Practically Speaking

Kyle, I think you are confused! No one said they wanted the government to RUN health care. We just want government to PAY FOR health care.

Oh, and welcome to the large list of DMV affectionatos. We really ought to start a support group!

Hi Kyle,

When calling the DMV, I have found that the answer will vary depending on the person picking up the line.  I have had more success by going in person to the Waukesha DMV.  The wait time is not too bad if you are able to go on a weekday.  The desk clerks there, at least the ones that I have dealt with, have always been polite and helpful.  Additionally, there may be a "supervisor" on duty if someone doesn't know the answer or to resolve conflicting responses.

Good luck,

Roxanne

Kyle's reply: Thanks for the tip. 

Kyle - I'm surprised to read this column because, frankly, you impress me as being too smart to make this sort of correlation between the DMV and health care.  No one's suggesting that the government administer any aspect of the health care system in this country.  Here are some facts for you to consider.  The U.S. spends about 15% of GDP on health care; far above any of those scary, socialized-medicine countries.  Yet, the WHO ranks us 12th or 13th in nearly all health - related statistics; far below any of those scary, socialized-medicine countries.  In addition, there are more than 55 million Americans that have no health insurance and, subsequently, extremely inadequate preventative care.  I recently inquired about health insurance for my family and the price was approximately $1,100 per month for a family of three with a $5,000 deductible.  Ever had cancer, the representative asked me.  If yes, we'd not be eligible for a policy for 10 years after treatment.  Sorry Kyle, even Adam Smith acknowledged that unfettered capitalism leads to monopolies and abuse.  If you want to share alternative facts, please do so.  But, save the useless rhetoric...you're above it.  

Kyle's reply: Many times when I must deal with a government entity such as the DMV or the Internal Revenue Service I find it a very frustrating experience. I don't want to see our health care system (that already has problems) be mired with even more inefficiency.

There is no doubt that health care needs improving, but I believe we need more choice, not less. Cost will not go down unless people have more control, options, and incentives for saving money. The problem is, I don't believe we have "unfettered capitalism". What we have for many working people is the group plan. The employer offers the group plan and the workers sign on. Maybe the worker doesn't need all of that coverage, they only want a major medical plan. Well, you can't get that. There is not much choice.

If we could buy health insurance like we buy car insurance, I think costs could go down. You would have the option of just getting the liability (major medical) and take your chances if you wanted to on the other coverage. Then if you needed to see the doctor for minor things, you can be the customer and you would be shopping around for the best value for those coverages.

There was a plan like that offered a number of years ago. It was called the Golden Plan (?). It was major medical and several thousand dollars allowance for more minor items. If you used more than the money allotted for the minor items, then you were responsible for those costs. If you did not need the allotment money, I think you got to keep it! Now, that was what I call incentive. The plan however did not catch on because people wanted it to cover EVERYTHING. I still think a system like that has merit and would do a lot to keep costs down.

You can believe that socialized medicine countries have great health care, but the waits are months long for surgery. The UK for instance is starting to look at limiting who gets what kind of care because they cannot afford to cover everyone. Do you smoke? Overweight? Not vaccinated? You go to the end of the line.  I don't want to see that here.

Medicare is government run health care and it has been overwhelmingly successful in allowing seniors health care, with a very low administrative cost, far less than private health insurers' administrative costs. Without Medicare, most people over age 65 would have no health insurance. Employers are mostly out of the business of covering or offering coverage to retirees, and health insurance companies would not insure this group due to the widespread chronic health conditions in this age group--heart disease, cancers, Alzheimers, etc. I'm glad my parents have Medicare coverage--they would have no coverage without it and my Dad would have died at age 66 from prostate cancer, my mother would have died in her early 70's from a stroke. As id is, they received appropriate care and have survived, are near 80 and are active and relatively healthy. I contrast this to a friend who was also diagnosed with prostate cancer in his late 40's, but since he had no employer health insurance, and could not afford private health insurance, he had to sell his home and take out loans to afford surgery to save his life. He's starting out close to age 50 with nothing--

I work for an insurance company that does "individual underwriting" of life and health insurance. As far as private health insurance goes, be young and have no health issues--no asthma, no allergies, no cancer, no pregnancies, no accidents, no childhood onset diabetes, nothing--or you will not be able to purchase coverage that is worth anything to you--

forget about your annual mammogram or pap test, forget about checkups, forget about shots for your kids--not covered or there's a huge deductible and co-pay.  Remember, private insurance companies are int he business of making a profit. An underwriter cannot make profit for the company by insuring people who will have claims.

Kyle's reply: Yes, Medicare is a blessing to seniors, but, it is not an accurate comparison to private health insurance or what government run health care will be.  Medicare is only successful because all working people pay into it for their entire working careers, just like social security (today's workers are paying for those now retired).

