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Do you think obese/overweight people should pay more for health insurance?
Replies
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No0
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kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
Suppositions about "understaffing," whether regional or otherwise, don't address the larger point about the fact that VA care is truly a case of unlimited demand (because care is "free") always meeting limited supply. Moreover, because there are no price signals in play, the VA either overstaffs and has clinics and facilities with providers twiddling their thumbs, or understaffs and has providers seeing patients back-to-back with no time to document.
Again, I have intimate knowledge of this.
This is not to fault the VA - it's just how the system is structured, and I wholeheartedly agree that the VA is more or less the endpoint of what socialized medicine would look like, with the exception of the disability rating / service connection process allowing the VA to ration care more effectively than a single-payer system would.
1 -
kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
Suppositions about "understaffing," whether regional or otherwise, don't address the larger point about the fact that VA care is truly a case of unlimited demand (because care is "free") always meeting limited supply. Moreover, because there are no price signals in play, the VA either overstaffs and has clinics and facilities with providers twiddling their thumbs, or understaffs and has providers seeing patients back-to-back with no time to document.
Again, I have intimate knowledge of this.
This is not to fault the VA - it's just how the system is structured, and I wholeheartedly agree that the VA is more or less the endpoint of what socialized medicine would look like, with the exception of the disability rating / service connection process allowing the VA to ration care more effectively than a single-payer system would.
It's not quite unlimited demand because demand can be projected quite easily based on the population on their rolls and said populations' medical records. They know how many people have each health issue, they know where they live, they know what treatments are needed and when. Too, the VA isn't really a socialised medical system or structure. It's more like a type of exclusive private network because VA users still have co pays and the VA network is dependent on the regular healthcare system which then bills the VA. This complex system of approvals, billing and co pays is the antithesis of a single payer socialised medical system.2 -
kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
I agree. The VA has gotten a bad reputation from a few big scandals, but my husband's experiences have only been positive. He only had to wait 10 days for his most recent appointment with the VA here in Southern California. I wish I could get an appointment that fast. I had to wait 11 weeks just to see the GP the last time I went to a doctor.1 -
kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
I agree. The VA has gotten a bad reputation from a few big scandals, but my husband's experiences have only been positive. He only had to wait 10 days for his most recent appointment with the VA here in Southern California. I wish I could get an appointment that fast. I had to wait 11 weeks just to see the GP the last time I went to a doctor.
It's been five years now, but my dad is one who died before the VA got through processing his paperwork. He had a stroke, and even with insurance, Medicare, etc the outstanding bills were in the six figure range, with no end in sight, and eventually a need for round the clock care, so my mom put in to the VA. She contacted them repeatedly and kept getting the runaround. I can't even remember all the steps involved, but I do recall that multiple people said they would do things and later when she checked back turned out not to have done their jobs. Three years later they called my mom out of the blue to say my dad was finally enrolled - by which time he had been dead for six months.
If you ever manage to get enrolled, the actual care is pretty good - my uncle's cancer was treated there, and I know many nurses who work both with the VA and with private hospitals, who say good things about the VA.3 -
rheddmobile wrote: »kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
I agree. The VA has gotten a bad reputation from a few big scandals, but my husband's experiences have only been positive. He only had to wait 10 days for his most recent appointment with the VA here in Southern California. I wish I could get an appointment that fast. I had to wait 11 weeks just to see the GP the last time I went to a doctor.
It's been five years now, but my dad is one who died before the VA got through processing his paperwork. He had a stroke, and even with insurance, Medicare, etc the outstanding bills were in the six figure range, with no end in sight, and eventually a need for round the clock care, so my mom put in to the VA. She contacted them repeatedly and kept getting the runaround. I can't even remember all the steps involved, but I do recall that multiple people said they would do things and later when she checked back turned out not to have done their jobs. Three years later they called my mom out of the blue to say my dad was finally enrolled - by which time he had been dead for six months.
