[luke warm]

in louisiana, state workers have a choice of 3 plans (except for retirees, who have more options - medicare advantage plans)... the state pays 75% of the premium, which of course varies with plan and coverage level... one plan is a ppo with a $500 deductible, one an aso with no deductible, and one an epo with a $300 in- and $300 out-network deductible... the epo is the most costly because it has a nationwide network, the other two have (mostly) in state providers... the drug benefits are the same for all 3 plans ($50 max copay until an out of pocket is reached, then free generics/$15 name brands)

i have no idea how universal healthcare can be implemented, and despite what others have said i don't think the canadian plan is as good as it's been portrayed on this forum... it seems to me there'd have to be some huge group plan implemented, but who pays what is a mystery

[mike777]

PassedOut, on May 30 2009, 12:00 PM, said:

helene_t, on May 30 2009, 10:50 AM, said:

I like the way it works in Denmark, where the government provides basic health care, and commercial insurance companies are then free to offer supplementary stuff like fancy dentistry, shorter waiting lists and most cosmetic surgery. Dunno if it would work in the U.S., and whether U.S. patients would like it.

Because the US is so late facing up to the need to solve our healthcare problems, we do have the advantage of seeing what has worked well in other countries and what has failed. I don't have any special axe to grind so far as specific solutions for the US, but I do want the problem solved one way or another. Picking a solution that has worked elsewhere would clearly be better than picking one that has already failed.

But we cannot go on as we do now. Our healthcare "system" costs too much, does not provide enough good outcomes, and places the costs unfairly.

One way or another, folks will have to pay for the basic healthcare benefits they stand to receive, and the costs of that care will have to be brought back into line. Our current healthcare rationing arrangement will have to be updated and regularized.

Yes hopefully more can be posted on just how such plans and costs are handled in Canada and Denmark. Hopefully more can be posted how on the issues of rationing and innovation/technology are handled. I really do not know for sure.

As I posted before it is a powerful argument that taxpayer funded basic health care should be provided to all regardless of what is costs or where the money comes from.

For instance I have read media reports that say the top tax bracket in Denmark is 60% and the VAT is 25% but I do not know if this is accurate. Given that Health Care is so very broadly defined I do not know what is covered(rationed) and what is not covered under the Denmark plan. I do not know how prices are set for new innovation and new technology and who sets them and who decides what is bought or not bought. In the USA capital markets make these allocation decisions.

In any event the Denmark model may be the way to go as far as social safety net programs.

[mike777]

"I like the way it works in Denmark, where the government provides basic health care"


In any case there will be an ongoing and never ending political debate on the definition of what basic health care coverage means. I expect massive numbers of special interest groups to spring up and lobby and contribute money to our politicians for their favorite definition.



" have got to scramble to get into the air as fast as we can because the system is headed towards a terrible calamity if we don’t. We have set zero dollars aside to pay for a $35-trillion liability for Medicare"

So we have a 35 trillion unfunded liabilty for Medicare, that is Medicare the way it works now, not Universal Health care.


http://www.cnsnews.com/public/content/arti...px?RsrcID=47639

[mike777]

"At which point we reach the Canadian model, which I understand works quite nicely.

Personally, I think it is both ludicrous and ridiculous to discuss heath-care within a structure based on capitalism - capitalism is antipathy to health-care. The idea of capitalism is to allocate resources to the most profitable areas - hence, when we find capitalism mixed with health-care we find what we should expect, and that is resources allocated to preventative medicine and the young and healthy."

"point we reach the Canadian model, which I understand works quite nicely."

"Overview of challenges in the health care industry

The health care industry in Canada is, from both financial and cultural perspectives, huge. The amount of money spent every year in Canada on health care takes up a significant and growing percentage of public spending. The profile, too, that health care has in the eye of the public cannot be underestimated. Health care funding, access, waiting times and efficiencies regularly dominate federal and provincial elections in Canada. But yet the circle of influence, those who are involved in and make decisions about health care, is quite small. Influencing those decision-makers is essential for anyone with a good idea about how to improve the health care system."
.

