Rant about medicare

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Most of the doctors I know simply won't take Medicare. Fortunately, I am working now so I have health insurance through my employer, but when I wasn't able to find work and used Medicare it was totally useless because no doctors in NYC take it! I can't really blame them - one told me he gets $7.00 for a doctor's visit for which he charges $150.

Has anyone else experienced this? What a total ripoff! I wonder whether Obamacare has any impact on this.

Really, the entire medical/insurance system in US is colosally f*ked up. I hope I don't get banned for using that abbreviation but the system is beyond dreadful. Why have I paid into this system for years and can't use it? What happens to the poor folks who have no insurance (I can hardly bear to think about it - my sister has nothing except what I can give her). Shame on everyone who devised this system and profits from it.
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I'm from the UK but the thought of America's healthcare system terrifies me!
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not quite there yet, but i can totally understand the drs not taking medicare. as a mental health provider, i will no longer accept it, even as a supplemental. the reason -- they make the paperwork you have to submit for billing totally ridiculous and they are never satisfied. so after countless hours doing paperwork, both myself and clients on the phone, i've never been reimbursed.
and, the healthy ny insurance, which picks up those who don't qualify for medicaid and cannot afford insurance, i will no longer take, either. it is based on income, so in the past i've had clients who met that limit and had healthy ny. then, the yr i was seeing them, they earned $1 over the limit, so the following yr insurance company asked for their money back. of course, i did not have to send them a check, but they would have deducted from fees i earned going forward, so... and, could i collect from people who are barely getting by??
it is downright scary. i have a friend from canada who is a us citizen, but she says she may very well return to canada when she retires so she will have medical care.
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I've been on Medicare for about 2 years now -- when I went deaf in 2008, I qualified for SSDI and then had to wait 2 years to be eligible for Medicare. I've been lucky, I guess -- I'm in Illinois and was able to keep all my regular doctors and my audiologist -- so I haven't had problems finding health care professionals that take Medicare. My mom hasn't had problems either, and she sees a variety of specialists as well as her regular doctor.

But I completely agree with your views on the US healthcare system! My kids were both on AllKids (the IL version of Medicaid for kids) and I had to switch from their regular pediatrician to one that accepted AllKids. I definitely noticed a difference in the level of care. Luckily, neither of them were ever really sick or had serious health issues.

I envy my friends in Canada!
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Everyone, thanks for responding. I don't want to seem like a grump but it just is so discouraging. I don't blame my drs. at all for not participating and at the same time why was I forced to pay into a system that is basically useless to me and so many others?

Could someone explain how the Canadian system works and why hasn't the US copied it?
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The biggest obstacle to healthcare reform in the US are the people who make money off of the current system- private insurance companies, pharmaceuticals, and companies that develop medical devices. They successfully lobby Congress to prevent any meaningful change. And forget anything resembling Canada's system- look at how many people rant and rave about Obamacare being socialized medicine (keep in mind that the entire concept of Obamacare was created by a conservative think-tank in response to Clinton's proposed healthcare reform in the 90s- there is nothing socialist about it).
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Could someone explain how the Canadian system works and why hasn't the US copied it?
Originally Posted by curlypearl
I'll provide a more detailed answer later (not good at smartphone typing!) but the primary feature is that it is single-payer: everyone pays into the federal government, which then subsidizes the provinces (analogous to states in the US), which administer payments to doctors and hospitals, both of which are private.

Because the gov't can use its leverage as the only buyer, costs are controlled and unnecessary tests and medications are eliminated. So Americans pay almost twice as much per person, yet have a lower life expectancy and higher infant mortality, among other things.

The UK is totally public (single payer, hospitals are govt owned & doctors are govt employees), while France has private insurance, doctors and hospitals that are paid according to contracts negotiated by the national government and financed through a payroll tax. This system performs the best, with the exception of Japan (which is unique for a number of reasons).

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Could someone explain how the Canadian system works and why hasn't the US copied it?
Originally Posted by curlypearl
I'll provide a more detailed answer later (not good at smartphone typing!) but the primary feature is that it is single-payer: everyone pays into the federal government, which then subsidizes the provinces (analogous to states in the US), which administer payments to doctors and hospitals, both of which are private.

Because the gov't can use its leverage as the only buyer, costs are controlled and unnecessary tests and medications are eliminated. So Americans pay almost twice as much per person, yet have a lower life expectancy and higher infant mortality, among other things.

