Obama’s National Health Insurance Plan
Monday April 13, 2009
Sometime this year, President Obama will press Congress to approve his national health insurance plan. Obama's plan, perhaps best described in Jacob Hacker’s “Health Care for America” plan has the ambitious and expensive goal of providing affordable health insurance to all Americans through a combination of a new federal “Medicare-like” program and existing employer-provided health plans. How would this plan work? What medical needs will it cover and how much will it cost? Get the answers here.
Comments
We have had the most broken and out-dated high cost health care in the world. Even those with insurance can’t afford to get sick because of co-pays and deductables. The only reason Obama won’t go with a government is because of the people that still think ‘insurance’ is our only way? These people are not of the working class that have been ‘HIT’ by a catastrafic disease.
Oh sure all hospitals and doctors want you if you have ‘insurance’ and treat you very well.
They collect what the insurance will pay them gladly then ‘Haunt’ the diseased, deceased ones spouse for the co-pays for the rest of their lifes’. I know, because I am being hunted every day.
Try taking just 20% for a deductable of a hundred thousand dollar bill! Thats $20,000.00 one needs to come up with. This does not include the doctor bill and the Lab bills and Oh the radiation bills!
My husband did die, and I can only say ‘Thank goodness he is not seeing how broke and devasted I am now. It looks like I will lose my home. (Thanks to the stock market) I have been sued, leins are every where, I owe taxes I have no money for. I still owe over $100,000 on all his treatments, then I was in a car accident, and my doctor will not release me to ever work again.
Nothing is fair. We both worked steady jobs for over 40 years and both paid into SS. We had our home paid for but had to borrow against it because the year he died, he had to have 24 hour care and I had to take off to care for him.
We were ‘Cheated’ out of OPERS retirement where they would have at least paid us enough to make the house payment and $600.00 for disibility and free health care.
This because STERS said he worked for them longer? Maybe a month, but he never quit OPERS, his death happened! STERS would pay us nothing per month and to have health care we would have had to pay them. (All this because he wanted to give back his lifelong working knowledge to others)
STERS should not be allowed to get away with what they do.
Had we/he (my deceased spouse) would never have went to work for them making less than a quarter % of what we were used to making.
STERS has ruined and made me miserable and I have to fight bill collectors every day. If ever there should be a state teachers program looked into and sued, fined for what they have put people through it should be STERS.
The only way our Health Care can be fixed is Government run.
Put these no account insurance companies out of business for what they do to hard working people.
I hear everyday how horrible government run insurance is, yet I hear from the other people in those countries and they are laughing at the ’stupidity’ of Americans that fight against it. They don’t have hospitals hounding them daily for deductables & co-pays for money they don’t have.
Oh we played by the ‘American dream rules for over 43 years’ only for me to end up in devastation and every bit of it is because of health care and we always had insurance.
Government run is the only way it can truly be fixed.
If you allow some insurnce companies to remain they will make it so no hospital or doctor will want to see any one but those on insurance.
Insurance has ruled the States now for a few decades for nothing but ‘Greed’
For goodness sake do something about these credit card thieves.
I believe every American should have health insurance. If we quit giving our money to other countries, and stop the space program for a few years, maybe we could afford it. We need to take care of America first then help other countries. Space is not the new frontier.
If Government runs our health care; we will be worse off then we are now! Medicaid, Medicare, and Social Security are BROKE! The elderly will be recieving counseling on how to die peacefully on drugs,if Obamacare goes through. I know this sounds way out there, but check the facts! “The health care bill that Obama proposes has this theme at its core and has in its crosshairs the Baby Boomer engine that is pulling the derailed economy as it takes its final lap toward retirement. In less than two years, Baby Boomers will begin retiring in multitudes, expecting to reclaim the hard earned money they have been paying into Social Security. But this Health Care Bill, HR3200, has other plans for them,” she wrote.
“Those 65 and older will be required to undergo mandatory ‘end of life’ counseling to determine if they are worthy to continue to not only live, but take much needed resources from those who are younger and more worthy to receive them. Counselors will be trained to discuss how to end life sooner, how to decline nutrition and hydration, how to go into hospice, etc.,” she said.