Current challenges across Canada
Attendees at Deloitte’s 2007 Health Care Innovation Summit spent some time focused on the ongoing provision of high quality care in the face of skyrocketing costs and an aging population that will put more of a demand on the system and, over time, pay less into it. Allan Horsburgh, Chief Financial Officer of the Nova Scotia Department of Health, made the point in dramatic fashion. “Our province is currently spending 46% of our non-debt servicing dollars on health care,” said Horsburgh. Conservative estimates put the growth in health care spending at 8.5% in that province, and revenue growth at 3%. “Left unchecked, heath care spending will consume 100% of our provincial program spending budget within 10 to 15 years.”"

http://www.deloitte.com/dtt/article/0,1002...D195647,00.html




"The results of this study are discouraging for Canada as it scores poorly in many important areas of technological health innovation. Substantial efforts are needed, and needed now, to revitalise health innovation systems and to refuel the capacity to commercialise health innovations. "

http://henrystewart.metapress.com/app/home...ults,1:120813,1

Yes, capitalisim allocated resouces given risk/reward. The maximum expected reward for a given level of risk you are willing to accept.

Again it would be nice to know how this works in the Canada/Denmark model when it comes to innovation and technology health care private companies located in those countries. You state it works nicely.



In other words has their model decreased or hampered innovation and technology being developed in their home countries or has these been farmed out to other countries?

Is capital readily available to these private companies? Are numerous new private companies/ventures being formed in the area of medical equipment/ medical supply or pharmaceuticals? If so that would be a powerful argument in favor of these models.

[mike777]

Found this link on the internet. Hopefully this link is fair, balanced and unbiased. It does include numerous citations.

http://www.civitas.o...load/Canada.pdf


I cannot seem to copy and paste from this document but read page 3 for starters.

It calls Canada's medicare system functionally obsolete when it comes to innovation and technology.

" an inability of the Canadian system to provide even equipment deemed basic, let alone new technology."

"...evident of a problem of waiting listsand dilipated technology and equipment."

Again I do not know this site, I hope this report with its citations is accurate.

[Winstonm]

Quote

I do not know what is covered(rationed) and what is not covered under the Denmark plan

Unfortunately, I can tell you how health-care is rationed in the U.S. It is much like the rationing of justice - it is reserved only to those wealthy enough to be able to afford it.

Quote

The health care industry in Canada is, from both financial and cultural perspectives, huge. The amount of money spent every year in Canada on health care takes up a significant and growing percentage of public spending

The U.S. spends more than the rest of the world combined on defense spending - there is negative economic reward for military Keynesianism after the first few years of defense spending. Dissolve empire and universal health-care becomes easily affordable.

[Lobowolf]

Winstonm, on May 30 2009, 09:10 PM, said:

Unfortunately, I can tell you how health-care is rationed in the U.S. It is much like the rationing of justice - it is reserved only to those wealthy enough to be able to afford it.

Wealth much more typically helps people avoid justice, not get it. The vast majority of criminal defendants did what they're believed to have done.

[mike777]

I do not know if my suggested plan is best but I do claim it will be the fastest.

On Monday the Congress will announce that starting July 4th 2009 everyone is covered under medicare. You do not need to fill out any forms to be accepted.


http://www.medicare.gov/


Summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. (128 pages)


http://www.medicare.gov/Library/PDFNavigat...Pub&PubID=10050

[helene_t]

mike777, on May 30 2009, 10:28 PM, said:

In any case there will be an ongoing and never ending political debate on the definition of what basic health care coverage means. I expect massive numbers of special interest groups to spring up and lobby and contribute money to our politicians for their favorite definition.

Yeah, this is kinda true.

Not sure how to avoid it, though.

Quote

For instance I have read media reports that say the top tax bracket in Denmark is 60% and the VAT is 25% but I do not know if this is accurate.

True as well but since Danish tax finance the health care system, you should compare those figures to tax plus basic health insurance in other countries. In the Netherlands I paid less tax but was forced to buy a particular health insurance, so that was just tax with another name. Here in UK an NHS contribution is deducted from my salary, conveniently it isn't called tax.

Even so, the Danish taxes are quite high, but the health care system is cheap, and especially the administrative overhead is small compared to countries where health care is financed by insurance companies.

