Truly unimportant

[luke warm]

For some reason, U.S. employers pay their employees' health insurances directly instead of paying it via a general tax, or via higher gross salaries subject to higher income tax. Of course the way the burden is shared between high-salary workers and low-salary workers has some implications, but other things being equal I wouldn't expect it matter much how it is implemented.

i don't know either, but it seems to me that paying for health care as a tax increases the cost on everyone... paying a tax creates a middle man (or 10), eh?

[JoAnneM]

Josh, that was an example of the "men will do anything if they are looking at a pair of ...... mentality" Not all women think like that.

 

In fact, was it here that I heard about the couple that stopped to help a car on the highway out in Wyoming in Colorado? The fellow asked for their name and address. Some time later their banker asked them to come down to their bank. They thought they had done something wrong and went down there. He informed them Bill Gates had paid off their mortgage. Don't know if this is an urban myth.

 

Anyway, there are nice people in the world.

[Trinidad]

For some reason, U.S. employers pay their employees' health insurances directly instead of paying it via a general tax, or via higher gross salaries subject to higher income tax. Of course the way the burden is shared between high-salary workers and low-salary workers has some implications, but other things being equal I wouldn't expect it matter much how it is implemented.

i don't know either, but it seems to me that paying for health care as a tax increases the cost on everyone... paying a tax creates a middle man (or 10), eh?

No. In this case, paying tax takes out the middle man (hundreds of them). Or more accurately: It takes out hundreds of inefficient middle men and puts 10 efficient ones in their place. It just says that the government (or something similar) should do something that the government can do better than private enterprise.

 

Look at a US hospital. How many people are doing nothing but sending bills and keeping track of what doctor/technician did what to whom and what health insurance to bill for that? Does this insurance even cover these costs or does the patient need to be billed? Will the patient be able to pay? Or even worse: How much time does a highly qualified doctor spend on paperwork? At what hourly rate? Are these doctors handy at taking care of paperwork? These are all "middle men".

 

If you take care of health care through taxes, you will, of course, need some central people to manage that. This means that you put 10 "middle men" in. But the hospitals can go back to taking care of people and the bulk of the administrative costs for hospitals are saved. And that takes hundreds of middle men out of the system. That makes health care through taxes (or another central health care system) so much cheaper.

 

Why do you think the health care cost in the USA are the highest in the world?

 

Just an aside: Like many Europeans, we travel around during Summer. Normally that is not a problem. Our health care system pays everywhere in the world. The only catch is that they pay, at most, the amount that the treatment would have cost in our home country. No problem within Europe. All medical costs are roughly the same. If there are relatively small differences, the health care system covers that too. Turns and roundabouts. No problem in Australia, Africa or Asia, either.

 

But this Summer we will travel to the US. This means that we have to get an extra health insurance for traveling to the US, since the medical costs are so much higher there that the health care system can't cover these costs. And what makes these costs so much higher? The fact that each individual hospital needs so many "middle men" to run the health care system.

 

Rik

[PassedOut]

Look at a US hospital. How many people are doing nothing but sending bills and keeping track of what doctor/technician did what to whom and what health insurance to bill for that? Does this insurance even cover these costs or does the patient need to be billed? Will the patient be able to pay? Or even worse: How much time does a highly qualified doctor spend on paperwork? At what hourly rate? Are these doctors handy at taking care of paperwork? These are all "middle men".

Responsible US businesses also have people spending far too much time on healthcare insurance issues, time that could be better spent furthering the core business. The cost to employers of the inefficient US system is very high, and is rising quickly.

 

Except for companies that profit directly from the inefficiencies of the US system, we'd all be better off if the government would accept its responsibility in this area, as other governments have done.

[helene_t]

There are many things that make the US health care system expensive. I am sure an inefficient insurance system is one of them, but there are others.

 

GPs in most European countries keep the master record of "their" patients. People are generally listed with one and only one GP. As far as I have understood, people in the US tend to visit various physicians depending on where they are and what the problem is, and sometimes go "shopping" or seek second opinion. Correct me if I am wrong but this sounds as if it must make GP services very expensive. Online patient records would help so at least physicians would not have to spend time obtaining the records (and performing the same test again if the record couldn't be obtained or the handwriting was unreadable). But even with full use of online records, it is still an enormous advantage that the GP knows the patient. Not everything is written in the records.

