Why do 92% of the French buy Supplemental private health Insurance if they have Single Payer?

[FrenchieCat]

Many French buy supplemental health insurance in France, to supplement their socialized Single Payer Health Care system. I know...cause I see advertisements for it when I go to France.

Why do you think that is, considering that their Single Payer Health is supposed to be the best one of the bunch?

It is because they have a 2 tier health care system....just in case some didn't know.

Higher Taxes (than here) pay for the socialized system, and people buy supplemental out of their pocket.

Just in case some weren't familiar with this system. My point is that Insurance companies
are still in the game.....

Private Insurance. “More than 92% of French residents have complementary private insurance.” This insurance pays for additional fees in order to access higher quality providers. Private health insurances makes up 12.7% of French health care spending. These complementary private insurance funds are very loosely regulated (less than in the U.S.) and the only stringent requirement is guaranteed renewability. Private insurance benefits are not equally distributed so there is, in essence, a two-tier system.

Physician Compensation. French doctors are paid by the national health insurance system based on a centrally planned fee schedule, but doctors can charge whatever price they want. The fees are based on an up front treatment lump sum, which is similar to DRGs in the U.S. The patient–or their private insurance–must make up the difference between the fee charged by the doctor and the amount paid for by the universal health care system. The average French doctor earns only €40,000, although medical school is free for them and the French legal system is fairly tort-averse.

Physician Choice. The French have a fair amount of choice in which doctors they choose. However, recently the French have moved towards a more “managed care” practice style where patients have a “preferred doctors” who acts as a gatekeeper for specialists.

Copayment/Deductibles. 10% to 40% copayments.

Technology. The government does not reimburse new technologies very generously and because of global budgets and fee restrictions, there is little incentive to make capital investments in medical technology.

Waiting Times. France has generally avoided waiting lists, likely due to the fairly high coinsurance charges. Recent trends towards Increased restrictions, reduced reimbursement rates, and rationing has increased wait times however.

Tanner’s summary. “To sum up: the French health care system clearly works better than most national health care systems. Despite some problems, France has generally avoided the rationing inherent in other systems. However, the program is threatened by increasing costs and may be forced to resort to rationing in the future.” http://healthcare-economist.com/2008/04/14/health-care-around-the-world-france/

[FrenchieCat]

1. Also, one of the reasons that many of the doctors are women is that

in France, Doctors don't earn a whole lot....but then, Medical School is Free.

We don't have Free Medical School here, so I'm not sure how single health could work here..... Guess that would have to happen too, hey? Free Medical School, I mean. :shrug:

[ZombieHorde]

2. Why would we have to copy them? nt

[FrenchieCat]

4. I'm just asking.......

because France's single payer is said to be the best, in terms of no waiting, no rationing.

[ZombieHorde]

5. Many people in the U.S. wish to expand medicade and medicare into single payer

since these systems are already in place. If you wish to know about France, you may do better asking French people.

[FrenchieCat]

7. I know a little about France......

I'm asking those single Payer advocates here exactly how this would work here in the US.....
since they want it, and want it now.

How much would we pay into this single payer system proposed here in the state, as far as individuals? What about businesses? Would they pay too?
Would coverage cover everything for everyone, or would we be offered to buy supplemental coverage,
like they do in France?

[ZombieHorde]

8. I think it is pretty cool 92% of French peope can afford supplemental coverage.

How much does this supplemental coverage cost? What does this supplemental coverage give them? If someone broke their leg, what additional treatment would supplemental coverage offer?

[FrenchieCat]

10. What happens is that when you go to the doctor,

depending on the doctor, he/she can charge you what they want (or what the market will bear), yet what the doctors get paid from the Government is one set fee for any given procedure.

Those docs can charge you more than the gov set fee though...and that is what the supplemental insurance is for....to pay the difference between what the government will pay and what you are actually charged. There are deductibles, and co pay that can range anywhere from 10% to 40% of the remainder.

Perhaps you want to go see someone with a great reputation who treats the richer folks....
you have to pay for that.

That's why it is considered a two tier system.

Those who are more affluent can get better health care than those who are not....but indeed, everyone gets health care as a basic right. Of course, everyone is paying for this via taxes....so it isn't really "free"....but the cost is certainly contained.

[ZombieHorde]

14. Interesting. Do you know anything about Canada's system? I don't.

I think we should look at the strengths and weaknesses of many systems before deciding.

A good start for gathering funds would be to end the war on drugs, release all victimless drug offenders from jail and prison, and tax drug sales; but this is a whole other issue in it self.

[FrenchieCat]

18. I think we can only walk back into a single payer.......

Make insurance companies less of a factor, and start using a public option to regulate prices and cost....and go from there.

But of course different folks will agree to disagree with my take.....and I understand that very well.

[Spazito]

199. In Canada, doctors cannot charge over the fee they have negotiated with their Provincial Governments

"Reimbursement mechanisms
• Physicians are reimbursed predominantly on a fee-for-service basis by the provincial
government; the fee schedule is negotiated between the provincial government and the
provincial medical association <1>.
• Most hospitals receive a global budget from the government, which is negotiated on an
annual basis. The hospital must find a way to stay within this budget from year to year <1,3>."

The patient does not pay that fee to the physician, the physician bills the government for the service.

Here is a good overview of how our system works:

http://www.amsa.org/studytours/CHS_FactSheet.pdf

[Doremus]

52. In the US, docs who participate in Medicare agree to accept the govt fee schedule.

Medicare patients who opt for supplemental policies do so to cover the portion that Medicare doesn't cover, not to pay the providers higher fees. Doctors who agree to see Medicare patients accept assignment, meaning they can't charge more than the approved rates.

On that distinction alone, I'd say our Medicare system is superior and it's high time they allowed all of us to enroll.

[ejpoeta]

200. i have to agree with you. they system is already in place and has a structure set up.

sure there would need to be some tweaking, i guess, but it's better than letting the insurance industry control any 'public' option. then let anyone join medicare, without the financial constraints. but their pay towards it would depend on income. or whatever they set up. then we would see how many really like their insurance or would opt for the public system. i would wager that eventually most folks would have the public option and maybe then we could switch the profit insurance companies to a supplemental insurance or something.

[Joe Chi Minh]

57. In spite of all that devilish taxation! amazing....

[Two Americas]

80. you don't?

You don't want single payer?

What is wrong with "now?"


...

[eridani]

130. You might try googling HR 676/1200

Instead of my $450/month "premium" I'd be paying a $150/month "tax."

Businesses would pay 10%, with reductions for startups and small businesses.

[AspenRose]

62. Her mom is French. She was born in France.

She's called "Frenchie Cat" for a reason :dunce:

But she's been here quite a while now.

[dbmk]

28. It is not single payer.

"The patient–or their private insurance–must make up the difference between the fee charged by the doctor and the amount paid for by the universal health care system."

=

Not single payer.

[Better Believe It]

71. Who says Frances health care system is the best?

It certainly is cheaper and better than the United States for profit system, but I haven't read any posts on DU indicating that the French system is the best system.

I'd like to read those posts.

Please provide a link to them.

Thanks.

[Hippo_Tron]

127. It was ranked #1 by the World Health Organization in 2001

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/

Canada was ranked 30th and the United States was ranked 37th.

[Mass]

99. The no rationing has nothing to do with the insurance. There were no rationing before they were

part of the system. It is based on the fact that doctors are private practitioners who decide what they are going to do, not a private or state insurance.

[kaygore]

111. Actually, France is considered about middle of the pack

But, we could take the best from various comprehensive federal run plans. Right now, a friend is in terrible pain and has been for over a month because she needs a hip replacement. She has to wait another month before there is a slot. A friend of mine fell and broke his hip in the UK a couple of weeks ago. The doctors recommended a hip replacement and he waited two days. He is now in rehab over there and will return when he is able to the US to finish his rehab. Cost to him=$0! Time to wait=two days!

There are problems with every system, but ours is the worse and a major reason is the greed and arrogance of the insurance companies. We have supplemental for Medicare right now and would probably have private supplemental health insurance here if we could get a program where we were all covered by Medicare. Cost would be reduced by 30% immediately and we could also bargain for drugs which would further reduce costs.

[kaygore]

112. PS--My friends in France LOVE the system

Two of them were US citizens and left the country after Reagan and changed their citizenship. All my French friends are horrified at the stories they hear of health care in this country.

I spent several months in the UK and France last year. Since I didn't have anything better to do, I would question people about their views of their health care. Everyone I spoke with in the UK and France said although their health care was not perfect, they had no complaints and would not change it. That certainly can't be said by most Americans.

The backlash on elected officials will swamp them if they sell us out on this.

[Hieronymus]

101. Why not copy the number one rated health care system in the world?

[ZombieHorde]

113. The best can often be approved upon. nt

[Hippo_Tron]

126. Do you have any suggestions as to how to improve upon the French system?

[ZombieHorde]

131. Make it single payer, 100% paid.

[Hippo_Tron]

132. They have single-payer in Canada, it's ranked 30th by the WHO

France is ranked 1st by the WHO so I don't see how single-payer is better than what France has. Both are an improvement over the status quo, though, because the United States is ranked 37th.

[ZombieHorde]

139. There must be some other difference than all paid versus some paid.

Though if the difference is cultural, it will be difficult to emulate.

[Hippo_Tron]

140. It's about the incentive structure and not having the 100% reimbursement is a good idea

Basically, the sicker you are, the more your expenses are reimbursed by the government. Thus, essential treatments get reimbursed at 100% and less essential treatments get reimbursed at a lower rate. Under single-payer everything that is covered would presumably get reimbursed at 100%.

There's a good article about it here. http://abcnews.go.com/Health/Story?id=4647483&page=1

The woman was saying that because she had cancer, her expenses were 100% paid for by the government. This ensures that anybody who needs these essential cancer treatments gets these essential treatments. Less essential treatments are not 100% covered, probably closer to 80%. The private supplementals pay part of the difference, I believe. I think the government also subsidizes those that can't really afford private insurance.

But the point is that if you want a non-essential treatment, you still have to pay something and that is a good incentive structure because some people will choose to save their money and not get the non-essential treatment. This means that fewer doctors, nurses, and hospital equipment will be used for non-essential treatments and more used for essential treatment.

The biggest cultural problem is the fact that doctors make a lot less in France and also that they don't pay for medical school. But that would be a problem if we implemented single-payer as well because doctors probably wouldn't make as much, either.

[Spazito]

201. Here is some info on the WHO report...

WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).

Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people's needs.

Fairness of financial contribution: When WHO measured the fairness of financial contribution to health systems, countries lined up differently. The measurement is based on the fraction of a household's capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments). Colombia was the top-rated country in this category, followed by Luxembourg, Belgium, Djibouti, Denmark, Ireland, Germany, Norway, Japan and Finland.

Colombia achieved top rank because someone with a low income might pay the equivalent of one dollar per year for health care, while a high- income individual pays 7.6 dollars.

Countries judged to have the least fair financing of health systems include Sierra Leone, Myanmar, Brazil, China, Viet Nam, Nepal, Russian Federation, Peru and Cambodia.

Brazil, a middle-income nation, ranks low in this table because its people make high out-of-pocket payments for health care. This means a substantial number of households pay a large fraction of their income (after paying for food) on health care. The same explanation applies to the fairness of financing Peru's health system. The reason why the Russian Federation ranks low is most likely related to the impact of the economic crisis in the 1990s. This has severely reduced government spending on health and led to increased out-of-pocket payment.

In North America, Canada rates as the country with the fairest mechanism for health system finance – ranked at 17-19, while the United States is at 54-55. Cuba is the highest among Latin American and Caribbean nations at 23-25.

The report indicates – clearly – the attributes of a good health system in relation to the elements of the performance measure, given below.

Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/ AIDS, among other causes.

Distribution of Health in the Populations: It is not sufficient to protect or improve the average health of the population, if - at the same time - inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. The health system also has the responsibility to try to reduce inequalities by prioritizing actions to improve the health of the worse-off, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. A gain in either one of these, with no change in the other, constitutes an improvement.

Responsiveness: Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider).

Distribution of Financing: There are good and bad ways to raise the resources for a health system, but they are more or less good primarily as they affect how fairly the financial burden is shared. Fair financing, as the name suggests, is only concerned with distribution. It is not related to the total resource bill, nor to how the funds are used. The objectives of the health system do not include any particular level of total spending, either absolutely or relative to income. This is because, at all levels of spending there are other possible uses for the resources devoted to health. The level of funding to allocate to the health system is a social choice – with no correct answer. Nonetheless, the report suggests that countries spending less than around 60 dollars per person per year on health find that their populations are unable to access health services from an adequately performing health system.

In order to reflect these attributes, health systems have to carry out certain functions. They build human resources through investment and training, they deliver services, they finance all these activities. They act as the overall stewards of the resources and powers entrusted to them. In focusing on these few universal functions of health systems, the report provides evidence to assist policy- makers as they make choices to improve health system performance.

Edited to add link:

http://www.who.int/whr/2000/media_centre/press_release/en/index.html

[clarence swinney]

172. single payer 100%

Amen

Tax

pay tax--wow!

20% GDP=2480 Billion/yr

a boon for small business.

force richest to pay fair percentage

cut costs--remove insurance firms--

preventative programs

age 70 bang bang you gone you are too expensive

[Hippo_Tron]

125. I've been asking that question a lot lately

Been told by some people that it can't work in the United States, basically because Americans are different than the French.

[tkmorris]

3. Holy crap, you are arguing for private insurance now?

I always figured actually jumping over a real shark was harder than it sounds, is it true?

[FrenchieCat]

6. Now that you have had your snark.....maybe we can have a conversation....

Isn't that what its supposed to be all about?
I don't claim to know everything about Single Payer.
But what I do know is that the French purchase Private supplemental insurance
and French government provides free medical school.

Why don't we talk about that, instead of giving me the freeper "treatment"?

What are you predicting as the method to make single payer health different in America?
How will it be paid for, and what would be done to make it different from France?

[tkmorris]

26. Fair enough, and my apologies for the snark

It stems from the impression I get from you, which is "Obama is always right, therefore I must formulate my argument so that it best proves it". Can't you see the problem with that? I think it far better to use logic to arrive at what we believe the best solutions to be, then ask Obama to support those positions if he doesn't already. Perhaps you do this and it simply isn't apparent. It certainly seems as if you go at it from the other direction.

In any case France's health care system isn't quite "universal single payer health care". It is more accurate to say that the govt there subsidizes health care, paying some or most of the cost for a given visit or procedure. Much like here, where our private insurance rarely covers the full cost of anything. We have deductibles, and of those things that are covered often we find that what our insurance is prepared to pay is not what our health care professionals are prepared to accept. We pay the difference. So do the French. However in France they can purchase mutuelle (private insurance) that pays for what the govt doesn't. None of this contradicts what you said BTW, I merely put it out there because it is important to understand the French model for health care, and it isn't universal single-payer nor is it meant to be. Which is of course why there is so much supplemental insurance coverage.

I think we would do far better to emulate Canada's model for our health care system. Supplemental coverage is not needed there for most any necessary procedure, but is available for those who want things covered that the govt system doesn't. Which isn't a lot frankly.

As for what I am predicting, I'm not. I will say that universal single payer has been successfully demonized enough that the public doesn't support it well enough to overcome Congress, who tends to vote as their largest donors dictate (hint: that aint you and me). If the public outcry was large enough we could force their hand but alas...

So, we are left with making as much single payer noise as we can, then accepting a "public option" as a compromise. I do feel that if we can get a public option out there, and keep our opponents from gutting it, the momentum will carry more and more people to it, thus achieving single-payer in the end. I think that is the best we can hope for at this point, but of course since we are fighting City Hall quite literally here, it is NOT the place to start negotiating from. We must demand the Sun, knowing full well the Moon is the best we can get.

How do we pay for it? Taxes pure and simple, just as we pay for everything else, but how much do we need to raise taxes versus cutting other budget items? What budget could we cut? In answer to that I offer the following without comment:



We have the money. It's simply a matter of priorities.

Once again I'd like to apologize for the snark and I welcome your invitation to have a civil (and hopefully educational) conversation about these matters. I mistakenly assumed you were not open to one. Mea maxima culpa.

[Enthusiast]

30. But but but, how in the world

will we stay safe? :sarcasm:

Look, these over-represented Republican talking heads on TV are already saying President Obama has slashed military spending to the bone. One would think there are no longer any bullets for the guns, if they listened to these advocates of the military industrial complex.

I don't think the American citizen is aware of the realities of our military spending. Duh.

[TheBigotBasher]

33. Have they explained why a 5% increase in budget

is slashing spending? From what I saw, it was changing the budget from toys that do not work to stuff that may actually be needed in a war.

As for health care systems, expanding medicare to all would be a good step towards bringing yje US to a system like the UK NHS. France is actually moving to a similar model, with the introduction of GPs as "gatekeepers" because it helps tp keep costs down.

[CTyankee]

38. Since we are an empire, we need a strong military, but we also need a "wise" military.

No more totally insane wars fought for nothing. No more torture that only produce more enemies for us to fight.

Wishing that we could have military spending along the lines of Canada or France is a waste of time, IMO. Sure it's a drag on other spending the government could do, but it is not realistic.

[Two Americas]

83. well...

We need a military that will defend an empire so long as we are committed to having an empire.

But I do think that many people support Democrats in order to have a more competently managed and stylishly presented empire, and military industrial complex. Naturally enough, that puts them at odds with those who are in any way slightly left wing politically, and the cause of all of the battles around here.

So the reason to stop torture and illegal wars is because they place the empire at risk? The Republicans are too ham-handed, apparently, but you want to see the same agenda pursued but with more intelligence and finesse?

I do not think the public elected Democrats thinking they were supporting the agenda you present here. Not that the people have much say. But that could backfire on the party, should your views prevail.

Interesting comments. When I suggested before the election that some people were actually supporting exactly what you are saying here, and not anything "progressive" or "liberal," that was vehemently denied.


...

[Two Americas]

84. that is really interesting

That is really interesting, the more I think about it. We can't afford to take care of the people, because we are an empire, and an empire requires massive military spending. Yet here over the months when people have said that this could be the thinking of those beating on the Left, it was denied.


...

[w4rma]

45. But Wall Street needs that military budget and they have priority. Other nations might nationalize

the multi-nationals' overseas factories without that military. Oil companies would have to pay more for their product without that military budget.

[Kalyke]

94. LOL!!! I just said the same thing before reading your post.

It stems from the impression I get from you, which is "Obama is always right, therefore I must formulate my argument so that it best proves it".

Agreed.

[Forkboy]

147. Man, we could so kick Luxembourg's ass.

:hide:

[JVS]

194. Wouldn't it be cheaper to hire Russia to kick their ass though?

[Norrin Radd]

206. It would be a quagmire.

Copious amounts of booze, rich food, and TV. We'd never want to leave.

[girl gone mad]

82. But it isn't easier for you to argue against single payer..

in America when you yourself have the option of getting free treatment in France?

[cyclezealot]

9. We live here.

The Carte Vitale pays for like 80% of a hospital bill.. It's not like there are a line up of insurance choices. The supplemental plan pays for the rest. Except for the 3 euro deductible.. As low as costs are here in France. who cares. My wife spent seven days in the hospital , the total bill including surgeon's fees were only 1200 euros... Probably the total deductible under the average American plan..
It's not like there are a large number of insurance companies to choose from.. There is only one approved insurance plan for the supplemental portion from which to choose. Yes. There are private hospitals. My wife used one this past December. Total fee for 7 days. Again. 1200 euros.. They are regulated as is the supplemental insurance plan.
The cost for the supplemental insurance to cover the final 20% of your bill.
For a family of two..
240 euros , = every 3 months.
.. ps. the use of the word gatekeeper.. Not quite what Americans have come to learn.
You go thru you GP because you must keep him informed of your overall medical situation. Never once has that doctor been under obligation to deny you services.. At 22 euros a visit. who cares. actually 3 euros.. the deductible.

[FrenchieCat]

11. Thanks for the detailed information.

So we are talking about approx $320 or so per quarter for a family of two...for the supplemental insurance.

What's the tax rate in France including what they don't call "Tax" but is Social Security?
I know that Sales tax is like 19% or so, but is built into the price so that you don't really see it.

Now....if only they could make Medical School free here like it is there.

[cyclezealot]

12. With single payer , we' d have recourse for bad doctors.

WHo are the source of our malpractice problems. W/0 millions spent on legal fees to make your case.. That would be as cost efficient as less costly medical educations.

[FrenchieCat]

15. I would love free College here, period.

My daughter is graduating from Harvard next month...and that cost an arm and a leg.

What part of France are you living in?