[blackshoe]

If the government takes your money, and that taking is not a direct payment for a specific service rendered, it's a tax. If the government requires that you spend your money on some particular thing, it's a tax. Most taxes, whether or not they're called taxes, ought to be eliminated.

[PassedOut]

blackshoe, on May 31 2009, 02:01 PM, said:

Most taxes, whether or not they're called taxes, ought to be eliminated.

Wouldn't it be prudent first to eliminate unwarranted expenditures?

[blackshoe]

First, or concurrently, sure.

[PassedOut]

According to Politico, the US congress looks likely to pass a bipartisan health reform bill this year: Barack Obama's health plan takes shape.

Quote

POLITICO (Washington) -- If Congress were to take a vote on a health reform bill today, Democrats and Republicans would find a surprising level of agreement — so much so that the broad outlines of a consensus plan already are taking shape.

Sick or healthy, rich or poor, all Americans would be guaranteed access to health insurance.

In fact, they'd probably be required to purchase it — perhaps through mandates in the law that would include stiff tax penalties for anyone who tried to opt out.

Newly created insurance marketplaces would make finding a plan as easy as shopping for cheap airfare. People could keep their coverage, even if they switched jobs. And they might be able to choose between private insurers and a government-backed plan.

But here's the catch — none of this would come free, with the wealthiest Americans likely to face higher taxes to help pay for coverage for all.

Getting the insurance coverage issues straightened out will address one part of the problem. It might be tougher to establish cost-effective, high-quality care everywhere.

[luke warm]

philosophically, would you be opposed to mandates at the federal level?

[PassedOut]

luke warm, on Jun 1 2009, 04:59 PM, said:

philosophically, would you be opposed to mandates at the federal level?

I don't have an overarching philosophical position on that. Guess it depends on the specific mandates, the objectives of the mandates, the alternatives to the mandates, and how well the mandates solve the problems we face.

[Winstonm]

I predict that the health-care debate will mimic the global warming debate in that there will be all sorts of distortions of truth based on agenda.

[Lobowolf]

Winstonm, on Jun 1 2009, 06:09 PM, said:

I predict that the health-care debate will mimic the global warming debate in that there will be all sorts of distortions of truth based on agenda.

Way to go out on that limb, Winston!

[helene_t]

In Denmark, at least when I was young, lots of people had a strong ideological preference for government-paid health care, even to the point of arguing that private clinics (not paid by the government) were anti-social because they remove the upper class' motive to support good general health care. I never understood that kind of reasoning. An ideological preference for private health care is just as alien to me. IMHO the only thing that should matter is that patients/taxpayers get the best possible value for money.

[onoway]

I got this in my email...not sure exactly how this works in Canada, but much the same, I would think. Also many pharmacies here charge anywhere from $7 up just to count pills from a big bottle and put them into a little bottle. It isn't as though they are making any of these things.
Another question which is totally aside from anything below, is how many drugs have major side effects which cause different and further problems...such as Celebrex helping with arthritis pain but vastly increasing the chances of a heart attack. Not exactly cost effective therapy in my book.
Anyway, I thought this was interesting. I haven't edited it. And I haven't checked to see if the person named actually exists Quote:

Make sure you read all the way past the list of the drugs.The woman that signed below is a Budget Analyst out of federal Washington, DC offices.

Did you ever wonder how much it costs a drug company for the active ingredient in prescription medications? Some people think it must cost a lot, since many drugs sell for more than $2.00 per tablet. We did a search of offshore chemical synthesizers that supply the active ingredients found in drugs approved by the FDA. As we have revealed in past issues of Life Extension a significant percentage of drugs sold in the United States contain active ingredients made in other countries. In our independent investigation of how much profit drug companies really make, we obtained the actual price of active ingredients used in some of the most popular drugs sold in America.



