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I am no expert on health care reform or the intricacies of the looming national health insurance debates that will take center stage during the Obama administration.  Writing this diary is more of an exercise in educating myself, and perhaps offering another perspective to the ongoing healthcare reform conversation.  I simply provide this post as a possible forum for more educated or aware Kossacks to put in their "two cents."  Look forward to your thoughts!

This week’s Stranger (Seattle alt weekly) has an article on Qliance Medical Group, a group of primary care physicians who have developed a business model that provides health care without dealing with insurance companies.  Sometimes described (perhaps dismissively) as boutique care or the "concierge approach", this model writ large might provide a compelling way forward in providing more people affordable primary and preventive health care -- care that specifically cuts out the insurance middleman.

"This model is mean to bring care to millions of people, not just a few hundred."

First, I should provide a couple brief blockquotes to describe Qliance and how it works (and no, I am not affiliated in any way with the company).  According to the Stranger article,

Qliance, a 15-month-old company based in a downtown Seattle clinic, saves money by cutting out the middlemen: bloated health- insurance companies that require doctors and insurance administrators to manage collections and payments on every service. Instead, Qliance charges a flat monthly fee of about $60 for basic health care.

...

Employers [who offer insurance to their employees] then take out a separate—and less expensive—catastrophic health-insurance policy, which covers things like car accidents and strokes. [These] employers also pay into a fund that employees can access for at-cost prescriptions from the Qliance pharmacy.

According to Qliance:

we charge an affordable monthly fee for unrestricted, 7 day a week access to a Qliance provider of your choice. Qliance features same or next-day appointments for urgent care, unhurried 30 to 60 minute office visits, 24 hour phone and email access to a physician and the convenience and cost savings of an on-site x-ray, laboratory and prescription drug dispensary.

...

Instead of spending [40%] of what patients pay for primary care on back office staff and accounting or giving it to the insurance company, Qliance uses it for state-of-the-art technology, more providers, longer operating hours and lower prices.

According to cofounder Dr.Garrison Bliss:

"With a monthly fee practice model," Bliss said, "we could shed the administrative overhead associated with insurance-based reimbursement and apply the savings toward lower pricing and higher physician staffing."
...
They created this model, Bliss said, because they had tried working within the insurance system and had seen that their costs would exceed their income unless they drastically cut staff and services. It was either that, he said, or do what the other primary-care doctors do -- increase patient encounters to 30 a day or more.

"Such a patient volume translates into long appointment lead times and time-pressured appointments -- typically 15 minutes maximum -- leaving both the patient and the physicians dissatisfied," Bliss said.

But, in simplest terms, under the monthly fee model general, non-emergency health care becomes similar to joining a 24-hr fitness gym:

  1. Costs are lowered due to avoiding insurance altogether, and to having in-house diagnostics like x-rays, etc.
  1. Patients spend more face-to-face time with their physician.
  1. Physicians and staff focus on the important task at hand: the health of patients, and NOT the boondoggle of insurance forms.
  1. Small business employers save money and can still offer benefits for catastrophic care to employees, while employees are responsible for ordinary, primary care out-of-pocket.

Further, this model appears to provide counterbalancing financial incentives for doctors to practice primary care as opposed to more specialized practices. As I understand it, one of the reasons that health care is so expensive these days for ordinary citizens is because there has been a decades-in-the-making trend toward specialization by physicians.  This trend is partly because of technological advances, but primarily because insurance companies pay care providers more for those specialized services than they do for good old fashioned primary care.  

My stepfather is a pediatrician, and like many doctors, the favorite part of his job is the physician-patient interaction.  Wouldn't it be great if doctors could be drawn to primary care because of competitive compensation AND enjoy their work more?

It seems like the Qliance approach, in that it eliminates entirely the administrative costs in dealing with insurance, significantly increases potential income for primary care doctors as compared to specialists -- while providing more individuals greater access to health care.

On the other hand, even if this model were to become common place, insurance would still perform a necessary role (in the absence of a single-payer system) for individuals to have coverage for catastrophic or emergency health care.  According to Qliance:

[P]air an individual high deductible insurance plan with comprehensive primary, preventive and wellness care from Qliance. You get the best of both worlds—less expensive insurance coverage in the event of a major medical problem, and affordable access to a family practice physician for your routine medical needs.

So... are there Kossack doctors in the house?  If it becomes more commonplace for physician practice groups to organize via this sliding-scale monthly fee medical care model in order to provide primary care would health care become more affordable across the country?  Can the federal government support a hybrid approach to healthcare reform that incentivizes doctors to organize in this manner and more or less relegates health insurance to catastrophic coverage?  

Would AHIP and the rest of the health insurance goons lose some of their market and lobby power over time were primary care doctors across the country to utilize this business model?

UPDATE: Lots of interesting criticisms in the comments. Wish I personally had the knowledge to address these valid points, but thanks for all your thoughts.  In all likelihood, this model -- even if it were to become widespread -- still would do little for those suffering from chronic conditions or those who cannot afford these services.  The question is whether the business model itself improves health care for the population as a whole.  I guess the jury's still out!

[See arodb's comment below for info re: boutique coverage]

Originally posted to gatorbot on Sat Jan 24, 2009 at 03:02 PM PST.

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  •  Thanks for reading n/t (217+ / 0-)
    Recommended by:
    Joe Bob, exsimo2, Chi, catdevotee, Odysseus, Fran for Dean, peggy, jxg, Pandora, nicolemm, Bob Love, sara seattle, cotterperson, gaff98, mslat27, Matilda, CivicServant, MarkInSanFran, givmeliberty, Creosote, Gustogirl, ReneInOregon, Ian S, otto, roses, BuckMulligan, gabie, peraspera, oslo, L0kI, TampaCPA, oceanview, dksbook, bigmama, SneakySnu, psnyder, wordene, Bailey Savings and Loan, hoolia, churchylafemme, arielle, RebeccaG, Liberaljentaps, alizard, dkmich, Oaktown Girl, count, KateCrashes, CanYouBeAngryAndStillDream, lalo456987, luvmovies2000, angrybird, paige, sd4david, Tinfoil Hat, capelza, el dorado gal, Chinton, PBen, dbsf, Brooke In Seattle, blue jersey mom, kaliope, Isara, Sharon Jumper, FunkyEntropy, optimusprime, CWalter, FightTheFuture, dsteffen, Eileen B, Snud, fhcec, begone, skywriter, third Party please, dus7, Showman, Shirl In Idaho, DrSpalding, Themistoclea, Dvalkure, NBBooks, tecampbell, Lashe, nonnie9999, gooderservice, imabluemerkin, Preston S, nativist, myrealname, ER Doc, doinaheckuvanutjob, rage, CA Nana, Clive all hat no horse Rodeo, buckeye blue, means are the ends, jjellin, drdana, blueintheface, Pandoras Box, Aaa T Tudeattack, DBunn, ladypockt, marykk, out of left field, oscarsmom, dmh44, yoduuuh do or do not, karmsy, Wino, gustynpip, Jimdotz, terabytes, twinpeaks, RosyFinch, Rex Manning, bmx writer, second gen, Heyroot, mcc777c2, cyncynical, jnhobbs, rogereaton, electric meatball, Assaf, GANJA, lump1, bkamr, hulagirl, scooter in brooklyn, Brinnon, LI Mike, Laughing Vergil, minerva1157, Lujane, tofumagoo, evora, Tam in CA, mofembot, Chrispy67, kyril, PMA, AJsBodBlog, luckylizard, joy sinha, Piren, poohsmom, shortgirl, princess k, maggiejean, prettygirlxoxoxo, Pris from LA, litoralis, gdwtch52, fearisthemindkiller, Dopeman, Hope08, notrouble, Nailbanger, earicicle, Hopeful Monster, mississippi boatrat, Daily Activist, platypus60, fokos, allep10, rubthorn, Green Karma, Shuruq, Bene Gesserit1, Dragon5616, Shocko from Seattle, winsock, longtimewatcher, ratmach, Lazar, ladygreenslippers, ppl can fly, Erica Jan, pyegar, Jez, Sand in Florida, roadbear, TheWesternSun, on board 47, Obamacrat, chrome327, KS 65 woman, freedapeople, scarlet slipper, sharonsz, debbieleft, MsGrin, berrieh, josebrwn, nosleep4u, AMfromATL, Its a New Day, the dogs sockpuppet, Empehi1961, RepTracker, uc booker, bgblcklab1, Fickle, ncarolinagirl, kevin k, tresgatos, princesspat, Santa Susanna Kid, dle2GA, Wheever, FrozeAgain, Fire bad tree pretty, Sark Svemes, Edgewater

    y el canto de todos que es mi propio canto

    by gatorbot on Sat Jan 24, 2009 at 03:03:29 PM PST

    •  One issue I have with this (50+ / 0-)

      or any other scheme that is less than full nationalized single-payer health care is that in order for it to work the doctor or insurance company most likely has to cherry-pick healthy patients.

      While cutting the admin costs of dealing with insurance is going to save this kind of group money that they can use to improve patient care I wonder if the savings is enough to provide this kind of care:

      we charge an affordable monthly fee for unrestricted, 7 day a week access to a Qliance provider of your choice. Qliance features same or next-day appointments for urgent care, unhurried 30 to 60 minute office visits, 24 hour phone and email access to a physician and the convenience and cost savings of an on-site x-ray, laboratory and prescription drug dispensary.

      to all-comers which would include people with serious chronic diseases, age-related illness, etc.  Right now it seems their focus is on a group of people who are employed and, presumably, fairly healthy overall.  I am skeptical that the savings would be sufficient.  

      It is this very issue that causes insurance companies to deny coverage to people who are actually sick and focus coverage on people who are pretty healthy.  In order to extract profit from medicine you have to limit the pool of people who actually need medical treatment.

      All of this leads me to answer this question:

      Can the federal government support a hybrid approach to healthcare reform that incentivizes doctors to organize in this manner and more or less relegates health insurance to catastrophic coverage?

      in the negative.  I think single-payer is the way to go.  Right now, the government health-care plans, Medicare and Medicade, are forced to provide care for the costliest, neediest patients.  Meanwhile the insurance companies cherry-pick the healthiest.  My bet is, that to provide the kind of care this group is providing, they have to cherry-pick too.

      If you have data showing that this isn't true I would be very interested to see it. (serious interest - not trying to be snarky)

      "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

      by Edgewater on Sat Jan 24, 2009 at 03:38:45 PM PST

      [ Parent ]

      •  Can we all agree that single payer (68+ / 0-)

        is obviously the best choice, that it is the ultimate goal, and also that it will be like pulling teeth to actually enact in this country in the near future?  IMO we are going to have to do something intermediate before we get to single payer, and plans like this are interesting models.

        If we insist on all or nothing we're very likely to get nothing.

        Save the parrots: Drink shade-grown coffee!

        by oscarsmom on Sat Jan 24, 2009 at 03:49:19 PM PST

        [ Parent ]

        •  I would suggest that if we don't have it all (19+ / 0-)

          then we will get nothing.  Or, if not nothing, a very poor government hybrid that allows insurance companies to skim off the profit of insuring healthy people while burdening the tax-payers with those the insurance companies refuse to cover fully or at all.

          While, as you say, this plan is interesting, I couldn't say just how interesting until I saw the kinds of patients they're caring for.

          Taking care of a healthy population is far different than caring for people who are actually sick.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sat Jan 24, 2009 at 03:55:04 PM PST

          [ Parent ]

        •  This is an interesting model (26+ / 0-)

          I would put it in the category of incremental improvement, along side such things as extending eligibility for SCHIP, or offering military health benefits to the National Guard. It helps more people than were being helped before, without meeting all their needs or helping all people with needs.

          This is not meant as a put down of the idea, and certainly not of the doctors who are experimenting with this innovative model. As an interim effort, it IS good, but we still need genuine systemic reform.

          •  The best part of this model is that insurance (15+ / 0-)

            companies can do little to stop it.  They can't bribe lobby congress to stop doctors from doing this.

            •  Well, they can fail to offer catastrophe policies (6+ / 0-)

              at reasonable prices.

              Last I checked, in my area catastrophic-only policies just weren't that much cheaper than comprehensive policies.  That pretty much screws this model.

              ...Unless the government offers universal, single-payer catastrophic coverage.  Maybe that would be an easier sell than total single-payer?  "Deductible of $5000/year, after that the government covers EVERYTHING"?

              -5.63, -8.10. Learn about Duverger's Law.

              by neroden on Sat Jan 24, 2009 at 08:14:51 PM PST

              [ Parent ]

              •  I think the easiest way (3+ / 0-)

                would be allow Americans to buy medicare level coverage from the govt with high deductibles. Extended medicare would be an easy sell. The only concern is congress would spend any surplus it created.

                Support Col Hackworth's because tomorrow is just a promise, not a guarantee

                by Dburn on Sat Jan 24, 2009 at 08:37:16 PM PST

                [ Parent ]

              •  Might be a good idea (2+ / 0-)
                Recommended by:
                luvmovies2000, Wino

                Do as you suggested, Federal universal, single-payer catastrophic coverage.  Promote it as helping people in these difficult economic times, but not burdening businesses or taxpayers excessively.

                Insurance companies might buy into it, seeing such a plan as a way to get out from under high payouts, simply by capping them and letting the Feds pick up the tab in those cases.

                Fine, let them.  At the same time thew Feds fill in at the bottom, too. Help the poor and long term ill; perhaps extension of Medicare & Medicaid.

                It appears to leave the majority of the existing system alone. Insurance companies don't fight much, right wing noise makers don't have a lot of ammunition; I'm sure there's plenty of human interest stories that could be promoted to make those talking heads look real bad if they yammer too much.

                Then tailor the Federally supported instances towards these insurance company free organizations. Without insurance's cut, there's a bit more money to go towards actual patient services.  Perhaps the Feds work out 'bulk accounts' with such organizations, which might reduce overhead even more.

                For those who can afford to pay, they may get better service for their dollar than with insurance taking the profit slice out. Increase medical deductions, and that medical savings deduction, so beloved by the GOP; in effect working towards single payer via the 1040.  Companies might consider providing employee health coverage through such arrangements rather than conventional insurance, or only use insurance for hospitalization.

                What you've done is started to pry the insurance companies away from their lock on the health field, without alarming them.  If more doctors move to such systems, the insurance companies slowly get pushed into a role similar to that they have in France, providing frills for those who can afford them.

                And there's other things the government could do to slide between insurance companies and their market. Subsidize all vaccinations, including flu and pneumonia ones, as public health with an eye towards 'homeland security'.    

                And this happens fairly slowly, the "frog on the stove" approach.  No sudden horde of insurance industry workers thrown out of work, no need to have an entire system in place on a certain date.  At steps along the way the support of insurance companies and Republicans would not be unlikely, in stead of their full fledged opposition as with current plans.

                 

            •  They can (0+ / 0-)

              jack up liability insurance for doctors - something they have already been doing for some time in order to get support for laws which limit liability for doctors.  The fact these liability limitations will also benefit polluters, irresponsible manufacturers, corporate theives, etc. ad infinitum is a problem.

              Laws which hold doctors accountable should be separated out from other tort suit types.  

        •  I would recommend this comment 100x if I could (4+ / 0-)

          There's nothing here I could say better so I won't try.

        •  That's as pragmatic as you can get (12+ / 0-)

          I would love to have the same access to health care as federal employees have and at the prices they pay in a single payer program.

          The reality is; junk insurance is nothing more than catastrophic insurance and then only of you can force the insurance company to do what they agreed to do.

          I would pay $60 - $100 a month for the type of service above and use a a junk policy for the accidents or a chronic disease.

          More importantly, I think people have to look at what this represents. Doctors not willing to work with insurance companies. If I were to think of a way to get insurance companies to fade away and die, I would take away their providers. In other words if someone applies for health insurance and finds out that the nearest Doctors is 5 hours away, the business itself stops becoming viable on Wall Street.

          Right now Obama is going to have hell of a time. I had high hopes for the insurance companies publicly held stocks to slide off the cliff as earnings dropped. But United Health just reported a good quarter and the stock is on a upswing. They have a pile of cash on hand and they aren't going away.

          If we had a congress that represented us , this wouldn't be a worry. But the reality is, we don't have that and are not even near that point.

          Unless  people can come up with a powerful lobby (loads of money) that uses a carrot and stick , we can get the votes. Until people wake up to the fact that it doesn't matter what party is in power, insurance companies win and we die young.

          Single payer represents the same to us as abortion does to the other side. Much lip service, no action. They have been talking about this for 75 years now. People on the D side are going to be very very disappointed with the results when Obama goes to congress with a watered down plan and the best we get is a promise of more regulation.

          So, I welcome anything that can be done to take some of the pain away . Especially for those of us who buy private insurance. Presumably, cash plans like this will take care of things like high blood pressure , cholosteral and other "getting old" small problems.

          If we could get a privacy law passed, then we wouldn't have to worry about going to a Doctor , getting diagnosed with high blood pressure and see our insurance rates double every 6 months.

          People like me who don't have group coverage have absolutely no protections against massive increases in premiums. I read about an attorney who had a by-pass and his premiums shot up to $4900 a month.

          When you have private plan, they can and will raise premiums to get back every penny they paid for your health problem or they will raise premiums in anticipation knowing that once you are diagnosed with a potential problem condition. Once you get prescribed then it goes on your record and you won't get a cheaper policy elsewhere.  

          I think the best we can hope for is no policy cancellations in the middle of major medical problem. If we get that, I would be pleasantly surprised. Single payer won't happen in my lifetime. Americans are fundamentally stupid when it comes to this.

          I also think that the people who are activists are also not being realistic. If they started with the idea that everyone in congress was corrupt and needed to be bribed, or contributions made to their PACs (the polite way of saying bribes).  The organization behind the lobby has to have well financed local chapters in each district that can fund a challange to any congressperson that votes against it. Carrot and stick.

          If they just make appearances at conventions and write sternly worded emails, then short of 5 million people marching on Washington, nothing will happen.

          That's why I won't get involved until I see a organization that understands how Washington works and gets serious funding at the NRA or AIPAC level. Right now we are a third world country and people have to face up to that. We may not look like it, but we sure as hell act like it.

          Unfortunately until more wealthy people go through an experience that Ece related, there just won't be that kind of money available. Obama raised close to a billion dollars and we all contributed, or most did in the hope he could perform miracles. Me I 'm more realistic. I just wanted a guy who was eductaed and could complete full sentences and wouldn't embarrass the country on a daily basis.  Anything extra is dessert.

          That's the kind of money we need for an advocacy organization for single payer. Until we get there, same shit different day. Maybe next election cycle people will realize it and stop sending money to congresspeople and start send it to an organization intent on getting single-payer.

          That's the only way we get there. Politicians won't do shit unless there is money involved or there is a real threat ( well funded) coming in the next election becuase they voted the way the Health Insurance companies bribed them to vote.  
           

          Support Col Hackworth's because tomorrow is just a promise, not a guarantee

          by Dburn on Sat Jan 24, 2009 at 08:33:37 PM PST

          [ Parent ]

        •  I'm pretty sure we can't (0+ / 0-)

          all agree that single payer is the best choice. I look at what portion of they taxes my wife and I pay goes to the NHS in the UK and compare that with what we payed in Switzerland and then compare the level of care available in Switzerland with the NHS and I have to say the Swiss come out ahead.

          My opinion of the NHS is very low. My wife fell and tore a muscle in her shoulder, it literally takes several months to see a doctor, get the appropriate scans/xrays and get any real treatment for what is a minor if rather irritating injury. Single payer, as realized by the NHS in the UK pretty much sucks.

          I hear Canada is better but I don't have any kind of first-hand experience. I'm not going to condemn single payer it is just that the best universal health care I have had experience with wasn't single payer.

          •  I'm curious as to what the differences (1+ / 0-)
            Recommended by:
            SarahLee

            are between the Swiss system and the UK system are as seen by someone who has used both.  Could you elaborate on your experience a little?

            I think most Americans want universal health care of some sort and, speaking for myself, single-payer is the only form I know much about.

            One thing I would like to see is ease of use and rapid access to basic and emergent care. I'd be willing to compromise a little timewise on more advanced treatment for minor, albeit irritating injuries, if I knew that people could be seen right away for things like ear infections, open fractures, and well-child appointments.  Seen right away and then not harrassed for months by complex bills and denials of claims that is.  

            What do you think of the comparison of ease of use and access for basic/emergent care between the Swiss and UK systems?

            "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

            by Edgewater on Sun Jan 25, 2009 at 04:46:38 AM PST

            [ Parent ]

          •  Single payer is NOT nationalized (1+ / 0-)
            Recommended by:
            SarahLee

            health insurance a la UK.

            Done with politics for the night? Have a nice glass of wine with Two Days per Bottle.

            by dhonig on Sun Jan 25, 2009 at 05:08:59 AM PST

            [ Parent ]

          •  For every horror story you get from one system (1+ / 0-)
            Recommended by:
            SarahLee

            You can match it with another from our system.  No system is perfect.  And it's a cold hard FACT that the per capita spending on health care in the US is 4-5 time that of countries with nationalized health care systems, despite your perception.

            Save the parrots: Drink shade-grown coffee!

            by oscarsmom on Sun Jan 25, 2009 at 05:32:40 PM PST

            [ Parent ]

      •  And the price is escalating. (28+ / 0-)

        In san diego, my doctor went boutique.  To keep his truly excellent level of care, I would have to pay $1800 a year, quite a bit more than $60 per month.  I would still need insurance, and would still pay their copays for drugs, testing, surgery, out of area care etc.
        I dont blame the doctor.  he now has roughly 400 patients, will meet them at his office or their home after hours, and is waiting for them when they show up for an appointment.  
        The danger here is that if insurance or even single payer is cut too close to the bone, the good doctors will go boutique and the level of care between economic classes with be divided even more.

        •  I agree with you that (5+ / 0-)
          Recommended by:
          oslo, ladybug53, DBunn, Nailbanger, HKPhooey

          the level of care between the economic classes is extremely divided right now.  I think the hardest hit are the uninsured working poor.

