[clemgrad85]

I hope so. Current projections are each person will have about $200,000 in healthcare expenses after retirement OVER AND ABOVE Medicare.

Keep on saving...

Thanks for the encouragement zelgo! I will strive to continue to save and reduce my debts! The only thing that might prevent this is if I have to keep paying higher and higher taxes (grrrrrrrrrrrr).

My goal with my HSA savings account is to build that up, separate from my retirement savings, so I can have additional funds over and above Medicare and my wife's health plan which we get to keep...cool, huh?
Don't forget to buy that Long Term Care plan though! You might want to buy that sooner than later as those premiums can get quite high!

[clemgrad85]

For those 10th Amendment aficianados-

The Constitution expressly allows the federal government to pass laws it needs to properly implement the powers it has been given.

A healthy population, unburdened by the bills of healthcare, is necessary for the federal government to execute its powers of defense, taxation, etc.

Thus, a national health insurance plan is allowed under the Constitution.

What? LOL Is this where you got that from?:

To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

Whew....that is really taking interpretation to a new height! I will say, that I agree with one aspect of your interpretation. Since it is clear that the Constitution gives Congress the power to support an Army and Navy to defend our country (you do agree with that, correct?), I would say that it would be constitutional to provide healthcare to those who defended our country....but that's about as far as I'll stretch that.

I personally don't see anything like what you are reaching for. But, that again is the power of the Presidency to be able to appoint our Justices. Conservative Presidents tend to appoint judges that are going to be an "Originalist", while Liberal Presidents (Obama) will obviously want judges who will interpret the Constitution for their own means. Two different theories......you believe in it being interpreted and I believe in the originalist approach.

[groovy]

Wow, I didn't know zelgo would ever be arguing in defense of the Patriot Act.

[bclinger]

Obama in 2003 for single payer: Barack Obama on single payer in 2003 | Physicians for a National Health Program.

We know he has never spoken against it. However now due to the difficulties being experienced he is back peddling with, "more than likely."

As for America cannot afford - hey, bubba - why not work toward making it affordable - you ever hear of tort reform? You ever hear of lawyers like Johnny Edwards (tax cheat, wife cheat, et cetera) and how he made his money?

You ever hear of Medicare and Medicade going broke? What makes you think this will be any different? Huh?

[davidra]

Obama in 2003 for single payer: Barack Obama on single payer in 2003 | Physicians for a National Health Program.

We know he has never spoken against it. However now due to the difficulties being experienced he is back peddling with, "more than likely."

As for America cannot afford - hey, bubba - why not work toward making it affordable - you ever hear of tort reform? You ever hear of lawyers like Johnny Edwards (tax cheat, wife cheat, et cetera) and how he made his money?

You ever hear of Medicare and Medicade going broke? What makes you think this will be any different? Huh?

Yeah. Tort reform is the supposed control? Only someone who knows nothing about medical practice thinks that. So if tort reform was passed, you'd support health reform? Fine. It will make almost no difference in controlling costs. As I said in my reference to the Rand study, there are billions of dollars to be saved simply by having money go to providers and not to intermediaries. Why is that beyond the grasp of the opponents? Because they really don't care. They don't care about people that don't have insurance, or who face medical bankruptcy. What they care about is having the freedom to choose inadequate insurance, and when that happens and they need a bone marrow transplant, we'll just let them die because they made a bad choice. Right?

[clemgrad85]

Yeah. Tort reform is the supposed control? Only someone who knows nothing about medical practice thinks that. So if tort reform was passed, you'd support health reform? Fine. It will make almost no difference in controlling costs. As I said in my reference to the Rand study, there are billions of dollars to be saved simply by having money go to providers and not to intermediaries. Why is that beyond the grasp of the opponents? Because they really don't care. They don't care about people that don't have insurance, or who face medical bankruptcy. What they care about is having the freedom to choose inadequate insurance, and when that happens and they need a bone marrow transplant, we'll just let them die because they made a bad choice. Right?

