Do you think the government should take care of people with "pre-existing medical conditions?


#122

Close. The costs of providing uncompensated care is part of the cost of doing business in the medical field in the United States… And those costs are passed along to paying customers as well as 3rd party payers including insurance companies.


#123

They’re burning cars in the streets of Paris, aren’t they?

I imagine the cost of healthcare is pretty far down on the list, but their wages are lower than here, their taxes are higher, their cost of food is double what it is here relative to income, their cost of gasoline is three times or more as much, and their “healthcare for all” system is two-tier; “Medicaid with deductibles” for 2/3 of the population and the best for 1/3.

There does come a point when people simply rebel at the level of cost and taxation they have to pay, and the fact that they get subsidies for some things doesn’t make up for it.


#124

Forgive me for saying so, but that’s nonsense. The problem is partially that they have different prices for different customers: private pay in cash vs. Medicare vs. different managed care organizations vs. different insurance companies. With a single payer system, all that goes away. Poof. Gone.

That’s quite a stretch. Keep in mind that no one (certainly not me) is advocating total government ownership of all healthcare facilities, supplies, etc. Although I do think that government-owned drug companies is the only realistic way to deal with drugs and vaccines. But under a single-payer system doctors are free to practice wherever they want, specialize in whatever they want, etc. And their fees are generally set by an annual negotiation between the national doctors’ organization and the government. Same for hospitals, nurses, supply companies, etc. etc. They are all private. But as it stands, some companies (McKesson is a good example–medical supplies. I think their sales are now in the $100 billion a year range. They’re the #8 corporation in the US) are so big they can simply dictate prices to their customers. As I keep saying, this is by no means a free market. And it has nothing to do with the government–it has to do with a giant supplier vs. much smaller customers who lack the clout to negotiate successfully.

Or, let’s take a situation I had to deal with today. I got a bill from a doctor: $518. I took a look at the EOB from my insurance company: they had denied payment. Why? The doctor had put my address in box 32 instead of his own address. I called the insurance company to see the exact nature of the problem. Then I had to call the doctor’s billing dept. (anyone want to count up how many “billing departments” there are in the US??? Waste???) to explain to them that they should re-submit their bill with the correct address in box 32. In other words, I was doing their job for them. Two phone calls and a lot of bother finding all the paperwork and interpreting their cryptic codes. Waste? Absolutely. What part did the government have in this? None at all. It was the “efficient” private market at work. I lived for about 20 years in Canada. How many times did I see a piece of paper? Never. Not my problem–it was between the government and the providers. I didn’t have to get involved in any of it.


#125

I’ll give another personal example. My mother had two children at Toronto General Hospital in the early 1970s. The operating room was large and bright–windows everywhere. It was pristine–clean as a whistle. Staff? Probably 10 people in the delivery room. Cost? $10 a day because she wanted a private room–so $40 total for each baby. If she had gone into a standard two-person room, the cost would have been 0.

Now jump ahead just two years. The third baby was born in Princeton NJ. I’m saying this because it wasn’t someplace 100 miles from civilization out in the hinterland. This was Princeton NJ. There is only one hospital–it’s not like she went to the poor people’s hospital. There was one hospital. She’s in labor. 10 PM rolls around. The anesthetist appears and says “Good luck. This is the end of my shift. There won’t be an anesthetist on duty until tomorrow morning.” Of course the baby came in a couple hours. Delivery room? About 10 x 6. No windows. The walls were spattered with dried blood. The baseboards and floor were filthy. Staff? 1 doctor and 1 nurse. Cost? $14,000. Which would you rather have? I think it’s clear.


#126

To be sure. But always remember Thalidomide.


#127

Yes yes yes!

It drives me absolutely batty when I see these overweight kids with screens in their hands.
Before the 90s, childhood type 2 diabetes was nearly unheard of and heavy kids were rare.


#128

This is absolutely right. I looked at my 1974 High School yearbook, and the kids I thought were really fat back then, really weren’t- not compared to kids today.