“This will not be done without coercion. For those who have amassed assets enough to take care of themselves in their old age will have these assets confiscated in the name of fiscal responsibility, because by this time, every citizen will be entered into a national database under the guise of improved efficiency. This database will be run by a type of ’star chamber,’ appointed by the president, that will determine whether or not you deserve the much needed operation your personal doctor thinks you need,” she said.” taken from a WorldNetDaily article entitled DOCTOR’S ORDERS
Obamacare called ‘euthanasia bill’
Critic: ‘Reflects regime worse than China’s one-child policy’
Even if everyone making $75k and higher were to be taxed at 100%, it would not be enough to pay the $1.8 Trillion deficit (thanks Bush and Obama and the Congress’ during their times’ in office)let alone the $1 trillion Health Care Plan put forth by our out of control Congress and President.
To Cindy: please review the actual language of the bill and call your congressman regarding the actual contents of the bill. Your claims are truly outrageous. There is no mandatory end of life plan as you stated. There is no “death panel” as described by Palin. These statements are just to get people riled up. The recent studies by independent analysts have rated the VA system as the best in patient satisfaction and delivery of care for the money expended. Medicare is not broke, most physicians and hospitals would be out of business if Medicare did not pay for the allowed services. The actual costs of delivering care are covered, while private insurance only spends between 65 and 70 cents of every premium dollar on care, the rest is for profit and administrative overhead. Ask the Medicare recipients if they want to give up Medicare, ask the vets if they want the VA to go away, ask the insurance companies how much their CEO made last year (and remember that money would have been spent on care). While you are at it, ask your physician how well and how easily he or she gets paid by the private insurance companies.
There is no single payer system in the world that provides better health care than found in the USA. Even the single payer systems within the USA do not function well, like Medicaid, Medicare and the VA system. Why in the world would we try a sure to fail single payer system?
For me as a German it is unimaginable to have no health insurance. And a state like the U.S can afford it. Just look how big is your defence budget. It so retarted to compare obama with hitler. This republican campaign reminds me of the third reich its propagandistic and polemic. And I can’t understand the american fear of socialism – to have set up a public health insurence – call it how you want – I call it humanity. At all a bit more redistribution would hurt nobody… all this billionaires and millionaires got more money they and their families could spend in generations – tax them right. So there is trully enough wealth… hopefully the usa will get a grip and change before the next (or the current) economy crises will destroy all the wealth fully. And that means to stop the turbo-capitalism and a change in mentality. I wonder if the U.S got it, if not it will be over with the superpower U.S.A. . I’m quite covinced to see it fall like rome (I don’t want to see this – but the gambling just goes on).
I had the good fortune to live in France for 7 years and have my 2 kids there. With French national health insurance, we could go to any doctor or dentist anywhere in the country and just give them our “securite sociale” number, no paperwork. Or we could not go; French doctors make house calls.
I had regular preventative care, with pregnancy tips and birthing lessons. I had my choice of public or private hospitals, all with 100% coverage. To recover from ordinary childbirth I got a week in a comfortable room with helpful staff. For that visit, for premature almost-labor, and for a scarily feverish baby, I just walked into hospitals and stayed. No wait, no bills, just good care and even good food.
I had no lifetime maximum coverage. I could move anywhere or change jobs or get sick and never be denied insurance.
France pays half as much as us for medical care per person ($3601 vs $7490/year). Yet rich or poor, all my French friends and in-laws get quality medical care. Forget the lies about “death panels”: the horror stories happen here, where insurance bureaucrats deny operations and half of foreclosures come from medical bills.
Please, give us a public payer option like French national health insurance.
U.S. vs. Canada: Doctors Give Their View
Delicia Honen Yard
President Obama’s initiative to reform the American health care system has stirred vigorous debate about the best way to accomplish the objectives of reining in costs and expanding coverage to the uninsured and underinsured. Some individuals believe the country should emulate Canada and adopt some type of single-payer system of universal coverage. Opponents claim such a system would result in long delays for care. Is this the case? And how do the American and Canadian systems compare with regard to the quality of patient care and the effect on medical practice? To find out, Renal & Urology News interviewed Canadian urologists and nephrologists who have practiced on both sides of the border. Overall, they indicated that although the Canadian model is not perfect, it is a good system in which patients generally receive timely and competent care and physicians have fewer practice hassles compared with their American counterparts.