The UK is totally public (single payer, hospitals are govt owned & doctors are govt employees), while France has private insurance, doctors and hospitals that are paid according to contracts negotiated by the national government and financed through a payroll tax. This system performs the best, with the exception of Japan (which is unique for a number of reasons).

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Originally Posted by yossarian
Yossarian, in the French system, what happens to those on disability?

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curlypearl, you should avoid the current Time magazine article about medical costs.

I’ve only read the first of several pages of it and it already has me seeing red.

The upshot, from the article:
“Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.”
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Yossarian, in the French system, what happens to those on disability?
Originally Posted by juanab
Everyone is covered, even if they can't work. In addition, paid sick leave is VERY generous.

You would think the system would be unsustainable (why should I work to subsidize someone sitting at home?) but health care costs are half those in the US, and the French have FAR less heart disease and diabetes despite consuming a lot more cholesterol and cigarettes.

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Last edited by yossarian; 02-25-2013 at 02:56 PM.
I haven't heard anyone around here mention that their doctors don't accept patients on medicare (not saying it doesn't happen, I just don't know of any). My parents have never had an issue with their doctors, but they did have problems with the local hospital and had to use a hospital 30 miles away for awhile. It was ridiculous.
The entire health care system needs overhauled top to bottom.
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Yossarian, in the French system, what happens to those on disability?
Originally Posted by juanab
Everyone is covered, even if they can't work. In addition, paid sick leave is VERY generous.

You would think the system would be unsustainable (why should I work to subsidize someone sitting at home?) but health care costs are half those in the US, and the French have FAR less heart disease and diabetes despite consuming a lot more cholesterol and cigarettes.

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Originally Posted by yossarian
Thanks for the answer. What is stopping the US from adopting the French system? Wouldn't be the easiest to transition to and more widely accepted?
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I haven't heard anyone around here mention that their doctors don't accept patients on medicare (not saying it doesn't happen, I just don't know of any). My parents have never had an issue with their doctors, but they did have problems with the local hospital and had to use a hospital 30 miles away for awhile. It was ridiculous.
The entire health care system needs overhauled top to bottom.
Originally Posted by jeepcurlygurl
I don't think a doctor's practice would last long in the state of Florida, if they didn't take Medicare.
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I don't think a doctor's practice would last long in the state of Florida, if they didn't take Medicare.
Originally Posted by juanab
lol good point!

My FIL is on Medicare, and has not yet been turned away because a doctor refuses to accept it.

Thanks for the answer. What is stopping the US from adopting the French system? Wouldn't be the easiest to transition to and more widely accepted?
Originally Posted by juanab
Yes, it would be, since all the components are private (insurance, hospitals, doctors and pharmaceutical firms). In fact,the Affordable Care Act ("Obamacare") is largely based on the Massachusetts health care reform, which is itself modeled on the French system. But there are several constraints that prevented us from going further.

The first is cultural. Contrast the American mantra of "life, liberty and pursuit of happiness" to its French counterpart of "liberte, egalite, fraternite" (liberty, equality, fraternity [as in brotherhood]). Ours places a heavy emphasis on the individual's right to choose his own path, whereas theirs evokes a sense of solidarity with & responsibility to,one's fellow citizens. In real terms, that means the French have a much broader conception of the role of government. To Americans, that smacks of {gasp} socialism. Every attempt to expand social programs has been met with dire warnings of creeping tyranny.

The second is economic. The US medical industry is comprised of a multitude of vested interests, who stand to lose a great deal if they had to deal with people collectively instead of as individuals. Imagine what a great deal you could get if Aetna, United Health, GlaxoSmithKline etc. had to negotiate prices for checkups, exams, prescriptions etc. with all of us as a group - we would have all the leverage. So of course they will fight tooth and nail to preserve the status quo, spending hundreds of millions to influence the political process.

In the UK and in France, universal health care was established in the aftermath of World War II, so they were essentially starting from scratch. There was also no other efficient way to take care of all the wounded and the refugees than with a government-run system. As a result, there was no organized resistance from the private sector. French doctors agreed to participate as long as they were free to practice as they chose & and patients were free to choose their own doctors. The insurance and pharmaceutical companies had no choice but to go along, or they would have been nationalized.

So the US is behind the 8 ball when it comes to a genuine reform of a broken system. I'm ecstatic that we've taken a big step forward with the ACA, but it's too watered down to fully address costs and access. But it's a start!
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Last edited by yossarian; 02-25-2013 at 10:41 PM.
I don't think a doctor's practice would last long in the state of Florida, if they didn't take Medicare.
Originally Posted by juanab
lol good point!