Let's be honest doc, we could save a TON of money if you doctors would stop sending us all over the place for tests we don't need and instead of prescribing brand name drugs recommend generic drugs (yup, those cute little pharmaceutical reps come around and get you to only recommend brand drugs first). I had 3 EKGs done in a 3 week period to prove that I didn't need a $2100+ Thallium Stress Test. You doctors need to clean up your mess as well, not to mention the botched surgeries that lead to issues as well. I believe I mentioned the sponge left inside a client of mine that required 3 more surgeries before getting his pacemaker put back in.

You doctors have this mentality that you are gods and that you do nothing wrong. Well get off YOUR high horse and fix your own problems before pointing your finger at everyone else. So many of the problems I deal with for clients start right back at the doctor's office. It amazes me how much money is wasted by YOU guys.

[palandri]

Let's be honest doc, we could save a TON of money if you doctors would stop sending us all over the place for tests we don't need and instead of prescribing brand name drugs recommend generic drugs (yup, those cute little pharmaceutical reps come around and get you to only recommend brand drugs first). I had 3 EKGs done in a 3 week period to prove that I didn't need a $2100+ Thallium Stress Test. You doctors need to clean up your mess as well, not to mention the botched surgeries that lead to issues as well. I believe I mentioned the sponge left inside a client of mine that required 3 more surgeries before getting his pacemaker put back in.

You doctors have this mentality that you are gods and that you do nothing wrong. Well get off YOUR high horse and fix your own problems before pointing your finger at everyone else. So many of the problems I deal with for clients start right back at the doctor's office. It amazes me how much money is wasted by YOU guys.

I guess you're the expert. I hope you never get asked for your medical license.

[davidra]

Let's be honest doc, we could save a TON of money if you doctors would stop sending us all over the place for tests we don't need and instead of prescribing brand name drugs recommend generic drugs (yup, those cute little pharmaceutical reps come around and get you to only recommend brand drugs first). I had 3 EKGs done in a 3 week period to prove that I didn't need a $2100+ Thallium Stress Test. You doctors need to clean up your mess as well, not to mention the botched surgeries that lead to issues as well. I believe I mentioned the sponge left inside a client of mine that required 3 more surgeries before getting his pacemaker put back in.

You doctors have this mentality that you are gods and that you do nothing wrong. Well get off YOUR high horse and fix your own problems before pointing your finger at everyone else. So many of the problems I deal with for clients start right back at the doctor's office. It amazes me how much money is wasted by YOU guys.

Interesting. Please don't generalize.
One of the things I do, and have done for 25 years, is teach a course in Evidence-based Medicine. The basis of the course is teaching students to determine, based on the current literature, which treatments are appropriate and which are not. Guess what? It turns out that much of what we do is inappropriate and not supported by evidence. There are three reasons that docs use inappropriate treatments: first, they don't know any better. Second, they are using them for reasons that will increase their income. And thirdly, and please don't minimize this, they use them because patients come into their offices and demand them. Yes, Prilosec will not do because I saw an ad for Nexium, and that's what I want. No, I didn't know that they are essentially the same drug, and that they're made by the same company, and that it just so happens that Prilosec is available generically.

Around the time you were apparently graduating from Clemson I published the first article that looked at an association between pharmaceutical funding and the outcome of clinical trials. I've been pushing for controls of pharmaceutical influence for a very long time, and two months ago our hospital banned any involvement from pharmaceutical representatives; they can't talk to students, residents, or faculty in the hospital. Those that have private practices are not really under control of the hospital, but are asked to follow similar guidelines. I also lecture on this topic. If you want to get a feel for how slimy our US pharmaceutical industry is, read this article, which was written by a former pharm rep. Link

While there are certainly lots of docs who spend excessively, please don't generalize to all. Many are making significant efforts to control costs, to use generic drugs, and to only use efficacious treatments. You may want to look at pharmaceutical companies and insurance companies if you want to control costs. They are a more appropriate target.

And by the way...while I would never claim to be able to determine this without much more information, multiple EKGs would not rule out the need for a thallium stress test, no matter how many you had. Much of what we do is probability-based, and while normal EKGs may make things less likely they can't rule them out. So the decision is really one of what degree of uncertainty are you willing to live with, and how much is the doctor willing to live with? Those are not easy decisions to make.

