[TurboFan]

I'm surprised this hasn't been brought up recently, given Obama's interest in sweeping changes to health care.

I think everyone will agree that health care is costly. We offer a quality of medical care unsurpassed anywhere in the world, and that comes at a price. The US leads the way on most fronts in terms of non-invasive technology and surgical techniques, and we re-train thousands of FMG's every year and send them back to their native country (or keep them here at times).

The standard of care in our country comes at a price. We hold our hospitals, doctors and medical schools to a very high standard, and we sue the shit out of them if we think there was *something more* that could have been done to save us from ourselves. We also have developed cutting edge treatments, at great expense, to treat very difficult and deadly diseases.

Sadly, Obama doesn't seem to understand where the costs are in medicine, or doesn't want to listen.

First of all, lets look at medical school. Go to a cheap in-state school right out of undergrad, and like most people, take out student loans to pay for school. After all, everyone should have a shot at medical school, regardless of your family income, and I support this. However, expect to graduate with a MINIMUM of $150,000 to $200,000 in student loan debt today. Go to a place like Harvard, and the tab is closer to $350,000.

Now do a residency. You will work 80-100 hours per week (the 80hr work rule is not effective) make $35k - $45k per year, depending on location, your first year. You'll get about 4% per year raise each year for 3-7 years, depending on your specialty. Lets say you do a 4 year residency. Now you are probably 29 years old, $200,000 in debt, you may have a decent car, but probably not, and you can't afford to buy a nice house in a safe neighborhood in middle America because you have jackshit to your name. You will rent for the next 2 years while you save a downpayment on decent (not huge, decent) house. BTW, you had to start paying $550/ month in student loan payments your 4th year of residency or allow the interest to capitalize.

Now you need to work in a hospital (or doctors office with rights at a few local hospitals). Hospital construction STARTS at $100/sqft, but usually runs closer to $150/sqft to meet modern laws and requirements. Doc in a box will run easily around $100/sqft just for the tenant improvements. If you're a large downtown hospital in a major metro area, figure on another $100-$200 million in medical equipment, MINIMUM.

The numbers are starting to get big. How does it all get paid for??

Oh, we still need to hire nursing at $35/hour, environmental services and other staff positions. There are easily a couple thousand people working in a large hospital, not including the docs. Most of these people are all highly trained and educated. They don't work for cheap (except EVS, which make about $15/hour for glorified janitorial services), so lets say 1000 people (not including doctors) making an average of $55,000 / year (very low ball, but work with me here) - that's $55,000,000 in payroll each year, plus employer taxes.

Now we need malpractice insurance. Figures vary widely, but it can be anywhere from $10k to $100k per doc per year, depending on a wide variety of factors. I know one OB who had a clean record with a large group and paid $80k/year.

This is just the big stuff. Now look at variable costs. This is the pisser.

Our court system has set precedent that a doc must basically administer every possible test under the sun if there is even a remote possibility it may detect even a minor issue. I know a few dozen or so docs across the country, and they all tell the same story. You come in with non-specific belly pain (a common complaint) and you will get a $20,000 work-up because you are a pussy with indigestion.

Furthermore, Medicare (who sets most rules for reimbursement) has decided that what a doctor knows is worth about 10% compared to what they do. The SYSTEM has incentivised physicians to do procedures, not sit and talk to the patient. Again it varies, but a doc gets maybe $20 for consult, versus hundreds or thousands for a procedure taking the same amount of time. Remember, that $20 for 15 minutes of their time has to cover the doc, the nurse, the admin, the billing admin, the physical facility, the furniture, and your kids' damn lollipop

So, in Mr. Obama's latest speech he said
"The best way to drive down health care costs is to persuade doctors and hospitals to emphasize quality of care over the quantity of procedures."

Great. He has gone on to include testing in that statement. I'm all for lowering the cost of health care, but as a country we need to educate ourselves about where the costs are, and not many people want to peel back that onion.

If we want to fix the issue of rising costs of health care in this country, we start with tort reform. We as a country need to adopt the standards of care already put in place by Medicare, the AMA and the certification bodies of each specialty. They are already there! Very little work to be done.

Once they are adopted, and everyone agrees, that's how you get treated, to that standard of care. It is already happening in virtually every academic hospital in the country, and most private hospitals.

We also must realize that there is a certain level of pay to play. It has already taken hold in Canada and England, two systems we seem to admire. There is a certain level of free care available, but if you want the more advanced (expensive care), you pay. No one works for free in medicine, why should you be treated for free?

As these standards are adopted, lawsuits can not even be carried forward to settlement until a judge decides a standard of care has been breached. We also set caps on settlements for violations, and we punish willful violations.

Once we fix that, and allow costs to settle down, we can look at other avenues, but we'll never know how effective any change was if we require doctors, nurses and hospitals to practice CYA medicine.

As for required insurance, I acknowledge there are people who can't buy groceries for their public housing apartment. However, there are far more people that CHOOSE not to afford insurance. To them I say tough luck. Trade in your bimmer, buy a Kia, and get insurance. I've wandered through more than a few dozen hospital ED's at all hours of the day and night, only to see people dressed in clothes I can't afford, talking on cell phones I couldn't afford, bitching that the hospital owed them a doctor to attend to their ill, and they've had to wait for 5 hours, even though they'll never pay their bill.

