I consider myself a fairly intelligent guy but I know next to NOTHING about it. My insurance went up $17 a month this year due to "the rising costs of healthcare" as sited by BCBS. At just under $200 a month I'm still getting a "steal"... which is scary...

So you are a bunch of intelligent folks... what do you think? anyone here work in the healthcare industry? care to share some insights on where this is all going?

My tendency is to think that the government intervening will only things into more of a bureaucratic mess and incentivize people to not "shop around", therefore only making matters worse.... But this is just a product of my right leaning tendencies and perhaps a misconception...

Thoughts anyone?

I have been a long time lurker to these forums and I finally decided to sign up because of this question.

I don't proclaim to know all the answers, however I do work in healthcare administration, and obviously am a healthcare consumer. I can tell you that you are definitely getting a steal at $200 per month, my health insurance (which my employer pays) is $350 for just me. A family of 4 is over $1100 per month. Most people can't afford this, so many people, especially the younger healthier ones, are opting out of the health insurance system and rolling the dice that they will not get sick. The result of this is that in general the more ill people are purchasers of health insurance. This is helping to push the cost of health insurance up. So the insurance population needs to be blended to include the younger and healthier population. When you add to that the profit that most health insurance companies must generate for their shareholders (most of them have reported record profits in the past several years) and the $100,000,000+ salary for the CEO's (Google the United Healthcare CEO) and you can see that the people stuck in the middle are the healthcare providers and the patient.

The government is already intervening and setting policy for healthcare that many insurance companies are following the lead on, and then setting their own rules to drain more profits from the system. We fight on a daily basis to get paid for procedures that our surgeons have performed and that have been authorized, that the insurance company still denies. While healthcare rationing is not a favorable policy, it is happening now all the time, its just not called that. Health insurance companies deny care to sick people every day. All it does is put more money into their bottom line.

I think as a start there needs to be more standardization across the various insurance companies and plans. If there were pre-stated "levels" of insurance coverage mandated across all insurance companies to make comparison shopping easier and known up front. Then if people want more coverage they know what they are not getting coverage for and how much it would cost. I also think that insurance should not be tied to the employer, so that people are free to move from job to job without concern about losing their coverage.

The state and federal safety nets of Medicaid and Medicare (and the Medicare Advantage plans) are not sufficient in reimbursing the healthcare providers despite the fact that over $4 Trillion is spent per year. The reimbursement to healthcare providers on these plans continues to decline or threaten to decline despite rising costs of providing the service. Many healthcare providers across the country are limiting access to these patients because they can't continue to lose money by seeing them.

Sorry for the book, but this is really a hot button topic for me and I am very interested/scared at some of the proposals floating out there by the presidential nominees. I am interested in other people's feeling on this as well.

My answer isn't nearly as well informed as that of numberlady, but I think it's a combination of a lot of things.

The lawsuit-happy culture in this country is a major factor. Because malpractice insurance is so expensive, that cost gets passed on, plus out of paranoia of missing anything doctors order more tests than are needed for some paitients. When our son passed away, many people asked "Are you going to sue?". It made me ill.

On the other hand, many healthcare providers forget that patients are customers, and so have horrible customer service, which discourages people from seeking care until their illness is fairly advanced. My wife was ill and scheduled an appointment. We live in chicago, and due to traffic, she was 5 minutes late. When she arrived they told her that because she was late, she couldn't be seen and had to reschedule. The next appointment was 5 days later. When she got to that appointment, they told her that she had the flu, and if she had come in the week before they could've given her something! (She got a new doctor right away.)

Finally, there's the fact that because of the cost, many people don't get preventative care (physicals, immunizations, etc) so they're more prone to only seeing a doctor when they're already ill rather than getting the care that would keep them from getting sick to start with.

As with many other things (crime, education), really fixing the problem requires a major cultural shift. Anything else is simply treating symptoms rather than causes.

Matrix-style future where our bodies are discarded and our brain waves stored in a computer -- hopefully with power backup & redundancy.

Great topic!

In "my ideal America" -- health care, like education, would be paid for by taxes for all of us. But 'universal coverage' not linked to employment is probably the best to hope for here. I pretty much agree with everything said above by numberlady!

I'm sure I've been affected by working 9 years in London in the 70s (when I was young and healthy and the NHS was still relatively robust) but it just seems that we should be clever enough to figure out a way to deliver top-notch healthcare (including preventive care) to all our citizens.

Nothing makes me angrier than hearing about "for-profit" medicine of any kind (just like "for-profit" education) unless it's insurance companies making massive profits!

Yes, I would be happy to have more taxes paid (instead of health insurance premiums) to ENSURE universal heath care and health promotion for all.

But then, in my neck of the woods, I'm the token bleeding-heart liberal...

Nationalized health care is simultaneously the most promising and scariest of ideas.

On one hand, I don't favor a big government, and wouldn't be a fan of (what would undoubtedly become) a huge bloated bureaucracy managing the health care system.

On the other had, I don't want anyone making medical decisions to have anything resembling a profit motive.

I'm already spoken for, but maybe some of our single Canadian friends can help out some unfortunate, single Americans?

(As a serious tangent, how is that working for you, Canada (or other countries)?)

Healthier lifestyles anyone?

The sound of "for profit medicine" does have a negative connotation i'll admit. But is profit not the ultimate motivator? Not to get overly extreme here but look at communism's track record. Universal healthcare sounds really peachy but could it ever REALLY work?? Systems such as Canada's seem to work well enough for young, healthy folks but what happens when you get really sick? And when Uncle Sam is writing all the checks what incentive will companies have to maintain competitive pricing? More importantly, what incentive will people have to seek out the lowest prices when they aren't the ones paying??