[clemgrad85]

I guess you're the expert. I hope you never get asked for your medical license.

I don't quite understand your comment. If you knew my health history and family health history, you would understand why I questioned the need for the Thallium Stress Test. I told by my primary doctor and the cardiologist that if I needed the Thallium Test I would go get it done and had the money to pay for it. But it just seemed a little odd that based on my history and the fact that this type of test was for checking on some very serious things (like whether you had a stroke or whether there was blockage) that there might be a better option first. The cardiologist determined this test was simply not needed. Sooooooo.....you (palandri) believe it would have been smarter to spend the money even though it wasn't needed? Interesting....and that is part of the problem with our healthcare system.....go get test after test so the doctor covers his or her ****. Yup.....that makes sense and I'm sure the government plan will fix all of that.

[clemgrad85]

Interesting. Please don't generalize.
One of the things I do, and have done for 25 years, is teach a course in Evidence-based Medicine. The basis of the course is teaching students to determine, based on the current literature, which treatments are appropriate and which are not. Guess what? It turns out that much of what we do is inappropriate and not supported by evidence. There are three reasons that docs use inappropriate treatments: first, they don't know any better. Second, they are using them for reasons that will increase their income. And thirdly, and please don't minimize this, they use them because patients come into their offices and demand them. Yes, Prilosec will not do because I saw an ad for Nexium, and that's what I want. No, I didn't know that they are essentially the same drug, and that they're made by the same company, and that it just so happens that Prilosec is available generically.

Around the time you were apparently graduating from Clemson I published the first article that looked at an association between pharmaceutical funding and the outcome of clinical trials. I've been pushing for controls of pharmaceutical influence for a very long time, and two months ago our hospital banned any involvement from pharmaceutical representatives; they can't talk to students, residents, or faculty in the hospital. Those that have private practices are not really under control of the hospital, but are asked to follow similar guidelines. I also lecture on this topic. If you want to get a feel for how slimy our US pharmaceutical industry is, read this article, which was written by a former pharm rep. Link

While there are certainly lots of docs who spend excessively, please don't generalize to all. Many are making significant efforts to control costs, to use generic drugs, and to only use efficacious treatments. You may want to look at pharmaceutical companies and insurance companies if you want to control costs. They are a more appropriate target.

Well I do commend you if you are teaching such things, but apparently many doctors are either snoozing during similar courses or simply are more interested in money. As I told the cardiologist when he told me I didn't need the TS test, I understood why my primary care referred me for the test (to cover her ****). So are you saying, that if we are all on a government health plan, these useless tests won't be recommended because the government wouldn't allow a doctor to get sued? I missed that part of the benefits of government health coverage.

This is where I get confused though....if you agree that some doctors (not all) refer people for unnecessary tests, then why isn't it okay for insurance companies to question whether these tests are necessary? Don't you think if I had gone in for that test, it would have been appropriate for the insurance company to request info as to the need for such an expensive test? Isn't this good? Doesn't this control costs? I seem to miss the logic in blasting the insurance company for questioning tests when you clearly agree that some medical procedures are unnecessary. Please explain. By the way....I do appreciate your efforts on getting unnecessary test and procedures from being done. You are to be commended (sincerely).

[palandri]

I don't quite understand your comment. If you knew my health history and family health history, you would understand why I questioned the need for the Thallium Stress Test. I told by my primary doctor and the cardiologist that if I needed the Thallium Test I would go get it done and had the money to pay for it. But it just seemed a little odd that based on my history and the fact that this type of test was for checking on some very serious things (like whether you had a stroke or whether there was blockage) that there might be a better option first. The cardiologist determined this test was simply not needed. Sooooooo.....you (palandri) believe it would have been smarter to spend the money even though it wasn't needed? Interesting....and that is part of the problem with our healthcare system.....go get test after test so the doctor covers his or her ****. Yup.....that makes sense and I'm sure the government plan will fix all of that.

Where do you practice medicine at?