My FIL is on Medicare, and has not yet been turned away because a doctor refuses to accept it.

Thanks for the answer. What is stopping the US from adopting the French system? Wouldn't be the easiest to transition to and more widely accepted?
Originally Posted by juanab
Yes, it would be, since all the components are private (insurance, hospitals, doctors and pharmaceutical firms). In fact,the Affordable Care Act ("Obamacare") is largely based on the Massachusetts health care reform, which is itself modeled on the French system. But there are several constraints that prevented us from going further.

The first is cultural. Contrast the American mantra of "life, liberty and pursuit of happiness" to its French counterpart of "liberte, egalite, fraternite" (liberty, equality, fraternity). Ours places a heavy emphasis on the individual's right to choose his own path, whereas theirs evokes a sense of solidarity with & responsibility to,one's fellow citizens. In real terms, that means the French have a much broader conception of the role of government. To Americans, that smacks of {gasp} socialism. Every attempt to expand social programs has been met with dire warnings of creeping tyranny.

The second is economic. The US medical industry is comprised of a multitude of vested interests, who stand to lose a great deal if they had to deal with people collectively instead of as individuals. Imagine what a great deal you could get if Aetna, United Health, GlaxoSmithKline etc. had to negotiate prices for checkups, exams, prescriptions etc. with all of us as a group - we would have all the leverage. So of course they will fight tooth and nail to preserve the status quo, spending hundreds of millions to influence the political process.

In the UK and in France, universal health care was established in the aftermath of World War II, so they were essentially starting from scratch. There was also no other efficient way to take care of all the wounded and the refugees than with a government-run system. As a result, there was no organized resistance from the private sector. French doctors agreed to participate as long as they were free to practice as they chose & and patients were free to choose their own doctors. The insurance and pharmaceutical companies had no choice but to go along, or they would have been nationalized.

So the US is behind the 8 ball when it comes to a genuine reform of a broken system. I'm ecstatic that we've taken a big step forward with the ACA, but it's too watered down to fully address costs and access. But it's a start!
Originally Posted by yossarian
Thank you. That makes sense. I really believe it will change. People are getting fed up.

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I haven't heard anyone around here mention that their doctors don't accept patients on medicare (not saying it doesn't happen, I just don't know of any). My parents have never had an issue with their doctors, but they did have problems with the local hospital and had to use a hospital 30 miles away for awhile. It was ridiculous.
The entire health care system needs overhauled top to bottom.
Originally Posted by jeepcurlygurl
I don't think a doctor's practice would last long in the state of Florida, if they didn't take Medicare.
Originally Posted by juanab
Same here in PA where the population is older.
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Thanks for the answer. What is stopping the US from adopting the French system? Wouldn't be the easiest to transition to and more widely accepted?
Originally Posted by juanab
Yes, it would be, since all the components are private (insurance, hospitals, doctors and pharmaceutical firms). In fact,the Affordable Care Act ("Obamacare") is largely based on the Massachusetts health care reform, which is itself modeled on the French system[/QUOTE]

interesting about massachusetts -- my son and daughter-in-law, and 2 granddaughters live in massachusetts. they have health insurance through my daughter-in-law's employer, a pharmaceutical company, and pay $8, EIGHT dollars, per month for family coverage. they can see any dr they want. i know both my granddaughters were born in mass gen, a good hospital. i always assumed it was because their insurance was thru a pharmaceutical employer, but now you are saying that massachusetts has health care reform based on the french system. why can't the rest of the country follow suit?

since this seems too good to be true -- another question -- are the drs earning a living wage? (clearly their own health insurance would then be affordable so that would be one personal cost lowered, LOL!)

i'm not following the other part of your discussion. it seems that the insurance companies just name the reimbursement rate, not individuals nor doctors. there does not seem to be any negotiation with anyone. i know in my profession here in ny at least, united healthcare has gobbled up many insurances, if not the whole package, then at least the mental health part, and so consequently they are naming the reimbursement rates, copays, like a monopoly.
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Thanks for the answer. What is stopping the US from adopting the French system? Wouldn't be the easiest to transition to and more widely accepted?
Originally Posted by juanab
Yes, it would be, since all the components are private (insurance, hospitals, doctors and pharmaceutical firms). In fact,the Affordable Care Act ("Obamacare") is largely based on the Massachusetts health care reform, which is itself modeled on the French system
Originally Posted by rbb
interesting about massachusetts -- my son and daughter-in-law, and 2 granddaughters live in massachusetts. they have health insurance through my daughter-in-law's employer, a pharmaceutical company, and pay $8, EIGHT dollars, per month for family coverage. they can see any dr they want. i know both my granddaughters were born in mass gen, a good hospital. i always assumed it was because their insurance was thru a pharmaceutical employer, but now you are saying that massachusetts has health care reform based on the french system. why can't the rest of the country follow suit?
In order to sell policies in MA, health insurance companies must submit plans to the state for approval. As a result, prices and options are much more reasonable than under a typical health care regime. In addition, the state provides assistance for poor individuals and families to buy insurance.

