What's even more interesting (or maybe explanatory for radical ideas being handed out?) is that the Tribune either has just, or is on the verge of declaring bankruptcy along with a handful of other major papers run by the same co!

lucy -- You think public health insurance is *radical*?

The paper newspaper is kaput. Sam Zell has made himself another silk purse out of a sow's ear. Can't wait to find out how he responded to Illinois Gov. Hairball's request to fire editorial staff members who called for his removal from office.

It's a BIG news day here, folks!

I remember that when Chrysler got bailed out at taxpayers' expense in the late 1970s, CEO Lee Iococa paid himself a salary of $1/yr, until the company paid back the loan...

YET, the current CEOs of the Big 3 Auto companies take private jets when they first came to Congress for a handout!
The CEOs expect that hourly workers will be willing to take 15-20% permenant paycuts, yet how much are they willing to cut their pay, benefits & perks, huh???

Before any govt money is released to corporations, let their incompetent CEOs return most of their bloated compensation packages from the last 5 years to the company coffers first.
As an incentive, for every $1 returned, the taxpayers will release to them $2 in loans...

I would like every American to be covered with some form of health care, also. The idea of a national health care system sounds great, but the devil is in the details. We have a flawed system currently, and not all the blame lies on the insurance companies. If we superimpose another reimbursement plan on this flawed system, we will be no better off.

Nobody has complaints about the plan and services for Federal employees, nor for the Veterans' plan and services. A government CAN do this well, but not while private insurance companies are the largest contributors to legislators' campaign funds. (Talk about 'pay to play'!) It's just so OBVIOUS why America is the only First World nation without public health insurance: Follow the money.

(Hey, I know about this stuff. I live in Chicagoland. LOL)

There's a big, public *crack* in the private insurance scam!

Oooh, could I live to see the end of this era of insurance companies deciding health procedures and benefits?

Nobody has complaints about the plan and services for Federal employees,

You do realize that Federal employee health plan is still just employer-subsidized private health insurance, through your same-old-same-old private insurance companies? As an employee, it's a big improvement over what most companies offer, because there's a choice of different insurers; most private employers have either Blue Cross, or Kaiser, or Aetna, or etc, and you take what they offer if you want the group rates and employer-subsidized premiums, whereas I can choose among them. But at the end of the day, I'm still covered by a private insurance company, and still have to haggle with them about what they will and won't pay for, same as anyone else.

And, nope, I'm not complaining, 'cause I know I got it better than most. But in no way shape or form does the fed employee plan eliminate private "insurance companies deciding health procedures and benefits".

the veteran's health care system is a completely different animal...

Quirk, thanks for the clarification of the federal health care insurance program. I don't know anything about it, but I did suspect that it was not a cost saving plan - just another expensive plan in which our taxes payed for.

I have heard MANY compaints about the VA system, by both physicians and patients. And the other government supported health plan, medicare, while a safety net for many seniors, is a very poor example of how any health care plan should work. The billing fraud alone should be a giant red flag.

I have worked in health care for a number of years before retiring to be a SAHM. I have seen so many reasons that our health care system is messed up. There is enough blame for EVERYONE - hospitals, insurance companies, doctors, healthcare employees, pharm companies, patients - and I mean everyone as a collective whole. There are lots of great people, but it is hard to make changes when the deck is stacked against you from the start. I recently picked up a book about this issue and I found that it only quantified what I already knew and saw. Having said that, there is no easy fix for our system. It's broken. It's flawed. It needs to be fixed from many different angles, and we need someone with the guts/integrity to lead the way. If that is done, and only then, would I ever entertain the idea of nationalized health care.

As for other nations that have health care for everyone, I can't comment because I haven't researched them. However, I view all comparisons suceptically until I'm satisfied that they have been compared fairly. It is very easy to only see the good and overlook the bad.

ruffian, I doubt it's any more or less expensive, on balance, than any other employer-subsidized health insurance, I just wanted to point out that that's all it is, is employer-subsidized health insurance through private insurers, just like other employer's health benefits. Just that the employer in this case is the government. Although there is also a good point that it is overall considered to be a good plan and pretty well-run, and federal employees are in general pretty happy with our health benefits, so the people who claim the government can't be trusted to do something like this well, it actually does. But it is not an alternative to private insurance companies.

I have no personal knowledge of the veteran's system, but my understanding was that it made a vast turn-around a decade or so ago and went from being mess to a very well-run system that provides good care. But again, that's based on what I see in the news, no personal knowledge.

quirk -- You made the points I was trying to make: That the government CAN do a good job providing health coverage. (Federal employees like their plan. The VA has been lauded for its plan since a big turn-around there.)