Medicare also dictates what they will pay for this or that procedure--not the real cost of that procedure--they only pay what they are willing to pay a doctor. Many doctors will not take Medicare patients for that reason. They simply cannot afford to because the amount Medicare will pay them is not equal to their expenses. The younger people (us) who do not have Medicare must make up the difference in price, much like the insured people pay for those non-insured patients who show up in the emergency room. Seniors also have Medicare supplemental plans that run from about $200/single to $500/couple per month.

Medicare is NOT government run healthcare.  If you don't have a supplement to cover all of the things they don't pay for you will have large bills if you have surgery.  To say we want the government to pay for it is to forget where they get the money.  There are not many efficient government programs, so you can be sure that when the SUPPOSEDLY uninsured are covered by the taxpayers, not "the government" it is going to either cost a lot or the deficits will go up further jeopardizing the future for our children.  

Anyone with an ounce of common sense knows the problems with costs are the way the consumer is kept out of the decisions.  Here's an example:

My wife uses a PPAP machine for sleep apnea.  She is allowed to get a new machine every so often even if the old one is still working.  The insurance company only allowed her to go to one source and they billed the insurance company about $1100 and the insurance allowed them about $1000.  We found the machine online for under $500 and asked if we could buy it and send the bill to the insurance company and they said "NO".  There are millions of examples of that every year.  Why....because most people are insured through their employers and the fact is that the insurance companies are just acting as the administrator and are guaranteed to make a certain percentage of profit.  Therefore it is in the interest of the insurance company not to lower costs.  Six percent of $10 million is more than six percent of $7 million.  The government needs to regulate these kinds of things.  

Consumers should be allowed to know fees in advance and should be able to buy from sources of their choice.  Insurance companies should advise what they will pay and let consumers go shopping.  And the bogus equipment such as motorized carts is a real scam!  If you're too fat to walk and you're spending all your money on food, why should medicare buy you a scooter?  Common sense is what's needed and you will never get that from government, especially the lower level workers who are like Rhett Butler and "don't give a damn".

Lastly, people should not be allowed to go to emergency rooms for anything that is not life threatening.  Abuse by people who don't pay is also something that needs to be prevented.  

I have a traditional supplement that costs me just under $1800/year and it pays everything that medicare doesn't.  I pay $96.50/month for medicare and $42 for part D, so in total it still costs $289 per month for insurance.  I don't think it gets cheaper than that for private and good healthcare, and it could be cheaper with common sense controls put in place to allow the consumer more control in the decisions affecting cost.  Remember...there is no free lunch!

Kyle,

For your argument to make sense, you must assume that all government entities perform at the same level--they don't.

Also, you'll need to keep yourself in the dark about the remarkable rebirth of the VA Healthcare system.  See, for example www.ama-assn.org/.../gvsa1210.htm, or simple Google VA Quality.

I can already hear the chorus of "the VA can't be that good."  Such insistence plays into the hands of insurance companies and drug companies that are happy to keep you paying way too much for very mediocre care.  The facts are that a high quality, efficient, guideline and information technology driven healthcare system is what America needs, and it exists today at VA.

As usual Contrarian comes with a comment that just begs to provoke controvery.  I don't know if the drug companies are "ripping us off" but I'm certain the cost of research, trials, and getting approval are astronomical.  If they can't make a buck they won't do it, and we must admit that modern drugs are wonderful and greatly reduce health problems and extend life.  I do not get mediocre care!  As a matter of fact I have always gotten excellent care for the 50 years that I have been out of my parents home.  I think anyone who calls our system mediocre is uninformed and is just a parrot for government healthcare proponents.  No mention is made about the cost of the VA system because it's just buried in the budget and the numbers aren't readily available.  

I have to disagree with Kyle's comment about the "group plan" that many employers now offer. In private industry, the high deductible plan is spreading like wildfire, and is akin to major medical. My spouse is a professional working for Harley Davidson, which started this type of plan last year. He elected the "no cost to the employee" plan which had a deductible of $ 2,200 for him. It did have the result of making him more aware of health care costs--he didn't go to the doctor when he should have because it was all "out of pocket." Harley does throw in some money into an HSA but it is a fraction of the deductible and can easily be spent in a single office visit. Reminds me of my old Blue Cross Blue Shield group plan of years ago, where a single office visit cost me more than a week's pay--and I could not afford that back then,  since I also needed to feed my child that week. As I see it, the problem now is not that the "worker doesn't need all that coverage." It's that many private industry workers do need some coverage and no longer receive much. I know it is different in the public sector where benefits are fairly generous.

