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Polls are irrelevant on this matter

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By the way, can you show us actual statistical, empirical evidence of folks "over-using" the systems in places with universal healthcare?

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Changing the way your doctors get paid may improve your health care -- and make it cheaper.

It's an idea the state plans to test in what may be one of the largest health care delivery and payment reform experiments in the country.

Since 1965, the year Medicare was created, the cost of health care has steadily increased. By 2018, the Centers for Medicare and Medicaid Services (CMS) predicts national health expenditures will reach $4.4 trillion, or about one-fifth of the country's gross domestic product (GDP.)

Part of the problem, experts believe, is the way doctors and hospitals get paid: The so-called fee-for-service model rewards volume, not quality. In the gray areas of medicine where best practice isn't well-defined, it can lead to wide -- and costly -- variations in care.

"If you pay for volume, you're probably going to get volume, and that's the way most of health care is paid for today," said Greg Poulson, senior vice president of Intermountain Healthcare.

Part of the problem was doctor disagreement about which treatments are best, and the financial pressures and incentives that drive them to check off tests, procedures and exams on insurance forms -- even when such items may not be necessary.

"You get paid for everything you do," said Scott Barlow, chief executive of the Central Utah Clinic in Provo. "It doesn't really motivate you to find innovative new ways to do things differently that are more cost-effective."

Every provider, I think, has a moral compass that says, 'We want to do the right thing; we want to give our patients the best care possible,' " she said. "And yet giving that best care, there is no way to code it on the insurance sheets."

As part of its 10-year effort to reform the health system, the Legislature in 2009 passed House Bill 165, directing the Office of Consumer Health Services to get providers and payers together to devise health care delivery and payment reform plans. Out of that was born this demonstration, which will change the way doctors providing health care for two initial groups of patients -- diabetics and pregnant women -- get paid.

Doctors treating diabetics will be paid a monthly retainer fee, giving them the flexibility to innovate. If a patient would be better served by calling them at home to make sure they are taking their medications, or checking their blood glucose regularly, for example, doctors can do that without worrying about whether the insurance company is going to pay.

If a patient has problems -- say a diabetic ends up in the emergency room for a preventable complication -- the doctor's monthly retainer fee goes down.

Additionally, doctors will be paid a "mini" fee for service so they aren't discouraged from providing care.

"Quality care doesn't cost more," she said, "in fact, it should cost less because if we're doing the right thing at the right time, then people aren't getting into trouble and ending up in the emergency department."

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Today, taxpayers and those who pay insurance premiums have taken the place of the nobility in terms of financially supporting those who cannot or will not pay their own medical bills.

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When one looks beyond our own borders, the data are even more troubling. In 2000, the last year I was able to obtain international data for comparison, the United States had an average life expectancy of 77.1 years. That same year, Finland boasted 77.4 years, Sweden 79.6 years, Japan 80.7 years, and San Marino 81.1 years. In contrast, Cambodia had an average life expectancy of only 56.5 years, Afghanistan 45.9 years, Angola 38.3 years, and Malawi 37.6 years.

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Pros: Easy to use forms on website

Cons: Very poor customer service, very poor results, long delays in processing

The Bottom Line: Avoid at all costs, due to lack of information, slow customer service, long processing times, refusal to take responsibility or find out status of application.

Secureserver's Full Review: eHealthInsurance.com: Seems to make applying for Health insurance easy. However, after completing the application, the "underwriting process" took over three months. They place you in higher risk categories if you have hay fever or a hang nail. Repeated phone calls to followup on online status reports were unresponsive. They always indicated that the insurance companies were severely backlogged with applications.