          Any plan that doesn't require everyone to help pay for it equally is doomed from the start to simply continue this situation forward.  If the wealthiest and healthiest can opt out the government ends up with exactly what we have now only on a larger scale.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sat Jan 24, 2009 at 04:01:00 PM PST

          [ Parent ]

          •  What is health? (7+ / 0-)

            Seriously?  I'm willing to share and share alike.  But I get pretty tired of paying enormous medical and insurance bills, because these costs are inflated by people like a friend of mine, who is physically healthier than any other fifty I know, but simply HAS to be at the doctor's at least every other month.  He has allergies, he says (I've never seen or heard them).  He has asthma (no sign of that, either).  He's lactose intolerant (not from the amount of cheese he can put down in one sitting).  He doesn't DARE eat anything in the nightshade family, it will give him arthritis (he eats pasta with tomato sauce as his staple diet).  He's gaining weight (yes, his shoulders are twice as broad as they were ten years ago, from spending two hours in the gym every day).  His back hurts from an accident fifteen years ago.  He needs antidepressants, or maybe anxiolytics, or maybe the problem is ADD, although his psychiatrist said "not".... then there are the people on 24-hour oxygen and nighttime ventilation because they're still smoking after fifty years, and we're just going to average the cost for their new lungs ... they'll pay 10%, and the other nine of us can each pay 10%, too.  Oh, and the fellow who's too fat to work, so he sits around and eats ice cream while watching TV; we're all going to pay for him to test his blood sugar six times a day and get insulin fed to him through a pump.  Oh, and we're all paying for the demented nonagenarian who is slowly dying of cancer, to get every expensive advanced life-support and extension treatment somebody wants to sell, even though his mind turned into a peppermint patty seven years ago and his kids are somewhere in the Bahamas.

            I'm not willing to go equal shares with the American public until the American public is willing to GROW UP.

            •  feel good that there are doctors who agree with (4+ / 0-)
              Recommended by:
              jxg, oslo, hoof32, Amber6541

              you.  Healthcare, in a wealthy society, shouldn't be unavailable to  those who need it and we need to do much better than we are currently doing.  Providing this care means, though, that people take on some responsibility for their health.  Why should I pay for the seventeenth asthma hospitalization for an asthmatic who is smoking? Why should we be paying for the disease effects of obesity?  It's so very complicated.

              •  Someday I suspect you two will have to listen (28+ / 0-)

                to a younger geneneration complain about subsidizing your health care because it's your own fault that you got old and/or ill for failing to do ... X, Y, or Z.  And it will be something that hasn't been discovered (or uncovered) yet, and that you didn't know you should or shouldn't do it until it's far too late to prevent the consequences.  It may even be something the medical establishment encouraged you to do, but that won't matter to the youngsters.

                And I'm sorry you'll have to listen to that, because I know exactly how it feels.

                Bush did inherit the 9/11 attacks ... from Dick Cheney

                by tovan on Sat Jan 24, 2009 at 06:02:42 PM PST

                [ Parent ]

                •  That's unlikely. (1+ / 0-)
                  Recommended by:
                  jxg

                  I had QUITE enough healthcare as a child to last me for a lifetime.  One reason I don't like spending money on hypochondriacs is that I personally won't go near a doctor without a fair amount of kicking and screaming.  So undoubtedly, whatever I finally get will be something that could have been caught, and forced to linger for a little while of constant harrassment and dependency, if I wanted to live out an extra year or two that way.  But I don't.  I made a conscious decision when I was sixteen that I wasn't going to live without independence.  When it's time to go, all I want is a nice od of painkillers.

                  •  I used to have plans almost exactly (6+ / 0-)

                    like yours.  Like most responsible adults, I made a living will, specified no extraordinary measures, and discussed it with my husband and adult children to make sure they understood.  I'm not particularly afraid of death--indeed I've come very close to it--and I wanted them to know that I regard it as either a gateway to an adventure or nothing.  I even promised to give them a sign at my wake, if I can!  Either way, there's no reason to fear it.  They all agreed. I thought.

                    My self-centered complacency lasted until the day I was wheeled in for emergency surgery and saw the distress and panic on their faces.  I can no longer be cavalier about taking an easy way out.  I can't do that to them.  And most of us have people in our lives who would be emotionally injured if we choose to leave them before we must ... or before they're ready.  And that matters.

                    Bush did inherit the 9/11 attacks ... from Dick Cheney

                    by tovan on Sat Jan 24, 2009 at 09:32:49 PM PST

                    [ Parent ]

                    •  Another perspective...more of the 'youth' culture (2+ / 0-)
                      Recommended by:
                      SarahLee, cynndara

                      tovan - the issue of "before we must ... or before they're ready" is made much worse by the disconnection with the end of life that our 'youth culture' has fostered.  We live (and consumer health care) as if we are not going to die.....obviously a delusion.

                      When it is time, it is time.  Historically certain cultures knew this....in time ours might.  

                      And anyone who may be  'emotionally injured' by another's death may want to consider that any one of us may die at any moment...that is the gift that the moments alive offer.

                      •  So true ... (0+ / 0-)

                        My father died unexpectedly from a heart attack brought on by, well, his typical lunacy.  My brother and I talked afterwards, and both had the same story ... we'd spoken with him on the phone within the last week, and the last words we had both said on hanging up were "I love you".  We loved him while he lived, and didn't have any unfinished business or regrets.

                    •  I guess we come (0+ / 0-)

                      from different stock.  I don't keep people in my life who can't accept reality.  Sorry to sound cold and heartless, but my family was military.  We  just don't cling and cry.  It's not a decent way to treat people you love.  You say "I love you, I will always love you, and don't worry about the mess; I'll take care of things when you're gone."  It's just what you DO.  And I've already done it, a number of times.

                      Because love isn't about what YOU need, it's about what the ones you love need, having the strength to love with open hands is part of what makes a person worth loving.

            •  if these patients (12+ / 0-)

              had good health education from childhood, and support services--like job training, child care, public transportation-- that didn't mean they were living in near-panic for most of their waking hours, many of their health problems wouldn't exist.

              where is your compassion? That nonegenarian paid taxes and worked for fifty years, may have fought in a war, or taught 1000 kids to read--you want him/her to suffer thru cancer with no care??

              •  No. (2+ / 0-)
                Recommended by:
                AlanF, Santa Susanna Kid

                But I do want care to be realistic, based on realistic expectations.  I don't want to throw the kitchen sink in a futile gesture based more on survivor guilt than any hope of survival, leaving fewer resources to cope with, say, prenatal care for young women whose children could  otherwise be born with severe birth defects.  We can't do everything, and currently, we seem to be choosing to do all the least effective, most futile things.  When I worked in the local hospital, we were constantly being sent people who were in state custody for mental health and dementia issues, to be fitted with nighttime breathing equipment.  These people were already gone ... their minds had pretty much left the body.  But we had to fit them for artificial respiration that they didn't want, and often fought against, because they were on Medicare and therefore, if it could keep them alive for another DAY, we had to do it ... and it kept the respiratory equipment dealers doing brisk business.

                I grew up in the military.  I learned the concept of triage before I was sixteen.  I apply it to everything in life: separate what you can fix from what you can't, what will fix itself from where your efforts will make a difference.  Concentrate on the things that you CAN do, that will actually change something.  It seems like basic common sense to me.  But we don't do it in medicine in this country.  Instead, we spend ridiculous amounts of money and effort trying to fix the unfixable and treating what will fix itself, while we put barriers in the way of doing the things that actually make a difference.  And I think we do it that way because INEFFICIENCY creates more opportunities for profit.  In the military, you're trying to allocate limited resources to an unlimited problem.  In civilian life, we pretend that the resources are unlimited, for certain people (the insured, including Medicare)and attempt to repeal the Law of Death; while for others, we do nothing at all, even if a simple ten-day prescription could prevent a lifetime's disability.  Compassion has to be informed by wisdom, not scattered about based on infantile fantasies of omnipotence.

            •  Let's apply your thinking to public education (18+ / 0-)

              Why spend tax dollars on kids who can't maintain a C average?  Why waste money on extra tutoring, extra aides, etc. for kids who won't even try, or who have parents who don't care?

              Why provide education for kids with IQs below 70?  Or occupational therapy and speech therapy for kids who--even with those supports--will never perform at a C or above?

              Are you still willing to pay into a system like that?

              Or how about firefighters?  Why should they respond to calls from homes on fire because someone fell asleep with a burning cigarette in their hand?  If they're irresponsible enough to start the fire through negligence, why should we, as a society, pay tax dollars to put out their fire?

              Why send an ambulance crew to help a drunk driver who is injured?

              And so on...

              •  The house next to me (0+ / 0-)

                in Detroit burned down one night, about this time of the year it was, too, 1984 or 85, because someone fell asleep with a burning cigarette in his hand.  And he was one of my landlady's psychiatric patients.  She had to identify the body.

                What do you want me to say?  Obviously, the man was an ass.  That my landlady had to deal with that, after waking up at two am with the house next to her life's savings burning in the wind, added insult to injury.  Maybe I'm supposed to feel compassion for him, but I never met him, so all I could ever really feel, was that he was a jerk, he'd ended his life miserably, and made people I cared about miserable into the bargain.  And yes, the fire department did come, and our house didn't catch fire from his.  Which is why public fire departments are Good Things, as is public health coverage ... but just as there have to be limits on playing with matches in crowded buildings, there also have to be limits as to what health messes our neighbors demand that we clean up after.  Give and take, a balancing of interests and concerns.  We can't all just scream "GIMME" at the top of our lungs.  We also have to do some of the giving.

                •  Judging who is deserving and who isn't (4+ / 0-)
                  Recommended by:
                  SarahLee, rogun, mbzoltan, Jez

                  sounds like a full-employment-for-lawyers system, with not much left for anything else. However annoying it is, it is far cheaper to let the "undeserving" through with everyone else than put everyone through having to prove their case. On the other hand, it would be unrealistic to think that single-payer national health could or would cover absolutely everything.

                  "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

                  by Alice in Florida on Sun Jan 25, 2009 at 12:45:57 AM PST

                  [ Parent ]

              •  For that matter (16+ / 0-)

                why should people without kids pay for pubic education at all? I think the analogies you make illustrate a very good point mbzoltan.

                The thing is, that at some point or another just about everyone can benefit from a society that decides to help rather than comdemn, that decides to be caring rather than cold.  And in many cases, it is shortsighted for society to refuse to look after its own that are in need of help - it can cost more in the long run to deny help than to give it.

                As far as making judgements about who deserves what health care where do you draw the line?  What about the guy who breaks his back while surf-boarding.  What about the parents who decide to have a baby knowing it has a significant birth defect? Should we deny those people access to universal health care?  

                After all - they made choices in both of those situations.  The same could be said for people who choose to engage in high-risk occupations - just because somebody chooses to be a miner doesn't mean I should have to pay for their respiratory problems.  Ditto for the truck driver who develops a lower extremity DVT.

                Pointing the finger at any given person and saying this person doesn't deserve the same health care other, presumeably better/smarter/more moral/better educated, people do is an extremely slippery slope.  Start agreeing with judgements like that and next thing you know you'll find someone else is putting you on the undeserving list.

                "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

                by Edgewater on Sat Jan 24, 2009 at 07:51:34 PM PST

                [ Parent ]

              •  Why bother rescuing (8+ / 0-)

                anyone from a hurricane? (OK, that one wasn't hypothetical.)

            •  With friends like you (5+ / 0-)

              who needs enemies?

              "There -- it's -- you know, one of the hardest parts of my job is to connect Iraq to the war on terror." --GWB

              by denise b on Sat Jan 24, 2009 at 09:43:22 PM PST

              [ Parent ]

            •  profiteers love your attitude (8+ / 0-)

              social darwinism is the best context in which capitalists can make the most profit, a truly every man for himself way of seeing the world, the tragedy of the commons, the end of humanity

        •  But $150/mo is cheap (9+ / 0-)

          compared to what most pay.  Granted still need ins. for catastrophic & drugs, vision, dental, of course.

          Impeachment in the New Year, please.

          by MsGrin on Sat Jan 24, 2009 at 04:14:40 PM PST

          [ Parent ]

          •  Those costs may not be included (4+ / 0-)
            Recommended by:
            oslo, Leap Year, karmsy, Edgewater

            in your out of pocket maximum from a high deductible plan.
            In any case, boutique care is a supplement, not a replacement, for health care through insurance.  It is something well off, health people can do to get superior health care. For the rest of us, it is no panacea.

          •  I personally pay for my own insurance. (3+ / 0-)
            Recommended by:
            auapplemac, oslo, MsGrin

            It is now close to $400/month, between Medicare and my regular insurance.  It does cover some dental and some optical, so that helps a lot.

            We never know the worth of water `til the well is dry. Thomas Fuller 1732

            by Amber6541 on Sat Jan 24, 2009 at 05:26:54 PM PST

            [ Parent ]

            •  Mine is 700 and rising fast (2+ / 0-)
              Recommended by:
              SarahLee, Amber6541

              And I have no Medicare, no dental, and limited vision coverage.

              My local small-town GP doctor does not take insurance. He gives receipts that you can submit to your own carrier but he does no insurance billing. His office visits are $45 if you have no insurance.

          •  Catastrophic costs same as standard insurance. (0+ / 0-)

            OK, it costs a little less, but not enough to matter.

            So, might make a marginal savings -- reduce your insurance premium by a little tiny bit more than your extra monthly costs.  But not much savings.

            -5.63, -8.10. Learn about Duverger's Law.

            by neroden on Sat Jan 24, 2009 at 08:23:20 PM PST

            [ Parent ]

        •  Good golly, that boutique doctor takes in (8+ / 0-)

          $60,000 a month by my count.  Seems like even with overhead and malpractice that would make family medicine worth practicing.

          Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle -8.12, -5.18

          by ncarolinagirl on Sat Jan 24, 2009 at 04:48:31 PM PST

          [ Parent ]

          •  The thing is he is a crazy good doctor (5+ / 0-)

            and it pains him that his clientele is now completely higher income.  But the insurance companies drove him absolutely batty and he got tired of chasing them for his fees.  So I am happy for him, even though it took me 2 years and 4 doctors to find someone that is remotely comparable.

          •  That may be what he takes in, but not (9+ / 0-)

            likely anywhere close to what he takes home.  Cost of running an office - rent, utilities, staff, lawyer, accountant, various insurance premiums, equipment, supplies, etc. can be large expenses.
             My background is accounting, not medical, so I may have left some important things off the list.

            We never know the worth of water `til the well is dry. Thomas Fuller 1732

            by Amber6541 on Sat Jan 24, 2009 at 05:32:12 PM PST

            [ Parent ]

            •  All true . . . I'm sure I don't know the half (0+ / 0-)

              of all that goes into running a doctor's office.  And I guess my borderline poverty existance (I'm a social worker in a relatively low cost-of-living area) distorts my perception of what can be done with $60,000 a month . . . I guess for lots of people that probably isn't worth getting out of bed for!!

              Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle -8.12, -5.18

              by ncarolinagirl on Sat Jan 24, 2009 at 07:42:48 PM PST

              [ Parent ]

              •  So even if his expenses are half (1+ / 0-)
                Recommended by:
                SarahLee

                So even if his expenses are half his gross he still makes 30,000 a month.

                Or even if his expenses are 2/3 of his gross he makes 20,000 a month.

                In many businesses, one-third of what you bring in is profit.

                No wonder that doctors make it so hard for anyone to become a doctor. They don't want to share the loot.

            •  My sister is an E.R. Doc in Texas... (2+ / 0-)
              Recommended by:
              wondering if, Amber6541

              Her full-time job, and overtime, is at the hospital. I few years ago, I asked her about opening a private practice. Her reply was, that with malpractice insurance costs, employee overhead, office costs/management/space rental, it was basically, kind of a waste of time. She realized that she was going to throw away most of her free time in the form of lost income, huge stress, and, in particular, dealing with various insurance carriers. In other words: A waste of time! Time is  compensable, but, especially, lost time over bullshit. is not! And she did confess to me that her highest role model is Mother Theresa! She loves what that woman stood for, as far as helping others, and self-sacrifice. Bottom line: insurance companies were the deal-breaker. And so it goes. Additionally, other reasoning was that we are here for a very limited time; Doctors and Nurses know this all too well. So the question for those practitioners is: What is sacrifice really worth? I want a life too. We age too quickly...then we're out!
               I do like cutting out the insurance middle-men b.s.. But, how can it benefit all income levels? The diarist has mentioned a great base model. How can something similar, but more encompassing, be implemented on a large scale?  A solution could be found, were it not for the greed factor! That is the roadblock.  Peace,  SSK

        •  That sounds more realistic (0+ / 0-)

          $60 a month these days does not sound realistic--maybe it's a brand new company that has run some numbers based on unrealistic utilization assumptions.

          "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

          by Alice in Florida on Sun Jan 25, 2009 at 12:21:49 AM PST

          [ Parent ]

      •  This model would not (13+ / 0-)

        work with chronic illness or specialist requiring illnesses.

        But for the basics and wellness care it looks great.

        Our noses are big so we can smell your money!

        by arielle on Sat Jan 24, 2009 at 03:52:34 PM PST

        [ Parent ]

        •  Unless you developed a chronic illness (6+ / 0-)

          or one that required a specialist I suppose.  Then you would be pretty much out of luck.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sat Jan 24, 2009 at 04:01:52 PM PST

          [ Parent ]

        •  For basic and wellness care, it's outrageously .. (5+ / 0-)
          Recommended by:
          jxg, oslo, arielle, neroden, Edgewater

          expensive.

          •  I don't think they claim to be that (4+ / 0-)
            Recommended by:
            oslo, arielle, CWalter, jj24

            I think speculation about cherry picking and this system being bad for patients with chronic conditions is merely speculation.

            Impeachment in the New Year, please.

            by MsGrin on Sat Jan 24, 2009 at 04:16:25 PM PST

            [ Parent ]

            •  Diabetes care (for one example) is now consuming (2+ / 0-)
              Recommended by:
              oslo, cyncynical

              $1 in $5 of health care costs so $60 a month probably isn't going to do it.

              Our noses are big so we can smell your money!

              by arielle on Sat Jan 24, 2009 at 04:28:18 PM PST

              [ Parent ]

              •  diabetes can be managed so much less expensively (4+ / 0-)
                Recommended by:
                Joe Bob, oslo, arielle, KateCrashes

                than it is today.

                post-diagnosis, there are at least two kinds of intensive intervention that can forestall and even reverse debilitation and chronic use of injected insulin.  they need to be common knowledge and commonly used.

              •  That is an incredible statistic. (7+ / 0-)

                Type 2 diabetes is easily brought under control with lifestyle changes + oral medicines, usually, and even then newly diagnosed patients don't usually need to visit the doc more than once a week for the first month, then monthly, then increasingly less as the patient learns to manage the condition.  Many chronic conditions are the same way, and if a physician actually has the time to talk with the patient (30 min to 60 min appointments are unbelieveable) and provide the education the patient needs to take control of their health, it would actually be cost efficient in the long run.

                Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle -8.12, -5.18

                by ncarolinagirl on Sat Jan 24, 2009 at 04:54:49 PM PST

                [ Parent ]

                •  We are currently reaping what the (9+ / 0-)

                  insurance industry sowed.

                  Because a person is only on a specific insurance plan on average 2 years, they took the stance that any complications incurred from lack of care or education would be somebody else's problem

                  Sort of a health insurance bill lotto game.

                  Couple that with huge increases in costs of medication and durable medical (like pumps and supplies) and type 1's needing high risk pregnancy care when they used to not have babies and needing eye surgery etc. which has become more expensive and used to happen less when we died younger and now it's ginormous.

                  $3.3 billion a year is spent on insulin.

                  When I became diabetic in 1975-1976, insulin was $3.60 a vial.  It is now ~$105.00 a vial.

                  The Biotechnology Industry Organization has been thwarting efforts to allow insulin and human growth hormone to be manufactured and sold generically.

                  So the fight now has been standards of care and results oriented care to keep diabetics out of the hospital and leading healthy and productive lives while saving boatloads of money.

                  Our noses are big so we can smell your money!

                  by arielle on Sat Jan 24, 2009 at 05:56:27 PM PST

                  [ Parent ]

                  •  Intellectual property versus (5+ / 0-)

                    the common good. Insulin is made with gene-spliced bacteria these days, pretty elementary biotech, though it was revolutionary 20 years ago or so.

                    These industries are more interested in their patent monopolies adn extending those monopolies than actually alleviating suffering. This is definitely a place where government intervention could mean something. Especially since the 'science' comes from public research.

                    There needs to be a definitive change in intellectual property rights so that this abuse stops.

                    In every cry of every man, In every infant's cry of fear, In every voice, in every ban, The mind-forged manacles I hear

                    by Areopagitica on Sun Jan 25, 2009 at 12:43:38 AM PST

                    [ Parent ]

                    •  Part of the issue is the analogue (0+ / 0-)

                      insulins and batch testing requirements of all of the insulins.

                      I think what will happen is they will allow generics of the basic insulins and not the analogues (which I take).

                      The majority take the regular stuff anyway.

                      Our noses are big so we can smell your money!

                      by arielle on Sun Jan 25, 2009 at 06:38:12 AM PST

                      [ Parent ]

            •  It's not speculation at all (10+ / 0-)

              All you have to do is go to their website and see what is and isn't covered to know this is a bad deal for patients with conditions who need specialist care.

            •  I could handle it. (5+ / 0-)
              Recommended by:
              Joe Bob, Creosote, oslo, arielle, debbieleft

              I have fibromyalgia, hypothyroidism, Raynaud's phenomenon, attentional issues, and orthopedic issues and chronic pain from a car wreck ten years ago. There isn't a cure for the fibromyalgia at this point; they're not even sure exactly what's going on. But it's the sort of thing where you try meds and lifestyle changes until it works. I keep a daily log of everything from my mood to my bowel habits to my food to the weather. To spend thirty minutes to an hour with the doctor reviewing that data, and knowing that it had been taken into account when she prescribes...that would be wonderful.

              Plus I wouldn't be sitting here with a sore wrist and hoping that I can get out of seeing the doctor. Are trackballs easier on the wrist than a mouse?

              •  Yes (3+ / 0-)
                Recommended by:
                oslo, arielle, Alexandra Lynch

                track balls can be better for some people, try one.  More importantly learn to use both hands and make sure the height adjustment is correct.  Your elbow should be at a 90 degrees and your wrist should be flat.

              •  Yes to the trackballs (1+ / 0-)
                Recommended by:
                arielle

                I spend pretty much all day every day on a computer. At the start of my current career, about 10 years ago, I was in constant pain from using a mouse and keyboard.

                My employer is enlightened enough make an ergonomics consultant available to employees who ask to see one. I set up an appointment, the guy visited me at my desk, and he recommended a trackball mouse as well as a low-profile adjustable keyboard tray.

                Within three weeks of using the new setup I was working with no pain at all. It felt pretty miraculous at the time. Prior to that I had been talking to my doctor about carpal tunnel and he had given me a trial prescription for an anti-inflammatory. The prescription was actually for Vioxx. Thankfully, I only took it for about a month.

                Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

                by Joe Bob on Sat Jan 24, 2009 at 11:18:16 PM PST

                [ Parent ]

              •  I can't do a trackball because (0+ / 0-)

                I don't have enough feeling in my fingers to manipulate it but mine is from neuropathy and lupus (among other things).

                So try the trackball.  I sometimes use a carpal brace when I'm on the keyboard to keep my wrist at the right angle or, if the Reynaud's is getting to me, neoprene gloves to keep my hands really warm.  Sometimes I put the brace on over the glove.

                Our noses are big so we can smell your money!

                by arielle on Sun Jan 25, 2009 at 06:53:22 AM PST

                [ Parent ]

            •  Ms. Grin... (0+ / 0-)

              ...you need to change your sig, unless it's Obama you want impeached (don't think you can impeach an ex-president!)

              "There is nothing false about hope." -- Barack Obama

              by DC Pol Sci on Sat Jan 24, 2009 at 06:34:16 PM PST

              [ Parent ]

          •  For me "basic" means (3+ / 0-)
            Recommended by:
            Creosote, oslo, Santa Susanna Kid

            anything not presently killing me.  :o)

            Stitches, broken bones, colds, flu, GYN care, x-rays, basic orthopedic/sports injury stuff, etc. is "basic".

            Our noses are big so we can smell your money!

            by arielle on Sat Jan 24, 2009 at 04:23:18 PM PST

            [ Parent ]

        •  In fact it is what I had as a child (1+ / 0-)
          Recommended by:
          arielle

          in the 1940s and '50s.

          The Quiliance rates are based on age; I'm in their top bracket.

          They are the option I will turn to first should an emergency arise.

          I like their motto: No insurance required, or accepted. Not even Medicare.

        •  If it was a group practice (1+ / 0-)
          Recommended by:
          arielle

          If it was a group practice, they easily could have many specialists in the group.

          That's really what goes on in the Kaiser health plans, which as I recall were originally set up as a group practice for the employees of one company in California.

          It would work fine for chronic illness; that just would mean more visits per month. I guess it would not work so fine in terms of the profit per patient for the group.

      •  Also, $720/year is a lot of money, probably (12+ / 0-)

        much less than a healthy person would pay out of pocket for a check up each year and maybe a visit to get a round of antibiotics (once co-pays are taken into account). What is really necessary is universal health insurance for catastrophic illness. It's the breast cancer, or the profoundly special needs child, or the slipped disk that sends families into the downward spiral of bankruptcy (you're diagnosed with cancer, you lose your job because you're on chemo, you lose your health care, down, down, down).

        Then if somebody wanted to pay $60/month for a service that they could basically self-insure for less, or employers want to provide that for valuable employees, that's well and good.

        But it's not the extra 15 minutes with the doc that's killing this country, it's the 16-day stay in the ER that costs $240,000.

        •  Yes but under a system (4+ / 0-)

          like what you're describing insurance companies and private groups like the one in the diary make money from taking care of the healthy.  Meanwhile the government is saddled with taking care of the sick and disabled.  This is pretty much where things stand now.

          Unless everyone is paying in regardless of their medical need a single-payer plan cannot work. If healthy people can opt out until they aren't healthy who is paying in?  All the sick, unemployable people?

          I agree with you that if people wanted an extra thing, on top of paying their fair share to a single-payer plan that is their right.  But they shouldn't be able to opt out of paying for the single-payer plan - it is their safety net too.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sat Jan 24, 2009 at 04:08:11 PM PST

          [ Parent ]

        •  I think you mean a lot MORE than a healthy ... (1+ / 0-)
          Recommended by:
          plumbobb

          person would pay out of pocket.

        •  I pay $528 per month as a state employee member (13+ / 0-)

          of a teacher's union, and the state pays in $11,000 per year.  Plus, I still have deductible.  

          "Render to Caesar the things that are Caesar's, and to God the things that are God's." And they were amazed at Him. Mark 12:17

          by bkamr on Sat Jan 24, 2009 at 04:36:31 PM PST

          [ Parent ]

        •  Can anyone explain to me why is so expensive (5+ / 0-)

          for hospital care:

          But it's not the extra 15 minutes with the doc that's killing this country, it's the 16-day stay in the ER that costs $240,000.

          "Render to Caesar the things that are Caesar's, and to God the things that are God's." And they were amazed at Him. Mark 12:17

          by bkamr on Sat Jan 24, 2009 at 04:38:03 PM PST

          [ Parent ]

          •  because it's insured nt (1+ / 0-)
            Recommended by:
            Pris from LA
          •  $32,000 for 4 hours outpatient (16+ / 0-)

            I had a pacemaker battery put in last fall.  I was outpatient and the total time in hospital was 4 hours.  I was awake the whole time.  My hospital bill was about $32,000.  I had COBRA ins. thankfully, but I still owe about $1700 on the bill.  As someone with chronic health conditions, I see my primary care Dr. monthly.  I'm lucky because I have a decent, young rural Dr. who takes my $15/mo co-pay even though my insurance co. won't pay him anything because he's out-of-network.  My Cobra insurance ends soon and I hope I don't have any major problems after it does.  I am blessed in having a Dr. who does care for his patients.

            •  WARNING: if there is any way (3+ / 0-)
              Recommended by:
              tbirchard, cyncynical, berrieh

              WARNING: if there is any way you can avoid a period of being uninsured, PLEASE try to get covered by some group plan, even if it is from AARP or something. Unions, associations, alumni groups, etc. all may give you a chance to be covered.

              Here's the problem: If you have a period of being uninsured, with no coverage, any subsequent insurance carrier, when you do get insurance, will be able to exclude pre-existing conditions! And it sounds as if you have some. Where, if you are able to go from one group plan to another, directly, with no period of being uninsured, my understanding is that under federal law they cannot exclude preexisting conditions.

              You may want to research this and start to find another group plan soon, before your current COBRA lapses.

          •  Well, (11+ / 0-)

            it's because SOME people are insured, and others aren't.

            Hospital "list prices" are only charged to people who actually pay the bill themselves.  And nobody does that.  Either they have insurance, or they can't pay.  The hospital has to take the percentage of non-payment it expects, and divvy it up among the paying customers.  Then it inflates that price by about 20% to reflect the "discount" that every insurer demands in order to be accepted by the insurance company.  So the billing price of $240,000 represents the real cost of $100,000, X2 to allow for 50% nonpaying customers, plus 20% so that the insurance companies can knock off the 20% and still be paying the $200,000 to cover you and the girl who works for WalMart who doesn't have insurance.

            Costs are also driven up by a general "racket" for all health-care supplies.  For example, a six-foot length of polyethelene tubing sold in an aquarium shop costs $2.  The same piece of tubing packaged in a white paper bag and labelled as "oxygen tubing", costs $10.  The markup in healthcare costs is a long tradition going back to the days when 80% of the population DID have insurance, and had it with one nonprofit organization, Blue Cross/Blue Shield.  Since insurance didn't ask cost questions in those days, it became the norm for all suppliers of healthcare equipment and drugs to charge "what the traffic would bear".  Healthcare is a "lemons market" -- the buyer has no leverage and little of the knowledge needed to evaluate the products.  People can't effectively shop or bargain when they are sick.  Therefore, you can always cheat them.

          •  I think it's because of all the (6+ / 0-)

            tests they do to identify the problem.  Used to be, the doc would look at the symptoms and make an educated guess to treat an illness.  Now, nobody is willing to risk the possiblity of a rare disease that could have been identified if the doc had only ordered one more test.

            I experienced this first-hand a couple of years ago.  I was having thyroid problems and instead of just doing blood work and prescribing medication, the initial bloodwork led to the recommendation of nuclear testing (just count the dollars adding up on that one) and ultrasounds which then led to a biopsy in the doctor's office.  After all was said and done there was no serious problem, except for my medical bills of $2600 that my insurance did not cover.  In complaining to the doc about it, he seemed shocked at what I had to pay - after all, I had "good" insurance - and he as much as admitted that I would probably have been fine without all the tests.  They were basically just a precaution.  I will never blindly agree to tests again without a really good understanding of what might happen if I just skip that round of testing and see if meds can fix the problem.

            Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle -8.12, -5.18

            by ncarolinagirl on Sat Jan 24, 2009 at 05:07:21 PM PST

            [ Parent ]

            •  I'm glad you showed that to him, (4+ / 0-)

              it probably saved other patients some money in the long run.  I used to see an older doctor here in this rather impoverished area.  He frequently gave me the options, and kept well informed on what things cost.  He would say stuff like "you have a sore throat that looks like strep. I could send you to the hospital for the test, or I could give you an $8 antibiotic you might not need.  Or I can write you a prescription you can hold a few days to see if this is a virus that goes away."  I really liked him.

              Watch this space. Something brilliant will come to me soon, I'm sure.

              by tresgatos on Sat Jan 24, 2009 at 06:18:10 PM PST

              [ Parent ]

              •  Exactly - docs have been to school for a reason, (2+ / 0-)
                Recommended by:
                Pris from LA, tresgatos

                and I think it is worthwhile to at least consider trusting their judgement in reasonable situations . . .

                Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle -8.12, -5.18

                by ncarolinagirl on Sat Jan 24, 2009 at 07:24:53 PM PST

                [ Parent ]

                •  That is not the direction the U.S. consumer (1+ / 0-)
                  Recommended by:
                  FishOutofWater

                  has taken.  As an obstetrician I can tell you about women diagnosed with gestational diabetes and warned of the risk that the baby could get grow large shoulders that get stuck at delivery.  They still want the doctor to do some test and guarantee whether they will be safe to have a normal delivery or whether they need a cesarean.  

                  If the doctor chooses normal delivery and is wrong there is a lawsuit waiting even with best management of delivery procedures.  If a cesarean is chosen and the obese diabetic patient has a problem, there is another lawsuit option.  

                  I do not think we can blame patients who have addiction to food or other substances for their illness.  They deserve to be given best health care like everyone else.  However, don't blame the doctors who do expensive test with a low yield when there is not liability reform.

            •  We could rely on 19th century technology (0+ / 0-)

              for a lot of things, and I'm sure we could do it cheaply.

              •  I get your point . . . and I am not (2+ / 0-)
                Recommended by:
                jxg, 50states

                advocating that we throw out our 21st century technology . . . but I think in my case it was not a situation of necessary testing to really identify the issue; it was a case of doing a bunch of expensive testing "just in case".  There ought to be some sort of decision tree that assists us and our docs in determining whether every possible test that could be done is really warranted or whether a medication and "wait and see" strategy is worth a try.  Sometimes that answer would be yes, but I think in just as many cases that answer would be no.  Somehow there has to be a balance between reasonable safety precautions and reasonable expense.

                Had I had the after-the-expensive-tests-which-were-not-covered-by-my-insurance discussion with my doctor BEFORE the tests, rather than after the tests, I might well have decided that for me the benefits of waiting were worth the risk.

                Whatever we do to the web, we do to ourselves. All things are bound together. All things connect. Chief Seattle -8.12, -5.18

                by ncarolinagirl on Sat Jan 24, 2009 at 07:35:35 PM PST

                [ Parent ]

                •  Exactly (2+ / 0-)
                  Recommended by:
                  Creosote, ncarolinagirl

                  I am perfectly healthy and never go to the doctor with a complaint but it seems that every time I go for my yearly physical the doctors prescribe all these extra test that cost me hundreds of extra dollars and always come back negative.   I really think they are just trying to pay for their fancy equipment.   I have decided to start saying no to these test unless I feel they really are needed. The other thing that frustrates me is that it is really difficult to  find out ahead of time if the insurance will even pay for the tests.    

            •  May I propose that... (3+ / 0-)
              Recommended by:
              Creosote, berrieh, ncarolinagirl

              the reason the doctor performed so many tests is BECAUSE you have "good" insurance?

              My mother-in-law went through something very similar with the thyroid.  Her husband is a union guy with top-notch insurance and she was bounced around to multiple specialists who conducted all kinds of tests, worried them for months, and it all turned out to be nothing.  

              They talked to other people in the union afterward and and found many had been through the same kind of experience.  One woman claimed she actually thought the testing (iodine) made her sick and required additional care (all anecdotal of course)...

              "...we reject as false the choice between our safety and our ideals."

              by mralex1974 on Sat Jan 24, 2009 at 07:44:18 PM PST

              [ Parent ]

              •  This happens to me all the time. (0+ / 0-)

                Besides my woman's well visit, I go to the doc about once, maybe twice, a year, and every time, they run about 4-6 tests for routine illnesses such as bronchitis or a UTI.

                During half of last year, I had kind of "meh" health insurance. The one time I had to use that insurance, I went to the doc and they just handed me the scrip. It was heaven.

                Now, I'm back to good insurance. I had a UTI a couple of weeks ago, and they decided to do 4 tests (over three visits and the course of a week and a half) before giving me the basic antibiotic I already knew I needed.

            •  A**-covering. (1+ / 0-)
              Recommended by:
              ncarolinagirl

              They are protecting their rears.

              Fear of lawyers.

          •  it is also so expensive (2+ / 0-)
            Recommended by:
            Joe Bob, Creosote

            because hospitals compete for patients--they buy new equipment (really, really expensive mri machines for example) when the hospital a mile away offers the same services. Then, they have to pass those costs on. If the hospitals services were planned based on regional needs, not every one would need to have new models of equip all the time.

            •  One can put hospitals (1+ / 0-)
              Recommended by:
              Santa Susanna Kid

              on a limited fancy equipment budget equal to the amount of money they raise and use for charity care based on Medicare rates.

              Dear Rich Folks:

                That fancy new machine seen in...we  want one just for you.

                The cost is $2 million bucks plus $2 million more for the charity care required by law.

                To save your life and to please Jesus, send us money.

              Dear Hospital:

                 Please find $100,000 enclosed
                 ....
                 Please find $52,000 enclosed

              Dear Sick Person:

                 We are pleased to be able to do the operation you need, but can't pay for. The hospital is proud of our charity work. Call 555-1212 to schedule your operation.

              Dear Equipment Maker:

                 Check for $2 million enclosed. Haul the thing over today.

            •  This actually happens to some degree (0+ / 0-)

              Most states, I think about 35 of them, have what are known as Certificate of Need programs. If someone wants to build a new hospital or purchase some pricey new medical gear they have to make a case to a state board that there is an actual need for these things.

              The Cert. of Need programs typically only cover large capital expenditures, so there's still a lot of medical spending they have no influence over. Also, I'm sure the state boards vary a lot in the strength of their oversight.

              Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

              by Joe Bob on Sat Jan 24, 2009 at 11:35:23 PM PST

              [ Parent ]

        •  I think this is a good idea though... (3+ / 0-)

          In ancient China, the herb doctor got a stipend every month from his/her client. When the client got sick, the stipend was withdrawn until the herb doctor made the client well again.

          I really would scrimp and pinch pennies and pay a $60 bill every month if it would mean I would get quality time with a family doctor when I needed one. As it is, I'm uninsured and if it weren't for El Proyecto del Barrio in Arleta I wouldn't have a "medical home." As it is, it's very hard to get an appointment there...they are strapped and starved and Ah-nuld and the Rethuglican Yacht Party holding the budget hostage is making matters much worse.

          Sure, Single Payer is best. But if more doctors did this, if more opted out of the "murder by spreadsheet" industry and brought people on at a reasonable amount per month, maybe private insurance would have less and less of a stranglehold on medicine. Maybe those "self-insuring" doctors might be amenable to a system where instead of the client paying money out of pocket for their services the government paid that amount. And maybe we'd get to Single Payer through not the front or the back door, but through a hole dynamited into the building.

          Weirder things have been known to happen. We elected a funny looking guy with a strange name to the Presidency. Anything is possible.

          Na na na na na na na na hey hey-ey goodbye.

          by Pris from LA on Sat Jan 24, 2009 at 11:26:49 PM PST

          [ Parent ]

      •  I think that the government should handle the (5+ / 0-)

        catastrophic care and not the day to day stuff.  The day to day stuff should be handle just this way.  We would eliminate the insurance companies totally.  Either the government or an employer provides the catastrophic care funding(through the government program) and the individual provides his own day to day coverage probably with an arrangement like this.  People need to learn to handle at least a part of their medical care and be better consumers, fee's need to be transparent and competitive.  Today because of the insurance structure, they are not, doctor's can't make a living, we have too much duplication, primary care does not pay and too many people use too much medication and too many specialists.  

        •  You need that yearly checkup, too. And if you're (13+ / 0-)

          really hurting, you're not going to pay $120 to go to the doctor. You're going to spend that on gas. So what has to be included in the "basics" is also going to have to be a yearly checkup, and screenings for breast cancer, colon cancer, blood tests, etc. at appropriate times.

          •  I take back what I just said above (2+ / 0-)
            Recommended by:
            Pris from LA, plumbobb

            we agree.

            Impeachment in the New Year, please.

            by MsGrin on Sat Jan 24, 2009 at 04:19:23 PM PST

            [ Parent ]

          •  We have all sold ourselves on universal health (8+ / 0-)

            care but we all NEED to understand that our taxes will have to go up substantially to cover all the things we expect.  Europeans pay a great deal more in taxes than we do and are glad to do it.  Americans whine like crazy about taxes but are nickel-ed and dim-ed to death with all these expenses.  We will have to pay for it one way or another and I don't just mean just the rich.  Obama has proposed a program where he thinks that he can provide the most care for the most people without increasing taxes.  We want universal care than we can expect substantial tax increases on top of what is already necessary to fix the deficit problems that have been created over the last eight years.  There is no way around this and yet we consistently fail to discuss it.  Just not realistic.

            •  I went to school in London and remember getting (10+ / 0-)

              bronchitis or something and going to the doctor. I wasn't insured, of course. I waited, and went in to his office (it was in his house). I was seen, prescribed antibiotics, and left after paying twelve pounds (this included the antibiotics). This was about $15 at the time. It would be about $25 today, probably.

              I've been a fan of those commie socialist single payer plans ever since.

              •  I am not against Universal Care but it will be (5+ / 0-)

                expensive and we have to be willing to pay the taxes to support it.  Europeans understand the exchange, we do not.  It has to be paid for by someone, one way or another.  We will have to lower our standard of living to support all these services, we will have a great safety net which I favor but we will have less money for other things.  We have to recognize the equation. As a student in London, you were riding on someone else's ability to pay those taxes so I am not sure you were in a position to judge the full cost of your care.

                •  I think that if one took into consideration (5+ / 0-)

                  everything that is paid by society for the costs of our peculiar system of employer-provided healthcare versus the benefits of universal health care, one would find that the benefits would outweigh the costs. For example, half of home foreclosures have medical problems as a component of the financial problems of borrowers

                  http://works.bepress.com/...

                  •  Well, I hope you still think that when your tax (1+ / 0-)
                    Recommended by:
                    offred

                    rate jumps to 35 to 50% of your income.  We have not discussed the costs in real terms(what will it cost me) but only in theoretical terms...it should be less etc but you know it won't be and we will have to raise our hands anyway if we really think that this is the right thing to do.  They will make this choice painful and we will just have to suck it up and pay for it until the efficiencies start to show themselves if they ever do.  Medicare is universal and the costs are astronomical and we never seems to discuss that.  We have universal care for the elderly and it just is not very cost efficient and the elderly have to bear a great amount of expense with co-pays, doughnut holes, etc.

                    •  Medicare insures the uninsurable (4+ / 0-)

                      Imagine if Medicare didn't exist and all of those seniors and disable people who are currently covered by Medicare had to go out and get health insurance on the private market.  What do you think that might do to the cost of insurance as a whole?  

                      "It means I'm going to get a hot dog."

                      by otto on Sat Jan 24, 2009 at 06:18:12 PM PST

                      [ Parent ]

                      •  You ignore my point, we do not even cover the (1+ / 0-)
                        Recommended by:
                        Pris from LA

                        costs of Medicare today, it runs huge deficits and it is likely to get worse.  It's not it it's right or wrong...we have to be willing to make the trade offs as a society.  You have to be willing to do with less so that someone else can have more.  What are we going to do without in order to make this choice real.

                        •  We're already paying for de facto healthcare for (5+ / 0-)

                          the most needy, via medicare, via unreimbursed ER indigent care, & via medicaid. To wrap in those more healthy persons private insurers are currently cherry picking off would only make this more economically viable.

                          •  In Los Angeles, (0+ / 0-)

                            I know many very productive working poor, who are legal citizens, that have zero insurance. I have run into illegals, who actually have health insurance cards, issued by L.A. County. They show up at a County facility, get treatment, and don't pay. The working poor cannot get this coverage, no matter how many times they try. They make too much money! The illegals pay nothing for their care, and are basically written off as far as: finding them again, or requiring repayment. Guess who pays the bill? Working poor, middle-class taxpayers. How can this be? Why is the state of CA in such a huge deficit? Why is our system out here broken? Questions need to be addressed...SSK

                            P.S.: We can go into illegal citizen college tuition fees vs. out-of-state legal citizen tuition fees, but this is not the post. Again, why are we broke?

                        •  Currently you have tax-payers paying (6+ / 0-)

                          taxes that go to Medicare and Medicaid.  Those programs cover the aged and the disabled among others. The ratio of people who need lots of medical care to little medical care in these programs is high.  

                          Tax-payers (or employers) also pay for private health insurance if they are fortunate enough to be able to afford it.  Private health insurance companies do everything they can to exclude anyone who needs lots of health care.  The ratio of people who need lots of medical care to little medical care covered by private insurance is very low.

                          Look at this situation and you can see why Medicare/Medicaid are expensive and seem so inefficient.  These programs are taking care of people who really need care and that costs money.

                          Private insurance, on the other hand, is largely taking care of people who are pretty healthy and that doesn't cost as much money.  These programs are expensive because insurance companies want to snap billions in profit out of the health care industry each year not because of all the health care they are helping to provide.

                          If all of those healthy people were paying into a single payer plan instead of private insurance the deficit in Medicare/Medicaid would be diminished significantly if not eliminated.  Insuring healthy people makes money and lots of it.  A single payer plan would reduce the amount people spend on health care and should be able to do so without a significant reduction in quality of health care.

                          The key thing is stop letting insurance companies cherry pick the healthy people while leaving the taxpayers to pay for the sickest of the sick.

                          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

                          by Edgewater on Sat Jan 24, 2009 at 08:22:32 PM PST

                          [ Parent ]

                    •  Do you have any numbers to back this up? (1+ / 0-)
                      Recommended by:
                      nicolemm

                      I have heard many competing theories on this but have not read anything definitive.