If you ever manage to get enrolled, the actual care is pretty good - my uncle's cancer was treated there, and I know many nurses who work both with the VA and with private hospitals, who say good things about the VA.
I'm sorry that happened to your family.
I have to say that it WAS a PITA to get my husband initially enrolled and set up with a provider. It did take a lot more effort than I thought it should. There seem to be multiple redundant steps and different departments have different ideas about how you go about doing it. Not everybody is on the same page, so to speak. Seems like the process could be streamlined. Thankfully, once he was finally settled in the system, it's been great ever since.
So it sounds like getting initial enrollment was the problem for your dad. He never even got in to see anyone. Based on your knowledge, is that the main problem that people were having? Waiting forever to get enrolled? Or were some people finding problems with accessing care and quality of care once they were in the system, too? This is a topic of interest for me, so I appreciate your insight.
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rheddmobile wrote: »kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
I agree. The VA has gotten a bad reputation from a few big scandals, but my husband's experiences have only been positive. He only had to wait 10 days for his most recent appointment with the VA here in Southern California. I wish I could get an appointment that fast. I had to wait 11 weeks just to see the GP the last time I went to a doctor.
It's been five years now, but my dad is one who died before the VA got through processing his paperwork. He had a stroke, and even with insurance, Medicare, etc the outstanding bills were in the six figure range, with no end in sight, and eventually a need for round the clock care, so my mom put in to the VA. She contacted them repeatedly and kept getting the runaround. I can't even remember all the steps involved, but I do recall that multiple people said they would do things and later when she checked back turned out not to have done their jobs. Three years later they called my mom out of the blue to say my dad was finally enrolled - by which time he had been dead for six months.
If you ever manage to get enrolled, the actual care is pretty good - my uncle's cancer was treated there, and I know many nurses who work both with the VA and with private hospitals, who say good things about the VA.
I'm sorry that happened to your family.
I have to say that it WAS a PITA to get my husband initially enrolled and set up with a provider. It did take a lot more effort than I thought it should. There seem to be multiple redundant steps and different departments have different ideas about how you go about doing it. Not everybody is on the same page, so to speak. Seems like the process could be streamlined. Thankfully, once he was finally settled in the system, it's been great ever since.
So it sounds like getting initial enrollment was the problem for your dad. He never even got in to see anyone. Based on your knowledge, is that the main problem that people were having? Waiting forever to get enrolled? Or were some people finding problems with accessing care and quality of care once they were in the system, too? This is a topic of interest for me, so I appreciate your insight.
Well, with my dad we never got as far as actual care, so I can't say whether it was bad or good. I do know that my uncle, who had recurring throat cancer, had nothing but good things to say about them. He had been enrolled for years before he had cancer - being self employed and without insurance he relied on them for his health care throughout his life. I know he also had a knee surgery there, so they gave good care for less urgent issues than cancer.2 -
rheddmobile wrote: »rheddmobile wrote: »kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
I agree. The VA has gotten a bad reputation from a few big scandals, but my husband's experiences have only been positive. He only had to wait 10 days for his most recent appointment with the VA here in Southern California. I wish I could get an appointment that fast. I had to wait 11 weeks just to see the GP the last time I went to a doctor.
It's been five years now, but my dad is one who died before the VA got through processing his paperwork. He had a stroke, and even with insurance, Medicare, etc the outstanding bills were in the six figure range, with no end in sight, and eventually a need for round the clock care, so my mom put in to the VA. She contacted them repeatedly and kept getting the runaround. I can't even remember all the steps involved, but I do recall that multiple people said they would do things and later when she checked back turned out not to have done their jobs. Three years later they called my mom out of the blue to say my dad was finally enrolled - by which time he had been dead for six months.
If you ever manage to get enrolled, the actual care is pretty good - my uncle's cancer was treated there, and I know many nurses who work both with the VA and with private hospitals, who say good things about the VA.
I'm sorry that happened to your family.