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Pros: Easy searching and comparing

Cons: Prices are only estimates; Some products cannot be searched

Now, let's talk about pricing. We all know that health insurance is quite expensive and continues to cost more and more with each passing month. The prices of the policies at eHealthInsurance.com are not cheap, but they are right in line with what they cost if you purchase them directly. But you need to be careful when you price compare. Often, the less expensive health insurance policies offered through this service are sorely lacking in coverage- almost to the point that they aren't even worth buying. Thus, it is important that you examine the coverages with a magnifying glass. If you already have an existing health insurance policy, I recommend obtaining a copy of the coverage and then comparing it, piece by piece, with the options in eHealthInsurance.com. If your current insurance is through your employer, there is a good chance the prices charged at eHealthInsurance.com for a comparable health insurance policy will be much greater. However, this isn't the fault of eHealthInsurance.com. The higher price is because the health insurance offered by eHealthInsurance.com doesn't include, of course, any assistance from your employer. You are buying the full policy yourself, so it is expected that the price would be higher.

eHealthInsurance.com is a very nice site for price comparisons between health insurance policies, but one must realize that all sections of eHealthInsurance.com are created equally. Most of the different sections allow you to conduct a search, compare plans, and make a selection, but others do not. Let's say I want a long term care plan. eHealthInsurance.com offers this service, but it doesn't allow its customers to conduct their own searches.

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There are those that prefer to keep the broken and costly system that's in place. I wonder why?

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Geezer, I'm going on the basis that nations with universal health care spend 50% of what WE spend on health care, AND they manage to cover everyone.

If you don't have to pay for egregious "administrative costs" and profits, then the cost of health care does indeed go down.

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Nations with universal health care go far beyond the public option insurance in their governmental involvement with the health care system. They often don't actually have folks pay insurance premiums, but finance the system from tax revenues. When they do allow private insurance it's heavily regulated. They also heavily regulate the prices that can be charged for health care and/or have nationalized all or part of the health care system as part of the government.

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Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues.

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All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

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my point was that universal healthcare, as practiced by the developed European countries, has a lot more government involvement in providing payment and setting the costs of care than is ever dreamed of in just public option insurance. Do you disagree with this?

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It would add a sliver of competition into the market — and, judging by the industry’s reaction, that’s threatening enough. It would save the government some $150 billion dollars, lower the cost of the bill, lower premiums by some 10%, and help bring about the kind of delivery system reforms that could lower the rate of growth in health care spending.

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The public health insurance option is a proposed government-run health insurance agency which competes with other health insurance companies. It is not the same as Publicly-funded health care. Called the public insurance option or public option, for short, it is a proposed health insurance plan that could be offered by the federal government of the United States.

In those bills the public option takes the form of a Qualified Health Benefit Plan competing with similar private insurance plans in an internet based exchange or market place, enabling citizens and small businesses to purchase health insurance meeting the minimum federal standard. Persons covered by other employer plans or by state insurance plans such as Medicare would not be eligible to obtain coverage from the exchange and therefore could not obtain this form of federal health insurance. The federal government's health insurance plan would be financed entirely by premiums without subsidy from the Federal government. The plans stated in the Senate HLP Committee and H.R. 3962, the two that contain clauses establishing a public insurance option, require the repayment of "seed money" to the Treasury over a ten year period.

An alternative that has been proposed is to pump federal money into various private non-profit health insurance cooperatives (co-ops) to get them to become large and established enough to provide cost savings. Prominent economists such as Robert Reich and 2008 Nobel Economics Laureate Paul Krugman have also questioned co-ops ability to become large enough to reduce health care costs significantly and thus support the public option instead.

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Existing cost estimates from the Congressional Budget Office, the Lewin Group and the Urban Institute agree that a public option would reduce overall health care costs in the United States and save the federal government money. The Urban Institute projects savings of $47 billion per year (more than $400 billion over a decade) to the government and $79 billion per year ($800 billion over a decade) overall. The Lewin Group projects around $40 billion per year in additional total savings from extending the public option from small firms to all firms. These economic projections most likely underestimate the benefits of a public option because they fail to consider the effect of a public option on competition in the health insurance market.

This report explains why the public option is likely to garner greater benefits and cost savings than previously projected. Previous estimates have suggested that costs would be shifted to private insurers and employers would drop private insurance in favor of a public option. While the public option would compete with private insurers, whose local monopoly power currently provides them advantages in many markets, there is no good empirical evidence that the public option’s lower reimbursement rates would shift costs onto private insurers. Nor does the evidence suggest that employers who currently provide insurance would suddenly stop covering their employees in favor of the public option.

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If the individual, or the insurance company, or the government, or whoever, is paying U.S. doctors two to three times what doctors in Europe are making, costs will not go down to European levels just because more folks, or even all folks, have insurance.

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