[cyclezealot]

20. In Roussillon

Near where the the Mediterranean and Pyrenees meet. Beautiful area. /.Part of the reason we are here. American HMO's . they almost destroyed my wife by letting her cancer get out of control. The U.S. , GP would not give us a referral.

[FrenchieCat]

22. I do not know that area well....although I have heard that it is beautiful.

I was born in Paris, in the 10th arroundissment.

[cyclezealot]

27. Which region of Paris is that..

We have a great friend we visit often who lives near the Pere Lachaise. We really relate to the Moore film Sicko. We took some friends to see it. They were aghast.. And the scene of American national saying how guilty they feel , using French social benefits and knowing the pain Americans live under. They felt guilty. We'll the Americans we know, relate very much to that scene. ..Comment from a French doctor in the audience. His question.. Do American doctors have to take the Hippocratic oath.. ?

[Bluenorthwest]

35. Thanks for the reality based information

I always notice how those who are not living in a system have such a fully diffrent explaination of things. Your assesment is so different from those who are not living with that system.

[clarence swinney]

173. free college

Remember California education system rated tops in world

Then Came Reagan.

GI BILL GREATEST THING SINCE beauty rest electric blankets

EDUCATION + HOMES + VET MEDICAL CARE

[OwnedByFerrets]

50. Thank you for a fantastic post!!

[Overseas]

81. Disappointing that the editorial ignores some important facts you gave us.

But it helps us understand how the Healthcare-For-Profit industries will be distorting information about other international public health systems.

Hey, most French people get supplemental insurance !

== Without letting us know that's because national health pays for 80% (!!) and the insurance is for the 20% it doesn't!

[Overseas]

85. And talks about physician choice as a problem-- as though we had it in the USA

The 46 MILLION people with no insurance have ZERO choice in doctors. Avoid them at all costs. Emergency room if you hurt to badly to ignore it.

The millions of us pushed into HMO's in order to maximize Big Business Healthcare profits don't have our choice of doctors. We get to choose among the approved list of doctors or pay a lot more to go outside the system.

The millions with pre-existing conditions who lose their coverage at work have no choice any more.

While our congress-people have been pampered with great health coverage all these years, the rest of us haven't been nearly as lucky.

The question should be--
Do you want to pay $500 per month for healthcare in order to preserve your right to choose among the list of doctors your HMO has chosen for you?

OR
Do you want to pay $100 per month for non-profit healthcare with the choice of doctors who are participating in the national health plan?

CHOICE is a false issue for the majority of Americans. So many of us have very limited choices now.

[clarence swinney]

174. hmo pay off physicians

Patient Premiums vs Expenses

Do not send patient to Specialist

How many doctrs get a kick back?

[Overseas]

86. And it carefully avoids mentioning the reasonable prices French pay for health care.

I've heard from friends about the low cost of health care in France.
You reported the same.

But US health industry corporate propaganda will be careful to avoid those attractive details.

[Zenlitened]

155. Kind of ironic, too...

... given the OP's penchant for accusing people of getting played by the media. Or, worse yet, abetting the media in deception.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8410050&mesg_id=8410346

[Hippo_Tron]

13. The French have the best system in the world according to the WHO

And it's actually not single-payer, they have multiple pseudo-government run "sickness funds" that pay for most of the expenses and then most of them own supplemental insurance. And it is two tiered but also it is the best in the world. Personally I think we should copy their model completely because it works but many of the single-payer advocates here aren't fond of that idea.

There are really two camps in this debate. Those who are most concerned about getting the uninsured some access to health care ASAP and those who want to punish the insurance companies for their sins.

[FrenchieCat]

16. That's why I brought it up.....

Because I do sense that to some, Insurance Companies have to be factored totally out.....and I think that is unrealistic.

I believe that Canada is also a hybrid, no?

[Hippo_Tron]

24. Canada has single-payer, but you can buy private insurance

And your senses are correct. There are a lot of people here who see this issue as insurance companies as entities that murder sick people for profits and therefore any solution that doesn't destroy them is immoral.

Don't get me wrong, I do think it's morally reprehensible to deny anybody a life-saving treatment simply because they do not have the ability to pay for it and any health care solution should reflect that. However, I rarely address issues with a paradigm of good and evil and thus I have no problem with a system that is mostly socialized but private insurance can still exist in a supplemental market if that is indeed the best system. And according to the WHO that is the best system.

That said, I know that such a system is just as politically impractical as single-payer probably even more so because the system I want doesn't even have people going to congressional hearings and getting arrested to advocate for it.

And quite frankly the single-payer advocates haven't even sold me on the idea that their system is the next best thing to the French system. Switzerland has private insurance that everybody is forced to buy and they are ranked 20th. Canada has single-payer and they are ranked 30th, only 7 above the United States.

[vaberella]

44. Basically. I've come to the same determination.

I want single payer but there has to be a lot and I mean tons of legislation passed in order to get it where I want it to be because of the pitfalls of having single payer in this nation. We've got too many laws and such protecting the industry that it will be hard to even implement a new single payer system without massive law reformation. But no doctor is going to like the idea that they're open to being sued. So now we move from issues with insurance companies to doctors who actually like the idea of being protected by the state for bad care that we can't fight.

[Fire1]

109. Indeed. No doctor in this country is going to go for socialized

medicine.

[eridani]

129. Bullshit

See http://www.pnhp.org/

[Fire1]

146. There is a big difference between socialized medicine and

health insurance.

[eridani]

152. So, explain why you disagree with Physicians for a National Health Plan, then n/t

[Fire1]

156. I'm not against it but as it is currently proposed needs some

serious modification. The deeper problem with socialized medicine is what it does to the doctor. They pay the biggest price by be ing at the mercy of the bureaucracy created by such a monolitic system, which will inevitably effect the patient. Socialized medicine makes the private practice of medicine obsolete. Doctors will no longer be working directly for the patient but for the gov't. Consequently, many will not see the need to strive for excellence b/c under this program they get patients regardless of their compentency or proficiency in their craft. This will generally drive a permanent wedge between doctor and patient and reduce the quality of care.

[eridani]

158. That is crap. Under single payer, doctors are NOT government employees

Unlike with private insurance, you get to choose ANY doctor. Why do you suppose the majority of providers favor single payer? It's because there are no more parasitic middlemen between themselves and their patients. The notion that doctors are constrained if the government pays the bills is about as silly as thinking that just because the government pays for the interstate highway system they tell everybody where to drive.

[Fire1]

166. "Unlike with private insurance, you get to choose ANY doctor."

On the contrary, one of the major benefits of private insurance is the opportunity to choose ANY doctor. Once the private insurance sector is completely out of business, which will be inevitable, doctors will have no choice but to follow government dictates. As it stands now, medical reimbursement rates for doctors are spiraling downward, even as tax rates go up. Doctors will no longer have the freedom to charge patients fee for service and vice versa for the patients seeking quality care. This is what universal coverage really means whether it's written into legislation or not.

[eridani]

187. This is flat out wrong. A tiny number of extremely expensive plans offer doctor choice, and then-

--if and only if you have no pre-existing insurance. People who get insurance through work are forced to choose from a list of doctors provided by whatever plan their employer negotiates. For that reason, I will be forced by private insurance to give up my doctor or the last 25 years when my COBRA runs out. My husband, who is old enough for the GOVERNMENT Medicare, gets to keep him. The government, and only the government, offers people with average means actual choice of providers.

Under single payer, providers will have a right they do not now have--the right to negotiate reimbursement rates instead of the take it or leave it scenario now in force.

The only "freedom" you are advocating is the freedom to execute poor and sick people. Doctors should not have the freedom to charge whatevery they want, any more than the fire department does.

Care to guess what happened to doctors' incomes in Canada after single payer was implemented nationally? They went up by 30%. That is why a majority of doctors now favor single payer.

[Fire1]

195. You know NOT of which you speak. I, personally, chose the

type of insurance I wanted THROUGH MY EMPLOYER and GOT IT and STILL HAVE IT TODAY!! I GO TO WHATEVER DOCTOR, SPECIALIST, SURGEON, DENTIST, ORTHODONIST, PODIATRIST, ETC. OF MY OWN CHOOSING!!! STOP SPREADING UNTRUTHS!!!

[eridani]

208. You represent 1% of the employed population. The rest of us go to doctors of our employer's choice

Private insurance only gives you the choices of death, misery or bankruptcy, unless you are one of those parasites whose health care is paid for by public taxes.

[Spazito]

203. That is NOT what universal coverage means...

I can go to ANY doctor I choose. The government does NOT decide who I see, what my treatment is, etc. The doctors negotiate with the Provincial Governments what the fee schedule will be for their services. The government's ONLY role is to PAY those fees once a claim is submitted. MY doctor decides my treatment, any prescriptions I might need, referrals to specialists, etc. Unlike private insurance, there is NO SUCH THING as pre-existing conditions to limit what the government will or will not pay.

[Fire1]

210. ok, but don't the doctors have to negotiate their fee for sevice?

[Spazito]

212. Ummm, I stated exactly that in my post...

Doctors can opt-out of the program and a few have tried but have found very quickly no Canadian is going to pay their outrageous bill when they get the same care from a Doctor who is in the program.

When a doctor is part of the program, they do not have the costs US doctors have due to the 'one-payer' aspect. The billing system is so streamlined, one person can submit the claims in a very short timeframe as opposed to the paperwork required in a private insurance system such as exists in the US.

[Fire1]

213. Yes, you clearly stated that. Had to go back and re-read.

My apologies. However, I don't think it's been clearly determined if the Canadian Model is the one being supported by the administration. Although, it SOUNDS good in theory and you all seem to be satisfied with it, I have a feeling that it's not going to be that simple, over HERE.

[Spazito]

215. It was not my intention to intimate the Canadian system is supported by ...

the Obama administration nor am I at all sure our system is the one that should be chosen. There are facets of the French system I would LOVE to see imported into our Canadian system.

One of the issues, I think, around what needs to be done to change the current US system is the question of major incremental change working toward a completely different system or going from the current system to one that is completely different in one fell swoop. Canada's system was NOT done in one fell swoop but over time, many years.

[Fire1]

216. And a good question, indeed. This should be interesting.

[Chisox08]

205. You are wrong on that front.

I have Blue Cross Blue Shield of Illinois. A few years ago I broke my ankle. The surgeon who operated on my ankle wasn't in my network so all of the follow up work was done by a differ nt doctor. My insurance would pay for the original Doctor to do the follow up work. The second doctor performed a surgery to remove the screws from my ankle. After the surgery the wound wouldn't heal. So I went to another doctor who is a family friend who checked it out for free as a favor for my mother discovered it was infected. It turns out that the second doctor was being sued by another patient because the received an infection after he operated on him. I later find out that the guy had multiple malpractice suits against him. All of the pain I've experienced since then could have been avoided if they would have paid the first doctor.

