I worked for a large hospital system for several years, and can tell you that a majority of healthcare providers, especially hospitals, depend on Medicare for an income stream. The single largest issue is with different reimbursement rates for different areas.
Just because they depend upon it doesn't mean that it isn't an inefficient boondoggle, not to mention that with increased effciency the hospitals could probably find alternate revenue streams.
The trick with medicare is if you ask the question 'who does it cover', the answer is mostly the retired and disabled. Who needs the most medical care? The retired and disabled.
Fraud is on the part of the 'healthcare providers'. You know, those good doctors and hospitals that care so much about their patients? It has nothing to with the Medicare system. I challenge you to name a system as big as Medicare without any 'fraud or mismanagement'. As far as 'huge paperwork', that is no longer the case thanks to the DRG system and electronic billing.
This came up on another forum, and I did a quick check. Approximately 11% of medicare payments are fraudulent. It happens everywhere. Sure, other companies will have fraud, waste and abuse. But 11%? This doesn't even include waste.
"Health insurance," as commonly referred to, is actually 'health service,' covering your preventive care, routine checkups, prescriptions, etc..
Agreed, though the 'High deductable' plans which combine what's essentially a savings account with insurance to cover if you exceed that level is close.
It is entirely possible for individuals to purchase affordable 'health insurance' that only covers hospitalization and major health issues - but most people find this useless, given that it's the cost of routine healthcare/specialists and drugs they feel to be prohibitive.
I've read of a number of cases where if it wasn't for the fighting between insurance companies and providers, care would be substantially cheaper.
For example, when my brother broke his arm he didn't have insurance. Still, they charged him half of what they would have charged an insurance company for paying cash upfront for the X-ray.
Years ago they had a tale of a GP who, fed up with life working in a clinic, closed shop and started working out of her home with a part time nurse. She charged for kids by the pound, kept minimal records, etc...
Many people with health plans would take their kids to her when they had minor illnesses/injuries because her basic fee was below their copay.
And she was making 2/3rds the money with 1/2 the work.
I don't know any Aussie, for example, who dreams of having American style healthcare. No Singaporeans either-indeed, healthcare is at least arguably more accessible (and just as good) in Thailand than in the USA. It's a third world country that somehow manages to secure and provide medicine as advanced as ours at a fraction of the cost.
Which do you think is more likely, Singapore/Australia style coverage, or the at least semi-broken mess that's Britain's and Canada's system?
Our problem is that we've managed to take the worst of both worlds of medical healthcare. We're neither free market or government single-payer. Instead we have the government sticking it's fingers(and money) into everything while the commercial operators try to work around it. Oh, and if you lose your job you'll eventually lose coverage as well(even assuming you have enough money to keep paying for coverage). At least through that company. You get the health insurance your company chooses, not you. At least for the majority of americans.
Unless that cold is bronchitis, which becomes pneumonia, which becomes a $3000 ER trip (the basic cost for walking through the door) that gets paid by you, your insurance (if it's the bottom of the barrel kind - and you hope they pick up the tab) or when you can't pay and your insurance can't pay... gets eaten by the hospital. (Now, if the argument then is that the hospital isn't really eating $3, that its actual costs are much lower, that circles around into the wisdom of a profit-oriented health system...)
Of you don't get an appointment to see your PCM until six months in the future because all appointments are full until then, and you end up in the ER anyways.
There are often issues with government healthcare, some of which is denial of care to needy people, sometimes until they don't need it anymore because they're dead.
Google medical waiting lists in the UK/Canada.
With 'Doc in a Box' type clinics I've seen outright cash charges around $40 for a 'cold/strep/pnemonia' assesment visit. Combine that with a high deductible insurance plan combined with a tax-advantaged health savings account where you just swipe your card(automatically tracks health care purchases) to pay for care.
The trouble with catastrophic plans, for me at least, is that they have never worked out financially. Still several hundreds dollars, still a six or eight thousand dollar deductible, and then still only 70 or 80% coverage.
Then you need to shop around a bit more. My dad's plan was 100% after the deductible was met. And that was an annual deductible, not per visit/incident.
the really horrible part of the situation is that if the hospital accepted the same payment from the consumer as what they accept from hmo's and medicare/aid, then i wouldn't need insurance for my family in the first place (as i could afford to pay it myself).
They're trying to make up for the uninsured who don't pay. Try negotiating up front(if possible). Either that or stay out of the large hospitals(admin nightmares) in favor of smaller clinics.