I feel we are being held hostage by profit-seeking private insurance companies who have strings on our legislators. The companies are the biggest contributors to election campaigns and employ brigades of lobbyists. This isn't just a waste of money, but insurance companies are setting standards and policies in *medicine*.

I know of no other First World country that does not have public health insurance. We are paying more and getting less because medicine is profit-driven here.

I hoped that employers would finally revolt over having to support health insurance. Whatever taxpayers would pay in aditional taxes could be balanced by higher salaries companies could pay if they didn't have this burden.

Doctors are already 'opting out' of submitting claims to both private insurers and Medicare. We have too few Family Practice MDs and too many specialists -- because the specialists rake in more insurance-subsidized dollars. Our infant mortality rates are awful for an 'advanced' country.

In surveys other First World countries are better satisfied with their public health plans than our citizens are with our non-plan.

chisue-- I agree with you; the government can do a good job providing health care. I also agree that we should have universal care, although I don't claim to know the best form that should take.

It just sounds like you think that the current fed employee health plan somehow bypasses private insurance. It does not. Those doctors opting out of submitting claims to private insurers? I see one of them, who opts out of my insurance-- it is private insurance. It is controlled by the private insurance company. If you want to get the private insurers out of the loop (and I am not expressing an opinion on whether or not this is the right way to go, it just sounds like that's what you have in mind), advocating expansion of the program federal employees have would not do that.

that's all i'm sayin'

The government already, to a great degree, has their hands in our healthcare. I'm not sure, though, that I'm really comfortable with giving them complete control over my life and health - more importantly that of my children and grandchildren.

When you look at the way our government does business, doesn't it make you wonder if they should be in charge of our very lives?

Yes, there is blame enough to go around. Insurance companies are a for-profit business - as much profit as they can make - just like all others these days.

Doctors don't mind making money either, and aren't above using the system to make more than simply getting paid for needed services rendered. Think about the group of doctors who purchase a new, expensive machine. Think of the propensity to use these machines when not really necessary.

Hospitals are the same. My daughter once had an ER visit and our insurance company, that should have paid 90%, paid only about half. Now this company had always paid very well in the past. They said in their letter to the hospital and to us that the hospital's charges were 'obscene'.

This left us owing a huge amount. We asked for an accounting of the charges. The hospital told us the couldn't do that! Can you imagine they expected us to pay a bill but wouldn't send us a copy of the various charges? We rocked along for a year with them refusing to send us charges, but demanding payment. Finally, we got a letter from a collection agency. After my husband told the collection agency unless they wanted to be named in the lawsuit, they would return the item to the hospital - the collection agency backed out - then we called the hospital. We finally settled for about 10 cents on the dollar.

My husband had a doctor gouge Medicare big time. He charged us about 10 times as much for a procedure when he was on Medicare as they had when he had private insurance.

One of the reasons for high costs is the large amount of the costs of free medical care that is not reimbursed to hospitals and doctors. They simply add the losses on these to the bills of paying customers. When insurance companies have to pay out more, they charge everyone else more.

Then we have to understand the people themselves overuse and misuse their insurance. People run to the doctor with every little illness when a day in bed with some aspirin and Vit C would take care of the problem.

We are all to blame.

When an employer offers health insurance, they have to be concerned about the cost - the government doesn't concern themselves with such thing.

More family practice MD's would be fantastic - they aren't nearly as well compensated as the specialties and this is easy to remedy.

I agree that there are too many "for profit" hands grabbing at each of our healthcare dollars. This problem is so huge that it is difficult to get a full grasp of the situation. The one thing that I keep seeming to fixate on is this: Doc's do not want to police themselves. I see this as THE premier failing of our system. I respect their high level of education, their rigorous training, and, in most cases, their dedication. Medical school is extremely expensive and residency salaries are low (especially when figuring $/hour). I can see why they resent a third party, a non-physician, passing judgement on the care that they give. But they have to do it themselves - and they choose not to. I have many examples, but I'll lay this one out. I worked in a procedure area, and when Doc X did one special procedure, I always had to direct him. It was clear that he did not know what he was doing. The two times that I was not there and junior staff helped him, the patient had major complications which required surgical correction. I notified each one of this doctors partners and also the MD head of my department. What got done? Nothing. He still did these procedures.