[Lydia Leftcoast]

217. Yes, doctors are private practitioners under single payer

Under the British system, which is NOT single payer, but a government health service, most doctors ARE salaried government employees, but there is also a private sector.

[Joe Chi Minh]

175. What a low opion you have of doctors. I believe I heard it reported on the TV news

the other night that Medecins sans Frontieres is the only remaining charity working in Afghanistan.

We seemed to have a bad bunch after WWII, who fought tooth and nail against Aneurin Bevan's plan to create the then totally free National Health Service. (In a recent documentary, one doctor wrily commented that he was called out in the middle of the night on the very first night after the creation of the NHS, only to be told by the "patient" that he just wanted to test whether it was true that a doctor would come out for an emergency at any time!)

The thing that finally got them all on board was job security, they would never lack for patients, but, far from slacking, there's been an awful lot of very good GPs in the NHS ever since. Venal physicians would not be "the right stuff", the best people to entrust your health care to. If it's that bad a problem for you, I feel more sorry for you than ever, over this business.

[Fire1]

178. I don't know what kind of 'problem' you think I have and is

really beside the point. I have a very high regard for physicians and think everyone deserves quality care.

[Joe Chi Minh]

179. Well, that they were only capable of being motivated by money.

[Fire1]

181. Suppose the gov't took control over YOUR chosen

profession, career or job and dictated your every move, including exactly what you could earn in that job, whether you do it well or not. Where is the incentive or motivation for excellence or quality? I know if I have that kind of expertise and knowledge I want to get equitably compensated for my sacrifice and talent and I don't mind paying for quality.

[Joe Chi Minh]

183. Well, with me, it's very, very simple, and no doubt I'll sound to you like Forrest Gump.

I was advised, as a young man, by an old Polish cafe proprietor I was chatting to one day, to do anything whatever I did, no matter how humble the task to the very best of my ability, and to do it for the glory of God. He explained that it was our God-given task to bring order out of chaos, and showed me how he'd arranged everything behind his counter as ergonomically as possible, i.e. as close as possible to the reach of his outstretched arm. And from that day onwards, I attacked whatever work I did (almost entirely unskilled or semi-skilled manual) like Cool Hand Luke attacked that road work, deeply upsetting the prison guard with the mirror glasses. Because he wasn't supposed to be enjoying himself.

I didn't want to be underpaid, but never coveted wealth, possessions or status. I loved my work. Period. With a lot of repetitive manual work, once you get into a rhythm its brilliant. You also feel a good sort of tireness at the end of the day. I've worked for the civil service and didn't find management intrusive. What are you on about?

Incidentally, he, that is, the old, Polish cafe proprietor also told me about his experiences in England as a pilot during WWII, and how he'd listen to other pilots conversations during meals and at other times, and learnt the quirks and defects of the various types of aircraft they often were called upon to fly. And that knowledge saved his life on a few occasions.

[Fire1]

184. The most dedicated doctors I have ever known loved their

work and were/are damned good at it. They deserve every dime of compensation they receive b/c in the real world, when it comes to my health and well being, you get what you pay for.

[Joe Chi Minh]

185. So, now it's not they who are venal and need financial motivation, you're venal

on their behalf, since they really need a lotta, lotta money. You're changing your tune all the time.

It happens that our doctors in the UK are extremely well-paid by the NHS, and they can even take private patients as well! Nor, I strongly suspect, would your doctors be forced to work for the single-payer health service. When they see the constant supply of work received by the NHS doctors, they'll rally to the flag soon enough, as they did in the UK.

[Fire1]

186. Incentive and motivation will always be key factors in the

controversy from both patient and doctor pov. My tune is consistent.

[eridani]

191. How about the incentive of not having to pay for the bullshit of dealing with

--thousands of different insurance plans, which may or may not compensate you for care you provide?

[Joe Chi Minh]

192. Just the nature of them that isn't.

[eridani]

190. Doctors in Canada were pleased that their incomes went up 1/3 after single payer

We currently spend about 1/3 of our money to pay pissant useless intermediaries to deny care. Paying directly for care would raise the incomes of those providing it, no?

[Joe Chi Minh]

193. Precisely. There is always a presumption on DU - totally false,

of course, but how else could Democrats interact - that you're having to deal with at least, half-reasonable people, but we ... and the whole world knows .... it ain't so. It's a mighty, giant man-eating crocodile.

[eridani]

189. That's odd. Firefighters seem to be good at what they do

They negotiate their compensation with governments.

[Fire1]

196. And they don't make NEARLY what they are worth. You made

my point, beautifully.

[eridani]

207. Right. Let's pay them all $500,000 a year. Doctors and lawyers too

Don't be silly. They are reasonably well paid for a good job.

What kind of sociopathic shitstain do you have to be to think of maximizing your salary as your most important life goal? Real producers have other priorities.

[Fire1]

211. Most 'shitstains' have a high level of self-esteem. eom.

[eridani]

218. You mean inflated sense of self-worth

--entitling them to consider other fellow citizens as disposable human garbage, worthy of being killed if necessary to make their own lives more pleasant.

[Overseas]

88. To get to the system you want, we need the Single Payer advocates

We need people to be pushing for total socialization of healthcare in order to even get a public option onto the final plan.

If we're not screaming from the progressive side, we'll get ridiculous offers like insurance companies offering to TRIM THEIR COST INCREASES BY 1.5% to save us money ! Zippity doo dah. To be outstanding corporate citizens they will stop jacking up their prices. Golly Gee !

[ejpoeta]

32. i don't think it's so much that they want them factored out as much as it is that

the insurance companies give lots of money to congress and they will get what they want and we will get screwed. them being at the table, so to speak, is frightening because i could see us ending up with some mandatory insurance that the insurance companies can charge us whatever they want for. that would be great for the insurance companies. i hope that doesn't happen. true they have a place and having them working WITH the congress and president to fashion a bill is better than having them fighting it.... but i fear their sticky fingers and what will come of it.

[Joe Chi Minh]

58. Our insurance companies in the UK and the US are, frankly, criminals.

In France, when they tried it on, the government came down on them like a ton of bricks.

A culture of criminal greed (Anglo-American capitalism) would not be not easy to reform. Its "movers and shakers" literally know no better. Witness the current expenses scandal at Westminster.

For the monied, since the Reagan/Thatcher royal anointings, money has grown on trees. For a while we poorer folk thought the same, since we were extended what transpired to be unrealistic levels of credit by the credit card companies, banks, mortgage-brokers, etc, IN LIEU OF A PROPER RIGHTFUL LEVEL OF WAGES; a LIVING wage. They always knew they would end up with the assets of their debtors with secured loans, and if they, themselves became bankrupt, why the taxpayers would "have to" bail them out. So, the expenses fiddles of the politicans here were simply extending their largesse with the taxpayers' money to their friends in big business and their public-service cronies at the management levels, to themselves.

The guilty parties in this more local, and frankly RELATIVELY trifling corruption, must have thought, "Why shouldn't we join in this wonderful beano we've been putting on for our friends in big business these last few decades?" So, it seems to me more than arguable that Obama would do better to have the health-system fully funded from income/corporation tax for that reason; as in the UK, though our friends at the trough have been doing their best to starve our NHS of funds.

Our MSM, as was ever their wont, like to parrot, "Our NHS is now funded more highly than it has ever been - instead of pointing out that, in terms of the GDP, it is one of the lowest-funded systems in Europe qua the weighted arithmetic mean.

Read this; it gets more and more interesting from the sub-heading, "Current and planned NHS spending as a share of GDP":

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1117660

But do we hear any of this from the MSM? Not a chance. "Didn't you know? "We're spending record amounts on the NHS!"

[Hippo_Tron]

104. Sorry, I don't buy this Anglo/American greed nonsense

Greed transcends national boundaries and French capitalists are no less greedy than English or American capitalists. The only difference is that they have designed a better system to keep those people in check because their people demand it.

[Joe Chi Minh]

133. Well, of course, it's the system I'm criticising. But it didn't grow in a vacuum.

Even so, you're substantially right, of course. It's always the fault of a country's leaders - how the nation is run. They have many weapons, the chief two being the mass of the people's unworldiness, and their own intensive disinformation/mendacious propaganda.

Now, however, many people who are more spiritually-oriented by nature, have, as a result of the above, now become greedy, crass and often murderous - with a master-race mentality.

[Hippo_Tron]

138. Look the bottom line is that France has the best health care system in the world

Canada has the 30th. Most of the left wants to go to Canada's and not France's. That makes no logical sense to me whatsoever.

[Joe Chi Minh]

142. But I've explained to you that British and American insurance companies are

unprincipled thieves, who, moreover have got used to being given a free hand to cheat and extort. In the UK, they even have an "industry" term for people who are too poor to hire a lawyer, and can be kept waiting, and I dare say in some cases, cheated out of any payment. I doubt if yours are any better.

Also, it is clear from the figures that, as well as having an insurance body under the tight control of the French government, the insured proportion in relation to the total is relatively insignificant. Do you really think your insurance comanies would:

a) Accept unification (I believe it's a single body in France) and strict government control;

b) A marginal proportion of the health-service funds.

So perhaps it's you, not the American public, who is being dumb, here, because they know that American insurance companies could not be trusted, nor the government trusted to keep them honest, for the above reasons.

[Hippo_Tron]

143. If their alternative is extinction then yes I think they will accept all of those things

French insurance companies don't act like they do because they are nice people. They act like they do because the law says they have to act that way. If the current insurance companies can't act that way then they can roll over and die and somebody else can start new companies that are willing to act in accordance with the law.

Additionally they will be far more likely to accept this system than one like Canada's where they have an even smaller percentage of the market share.

[Joe Chi Minh]

153. No. It is clear Obama doesn't believe he has the power to impose

the requisite strong regulation on the big banks and insurance companies. You seem to forget that the large corporations buy the politicians their power and have them in their pocket.