The other factor with Type 2 Diabetes is that there really weren’t drugs for the disease back then, so there was no real motivation to make the diagnosis. Nowadays, there are any number of pills you can take. Look at the ads on TV. COPD, restless leg, pancreatic insufficiency, ED, autism, nothing really could be done pharmaceutically back in the day.


#129

Same here.
The “fat girl” in my grade school class wasn’t all that heavy, in comparison.


#130

We have it for life, car and property insurance.


#131

Consider that unhealthy and risky life style choices drive up costs for everyone.

NYS has a workers compensation that rewards safe companies with return dividends.


#132

Possibly. I’ve been out of the industry for a long time. It would certainly be easy enough to get the Medicare schedule of payments and then just take a % of that. Then they wouldn’t have to pay United Health Care to get the data. So it could be a cost savings measure on their part.

I don’t know the details. But I can see an insurance company selling a variety of plans at different premiums and coverages. They may indeed use the same “reasonable and customary” but pay different percentages. Or they may do it selectively–different percentages here and there. Or they may cover a lot more, say pre-existing conditions, and then jack up the rates across the board (or selectively) on other procedures to cover the cost. But I think that’s the point–it’s not transparent. The general public doesn’t know how they’re arriving at either their premiums or their reimbursement. So if you don’t know that, how can you choose plan A over plan B or company A over company B? You can’t. Once again, no knowledge of the market = no free market.

Sounds logical to me. One thing is for sure: the insurance companies aren’t going to lose money in the long run. Over a year, maybe. But not over two years.

Another thing to consider: my father was a bill collector for doctors in the 1950s and 1960s. He had his own company. Doctors paid him 50% of the bills he collected below a certain $ amount, and 30% of whatever was above the certain amount. But first of all, the doctors would charge what they thought the patient could pay–obviously not every time, but if a patient appeared who was clearly working at a low-paying job, etc. the doctor would adjust his fee accordingly. And after that, my father–the bill collector–did his own assessment. If he thought someone couldn’t realistically pay the full amount, he would try a payment plan or try lowering the amount owed. Sometimes he simply wrote it off as “uncollectible.” It was his own judgment. On the other hand, if a patient had a good job and the bill was reasonable, he would go after them and take them to court and garnishee their wages. The point is that there were two points where judgment came in: the doctor himself and the bill collector. Today all that is illegal–it’s considered health care fraud to charge someone less than you charge someone else. Insurance companies will sue you. So it’s much more impersonal and much more bureaucratic.


#133

Do we? How do you know? You would need to know the cost structure of the insurance companies, how they compete, etc. All that is secret. Do they collude? Absolutely, but subtly. I’ve been in meetings with VPs of health insurance companies. They are very careful to avoid outright collusion, but if company X starts charging a different amount, or covering a new procedure, etc. etc. they follow suit. Like any oligopoly–airlines are a good example. So is that a free market? No. It’s oligopoly–there are price setters.


#134

The government will set prices and salaries of health care professionals.

Price fixing is illegal.


#135

Here’s my very short answer to the question posed in the OP:

We should take care of our brothers and sisters with pre-existing conditions. Government is a useful tool for doing so.


#136

Charity is a useful tool for doing so.


#137

Just because someone has a pre-existing condition doesn’t mean that they are destitute or a proper object of charity.

Truth be told, sooner or later, we all have pre-existing conditions if we get old enough.


#138

To be sure.

But the claim (often made here at CAF, although I’m not saying that you’re making it) that private charity will provide (especially if we reduce or eliminate income taxes) for the health care needs of a nation with a population of well over 300 million, with enormous disparities in income, is unsupportable.


#139

No, of course it doesn’t. Nor did I say it does.


#140

So is this a Good thing?

My mother was too old for a medicare pacemaker so the doctor said take her home and make her comfortable. So she died . he didn’t tell us that for 20,000 dollars she could have lived. And she did have the money to pay for it


#141

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