                      I have read that by:

                      - eliminating the waste of overhead - putting everyone into single-payer, which drops cost per patient significantly - providing preventative care and early detection to reduce later costs - creating a system that compensates all doctors more evenly regardless of specialty

                      that much of the additional cost of running the system is reduced.

                      I don't have numbers either, but at first blush raising tax rates to 50% would seem to create ungodly amounts of additional revenue, more than we would need.

                      "...we reject as false the choice between our safety and our ideals."

                      by mralex1974 on Sat Jan 24, 2009 at 07:56:20 PM PST

                      [ Parent ]

                      •  Here is a review of both Social Security (0+ / 0-)

                        and Medicare. There are several others but the overall is that 1 of every 2 tax dollars in a few years will eaten up by these programs and that is without adding anything new.  I am sure there are others but this seemed the clearest.  I personally believe the Social Security info is hyped but the health care costs are another matter.  We all know personally that these are very high.
                        Social Security and Medicare Costs

                        •  The Social Security program (1+ / 0-)
                          Recommended by:
                          Joe Bob

                          is currently not only paying for itself but also is "lending" millions each year to the General Fund.

                        •  You are missing the point (3+ / 0-)
                          Recommended by:
                          otto, berrieh, Edgewater

                          The point the others are trying to make is that insuring the young and mostly healthy is a PROFITMAKING business. It's the business that insurance companies are in; they make a profit and pay dividends and pay their executives huge amounts of money and bonuses every year.

                          You're right, insuring the elderly and sick costs money. That's what the government is doing now. That's what our taxes pay for.

                          Isn't it clear what is wrong with this picture????

                •  Ummm, have you looked at (2+ / 0-)
                  Recommended by:
                  Santa Susanna Kid, Edgewater

                  Have you looked at the bottom line of insurance companies?

                  Have you seen the dividends they pay out, and how much their executives make?

                  Put that money back into the actual medical care!

                  We get less for our money than almost any other country.

                •  I pay a *minimum* of $7100 per year (2+ / 0-)
                  Recommended by:
                  berrieh, Edgewater

                  for health coverage.

                  $3200 for premiums (company covers the other $16K--yes, our total family coverage is $1800/month, $19,200 per year here in MA)

                  $3000 family deductible

                  $900 for prescription copays

                  Aside from the prescriptions being covered by the copay (prescriptions that would cost $11,000 out of pocket, so thank goodness for insurance), we spend the other $6200 out of pocket before getting a PENNY of insurance coverage for our health issues.

                  I get hit with about 6 healthcare bills each month.  Mole removal?  There's labwork, the hospital bill, the specific pathologist's bill, my PCP's bill...etc.

                  So please--raise our tax bill by $7100 per year and give me single payer coverage.  Eliminate the 70+ bills I manage each year, the constant checking to see if a doctor is in network, etc....

              •  Had the same kind of experience in Canada (1+ / 0-)
                Recommended by:
                Santa Susanna Kid

                Emergency room visit.

                Seen, diagnosed, prescribed. No sweat.

                Would have been at least $1000 bucks here.

            •  if the WEALTHY paid (2+ / 0-)
              Recommended by:
              catdevotee, berrieh

              the taxes at rates like the 1950's, the rest of us would have quite reasonable taxes for health care.

              •  So you make my point, you appear to (0+ / 0-)

                want universal care only if someone else pays for it, not terribly realistic.

                •  I want the cost of health care (3+ / 0-)

                  to be proportionate to one's income. I was working as a teacher when I got cancer at age 42. I didn't do anything to cause my cancer. Teaching was a second career because my first got re-written due to computers. I didn't have time to build up savings to pay for my illness.

                  Yes, I want someone who has over-the-top income to pay more. They have that income because they're white and went to better than average schools and lived in the right neighborhoods and learned the "codes" to buddy up to other rich people.

                •  I want a progressive tax code and universal care. (0+ / 0-)

                  That's me, personally. My parents, who make 6 figures now and have a great asset/debt ratio (but who have actually been the working poor and middle class at various times), want the same thing, even though they'd potentially pay more in taxes.

                  I'm not sure what I'll pay over my lifetime, because I have no idea how much I'll make; right now, I'm lower-middle class, working at a nonprofit. I help schools improve their literacy programs, and I help children learn to read and love reading. I'm healthy and don't pay for my current healthcare (I have it through work, and my parents birthday gift to me every year is to pay all my deductibles, co-pays, perscription fees, etc, so I pay literally $0 for healthcare), but I'd gladly pay a bit in taxes to make things equitable and to make healthcare available to all.

                  Suggesting that those who can afford to, the rich, should pay the burden is not ridiculous. Heck, if we'd fix capital gains taxes (raise 'em up!) and tax those multi-million dollar so-called "bonuses" fairly, we could afford to pay for a lot of things.

            •  Bring it on (1+ / 0-)
              Recommended by:
              Edgewater

              I was just working on my taxes, so the numbers are fresh in my mind.

              My income is very near the household median for the US. The difference between my total federal income tax liability and my annual health insurance premiums is about $200. If you were to add in my additional out-of-pocket costs for health care, e.g.: co-pays and deductibles, my health costs would exceed my federal tax liability by several hundred dollars. Since I have a high-deductible policy, if I were to actually need much medical care my expenses would blow away what I might owe in taxes.

              Point being: To fund single-payer, you could raise my federal income taxes 50% and I would still come out a big winner on the deal. You could raise my taxes 100% and it's still better than a break even proposition because I would no longer have the risk exposure of covering a huge deductible.

              Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

              by Joe Bob on Sun Jan 25, 2009 at 12:23:35 AM PST

              [ Parent ]

          •  Aw, you DON'T (3+ / 0-)
            Recommended by:
            nicolemm, Santa Susanna Kid, 50states

            really need all that crap.  Doesn't it occur to anyone that even with the best will and intent in the world, it's to the medical profession's economic interest to continuously increase the number of tests and treatments that you just "HAVE" to have?  Very few people die for lack of a test who wouldn't have died anyway.  Really.  Yes, overall they save lives.  But in proportion to the entire population, and the number of tests run to save each life, the costs are staggering.  Mammograms are NOT cheap.  We can socialize the costs and all stagger a little, or we can look at the price tags ourselves and blink, but the fact is, that we are again buying very little insurance at a very high price.  Eating right and getting enough sleep is MUCH better benefit for the cost.  But of course, who has time for that?  We're all too busy working 60-hour weeks to pay for our health insurance.

            Tip: the most important thing you can do to reduce your probability of illness and death is to EAT LOTS OF VEGETABLES.  The second most important thing is to GET ENOUGH SLEEP.  Third is EXERCISE.  Fourth is, in general, DON'T STRESS.  Medicine?  Medicine is for last-ditch fixes when you screwed up the basics.  And testing is mostly to make profits for diagnostic equipment companies.

            Finally, you ain't gonna live forever.  Get over it.

            •  My dad was diagnosed in 1979 with prostate cancer (4+ / 0-)
              Recommended by:
              Joe Bob, jxg, tresgatos, slouchsock

              as the result of a screening test. He died last year, having lived probably 20 years longer than he would have lived had he not been pretty diligent about getting his checkups.

              I don't think that a 15 minute session with a mammographer and the use of the expensive machine for that short time should be terribly expensive, and I think it's a good way to spend my time and money, especially considering my family history of breast cancer.

              •  Statistics change (1+ / 0-)
                Recommended by:
                50states

                if you have actual genetic data.  I would agree, if you have a family history, that it's a good use of resources.  My family, OTOH, never gets cancer, period.  We all die of cardiovascular disease.  There hasn't been a cancer on either side of the family in three generations.  We have hyperactive immune systems.  So I rate my need for cancer screening at pretty low, especially since I do eat the veggies.

                Just goes to show you that universal rules really don't relate to individuals.  Knowing your own real risks and managing them intelligently is both more efficient and more effective.

            •  One famous Kossack in NYC (1+ / 0-)
              Recommended by:
              Joe Bob

              said her mammogram cost $16.

              There might have been additional fees paid as well unknown to patients.

              I would imagine $50 is a more realistic number.

              Two to four sheets of film at $3 each, chemicals for developing, waste management costs above silver recovery costs, technician time, and about 10 minutes of radiologist time to read and compare with previous X-rays and to write down findings.

      •  As a patient with chronic conditioons (6+ / 0-)
        Recommended by:
        nicolemm, Chinton, CWalter, neroden, Rogneid, karmsy

        I suspect they COULD afford me.  I tend to need frequent quick visits, but there should be room in a system like this for me.

        Impeachment in the New Year, please.

        by MsGrin on Sat Jan 24, 2009 at 04:11:47 PM PST

        [ Parent ]

        •  It depends on what that chronic condition is (2+ / 0-)
          Recommended by:
          churchylafemme, neroden

          I can imagine several off the top of my head that wouldn't fit into this model too well.  Sickle-cell anemia, cystic fibrosis, paraplegia, schizophrenia, etc.  The list goes on.  

          The model will only work if the population being served is fairly healthy and requires few visits to specialists or hospitalizations.  A chronic condition like hypertension could fit into the model while a severe condition would not. As I said above - making this work well would require cherry-picking.

          "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

          by Edgewater on Sat Jan 24, 2009 at 04:20:12 PM PST

          [ Parent ]

          •  My only quibble is with your calling Hypertension (0+ / 0-)

            not severe - it may be less expensive to monitor, but can be just as deadly.

            But I think most of us agree that sinle payer is the only way to get costs down across the board so everyone can get medical care.

            Impeachment in the New Year, please.

            by MsGrin on Sat Jan 24, 2009 at 04:31:14 PM PST

            [ Parent ]

            •  Absolutely hypertension is a serious illness (3+ / 0-)
              Recommended by:
              jxg, offred, MsGrin

              but, in general, it is a straightforward primary care condition.  That is, no specialist is needed to check it, prescribe better diet and meds, and nag you to take better care of yourself.

              On the other hand, the conditions I listed often cause the patient to require specialist care and in severe cases multiple hospitalizations each year.  Some conditions can require multiple surgeries throughout a lifetime.  

              I know most of us agree single-payer is the way to go.  I am just trying to point out that the method of delivering health care described in this diary is probably presenting itself in its ads as being a lot better than it is at serving a large, diverse patient population.

              According to their ad:

              You get the best of both worlds—less expensive insurance coverage in the event of a major medical problem, and affordable access to a family practice physician for your routine medical needs.

              I don't see them as providing the best of both worlds unless the patient is already basically pretty healthy and employed. It is the really sick and the poor who most need solutions.  This group is probably not going to provide that.

              "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

              by Edgewater on Sat Jan 24, 2009 at 04:53:44 PM PST

              [ Parent ]

              •  No argument with any of that (2+ / 0-)
                Recommended by:
                Chinton, Edgewater

                Perhaps I'm delusional -

                I guess I DO appreciate reading the stories of new attempts (even if I wouldn't want to try them myself)they're just showing how we really have no choice BUT single payer if the objective is to keep costs contained and to keep people healthy.  There's this bizarre notion that keeping healthcare private somehow improves our care - of course that flies in the face of reality utterly.

                I'm tired of some of us knowing how sucky it is and a whole lot of folks who LIKE the current care because they've never needed it for much... I don't know how to get through to them, and I'm getting impatient.

                Impeachment in the New Year, please.

                by MsGrin on Sat Jan 24, 2009 at 05:17:53 PM PST

                [ Parent ]

          •  Other very expensive chronic conditions (3+ / 0-)

            Rheumatoid arthritis came to my mind.

            Any system which doesn't address crippling chronic illnesses isn't even attempting to solve our problems.

            -5.63, -8.10. Learn about Duverger's Law.

            by neroden on Sat Jan 24, 2009 at 08:17:54 PM PST

            [ Parent ]

        •  they use the cost argument too much (1+ / 0-)
          Recommended by:
          catdevotee

          I don't believe it.  My Dr. sees me for $15/mo.  I get periodic blood work or tests or meds. that I pay extra for sometimes (e.g. xrays, flu vaccine, etc.)  His staff is competent, they know me and my situation.  I actually talk with the Dr. and although we don't spend much time together, I am happy with his care.  

          Too much time is spent evaluating patients at emergency rooms and clinics.  Doctors usually don't know the patients because people with chronic conditions can't afford a monthly visit usually.

      •  $60 (4+ / 0-)

        every month still looks like a lot to me, considering that I generally only drag myself to a doctor once every seven years.  The cat has scratched my eye by accident twice.  There was a bad cold fourteen years ago that I wanted to check for strep (and the antibiotic the damned doctor gave me made me twice as sick as I was going in).  And then there was a UTI six years ago, with a rather high fever and proteinuria ... and the emergency room doc didn't give me ENOUGH antibiotic in the prescription, so it relapsed and I didn't get rid of it for another six months.  So I'm rather jaundiced about the value of doctors.  I really can't see paying five hundred dollars a year for nothing.  It would be SOOOO much cheaper if we could just pass a law allowing people to buy their own antibiotics instead of having to go pay fifty to a hundred bucks to get a permission slip, THEN go buy the drugs.

        My vets can take a walk-in patient on less than 24 hours notice, do procedures requiring sedation and minor surgery in the office, and hand out antibiotics on the spot from their own supply.  I don't see why human doctors can't be as efficient, especially with the added advantage of being able to talk directly to their patients.  Although I had one vet, who would describe human emotions to me in horse behavior, so I don't think she would consider it an advantage.  She spoke pretty good Cat, too.

        •  In Spain (4+ / 0-)

          they sell antibiotics and asthma medications in drug stores without prescriptions.

          In Britain, over-the-counter means a chat with the pharmacist.

          Americans could be trained to recognize when antibiotics are probably appropriate.

          People could take a community college course and get an antibiotic buying permit.

          •  I'd prefer if almost all drugs were OTC (1+ / 0-)
            Recommended by:
            catdevotee

            but I don't know about antibiotics. Yes, they treat many of the most common problems, and yes, it's expensive to have to see a doctor just to get a prescription - but those things are truly dangerous; bacteria just evolve too quickly.

            Perhaps the growing trend toward NPs providing basic care will help with the cost issue.

            •  Nurse Practitioners (3+ / 0-)
              Recommended by:
              jxg, ppluto, Santa Susanna Kid

              are an important factor which is never mentioned in discussions about healthcare. It's not just single payer that we need, it's a total overhaul of the whole healthcare system.

              One big change which could benefit everyone is the utilization of highly trained nurses for triage and basic primary care. Other countries do this with excellent results.

          •  The last thing we need (1+ / 0-)
            Recommended by:
            jxg

            The last thing we need is more people deciding that they should just pop a few antibiotics!

            Even now people insist that their doctors give them antibiotics for no good reason. Antibiotics don't help if you have a virus, for example.

            People take too many antibiotics, don't finish doses, etc. That's why we have antibiotic resitant bacteria now.

          •  Not lately (1+ / 0-)
            Recommended by:
            Edgewater

            I live in Spain and things like antibiotics, antidepressants, mild tranquilizers used to be easily obtainable at pharmacies without a prescription, despite the "con receta médica" (prescription only) label on the package. This summer I was helping a visiting relative in the Canary Islands (as relaxed a place as you could ask for) who needed antibiotics and was politely directed by the pharmacist to see a doctor first.

            Things are less lax now, especially given the attention to antibiotic abuse and resistant bacteria. Few pharmacies will dispense controlled medication now without a prescription and patients need the state health system prescription anyway to avoid paying retail prices.

            Over-the-counter antibiotic availability is not wise. Spain has a tradition of overusing antibiotics, in part due to lax government control, in part because physicians still over-prescribe them, and finally because medications are sold in standard packages rather than in the prescribed quantities, so everyone ends up with leftovers in the medicine chest that they can use to self-medicate with the next cold -- until the symptoms go away or the pills run out.

      •  I don't think they'll need to cherry-pick (5+ / 0-)

        patients.

        . Qliance specifically does not cover catastrophic illness.
        . Qliance has no obligation to treat patients that cannot pay.

        These are the two biggies that distort cost.

        The devil is in the details of course, but it seems they have a shot at operating well.

        .....

        That said, single-payer universal would be better.

        Member, The Angry Left.

        by nosleep4u on Sat Jan 24, 2009 at 04:48:14 PM PST

        [ Parent ]

      •  In Ontario (3+ / 0-)
        Recommended by:
        Chinton, neroden, Pris from LA

        The Ministry of Health has offered primary physicians and their patients a ton of incentives to reorganize their practices into these comprehensive groups.

        This is not an alternative to single payer, but an organizational form that can exist under either model of payment.

        It works out pretty well here: you can get seen by someone in your practice quickly and over a broader range of hours.

      •  Our family uses a similar program in Cary, NC (3+ / 0-)
        Recommended by:
        Creosote, Amanda in NC, Pris from LA

        They don't cherry pick and it's even more affordable.  I wrote a lot more about it downthread.

        For basic primary care it is wonderful

        Check out their website.  This outfit literally saved my life since for many years we had absoluetly no health care coverage and I had not seen a doc in years

        $300 a year for an access card and then unlimited visits @ $20 each visit.

        http://prosites-bforrest.homestead.com/

    •  Under this plan, chronically ill patients still.. (6+ / 0-)

      get screwed. Fail.

      If my students can't explain it, they don't understand it.

      by Jimdotz on Sat Jan 24, 2009 at 04:40:41 PM PST

      [ Parent ]

    •  have you noticed that primary care doctors don't (3+ / 0-)
      Recommended by:
      jxg, Santa Susanna Kid, Edgewater

      touch their patients?  They just seem to think they are there to send you on to a specialist.  I have gone to doctor complaining of pain in my abdomen and never took off my coat.  Charge: $123.00 for comprehensive visit.

      There are a group of physicians now called "Proaliance."  They have their own surgery centers, physical therapy and cat-scan/mri testing centers.  Of course, you get sent to their centers.  I went there because  I had a problem with my sholder and Dr. Kinahan (I don't mind identifying him because I hope no one ever goes there) insisted I needed surgery.  Even though I told him that they could not give me marcaine (info was on my chart) when I got to the surgery center I found out that marcaine was what the nurse had loaded up to give me.  I had to ask because the form they asked me to sign said "numbing medicine."   I walked out.   I ended up at Virginia Mason Medical Center and the Doctor there said there was no way he would operate.  He sent me to a massage therapist who worked out my frozen shoulder.

      I am so furious that medicine and surgery is big business and there are doctors that just look for the bucks without caring what the patient needs or damage they could do.

      It used to be against the law for doctors to have multiple interests in medical facilities and certainly should be now.

      Health insurance should go back to being non-profit also.   The american people were sold a bunch of bull shit about private companies doing a better job.  Thank you, you worthless lying Republicans.

      Privatizing health care has made some people billionaires and the rest of us suffer and die.

      sorry for the rant!!!!!

  •  Interesting. (9+ / 0-)

    I am forwarding to offspring in Seattle.
    Thank you for letting us know. Do you know anyone who is part of this plan?

  •  Insurance companies are what's wrong with America (34+ / 0-)

    I remember when I lived in San Diego during the RNC Convention.  The local channels refused to run commercials advocating the abolition of insurance companies because they were too controversial.  They need to be forced into non-profit status if we are to keep them at all.  You know why we can't open windows in our offices? Insurance companies.  You know who did not pay out Katrina claims? Insurance companies.  Do you want more?

  •  Wow! This is great (10+ / 0-)

    and it cuts costs at the same time as providing great care to people!!

  •  My husband is a computer repair guy (21+ / 0-)

    but he has a customer - a pediatrician - who charges his patients a monthly fee and in exchange, provides his medical care to their children by house call!  Yes, house call!  I was amazed.  it is so hard to get the kids to the doctor's office when they are sick.  

    "We struck down evil with the mighty sword of teamwork and the hammer of not bickering!" - The Shoveler

    by Pandoras Box on Sat Jan 24, 2009 at 03:12:18 PM PST

    •  There is a company in Austin, Texas (12+ / 0-)

      called "White Glove House Call Health" that is showing TV commercials that advertise such a service.

      I don't know what the exact pricing structure is, but they say they ALSO accept insurance.

      It's a $35 per visit charge (probably less if you have insurance), including any generic meds you need, and they work 7 days 8 am to 8 pm.

      Luckily, I haven't had to try them.

      "It always seems impossible until it's done." - Nelson Mandela

      by Brooke In Seattle on Sat Jan 24, 2009 at 03:29:41 PM PST

      [ Parent ]

    •  That's great (1+ / 0-)
      Recommended by:
      Pandoras Box

      but why are house calls now so rare? When I was a child, (admittedly a long time ago) my family pediatrician made house calls any time I was really sick. It seems strange and wrong to me that if a child has a high fever or is in great distress, the only way for a doctor to see him is for his parents to somehow bundle him up and take him to a waiting room to sit with other sick kids.

      There has to be a better way to deliver health care.

  •  Can you define (11+ / 0-)

    "affordable"?  And what do patients do if they travel?
    I understand that there is a back-up catastrophic health insurance, but what about more minor conditions - would you have to pay full price at ER?  That could run hundreds of dollars or more for a very minor illness or injury.   I'm not knocking it, but I wonder about some of the details.

  •  My husband just lost his job..... (16+ / 0-)

    Our COBRA payments will be over $1200/ month!  That is for the "moderate" silver plan.... he just lost his job and we don't have $1200/ month to spend!

    The Religious Right is Neither.

    by cyncynical on Sat Jan 24, 2009 at 03:17:49 PM PST

  •  Tipped and rec'd for alternative (22+ / 0-)

    approaches. As far as I am concerned, anything that keep the insurance companies from practicing medicine would be an improvement. I don't use a lot of mediecal services, but when I do go to the doctor, most of my time is spent with paperwork and insurance forms, rather than with the physicians and nurses.

    •  Exactly! (7+ / 0-)

      For me personally, I feel lucky in some respects that I am so ignorant of health care insurance generally -- now my employer provides -- but I've never had to learn how to deal with insurance companies because I've never been seriously sick (knocks wood).

      y el canto de todos que es mi propio canto

      by gatorbot on Sat Jan 24, 2009 at 03:22:28 PM PST

      [ Parent ]

    •  My last trip to the dr was 90 min long (8+ / 0-)

      I doubt I spent more than 12 minutes with the Doctor.  I say 12 because It was even 15 minutes.    This for insurance that cost me last year 3800 dollars or 80 dollars a week for a single person.

      •  The overbooked MD offices mean miserable waits (7+ / 0-)

        We have Tricare.  The local base cannot find nor keep civilian family practice providers.  I was assigned to a new provider every 4 months.  Occasionally we were farmed out to local health care groups in the community.  One memorable routine visit was in the basement of the community college.