John Kennedy was indebted to the Mafia, and I don't rate American big business much more ethically-oriented. I take it you read, yesterday, about the weird juxtaposition of photos of Obamas young daughters next to a story about the murder of some (other) Chicago children on a page of the Washington Post? It's a viciously ruthless and predatory culture Obama has to try to finesse. Hopefully, the mess they've made of the country's economic prospects may eventually make it significantly easier for him - although a supremely arrogant and deeply ingrained culture is hardly changed overnight. Really, above all else, a general, spiritual regeneration is what is required, in order for good, significant changes to our national cultures to take root.

Incidentally, such a reduction WOULD amount to extinction in their eyes. They would not be remotely interested in the kind of profits yielded by that French insurance company. Remember, they are the last to read the signs of the times. They have a visceral fear of anything more humane than wage-slave exploitation. They are like the monsters in the movies, who rear up with a dagger in their hand, the moment the hero turns away for a second, thinking they're dead. They NEVER say die, until they are overpowered and broken up. And even then they struggle to re-assert their hegemony.

"Additionally they will be far more likely to accept this system than one like Canada's where they have an even smaller percentage of the market share."

Who cares what "they will be more likely accept"? Apart from the politicians who have to take them on, of course. As far as the people are concerned, the sooner they are "dead meat" in the health sector, the better. And you? what's your interest?

[Hippo_Tron]

157. What's my interest?

It's pretty simple. France has the best health care system in the world. I think we should precisely replicate it in the United State so that we can also have the best health care system in the world.

And yes I know it's not politically realistic at this time. Neither is single-payer.

[Joe Chi Minh]

161. But it's a false assumption - at least a gratuitous one - that the reason it is considered to be

the best in the world is because of its very small supplementary insurance component. You have a much larger one(!), and look where that's got you...!

Don't you see the wisdom of the public's desire to work away at overcoming the ministrations of your uber capitalist "movers and shakers", in tandem with the rolling disaster they seem to have brought upon them, precisely by those same ministrations? You appear to want to preserve the status quo, at least, as best you can, if your preference for the principle of private intervention is the guide it seems to be. And on the apparently specious ground that its very small private-insurance component is what makes France's system the best.

[Hippo_Tron]

167. A proper mix of socialism and capitalism tends to make for the best system

In France's case they seem to have gone for about an 80% socialism and 20% capitalism mix in their health care system. If that gets them ranked #1 then that's what I want to do, end of story.

And yes there is far more to it than simply the small private insurance component. Amongst the other things they do is have the government pay for medical school in exchange for doctors making substantially less. We need to do that here as well.

When I said that I want to copy every aspect of the French system I don't just mean the public/private mix. I mean literally every aspect. I don't think that's remotely in the realm of "defending the status quo as much as possible".

[Joe Chi Minh]

169. There are a lot of things we all know are highly desirable that are

normal in many countries, but surely you see the difficulty of legislating for an honest insurance set-up in the US, given that it's at the extreme end of the far right. Socialism is still bandied about by the addle-brained right and their naive dupes as the new "reds under the bed". Not that I've got any time for its contempt for personal morality, now a feature of our whole polity in the UK.

[Hippo_Tron]

171. I see no such difficulty

You make the laws and you enforce the laws. If the current insurance executives want to get out of the business they will get out of the business. Somebody else who thinks making lower profits is acceptable will start new insurance companies and play by the new rules.

[Joe Chi Minh]

180. "You make the laws and you enforce the laws. " Are you Rip Van Winkle?

How much accountability in relation to crimes by the Administration over the past 8 years has there been?

You make it sound so simple. They tried to bump off Roosevelt because they considered him a Commie, and its only because Smedley-Butler dug his heels in, they didn't. Why do you suppose those treasonous bankers were not brought to book, pray? What Roosevelt did manage to use it for was leverage to get them to give him a pass with his policics. Kind of threatening them with truth and justice, equivalent to garlic and a cross.

[MessiahRp]

75. How closely does it rate to England's NHS?

I think their model seems intriguing as well.

Look I think you can probably find parts of the Canadian, French or British systems that are lacking but even if they have issues in one area or another they aren't complete FAIL like what the HMOs have created here.

Rp

[Hippo_Tron]

102. The UK's NHS is, I believe, 18th

But that isn't single-payer, the government runs the entire system in the UK.

[Two Americas]

87. what?

No one has any interest in "punishing the insurance companies for their sins." What a reactionary and inflammatory thing to say.

[Hippo_Tron]

105. I stand by my statement

The hard-core single payer advocates will not accept any system where private insurance remains and I believe it is because they consider private insurance to be something that is fundamentally evil and must be eliminated. I'm not mocking people for those views, by the way. I simply don't share them and I think that is the wrong approach to take when looking at this problem.

[Two Americas]

107. have not seen that

Of course there may be someone somewhere saying that the goal is to eliminate insurance companies. I have not sen that, and I think your statement that it is the "hard-core single payer advocates" who are trying to eliminate insurance companies is false.

Eliminating private interests of all kinds from public programs and agencies? That is a different subject and I am opposed to privatization myself, be it Blackwater in the military or corporate adverting in public schools. Keeping private interests out of public programs is not the same as trying to eliminate those private interests altogether, and you are trying to blur the line between the two.

We have a public postal delivery system, but that does not mean that people are not free to use UPS or whatever.

We have a public education system, but that does not mean that private education is outlawed.

We have a public parks system, but that does not mean that people cannot build or visit private parks.

We have public transportation, but that does not mean private automobiles are outlawed.

We have public libraries, but people are free to build their own libraries if they want.

We have public retirement - Social Security - but this does not prevent people from setting up whatever sort of private retirement plan they choose.

The right wingers are trying to present this as either/or all or nothing, to get people to say "I am opposed to a public system because I like my private stuff." So people argue against public transportation because they like their cars, against public education because they like the idea of sending their kids to private schools, etc.

People are being deceived. Setting up a public system is not the same thing as outlawing private options, and few if any ever argue for outlawing private systems. What many of us WILL oppose is letting private interests into any public system.

That is where people are going with this.

"The French supposedly have the best system, yet people there still buy private insurance, therefore a public system is not the best way to go or all it is cracked up to be, therefore Obama should sit down with the insurance companies when designing a public system since they will be in the loop no matter what and since having them in the loop is a good thing, and therefore all of the single payer advocates are unrealistic and should be ignored and dismissed."

No one is talking about stringing up insurance company executives, or outlawing insurance or criminalizing their business, as some suggest. What we are saying is keep private interests out of the public system, because they are strongly motivated to sabotage or kill any public system.


...

[Hippo_Tron]

108. I'm not suggesting that most want to outlaw private insurance

Although I have seen that view prevented on DU from time to time. But I have been told that the French system keeps too many private interests in the system and therefore it can't work because somehow American private interests are more greedy than French private interests.

As far as I'm concerned, if private interests can be controlled in France they can be controlled here as well. If keeping them into the system on a short leash will give us the best system in the world then there's no reason not to do it.

Thus I don't take the view that the objective in all of this should be to eliminate all private interests from the public system. If that is indeed the system that will work best then we should do it. But if it isn't then I don't think we should do it. And according to the rankings, the French have the best system.

[Two Americas]

110. not really

Private health insurance can exist without being "in the system" - the public system. We need to be clear which we are talking about - private insurance still existing or private insurance companies influencing or controlling the public system.

Since there is no danger of private insurance companies being outlawed or people being prevented from having private plans, what is the relevance of what you are saying to the discussion?

You do say that you "don't take the view that the objective in all of this should be to eliminate all private interests from the public system." Why do you support allowing private interests to be involved in the public program? Why do you make that sound as though people are trying to destroy insurance companies when they oppose your view?


...

[Hippo_Tron]

115. I already said I'm not accusing people of advocating the outlawing of private insurance

But I do believe that the single-payer advocates are trying to create a public health system void of any private insurance companies as their primary goal. I think that is the wrong goal. I think the goal should be able to create the best system possible even if that means there are some private insurance companies in the public system.

Let me ask you a question. Do you consider the system in France to be one that is completely void of private insurance companies inside of the public health system?

[Two Americas]

116. that is true

Many of us who are advocating single payer think that private industry should not be at the table in planning, nor involv4ed in any way in implementing and managing a public program. Of course.

My understanding, and no one here has claimed otherwise, would be that private insurance co-exists with the public program in France, the same way private schools co-exist with public schools here. The private schools are not "in the public system" though.

So you are arguing that private enterprise should be involved in administering a public program? I oppose that and all other privatization schemes. I don't want UPS making decisions about the US Postal Service, either, and I don't want Blackwater acting as the US military.



...

[Hippo_Tron]

118. I think we're arguing semantics at this point, but...

I'll try this again. France does not have single-payer. Everybody is covered by one of several heavily regulated not-for-profit "sickness funds" that are funded by employer, employee, and government contributions. This covers 75% of their medical expenses. The rest are funded by supplemental private insurance or out of pocket expenses. 90% of the country buys supplemental insurance.

This is not single-payer, although you may consider this to be a system where private insurance is absent from the public system. I was told by another DUer that such "sickness funds" are indeed private entities and that they are therefore they are unacceptable in the public system. I personally don't really consider them private entities or anything resembling private for-profit corporations for that matter, so I wonder what you would consider them.

But if you're asking me if I think private insurance should be involved in the public health system my answer is that I'm not entirely close minded to the idea. They do that in Switzerland and their system is ranked higher than Canada's.

[Two Americas]

119. ok

Not sure where you are going. I agree that there is much confusion in the exchange.

You have not clarified what you mean, but you have said that you are "not entirely close minded to the idea" of "private insurance being involved in the public health system." Not sure what that means, and I can't get you to tell us. That is a log way from your original statement, and is vague and unclear, Involved how? In what capacity? Why need we worry about that at this point? All left vague and mysterious.

You started out saying that there were those here - single payer advocates - who had it in for the insurance companies. Did you not? You have since backed off of that, when I challenged it. You never supported that assertion and changed what you were saying a couple of times. Now you don't say what "involved" would mean.

I cannot see what you might be trying to do other than to seriously confuse people, and to argue that private insurance companies should have some power or influence over any public plan. I guess.


...

[Hippo_Tron]

120. I can't prove peoples' motives because I can't read minds and I'm not a prosecutor

Do I think that some of the more hardcore single-payer advocates are motivated by their views that insurance companies are evil? Yes I do. Can I prove it? No, I absolutely can't. You got me there, I posted something on a message board that I can't prove. Regardless I still think I'm right about the motives however I don't feel the need to convince you that I am right on that account and I certainly wouldn't expect you to believe me without any proof. You are free to continue to disagree with me about these motives and I suspect you will.