[davidra]

Well I do commend you if you are teaching such things, but apparently many doctors are either snoozing during similar courses or simply are more interested in money. As I told the cardiologist when he told me I didn't need the TS test, I understood why my primary care referred me for the test (to cover her ****). So are you saying, that if we are all on a government health plan, these useless tests won't be recommended because the government wouldn't allow a doctor to get sued? I missed that part of the benefits of government health coverage.

This is where I get confused though....if you agree that some doctors (not all) refer people for unnecessary tests, then why isn't it okay for insurance companies to question whether these tests are necessary? Don't you think if I had gone in for that test, it would have been appropriate for the insurance company to request info as to the need for such an expensive test? Isn't this good? Doesn't this control costs? I seem to miss the logic in blasting the insurance company for questioning tests when you clearly agree that some medical procedures are unnecessary. Please explain. By the way....I do appreciate your efforts on getting unnecessary test and procedures from being done. You are to be commended (sincerely).

If you expect me to argue with you about this, you are definitively wrong. In fact, the only time that health care costs have leveled off in this country was in the early '90s (there are tons of graphs that show the percentage of the GDP over time; click on the top graph on this link). The reason? HMOs were in full bloom, all patients had assigned primary care docs, they couldn't go to specialists without approval, and denials were much more frequent than today. What happened? This was unacceptable to the population. Think "As Good as it Gets" when Helen Hunt ranted and raved to Jack Nicholson about the HMO and how it was not providing needed care to her asthmatic child. The audience clapped. Patients do not want strict controls on their doctors. It makes them think they are getting poor care. The fact is that they are getting better care. But because the population didn't want those controls, the HMOs had to stop being so restrictive, otherwise they would lose "clients"....so the controls went away, things were loosened, and health care costs resumed their climb upwards and have never looked back.

I don't know your case, but if a thallium study was not indicated and you had it anyway, and it were positive, that would lead to an invasive procedure (a cardiac cath) that never should have been done in the first place (again, for all I know it wasn't indicated, but an EKG would not make any difference in that determination, IMHO). More care is definitely not better care. This is a cultural issue as well as an economic one. When I have a wealthy young healthy person come in and demand an exercise test and multiple expensive lab tests and a variety of things that are not recommended by guidelines, if I tell them I don't think they are indicated, the person will just go to someone else and get them done, because they want "the best". Of course, that's what they have to do, because I won't do those things, which is why I could never run a for-profit executive health program, which I was once asked to do. There are quality issues involved that most patients don't think about. What are called "downstream costs" that involve not only money but also increased patient risk. Believe me, this is not easy stuff, and having politicians trying to insert themselves into the decision-making process is very irritating. But overall, the health of the individual is what counts, and we have 40 million or so people who cannot get care they need....and that takes precedence to me, because I see the pain they are in, the bankruptcies they have to file. People on this board are computer literate, educated (except for some of the teenybopper pre users that post gibberish) and by and large are happy with what they have. That's not what I see all day, and my perspectiive is quite different.

[clemgrad85]

Where do you practice medicine at?

Ohhhh....it's called the practice of Common Sense You should try it!

[clemgrad85]

If you expect me to argue with you about this, you are definitively wrong. In fact, the only time that health care costs have leveled off in this country was in the early '90s (there are tons of graphs that show the percentage of the GDP over time; click on the top graph on this link). The reason? HMOs were in full bloom, all patients had assigned primary care docs, they couldn't go to specialists without approval, and denials were much more frequent than today. What happened? This was unacceptable to the population. Think "As Good as it Gets" when Helen Hunt ranted and raved to Jack Nicholson about the HMO and how it was not providing needed care to her asthmatic child. The audience clapped. Patients do not want strict controls on their doctors. It makes them think they are getting poor care. The fact is that they are getting better care. But because the population didn't want those controls, the HMOs had to stop being so restrictive, otherwise they would lose "clients"....so the controls went away, things were loosened, and health care costs resumed their climb upwards and have never looked back.

Yup....I experienced the same thing with my clients, they simply did not want all that HMO control. I thought it was more of a Southern thing because HMOs seemed to be more active in the North. People seem to prefer to have complete control over who they see and without having to get a referral first (though many practices, as you know, still require some type of referral first).