“I think universal coverage works,” said Hesam Farivar-Mohseni, MD, of Ontario’s Brampton Civic Hospital, a Canadian citizen who spent nearly 11 years in the United States. Following a two-year fellowship at Memorial Sloan-Kettering Cancer Center in New York, he spent time working in New York and at West Virginia University Hospitals in Morgantown.
Misconceptions on both sides
“Patients in Canada are not being denied anything,” he said. “People in the U.S. think that patients here [in Canada] are waiting outside the hospital, they have no access to the hospital, and they’re dying because this is government-sponsored health care. That’s not true at all. If there’s a serious disease the family doctor calls a specialist and the person is seen right away. If a patient has a kidney stone or something similar, they may wait for eight hours, but that’s true in the States, too. Such patients don’t get seen in the emergency room there right away, either.
“And the funny thing,” he continued, “is that people here think people in the States are dying on the street corner because they have no insurance, and that’s not true, either. They go to a university hospital and get the same treatment that most patients get.”
Dr. Farivar-Mohseni said he believes the Canadian health-care model could be successfully implemented in the United States. “I have no doubt in my mind,” he said. “The good thing about the Canadian system is it’s much cheaper and provides the same quality of health care in general. In the U.S. there are middlemen: You have the insurance companies and the hospitals, which need to make money. Here, only the physician and the pharmacy need to make money. So that’s a totally different attitude, and the cost is definitely lower because there’s no profit there.”
Because Canada’s coverage is not only free but portable, there is no such concept as going out-of-network. “You can go anywhere in the country and should not be denied any treatment by any doctor,” Dr. Farivar-Mohseni said. “You can ask to be referred to a particular doctor or location. For example, if you are from Toronto, you can go to London, Ontario, or to Ottawa if you want. That’s one of the advantages here.”
Despite the disparities in the Canadian and U.S. medical infrastructures, “there’s not much difference between the two systems,” Dr. Farivar-Mohseni said. “We treat the patients exactly the same way—the same medications, the same surgeries, the same instruments.”
Sometimes, fewer options
Still, the medical system in Canada can be more restrictive than in the United States, he said. “Here [in Canada] the government decides that this hospital does this, that hospital does that,” he said. “In the U.S., if you want to do something, and you’re capable of doing it, nobody stops you. And I think that makes things more accessible to the patient.”
Lithotripsy is among the procedures that are more readily available in the United States than in Canada, he noted. In New York State, for example, lithotripters are available in more cities compared with Ontario, and some hospitals that do not have the devices can have mobile lithotripters come to the hospital on certain days, according to Dr. Farivar-Mohseni. “In Ontario, however, patients can undergo lithotripsy in only one of two places throughout the entire province: downtown Toronto or London, Ontario,” he said. “And I think that’s bad for the patient and also bad for the physician, because then you’re only letting certain physicians do [the procedure],” Dr. Farivar-Mohseni said. “That’s, in fact, a major problem.”
In addition, Dr. Farivar-Mohseni, who also is in private practice, said it is not easy in the Canadian system to introduce a new technique or obtain a new technology, such as robotic prostatectomy or brachytherapy for prostate cancer. “You have to go through a lot of hoopla, and eventually the response is, ‘No, we don’t have the money,’ or, ‘We’re not the place to do this. The government says another place has to do it.’”
Patients never see a bill
The major distinction in patient care between the United States and Canada is the fact that Canadians incur no charges for services. Patients never see a bill in this taxpayer-funded system. The Canadian system gives a per-person allotment to each province, and then each province decides how it is going to pay for health care. In Canada, every patient has a family physician who serves as the conduit between all patients and specialists. Rulan Parekh, MD, MS, a nephrologist at the University of Toronto and who formerly worked at Johns Hopkins University in Baltimore, noted that in Canada, all patients need to be referred to specialists by their family physician. “So everybody has a gatekeeper, and that gatekeeper takes care of them from a general point of view,” said Dr. Parekh, who is on the Editorial Advisory Board of Renal & Urology News. “Canadians are willing to wait to see the specialists and just see their family physician instead. They want to try to do as much as they can with the family physician. As a result, in Canada, you have many more family physicians and fewer consultants. In the States, it’s the opposite.”