When a doctor does want to report another, it usually does not go well. A doc wanted to have a coworker undergo mandatory drug rehab so that he did not pose a danger to patients. The hospital attorneys said that they would not support the whistleblower, that he could report the problem, but that he was opening himself up to litigation - and he could not only lose his practice, but also his house. What a choice. The drug popping doc was reported anonymously, which in itself lacks merit, and nothing was done.

I asked several docs (about 8) what they would do if they had a "bad" doc in their practice, or if they knew of a blatantly crocked doc. Two docs reported that they already had one in their respective practices and that they tried to distance themselves from the bad one as to protect themselves. The others said that they would not report anything because then they would be "blackballed." It all seems to be about self preservation.

I'm not for or against any system. I've seen many things that are wrong, but many that are right. I firmly beleive that we are not going to be better off until we "clean house," reevaluate what we have, and then make changes to our system. I try to keep informed, and love chats like this to get a feel for what people are thinking and hear new ideas. Some things to think about - our government already provides medical care in one form or another for approx. 30% of the population and if we elimated the waste in healthcare, our current level of spending would cover the cost of the uninsured.

quirk -- I understand. I muddied the waters by lumping the Federal Employees' plan with the VA plan. I meant to point out that both are 'your govenment at work', and both DO WORK WELL.

I don't know why Americans are uniquely afraid of a national health plan. Do we think our government is uniquely inept and corrupt, while other large countries with national health plans are not? (I'm out on a limb here as right now the governor of my state -- Gov. Hairball, as my DH calls him -- is a prime example of corruption. However...the system is working, even there: He is indicted.)

My DIL's father recently retired as counsel for a large hospital. He and management contacted MD affiliates to lay out exactly how the hospital would support MDs and staff who reported bad docs. After all, the hospital doesn't want to get sued!

Sometimes good things come out of bad times. I'm hoping we can find gumption (and the money) to implement national health care. Didn't have a problem supporting funds for the V.P.'s friends to profit on a delusional war in Iraq.

It will take a tremendous outcry from business, Medicine and individual Americans to defeat the insurance companies' greed. You may actually need to call and write your legislators; the First Law they understand is staying in office, and they need your vote.

I'm afraid of national health care because:

1) I dont want to pay more than I do now (at least $5400/year for health care, plus medicare payments taken out of paycheck, and state taxes for medicaid) Stretch my dollars, but don't take more.

2) I have not heard of any politician talk of true reform - only different ways to pay insurance premiums (by way of cost shifting). If there is to be true reform, count me in.

3) True reform will take more than eliminating insurance companies.

4) The grass always looks greener - a quick google tells me that other countries plans are muddier than we think.

ruffian1 --

I believe you would pay LESS and get MORE.

Politicians respond to the last loud voice they heard. Right now that's insurance companies, but it oould become business, Medicine, and consumers.

We do need to eliminate the private insurance companies' stranglehold on Medicine, but, yes, we need *a plan*!

What do you object to (or have heard about) in other countries' national health plans? Everyone I know living with national plans is pretty happy with them. Granted, I only know a handful of Canadians, French, Brits, but the criticisms seem pale to me when compared to the problems here.

Yes, it seems countries with national healthcare are happy with their situation. I don't know for sure.

I'm wondering, though, if they have known any other system AND if those same countries were trying to come from a semi non-governmental system like ours and put in place a national system - could they do it? Would it work as well?

When theirs was put in place, the drug companies, etc., did not 'own' as many of their lawmakers as they do ours.

I think the system works for politicians. When one doesn't play ball or steps on the wrong toes, he/she sometime gets exposed. That doesn't mean it is working to get all the bad ones or for the good of the people.

One thing we need to really realize, healthcare is one of the largest industries in this country. There is no way they are going to relinquish that golden egg laying goose.

Whether our government is more corrupt than others, I don't know. I just know I think it is too corrupt to be trusted to take over our very lives and health - any more than they already do.

Remember, this government we want to be in charge of our healthcare don't want people to be able to sue drug companies in state court for damage done by drugs - if those drugs were approved by the FDA. That just doesn't sound like a government that is going to be thinking more of the people than of the drug companies and other corporations.

ruffian, I think you are right - the medical profession does not police itself and that is why bad people continue to be able to harm others, overcharge, and outright steal.

Politicians do respond to the loudest voice - right now that isn't just insurance companies - it is drug companies and healthcare institutions. I wish I could remember the number of drug company lobbyists reported to be in DC - it was staggering. MOney talks, and drowns out anything we have to say.