Celebrex:100 mg
Consumer price (100 tablets): $130.27
Cost of general active ingredients: $0.60
Percent markup: 21,712%


Claritin:10 mg
Consumer Price (100 tablets): $215.17
Cost of general active ingredients: $0.71
Percent markup: 30,306%


Keflex:250 mg
Consumer Price (100 tablets): $157.39
Cost of general active ingredients: $1.88
Percent markup: 8,372%


Lipitor:20 mg
Consumer Price (100 tablets): $272.37
Cost of general active ingredients: $5.80
Percent markup: 4,696%


Norvasc:10 mg
Consumer price (100 tablets): $188.29
Cost of general active ingredients: $0.14
Percent markup: 134,493%


Paxil:20 mg
Consumer price (100 tablets): $220.27
Cost of general active ingredients: $7.60
Percent markup: 2,898%


Prevacid:30 mg
Consumer price (100 tablets): $44.77
Cost of general active ingredients: $1.01
Percent markup: 34,136%


Prilosec: 20 mg
Consumer price (100 tablets): $360.97
Cost of general active ingredients $0.52
Percent markup: 69,417%


Prozac:20 mg
Consumer price (100 tablets) : $247.47
Cost of general active ingredients: $0.11
Percent markup: 224,973%


Tenormin:50 mg
Consumer price (100 tablets): $104.47
Cost of general active ingredients: $0.13
Percent markup: 80,362%


Vasotec:10 mg
Consumer price (100 tablets): $102.37
Cost of general active ingredients: $0.20
Percent markup: 51,185%


Xanax:1 mg
Consumer price (100 tablets) : $136.79
Cost of general active ingredients: $0.024
Percent markup: 569,958%


Zestril:20 mg
Consumer price (100 tablets) $89.89
Cost of general active ingredients $3.20
Percent markup: 2,809%


Zithromax:600 mg
Consumer price (100 tablets): $1,482.19
Cost of general active ingredients: $18.78
Percent markup: 7,892%


Zocor:40 mg
Consumer price (100 tablets): $350.27
Cost of general active ingredients: $8.63
Percent markup: 4,059%

Zoloft:50 mg
Consumer price: $206.87
Cost of general active ingredients: $1.75
Percent markup: 11,821%


Since the cost of prescription drugs is so outrageous, I thought everyone should know about this.�
It pays to shop around! This helps to solve the mystery as to why they can afford to put a Walgreen's on every corner. On Monday night, Steve Wilson, an investigative reporter for Channel 7 News in� Detroit �, did a story on generic drug prices gouging by pharmacies. He found in his investigation that some of these generic drugs were marked up as much as 3,000% or more. So often we blame the drug companies for the high cost of drugs, and usually rightfully so. But in this case, the fault clearly lies with the pharmacies themselves. For example if you had to buy a prescription drug, and bought the name brand, you might pay $100 for 100 pills.
The pharmacist might tell you that if you get the generic equivalent, they would only cost $80, making you think you are saving $20. What the pharmacist is not telling you is that those 100 generic pills may have only cost him $10!

At the end of the report, one of the anchors asked Mr. Wilson whether or not there were any pharmacies that did not adhere to this practice, and he said that Costco consistently charged little over their cost for the generic drugs.


I went to the Costco site, where you can look up any drug, and get its online price. It says that the in-store prices are consistent with the online prices. I was appalled. Just to give you one example from my own experience I had to use the drug Compazine which helps prevent nausea in chemo patients.

I used the generic equivalent, which cost $54.99 for 60 pills at CVS. I checked the price at Costco, and I could have bought 100 pills for $19.89. For 145 of my pain pills, I paid $72.57. I could have got 150 at Costco for $28.08.

I would like to mention, that although Costco is a 'membership' type store, you do NOT have to be a member to buy prescriptions there as it is a federally regulated substance. You just tell them at the door that you wish to use the pharmacy, and they will let you in.

I am asking each of you to please help me by copying this letter, and passing it into your own e-mail, and send it to everyone you know with an e-mail address.

Sharon L. Davis
Budget�Analyst
U.S. �Department of Commerce
Room 6839
Office Ph: �202-48...
Office Fax: 202-482-5480
E-mail Address:sdavis@doc.gov
(end of quote)

[blackshoe]

I smell a rat. For one thing, this "analyst" doesn't take into account the cost of R&D. How else are the drug companies to recoup those costs?