What are acceptable copays in Single Payer, to you?

[imdjh]

Right now I have an HMO. I pay $10 copay to see my primary, $25 to see a specialist, and going to the ER is a crapshoot $500 if I am not admitted, $150 if I am. At least that's the way I understand it. The benefits summary reads like a credit card agreement.

I understand co-pays, and I understand the need to discourage abuse must be balanced with making preventative care accessible.

I think the ER co-pay is too high, and I would OK with a higher co-pay for primary office visit to offset a lower ER copay. Or perhaps another system can be devised to prevent ER abuse. I don't kid myself that there aren't people who would misuse access to the ER, but at the same time I myself have not gone to the ER when I should have because it's so expensive. I have been scolded by my doctor for not going to the ER on Saturday (after I had already made it to Monday) because my symptoms could have been life threatening.

I also realize that there are people, especially those with children, for whom a higher office visit co-pay would be a burden, but those same people would be screwed by the current ER copay.

I'm curious as to what the DU jury thinks is OK for copay.

[quiller4]

1. $25 for a primary office call; $200 urgent care n/t

[sandnsea]

4. $200??

What are you defining as urgent care?

[imdjh]

7. I think QUiller meant ER- Urgent care clinics are usually $50 on most plans now.

[LaydeeBug]

2. whatever the senators and us reps pay for theirs. that's what we should get. nt

[imdjh]

8. I believe they have BCBS high option- so they pay 20% if I recall correctly. I used to have that.

And they probably have a deductible. When I had BCBS it was $1500 deductible, 2-% co-pay, and $5000 maximum out of pocket. That would really hurt me right now. Hell, it wasn't fun back then.

[YewNork]

13. Or put it in proportion to what the senators and representatives pay

Senators and Reps' salaries are approximately 169,000 a year, so put everything in proportion to the their salaries.

A $1,500 deductible for someone in Congress would be 0.009 of their salary. So let the publics' deductible be .009 of the insured's salary. Same thing with the max out of pocket, etc.

[sandnsea]

3. Doctors used to have emergency phone numbers

and you could - oh my god - call them on the week-end and they would tell you whether or not you needed to go to the ER.

If the insurance companies don't want to pay for ER, then they need to foot the bill for an ER hotline, and the deaths that not going to the ER causes.

[imdjh]

6. I've had a doctor do some risky stuff on the phone, but I know what you mean

Many years ago, I thought I was having a heart attack, and possibly due to my youth, my doctor diagnosed severe indigestion or heartburn over the phone. I never really felt as good about him after that.

I think it would be nice to be able to call the ER for advice, but I"m wondering if they wouldn't just "play it safe" all the time to avoid the occasional fatal error.

[sandnsea]

10. Yes the ER does "play it safe"

and always tells you to come in. That's not what I'm talking about. I'm talking about the kind of phone call you had with your doctor, who likely asked questions that helped him make the diagnosis, regardless of your age. They used to do that all the time and always returned your phone inquiries. I can't remember the last time I talked to a doctor on a phone.

[elleng]

5. ER MUCH too high;

mine is free. (MAY BE at preferred hosp.) Others OK, imo.

[YewNork]

9. How about $0

I think if we had single payer that covered every resident then abuse would not be a problem because
people would know that they could go when they had a problem and not simply for a hangnail.

So, I'm going to say there should be no co-pays. Not if it has the possibility of preventing someone
who truly needs medical care from getting it.

[MercutioATC]

14. Can they have ponies, too?

Copays serve three important functions:

1) They help defray the cost of care.

2) They serve as a deterrent to abuse.

3) They help to keep the system from being overloaded by people who do not NEED care.

Requiring zero copays would be a disaster.

[YewNork]

15. Do other countries with single payer have co-pays?

[imdjh]

17. Yes.

I think Sweden just raised their co-pays. Canadians have co-pays and they also need to buy travel insurance when coming to the US for more than a couple of weeks.

I have a neighbor who had a face-lift in Norway, it was $1500. A friend's mother broke her leg in Austria and they had to pay $1500. So I'm guessing that $1500 must be the out of pocket limit in these places.

[YewNork]

20. Canadians don't have co-pays.

I lived in Canada for quite a few years until recently, and they do NOT have co-pays in Canada to
see doctors, to use the ER, or to be treated in a hospital. It's a violation of the Canada Health Act
to charge a co-payment or any other additional fee for an treatment that is covered under a
government health plan.

[imdjh]

23. You are correct. My error. Germany co-pay is 10% of charges up to max 1% of income

New Zealand has co-pays. http://healthcare.change.org/blog/view/in_defense_of_english-speaking_health_care

Japan has them. http://pn.psychiatryonline.org/cgi/content/full/43/18/10

[YewNork]

24. No problem. Still co-pays are a potential problem

The point I'm trying to make is that in Canada, they don't have co-pays and people, for the most part, don't abuse the system either.
They go to the ER for an emergency, and they go to the doctor's office otherwise.

Now, I'm not saying that co-pays aren't a potential way to throttle the system, but how do you deal with the people who can't afford
the co-pays, unless you put in some type of income percentage limit.

[imdjh]

26. Oddly, I don't recall reading that anything is currently even SAID to those who abuse

It's been awhile since I read that article (like ten years) but I don't recall them saying that they do anything to discourage those who abuse. Perhaps simply telling the abuser, "Hey, I know you don't pay for this, but it cost the taxpayers money and you need to stop abusing it. Don't bring little Nancy in for a cold. You're old enough to know what a cold looks like." might have some effect.