And what I mean by "I'm not entirely close minded to the idea" is that I am willing to consider several different options for public health care whether they include private insurance companies or not. Everything should be on the table and all solutions should be considered.

You still haven't really answered my questions about what your conception of the level of private involvement in the French system is, nor addressed the fact that single-payer advocates have told me that the French system is too private. That is something that is actually has happened in these discussions and not just my speculation.

If you want to get an idea of the kind of thing I'm talking about, the OP of this thread is an example http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8404009&mesg_id=8404009

I can't imagine why any person would have the audacity to say that universal single-payer not for profit health care is the ONLY possible solution. This to me suggests that they are close minded to any other solutions, such as the one that the French use which is, again, the best in the world.

[Two Americas]

121. no idea

Of course you can't read people's minds. You made the assertion. You hoped that you could put single payer advocated in a bad light without being challenged on that, and them are trying to confuse people about private involvement in a public health care plan. You are being deceptive and coy. If I thought you were sincere I would put some time into dismantling what you have said, but I fear you seek to draw me into a labyrinth and a fog of distraction to drive people away from the topic.

I gave examples and perfectly and adequately explained what I am saying. You don't want people to consider that argument, so are throwing sand in people's faces. You don't want to honestly and overtly state your position, because you know that if you did people would reject it. So you seek to confuse them.

This recent post is a bunch of double talk. If you or anyone else wants to know what I am saying, simply look at my earlier posts. They are quite clear, honest and straightforward, and sound and persuasive.


...

[Hippo_Tron]

122. Fact is, you can't speak for anybody but yourself

You gave broad examples of how you oppose privatization and what you believe, which is fine. It didn't really address anything to do with the other posters I am talking about, except that you did correctly point out that I can't prove motive and that is true. Nonetheless the posters I am talking about will not consider anything other than single-payer and I find that disturbing and confusing.

And trust me, I've been on DU far too long to expect anything to go unchallenged. It is indeed pointless to further discuss this because I would have to start calling out people at this point.

[Two Americas]

123. sure I can

You tried to imply that single payer advocates were mainly trying to destroy the insurance companies. I don't see how you can deny that.

You would have to start calling people out? Why would that be? Why not respond to the specific post by specific people at the time they post things with which you disagree? I will tell you why - because you tried to sneak in a slimy and dishonest smear of ALL of the people with whom you disagree, that is why.

I don't need to call anyone out. I have the courage and honesty to state my opinion, and speak directly to the one person - you - with whom I disagree. My argument crushed yours, a long time back on this thread. You don't like that, and are trying to stir things up and introduce confusion and misdirection to save face and salvage some credibility.

I am defending all of the people you tried to smear. If any of THEM think I am out of line speaking for them, they can take that up with me.

Who here does not really care about health care, but merely ants to destroy the insurance companies and is using advocacy for single payer as cover for that? That is what was implied. Anyone? Anyone mind me defending all of us and calling that a lie?

The early Labor organizers would not consider anything other than the right to organize and the right to collective bargaining - period, no compromise. They were not interested in giving management a say so in union leadership. Would you have found that confusing and disturbing? The Suffragettes demanded the vote for all women, and nothing less. They were not willing to consider anything else. They were not willing to invite their opponents to the table and make decisions for them. Period. No compromise. Is that confusing and disturbing? The Abolitionists would not consider anything other than an end to slavery. Would you have advocated a seat at the table for the slave owners? Would you have been open to that possibility, so as to consider all options? Would you have been confused and disturbed by the intransigence of the Abolitionists?

Single payer - period, no compromise. No insurance companies at the table. Got it? You are free to disagree, but please do so honestly and clearly and stop playing games and stop trying to smear those with whom you disagree.


..

[Hippo_Tron]

124. At the risk of swallowing some pride...

I will say that I am sorry for making that comment and I should not have.

In exchange I would like to discuss policy. You say "single payer - period, no compromise." I ask you, why you insist that it be single-payer? What is wrong with another non-profit system like the French multi-payer system that is the best in the world?

[Two Americas]

134. thanks

Much appreciated.

What we advocate for and what we wind up with may well be - probably always are - different. We should never advocate for something we would settle for, but I see people arguing that all the time. For example, people say "I think that the New Deal policies were the best, so stop advocating for something more radical you lefties." But the New Deal would not have been possible without strong advocacy from the political Left, from organized Labor.

It is not our job to figure out the best course for the politicians to take, what is best for the rulers, what would satisfy any powerful and wealthy group of people or industry or business concern. It is not our job to come up with practical or reasonable ways for politicians to shut us all up. It is not our job to police and scold critics and dissenters. It is our job to speak out for what is best for the people.

There is no need for the insurance industry to be involved in the planning, implementation or management of any public health care system. We have no business being advocates for them.



...

[Hippo_Tron]

137. Okay but again, why is single-payer best for the people?

Why not the French system? According to the rankings, they are #1.

[Two Americas]

141. simple

The problem with health care is the involvement of the insurance companies and for profit health care corporations. That is because their mission is contradictory to public health. That doesn't make them evil people, it makes the for-profit investor driven Wall Street model inappropriate and unworkable for advancing public health. whatever they may have in France represents a stage in the struggle between the private and the public interest. They never could have achieved that compromise were there not people strongly advocating for the public interest. Advocacy for single payer is where the battle lines are drawn here, and our job is to advocate for the public interest, not for some compromise with the private interests who are motivated to work against the public interest.

Only in dictatorships are "systems" installed or imposed. In a representative democracy, systems evolve and coalesce as the result of a process. Merely intellectually choosing what we think might be the "best system" and then promoting that is an abrogation of our moral responsibility and civic duty, and a surrendering of any leverage or power we have.

The private for-profit health care industry is going to grab all they can, and press their own advantage as much as possible. That is their job - maximize profits and return to investors no matter what that takes. They have no choice do do anything else. That is inevitably incompatible with and antagonistic to the best health care for all of the people.

Our response is to press for maximum equality and availability and quality of health care for everyone. That is inevitably incompatible with and antagonistic to maximized profits and highest returns to investors for the Wall Street crowd.

The opposition knows what the battle is about and where the battle lines are drawn and what is at stake. They are under no illusions. Nor should we be.


...


...

[Hippo_Tron]

144. I don't agree

A system can be installed and imposed by the government in a democracy if enough people demand the government impose the system. And it can be maintained if people are generally satisfied with the system.

[Two Americas]

148. no kidding lol

I know we don't agree. No problem. I was going for clarity about the disagreement, for the benefit of the others reading this thread.

There really are never any systems being installed. There was an enormous battle between the privileged and wealthy and the common people in the 30's. The people won some battles, and lost others. Ever since, the reforms that were enacted in the New Deal have been under continual attack by those representing the privileged and wealthy and powerful, and have been gradually destroyed until today there is almost nothing of them remaining. There never was one system that was installed and then was in place.

The struggle is never-ending. Systems are ever-changing. It is the ruling class that says "here is your system. Are you happy now? Will you stay quiet and peaceful and not interfere with our enjoyment of our power, wealth and privilege?"

This idea of balancing the desires of all Americans always means giving the wealthiest few total freedom and security and protection, while throwing a few bones to the other 90% of us to keep us docile and compliant.

Question: do you believe that access to health care is a fundamental human right, or no?


...

[Hippo_Tron]

151. Yes I do

[depakid]

17. Why do you not realize that you have zero credibility when attempting to discuss policy matters

that go down with this administration?

Curious as to what you might think.

[FrenchieCat]

19. You are obviously NOT curious as to what I might think.

So, don't post in this thread....is what I say.

There are others who don't mind having a conversation with someone
who appreciates this President.

In otherwords, you ain't that special.

[depakid]

21. Actually I am

Americans all lived through similar sorts of deals- and it didn't work out so well.

[FrenchieCat]

23. Do you have anything to discuss in reference to the topic.....?

or did you just want to diss me to make yourself feel better?

If so, I hope you are feeling much better now.

[depakid]

29. With respect to responsible health care policy or what?

If it helps you to see any better on some sorts of things (not my style to disclose things like this) my parter and I (yeah, we're man and woman) we made our way many miles to Canberra to STAND in front of Parliament with a lot of folks of many colors. You and your husband- all cool folks we thought about you all- very much, Frenchie Cat.

And we set all our minds toward making things better and ending the corruption that divides and guts us all.

Not an easy task, to be sure.

http://www.youtube.com/watch?v=SUVnAp4lXfI

[stevenleser]

55. You forgot to add the words "to me" after credibility in your subject

Frenchie has loads of credibility to many people here.

[Adelante]

60. Yep, she sure has

But somehow personal attacks come easier.

[Captain Hilts]

69. True!

I'm just not into the cult of the personality for any politician.

I've worked in Washington too long.

[Captain Hilts]

68. I couldn't have said it better. nt

[dbmk]

25. "France has generally avoided waiting lists, likely due to the fairly high coinsurance charges."

NICE! I hate waiting in line with poor people.

[Joe Chi Minh]

176. "likely" is a nice "weasel word", too.

[leftofcool]

31. Frenchie, this might help

Some purchase supplemental insurance to have private rooms if they go to the hospital. Same thing in Canada as I understand it. A friend of mine in Canada pays about 6 dollars a month on a private policy so she can have a private room.

[uponit7771]

34. Shit, 6 bucks a month!! Our issue is the COST of insurance IMHO, cutting it into a 3rd of the

...cost that it cost now is the thing we must do

[Spazito]

74. It's true, in Canada I purchase supplemental insurance for $20.50 a month...

which is coverage for dental care, vision care, private rooms, ambulance services, prescriptions, etc. Those below the poverty level do not have to pay for this, it is covered by the government.

[flpoljunkie]

164. Now that's a great price. Have any idea why WHO would rank Canada 30th? Doesn't make sense.

[Spazito]

202. I have been looking at the 5 indicators used to do the ranking...

they are the following:

"WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs)."

I didn't want to download the report itself as it is a large file so I am guessing this is one area that lowered our ranking:

"health inequalities (or disparities) within the population"

Canada's First Nations have suffered and continue to suffer inequities in our system so their overall health is poorer than that of the average Canadian, the availability for care in remote regions is less than adequate therefore there are very real health inequalities to be found.

[DatManFromNawlins]

197. This is exactly why

it won't work in the US.