        I balked when the base insisted that my newest provider was located in a middle school health office in an iffy area of town.

        After calling 40 providers who accept Tricare, I found a resident who accepting new patients.  My last visit was 3 hours of waiting for a 15 minute appt.  Overbooked? Absolutely.

        The sad part is, she is so overbooked that for anything urgent, it's impossible to get an appointment earlier than 6 weeks out.

        An animal attack, a urinary tract infection, a bone tumor (my son)- we have seen the local urgent care clinic for all of these.  I dread the 5 hour wait for a 15 minute appt in a filthy waiting room that compounds the misery of being sick or hurt.

        I've never seen the same provider twice.  There's no continuity of care.  My high blood pressure went untreated for four years while overworked doctors passed the problem off.

        Why did we bother to beat the Soviet Union if we were just going to become it? Molly Ivins

        by offred on Sat Jan 24, 2009 at 07:51:21 PM PST

        [ Parent ]

    •  Although, as an apparent NJ resident, you're (0+ / 0-)

      likely aware of the many physicians in parts of the state who have decided that "concierge" means, "charge whatever I deem appropriate, based upon my reputation."

      There's unfortunately plenty of physicians in the Northeast part of the state - plus in NYC and Westchester county - who essentially charge what the market will bear for their skills, taking some of the more talented surgeons (in most cases) out of the reach of people below the top 5% of income/savings.

      These are folks attempting to maintain profits which they feel should be expected in any system going forward, for which reason I have little hope that a market for boutique care would competitively keep prices and availability open to society's needs, rather than a market's desire to maximize profit.

      I agree that alternatives are good to consider, and something like this could be considered in a hybrid approach with governmental healthcare policy, in addition to simply operating on their own business case.

      "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

      by wader on Sun Jan 25, 2009 at 12:11:47 AM PST

      [ Parent ]

  •  REC THIS UP (12+ / 0-)

    I wish my health economics course in college made this much sense (based on insurance/hmo theory)

    When we got into office, the thing that surprised me most was to find that things were just as bad as we'd been saying they were. -JFK

    by optimusprime on Sat Jan 24, 2009 at 03:19:56 PM PST

    •  Thanks for the rec reminder (2+ / 0-)
      Recommended by:
      jkb246, cyncynical

      You know, you get a little older and...

    •  A "health economics" course? (4+ / 0-)

      WTF. Could you please explain a bit more. This may be a fascinating example of how a culture of usury has infested the U.S. making it nearly impossible to actually solve any economic problems.

      A conservative is a scab for the oligarchy.

      by NBBooks on Sat Jan 24, 2009 at 03:34:56 PM PST

      [ Parent ]

      •  You know, health economics. You have bad health (2+ / 0-)
        Recommended by:
        CWalter, MsGrin

        and you have to file for bankruptcy like all of the other companies.

      •  The course was centered on a book (0+ / 0-)

        "Health Economics" by Charles Phelps.  Kept the book figuring to read it one day (haven't yet).  Mainly skimmed the required reading portions and highlighted key words in college.  A dense book filled with economic theory with function and utility graphs and empirical studies.

        When we got into office, the thing that surprised me most was to find that things were just as bad as we'd been saying they were. -JFK

        by optimusprime on Sat Jan 24, 2009 at 05:28:49 PM PST

        [ Parent ]

    •  Speaking of colleges-- (3+ / 0-)
      Recommended by:
      jkb246, CWalter, luckylizard

      Wouldn't this be a great way for colleges and universities to go?  Offer access to health care as part of the tuition cost and circumventing the insurance--and since they deal mainly with the young it wouldn't even be all that expensive.

      Save the parrots: Drink shade-grown coffee!

      by oscarsmom on Sat Jan 24, 2009 at 03:34:58 PM PST

      [ Parent ]

      •  Many colleges (0+ / 0-)

        have a student health center.

        I think some places break out the charge for this.

      •  how my university runs its health program (1+ / 0-)
        Recommended by:
        catdevotee

        there is an on-campus primary care doctor, along with a waiting room, a few examination rooms and a secretary and a nurse.  Also, students are required to either have health insurance or pay some additional fee (forgot exactly what it was and what it gets you, I have health insurance and I just remember having to decline that option since it overlaps with my family's insurance).  Anything the primary care can handle is no-charge.

        I actually got a false negative on a mononucleosis test freshman year there, which led to getting written up a referral for a blood test off-campus to check for thyroid or other problems (I had, as you'd expect, severe fatigue).  Blood test indicated only a viral infection, so I got some lymph nodes under my jaw felt up and a second mono test which came up positive.

        you do it to yourself, you do and that's what really hurts

        by Demosthenes on Sat Jan 24, 2009 at 10:08:33 PM PST

        [ Parent ]

  •  My former OB-GYN used to work like this (13+ / 0-)

    for the most part. He still had the insurance companies involved, but it was a one-stop shop for a flat fee and his office filed all the paperwork.

    He had his own lab, his own ultrasound machine, and his own dispensary for common meds.

    When I was pregnant with my daughter, I had two ultrasounds in his office and no insurance company was involved.

    By the time I had my son four years later, and had to change doctors, the insurance companies had gotten involved and made doctors take the ultrasound machines and labs out of their offices and put them in hospitals, and even my pre-natal vitamins were by prescription.

    And I was also only allowed to have one ultrasound for my son, for which I was charged about $300.

    If I were still in Seattle, and had a job to pay for it, I would check this out.

    "It always seems impossible until it's done." - Nelson Mandela

    by Brooke In Seattle on Sat Jan 24, 2009 at 03:22:14 PM PST

  •  Question (5+ / 0-)
    Recommended by:
    jxg, offred, oscarsmom, gatorbot, Pris from LA

    How much is the "monthly fee" to be part of Qlince? Also what happens if something bad happens to you or if you have to go to a hospital away from their facility? And what if you need care for a condition that Qlince doesn't have the capacity or the capability to treat?

    Some parts of it sound interesting, but there are other questions that I have about it.

  •  fine if you're healthy (11+ / 0-)

    Anyone with chronic illness such as diabetes is screwed under this arrangement. Insulin and diabetic products are not cheap even if they are sold at cost. I can't imagine having to pay several hundred dollars each month in medication costs.

  •  Totally excellent! (8+ / 0-)

    These are the kinds of solutions we need. This one is particularly elegant because the Republicans theoretically can't bitch about this because the doctor's office is competing against the insurance companies.

    I hope this catches on. It makes great sense to me. It also has the added benefit (for the most part) of cutting out Big Insurance. Great diary!

    This ain't no party. This ain't no disco. This ain't no foolin' around!

    by Snud on Sat Jan 24, 2009 at 03:26:18 PM PST

  •  Good for the rich (12+ / 0-)

    As a nurse, I work at one hospital that has an agreement with some doctors that do boutique care. I am not sure the exact rate, but I know it is not full price.  However, it is still a lot per day and the doctor isn't paying it.

    The problem for most people is that it is not a substitute for health insurance unless you have deep pockets.  A doctor can negotiate his (or her) services, but they can't do anything about negotiating a lower cost when you need an MRI, x-rays, surgery, ect.  
    What if your private doctor diagnoses you with diabetes?  Now you can't get traditional health insurance w/o the diabetes being a preexisting condition.  All your diabetes supplies will not be covered by insurance and what happens when you need dialysis? Most people I know who use boutique care already have insurance through work but are rich enough to do this because they find it more convenient.

    •  They claim to be able to cover it (1+ / 0-)
      Recommended by:
      Edgewater

      I doubt their claim, given that they are charging a patient between 50 and 150 dollars a month.  

      I think that their costs are too low and eventually they'll be increasing them.  Also, any specialty care will not be done in their offices.  

      I had ACL surgery, and I would not let anyone except a trained orthopedic surgeon who specializes in knees do that operation again.  

      "It means I'm going to get a hot dog."

      by otto on Sat Jan 24, 2009 at 03:32:10 PM PST

      [ Parent ]

      •  Don't underestimate the savings (6+ / 0-)

        you get when you eliminate the insurance company middleman.  Jus' saying.

        Save the parrots: Drink shade-grown coffee!

        by oscarsmom on Sat Jan 24, 2009 at 03:38:44 PM PST

        [ Parent ]

      •  Insurance companies pay 30 cents on the dollar (3+ / 0-)
        Recommended by:
        Creosote, offred, neroden

        I paid more to have my car tuned up than the insurance company paid my doctor to do a test that involved anesthetic, a surgical nurse and 45 minutes of his time.  It's ridiculous.

        •  And mechanic's are not rich! (0+ / 0-)

          Yes - car care costs a lot of money, but I don't know any rich mechanics!  The shop owners suck up all the profits and the guy who fixes your car get a tiny percentage of what is charged!!!!

        •  Or 5 cents on the dollar. (1+ / 0-)
          Recommended by:
          Pris from LA

          True example for a lab test recently.

          In actual fact, I suspect the insurance company is paying the true cost.  I think the labs are simply upping their prices to match whatever level of discounts the insurance companies demand.  They demand 95% discounts?  Well, the lab multiplies its price by 20!

          This is why I have to have insurance, period -- otherwise I pay SUCKER PRICES.  Total extortion racket.

          -5.63, -8.10. Learn about Duverger's Law.

          by neroden on Sat Jan 24, 2009 at 08:20:31 PM PST

          [ Parent ]

          •  I wish that was true but I would be hard pressed (0+ / 0-)

            to believe they could do this test for the $260.00 that they were paid considering the cost of the medication, the nurse prep, the doctor's time, the hospital's cost and the cost of the equipment but my insurer is Cigna and they are not going to tell Cigna to go pound salt. It used to be that insurers paid 60% of the billed costs but now they have dropped to 30%.  I forsee many hospitals and doctors leaving and we are going to be in a world of hurt in terms of even finding health providers.

    •  Good points. (6+ / 0-)

      I think it's supposed to supplement insurance for those who can afford a 50 or 60 dollars a month in fees for primary care.  Qliance has their xray machine on site and I think even have generic drugs available for prescription.  Also, I think in the print version of the Stranger article or elsewhere I read that the Qliance doctors had negotiated with outside diagnostic providers pretty low rates -- X ray diagnosis for $5, e.g.

      y el canto de todos que es mi propio canto

      by gatorbot on Sat Jan 24, 2009 at 03:33:47 PM PST

      [ Parent ]

    •  I also wonder about hospitalization and (2+ / 0-)
      Recommended by:
      jxg, luckylizard

      specialists. Catastrophic care only kicks in after  a hefty deductible. So you'd have to set up an HSA and possibly pay thousands out of pocket if you needed something more. Still, it provides access to basic care which would cost only $60 per month. That would also be tax deductible i think.

    •  My understanding of the diary (5+ / 0-)

      is that you would supplement this monthly fee with a catastrophic plan for the big stuff.  That might be covered by your employer.  If not, the two fees put together might run you about $200 a month-- not cheap, but a lot less than many of us pay now.

      There is, of course, the danger of falling between the cracks of the primary care and the catastrophic and being liable for a few thousand bucks in medium types of costs (I assume your monthly fee can't count towards the catastrophic deductible!).  I agree with comments above-- this could a great system, but only if you're generally pretty healthy.  And you'd want to carry the catastrophic too, in case you develop any serious conditions that would make it difficult to apply for new insurance.

    •  Or they can afford paying the (1+ / 0-)
      Recommended by:
      oscarsmom

      out of network rate. What they probably do is get the receipt and send it to their health insurance companies, who then reimburse at the out of network rate. Or they put the money into a Flexible Spending Account, funding it with pretax dollars.

    •  Well, dialysis qualifies you for Medicare (0+ / 0-)

      I'm pretty certain of that.

      Impeachment in the New Year, please.

      by MsGrin on Sat Jan 24, 2009 at 04:37:38 PM PST

      [ Parent ]

      •  Post Kidney transplant care doesn't qualify (4+ / 0-)
        Recommended by:
        Joe Bob, offred, Pris from LA, MsGrin

        My neighbor had a kidney transplant about 7-8 yrs ago.  She doesn't qualify for Medicare now and has problems getting her meds.  They told her the only way she could get back on Medicare was if she goes back on dialysis.  Isn't that the craziest thing you ever heard?  This woman has to have anti-rejection drugs for the rest of her life, yet she does not qualify for Medicare.  It's nuts!

        •  It's a horrible situation (2+ / 0-)
          Recommended by:
          Creosote, Pris from LA

          Medicare only pays for transplant meds for 3 years.  It's absurd.  Patient groups have been lobbying about it.  

          I don't think they get dumped off Medicare all together, I'm not sure, I think it's just the meds which have a limited coverage time.

          If you have some other problem which improves enough to allow a person to return to work, they get to keep Medicare as long as the underlying problems persist - I believe that goes for transplant patients, as well, with the exception of the transplant meds.

          No idea what sort of twisted logic put that in place.

          Impeachment in the New Year, please.

          by MsGrin on Sat Jan 24, 2009 at 06:16:04 PM PST

          [ Parent ]

          •  My neighbor was dumped from SSDI & Medicare (0+ / 0-)

            She's sick right now, and I can't get her to go to the hospital.  I took her a few months ago and they just gave her a prescription for an antibiotic which she couldn't afford.  They told her to see her regular doctor, but her regular doctor won't see her because she owes him money.

            The lady had a kidney transplant about 7-8 yrs ago.  Kidney disease runs in her family; her mother died from it.  She can't get a job and has no support.  It's disgusting how this system works.  My neighbor is a proud woman.  She's tired of fighting with the system.  I can't believe the system is so sick.  I guess they think they've spent enough on her and that she's not worth anymore.  How can this sick system give someone a kidney transplant and then not continue to provide care after the transplant?  

  •  Couple things (14+ / 0-)

    A.  The article from the Stranger is an article written by an auction winner.  The auction winner got to write an article for the Stranger.  It is basically a paid advertisement for their business.

    B.  Check out the article here written by Garrison Bliss.  It's perhaps the worst article I've ever read on healthcare problems, and it lays the blame for our healthcare problems at the feet of Medicare.  Bliss is a doctor at Qliance, though he never divulges that information in his paid for article.

    In his article, he essentially suggests that we save healthcare by paying cash for it.  

    I don't say this to condemn someone's attempts at changing the way the system works.  I say this because it's important to know where the information is coming from.

    "It means I'm going to get a hot dog."

    by otto on Sat Jan 24, 2009 at 03:30:03 PM PST

    •  I am reading the article (2+ / 0-)
      Recommended by:
      otto, Edgewater

      This quote already concerns me:

      The enormous restraint inherent in a doctor-patient transaction was gone.

      What does he exactly mean by "restraint"? Does he mean that patients started demanding "expensive care"?

      He says that insurance is a problem and mentions Qliance. Qliance seems good if you are well, but I have other concerns about it.

      •  I read that article when I was on the bus (1+ / 0-)
        Recommended by:
        Edgewater

        I got pretty excited. I was looking forward to an informative article from a trained doctor.  Unfortunately, it appears that the Doc's take on the situation is that people need to be restrained from spending too much money on healthcare.  This will happen when it's not an insurance company or outside source who is paying the bills.

        I know there is more than that in the article, but it seems to be fairly pervasive.

        "It means I'm going to get a hot dog."

        by otto on Sat Jan 24, 2009 at 03:40:15 PM PST

        [ Parent ]

        •  If you also look further on the (1+ / 0-)
          Recommended by:
          otto

          company's site there is a section where Qliance advocates that its patients sign up for high-deductible insurance plans and Health Savings Account. This basically seems to be the model that McCain wanted to force most people to sign up for.

          This plan works well for someone relatively young, right out of school, and in good health. It works well for the extremely healthy person who only has to go to the doctor once or twice a year for routine examinations.

          However, for a person with more severe conditions , Qliance is not practical. For someone who needs specialist care, suffers from chronic conditions, or requires monthly medications., Qliance would be prohibitively expensive.

      •  One concern I have in reading that quote (5+ / 0-)

        is that he describes the doctor-patient relationship as a transaction.

        Quite frankly, transaction is a word that should be limited to customers and service providers.    

        I know the insurance companies have tried to sell "care provider" as a word for doctor.  
        This guy using the same kind of language plays into the model that health care is just another commodity like any other.  

        It is thinking like this, that medicine is, or should be a for-profit machine, that has caused so many of the problems in health care that we have now.

        "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

        by Edgewater on Sat Jan 24, 2009 at 03:52:01 PM PST

        [ Parent ]

        •  Read this (1+ / 0-)
          Recommended by:
          Edgewater

          section on the Qliance website. They seem to be arguing for the type of healthcare "reform" that McCain wanted to force everyone on.

        •  Exactly. (0+ / 0-)

          The for-profit model both drives up "standards" -- what the Professional Community recommends that everybody just "has" to do to be merely adequate -- and the costs of everything to be done.  Cost-effectiveness is the LAST thing to be considered in a for-profit model -- which ends up with us paying in general, more on the last two weeks of a terminal patient's hospital stay, than was spent in his/her entire preceding life; more for useless, frivolous, futile, and downright counterproductive heroic procedures, than on simple things that, done at the right time and place, provide the most global positive outcomes over the widest range of population.  We have specialized in all the newest, brightest, and most expensive treatments, but ignore and belittle the good that can be done by a bottle of vitamins, a heating pad, and three days off from work to let our immune systems function.

          As long as we treat health and human kindness as a commodity, it will be a vastly overpriced commodity with a tendency towards excessively invasive procedures.  Of course, a society that has worshipped at the altar of Greed as a Virtue for the last century, hardly knows how to value anything except as a commodity.

      •  It disrupts the fiduciary relationship (2+ / 0-)
        Recommended by:
        Pris from LA, Edgewater

        between MD and patient.  There are protections so that physicians cannot refer for lab tests and imaging where they benefit.  I can just see some of these doctors telling patients that they need expensive MRIs from machines that are a part of their boutique practice.  Again, an ethical problem.

        We've got serious work to do. Health care and civil rights for all, please!

        by the dogs sockpuppet on Sat Jan 24, 2009 at 03:53:12 PM PST

        [ Parent ]

        •  But isn't that the point? (3+ / 0-)
          Recommended by:
          Creosote, elwior, Pris from LA

          You don't have to pay extra for those services or to have the results read.

          Isn't it part of the whole payment package?

          As I described in a comment above, when my OB-GYN had his own ultrasound machine in his office, he didn't charge me anything for two ultrasounds that he did. It was part of the overall doctor's fee that covered all of my maternity appointments.

          I thought this was the same way -- monthly fee covers all reasonable tests and meds are filled in their own pharmacy.

          Why would they charge anything extra?

          "It always seems impossible until it's done." - Nelson Mandela

          by Brooke In Seattle on Sat Jan 24, 2009 at 04:02:01 PM PST

          [ Parent ]

          •  There would be extra charges for MRIs (2+ / 0-)
            Recommended by:
            jxg, Pris from LA

            or CTs in many of these programs.  They cover the "primary care", but the system only works if you are not using the more tertiary modalities.  That MRI machine costs millions of dollars.  Ultrasounds are one thing.  Once you've purchased the machine (which is not that expensive to begin with) you are set.  MRI and CT machines are a whole other level, expensive to buy and maintain.  

            I would bet donuts to dollars that MRI and CT services would not be covered (though I could be wrong.  The SF program I was reading about just now did not cover these modalities.

            We've got serious work to do. Health care and civil rights for all, please!

            by the dogs sockpuppet on Sat Jan 24, 2009 at 04:07:57 PM PST

            [ Parent ]

          •  My impression is that you're right. (0+ / 0-)

            Having spent a bit of time reading the Qliance site.

            There's a page of procedure costs, another for drugs; both seem surprisingly low.

            Moreover, it appeared, when I last checked, that should I experience an emergency
            I could be seen by paying the monthly fee, yet might not be obligated to continue paying that fee henceforth.

            They're also centrally located, with easy Metro access - vital for someone with no car.

            With the longer time spent with the physician, I imagine I would also have better grounds on which to to trust their referrals.

            For a number of years I had insurance through a group for the self-employed; their per-month rate was more than four times what I'd pay at Qliance, and my phone contacts with the staff at their Texas-based office led me to feel that should anything major occur they'd likely stall or reject reimbursement.

          •  I just went on the website to learn more. (0+ / 0-)

            This is what they say.

            The following services are not provided at Qliance at all.

            - Colonoscopy - CT Scan - Endoscopy - Mammograms - MRI - Ultrasound - Outpatient labs (beyond the labs tests performed at Qliance) - Outpatient surgery (beyond the procedures performed at Qliance) - Outpatient radiology (beyond x‐rays performed at Qliance

            This does not seem like a good deal to me.  Some of these things are very routine, normal health care!

            We've got serious work to do. Health care and civil rights for all, please!

            by the dogs sockpuppet on Mon Jan 26, 2009 at 11:31:52 AM PST

            [ Parent ]

    •  Thanks. (4+ / 0-)

      I tried to avoid coming across as providing too much free advertising for them myself :) ... but the model itself that Qliance works under seems fascinating as an alternative to business as usual.

      y el canto de todos que es mi propio canto

      by gatorbot on Sat Jan 24, 2009 at 03:37:27 PM PST

      [ Parent ]

  •  This is VERY interesting (4+ / 0-)

    And good to know about, since we're in the area!

    It seems like a GREAT first step towards first partnering with, then eventually eliminating the insurance companies.  Provide easy access to preventative and everyday health care, and partner with businesses so they only provide the catastrophic coverage.  

    Very thought-provoking indeed.  I hope some higher-ups take note.  Let's write Daschle!

    Save the parrots: Drink shade-grown coffee!

    by oscarsmom on Sat Jan 24, 2009 at 03:30:49 PM PST

  •  I don't necessarily think it's a bad idea (6+ / 0-)

    but how primary care doctors and nurse practitioners bill their clients is likely only to do the tiniest amount to change the current medical crisis.

    Your PCP can give you antibiotics for the cold, or antidepressants, and ship blood to a lab - but if you have a serious problem you'll need to see a specialist, who doesn't give cash discounts and irrespective of your insurance coverage needs to pay for the enormous capital outlays that are needed to perform modern medicine.

  •  Every healthcare system (6+ / 0-)

    innovation has looked good at the beginning.  Reducing employee-paid employee insurance costs from $620 to $360 by using Qliance for the monthly flat fee of $60 for primary care coverage tells us two things: 1) supplying primary care coverage is cheap 2) insurance for everything else is expensive.  $360 per month is roughly comparable to what Kaiser charges.  That's still over $4,300/person/year -- far beyond the means of the un/underinsured and their employers.  