I have to say that it WAS a PITA to get my husband initially enrolled and set up with a provider. It did take a lot more effort than I thought it should. There seem to be multiple redundant steps and different departments have different ideas about how you go about doing it. Not everybody is on the same page, so to speak. Seems like the process could be streamlined. Thankfully, once he was finally settled in the system, it's been great ever since.
So it sounds like getting initial enrollment was the problem for your dad. He never even got in to see anyone. Based on your knowledge, is that the main problem that people were having? Waiting forever to get enrolled? Or were some people finding problems with accessing care and quality of care once they were in the system, too? This is a topic of interest for me, so I appreciate your insight.
Well, with my dad we never got as far as actual care, so I can't say whether it was bad or good. I do know that my uncle, who had recurring throat cancer, had nothing but good things to say about them. He had been enrolled for years before he had cancer - being self employed and without insurance he relied on them for his health care throughout his life. I know he also had a knee surgery there, so they gave good care for less urgent issues than cancer.
That's good to know. Thanks!0 -
If obese people should pay more then so should those who participate in contact sports or extreme risk sports like motorcycle racing, rock climbing, down hill bicycle racing etc....
Anyone who lives a proven risky life style should pay more.
Seems fair.
After all, people who race motorcycles can't get life insurance at the same cost of those who don't.
I can't get LTD insurance because I was diagnosed with sleep apnea 6 years ago.2 -
kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
Suppositions about "understaffing," whether regional or otherwise, don't address the larger point about the fact that VA care is truly a case of unlimited demand (because care is "free") always meeting limited supply. Moreover, because there are no price signals in play, the VA either overstaffs and has clinics and facilities with providers twiddling their thumbs, or understaffs and has providers seeing patients back-to-back with no time to document.
Again, I have intimate knowledge of this.
This is not to fault the VA - it's just how the system is structured, and I wholeheartedly agree that the VA is more or less the endpoint of what socialized medicine would look like, with the exception of the disability rating / service connection process allowing the VA to ration care more effectively than a single-payer system would.
It's not quite unlimited demand because demand can be projected quite easily based on the population on their rolls and said populations' medical records. They know how many people have each health issue, they know where they live, they know what treatments are needed and when. Too, the VA isn't really a socialised medical system or structure. It's more like a type of exclusive private network because VA users still have co pays and the VA network is dependent on the regular healthcare system which then bills the VA. This complex system of approvals, billing and co pays is the antithesis of a single payer socialised medical system.
How much medical treatment (preventative or interventional) is "enough"? Who gets to decide what is "needed"? The federal government has been (unsuccessfully) creating and re-updating formulas and new systems for funding, reimbursement, pricing, etc. in order to forecast demand and properly dole out the always-limited supplies of medical services and supplies out there, basically since government began to encroach into the medical insurance / reimbursement market (back in the 1940s).
They always fail.
The VA is no different.
2 -
kshama2001 wrote: »kshama2001 wrote: »
I'm with you.SoulRadiation wrote: »I think it would be more logical to do away with the private insurance industry, have national healthcare, and provide tax incentives for living well (healthy weight, non-smoking, etc)...and do so under the justification that this is done to promote the common welfare.
The VA has a different set of pros and cons than private insurance. My personal list:MonaLisaLianne wrote: »Because we can see what a wonderful job the one-payer system called the Veteran's Administration has done in providing health care?- I like getting a LOT more time with my providers than I did when in an HMO.
- I don't like having to commute into Boston for an ultrasound or to see a dermatologist.
- I don't have long wait times here in MA, and the only time I had long wait times in FL was for an ultrasound, and that was before the VA Choice program.
- I like that everything is coordinated and all my providers can see my records.
- I don't the bureaucracy that creates inefficiency and necessitates multiple visits.