There is also a problem with "consumers" pricing health care "in advance." That requires the consumer to know what their diagnosis is before they've been seen and evaluated, and knowing what testing or procedures will need to take place. If you know you need a hip replacement, I suppose you can find out what the surgeon's fee will be, the anesthesiologist's fee, the hospital fee, the drug fees, the physical therapy fees, and then proceed to comparison shop on all that, assuming you can find price competitive providers who practice at the hospital you choose, etc. etc. For a more complicated problem, that may or may not require surgery, how can you "price shop" if you don't know what's wrong with you? That's what most health care costs involve, especially for the elderly. And most people don't know all the possible cost centers that impact what they pay, so would not know to call all these service providers, who are separately incorportated and bill you independently. If anyone has gone through medical bills for their elderly parents, you can attest to all the bills that come through from providers you never knew about. It's mind boggling!

Relative to the  quality of US health care providers, and the science that backs them up, they are the best and most advanced in the world. The problem is that we can't afford this health care system. Health care costs will continue to consume more and more of our gross domestic product until the system will be unsustainable. That time will come within the next twenty years, I believe, and there will be need for a major change in how health care is provided and paid for in this country.

I did intend to provoke controversy.  If the government, through the VA, is running the most efficient, safest and highest quality system in the country, we are fools to look past the lessons of VA simply because that system failed in the past.  The VA is a single payor system that avoids the high administrative costs of tracking and billing every little event.  It takes the dollars, provides the care, and has created the wherewithall to track and improve quality.  Look it up.

We can all be glad that Intewedm has gotten excellent care throughout his life.  We cannot do decision making by antecdotal experience.  The Institute of Medicine tells us that 100K Americans die of medical error.  We have third world infant mortality rates.  We have 60M uninsured Americans, filling our ERs because they have no other option, getting high cost, fragmented care.  We rank 37th in aggregate health statistics as measured by WHO (right up there with Solvenia, Costa Rica, etc).  We spend 16% of our GDP on health care, twice as much as most of the developed world, and they all get much better care.  The Drug Industry does spend on R&D, but they spend more on marketing.  Big Pharma lobbies well also.  They made sure that Medicare part D doesn't do large contract purchasing, keeping the costs up.  (The VA has a very effective competitive purchasing contracting process for drugs, resulting in much lower costs.)  Finally, if you ask any American CEO whats wrong in American business, they will tell you that they are hammered by health care costs.

The VA budget is actually a fairly simple one.  As a cabinet post, it is a line item that does only three things: VA cemetaries, disability benefits, and healthcare.  If it runs a drop of red ink, it has to go back to Congress at the end of the FY for a supplemental.  It is very well understood statisticly as a healthcare provider because of its simplicity.

So who is uninformed here?  American healthcare is in crisis. It is killing our people and killing our businesses.  Sticking our collective heads in the sand is foolish and dangerous.

Kyle's reply: The VA is a very different system than say Medicare. VA has complete control over its hospitals and doctors etc. Medicare uses the present medical system. Healthy Wisconsin was going to tax all workers and then have a limited amount of health insurance plans to choose from. Badger Care, I believe, is a govt. run program. It is all such a mess. I just want to make sure that the "cure" is not worse than the problems we already have. 

You and I do agree about drug companies. They promote a lot and push medications that do not necessarily cure the problem. These medications are expensive and have harmful side effects. Example: Cholesterol medications. I questioned why my father was taking a cholesterol lowering drug when his total cholesterol was lower than 100. The Doctor said, well we want his HDL to increase. I said, it won't increase under that drug, can't we do some nutritional supplements? Oh, the doc. said, we could switch him to Niacin (vitamin). Argh. FYI, Now those cholesterol lowering drugs are coming under fire because although they lower cholesterol, they do nothing about plaque, the problem that many doctors now believe causes heart attacks.
 

Kyle, Before buying into Tweeties 'profit hog private pay' vs. 'Medicare-like national health insurance' argument, you might want to read the following article:

Health Insurer Fined $9 Million for Dropping Breast

Cancer Patient in Middle of Chemo Treatment

www.foxnews.com/.../0,2933,332060,00.html

My guess is that Tweet was an insurance salesman in a former life. They are the only ones who can find anything good to say about health insurance in America. As for me, I say sue em good and sue em often!

I've had to file several law suits against insurance companies just to get the buggers to pay the bills. And I won ALL of them!

The quicker they're gone, the sooner we profit! They are THE bottom feeders in our pond.

Kyle's reply: I did see that bit of news. I am not saying the system is perfect, good, or not in need of improvement. BUT please remember that Medicare expenses, like Social Security, are not self sufficient. All workers pay in for those few collecting. What isn't covered under their fee structure is passed onto all using a facility's services. Again, there is no free lunch.  

Hi Kyle, welcome to the world of voice mail jail. Want a treat, try to straighten something out at Medicare, got to use a phone with a speaker and do some paper work at your desk or computer while you press buttons or try to get the puter on the other end to understand the voice commands. Oh well, so be it. Speaker phone at least lets you use both hands for something else.

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