It isn't "covered by the government." It's covered by the taxpayers. If you want to architect a single payer system in the US, the first thing that has to be thrown out the door is the concept (and by concept I mean in a verbal sense) of wage earners paying extra for what the poor get for free. Even if the overall system costs more in terms of taxes or however you want to fund it, there are way too many people in this country whose blood boils when they hear that the poor are getting a benefit that THEY are paying for, and then they have to pay to receive that benefit for themselves.

[Spazito]

198. Ummm, US taxpayers ALREADY pay extra "for what the poor get for free"...

It's called Medicaid, I believe. The US taxpayers are paying MORE for their private, inefficient, ineffective system than Canadians are for their universal healthcare system. It amazes me that so many buy into the fallacy that US taxpayers aren't paying for their system, the sad fact is they are are paying for a poor system as well as the outrageous profits garnered by the HMOs.

[Bluenorthwest]

36. As actual French people have noted

France does not have a single payer system. And the co-payments reported on this thread by those who actually pay them sound like a bargin and a half. Many of us have friends and family who live in countries with good health care policy. There is no reason to listen to rumor, or to assumptions, or stories from media or any of that. We can find the truth from those who live in those systems, people we know and love. It takes an email or a phone call. Many of us have been having these conversations for years. I've never met a French citizen who did not like their health care, not one. I've met precious few Americans who like theirs at all, and 90% of those people are too young to have needed the plan, another 5% work for the insurance industry.
If I want to know how the Austrailian plan works and if people like it, I can ask an Australian who lives there. Same for the entire globe. Second hand folks saying "I've heard horror stories" just don't measure up to real people who say "thank God we don't live in America now that she's sick."

[Soylent Brice]

37. intresting.

[olegramps]

39. Wouldn't a single payer system be helpful to our industries?

It is my understanding that a major factor in auto industry is the exorbitant cost of health insurance for the workers and especially their retirees. These costs are rolled into the price of the car making them less competitive. It would seem to me if Obama wanted to simulate the entire range of American industry this could be the most effective means to achieve this. I wonder if any studies have been conducted on this aspect.

[vaberella]

43. People like to think that. There is a cost but they are subsidized to get health insurance.

Meaning?! Our industries actually get massive tax breaks for one and the second thing is those that are able to outsource go to other nations that don't have either any health insurance plan or one that takes the burden entirely off them to provide. But they do enjoy major tax breaks..not a lot but considerably.

[OwnedByFerrets]

49. They do NOT want single payer because.....

they use insurance to keep workers under their thumb. Millions dont change jobs or are afraid to because they might lose their insurance coverage.

[vaberella]

51. That's an INCORRECT misconception.

Many industries actually want to have single payer because overall cost is eliminated, even though on the offhand some like to think that it helps with managing the 6% unemployment if this system is retained. In actuality jobs need workers, and workers need to be healthy in order to work so...in the end it benefits them to have universal health care.

Plus with free health care they can lower the price they pay their workers. So if companies want to really keep workers under their thumb they would see universal health care as the best thing because they could minimize the minimum wage and lower wages in general. Since the higher wage earners would be paying more through taxes for health care.

[OwnedByFerrets]

66. You have your opinion, I have Thom Hartmanns....I will

trust Thoms, ty. I also believe you are very wrong concerning minimizing the minimum wage. Im at work, so I cant go into it now. Sorry.

[vaberella]

70. Thats true...

I went over the top with the whole minimizing minimum wage, but they have enough clout to push against an increase in minimum wage. And to not increase pay..actually the health care taken out would actually decrease the amount of wage someone can get---even with a regular tax considering if they reallocate taxes accordingly.

I don't agree with everything Thom Hartman says...I study economics and my fave is health econ.

[flpoljunkie]

165. They also like their big profits--made from denying health care to their customers.

[and-justice-for-all]

96. Yes it would....

because companies would no loner have to provide health care to their employees, saving them millions.

[niceypoo]

40. But, but, but.....

Freedom fries and surrender monkeys and toast n stuff!!

[bertman]

41. Thanks for posting this, Frenchie Cat. While we're pushing for the single payer/public option

we need to be thinking of alternatives that will work for America. Cause we sure as hell aren't getting single payer--and maybe not public option--any time soon.

Recommend.

And thanks to those who have posted with very good info.

[Faryn Balyncd]

64. Adopting a "private insurance only" system with NO public option will permanently kill Single Payer

.....and bankrupt America.

[bertman]

72. Looks that way to me too, Faryn.

[subterranean]

76. Especially if the private insurance remains for-profit

Some countries do have universal health care using mandatory private insurance, BUT the basic insurance plans are non-profit and heavily regulated. The insurance companies can compete freely by offering supplemental policies that cover extras not included in the basic plan. I don't know if that's feasible here, but it seems like it would fit in with Obama's desire to build on the existing infrastructure. For some reason, I haven't seen it discussed much.

I wouldn't mind a system like that, but I do NOT want any reform that forces us to subsidize a private company's profits and a CEO's seven- or eight-figure salary.

[Better Believe It]

42. Do you even bother to ask the French people that question during your visits?

[harun]

46. Do they buy it or their employer? Is it for-profit? What do all the people

in France you around tell you when you ask them about these additional services they buy?

[SteelPenguin]

47. Oh Noes! A two tier system!

You mean a system where everyone gets basic care, and then the people that can afford a little more supplemental insurance get even better care?

That'd be so much worse than our system where the first tier gets no care at all.

[Shrek]

48. How could such a system be considered single-payer?

If premiums are paid to an insurer, then I assume the insurer also remits claims.

In that case, isn't there more than one payer in the system?

[Schema Thing]

53. My friend in Paris is in the hospital this very week...

...for the full week, seven days, having a procedure (she has fibroid tumors) done that my friend here in the states spent ONE night in the hospital to have done - the same procedure.

[LostinVA]

59. Good -- they aren't rushing them out of the hospital like here

[cyclezealot]

78. Heck. My wife thought he condition not that severe.

French doctors said she's not ready to go home.. If she did not stay the 7 days, she'd have to sign a paper.. She refused treatment. So she stayed the whole week for only 1200 euros.. No charge for wine with lunch and dinner. A good bordeaux too.

[gblady]

54. thanks, Frenchie....

for this thread...it's the first time I've seen how the two sides...
insurance and public could co-exist.....
food for thought!

[Phx_Dem]

56. Many seniors who can afford to, do the same thing in the U.S..

They carry private supplemental insurance to cover what Medicare does not. My father did and thank God he could afford to because he was in the hospital and then rehab for the better part of a year before he died from a severe stroke and diabetic complications. Medicare didn't cover alot of the rehab and home-care costs he required. Ditto for my father-in-law who died of cancer.

I imagine single-payer health care would be just like Medicare -- which is very good, but not enough. I think we deserve to choose our own health care option -- public or private, or both.

[Bonobo]

61. Same in Japan. They buy because they CAN.

And when they get sick, or injured, they wind up actually MAKING MONEY! Can you believe it? Well, it's true.

Americans are so used to getting kicked in the teeth, they can no longer imagine a life where they aren't forced to be on a liquid-only diet.

[Faryn Balyncd]

63. And why do many American seniors purchase Medi-gap insurance, even though they have Single Payer?

Business Week:

".....But the French system is much more generous to its entire population than the U.S. is to its seniors. Unlike with Medicare, there are no deductibles, just modest co- payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care."


http://www.businessweek.com/magazine/content/07_28/b4042070.htm

[Joe Chi Minh]

67. Really, the private portion seems negligible, and, in fact, thanks to the "heavy hand of

government!!!!" on the insurance companies, widely affordable.

It would obviously be considered un-American for the insurance companies/company concerned not to try to "rip off" patients as efficiently as is humanly, if not humanely possible. Don't they owe it to their shareholders?!?! The rentier economy of the UK and US countries is an albatross around our necks. Read Will Hutton's best-seller, The State We're In.

[Better Believe It]

65. Another opponent of Medicare for All has spoken. The insurance industry thanks you.

[Captain Hilts]

73. Supporting President Obama is more important than affordable healthcare for all, evidently.

Though I think he wants healthcare to be affordable to everyone, throwing away the most liberal solution to the healthcare crisis before sitting down with Insurance companies, etc. is NOT a good idea.

It's about more than cutting costs.

[Doremus]

77. Providers who accept Medicare cannot charge more than agreed upon fees.

Unlike the French system, Medicare patients are not billed more than the Medicare-approved rates.

When providers sign up with Medicare they agree to accept whatever Medicare pays them.


We ALL need Medicare NOW!

[Jakes Progress]

79. Okay, then.

Just give me the same insurance that my president, senators, and representatives have. At the same price.

They get to vote on their insurance so I think they ought to vote the same for my family.

[FrenchieCat]

91. I agree with your suggestion.

[Two Americas]

89. phony debate

No one has advocated outlawing private insurance.

Just as public transportation does not mean you cannot own an automobile, and public education does not mean you cannot send your kids to private schools, so too there is no validity to this idea that is being spread by industry shills that providing public health care somehow will make people getting their own private care or insurance illegal or something. This is a phony debate.

No one is trying to tear down insurance companies for the sake of it, as some are claiming here. No one is advocating restricting people's choices to go get private care or private insurance as is being implied on this thread.

We are starting to see some clever and deceptive arguments being used against single payer.


...

[FrenchieCat]

90. I think you may know more than others on what Single Payer means.

France apparently doesn't have a Single Payer system per se.

I was simply bringing information to those who may not be fully aware of how it could work.

You can debase my OP if you want....
bottomline is that plenty information was gotten by it.
Moreso than your own post.

[Two Americas]

98. I don't know

I didn't think I was attacking you. Nor was I comparing France to here, nor saying what France does or does not have.

I am talking about some of the misleading things people are saying on the thread. I think I explained that adequately.

"Information" is not in and of itself valuable. Clarity is what is needed, and there is a massive disinformation campaign going on by the health care industry. Pretending that is not so is naive at best. How the "information" is being presented is the problem. The "information" is not benign or neutral.


...

[Seen the light]

214. That's a great post

Thanks for posting that.

[Kalyke]

92. Ahhh... you're not for it because Obama's not advocating it.

And you don't let yourself think anything that Obama doesn't advocate.

Geesch.

:eyes:

[FrenchieCat]

95. I am providing information. Are you scared of it.....?

because you haven't contributed anything of substance beyond the normal accusations that I am subject to.

I read the OPs and post of many that I don't always agree with, including those who are 100% against this President with each and everyone of their post. So let your prejudice get in your way....as I really don't give a shit.

[and-justice-for-all]

93. Germany still has private health coverage

because some still feel that the NHC does not go far enough and so they still buy supplemental coverage.