Dr. Parekh returned to Canada after 20 years of practicing adult and pediatric nephrology in the United States. Although Dr. Parekh has not been in private practice in either country, she said she can still relate to the obstacles faced by American patients. “I feel that the burden to the patient in dealing with all the health-care bureaucracy in the States is enormous,” she said. “[In Canada], you walk in, you give your health card, and that’s it. Nobody asks you to sign your life away, nobody asks you to make sure you pay for the bill, nobody asks you about co-pays, nobody tells you that your insurance won’t cover this so you have to pay for it. I don’t think Canadians realize how much stress there is in the United States for patients who are really ill.”
Dr. Parekh said she doubts that the Canadian model would translate easily to the United States because of inherent differences between the two systems. “For example, U.S. medical students graduate with a huge burden in loans, so they have to become specialists,” she said. “How else are you going to pay off those loans unless you join a medical field which is procedural based to obtain an adequate income? You have to opt out of Medicare because if you’re in general practice or an internist, you can’t make the money to support your practice with only Medicare patients.” In contrast, most medical students enter family medicine and thus provide general medical care to patients. In Canada, “the reimbursement to family physicians and to specialists may be lower but the fact that you get 100% reimbursement and not a discounted amount allows you to plan your practice,” Dr. Parekh said. “[All] physicians can do very well financially regardless if your clinical practice is procedural based or not.” Reimbursement amounts in Ontario in general seem small because services cost less, particularly without the overhead and markups associated with American medical care, she added. At the same time, however, all types of physicians in Ontario have heavy patient loads because of a shortage of both generalist and specialist physicians.
Another major feature of the Canadian system is the regionalization of medical care. Certain facilities serve as centers of excellence to which patients are referred for particular types of specialty care, she explained. By caring for large numbers of patients with specific medical problems, these centers develop an expertise in certain treatments that might not be possible at smaller centers caring for fewer patients.
Media messages
Canadian-born urologist Joel Teichman, MD, who became a naturalized American citizen, believes people have been getting distorted views of both countries’ health care systems from the media. He described a recent Canadian television ad sponsored by a political action committee. It featured a woman from Ontario who had a rare brain tumor that required her to seek treatment in the United States. According to the commercial, the woman would have died from lack of treatment in Canada. The message: Americans should avoid adopting the Canadian system.
“Meanwhile, the Canadian media offer stories of hardworking, tax-paying Americans who end up requiring some necessary medical treatment that bankrupts them,” Dr. Teichman told Renal & Urology News. “Americans learn to fear our ‘incompetent’ system, and Canadians learn to fear the ‘unfairness’ of the American system.”
Dr. Teichman was an Associate Professor at the University of Texas Health Science Center at San Antonio from 1994 to 2003. He moved back to Canada after being unable to resist a recruiting offer in Vancouver, where he is a professor at the University of British Columbia.
Streamlined billing
Dr. Teichman mainly sees patients suffering from kidney stones and interstitial cystitis, but he sees more patients in Canada than in Texas. According to Dr. Teichman, this may be attributable to the fact that there are fewer specialists per capita in Canada than in the United States or that he was not focused on competing for business in the United States. Moreover, in Canada, the much more streamlined billing process helps free up time and resources. “In Texas, my urology group at the university employed multiple billing people full-time to preauthorize insurance claims, file claims, chase down insurance companies for failure to pay, and handle insurance denials,” Dr. Teichman said. “Here in British Columbia, I file all my claims electronically to the province insurer and am reimbursed within two weeks. It occupies five to 10 minutes per day. I employ no billing person.”
Lawsuit paranoia in the U.S.
Dr. Teichman may also be able to see more patients because he does not have to spend as much time conducting elaborate informed-consent discussions. “For my American patients, I spent more time detailing all the potential adverse outcomes for drugs, therapy, or surgery. In Canada, I feel more comfortable telling patients they do not need a certain test than I would have in the U.S. There’s a greater paranoia in American medical practice because of medicolegal ramifications.” Physicians are concerned that “if you fail to dot the I’s and cross the T’s and go absolutely obsessively over every last possible complication, a patient will turn around and say, ‘You failed to give me appropriate informed consent,’ and sue you,” he explained.
As a result, Dr. Teichman said, physicians working in the United States have to spend a lot more time and money than their Canadian counterparts ordering irrelevant and costly tests “merely for the sake of covering themselves.”