[Micael]

If you expect me to argue with you about this, you are definitively wrong. In fact, the only time that health care costs have leveled off in this country was in the early '90s (there are tons of graphs that show the percentage of the GDP over time; click on the top graph on this link). The reason? HMOs were in full bloom, all patients had assigned primary care docs, they couldn't go to specialists without approval, and denials were much more frequent than today. What happened? This was unacceptable to the population. Think "As Good as it Gets" when Helen Hunt ranted and raved to Jack Nicholson about the HMO and how it was not providing needed care to her asthmatic child. The audience clapped. Patients do not want strict controls on their doctors. It makes them think they are getting poor care. The fact is that they are getting better care. But because the population didn't want those controls, the HMOs had to stop being so restrictive, otherwise they would lose "clients"....so the controls went away, things were loosened, and health care costs resumed their climb upwards and have never looked back.

I don't know your case, but if a thallium study was not indicated and you had it anyway, and it were positive, that would lead to an invasive procedure (a cardiac cath) that never should have been done in the first place (again, for all I know it wasn't indicated, but an EKG would not make any difference in that determination, IMHO). More care is definitely not better care. This is a cultural issue as well as an economic one. When I have a wealthy young healthy person come in and demand an exercise test and multiple expensive lab tests and a variety of things that are not recommended by guidelines, if I tell them I don't think they are indicated, the person will just go to someone else and get them done, because they want "the best". Of course, that's what they have to do, because I won't do those things, which is why I could never run a for-profit executive health program, which I was once asked to do. There are quality issues involved that most patients don't think about. What are called "downstream costs" that involve not only money but also increased patient risk. Believe me, this is not easy stuff, and having politicians trying to insert themselves into the decision-making process is very irritating. But overall, the health of the individual is what counts, and we have 40 million or so people who cannot get care they need....and that takes precedence to me, because I see the pain they are in, the bankruptcies they have to file. People on this board are computer literate, educated (except for some of the teenybopper pre users that post gibberish) and by and large are happy with what they have. That's not what I see all day, and my perspectiive is quite different.

I appreciate your posts and your thoughtful perspective. I'm a bit confused though. On one hand you seem to be very negative towards controls that reduce costs that are imposed by insurance companies, and on the other hand you seem to be supportive of the HMO controls. In both instances, the goal is actually to reduce costs. Am I off track?

[Toby]

For those 10th Amendment aficianados-

I'm not particularly a 10th Amendment aficionado. I generally try to take the whole thing into account.

The Constitution expressly allows the federal government to pass laws it needs to properly implement the powers it has been given.

So far, no problems.

A healthy population, unburdened by the bills of healthcare, is necessary for the federal government to execute its powers of defense, taxation, etc.

There are several flaws in your premise here. First and foremost is that 'unburdening' us of health care costs is necessary for the federal government to be able to tax us for other purposes. It's just shifting the burden, requiring us to direct that money to the federal government instead of private insurers, so at best it is moving the burden and not eliminating it. As an aside, while trying to find some actual numbers to compare Medicare costs to private insurance costs, I ran across an interesting analysis on the subject. Haven't finished reading it through yet, though. At first blush, though, it seems sound enough.

The second big flaw in your premise is that if it's federal government's job to unburden us of such costs, why should it end with health care? Those of us that live in houses certainly expend a significant portion of our salary in paying mortgages. If health care is a right, certainly food and shelter are as well, since food and shelter are considered bare minimums in the Maslow hierarchy. The federal government should therefore be unburdening us of that cost and providing everyone with housing and food. We'll have very few burdens then.

Third is that the federal government is allowed to do anything it wants to execute its other powers. As groovy pointed out, this is the same reasoning that brought us the Patriot Act and Guantanamo detentions.

Thus, a national health insurance plan is allowed under the Constitution.

Sorry, but your premise is flawed, so your conclusion does not follow. As another aside, I can't believe the public option folks are as up in arms as they are against John Mackey. I just read his op-ed, and it seems to me that he has some very sensible reform ideas. I suppose that's the problem with them, though. They conflict with the "we either do this, or we do nothing" false dichotomy that we're being presented with at the moment. Who else in recent memory was so fond of that tactic? Meet the new boss. Same as the old boss.