Which would be the same option we would have too.

[FrenchieCat]

97. Interesting. I haven't looked into the German System.....

But I think I will.

Thanks!

[and-justice-for-all]

117. I had a friend from Germany who told me all about it...

Capitalism does not die at the onset of such program implementation.

[Mass]

100. 92 % seems high, but it is true that many French people have a complementary insurance to cover for

the copays, and, in large cities, for higher fees. This said, these higher fees and copays are small. When I was living in France 6 years ago, Paris doctors who have higher rents would get about 3 or 4 dollars more than the "conventionned" doctor who is about 21 euros, so the insurance was not very important.

In addition, under a certain level of income, this insurance is paid by the government, and if you have a chronic disease, you get a full covereage as well.

Also, it is wrong to say that doctors who are paid more are better. Most often, with a few exceptions of doctors for the rich who want a fancy practice (they are not necessarily better but have a more comfortable waiting room), the reason for these higher fees is that renting is expensive. Also, many well known and highly qualified professors are working in public hospitals who get paid the minimum fee. I am not sure what are the proportion of doctors who take free fees, but my guess is that for a basic MD, most doctors accept the fee from the state, except in large cities.

So, while it is true that the French system is not the British system where everything is paid by taxes, most the healthcare cost is based on income (payroll taxes and income taxe), and the cost of these private insurances are very minimal and certainly do not dictate the system as they would in this country because they are so prevalent and so essential.

Also, the question is different than the one in the US. Nobody depends fully on private insurance for their healthcare costs. It is a supplementary assistance that covers in average 12 % of the costs.

[Rosa Luxemburg]

103. People do this in the UK because they think they can 'jump the queue'

[BlooInBloo]

106. You mean... The phrase "single payer" isn't MAGIC???? GASP!!!!

[WillYourVoteBCounted]

114. my cousins in NZ and AU have public health care and don't need suplimentals

you can buy private insurance if you prefer to be treated in a private facility.

At least they have access, and the two countries even have an agreement on treating each
other's citizens.

Neat, eh?

[eridani]

128. Now tell us how Obama plans to limit US insurance to 13% of the total expenditures

That would be acceptable to me.

[Hello_Kitty]

135. The majority of Medicare recipients in the U.S. buy supplemental coverage too

Yet Medicare is still a very good system. :shrug:

[ItNerd4life]

136. Thank you very much for posting this!

I've never liked the idea of single payer or any nationalized as the only choice. If we had a program
like this then I could see supporting it.

I like the idea of a minimum standard to help everybody, and then a marketplace system for additional care.

Some people don't understand that if everybody get's the same care, food, clothing, shelter, etc. whether
they work or not, then nobody will work. The marketplace for additional care is one small way of encouraging
people to strive to do better for themselves.

[slipslidingaway]

149. The system for basic coverage is Not for profit, big difference in

what is being proposed here.

I agree with you that a basic coverage should be provided and then the extras should be provided by for profit companies, that is not what is being talked about in congress.

[rhett o rick]

145. We also have a two tier system. the bottom tier don't get no coverage. nm

[Sen. Walter Sobchak]

150. That is virtually everywhere on earth

I am working in Canada, I am covered by Alberta Healthcare and on top of that a supplemental plan through our Canadian affiliate that covers vision, dental, drugs and a bunch of new age shit along with things like upgrades like a private room while in the hospital.

[DuaneBidoux]

154. If you want to know read this post.

I've lived and worked in France, have a wife with dual French/American citizenship and have seen the French medical system up close and personally (unfortunately once in a fairly serious situation).

There are, indeed, things the French system does not cover--for example, orthodontics (and if you've ever seen an average French person smile you might have figured this out). Also, there are things such as eyeglass frames (although not the lenses themselves) that are not covered.

The insurance doesn't allow you to access a higher quality of service but allows you to get reimbursed for services not covered by national health.

On numerous occasions, including the last five months of my father-in-laws life when he died in the hospital I have watched the French system function. It is a dozen times more efficient and humane than our own. I would rather be extremely ill in France than here by a wide margin. Watching the overall care of my father-in-law in his last months was astonishing. I could not believe the civility, competency, and care he received.

The non single payer crowd can criticize the French system all they want, but the UN rated it the number one health care system in the world. They spend 1/3 what we spend per patient and they have better health statistics in every single health category bar NONE.

[eridani]

159. Guess what? Obama is not proposing a French system

He is proposing to let the shitstain sociopathic for profit insurance industry continue to bleed us dry. In France, supplemental insurance in no way is responsible for covering the essentials, or determining whether people live or die. Even though 92% of the French have it, it accounts for less than 15% of total health care expenditures.

[FrenchieCat]

160. Never said he was.....

And here's the German system, best as I can see it....
Folks should add what they know to this as well.....

German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted.
http://www.npr.org/templates/story/story.php?storyId=91971406

Health insurance is obligatory for everyone residing in Germany who is employed full-time by a company. The company pays half of the insurance contributions, the other half comes out of the employee's salary. The employee's half usually totals around 10% of their gross salary. When starting work with a company usually the employee won't have to worry too much about how the system works. The company will automatically sign them up with an insurance company and the contributions automatically deducted from the salary. Sometimes the employee may be asked if they have a preferred insurance company. It is recommended to simply go with one of the big names, like "AOK" or "TKK". They are all pretty similar.

Health insurance has been obligatory for everybody in Germany, including the self-employed, since 2007. Medical treatment can be hugely expensive.

There are two types of health insurance in Germany. These are the "public" and "private" systems. This system often causes considerable confusion. Full details are given below.

if you are employed by a German company or any other foreign company in Germany and you earn less than EUR 4,050 gross salary per month, you are f...ed, I mean, you are a mandatory member of the public German health insurance system. You pay half plus 0.9% and your employer pays roughly half of the insurance premium too. As of 2009, the premium has been standardised for all public health insurance companies at 15.5% of gross salary up to the threshold (Beitragsbemessungsgrenze) of EUR 44,100. This will drop to 14.9% from July 2009. Although they more or less offer the same services, it's still worth comparing.

Public health insurance is great, however, if you earn only a small amount (because you get a lot of insurance for a low sum of money) or if you are married and have a spouse and children with you - because they are covered by the public health insurance too (this may change in the near future, though, according to the latest political plans). But beware: since a lot of services from the public health insurance system have been downgraded or cancelled in recent years, you might want to consider getting additional private insurance to cover some services like 1- or 2-bed rooms in hospital, Chefarzt-Betreuung (operation and treatment by the head doctor of the hospital) or full dental services/replacement etc. Even then you might still have to pay some extra if you have a very complicated illness and you try to get the most-respected expert in Germany to treat you, because in these cases treatment is only covered up to a certain limit. If you want to be sure about having enough funds in the event of severe illness to get the best possible treatment, other insurance types

Now if you are earning more than the threshold of EUR 4,050 gross salary per month, you can elect to leave the public health insurance and get a private health insurance while employed in Germany. Here the comparison between different offers is a bit more complicated and you may want to get the advice of a professional advisor or broker. I have seen some attempts to compare different quotations from different private health insurances, but you cannot just take one quote with the price XYZ and another one with ABC to be paid per month and say that the cheaper one is the better choice - it may vary strongly regarding the insured coverage. The best way to start a comparison is to ask private insurers to send you a quotation "Analog GKV", meaning with the same coverage as the public health insurance. Then you can compare the insurance quotations on an even footing. You can also lower your premium by using "excess options (Selbstbeteiligung)". This means that you are willing to pay for instance the first 300.- EUR every year out of your own pocket and you will receive reimbursement only for the costs in excess of that 300.- EUR. Since most of the private insurances offer to repay you 1 or 2 monthly premiums after one year of not having using the insurance at all, you should add this repayment amount to the excess-option-amount agreed in your contract and then you know at what medical cost per year it makes economical sense to hand in all invoices to the insurer during any given year. The highest excess option I know of is 2.400.- EUR per year; standard is between 300 and 750 EUR per year. If you take a very high excess option, you will achieve a similar coverage like with most expat health insurances: you are covered for all serious medical problems, but you will pay for all prescriptions and ordinary consultations of a doctor out of pocket. So, a Private Health insurance can be much lower in monthly premium than a Public health insurance while providing you with more and better coverage. Still: if you are married with children and your spouse does not earn any income here in Germany, public insurance covering all family members with your own premium can be the better deal. And if you want to have a better coverage than Public Insurance offers, you can always get an add-on insurance from private insurance companies, where you cover certain medical issues that you deem to be important for you.
http://www.toytowngermany.com/wiki/Health_insurance

[eridani]

188. You neglected to mention that 92% choose the public option--

--and that insurance companies are not allowed to turn anyone down or earn whatever profits they can get. They are strictly regulated.

Single payer does NOT disallow supplemental private insurance for things it doesn't cover, BTW.

[jumptheshadow]

209. Wish we could pay an inexpensive supplemental for a private room

When you're in pain and the other person in the room is moaning, it is not conducive to getting the rest you need for recovery.

We have a great insurance program -- until the company takes it away in next year's contract -- but I still have to pay considerably extra to see that specialist who saved my life.

Government-funded insurance with a reasonable supplement sounds great to me.

P.S. To belabor the point yet one more time, our soon-to-be-abolished insurance program rocks -- except, because I am a domestic partner, we pay federal taxes on my insurance, and it is a substantial amount of money.

[Silent3]

162. I don't suppose I can argue with good results. The level of care must be good...

...in the French system, seeing how highly rated it is, but somehow, the idea of having my health care administered by doctors who only make an average of €40,000/year (about $54,000 at today's exchange rate) seems kind of scary.

Then again perhaps the relatively low pay means that the people attracted to the profession are more motivated by a desire to help others than to get rich, and that could be a good thing.

[redqueen]

163. Thanks for posting this...

lots of information in this thread.

Also, love the sig. :)

[IndianaGreen]

168. You get supplemental insurance when under Medicare

Medicare for all!

[clarence swinney]

170. 92% pay 12.7%

What do they get for 12 cents on the dollar???

[centristgrandpa]

177. Royala with cheese anyone?

Because they have a choice...

[Orsino]

182. Because they can afford it.

France obviously regulates private health insurance sufficiently to keep it from becoming ruinously expensive.

[MasonJar]

204. Watch Sicko and see how Americans in France view the French

medical system. They love it. So do the Canadians and the British and all the etcs. Most of the things we hear are GOPer/corporate propaganda.