 

Then there are all the costs related to medical malpractice lawsuits, probably the largest being unnecessary exams etc. that are made only to prevent lawsuits.

[PassedOut]

There are many things that make the US health care system expensive. I am sure an inefficient insurance system is one of them, but there are others.

 

GPs in most European countries keep the master record of "their" patients. People are generally listed with one and only one GP. As far as I have understood, people in the US tend to visit various physicians depending on where they are and what the problem is, and sometimes go "shopping" or seek second opinion. Correct me if I am wrong but this sounds as if it must make GP services very expensive. Online patient records would help so at least physicians would not have to spend time obtaining the records (and performing the same test again if the record couldn't be obtained or the handwriting was unreadable). But even with full use of online records, it is still an enormous advantage that the GP knows the patient. Not everything is written in the records.

 

Then there are all the costs related to medical malpractice lawsuits, probably the largest being unnecessary exams etc. that are made only to prevent lawsuits.

Although I have one primary physician (as do most folks in the US, I think), it is very common for her to refer me to a specialist when I come up with something outside her direct expertise. Because there is no central database, each specialist provides a form for new patients to fill in by hand, giving the patient's "medical history."

 

When you get anywhere close to my age, you find it hard to remember all of your medical history, so I always print a document from my own computer giving my complete medical history from childhood, and attach it to the new patient form. The new physician always likes that, but almost invariably laments the lack of that information with most new customers. I know Obama wants to fix that problem.

 

As for shopping for physicians, I can say that I do that when someone in my family needs surgery that is not completely routine. In that case, I will find a surgeon (usually at the Mayo Clinic in Minnesota) who has a lot of experience with the procedure and a good record.

 

(As an aside, let me say that dealing with the Mayo Clinic is a real pleasure. They truly run their business well in terms of competence, efficiency, and customer service.)

[luke warm]

There are many things that make the US health care system expensive. I am sure an inefficient insurance system is one of them, but there are others.

 

GPs in most European countries keep the master record of "their" patients. People are generally listed with one and only one GP. As far as I have understood, people in the US tend to visit various physicians depending on where they are and what the problem is, and sometimes go "shopping" or seek second opinion. Correct me if I am wrong but this sounds as if it must make GP services very expensive. Online patient records would help so at least physicians would not have to spend time obtaining the records (and performing the same test again if the record couldn't be obtained or the handwriting was unreadable). But even with full use of online records, it is still an enormous advantage that the GP knows the patient. Not everything is written in the records.

 

Then there are all the costs related to medical malpractice lawsuits, probably the largest being unnecessary exams etc. that are made only to prevent lawsuits.

Although I have one primary physician (as do most folks in the US, I think), it is very common for her to refer me to a specialist when I come up with something outside her direct expertise. Because there is no central database, each specialist provides a form for new patients to fill in by hand, giving the patient's "medical history."

 

When you get anywhere close to my age, you find it hard to remember all of your medical history, so I always print a document from my own computer giving my complete medical history from childhood, and attach it to the new patient form. The new physician always likes that, but almost invariably laments the lack of that information with most new customers. I know Obama wants to fix that problem.

 

As for shopping for physicians, I can say that I do that when someone in my family needs surgery that is not completely routine. In that case, I will find a surgeon (usually at the Mayo Clinic in Minnesota) who has a lot of experience with the procedure and a good record.

 

(As an aside, let me say that dealing with the Mayo Clinic is a real pleasure. They truly run their business well in terms of competence, efficiency, and customer service.)

i can see the logic in having a centralized database, but there is a real problem with phi (especially given the hipaa laws)... just recently there were some medical databases hacked, i can't imagine the same not happening if there was one centralized one, and i imagine then that there would be some sort of backlash

[Lobowolf]

Given the veering over toward healthcare, this seems like a good place for an interesting re-post of a link to an interesting article on healthcare problems and potential fixes from an old friend of mine who has the new president's ear. Very general and superficial, but a good outline, and amusing read, and a good look and how and why workable solutions might not be as easy to spot as the current problems.

