensive bureaucracy required to assess risk, rate premiums, design benefit packages and review, pay or refuse claims." Public insurance plans have far less bureaucracy because they don't try to screen out high-risk clients or charge them higher fees.

And the costs directly incurred by insurers are only half the story. Doctors "must hire office personnel just to deal with the insurance companies," Dr. Atul Gawande, a practicing physician, wrote in The New Yorker. "A well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That's how a doctor makes money. ... It's a war with insurance, every step of the way."

Isn't competition supposed to make the private sector more efficient than the public sector? Well, as the World Health Organization put it in a discussion of Western Europe, private insurers generally don't compete by delivering care at lower cost. Instead, they "compete on the basis of risk selection" - that is, by turning away people who are likely to have high medical bills and by refusing or delaying any payment they can.

I'll try to look out the WHO source for this.

by afew (afew(a in a circle)eurotrib_dot_com) on Fri Oct 14th, 2005 at 04:57:49 AM EST
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