I'm confused why everyone thinks it is just the insurance companies that are costing. Certainly they are charging big time, and they are cutting back payments, etc.

When drug companies raise their prices, the price gets passed to the consumer, they pass to the insurance company, the insurance sends it back to the customer in the form of higher premiums. The same goes for the doctors who order unnecessary tests, treatment, etc., and for the hospitals who overcharge, etc.

While the insurance companies are not the good guys here - but it puzzles me why people don't realize the doctors and hospitals are just part of the vicious circle as well.

If we could get rid of just the fraud and waste in medicene, the prices would come down to the point, we could afford healthcare.

If we do have any voice, I wish we would use it to convince the government to help make healthcare work for the people rather than taking over our very lives.

I'm just pretty sure those same politicians we are begging to take over our healthcare, won't be using the same system they will devise for us.

Insurance companies are driving the wagon. They determine what procedures are approved and what payments doctors and hospitals will receive for performing them. There's too much money poured into extreme end-of-life 'treatments' with negligable results, and far too little given to preventive medicine.

We are such suckers to accept this overpriced and mediocre 'Medicine'.

Having also worked in health care for many years everyone is leaving out one of the largest causes of the health care mess...lawyers! Everyone is sue-crazy! Why do doctors order tons on unnecessary tests? Because, they are afraid of missing something and getting sued.They don't have a choice, thanks to law suits.

The CEO of United Healthcare took a 15-million dollar Christmas bonus.They fly around in their private jets. The money you spend on health insurance goes in the pockets of CEO's of these companies. They pay doctors peanuts, dictate how they treat their patients and what medications they prescribe. Its a nightmare.

Everyone is upset over the automobile crisis yet no one talks about the huge profits these health insurance companies rake in. They have no interest in your health, only your money.

"My husband had a doctor gouge Medicare big time. He charged us about 10 times as much for a procedure when he was on Medicare as they had when he had private insurance."

Baloney! I don't know how that was possible because Medicare only pays what they 'allow.' I could charge Medicare 2 million dollars for a patient's sore throat and they would still pay $40.00. The only way this could occur would be if the doctor fraudulently charged for multiple procedures not preformed. You would know that.
Patients should be responsible for their health-care. They should be able to shop around for a doctor and prices for procedures. Costs would drop because it would invite competition among doctors and specialists. Government sponsored health-care for catastrophic illness should be available.

People pay out-of-pocket all the time for Dentists and Veterinarians. Primary care doctors are suffering because of dwindling insurance payments and multiple frivolousness law suits. Insurance companies are paying them close to nothing. They can't charge the patient for more that the insurance company 'allows.' Doctors can't afford their over-head, malpractice insurance keeps rising, thanks to Law-suits . They have to pack in patients to make ends meet. It is a very sad state of affair.

Lawyers charge you for every phone call, every piece of paper that cross their desk. Try reaching them during an emergency. They answer to no-one. Lawyers and Health Insurance Companies are rich off the sweat of the doctors and the pockets of the patients.

If people don't start looking a the real cause of the failure of our health-care system it will only get worse. Doctors will drop out of insurance plans and you will be forced to pay out of pocket for healthcare which should have been covered by insurance. Doctors can not continue to work under these conditions. Employers should not have to shoulder the continuing high cost of health care for their employees while the insurance companies continue to make huge profits. Lawyers should be reined in. Hospitals and doctors can't afford to continually fight ridiculous law suits. There needs to be regulation to control the actions of lawyers. If we lose our doctors, who will handle our medical care?

Apart from the problems over financing the medical system at current levels, there's another dimension to the situation that hasn't been mentioned ... but that's almost frightening.

My old uncle, who died three years ago in his mid-80s, had 3 hip replacements (and substantial pain, subsequently). Such preocedures have become frequent and routine ... but fifty (I think) years ago such a procedure was unknown.

And that cost is peanuts in comparison with a heart bypass, let alone a replacement: I've heard a rumour that there are 25 in the O.R. on such occasions ... but, whatever, each such procedure is hugely expensive.

More complicated procedures are being developed all of the time ... which will cost much more, per procedure, in future years.

Not a confidence-inspiring idea, as far as the continuing financial viability of the system is concerned.

Millions of Canadians can't find a doctor ... and, since a government-related agency is pretty well entirely the single payer in the system, some of us suspect that they aren't falling all over themselves either training new ones (and many of the doctors and nurses, as many farmers, are old, so soon to retire) or certifying many fairly well-trained practitioners who are immigrants from various countries of the world who haven't been certified here in earlier years.