    What FDR giveth; GWB taketh away.

    by Marie on Sat Jan 24, 2009 at 03:38:09 PM PST

  •  I'm a Seattle physician (17+ / 0-)

    and I actually pay $35/month to one of these boutique docs, although it still involved my insurance company as well.  For the extra money, I get email access, same-day appointments, more time with my internist, and better office staff that coordinate health maintenance stuff for me rather than me making a bunch of phone calls.  

    I do worry that if you need a specialists' care, the cost becomes prohibitive without insurance, but if this is your only option (this vs. nothing), seems like a great start.

  •  It's certainly not bad for the young & healthy (1+ / 0-)
    Recommended by:
    Pris from LA

    It would be a start like buying a condo before your first house.

    •  Actually it's probably worse for them (2+ / 0-)
      Recommended by:
      neroden, Pris from LA

      The young and healthy don't have nearly as much a need for routine maintenance as older folks do. But they are still at risk of getting in a car accident, or having one of their organs suddenly fail on them and needing emergency surgery, or beginning to develop a chronic condition which will render them both in need of a house and blacklisted by all the realtors.

      •  How could it be worse? (1+ / 0-)
        Recommended by:
        Pris from LA

        Yes we did, yes we will. President Obama

        by marketgeek on Sat Jan 24, 2009 at 10:02:00 PM PST

        [ Parent ]

        •  Darn that return key-- (4+ / 0-)

          I meant to say that my daughter's insurance is $105 a month and she gets only one physical check-up every two years. If she does have a problem, we are at the mercy of whatever code the doctor uses. So her last visit, to check on her health cost us $290. We thought it was routine, but she also told the doctors he was stressed by school, so the visit was disallowed as being a mental health visit. She is not able to visit her primary care physician whenever needed for advice because the standard response is to disallow and make us fight it out. In other words, she has no primary care with insurance that costs more than what these physicians are offering.

          Yes we did, yes we will. President Obama

          by marketgeek on Sat Jan 24, 2009 at 10:07:20 PM PST

          [ Parent ]

          •  That's terrible (2+ / 0-)
            Recommended by:
            Pris from LA, Edgewater

            and obviously I wish the referral and billing system weren't such a ridiculous game, but if she ever ends up with a problem that a general practitioner couldn't handle (which is a lot of them), she can go to an E.R. and your insurance will be contractually required to pay for it. If she needs long-term attention, she can find her way to a specialist and the insurance will be contractually required to pay.

            Of course, whether they will pay is a separate issue, but a boutique members' clinic of primary care docs like this one will not cover that sort of thing, and even beyond the financial issues will have no training and likely no equipment with which to treat her.

            •  Ours (0+ / 0-)

              she can go to an E.R. and your insurance will be contractually required to pay for it.

              I have a pretty good insurance plan but I do know that on my plan if we go to the ER and it is not an emergency. Unless I am going to die or broke a bone, etc , they will only pay half.

              I don't care what you do in your beds, just keep your hand out of my pocket.

              by the mom in the middle on Sun Jan 25, 2009 at 06:27:47 AM PST

              [ Parent ]

  •  This is actually about (7+ / 0-)

    the worst possible thing to happen, except for those who well off financially.  

    All the monthly, per-person fee gets the patient is a guarantee of an appointment, and only for the pre-paid period.  The older you are the more your pay. They don't take insurance payments at all, not even Medicare or Medicaid.  They won't even bill the insurance carriers - patient have to do it themselves.

    You are way off base if you think this is a model for health care reform.

  •  Congrats gatorbot for making the Rec Diary List! (3+ / 0-)

    great diarrhea, good work!!!

  •  Well I have seen how at least, here in (7+ / 0-)

    the DC area, more and more doctors, especially those in the mental health fields like psychology and psychiatry, are not taking any insurance. Instead they are charging patients full price, then giving them a request and leaving it up to them to get reimbursement from their insurance companies at a lower rate.

  •  Boutique Medicine is quite different... (6+ / 0-)

    Here's an articleon it.

    It is technically against the law to use this with medicare patients, but the previous administration allowed.  Unlike the group in this diary, those in concierge medicine use insurence companies, either private such as Blue Cross, or Medicare.

    They offer an increased use of these resources since for their fee they follow up, and will direct more patients to specialists.

    So the rich who pay for this, will make greater use, get a greater share of publicly sponsored insurance.

    Don't confuse the two systlems.  The group described in this diary should get public subsidies, while doctors using MDVIPare really piggybacking a public system for private gain.

    •  Yes. (4+ / 0-)
      Recommended by:
      Creosote, bigchin, arodb, Pris from LA

      What is typically called boutique medicine is a different beast entirely and I should have clarified that a bit better in the diary... like I said, though, I don't/barely know what I'm talking about w/r/t these matters. Maybe I'll provide a link to yr comment in the diary.

      y el canto de todos que es mi propio canto

      by gatorbot on Sat Jan 24, 2009 at 03:51:54 PM PST

      [ Parent ]

      •  It would be good if you did (2+ / 0-)
        Recommended by:
        bigchin, Pris from LA

        since technically, if a provider takes medicare, he may not charge more than the payment that medicare provides.  The annual fee, a type of retainer, is an increased charge.  

        The doctors claim that the fee, around $2500 is for a yearly physical, which because Medicare does not provide, is allowed to be charged separately.  But that's a scam, since it is a cursury exam worth a few hundred dollars at the most.

        This brings up some serious issues of how unless the rules are enforced, more money could be spent on those who are richer, since they can buy a service that will facilitate greater use of the resources of the plan irrespective of their state of health.    

  •  Healthy Howard, Inc. (4+ / 0-)
    Recommended by:
    Creosote, CWalter, gatorbot, Pris from LA

    People are looking for alternatives, for sure, and this approach looks interesting. They are covering only 2000 people after 15 months (and expanding, as you pointed out). This emphasizes the difficulty of lauching a new paradigm. Depending on how this works out, they should have good information to give Tom Daschle as he tries to develop a way forward.

    Here's a brief update article about Healthy Howard, Inc. Howard County is in Maryland, and they are trying to find a way to provide coverage to people who lack insurance. It's another new approach, and the program is taking baby steps as it sorts out the difficulties and opportunities.

    Here is a brief article about an early January meeting, held in Howard County, to solicit information and ideas to funnel to the Obama team. Republican invitees were too busy to attend, suspicious of the meeting, sounded like a rally, smells like socialized medicine.

    Sigh.

  •  This is deceptive pricing (8+ / 0-)

    I assume that rate was calculated to provide a comfortable income for the physician.  If the average visit is 30 minutes and the doctor works 40 hr/wk in office, they see 80 pt/wk.  If there are 4 weeks vacation allowed, the doctor has 3840 slots/yr.  The average patient is seen 3.2 times/yr http://www.medscape.com/...
    Thus each doctor can handle 1200 patients.  

    In fact Qliance has a sliding scale depending on the patient's age with younger patients paying less and older more.  Additionally there are two tiers with a low of a 10% higher fee for children and a 63% higher fee for those over 65.  The higher fee provides coverage by an internist rather than a family physician.  Why would you want a child to be seen by an internist is a whole additional issue?
    At an average of $75/mo, or $900/yr, and 1200 patients...Each doctor generates $1,080,000 per year !!  Even if the  overhead is 50%, that is an unbelievable income for a primary care doctor.
    In office lab work is additional.  Xrays other than simple in office are additional. Generic medications are available at a higher cost than the charges at costco's online listing.
    So for me, in my 50's, and preferring an internist, I pay $109/mo, 1308/yr for my 3.2 visits/yr.  And I have no coverage for this fee for hospitalization, medications, or specialty care.
    Sorry, this is not the wave of the future except for the wealthy, thus the accurate term, boutique care.

  •  In a study of concierge practices, (9+ / 0-)

    it was found that they treat fewer chronically ill and minority patients.  Though there is antecdotal evidence for improvements in care, it has not translated to an overall improvement of health outcomes. It also creates an unethical two-tiered system where some people can afford to pay for it and others can't.  If we truly believe that health care is a right and not a privilege, then this creates an ethical problem.

    Here is a reference:
    Link

    We've got serious work to do. Health care and civil rights for all, please!

    by the dogs sockpuppet on Sat Jan 24, 2009 at 03:49:17 PM PST

  •  This is a disaster if it becomes widespread! (10+ / 0-)

    My former internist's group (in suburban Baltimore) announced that they were converting their practice to this model, so my wife and I found new internists.  You've still got to have insurance to cover hospitalizations, specialists, emergency room visits, and anything that happens when you're traveling.

    The fee in this group, if you want to have an internist as your primary care doctor, adds up to more than $1,500 per year for somebody who is 60-64 years old (as both my wife and I are).  That's a little more than $3,000 per year for a couple, PLUS you've still got to have insurance.

    How many times per year does the average person visit their primary care doctor, even if they've got a chronic condition such as high blood pressure?  Probably about 3 times per year.  That means that in most years, you're paying $500 per office visit (or more, if you only go in for an annual check-up, plus maybe once for the flu or something).  If you develop a serious illness such as cancer, most of your doctor's visits are going to be to a specialist, which isn't covered.

    As I see it, this is a great plan for primary care doctors if significant numbers of patients are stupid enough to buy into it, and it's a great plan for patients who happen to be hypochondriacs, but it's a lousy deal for everybody else.  If you look at some of the websites touting this kind of plan to physicians, they're full of puff pieces about how much more primary care docs can make with this practice model, while working less hours and taking care of less patients.

    If most primary care doctors convert to this practice model, who will take care of the majority of patients who simply can't afford these fees plus insurance?  (And even if MOST patients can't afford it, the money being paid per patient to primary care doctors under these plans is so much higher than under the present system that most primary care doctors could convert to it, if enough patients who CAN afford it go along.)

    •  This seems a lot like what McCain wanted (1+ / 0-)
      Recommended by:
      Edgewater

      people do to. This section says it all. They want their patients to sign up for what NYCeve has referred to as "junk insurance" and pay for their services through an HSA or Flexible Spending Account.

      This works well for someone who is young, right out of school, and in good health. The person who only goes to the doctor once a year for physicals would probably come out financially ahead with Qliance and junk insurance.

      The rest of us, though, wouldn't. Anyone with chronic care and conditions requiring specialist visits would not do well with this plan. Anyone who needs monthly medication wouldn't do well with Qliance either.

      Qliance seems to be basically only for either the rich and/or very healthy.  It works for those people. It seems to be that they are orienting their practice to those populations while excluding the poor, the sick, the unhealthy, and those with chronic conditions.

      I'd be more supportive if Qliance expanded their services, had specialists, and did their own tests in house. But under its current model it only works for the rich and the healthy.

  •  All physicians should really just take control (1+ / 0-)
    Recommended by:
    Pris from LA

    Dealing with insurers has become so complex that it is actually easier to manage everything by yourself.

    I miss the good old days when doctors could actually practice medicine and take care of patients and that's it. That would be enough to earn a good living. (Ok, I am not old enough to remember those days but I am an idealist.)

    One guy in our group actually has an MBA. These days...you need it.

    An eye for an eye and the whole world will be blind.

    by rini6 on Sat Jan 24, 2009 at 03:54:49 PM PST

    •  With about 40% (4+ / 0-)
      Recommended by:
      Creosote, jkb246, Pris from LA, rini6

      of the population now uninsured, I would think that there would be a niche for cash-and-carry, acute walk-in primary medicine -- no insurance, just medicine, priced at a reasonable cost for care that is needed when it's needed, as opposed to the chronic-care model of a monthly fee.  I don't understand why I don't see this cropping up ... it's how vets manage things, and I don't see them going out of business.

      •  Probably because (3+ / 0-)
        Recommended by:
        sam storm, Pris from LA, rini6

        people who aren't doing well economically tend to cut back on luxuries, and primary care medicine is a luxury if anything is.

        •  It depends on your definition of primary care (1+ / 0-)
          Recommended by:
          Pris from LA

          Acute care clinics are cropping up at CVS and other pharmacies, supermarkets and in malls.

          I think they do try to work with insurance, though.

          A painful ear infection or uncomfortable rash will drive people to pay some money. Acute care is not really a luxury. It's always better, though, if people don't use the ER for these things.

          An eye for an eye and the whole world will be blind.

          by rini6 on Sat Jan 24, 2009 at 07:36:38 PM PST

          [ Parent ]

          •  poor primary care is often very expensive (1+ / 0-)
            Recommended by:
            rini6

            in the long run because many conditions and illnesses can be prevented or better treated if caught early. So there is some balance to maintain and whatever health system we get should encourage that.

      •  A few of our Pharmacys (0+ / 0-)

        around here are offering clinics with nurse practitioners for a cash-and-carry medicine.They treat minor stuff and refer you for big stuff.

        I don't care what you do in your beds, just keep your hand out of my pocket.

        by the mom in the middle on Sun Jan 25, 2009 at 06:29:57 AM PST

        [ Parent ]

  •  This isn't as good as I thought because (6+ / 0-)

    I went to their website and found this section. Basically Qliance is advocating that its patients sign up with them and then get what NYCeve refers to as "junk insurance". They also seem to be supportive of Health Savings Accounts.

    I am not saying that this arrangement is bad, but this sounds a lot like the plan that McCain wanted to push people onto in the presidential campaign. This plan works well for someone who is young, right out of school, and in good health. It works for the person who goes to the doctor and to the dentist once a year for routine examinations and nothing else. That type of person would work with Qliance and a "junk insurance" plan.

    However, for people who need complex tests, chronic care, or frequent medications, it seems like it would not be a good idea. It seems like Qliance basically operates as a primary care doctor without specialists or other services that would work for patients with sicker care.

    So it seems like Qliance really is only a practice that works for the healthy and the affluent. For the rest of us it's probably not a viable solution.

  •  Wow this sounds like a wonderful idea (3+ / 0-)
    Recommended by:
    gatorbot, Pris from LA, fokos

    And a great compromise. Local Doctor groups would manage the basic care aspect of people and the federal govt would manage hospital care and catastrophic care.  This way people could still choose the doctor group of there choice, but also know that if they get Cancer,etc... The insurance industry wouldn't be able to deny deny deny.  

    •  If you think this is a great idea for anybody ... (3+ / 0-)
      Recommended by:
      jxg, jbdigriz, Edgewater

      except some primary care doctors who want to get rich while not working all that hard, I've got a bridge to sell you.

      •  I'm guessing that for most people (5+ / 0-)
        Recommended by:
        jxg, mijita, leevank, Pris from LA, Edgewater

        Except those with serious medical conditions--who would likely be refused membership by these plans anyway and referred to conventional insurance plans, which would likely deny them too--the annual costs for such plans would significantly exceed what they'd be with standard per-visit out of pocket costs for the typical annual physical and the occasional flu or sprained knee, kind of like how for most people an extended warranty for their iPod makes no sense. Now, if people want "peace of mind", that oft-repeated insurance industry mantra, and can afford it, ok. But for most people, who are tight on funds, it might not make that much fiscal sense.

        The liberal soul shall be made fat. He who waters shall be watered also himself. (Proverbs 11:25)

        by kovie on Sat Jan 24, 2009 at 04:21:07 PM PST

        [ Parent ]

      •  I'm not sure what you think docs do (5+ / 0-)
        Recommended by:
        Joe Bob, Creosote, offred, kck, Pris from LA

        but let me give you an idea.  I graduated from a top 25 Pediatric Residency program with 16 other individuals who, on average, had 200,000 in med school loans.  8 years later, only half of them are still practicing medicine because of a combination of utter and total burnout, not being able to support a mortgage, child care costs and loans.  Docs work insanely hard and then worry about their patients when they wake up at night all while being constantly afraid of being sued, doing the wrong thing, and inundated with paperwork, continuing medical education requirements, and recredentialing.  It's not a job - it's an all encompassing lifestyle.  24/7.  Certainly, we make a decent living,  but the grand majority of doctors are not getting rich and primary care docs probably have more trouble than you think paying off their loans, their mortgage, their kids day care, their car loans, etc.  And a large number of our patients walk in the door with the same set of assumptions that you display above - making all the stress/angst hardly worth it.  A recent NYTIMES survey said that 50% of doctors don't want to be doctors anymore!!!!!  If it gets worse, fewer docs will remain or select the profession.

        •  I have more knowledge of what docs do than you .. (6+ / 0-)

          think.  I have three family members who are physicians, including one in a primary care field.  I fully support the fact that primary care docs need to be reimbursed better, so that more medical school graduates go into primary care.  And I fully understand the frustration that ALL doctors feel about insurance companies, Medicare, etc. inserting themselves into the doctor-patient relationship.

          But this isn't the answer.  If there's a reponsible answer, it seems to me for more primary care doctors to simply refuse to deal with insurance companies and require patients to pay directly on a fee-for-service basis, while giving the patient an invoice that the patient can submit to his or her insurance company for (partial at best) reimbursement.  That's the way the first couple of primary care docs I had as an adult operated, and it enabled them to charge sufficiently low office visit charges that I typically didn't even submit them to the insurance company.  And judging from where they lived, they made a good living practicing medicine that way.

          A number of years ago, my late mother had suffered 3 bouts of pneumonia in about a year, all in the same location.  Every treating physician, and the physicians in my family, all thought it was important that she be bronchoscoped to determine whether there was a blockage (such as a tumor) that was causing the repeated pneumonias.  Owing to an administrative screw-up by the hospital staff, she could't be bronchoscoped as scheduled, and because she was extremely nervous about it, her wonderful pulmonologist came in at night to do the bronchoscopy.  Somebody at Medicare determined that the procedure hadn't been medically necessary, and refused to pay a penny to the pulmonologist.  I would have been happy to pay for it out of my own pocket, except that under Medicare rules, it would have been illegal for the pulmonologist to accept the money.  That system stinks, and I fully understand the frustration of all doctors with the system.

          But much as I understand docs' frustration, this practice model isn't an answer -- at least not for any doc who cares about actually caring for sick people, rather than merely for rich people.  And it's CERTAINLY not an answer for our crisis in coverage for medical care.

        •  Docs have become high priced labor (1+ / 0-)
          Recommended by:
          Edgewater

          Managed care is all about turning doctors into overworked employees of large corporations.

          However, boutique care is not an answer. It's good for the doctors doing it but doesn't help people who have serious health problems.

          "It's the planet, stupid."

          by FishOutofWater on Sun Jan 25, 2009 at 06:53:03 AM PST

          [ Parent ]

      •  primary care doctors wanting to get rich???!! (0+ / 0-)

        simply
        not
        possible

        •  It's certainly possible with this plan (1+ / 0-)
          Recommended by:
          Pris from LA

          A primary care doc could easily be generating well over $1 million per year, and with substantially reduced overhead because of eliminating all of the costs associated with insurance, a larger percentage of that would be in his pocket.

          It's not possible NOW, that's for sure, but it definitely would be under this plan if you've got enough patients who will pay for it.

    •  Qliance works only for those in good health (5+ / 0-)

      without severe medical problems. The second that you develop a need for something more than routine care it probably becomes prohibitively expensive.

    •  This does not replace insurance (4+ / 0-)
      Recommended by:
      jxg, mijita, jbdigriz, Edgewater

      I can't improve on what Ralphdog. And this isn't a new idea.

      Here's a 2005 article from the NY Times

      Since its debut in 1996, concierge medicine has evoked criticism from many corners. Some ethicists say it is exacerbating the inequities in American health care. Insurance regulators have raised concerns about fraud. Government watchdogs, worried that it threatens the tenuous equilibrium of the health care system, are keeping an eye on trends.

      "Concierge care is like a new country club for the rich," Representative Pete Stark, Democrat of California, said at a joint economic committee hearing in Congress last year. "The danger is that if a large number of doctors choose to open up these types of practices, the health care system will become even more inequitable than it is today."

  •  I'm wondering if insurers might be willing (2+ / 0-)
    Recommended by:
    jkb246, Pris from LA

    to offer some sort of discount for members who can demonstrate that they belong to one of these practice plans and have been going in for regular physicals for some time, kind of like how they offer a non-smoker's discount. This way they benefit from the advantages (to them) of having relatively healthy members, but without having to pay for preventive and maintenance care in full.

    In any case, if these things take off and we don't get universal health insurance soon, it's just a matter of time before the big insurers end up swallowing up these plans and incorporating them into their overall insurance plan offerings. At which point, of course, they'd start raising prices and denying coverage. The power of money and scale is supreme in our economic system, and this would be inevitable.

    Which is why this is likely just another interim stopgap on the path to genuine universal health insurance, managed by the federal government. The "free" market is a fraud.

    The liberal soul shall be made fat. He who waters shall be watered also himself. (Proverbs 11:25)

    by kovie on Sat Jan 24, 2009 at 04:10:07 PM PST

  •  what to do about catastrophes? (2+ / 0-)
    Recommended by:
    Creosote, denise b

    I am a primary care physician, and I agree with this model.  Primary care is not that expensive, but specialty procedures and cancer care is - people still need insurance for that.

  •  Has NYeve loooked (2+ / 0-)
    Recommended by:
    Creosote, Pris from LA

    at this thread yet?

  •  Read the New Yorker (3+ / 0-)
    Recommended by:
    Joe Bob, Creosote, gatorbot

    The most recent issue of the New Yorker has a great article by Atul Gawande about how other countries have brought about universal coverage.  The article also goes into how Massachusetts brought about universal coverage.  The thing about single payer is that, as a primary care doctor, it frightens me.  

    What other profession would agree to have all it's prices and fees set by the government?  I think many physicians would object, and for any health plan to be successful, most physicians must be for it.  

    •  How many other professions (5+ / 0-)

      off of such basic quality of life issues as health?

      And my state does have a say in water and electricity costs, for a start.

    •  Medicare vs. for-profit insurance? No contest. (17+ / 0-)

      I've been in practice for about 25 years, and I would welcome a world where every insurance carrier was replaced by Medicare.

      The paperwork is simple, they pay promptly, the overhead is minimal, and the rules are transparent.

      Sure, there'll be problems having to answer to a single government payer. But it'll be one hell of a lot better for my patients. Last week I saw at least five people who've lost their insurance (along with their jobs) within the past month. I'm scrambling to try and make sure they get the meds they need to stay healthy and alive, while trying to figure out how to care for them without costly imaging and blood tests they simply can't afford.

      I'm okay with it not always being about what docs want.

    •  As a physician (4+ / 0-)

      I have to say that if being a doc gets much harder (and I try to remind myself that I can count myself as a very lucky and blessed person) .... I just won't survive it.