Interesting idea.richardgavel wrote: »I'm not in favor of single payer, but the VA issue is not really one of single payer. Rather it's single PROVIDER. The two are not necessarily mutually linked. Personally I wish VA would be more like Medicare, the entity that pays the bills and a smaller medical VA that might specialize in medical issues unique to service members and leave more standard stuff to standard providers.
The VA is a single-payer system. All the bills are paid for by the taxpayer. All providers, all services, all materials and equipment are paid for by Uncle Sam.
The VA is interesting. Typically patients enrolled in VA care and receiving treatment report high satisfaction with their providers and care (with some exceptions). However, the rub is that in order to get VA care, you need to be 1) eligible for care and 2) enrolled in the VA and 3) satisfy the means-testing and disability-rating process in order to receive services (depending on the service).
This basically translates into the VA being the most highly managed, managed-care system on earth. Once you're enrolled and 100% service connected, you do pretty darn good, everything is "free." But you need to go through mountains of red tape and waiting lists to get there.
(I know all of this in intimate detail - don't ask why)
The VA is an excellent example of the ultimate endpoint of all socialized structures. I should be able to get nearly all my care through the VA; however due to the waiting lines and structure this system makes me holding a job and receiving care impossible.
For the few instances I've utilized the VA - outstanding service. The medical staff are top notch and as many are veterans there is a common bond which enhances the bedside manner and relationship between caregiver and patient. Getting care is the issue and since you have limited resources and unlimited demand you have to ration. A teammate documented his attempts to get care for severe pain connected to a service related injury - he waited for an initial examination six months.
The key difference is that with the VA there is a connection to service. This does not exist in single payer, so any issues you find with the VA will be compounded exponentially.
Given my experience in Miami and Boston, I believe problems with wait times in the VA are due to regional understaffing, not a problem with the system as a whole.
Also, since the scandal about wait times in Phoenix, they've been aggressive about scheduling me for appointments I'm not even ready to schedule.
Suppositions about "understaffing," whether regional or otherwise, don't address the larger point about the fact that VA care is truly a case of unlimited demand (because care is "free") always meeting limited supply. Moreover, because there are no price signals in play, the VA either overstaffs and has clinics and facilities with providers twiddling their thumbs, or understaffs and has providers seeing patients back-to-back with no time to document.
Again, I have intimate knowledge of this.
This is not to fault the VA - it's just how the system is structured, and I wholeheartedly agree that the VA is more or less the endpoint of what socialized medicine would look like, with the exception of the disability rating / service connection process allowing the VA to ration care more effectively than a single-payer system would.
It's not quite unlimited demand because demand can be projected quite easily based on the population on their rolls and said populations' medical records. They know how many people have each health issue, they know where they live, they know what treatments are needed and when. Too, the VA isn't really a socialised medical system or structure. It's more like a type of exclusive private network because VA users still have co pays and the VA network is dependent on the regular healthcare system which then bills the VA. This complex system of approvals, billing and co pays is the antithesis of a single payer socialised medical system.
How much medical treatment (preventative or interventional) is "enough"? Who gets to decide what is "needed"? The federal government has been (unsuccessfully) creating and re-updating formulas and new systems for funding, reimbursement, pricing, etc. in order to forecast demand and properly dole out the always-limited supplies of medical services and supplies out there, basically since government began to encroach into the medical insurance / reimbursement market (back in the 1940s).
They always fail.
The VA is no different.
Completely agree the US Government has failed at regulating healthcare. Other countries governments have been far more successful.1 -
If obese people should pay more then so should those who participate in contact sports or extreme risk sports like motorcycle racing, rock climbing, down hill bicycle racing etc....
Anyone who lives a proven risky life style should pay more.
Seems fair.
After all, people who race motorcycles can't get life insurance at the same cost of those who don't.
I can't get LTD insurance because I was diagnosed with sleep apnea 6 years ago.
When downhill cycling related issues take over as the number one expense from obesity related illnesses, you'll have a point.4 -
NorthCascades wrote: »If obese people should pay more then so should those who participate in contact sports or extreme risk sports like motorcycle racing, rock climbing, down hill bicycle racing etc....