Apart from the increasing age of a substantial and increasing segment of the population, who will be requiring increased medical services as well as residential and nursing home care in future years.

ole joyful

chisue: "Insurance companies are driving the wagon. They determine what procedures are approved and what payments doctors and hospitals will receive for performing them. There's too much money poured into extreme end-of-life 'treatments' with negligable results, and far too little given to preventive medicine.
We are such suckers to accept this overpriced and mediocre 'Medicine'."

Chisue, I think that you still must not understand what quirk has been telling you about FEHBP. The insurance companies in the federal plan ARE driving the wagon and making all of these decisions. The private insurance companies still determine what will and will not be covered, what the ucr charge is for any office visit or procedure, and then they pay out their benefits accordingly.

The only difference between the federal employees program and most other private sector employer-sponsored plans, is that the government (through OPM) can help keep the overall cost of the biweekly or monthly premiums down because they are negotiating with a multitude of plans and the customer base is several million employees, retirees and their families. The federal agency employing the individual then pay roughly 72% of the cost of the premium, with the employee picking up the rest.

Jane,
That's pretty close to calling me a liar and I'm wondering what someone gets out of that kind of behavior.

What's the pay off for something like that? It is one thing to say - 'I don't understand' - "I don't agree." "That doesn't sound right."

Don't we have enough problems in this country and world - do we really need to be nasty to each other for no reason.

Let me put it this way - and realize I only have my very own experience, cancelled checks, and husband's medical records to back it up -

Very involved procedure - charged $1K - private insurance paid $900.

An approx 30 minute procedure - minor - charged $4K - Medicare paid $3K.

Sorry I came off so strong. Medicare pays very little for procedures and will deny many. Unless the physician had proof (and even that doesn't always work) they will deny payment. When you read about Medicare fraud it usually involves patients who don't exsist or billing for patients who never received the service.

Medicare can be ruthless when fraud is involved and can literally put a doctor out of business even if it was a mistake.

Medicare has hired a private company to run audits on physicians and check their billing. If anything is wrong they will audit and force the doctor to repay with interest. Because of this and their low payments, many doctors are opting-out of Medicare and charging privately. If changes aren't made to keep doctors enrolled in their program, many seniors will loose their doctors.

There is no one procedure which they would pay $4K. There would have to be multiple charges which might have totaled that amount. Any 'involved procedure' which involved multiple 'sub-procedures' and charges. I am assuming you are talking about a surgical procedure, in-hospital. Without knowing more details, if you believe there was fraud you can always report that.

I'm sorry if I offended you, but I do believe doctors and hospitals are constantly blamed for the high expense of health-care.

Jane

Not a problem -

I know what Medicare paid, I know what the Dr. charged, I know what was done. What I wrote was exactly what happened.

There is no way we can get around the fact that healthcare providers - hospitals and doctors are part of the problem and do we want to talk about drug companies?

I know nothing about audits, what they pay, what they don't pay - I only know our experience.

It seems to me that we are all arguing the same position. The only difference is that we see different things as being broken in our system. No doubt this is from our own personal experiences. All the points are excellent, and valid IMHO; only if all these issues are addressed are we going to be better off personally and as a nation.

Billing issues like the discrepancy between medicare and private insurance payments seem to go on all the time and it's not always the insurance co. that is the bad guy. The 'mistake' could be anywhere from the provider of care to the insurance co. My MIL was billed for having 4 eyes operated on, and the ins. co. paid it. The last I checked she only had 2 eyes. (she had these charges removed)

For the most part, the people who I hear complain about health care are unhappy because (1) it's too expensive or (2) they have been denied something. I think that many satisfied people should be complaining also, but they don't know enough to complain. I'll give two examples, both involving a vulnerable group of people - the elderly. I went with a family member to see her Primary and he told her that she had to have heart surgery. She was very upset, and I told her that we have to get a second opinion and that sometimes these conditions can be handled medically. The doctor stated emphatically that she needed the surgery and gave her a name of a surgeon. Needless to say, a yearly trip to the cardiologist was all she needed. She has always been happy with her health care and providers - she just didn't know any better. Had she gone through with the surgery, I don't think she would have had enough marbles left in her head to complain. Another elderly friend (95 years old) was told she needed heart surgery. Fortunately for her, she was sharp as a whip. She said that they are "crazy" and why would I want that at my age. She lived independently for another 5 years before her death. The insurance company would have paid for both of these women, and both were happy with their coverage. Both women would not have been denied the surgery, but it was unneccessary. The less expensive treatment (medications, diet adjustment) was effective and did not carry the enormous risks of surgery.