The flip side is that all MA residents must purchase insurance (the "individual mandate") so that insurance companies can spread their risk across a pool of both healthy and sick people. Otherwise, the majority of people buying policies would be those with pre-existing conditions, and the insurance companies would go bankrupt.

Why can't the rest of the country do likewise? Because of Americans' traditional hostility to any government involvement in the economy. It is typically portrayed as an invasion of privacy and an instrument of control. You should hear the arguments that were made against Medicare - you'd have thought the country would become a Stalinist gulag! Right wingers organized a campaign called "Operation Coffee Cup" to whip up opposition to the proposal. Future president Ronald Reagan even cut an album to support the effort (Ronald Reagan speaks out on Socialized Medicine - Audio - YouTube)

And now we couldn't imagine eliminating Medicare. Yet some people don't get that this is national health care for the elderly and disabled - hence the "Keep the government out of my Medicare!" signs at protests against Obamacare. Ignorance kills.

I must also say that President Obama did a p*ss poor job selling the program to the public. The facts speak for themselves: we spend more than any other advanced democracy on health care, yet are much less healthy by any measure. Pay more, get less! But Obama really didn't lay out the case in persuasive way. Did you know that before the ACA was passed, 50,000 Americans died every year because they lacked health insurance? If not, you're not alone.

We also have this irrational hatred towards all things French, especially since they refused to go along with the invasion of Iraq. So there's a reflexive objection to the idea of emulating the French system, even if it would benefit millions of Americans. Freedom fries for all

since this seems too good to be true -- another question -- are the drs earning a living wage? (clearly their own health insurance would then be affordable so that would be one personal cost lowered, LOL!)
Doctors in the US make about twice what French doctors earn, BUT there are a few caveats. Medical schools in France are free, so if you are good enough to get in, you don't have to worry about graduating with $200,000 in debt. Malpractice is also not a major issue in France like it is here, for several reasons. Yes, tort (injury) lawsuits are excessive here, but the larger problem is that incompetent doctors are allowed to continue practicing medicine, even if they have numerous complaints against them. State medical boards are generally made up of doctors, and are reluctant to rule against a colleague. 85% of doctors who have been found guilty of malpractice 4 or more times are not even disciplined. As a result, a few bad apples cost us all a fortune: 5% of doctors account for 53% of malpractice awards. Not only is this expensive, it's also scary as a patient!

i'm not following the other part of your discussion. it seems that the insurance companies just name the reimbursement rate, not individuals nor doctors. there does not seem to be any negotiation with anyone. i know in my profession here in ny at least, united healthcare has gobbled up many insurances, if not the whole package, then at least the mental health part, and so consequently they are naming the reimbursement rates, copays, like a monopoly.
Yes, that's the point - individuals and small businesses face a "take it or leave it" proposition in regard to medical insurance. We simply have no bargaining power. OTOH, those who are able to negotiate as a group (such as unions and larger firms) are able to get much better policies. There is strength in numbers, which the single-payer systems use to great advantage.

ETA: One point I forgot to make earlier - if you need any proof of the extent to which insurance & pharmaceutical companies manipulate the system, note the fact that Medicare Part D (prescription coverage) does not pay for mail-order medication from Canada, even though it would save taxpayers billions.
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Last edited by yossarian; 02-26-2013 at 08:31 AM.
i would just like to add that my marginal tax rate would probably cause all of you to go:



but i've had 3 surgeries in the past 20 years, including one with serious complications, and walked into and out of the hospital without a penny changing hands, no credit cards, no bills.

my sister and i got money BACK from the Quebec health system after my father died - his cancer care cost us nothing. the same with mom's spinal surgery last fall.
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just have to add that my canadian friend was telling me her mom is sick, has emphysema, and is now entitled to FREE HOUSECLEANING once a week, in addition to meals delivered to her 3x/day for $4 each meal (i guess like a meals on wheels, which is only once a day, tho.)
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