      •  what do you feel makes it hard? (1+ / 0-)
        Recommended by:
        Pris from LA

        This is a sincere question. Is it the management by the insurance companies and the paperwork and staffing required? The loans you're paying back? Finding good help?

        •  There is no simple answer. (7+ / 0-)

          My experience is pediatrics specific and we are the lowest paid physicans in the county.  It's not a job.... it's a lifestyle.  It's 24/7.  In order to pay a mortgage on a modest 2 bedroom home, my med school loans, day care, etc..... the economics of the "business" means that I need to see 25-30 patients a day and then fight with insurance companies, document meticulously (lawsuits, billing), and then go home after 12-14 hours and try to keep up to date with everything we're supposed to know.  It's just not a sustainable lifestyle.   It should be of concern to the populace though.... of the 16 docs in my residency program with whom I graduated, 8 have quit beacause of utter burnout.

          •  yes, i can see where its not sustainable (1+ / 0-)
            Recommended by:
            Pris from LA

            I have never understood why the medical schools make their students work the kind of hours they do. As a country, we HAVE to simplify the billing and subsidize the education.

            Thanks for doing this job, and please hang in there with keeping up with the latest and being meticulous!
            Get your patients to help you--teach them where to find reputable info on line and support them to support each other. parent's groups can share a lot of info.

            •  It is not the students who work too hard (1+ / 0-)
              Recommended by:
              Pris from LA

              It is not the students who work too hard - it is the interns and residents.  But this is changing - most residencies now have to follow an 80 hour maximum work week.  And this certainly adds to the cost because the work still needs to get done, and now it gets done mostly by midlevels and some by the attendings.  Now that hours are cut, they have to hire more trained people to do the work, which adds to costs.  By the way, I am all for making life more liveable for interns and residents, but we must be honest about the cost.

          •  Is this different in other countries? (0+ / 0-)

            If so, how?

            And/or, why?

            Be good to each other. It matters.

            by AllisonInSeattle on Sat Jan 24, 2009 at 09:44:52 PM PST

            [ Parent ]

          •  That's because it is a "business" (1+ / 0-)
            Recommended by:
            Santa Susanna Kid

            Health care should be not for profit.

            Doctors should be well paid.

            What kind of income scale do you think is fair, citizengeo?

            (I ask because frankly, many people work as hard as you do and assuredly make a lot less. But many places do not have enough doctors, and doctors often are forced to work too many hours. Not surprisingly, physicians tend to cluster where the wages for doctors are highest.)

        •  It's not hard for me (0+ / 0-)

          It's not hard for me - I am salaried and don't have student loans.  But I hear from others that it is very difficult, and the thought of one single entity deciding everything seeoms troubling.  I work for the federal government, and they are great about some things and horrible about others.

          •  i have $400,000 in debt... (7+ / 0-)

            between myself and my wife, both of us resident physicians.  i would love to be a better advocate for health care reform, but i work all of the time.  and after i finish training, i will be working all of the time to pay my bills.... an indentured servant to a flawed system with no time or ability to use my credentials to reform it.  I am being a tad dramatic, but when i see the glaring flaws, i begin to feel that way.  The way out for many is to gain a fellowship into a feld where you can may large sums performing procedures, doing catheterizations as a cardiologist, colonoscopies and endoscopies as a GI doc.  Basically, specialize or languish in debt and low income relative to other physicians.  We have placed the incentives on the side of specializing by our reimbursement structure.  My wife is a pediatician, she is in a much better position to place a child on a path to a life of good health, but she will never be paid 1/4 of what a cardiologist performing a stenting for someone whose health is irreversibly poor due to advanced heart disease. The money is on the side of treating those with advanced illness due to unhealthy lifestyles, but not on the side of helping create healthy lifestyles, but this is the way in which we become batteries for the economy... spend our money on unhealthy lifestyle choices, then spend our money on ineffective diet products, and finally pay it all out in the ned to treat our chronic illnesses.  Great for our economy and making profit, bad for our health and a life that could have been led with dignity.  The obesity epidemic provides us with a million human metaphors for the bloated stock portfolios of our most rich , but our poor health as a nation is intimately tied to the income gap that results from our free market approach to medicine as well as the rest of our societal needs.

            •  Right, so if you didn't have all the debt? (2+ / 0-)
              Recommended by:
              Creosote, Pris from LA

              Then would all the decisions about careers still be based on money?

              Did you go in to make more money than the average person?

              Or did you go in to help heal people?

              Or some combination, or another reason? (stood in wrong line for wrong class, didn't notice... attempt at humor).

              Let me answer for myself, first, to show I'm willing to take that plunge. I am living my life trying to make a difference. That is what is most important to me. I don't have temperment to be a doc, you prob don't to do what I'm doing, just a guess.

              Be good to each other. It matters.

              by AllisonInSeattle on Sat Jan 24, 2009 at 09:44:04 PM PST

              [ Parent ]

              •  a large number of med students want to help (3+ / 0-)

                but there is far too little knowledge of the structure of our system even amongst medical students, and they usually sate their desire to help by going on week long trips to third world countries and giving some free car, admirable, but it makes no sense with the mess we have at home.  As a student i referred to them as "white man's burden medical missions."  Most students and doctors fail to recognize the role we can play as patient advocates, despite their good intentions, but a large part of this is the lack of education in health care policy or public health, that is a different degree entirely.

                •  Free care, you mean? (0+ / 0-)

                  Heh. Took me a while to figure it out. Didn't want to miss out, so I really struggled to figure out why med students would travel to give someone a car. Light bulb, oh, typo.  

                  All I can think is "We gotta git outta this place..." This rut we're stuck in re health care. If single payer is working in 20-30 other industrialized nations... maybe we could just try it on for 2-3 decades, and see how it works.

                  Be good to each other. It matters.

                  by AllisonInSeattle on Sun Jan 25, 2009 at 11:32:16 PM PST

                  [ Parent ]

            •  Hang in there (1+ / 0-)
              Recommended by:
              Creosote

              Sounds tough.  I had a manageable student loan debt of around $30,000 because I got funding from the Army and served on active duty for 5 years, which is now done.  I took the stafford every year and a loan at the end to fund my move from med school to residency.  I know the military route is not for everyone, but I thought it would be better for me than taking $160K in loans, which is what my education cost back in the 90's.  I do primary care and like it, but I would hate owning a practice and having to pay rent, pay employees, and worry about the bottom line.  I work at the VA, which is about as non-entrepreneurial as you can get.  I dont' think we will have many primary care docs left in years to come - it will all be midlevels, and the MD's will be doing procedures.  But in response to Allison, yes - the lack of debt made it easier for me to choose primary care.  And yes, part of my attaction to medicine was that I thought being a doctor would give me financial stability - I don't think I expected to be fabulously wealthy.  I also ruled out jobs I might have liked that were low-paying - like school teacher.  I earn way at the bottom end of income for a doctor, but I enjoy my work tremendously, and I am able to choose a job like this because I don't have any loans.  I think the education should be funded for students who are committed to primary care, and they in turn should be willing to work in a physician shortage area for fou years after residency.

            •  With all respect, your debt as a % of (0+ / 0-)

              your collective income is likely no more than someone who graduates from College. If your collective income is half your debt (avg. doctor salaries) you should be quite capable of paying it off in a reasonable amount of time.

              I think doctors overstate their debts in relation to their income much of the time.

    •  One of the problems is that MD's (0+ / 0-)

      in the US charge to much.

      Sorry, but it's true.

      "The military industrial complex not only controls our government, lock, stock and barrel, but they control our culture." - Mike Gravel

      by Wilberforce on Sat Jan 24, 2009 at 05:10:29 PM PST

      [ Parent ]

    •  a profession that has its fees set (5+ / 0-)

      would be education. Another would be nursing. Most engineers are paid salaries. Pilots have a union that negotiates, but their fees are not based on market rates or volume.

    •  At some point (0+ / 0-)

      At some point, look, I wouldn't even care if it was a state medical board made up of mostly physicians that set the fees. So long as some objective eye was there to review it and at least ensure it was reasonable.

  •  My first two internists in Balimore made it ... (4+ / 0-)

    simple:  They didn't deal with insurance companies, but would give you a statement that you could send to your insurance company to try to get reimbursed.  (Normally, I didn't even bother, because they charged little enough for an office visit that it didn't seem worth the trouble.)  THAT'S the traditional physician-patient model, and for the average patient, it's going to be a lot cheaper than this model.

  •  As a physical therapist, this concerns me (4+ / 0-)
    Recommended by:
    Creosote, jbdigriz, gatorbot, Pris from LA
    for a number of reasons.  Here in the state of Kansas we still have a law that requires a referral from a doctor (M.D., D.O., P.A., or Nurse Practitioner) in order to see a patient and treat them for their particular problem.  With companies like these popping up, what kind of out of pocket expenses would they produce for physical therapy visits?  Right now we're seeing our business slowly being hurt by rising deductibles and co-pays.  As an example, a patient yesterday with severe low back pain from a bulging disc told me he can only afford 3 visits because of his $2000 deductible and $50 co-pay PER VISIT to see a PT.  I'd like to think I can help him completely to full recovery in those 3 visits, but that's pretty unrealistic.

    My point is, if someone bought into these companies for $60/mo, I have my sincere doubts that Qliance would cover physical therapy or other secondary services very well at all.  And I certainly know any secondary insurance like disaster coverage the diarist was referring to would cover this either.

    So while this may be ideal for situations involving doctors, does anyone know how well this works for other secondary services like PT/OT, mental health, specialists, etc?

    Lawrence, KS - From ashes to immortality

    by MisterOpus1 on Sat Jan 24, 2009 at 04:33:33 PM PST

  •  I'm a doctor; this plan is less than worthless. (19+ / 0-)

    Concierge or "boutique" care is exactly the right term for this model of medical care delivery; it's care for affluent people who are willing to pay a few more bucks to cut to the head of the line. It is profoundly elitist, anti-Democratic, even anti-American.

    And the notion that this will "cut out the insurance middleman"? That's a bogus understanding of the basic concept of insurance. 'Cuz here's the thing: you're paying, what, $60 a month to your primary care doc to buy preferred access to his/her services. Tell me, what happens when your child develops leukemia?

    I'll tell you. That $60/month fee buys your way to the head of the line to see your 'concierge' primary care doc. She may do a blood test, but once the diagnosis is made, the half a million dollars it costs to treat acute lymphocytic leukemia? It's not covered by that $60/month. It will have to come from somewhere. That would be from your medical insurance- unless you foolishly dropped it hoping that boutique care would take care of everything.

    I want to be completely up front about this. I'm a rural family doctor who takes care of everyone coming to my office regardless of insurance status. Rich or poor, Medicaid or uninsured, I'll find a way to care for you. That's why I don't earn as much as a suburban doc "specializing in diseases of the well insured". I feel very strongly that boutique or concierge medicine is a moral abomination. It means that a doctor whose heavily subsidized training consumed thousands of taxpayer dollars now cares only for affluent folks who are willing to pony up some cash right up front. It's wrong morally, ethically and effectively.

    And the fact that our current 'system' of employment based insurance is broken does not justify such ammoral behavior from physicians.

    •  Interesting. Thanks. (1+ / 0-)
      Recommended by:
      Pris from LA

      I appreciate your work and your generosity with all comers in your rural office.

      My understanding (and I look forward to your correction) is that this is a slightly different creature than other types of "boutique care" -- see arodb's comment above.  With respect to this entity, I don't see the head-of-the-line argument, because everyone who pays the fees at Qliance is already at the head of the line -- they're not competing against other patients of those doctors because those doctors only see these patients through their membership with Qliance.  

      y el canto de todos que es mi propio canto

      by gatorbot on Sat Jan 24, 2009 at 05:07:21 PM PST

      [ Parent ]

      •  Ah, but they are competing. (4+ / 0-)

        It works like this. In a given community there are a certain number of primary care doctors available to care for the population. Nowadays, this number is grossly inadequate and falling like a stone as older docs retire and younger docs shun primary care.

        Now, subtract the docs who are retiring, who have dropped out to do 'industrial medicine', to represent Workers Comp carriers etc.; then subtract those who won't see Medicaid patients or who demand cash up front from the uninsured. You're talking about a much, much smaller pool of doctors.

        Now, subtract from this smaller pool a bunch of doctors in the prime of their professional careers. Limit their patient load to only those folks willing and able to pony up that $60/month fee, which I guarantee you means this is a relatively affluent group of patients.

        This means that the remaining doctors in the community are instantly compelled to shoulder a disproportionate share of the financial burden of caring for Medicaid and uninsured patients. It drives their income sharply lower; it'll drive some of them out of business or into a more remunerative practice arrangement.

        There is no free lunch. Extra service for the already affluent tends to come out of the hides of the poor.

        •  I've been running on the assumption... (0+ / 0-)

          that this model would attract more doctors toward primary care, which perhaps would not better the situation for the less affluent, but at the same time would not necessarily make things worse for them or the providers who treat them.

          Interesting comment and perspective -- thanks for your thoughts.

          y el canto de todos que es mi propio canto

          by gatorbot on Sat Jan 24, 2009 at 06:05:05 PM PST

          [ Parent ]

        •  As intended. (outstanding comments) (1+ / 0-)
          Recommended by:
          Edgewater

          Extra service for the already affluent tends to come out of the hides of the poor.

          "It's the planet, stupid."

          by FishOutofWater on Sun Jan 25, 2009 at 07:00:53 AM PST

          [ Parent ]

    •  I admire your practice philosophy, Doc, but (1+ / 0-)
      Recommended by:
      gatorbot

      take exception to labeling the plan "un-American."  First, unless we move WAY to the left, Americans are going to retain the freedom to contract privately for goods and services, within the bounds of the law, of course -- and I can't see any justification for outlawing this particular arrangement.  Second, our economy and society have generally -- admittedly, not in every case -- been well served by encouraging experimentation and innovation, and this appears to be one such experiment.

      •  I could not disagree more. (3+ / 0-)
        Recommended by:
        mijita, denise b, FishOutofWater

        Your free market fundamentalism is completely divorced from the way medicine is actually practiced. First, medical education is heavily subsidized by the taxpayers. They (we) absolutely have the right to place some restrictions on doctors' practice choices in return. Second, stating that doctors and patients "contract privately for goods and services" may sound good in economics class, but it's not how the game is played in the real world.

        It's not "experimentation and innovation" when wealthy patients buy their way to the head of the line. That's the way things work in banana republics around the world. However, it's not the way it works in the rest of the industrialized world, where every citizen has access to health care without courting bankruptcy.

        •  You think it's a bad model/solution. Fine. (0+ / 0-)

          I don't have a strong opinion on it, but don't think there's anything anti-American about it, that's all.  And in truth, most education is "heavily subsidized by the taxpayers"; but that doesn't necessarily imply it's in the taxpayers' best interest to dictate how graduates of every publicly-subsidized institution ply their respective trades.  "Some restrictions"? Sure, we all live with "some" restrictions - hopefully, reasonable ones, but clearly not always so.  Would you care to explain how the program described in this diary doesn't involve a private contract (or more precisely, a large set of similar contracts) for medical services?  What sort of law would you propose to enact, or what existing law would you cite, to prohibit such a practice model?  I heard this general topic discussed on NPR, and apparently there is an argument that it represents a form of insurance that falls under the jurisdiction of insurance regulation.  I don't know enough to judge whether that's a strong argument.

    •  I tend to agree with you (1+ / 0-)
      Recommended by:
      jxg

      At first it sounded good. But then when I read the section about their "strategy" for individuals and insurance, I realized that they are pushing for what John McCain wanted to do with the healthcare system. Qliance wants to throw people onto "junk insurance" plans that provide little benefit.

    •  It's kind of how the Australian medical system (2+ / 0-)
      Recommended by:
      ppluto, gatorbot

      works.  Everyone pays into the government health care system.  (I think it's something like 1.5% of your income.)  But, you can also buy private insurance that gets you to the front of the line.  But, that's the front of the line in situations where there is not an emergency.  Most people usually can see a doctor the day they are sick and all can get immediate care if there is an emergency.  It is an elitist system.  But, in some ways the poor benefit from the rich opting out since the rich are still paying into the government health system and subsidizing the health care of others.  Apparently, a doctor may work in both systems; as a patient, your insurance just dictates when you get the doctor's care in less urgent situations. Personally, I'd love to be in a system where every single woman had access to mammograms, even if some people got their knee surgery faster than others.  It sure beats our system.  

  •  I know a lot of people who have to pay (2+ / 0-)
    Recommended by:
    AllisonInSeattle, gatorbot

    around $400 per month for a single immediate relative to be on the health insurance provided by their work. The doctor's visits still have copays. The only good thing is that the monthly insurance payment is taken out before taxes.

    So. Would a person in this situation benefit from dropping the $400 per month insurance coverage, pay $60 month for the basic coverage, and take out some sort of insurance for the catastrophic stuff?

    Thoughts?

  •  I think insurance companies have become large (4+ / 0-)

    powerful monsters that are sucking us dry - health insurance - car insurance - you name it they write the rules and their lobbies are so powerful that no meaningful microscope is ever applied to them or how they do business.  I am a huge Obama supporter but I truly question that any health care reform can be built on the back of our present insurance system without major reform and oversight.

    Anyone who is brave enough to step out and try a different model gets my vote whether it has some flaws or not.  Thank you for sharing this information.

    •  Insured Bill of Rights (1+ / 0-)
      Recommended by:
      HKPhooey

      A law that said every insurance company must charge a flat fee to everyone no matter and weren't allowed to drop coverage or raise rates once coverage was enacted would go a very long way to fixing these problems very quickly. Right now the insurance company is trying to make money by exclusion. You change that and they have to make money by inclusion. It's not perfect but it would be a sea change and would be like flipping a switch.

      •  The healthy could buy (0+ / 0-)

        health insurance from a foreigner insurer selling say in the Grand Caymens or Bermuda.

        They might alternately buy accident insurance in the US and private French insurance for the expensive stuff and pay for a few doctors visits out of pocket.

        In the end, to fix the problem would be to effectively convert to single-payer.

        •  Possible (0+ / 0-)

          But I see it as unlikely. There'd just wouldn't be enough benefits to the healthy people to do so. Unregulated insurance for the healthy might be cheaper but it's only cheaper when they're healthy. The moment they got sick the rates could double or triple, they could be dropped or dicked around. The market would insure that they would have to play nice and offer the same benefits as American based regulated insurance or no one would buy from them. Healthy people aren't buying insurance from these clowns now because they offer superior care. They're doing it because they're the best option. You give people a better option and they will take it. The inferior options will wilt away.

  •  More of a symptom than the cure (2+ / 0-)
    Recommended by:
    Joe Bob, Creosote

    It's obvious this is more of a symptom than the cure. I've spent more time trying to get the insurance company to pay for my wisdom teeth coming out than I did actually having them out. The doctor I went through has had to spend probably more staff time dealing with the insurance company than actually taking them out.

    Getting an insurance company to pay out is as hard as the actual procedures.

  •  This essentially what I have done (4+ / 0-)

    After losing my job and insurance in August, I researched it and decided that it was a better use of my dollars to pay as I go and have catastrophic insurance only. All my doctors all agreed to give me a sliding scale based on income except the peridontist. It's not perfect the alternative is out of the question. Also, my last gp changed his practice a few years ago to another model--you pay him $1000 a year and he keeps you well!

    The insurance companies are a racket. Death to the insurance companies. I think that progressive communities like Seattle are ahead of the curve on these sorts of things.

    Always forgive your enemies; nothing annoys them so much.--Oscar Wilde

    by lascaux on Sat Jan 24, 2009 at 06:04:27 PM PST

  •  "non-emergency" - that's the key (4+ / 0-)

    they are just cherry-picking what they will do, and everyone else goes to the hospital.  Works for them.  Will not work for all.  Will not work for the public.  Will not work for chronic illness, accidents, major diseases, and on and on and on.

  •  What we physicians hate... (4+ / 0-)
    Recommended by:
    jxg, denise b, In her own Voice, fokos

    You go to Med school so you can treat patients and not become an accountant. The way we do billing, is really ridiculous. The coders (aka people who look at your medical chart to figure out how the physician will bill the insurance) will count how many questions you ask the patients, whether you asked about the family history, how many areas you examined, how many labs you looked at etc to come up with one of five levels of complexity for the visit. Inpatient care and billing is also as complex. And who invented this crap?
    Not the private insurance companies, but the government. Most private insurers follow Medicare guidelines. For those who wish for a single payer system, you must realize that every year a fight brews between medicare and physicians about fees. And many physicians are dumping medicare for boutique care.
    What this company is doing is called capitation and it is something medicare and private insurers have and still are experimenting with.
    There is no simple solution. But everyone should sit at the same table (including private insurers) and see how we improve the system.
    And one more thing: Medical care employs Americans. Hopefully we can reduce cost to expand coverage to all Americans. But if you are going to save $100 in premium so you can buy some Made in China gadget, I'd rather give it to the back office lady with 2 small kids to feed.

  •  the magic of single payer system.. (5+ / 0-)

    is that it gives an incentive for preventative care to the one entity that can actually enact the kinds of changes in public health that will drastically improve health outcomes for the entire country: the federal government.  health insurance companies help to control cost by cherry picking who they will insure, but a federally funded single payer system will force us to control costs by actually improving the health of the nation.  What this means is providing the political will to reform our agricultural policies, encourage child exercise programs, more pressure on smoking cessation, not to mention the health outcomes related to poverty.  A national single payer system helps to become a part of the engine for a myriad of progressive policies as  our tolerance for poverty and the elevation of profit over public well being manifests itself in the bad health of our citizenry.  This is why a single payer system is not only a part of but would be the backbone of a new progressive agenda.  
    will an eighty year old diabetic with heart disease find better care in a single payer system.... no.  but the odds of your child growing to become that eighty year old diabetic with heart disease will be drastically decreased.  that is the real benefit of a single payer system.  We just need to begin to see the welfare of our citizens as more important than making profit.  The fact that our priorities are reversed explains the vast majority of decisions made regarding health care in our country to date.  
    i am a physician living in nyc.

    •  No Magic (1+ / 0-)
      Recommended by:
      mijita

      Insurance companies do not always cherry pick who they insure. If you have coverage and develop a condition they must continue to insure you through your employer provided plan. If you switch jobs,they cannot deny employer provided insurance if you had continuous coverage.
      An eighty year old diabetic is covered by Medicare, a government provided single payer system.
      A single payer system will not solve the obesity problem or smoking cessation or drug use or STDs.