I just don't know.

Thank you everyone for your thoughts thus far, especially numberlady. As usual, no simple answer...

a couple of beers and I'll just forget about it and go on pretending it's all ok.... ahhh the american way

must you be so idealistic?

I agree with you, but would also say it's not quite that easy. The area of medicine I am most familiar with is orthopedics. Probably over half of the injuries seen in orthopedics are accident related (car accidents, work accidents, falls, etc.) and no amount of a healthy lifestyle can prevent them. Other areas of medicine could certainly be reduced more by healthy living.

Many people are just unfortunate and sickly with respect to their health. Those people should have adequate care to at least keep their diseases and illnesses in check, and many times routine screenings go by the wayside because of lack of health insurance. Did anyone see 60 Minutes this past Sunday?

I can tell you what happens today when the government writes the check. They tell the provider what they are going to pay for any particular procedure and that is all they pay. The provider is then prohibited from billing the patient for any balance above and beyond that (with a few exceptions). I imagine that this same protocol would also work for health insurance policies. Of course they will have to get past the large powerful insurance lobby and that will be the most difficult part. We may never make it there.

Universal healthcare works pretty well everywhere else. What happens when you get really sick, is that you get treatment, and you aren't bankrupted, not matter what your income level.

I probably wouldn't advise that you go for a direct replica of the British system, but state funded healthcare does not have to mean healthcare provided by the state, there are loads of other great solutions out there.

I'm a Canadian who immigrated to the US in 2006 and in the last two years have had some experience with the US health care system as my wife had some health concerns and I was fortunate enough to be blessed with beautiful twin girls last May. Comparing the two it's really a no-brainer for me, the Canadian system is much better, however I'm not convinced it's optimal, and I think some sort of two tier health care would probably provide the best of both worlds.

Firstly, to compare the two I am going mainly by personal experience, and there are some significant differences. Firstly, the quality of care was comparable in both countries, however the creature comforts in the US were much more plentiful. When my wife went in to the hospital for her pregnancy and complications related to it she was given a private room, with a telephone, TV, DVD player, WiFi access, couches and chairs for guests and a full menu room service. In comparison, when my dad was in for surgery he shared a room with three other people separated by curtains. If you wanted to use the TV or a telephone you'd have to pay extra and there was no access to a DVD player and only a few chairs for guests. The reasons for this are clear, US hospitals are focused on attracting customers and Canadian hospitals are focused on reducing cost and have no need to attract new business.

In terms of cost, I've never paid for any hospital or doctors visit in Canada, you're still required to pay for prescriptions, eye care and dental however insurance given by employers generally covers these and you can pick up individual insurance as well if you feel you need these services and don't want to pay cash. In comparison, I had a mind boggling $4000 just for the hospital visits, not to mention the $1000 a month we're paying, and which doesn't include co-pays for follow up visits, lab work or the hassle we've had to deal with because of double billings and mistakes made by our insurance company! For example we were eligible to receive a Synagis shot to vaccinate against a particularly nasty bug for infants. When the doctor put in the request we got a call from the insurance company about a $250 copay per shot per child, which worked out to be ~$2000 for the twins. Now we certainly couldn't afford that so we told the insurance company we didn't want the shots. About 20 minutes later, they called back to tell us they would waive the fee, which from a rational perspective makes perfect sense, it's better the vaccinate then bear the full cost of hospitalization and we should never have had to ask for them to waive the fee. So once we had confirmation that the copay would be waived, we went ahead with the shot. This did not stop the insurance company for sending us a bill however, and we've been on the phone with the three times already while they escalate this through their internal red tape. Every time they assure us that it'll be taken care of, and every time someone else calls with a minimal understanding of what the previous person has done or said.

Needless to say, I'd vouch for relatively stress free government run health care system with bureaucratic inefficiencies (and believe me, they exist and can provide ample frustration) then the Gong Show that is the US health care system. When the chips are down, and I need care, I don't want to be thinking about how much it's going to cost me, I just want to know that quality care is available to me when I need it. When the cost of both systems are compared, it's enlightening to note that the extra taxes Canadians pay work out to be approximately what Americans average for insurance. As numberlady said, when the Canadian government writes the checks, they also set the fees which are standard no matter who's providing the service, and the problem isn't with the doctors themselves but with the insurance companies which create a gluttonous middle man.

And to whoever said "Healthier lifestyles anyone?" I can understand the sentiment, however it's naive to believe that living healthier is going to help people who really need the care. My wife and I have a friend in the Parents of Multiples group that we belong to who recently had triplets and at birth they had significant complications. Their insurance stopped covering care about three days into treatment and they racked up millions of dollars in medical bills over the next few months during which you can imagine they were also dealing with loss of income from the stress and complications related to their children's care, and the death of their son after 6 months of struggling for life. Somehow I don't think eating more greens and going for a jog were really viable options for this couple who's financial lives have been destroyed by this tragedy.

The comparison of public education to public healthcare is was terrifies me about the idea of government run healthcare.

I live a block away from a public high school. It has a 25% graduation rate, and is by far the highest crime location in the neighborhood. Anyone who can afford it here sends their kids to private school. The nearest hospital also (being in a low-income area) gets a lot medicaid patients. The service there is horrible. They let my wife sit in the waiting room and bleed for several hours when she miscarried before a doctor came to talk to her (not examine her, just talk to her and tell her she wasn't really bleeding that much) I have no faith that expanding these programs will improve them, or improve the disparity between what people in wealthy neighborhoods see and what people in my neighborhood see.

I know that different insurance companies bill out generics at different prices at different chains. Tis why my generics come from Costco since while it doesnt save me any money, I know that costco bills the insurance company much less than say, CVS