Old Joyful, I've been a lurker for years and have always enjoyed your posts. If our nation can ever acknowledge the full extent of our problem and fix it, maybe we can send some doc's your way. I asked five foreign docs that I worked with why they came to America (Japan, Spain, Germany, South Africa, Pakistan). All but one said it was for the lifestyle ($$). The other was for political unrest in their country. "On my salary in Germany, I could only afford a small flat." "Property in Japan is so expensive - and the greens fees."

Disclaimer:Physician

There are so many half truths in this thread as to make it a bit pointless. As a physician, you can opt out of Medicare. You then have to handle getting cash directly from patients. You have the privilege of billing 5% more than you can if you contract with Medicare.

Example: Gallbladder surgery- medicare pays about $500. If you opt out of Medicare, you are allowed to bill $525. Needless to say that, very few physicians opt-out of Medicare - now - doctors can refuse to see Medicare patients but you are forbidden by law to charge more than 105% of allowable fees. As an aside - gallbladder surgery has a roughly 1 in a 1,000 incidence of common bile duct injury - the average payout for that injury is $650,000. So by that measure, Medicare does not even cover the liability risk associated with the procedure. Now - not everyone sues or wins - but if they did....

I have to comment on the VA. I have to operate on VA patients all the time for semi-elective operations. They tell the patients to go to private hospitals for certain procedures - ie show up in the Emergency Room with your gallbladder attack and the private physician is obligated to take care of you if it is an emergency. We get paid - but it takes months, lots of paperwork and is less than Medicare I believe. VA's only survive because they are attached to academic centers. There is so much money flowing to acaemic centers to cover resident's salary and they do most of the work in the VA system (Medicare pays about $200,000 per resident annually to pay for their education - both directly and indirectly).

No middle class American with health insurance would be satisfied with the atmosphere/convenience etc at most VA hospitals and clinics.

It is nice to see that you all have ideas on how it can be done. There are very smart well intentioned people who can't figure it out and they study it full time.

The final result will most likely be a dissappointment to most Americans - necessary perhaps but a huge letdown. Physicans will be harder to locate and contact, (can you even imagine that?!?) ERs will be more crowded, waiting for care will become the norm, quality will decline. There is no magic bullet and the problem is not all about greed. There are high expectations and servicing that costs money. Improvements can be made but don't expect it all to be roses.

ruffian, I agree.

Perhaps our perspective is much like the poem of the blind men and the elephant - different systems - different opinions.

Yes, much surgery is ordered that is not necessary, many tests are ordered that are not necessary, and hospitals, etc., do overcharge.

It may not seem like much, but a hospital overcharging just $50 on every patient's stay can make a difference to all of us.

A doctor prescribing unnecessary and expensive medication, affects all of us.

How many people actually check their hospital bill to know if they got all the medication charged, or if all the dressing charges were legitimate?

How many people do research on the medication they get and question if it is necessary or not?

One usually deals with doctors, hospitals, and insurance companies at stressful and sometimes frightening times in their life. They are not always able or capable of researching and questioning.

The insurance companies seldom check. They just pay the bill and up the premiums.

These things affect the cost of healthcare to all of us, whether we have no insurance, great insurance, or Medicare.

It's nice to hear from a docs point of view. You've clearly identified problems in the system - and we all know that there are many more. Discussions like this are important because we need to realize that there are so many problems and there isn't an easy fix. However, things will change - our Nations health care costs can't continue rise while providing coverage for fewer people. I do beleive the consumer will have some say in what changes take place - they'll vote at the ballot box or with their wallet.

I agree that most middle class would not be satisfied with "less than they're used to." A recent acquaintance told me of living in Italy for 7 years. She said that there was an expectation that if someone was hospitalized, a family member was expected to provide 'basic services.' I can't see that going over well in America.

I'm not doubting that many smart people can't figure out a fix but we have to start somewhere. Throwing up our hands in defeat and saying the problem is too big should not be an option.

david_cary -- Would you please tell me in what branches of medicine your 'foreign' MDs specialize? (BTW there's a lot more to American 'lifestyle' than just your salary. Here you can buy a mansion with no money down! LOL And there you don't have to buy expensive health insurance! LOL again!)

I'm not clear about your statement on how much an MD can charge after opting out of Medicare. My orthopod opted out; charged me $7K for his part in my hip replacement. I'm pretty sure that's more than 105% of what Medicare would have paid him.