Dr. Teichman has a working theory about why some Americans fight the prospect of what seems like a great deal—free health care: “Canada was founded around stability and good governance, and America on principles of individual freedom, liberty, and pursuit of personal happiness,” he said. “An extension of the American sense of liberty is that many Americans distrust government and abhor lack of choice. A single-payer system conjures up the possibility of lack of choice and a heavy-handed, government-run boondoggle. I think most Americans would be surprised to learn that the majority of Canadians receive quality health care from their own physicians and without government intrusion. Some American insurance companies pose much more significant intrusion and interference on patient care, and limits choice, more than exists here in Canada.”
All in all, Dr. Teichman said, “The Canadian system covers everyone quite well, so no one is left behind—but a deluxe model of enhanced health care for purchase is not really available here. I believe the U.S. system is the best health care available anywhere—if you have insurance. Both systems work reasonably well as long as you have access to health care.”
Paucity of primary care docs
Barbara Ballermann, MD, who spent a large part of her career in the United States and who now is the President of the Canadian Society of Nephrology, said she appreciates the peace of mind that Canada’s universal health coverage brings to all constituents. “For Canadian people and physicians, the basic principle that everyone has equal access to health care without worrying about payment is an enormous advantage that cannot be overstated. I believe this could be achieved in the U.S., even without a single-payer system.”
The Canadian system, however, is not without its problems, said Dr. Ballermann, Professor of Medicine at the University of Alberta in Edmonton. One is that the provincial government system basically still pays more for procedure-based and specialty-based medicine than it does for primary care. “So we have a huge shortage of primary-care physicians.”
This is a familiar complaint in the United States as well, where a lack of insurance frequently prevents people from obtaining primary care services. In Canada, the problem stems from the fact that there simply are not enough general practitioners available. Consequently, Dr. Ballermann said, “People without a primary-care physician don’t see anyone for preventive care. When they feel ill, they usually come to the emergency room. Of course, the cost for treatment goes up. So, as in the U.S., access to primary care is not available to everyone.”
In addition, people get put on long waiting lists for primary care. “We’re trying to shrink that wait list,” she said.
Delays in specialized service
Delays also extend to more specialized services, an issue that became personal for Dr. Ballermann when her then 82-year-old father faced a three-year wait for hip replacement surgery. Knowing that the lag time could lead to severe neuromuscular de-generation that would impede her father’s recovery, Dr. Ballermann considered taking her father out of the country where she could pay for faster service. She eventually found a way within the Canadian system to get her father his surgery within six months, but she can understand why small factions of practitioners and patients throughout Canada have lobbied for the right to provide and obtain private health care, even though such actions go against the spirit of the Canada Health Act.
At the University of Alberta, Dr. Ballermann and her colleagues have established a triage system. Patients requiring urgent care might be seen that same day or within a week, and a person with a non-urgent condition might wait up to two months for an appointment. “But you would never wait longer than three months. We have limits built in,” she said.
Another problem with the Canadian system, she said, is that it stifles innovation and removes “some of the incentives to do better.” Compared with Canada, the U. S. provides more opportunity to conduct innovative research, supported by both government and industry. “There’s a greater innovative spirit. It’s just part of the U.S. culture.”
Health Ins. companies are the enemy. They should not at this point be allowed in the room or be part of a national plan as it is formed. We live in Colorado and were told my wife’s visit to the Mayo clinic was covered by our PPO which ironicly was called “Golden Rule Insurance”. Upon returning, approx. 4600.00 of the visit was challenged, according to them, for testing THEY felt was not needed. The Colorado State Ins. Commission ultimatly sided with the ins. company as they are nothing more than Patsys of the insurance industry! The government should protect the people from this type of behavior. Health care should be a given and not a corporate decision that always has it’s patient’s interests last. Share This!
How much is the gov insurance going to cost each person/family?
I supported you(Obama) as a candidate. I gave donations for the first time ever and am 55 years old. I support single payer. I am willing to settle for public option. After GWB sent us to Iraq and the Dems supported it I left the Democrat party. I only came back to vote for you in the primary. I will accept nothing less than a strong public option. (Remember that I am settling for that.)I am part of the base that elected you. It is not okay with me that you cater to the republican base. Why do you cater to the party of no? I understand that we as your base need to make you listen. I need to know that you hear us.