Anyone who lives a proven risky life style should pay more.
Seems fair.
After all, people who race motorcycles can't get life insurance at the same cost of those who don't.
I can't get LTD insurance because I was diagnosed with sleep apnea 6 years ago.
When downhill cycling related issues take over as the number one expense from obesity related illnesses, you'll have a point.
I think cows also need to pay their fair share, especially when it comes to downhill bicycle racing.
2 -
NorthCascades wrote: »If obese people should pay more then so should those who participate in contact sports or extreme risk sports like motorcycle racing, rock climbing, down hill bicycle racing etc....
Anyone who lives a proven risky life style should pay more.
Seems fair.
After all, people who race motorcycles can't get life insurance at the same cost of those who don't.
I can't get LTD insurance because I was diagnosed with sleep apnea 6 years ago.
When downhill cycling related issues take over as the number one expense from obesity related illnesses, you'll have a point.
His co-pay should be more than mine.
6 -
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I struggle due to medications and injuries from a medical issue.
I can't afford decent insurance as it is. If there was a penalty, I'd likely lose all insurance, and be worse off than I am now.
I'd be more stressed, less able to be active, less money to eat healthier, depressed. I'd likely just give up on trying altogether.
I truly believe it'd have major and long-lasting repercussions, and not in a good way.
A better education as a kid would have helped.(from a very young age. a more comprehensive program, cooking fast and healthy, calorie costs, what a balanced plate looks like, knowing what my own personal requirements/goals were (carbs, sugars, proteins, etc)
Better health care.
Easier access to healthy foods.
1 -
Definitely not, this is a slippery slope and the insurance industry is for profit and it will be used for more profits first and foremost as it always is, most benefit will always go into someone at the top's pocket, minimal help for premium reductions and more intrusion with each step. People need to realize it will not stop with BMI, and every little thing will have a 'good reason' to be measured, you can make an argument for monitoring everyone for identifying any risks. Which also costs more, and reduces any premium lowering effect...
It would start with the fact BMI is a bad measure, and to be fair you'd need all kinds of other measures. So sure, lets monitor things like how many exercise sessions per week on average and for how long, aerobic capacity and performance, relative strength, whats your family history of disease compared to their BMI.. where does it stop? What about lung volume, whats your cholesterol, whats your blood pressure, how about some blood enzyme testing while we are at it and blood chemistry for factors, what about your genetics, how much do you drive per day, are the streets you drive higher or lower speed/accident severity in recent history, lets monitor to see how often you speed, do you stop completely every time, how much high fat food are you eating, how many and what kind of veggies did you eat this week, random drug testing to assess risk too, how much do you drink, how many social connections do you have, are you depressed, are your relationships good ones for mental health, where do you score on psychological type, do you have pets, how often do you clean your house, do you sanitize your counter tops enough or too much, what products do you use, whats the air quality where you live...etc etc etc. I'm not sure what can't be a good aspect to monitor to get more info on true risk insuring someone.
Then there is the weighing of the risk factors. Is an obese stay at home guy really any more risky than a lean socially active guy? We know the obese risks, but the lean guy is probably statistically more prone to drinking, drug using, sexual disease risks, risky driving behaviors, aggression ... its possible the risk may be even or even headed in the other direction, especially when we consider one of the biggest risks of all: kids. To an insurance company, that's a hell of a risk, and very expensive when it happens. Why should they stop calculating risks before this one? Having children can be considered a monumental risk and they are very expensive both for mother's care and then for the child afterwards. Especially since in truth you get a huge discount in premiums for children compared to the costs, they stack up quickly. So then, we are going to fairly charge large premiums for children? Especially the first years of life when they need all types of exams, vaccinations, flu shots, antibiotics, they make the parents health deteriorate too so the cost compounds...again where does it stop...almost anything can be viewed as a risk and monetized by the insurance company...2 -
This "slippery slope" argument doesn't hold water. Young men already pay more for auto insurance than young woman, and the world hasn't ended.4
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No, and neither should smokers. Though really my actual answer to this is? No one should, not directly. It's long past time that the US catch up with the rest of the world and offer Universal Healthcare (Single-Payer)4
-
NorthCascades wrote: »This "slippery slope" argument doesn't hold water. Young men already pay more for auto insurance than young woman, and the world hasn't ended.