In America we've been taught to expect that EVERY disease can be cured, that it is somehow wise and necessary to put even a *terminal* patient through hugely expensive and often agonizing 'therapies' to gain a slight extension of life, regardless of the quality of the life. National health plans don't do that -- don't take it beyond reason. They do spend on basics like family practice medicine. They don't respond with overkill on every complaint, but they do recognize and treat emergency situations. There's an overall 'triage' to the system. Of course Americans would HATE that! At first.

As for a shortage of MDs, that's already happening. And let's not forget the shortfall in RNs!

CHANGE is the big mantra, but change is hard. It's pretty much against most human nature to RISK. People have to see what's wrong with the status quo and what's right with the change that's proposed.

Sorry, it was ruffian1 who posted about the foreign docs. Still would like to know if they are family practice or specialists or what.

Chisue,

the foreign docs were all in a well paid specialty. I worked within this specialty, so you can see there is a big sampling error. I would have never asked that question to a stranger.

The end of life care and our expectations are so out of whack. We always seem to remember our bad experiences so vividly, but I have to tell you about my MIL. She had a chronic condition (emphysema) and she had extremely unrealistic expectations. Her doctor handled her 'end of life' care with such compassion and skill - I'm still in awe.

I am sure there are a lot of people working on this - certainly some of them are well intentioned.

The fact is, however, there are large numbers of lobbyists out there wanting their piece of the pie to continue, or, to get larger. The lobbyists have a huge affect on anything that is done in this country.
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Also, there are a lot of smart, well-intentioned ordinary people out here, and on this board, who are telling of their own experiences, giving their opinions as well. I doubt anyone making decisions, will listen to them, but that doesn't mean their experiences, their ideas are not good or just as 'smart' as all those others who are thinking about it.

My experience with Medicare is the exactly as I described and it is the only experience. I can't speak to what 'Medicare allows' - only what the doctor charged and what Medicare paid. I have no copy of the rules, only the medical bills.

We will have to wait and see what Americans will tolerate in healthcare - because I think change is coming. I'm pretty sure some form of national healthcare is in the future - just don't know what kind.

We do expect too much from medical care and too many procedures are done that I think should not. A lady I knew in her mid 80's was convinced to have bypass surgery. She was a pretty active, self-sufficient lady, and I don't know if she had had a heart attack, never heard of it, but it's possible. She lived 7 years after the surgery, but never recovered, those years were spent on dialysis, in a wheelchair and then dementia before she died.

That was cruel - to her - to her family.

ruffian1 -- Thanks for clarifying. It's what I guessed: They are all 'specialists'.

I'm now old enough to have a number of friends who are ill or dying, or who have died. I think the milking of the system is even worse than before my mother died of leukemia in 1978, in the days before DRGs. Her MDs had her in and out of hospital for transfusions so often that she spent three-quarters of her last year in hospital. And the point was...? (This was before Hospice got a foothold in our area, something I consider to be a blessing, although even that has been taken over in many instances by profit-making hospitals -- along with home care.)

Today I see extensive, usually painful 'therapies' for cancers that are going to kill the patient in a few months anyway. My first friend (from when we were three and four) died of a glioblastoma last year, but only after enduring nearly a full year of horrible 'therapies' -- urged on to 'keep fighting' when the odds were 98% against her. This is where the Big Money is -- and possibility of Big Fame if you are a researcher.

Other First World countries don't do anywhere near the cancer 'therapies' or end-stage interventions we do here. I can't imagine how drug company profits would fall if we quit. My town would suffer since Baxter is just up the road! LOL

Chisue - you are correct that under certain conditions, a MD can opt out of Medicare and then enter private contracts with patients for care. This has to be done well above board and it basically gives an option to the rich and famous. I am surprised (shocked) to hear that you would have entered into a private contract (willingly) with a MD that opted out of Medicare - and agreed to pay cash. If you have Medicare - why would you do that?

Hip replacements are very well reimbursed procedures and it wouldn't surprise me too much if Medicare was up to that level. To give you a comparison - a liver transplant is about that number....

If you paid $7k cash to an orthopod and hadn't agreed ahead of time to pay cash outside of Medicare, then I suggest you call a lawyer. The penalties for this kind of fraud are severe and may even include jail time. I am not kidding. It would be a no brainer to get that money back.

The 105% limitation was for emergency conditions. Otherwise you are not able to treat medicare patients except for cash - with private agreements prior to procedures/billings.