 

http://www.slate.com/id/2169454/

[PassedOut]

Given the veering over toward healthcare, this seems like a good place for an interesting re-post of a link to an interesting article on healthcare problems and potential fixes from an old friend of mine who has the new president's ear. Very general and superficial, but a good outline, and amusing read, and a good look and how and why workable solutions might not be as easy to spot as the current problems.

 

http://www.slate.com/id/2169454/

Good article. Thanks for the link.

[mike777]

Look at a US hospital. How many people are doing nothing but sending bills and keeping track of what doctor/technician did what to whom and what health insurance to bill for that? Does this insurance even cover these costs or does the patient need to be billed? Will the patient be able to pay? Or even worse: How much time does a highly qualified doctor spend on paperwork? At what hourly rate? Are these doctors handy at taking care of paperwork? These are all "middle men".

Responsible US businesses also have people spending far too much time on healthcare insurance issues, time that could be better spent furthering the core business. The cost to employers of the inefficient US system is very high, and is rising quickly.

 

Except for companies that profit directly from the inefficiencies of the US system, we'd all be better off if the government would accept its responsibility in this area, as other governments have done.

First time I can remember that one argues that usa government can manage/more efficient a multi billion/trillion buck program better than private sector...If true expect to see government handle much more.

 

Last time I checked medicare is deep in a hole but....look forward to hearing more facts that prove government is better.

 

Bottom line as I posted in an other thread if the government is smarter than free markets in managing/allocating capital in a program that is a powerful argument for more government.

 

 

In this case if government is better in regards:

1) innovation/technology in medical care

2) rationing

[mike777]

"GPs in most European countries keep the master record of "their" patients. People are generally listed with one and only one GP. As far as I have understood, people in the US tend to visit various physicians depending on where they are and what the problem is, and sometimes go "shopping" or seek second opinion. Correct me if I am wrong but this sounds as if it must make GP services very expensive."

 

 

This is very very accurate for the USA. In fact it is very common to fly thousands of miles to get a second opinion.

 

It is very common to change GP often in one's lifetime, very often.

[gwnn]

I found this ridiculous website today and it reminded me of this thread :P

 

There is a consequence.

 

http://www.lousytippers.com/

[kenberg]

I found this ridiculous website today and it reminded me of this thread :angry:

 

There is a consequence.

 

http://www.lousytippers.com/

This is a very useful site ( :) ) since it explicitly states that old people are exempt from criticism for not leaving tips. I think I will go back to yesterday's Mexican restaurant and retrieve my ten bucks. Yo muy viejo, muy, muy.

[PassedOut]

Kids today have it so easy. All you have to do to earn money is steal the pizza delivery person's tip. Back in the old days, we didn't have pizza deliveries! We had to mow lawns and deliver newspapers...

:angry:

[kenberg]

Yes, kids have it easy now. Still..

 

 

When I was ten or so my mother would give me money before Christmas so that I could buy gifts for the family. If she ever compared the total spent with the amount given she might have noticed that the difference was about the cost of a chocolate malt. Or maybe two chocolate malts.

[ggwhiz]

The Casinos in Quebec are government run and a dealer told me that unless the tips go above some large amount per shift, the government keeps them. They also pay their staff straight time on Christmas Day!

 

I only tip at Indian casinos now.

 

Best tip I ever made: My pard and I got to the playing site in South Africa a day early in 99 and they don't tip at all, at least not anyone black. Into the lobby bar I paid for 16 rands worth of drinks with a c-note and told the guy I don't like tipping every time, this is for the week and share that with the staff.

 

Next day between sessions, 6 deep at the bar, all hollering and our drinks were in front of us before we sat down. The look on my pards face was priceless and he coughed up another c-note.

 

3 a.m., lights out, drinks finished, lean over the bar and there is a fresh tray of glasses and a working draft tap. By the end of the week there may have been another dozen South Africans that started tipping.

[Fluffy]

There is a special person I know who is said that when he came to a casino in Montecarlo leaving his car, all the bellboys run towards him giving a reverence and ignored an arab sheik who had got out at the same time.

 

He payed high enough tips to acomplish that, but he weren't very rich, the key is, after eating/staying in a restaurant/hotel he would just leave by the front door without paying, and no employee was gonna stop him.