      •  i am not saying it will solve the problems... (1+ / 0-)
        Recommended by:
        Creosote

        but will definitely provide incentive to solve the problems.  at the moment, there is a great amount of money made from the industries contributing to many chronic illness with strong lobbying (primarily agribusiness).  The political will to combat the practices that result in increased rates of obesity, diabetes, and other illnesses is currently not there.
        also, insurance companies absolutely attempt to avoid covering the chronically ill, both proactively and retroactively.  True, there are laws protecting the insured, but they do not help to provide everyone with insurance, the rates of uninsured speak to this reality.  And yes, the elderly and chronically ill are treated through medicare, my point is merely that a single payer will better system will lead to a greater emphasis on public health and prevention.  And a greater emphasis on public health will lead to reductions in all of the illnesses you listed.  You are right, it is not magic, just a recognition that public realities are shaped by incentive structures, and a single payer completely changes that structure.

        •  true (3+ / 0-)
          Recommended by:
          Creosote, mijita, Santa Susanna Kid

          True, there are laws protecting the insured, but they do not help to provide everyone with insurance, the rates of uninsured speak to this reality.

          Very true. The worst I see in my profession are:

          1. people who work have insurance then can't work because of illness then lose their insurance
          1. People who work, but do not qualify for Medicaid because they work.

          Private ins needs new laws and regulations. We need a way to allow  the uninsured to get insurance. Eventually, we may end up with a single payer system like medicare. I don't know whether it is good or bad, but right now the system is badly broken and needs soe repair.

  •  Insurance companies need challenges (1+ / 0-)
    Recommended by:
    fokos

    like this from all over the country.

    They have had a free ride for too long.  They focus on raking in the premiums and are a big fail on providing service.

    •  Agreed (1+ / 0-)
      Recommended by:
      Creosote

      because currently for most people the alternative to medical insurance is disaster. That is why insurance companies get away with it. They need challenge from a basic government provided plan that they cannot dump patients on.

  •  Instead of giving tax cuts to "small (0+ / 0-)

    businesses," use that same money to start a Universal Healthcare Pot (Fund), and immediately the "small businesses" would pay, say, 50% of what they're paying now per employee per year into the fund, and that certainly will be found money for them.  

    If anyone can find any redeeming value of the Joe Scarborough show, I'm searching for some; one will do.

    by gooderservice on Sat Jan 24, 2009 at 08:17:22 PM PST

    •  I just wish they would level the playing field (1+ / 0-)
      Recommended by:
      Amanda in NC

      I just wish they would level the playing field and not punish us for being a small business. I want to be able to buy insurance for our employees at the same price a large company would pay.

      •  I would like it if employers (3+ / 0-)
        Recommended by:
        jxg, Jlukes, gooderservice

        didn't have to worry about their employees health coverage at all.  It makes about as much sense to me as employers being responsible for arranging their employees' mortgage for them.

        Health insurance should not be tied to a specific place of employment and people shouldn't be put at risk of losing coverage when they lose or switch their job.

        "The time for justice is always right now!" - Samantha Booke, Wiley College debate team, 1935

        by Edgewater on Sun Jan 25, 2009 at 05:24:06 AM PST

        [ Parent ]

  •  Doesn't cover out of office lab tests (1+ / 0-)
    Recommended by:
    churchylafemme

    which makes it unworkable for many of sick people who require regular and expensive laboratory testing.

    Whoever determines what can be talked about also determines what can be known.

    by fearisthemindkiller on Sat Jan 24, 2009 at 09:03:36 PM PST

  •  Our family is on a similar plan in NC (3+ / 0-)
    Recommended by:
    mijita, AllisonInSeattle, fokos

    We heard this doctor on NPR talking about cutting out the insurance companies and being able to reduce costs by 60%.  I went to his site:

    http://prosites-bforrest.homestead.com/

    and signed up.  We each pay $300 per year for a health card and are entitled to unlimited visits for $20 each.  Every year you get a complete check up with a full blood panel.  They take care of all sorts of minor emergencies like stitches and what not, plus they have arrangements with other local specialists to dramatically discount visits and services.  After going there for 2 years I was recently diagnosed Type 2 diabetes.  In the past 3 months I have been back 3 times and each time all the blood work was included in the $20 co pay plus they were very willing to discuss alternate means to get my diabetes under control.  Even suggesting a great book on reversing diabetes or at least decreasing your reliance on drugs to keep it under control.  Each time we visit the doc will spend easily up to an hour with us talking about our health.  I am now off meds and my blood sugar is consistently in the normal range (was over 300 at one point and my ACP1 test was 12.6!!)  They are great and we feel so lucky that we heard that NPR interview with him.  We have additional catastrophic health insurance with a high deductible as a just in case for the worst case scenario.  Oh and whenever they can they freely give me several months supply of my cholesterol drug in the form of free samples they get.  I try not to abuse it since I am so grateful.  Check out their web site and if you know anyone in NC that does not have health insurance but is looking for an affordable way to take care of themselves let them know.  PS I have no financial interest in this at all.

    This outfit has been a lifesaver for us and me in particular.  Had I not been getting a regular check up my diabetes might not have been discovered until some serious damage had been done.

  •  So many curves in the the road but it still leads (4+ / 0-)
    Recommended by:
    Joe Bob, Creosote, gatorbot, Edgewater

    ...to the same road-tested, 50+ year old staff model single-payer integrated health system as used by Kaiser Permanente and the Veterans Administration.

    Providers have always come up with all sorts of new models that will be ideal for them, this diary explains one. But it's only primary care! Sadly, bodies are not so neatly segmented.

    Every different consultant will massage it or tailor it to justify their existence. But the human and process requirements are constant and they spell out a/the solution.

    Only with full cradle-to-grave coverage with salaried physicians will/can the providers deliver the best health care possible. The incentive is for a long healthy life. Also fees for services are eliminated, the delivery system is purified of non-patient centered tasks, billing systems are eliminated, and there is no "transfer" of the patient from primary to acute care needs.

    To genericize the Kaiser model requires a patient's experience to mimic a national single-payer (it's irrelevant imo what happens on the backend), a delivery and physician/practice payment model based on salaries and not services,a robust central regulatory agency, like CMS, to oversee, track and publish outcome and quality metrics, adjudicate when necessary. And all sorts of ancillary systems will change as needed (e.g., education, insurance for discretionary services).

    Whether all patients pay a single pooled rate or it is a tax, imo, is a detail. Taking Kaiser as an example, I know Individual policy holders who are healthy and who pay $93/m and another, healthy, pays $800/m. This insanity stops with community rating or tax solutions.  

    If President Obama creates a new core model for how we pay and deliver care, then he will get open ears to eliminate Medicare/MedicAid like he's hinting toward. If he simply add bandaids to a sick system, a few renovations to a broken architecture, then we all FAIL.

    HR 676 - Health care reform we can believe in.

    by kck on Sat Jan 24, 2009 at 09:10:20 PM PST

  •  Let's move beyond Single-Payor (1+ / 0-)
    Recommended by:
    Santa Susanna Kid

    I want a single, government-run, taxpayer-funded "Sh*t Happens" fund.

    I want the fund to take care of every form of sh*t that could reasonably be expected to happen to everybody in their lifetimes, period.

    I would be fine with the "Department of Sh*t Happenings" being subdivided into categories for administrative purposes, such as:

    Auto: for car accidents

    Business: for lawsuits and other business-related disasters, anything that used to be covered by business and liability insurance

    Death: for funeral costs, death benefits for surviving minor children

    Employment: for unemployment, worker's disability compensation

    Health: for emergency healthcare and serious/chronic disease treatment, mental healthcare, eldercare, primary care

    Housing and property: for fires, floods, earthquakes, robberies and other instances of property destruction

    Family/Life: for childcare, nutrition for the food-insecure

    Etcetera, etcetera.

    You get the idea.  I think the "insurance industry" model is terrible and should be replaced.  In every life, a little sh*t will happen now and then, so why not just consolidate all these wierd insurances, entitlements, allowences, and benefits programs into one big provider that is taxpayer-funded and covers pretty much EVERYTHING?  There's nothing more inefficient than having to buy 20 different kinds of insurance from a bunch of different companies that have been set up to screw you out of money so that they can profit.  We now live in a computer age where we can keep track of all the data we would need to in order to do something like this.  So why not just get it done?  Create one massive social safety net for everyone, so that nobody anywhere "falls through the cracks" when sh*t happens to them ever again.

    •  but where is the profit in that? (0+ / 0-)

      this is Amurika.. someone's gotta make some money in every little nook and cranny of human existence, and suffering.  

      •  Nope! (2+ / 0-)

        No profit!  Government-run!
        People should not be profiting off of sh*t happening to other people.  It's wrong and I think we're all sick of it.  You want profit?  MAKE SOMETHING NEW!  Invent something, build something, turn a great idea into something useful for society.

        I have a friend who works for a company that buys people's spare insurance policies, gets the former owner to name them as the beneficiary, and then keeps making the payments until the person dies, when they get the payout.  This kind of thing has ABSOLUTELY NO BENEFIT for society.  It also drives up the costs for people who legitimately need insurance, because the insurers have to charge more, since they aren't "winning" as many of the bets they make (since people no longer drop policies they don't need anymore, but sell them to a company that maintains them.)  WTF.  This kind of thing IS the American way today.  We are not creating anything of value, we are just bilking people out of money in an endless cycle, and I want it stopped.  Insurance isn't efficient anymore.  Let's replace it all with something that works for the intended purpose: actually helping people out when sh*t happens to them.

  •  I could go for this plan with a twist (0+ / 0-)

    The monthly fee is  to keep you well not just for whatever is called basic care. If the basic care isn't enough to keep you well, then the practice has to eat the extra cost of getting you what you need. Didn't they do something like this in ancient China or is that just a legend?

    -7.75, -6.05 Why can't we see that when we bleed we bleed the same? -Matt Bellamy, lyrics from Map of the Problematique

    by nicolemm on Sat Jan 24, 2009 at 09:30:48 PM PST

    •  That hardly seems fair to the doctors (0+ / 0-)

      If they have a patient who is continually being advised to eat right and exercise or they'll get diabetes, and they refuse to do as they're advised, and get diabetes, the practice shouldn't have to pay for that ongoing care.  Doctors are just people trying to earn a living, just like the rest of us.

  •  seems like an excellent alternative (0+ / 0-)

    to the looming threat of government-run healthcare.

    I'm looking forward to hearing more about this idea, and hopefully it will spread to more cities.

  •  A few months ago, a nurse practioner (3+ / 0-)
    Recommended by:
    jxg, Creosote, WedtoReason

    told me that her own doctor does not take health insurance, but that she thought it was worth paying the money to see that doctor because the best doctors in the city did not take insurance.  She sees her medical insurance as being there in the event of an accident or very serious illness.  I've thought about using this approach; the reason I was seeing the nurse practioner is that they didn't have a doctor's appointment available for months and I couldn't wait that long.  When I do get to see a doctor, the doctor is in a rush, doesn't listen to me, and doesn't provide very good care.  It might be worth it to me to spend a few hundred dollars per year to see a good doctor who took the time to practice good medicine, especially if I ended up buying a cheaper insurance policy that was geared towards catastrophes only.

  •  I've heard that in order to set up (1+ / 0-)
    Recommended by:
    gatorbot

    this sort of practice, the provider needs to drastically reduce the number of patients that have. So if this becomes the norm, where will all the new doctors come from to take in these people who now do not have a primary care giver?

    •  I'll add that MarketPlace had a story (2+ / 0-)
      Recommended by:
      gatorbot, Edgewater

      last week on just this thing, and the doctor they cited (who still filed insurance claims) reduced his number of patients from over 3,000 to 600. He charged each of those that are left $1,500, or a cool $900,000 in total each year.

  •  This is fine for most working adults who... (1+ / 0-)
    Recommended by:
    gatorbot

    ...don't need $1000/month in drugs.

    Most healthcare costs go to drugs, long term care, and hospitalization.  More than half of all heathcare dollars are spent in the last year of life, usually after retirement.

    This can be part of the solution, but a fairly small part.

    Good diary, though.  

  •  This is a terribly bad idea (4+ / 0-)
    Recommended by:
    jxg, gatorbot, rhutcheson, doctoraaron

    in our existing insurance environment, and an even worse solution to a better insurance environment.

    Present insurance environment

    This model forces people with insurance through their employers to pay cash out of pocket for services coverd by their insurance, to save the DOCTORS the inconvenience of filing insurance and to keep their profit margins up by taking them out of the negotiated "preferred provider" system.  Instead, it's all profit for the doctor.  Also, this model provides fabulous care IF YOU AREN'T SICK.  You pay a whole bunch of money for preventive care that most insurers now cover, and if you get sick you get dropped into your other insurance.  

    What are you really paying for?  Attention.  The doctor will treat you like a person, instead of like a little paper number at the bakery.  Think about that for a minute- "I'll treat you like a human being if you pay me a premium."  My response?  FUCK YOU. HOW ABOUT YOU TREAT ME DECENTLY ANYWAY?!  The doctor's argument is that they can't, because they don't make enough money that way.  Stop and think about that for a minute.  ENOUGH money.  Not "money," but "ENOUGH money."  Define "enough."  

    Hey doc, if you don't like screwing with insurance companies, if you don't like the 15% overhead (yeah, your 40% number is bullshit, it's 15%, and that's too damned high, too), stop fighting against single-payer, because that will reduce overhead to 2% or less.

    Name another industry, anywhere, that can say to you "I'll treat you like shit for the list price, but if you pay me extra I'll treat you like a person," and get away with it.

    Better insurance environment

    The idea behind this is to take advantage of Medical Savings Accounts. Do you know what those are?  Here's what we are told they are- pre-tax savings accounts created to force people to make informed decisions about their medical care.

    Nope.  Here, try an experiment.  Call every hospital in your town and ask them how much it costs to get a hoo-hoo-ectomy under your insurance.  Every one of them will tell you the price off their chargemaster, and not one will tell you your insurers "preferred provider" cost.  They will tell you (a) they can't tell you because every surgery is different (except they charge by DRG code for inpatient services, and that's BS), and (b) the insurance contract prohibits giving that info and you have to call the insurer. Guess what the insurer tells you?  Yup, call the hospital. In other words, you CAN'T be an informed provider.  

    So what are the MSAs, then?  I'll tell you the secret.  They're additional IRAs for wealthy people.  Can you afford to take an additional $4K out of your pay every year?  I can, but I make a shitload of money.  And once I retire, all the money saved up in my MSA, all the money I didn't spend, becomes just like any other IRA.  Once I'm 65, I don't have to spend that on healthcare.  Hell, once I'm 65 I have Medicare, so I don't need the MSA.  What is it really, then?  Another deferred-tax retirement program for people with disposable income.

    Perpetuating that system keeps us farther and farther away from single-payer, and continues to heap a burden upon the people who can't afford health care.

    This program is a fraud, a line-the-doctors'-pockets system to get people to pay for something they already paid for, to bribe doctors into acting like human beings, and to hold off an insurance program that might help people who need it.

    No thank.

    Done with politics for the night? Have a nice glass of wine with Two Days per Bottle.

    by dhonig on Sun Jan 25, 2009 at 05:27:59 AM PST

  •  re: Federal Employee Health Insurance (1+ / 0-)
    Recommended by:
    gatorbot

    >Dburn said

    >I would love to have the same access to health care as >federal employees have and at the prices they pay in a >single payer program.

    Our family has Blue Cross Federal insurance. Yes,
    I am lucky I am a gov. employee with access to
    health insurance, but I have seen the insurance
    coverage go down every year and get more expensive
    for decades. Some specific complaints:

    1. More and more doctors are not covered by Blue

    Cross. If the doctor is not on the "list" of
    covered doctors, Blue Cross pays way less for
    the insurance reinbursement.

    1. The deductables are too high for a family.
    1. Blue Cross requires physicians to receive too little

    charges for their services, continuing the viscious
    circle of doctors getting out of Blue Cross
    insurance and/or not becoming doctors, in the first
    place. That combined with sky high malpractice
    insurance causes even less physicians to exist from
    year to year. (obviously there is risk with any
    medical procedure or illness treatment, but some
    people think it should be 100% risk free).

    1. As stated by the original poster, the insurance

    companies, including Blue Cross suck up a big percentage of the health
    care costs, driving up fees consumers of health
    care pay.

    1. What right does Blue Cross or other insurance

    company have to try and pick my doctor on a list?
    As long as the doctor is board certified, they
    should cover the doctor, in my opinion.

    Most people I have talked to on health insurance
    of all walks of life have told me they do not
    want gov. health insurance or the gov. to have
    anything to do with health insurance. They think
    the health insurance companies are "only trying
    to make a profit" and they tell me to shut up and
    just pay the extra money for health care, since
    I am fortunate enough to have a job where I can
    afford health care. Forgetting about me - what about
    some youngster starting out in life who has to pay
    the astronomical costs of health care?  I guess they
    should "suck it up", too???!!

    Having health insurance dependent on the employer
    locks people into a health insurance company for fear
    of possibly losing critical coverage if they change
    jobs.

    I would love to change my health insurance to a plan
    where I could see a doctor(s) as needed and not
    have to wait 2 weeks for an appointment, since all
    the doctors are overloaded by the wreck of a health
    care system we have - viscious circle of doctors
    spending less and less time patient in an attempt
    to recover their costs. A friend of a relative
    who is a doctor explained how little he receives
    through the insurance company for each patient, thus
    we have a system where quantity of patients is the
    only way a doctor can survive.

    Therefore, I agree 100% with the original poster
    on a "modified boutique medical insurance system".

  •  Sounds good to me. The docs have always had (1+ / 0-)
    Recommended by:
    gatorbot

    the power to fix this thing.

    Just looking at the data diaried here the Qplan could be a good one, and it is certainly better than the one Rahm Emmanuel's brother wrote about in his book, Healthcare Guaranteed.  He appeared on BookTV yesterday and was a shill for the insurance industry.  It was disgusting.

    I was on the team that developed the first Medicare system and spent a long career building and managing systems for health insurance companies, HMO's of all types, and large self-insured groups.  At one point I was health benefits manager for a company that had more than 50,000 employees.  I have sat on executive committes of these various health companies and witnessed the impact that profit has on medical decison-making.  I have listened as paralegals talked to physicians via phone as to whether a patient was well enough to transport across town to a cheaper medical facility.

    Health insurance companies, more than anyone else in America, want, hope for, pray for, national health insurance so long as they can write the rules and so long as they can get access to the national treasury.  Watching how the Wall Street boys have been feeding at the public trough must be making the insurance company executives writhe in painful envy.

    And if you want to see health insurance dollars at work just watch Rahm Emmanuel's brother the next time he appears on TV.

    If you don't have an earthshaking idea, get one, you'll love building a better world.

    by hestal on Sun Jan 25, 2009 at 06:56:32 AM PST

    •  I forgot to say, that Mr. Emmanuel is (2+ / 0-)
      Recommended by:
      gatorbot, doctoraaron

      strongly opposed to the single-payer idea.  He gives many reasons, all faulty.  For example he says that no system is capable of administering a benefits program for 300,000,000 people.  But I know that he is wrong.  There are many ways to handle the volume under a single-payer approach.

      And the idiotic thing about Emmanuel's argument on this point is that whatever system is chosen it would have to cover 300,000,000 people.

      He simply wants to divide the pie among the many insurance companies and he is blowing smoke in support of corruption.

      If you don't have an earthshaking idea, get one, you'll love building a better world.

      by hestal on Sun Jan 25, 2009 at 07:00:46 AM PST

      [ Parent ]

  •  gatobot writeth: (1+ / 0-)
    Recommended by:
    gatorbot

    In all likelihood, this model -- even if it were to become widespread -- still would do little for those suffering from chronic conditions or those who cannot afford these services.  

    No, but then Medicare does a decent job with chronic conditions --- at least debilitating ones.

    Every good Christian should line up and kick Jerry Falwell's ass. - Barry Goldwater, 1981

    by Doug in SF on Sun Jan 25, 2009 at 07:31:17 AM PST

  •  As a greater Seattle area resident (2+ / 0-)
    Recommended by:
    jxg, gatorbot

    I see the Stranger often. This week's issue is what they call Strangercrombie; they sell out. Literally. Once a year, they allow companies to buy the right to place articles in the Stranger for one issue, and that's Strangercrombie.

    Qliance bought these articles. They're not independently written. They wrote most of them, if not all of them, themselves.

    Take that into consideration when reviewing these articles.

    Want to be a living kidney donor? I need one from someone with a bloodtype of B or O. Drop a note at riverheart.livejournal.com.

    by Kitsap River on Sun Jan 25, 2009 at 07:32:03 AM PST

  •  And as to treatment of chronic conditions... (1+ / 0-)
    Recommended by:
    gatorbot

    As someone with multiple chronic conditions, this of course interests me greatly. If there is a different model of care that will work better for people like me, I want to hear about it. Here's a little snippet from another Stranger article on Qliance:

    Patients with hypertension and diabetes have been able to get their conditions under control by checking in with the doctor every week—previously, they hadn't been able to afford it—preventing emergency-room visits and the worsening of their own health.

    Another patient with dangerously high blood pressure had stopped seeing doctors and taking her medication because (a) it was expensive and (b) she felt like doctors weren't listening to her. Through a slow process of building rapport, one of the Qliance doctors convinced her to take a regime of blood- pressure medication and teased a family medical history out of her. The history combined with a CAT scan showed the hereditary polycystic kidney disease, which can cause brain aneurysms. (The patient's mother had died of an aneurysm at 39.) Further investigation revealed two aneurysms in the patient that were repaired last summer. The patient, according to a report from her doctor, "is alive and well, without complications. I feel that having enough time to spend with patients in order to obtain a thorough family history is what allowed me to make this diagnosis." That diagnosis probably saved her life.

    PKD can and often does cause kidney failure as well. This patient is going to need ongoing monitoring for a number of things, not least of which is her kidney function. If she can get it there, more power to them!

    Want to be a living kidney donor? I need one from someone with a bloodtype of B or O. Drop a note at riverheart.livejournal.com.

    by Kitsap River on Sun Jan 25, 2009 at 07:36:56 AM PST

  •  Not Only Company Doing This (0+ / 0-)

    I actually own a small amount of stock in a company that does this. The stock is really sucking but I am holding out hope.  
    I think there is a market for this cheaper, semi insurance, discount care, whatever you want to call it. Especially for small businesses who offer nothing to their employers. National Health Partners caters to that market. Their memberships are only $40 a month.
    Company site.
    http://nationalhealthpartners.com/

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