There are three options for physicians with Medicare. Participing, non-participating and 'opting-out'. A doctor who opts out of Medicare can not bill Medicare and can only treat Medicare patients with a signed contract stating that the patient 'chooses' to not get reimbursed by Medicare. The doctor can then charge whatever they want to the patient. The patient cannot get reimbursed by Medicare.

David, patients have the right to choose their doctors. In the NY area many doctors have opted out of Medicare because of low payments. You have the right to seek the best in the field and most have washed their hands of Medicare. There are othopods and there are othopods. If I were having my hip replaced, liver transplanted, I would seek the top in that specialty. If that doctor told me he is not involved with Medicare, I would have to make the decision whether to 'hire' him/her or not.

The comment about ending life with dignity and stopping medical intervention depends on whether a doctor will be facing a law-suit. Could you imagine a doctor telling a patient they would not operate on their cancer because they were too old. The lawyers would be lining up at the door.

david_cary -- Thanks for clarifying that the 105% billing is for emergency procedures.

Before I was 65 I had my left hip replaced by the top hip surgeon in the Chicaoland area. (James Kudrna, if you want to look him up.) This year, as a Senior, I wanted the same top guy, but opted out of Medicare starting last year. That's why I paid his $7K fee. (I should be glad I'm not obese; would have been $9K! Hip *Revisions* are $12K/$15.6K.) Medicare paid everything connected with the surgery except his fee, which included pre- and post-op visits.

I have to say it seems unfair that the agreement between an MD and Medicare should preclude the *patient* from receiving the amount Medicare would have paid a surgeon, but I have no 'in house' legal counsel to pursue THAT for the next ten years.

jane_ny -- In national health service countries MDs do say, "No," to excessive, 99% fruitless end-of-life procedures. They probably back it up with, "The state won't approve this procedure." Here, while MDs could explain the odds and outcomes and discourage the 'therapies', they tend to downplay the problems. They push experimental and even disproven drugs. (Sorry to use such a general 'they', but it is the norm in my experience.)

I agree no doctor is going to put himself at risk by simply saying, 'you're too old, we won't operate/treat'.

It is something very different, however, to suggest they talk candidly with the patient about the situation. The patient should be made aware of all the risks involved, the side effects, the cost, and necessary future treatments. They should also be told of the benefits - good or minimal.

"David, patients have the right to choose their doctors. In the NY area many doctors have opted out of Medicare because of low payments. You have the right to seek the best in the field and most have washed their hands of Medicare. There are othopods and there are othopods. If I were having my hip replaced, liver transplanted, I would seek the top in that specialty. If that doctor told me he is not involved with Medicare, I would have to make the decision whether to 'hire' him/her or not. "

Absolutely but don't complain about costs. By the manner Chisue was complaining about the high costs I was surprised that she agreed to do that ahead of time. I think the original purpose of this thread was about a National health care system. It seems that people want that but then the rich want the option to opt out. I think that is fine but I find it hypocritical to complain about costs and then voluntarily pay $7000 more than you needed to. Sorry Chisue but that is how it looked to me. I'm a "rich overpaid doctor" but I would never ever spend that kind of money that I didn't have to. But hey to each his own, but again complaining about it is crazy - kind of like saying that BMW has really gotten unreasonable with their costs - maybe we need a National automobile system.

Going to and supporting physicians that opt-out is essentially the antithesis of National Health Care. I would suspect that in the vast majority of the country,

The internist DH and I used 30 years ago expected to be paid for services at the time of service. He would not file insurance, but would provide documentation so that we could file. He never accepted Medicare either.

Several internists in our Chicagoland area have gotten out of the insurance game entirely. They have annual fee 'retainer' practices.

When we moved in 2001 it was VERY difficult to find a good internist who accepted insurance and new patients. We've been satisfied with our current MD. He's competent, and of equal importance to us, he is part of a practice with a superb office management team.

It seems to me that both the medical community and consumers are reaching a point where they will protest this crazy insurance-directed system. The doc's aren't getting paid enough and the patients can't find (preventive services) doc's. We need more internists, pediatricians, ob-gyn's -- and, IMO, fewer oncologists, etc.

I can afford to pay out-of-pocket. Most people can't. I fail to understand how a rich nation 'can't afford' national health care -- especially when we now have less care at higher prices, with insurance companies pocketing the $$$. Follow the money trail to see the direction of medicine in America -- except it isn't people with medical training who are making the decisions.