[imdjh]

16. I have to disagree

There really are people on free or don't pay anyway health programs who go to the ER for minor problems repeatedly. I once read an article about the ER stats at major city public hospital and they were totally unacceptable. I don't see how access to preventative care would stop a person who has no care for the cost of their actions to society from going to the ER when it isn't necessary. Sometimes, you really do have to have a behavior system in place.

There are people who go to the ER for cough syrup.

[YewNork]

22. Then you have to ask why do they go to the ER now

If they currently have the ability to go to a doctor's office for cough syrup, then the question that needs to be asked is "why do they go to the ER for it? "
There would have to be something that makes going to the ER for a minor ailment, versus going to a doctor's office, more appealing. What is it?

[LeftyMom]

33. Having gone to the ER for several minor complaints this year

in my case it was because my insurer has a limited number of doctors covered "to keep costs down" which does not work because all of them are backed up and can't get anybody in for months. So when I had an ear infection, my choices were to wait two months to be seen by my primary care physician (who has to see me in person to send me anywhere else) or go to the ER.

Naturally I passed half a dozen urgent care and doc in a box places on my way to the ER that would be perfectly capable of handling an ear infection, but rather than pay them a few bucks more than my primary care doctor costs (or would cost if I could ever actually see him) my insurance company restricts my choice of physicians and thus I wind up in the ER for stupid things like ear infections.

[YewNork]

34. So you went to the ER because of restrictions by your insurer

So, you went to the ER because your insurance company wouldn't pay for you to see any doctor but your own primary care physician, and he had a two month wait.

Unlike in Canada where there are no co-pays, you can go to any general practitioner or walk in clinic that you want to, and you don't wait days to see
a GP.

[LeftyMom]

35. Exactly. It's a good thing we don't have that horrible socialized health care, eh?

:eyes:

[paulsby]

11. mine is very simple and excellent

they cover most things at 90% (massage, chiro, etc.) and dr's visits at 90%.

once you go over having paid $400 in a year for total copays, everything get's bumped up to 100%.

so, at 90%, massage cost me $9, chiro $5, and yer average dr visit about $15 or so

but i'm already over the $400, so it costs me NOTHING to get chiro, massage, chiro, or see my primary care, etc.

it's friggin sweet

[imdjh]

18. I used to have a plan like that. I miss it, but I don't expect SP to cover chiro and massage

Or accupuncture.

[paulsby]

19. yea. i realize mine is kind of luxurious

but i can state unequivocally that chiro and massage have done things for me that conventional MD's either couldn't (most likely) or didn't care to.

it's really friggin' sweet to get dozens of free massages a year, though :)

[Coyote_Bandit]

12. Co-Pays should be

income based - with a set maximum.

It really isn't a co-pay if the amount is equal to or greater than the value of the services rendered.

[Laelth]

21. As I understand it, the co-pay in the U.K. is 0. That's zero pounds.

That would be acceptable to me.

:dem:

-Laelth

[bkkyosemite]

25. There are 307 Million people here. $100 ea a month for everything:

medical, dental, vision, prescriptions (and ALL prescriptions)....they would have enough...100x307 million a month.

[yy4me]

30. Right now, $100.00 is is taken from my $951.00 Social Security

check each month for Medicare. No drug coverage, balance billing from the Doctors office. I cannot afford to have another chunk taken out for a supplement to pay the balance of MD fees or hospital fees. I had to cancel a colonoscopy because I know the bill will be large. Actually, I canceled the Doctors visit too.


No dental, 1 eye exam but not glasses. In order to be really covered, I would have to have at least $200.00 dollars a month taken from that check. I am having enough trouble making it now. Just to meet my house taxes, I have to put aside a little over $1000.00 a quarter. Not much left for we Seniors when all is done. I just hope I live long enough to see something happen with Single Payer. It better incorporate all people now on Medicare.

Medicare to many means "free health care". Not the case. It is expensive and leaves big holes into which you are encourages to drop more money.

[bkkyosemite]

32. I'm on SS too and what I meant is that $96 become $100 for us on SS and also $100 for everyone else.

Maybe a family would get a discount if they have more than 2 children and no more than $200 a month...$100 for each adult and $50/mo for each child up to two children...coverage for everything and I mean everything.

[My Good Babushka]

27. $500 for ER!

That would never do! Especially if you have small children. They have a knack for spiking fevers and getting injuries on the weekend, or else late at night, or Wednesdays, when our pediatrician does not have office hours.

[imdjh]

28. I went to the ER once between age 0 and age 18.

I was 12. It was the only time I went to the ER, and had it happened at my grandparents' I probably would have been taken to the doctor, but because it was neighbors handling the adult duties an ambulance was called.

[My Good Babushka]

31. Lucky you.

[hedgehog]

29. A co-pay is meant to deter abuse by deterring people from visiting a doctor.

How many people do you know look forward to visiting a doctor needlessly? Take off half a day from work, sometimes fight for downtown parking, sit around a boring office for an hour or so, then spend another half hour in a tiny examining room for maybe 10 minutes face time.

The copay is a nuisance for people who can afford it and a problem for people who can't. How many parents end up with a sick kid at the ER at 2AM because they put off calling a doctor at 9AM the previous morning because they didn't have the co-pay and hoped the kid would get better on his own?

The money spent collecting and accounting for co-pays would be better spent educating patients about when to call the doctor!

[WillYourVoteBCounted]

36. you mean AFTER I meet the $5,000 deductible?

for my daughter's insurance.

I don't have any.

[Shagbark Hickory]

37. $15 for your assigned GP $25 other GP $30 specialist $5.00 prescriptions

Oh wait now I'm dreaming.

[Why Syzygy]

38. I used to pay $10 copay at any doctor.

Rx was $5.00 .. United Health care, year 2000.