You aren't thinking of the future at all, comparing to a different animal and being absurd with a nonesense result. Time keeps moving, more things are being included as it progresses, and we actually have moved to voluntarily monitoring of driving habits in the automobile insurance venue, so your argument actually supports what I'm saying. But that's a different issue, its not medical. The more we allow as fair game info, the faster this progression goes. Not only this, but there are many many more reasons to reasonably gain and assess more medical info (lots of nuggets are right there in your medical history they already could use if we allowed it) for a medical claim pricing than there are to gain unrelated info for a different kind of insurance.
1 -
This isn't a zero sum game, of course. Most health insurance is priced at group rates. So if a penalty isn't put on overweight people, we ALL pay the additional costs. They just raise the prices on the whole group overall the next time the employer negogiates with the insurance company.1
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NorthCascades wrote: »This "slippery slope" argument doesn't hold water. Young men already pay more for auto insurance than young woman, and the world hasn't ended.
Here in the EU gender equality for car insurance was made a law in 2012. It's no longer legal to charge someone more because they are male.8 -
Just found out my job doesn't charge for being obese but if you go and get a health screening, and work on what they tell you to work on, you get a $250 health spending card.2
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I worked in public health, specifically related to cancer prevention. I saw patients suffer and many who passrd away from cancer due to their poor lifestyle choices i.e. years of smoking, poor nutrition, obesity, etc. I also have friends and family who died from heart attacks and strokes based on their poor lifestyle choices.
I do not know if charging obese patients more for their health insurance would be enough motivation for patients to make permanent, lifestyle changes. Usually it takes a brush with death, cancer, triple bypass surgery, heart attack stroke, etc. for people to wake up and realize they need to make changes or they will die.
You can hit a person's wallet only so much, but we really need to help people with preventative health education, especially basic nutrition education and teaching people about the health benefits of exercise. Then you add socioeconomic factors, lack of accessibility to healthy food such as fresh fruits and vegs, cultural dynamics associated with their diet/nutrition, etc. so it is a big debate and a huge issue, especially in the U.S.
Not sure if there is an easy answer or solution.
6 -
No. Everyone should be entitled to the same level of healthcare. I feel it's a basic human right. It's similar to charging people more who have a pre existing condition. What else, are we going to charge people more who have a genetic predisposition to certain Illnesses?6
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No. Everyone should be entitled to the same level of healthcare. I feel it's a basic human right. ]]
That's a great applause line but we all know that it's far, far more complex than that.
It begs the question :
What is healthcare ?
i.e.
Where does one draw the line on services?
And, of course, who pays for it?
3 -
Definitely. People who are more at risk should pay more. As a young male, I pay more for car insurance then almost everybody. The same should apply to healthcare.1
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Should older people pay more for health insurance? How about health care? Should a doctor charge a 60 year old more than a 20 year old for the same procedure?3
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Absolutely not! Obese people as well as others with serious health conditions (such as old people) should not carry an extra burden. Instead of blaming obese people for their condition which is a tricky combination of physical and mental issues - more should be invested into prevention, research, and treatment. The world is dealing with this problem for less than fifty years.
Making someone pay for being sick is cruel.3 -
No. Everyone should be entitled to the same level of healthcare. I feel it's a basic human right. It's similar to charging people more who have a pre existing condition. What else, are we going to charge people more who have a genetic predisposition to certain Illnesses?
Basic human rights would be life, liberty and pursuit of happiness.
You have no right to demand services provided by another individual.6
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