[clemgrad85]

I appreciate your posts and your thoughtful perspective. I'm a bit confused though. On one hand you seem to be very negative towards controls that reduce costs that are imposed by insurance companies, and on the other hand you seem to be supportive of the HMO controls. In both instances, the goal is actually to reduce costs. Am I off track?

Yup....I was confused by that as well....for some reason people are fine with government controls/rationing, but against private insurance control/rationing. Go figure.

[Micael]

Private insurance rations based on money. As a profit-based entity, it rations based upon whether allowing a test or a drug will cut into profits.

This is blatantly false. An outright lie. Do you enjoy making up the world as you go along?

[davidra]

I appreciate your posts and your thoughtful perspective. I'm a bit confused though. On one hand you seem to be very negative towards controls that reduce costs that are imposed by insurance companies, and on the other hand you seem to be supportive of the HMO controls. In both instances, the goal is actually to reduce costs. Am I off track?

Actually, I suspect you misspoke, as HMO's are insurance companies. I support all reasoned cost control measures. For several years I served on an advisory board for a non-profit HMO; this board reviewed the application of member docs for approval of devices and procedures. The panel was made up of mostly outside private practice guys, some of whom weren't even contracted with the health plan. The staff did a great job of collecting publlished literature about efficacy and cost-effectiveness, and the decisions that the panel made were very reasonable. In fact, I found myself as wanting to deny approval of more things than the HMO docs did, just because of a lack of evidence of efficacy. Here's the thing: individuals could not enroll in the HMO. HMO's and insurance companies successfully exclude people that actually are likely to need them. I'm sure you realize that. Pre-existiing conditions? Not a chance, unless you happen to be working for a huge employer so the risk is spread around. And that's what needs to happen. The risk needs to be spread around, but around a much larger group of people. No cherry-picking. Is it any wonder that an HMO that only accepts patients who are actively working have a greater chance of making a profit than someone who accepts all comers, regardless of age or condition? We have systematically excluded people from insurance who need it the most, and I'm not necessarily talking about the elderly (they have excellent coverage) and the poor (they have Medicaid). I'm talking about the worker in the small company, or the day laborer, or the student. I have a friend who probably has polycystic kidney disease, but I can't do the test to document it because she's still a student. Once she has it documented she willl never be able to get insurance the rest of her life. She's 30. Does that should reasonable to you? I have no problem with cost controls; I have a problem with denying coverage to people who need it.

[clemgrad85]

Sadly, Common sense isn't all that common. So, you're going to be negotiating with your doctor every time he/she orders a test?

Expense, rather than necessity, seems to be the main factor for you. If the test were free, would you have argued?

When you're on the gurney after a heart attack, are you going to be arguing whether you need a cardiac catherization? How about when you have a cardiac arrest or a stroke--will you be using your cherished "common sense" then?

Why bother with having doctors at all if all you need is common sense?

Since the test would have taken 4 hours, I would have definitely questioned it (time is money!). But, and no offense, but to say "if it was free" is kind of stupid because it isn't free and it was over $2100. When I was prescribed an $85/month prescription I guestioned (not argued) whether a less expensive option was available that would accomplish the same thing and she said "yes", and that cost $5.60. Was that wrong?

But you did prove something that often shows up in the surveys, and that is if healthcare is "free", people are often for it....but....when the survey question adds that it will cost, well, they suddenly aren't as excited. So, we want people who can afford to pay to pay for something that many people only want if they don't have to pay anything them self (unitl they need it, of course).

Well....now you are being silly and you aren't using common sense. If I'm on a table and "out of it", I doubt I'll be questioning much at all...WTF kind of question is that? I did, however, call before a back surgery to question whether the anesthesiolgist was in my network....he wasn't....so I called them and negotiated a 40% discount if it was paid within 30 days. Was that common sense? I think so....and....it did save me some money. So now common sense is bad....weird stuff in here, LOL.

I just don't see the problem with asking questions of doctors and past events have shown me that these questions were the right thing. And what's even more interesting is my primary doctor doesn't think poorly of me!