When was the last time a restaurant was required to hand out free food to every hungry homeless person that walked through the door? Why should a doctor be required to work for free? These free-loaders also drive up the cost for paying patients and their insurance, as the bad debt is figured into the overhead used to calculate the cost of care.

[sayemthree]

TUrbo Fan - dont you know the GOvernment can run everything better for you. just relax and they will take care of everything. just think of all the great programs they run, post office, DMW, caltrans (DOT), social security, welfare, its all good!!!!

[NoKids]

Originally Posted by sayemthree

TUrbo Fan - dont you know the GOvernment can run everything better for you. just relax and they will take care of everything. just think of all the great programs they run, post office, DMW, caltrans (DOT), social security, welfare, its all good!!!!

gov't is not going to run healthcare. doctors and hospitals will run it. i believe the government just writes the check, i mean, you will write the check.

[TurboFan]

yeah right

Ask any hospital administrator that has to take Medicare - the gov't runs healthcare, and they do a shatty job!

[TMNT]

If you have your own health insurance via an employer, you have nothing to worry about...you'll get to keep your healthcare coverage.

If you're poor, jobless, employed without health insurance, or a small business owner who can't afford the premiums then this plan is being devised to help you.

As long as it doesn't F*** with my shit, I'm not worried about it.

[JesusFrEAk]

TurboFan you hit the nail on the head!! We may not agree on religion but we certainly see eye to eye with the way the healthcare system is being taken advantage of and improperly run by the government.

First let me say I have first hand experience with all the issues TurboFan mentioned cuz my wife is a doctor (Dermatologist) and we are constantly doing battle with the insurance companies.

I don't want to go on what may seem like a rant but basically there is no other industry, that I can think of, where the government decides how much you should make.

Everytime claims are submitted to Medicare (run by government) for lets say an office visit and some sort of injection. Super bills are filled out with a slue of billing codes that allow the insurance companies to determine what you did and what to pay for. Seems standard, however if the procedure cost lets say $150.00 which would include the room, office visit with doctor, the nurse, a sterile tray, medicine and syringe for injections it seems that that's a fair amount to charge.

Unfortunately what happens next is Medicare will send us a check for half the amount and we just have to accept it and make no fuss. (This happens on a day to day basis.)

I repeat NO OTHER INDUSTRY that I know of, is told how much their work and expertise cost other than healthcare. It is the insurance companies that are the culprits.

I'll end with this. Awhile back Medicare required my wifes practice to get a new number for some electronic claims stuff and it takes like 8 weeks to process. Well, ultimately took about 5 months cuz Medicare so conveniently forgot to tell us each time we sent the form that there was additional information we needed to fill out once they recieved it.

Since Medicare is the primary income of most doctors it was unfair that my wife didn't get the money she was owed for the work she already completed for 6 months!!!!

What needs reform in my opinion are the insurance companies because they basically decide everything and as TurboFan put it, it's gotten to the point that what a doctor knows isn't worth a dime anymore.

[JesusFrEAk]

I wish I could go to Bestbuy and buy the big 52' Sony that sells for 3000 dollars, cut them a check for 1500 and take it home no questions asked.....that'll be that day.

[TMNT]

Originally Posted by JesusFrEAk

I don't want to go on what may seem like a rant but basically there is no other industry, that I can think of, where the government decides how much you should make.

Have you thought about not accepting medicare patients anymore? What implications would you face if you do? I hear some doctors lose around $100 a year per patient when the accept medicare.

[JesusFrEAk]

Originally Posted by TMNT

Have you thought about not accepting medicare patients anymore? What implications would you face if you do? I hear some doctors lose around $100 a year per patient when the accept medicare.

"Some doctors lose $100.00 a year???" Highly unlikely. more like 100k.

There are some doctors who have a cash only practice but it's dangerous and not reasonable as most people aren't going to pay out of pocket for something when their $45 co pay takes care of mostly everything.

Another dumb rule we have to follow is that if we accept Medicare and someone wants to pay cash we could get in trouble for not filling it with the insurance company.

[TMNT]

Originally Posted by JesusFrEAk

"Some doctors lose $100.00 a year???" Highly unlikely. more like 100k.

There are some doctors who have a cash only practice but it's dangerous and not reasonable as most people aren't going to pay out of pocket for something when their $45 co pay takes care of mostly everything.

Another dumb rule we have to follow is that if we accept Medicare and someone wants to pay cash we could get in trouble for not filling it with the insurance company.

100k per patient per year? Why are you still accepting Medicare? That's obviously not good business. There must be some benefit of accepting Medicare insurance that outweights loosing 100k per patient per year.....what is it?

[JesusFrEAk]

I thought you made a typo. What I'm simply saying is not accepting Medicare would be like throwing away 80% of potential patients. Bad for business and bad for people.

[TurboFan]

In many cases, you don't have an option for Medicare. The government knows practically no one would take Medicare if they didn't have to, so if a hospital has an emergency department (ED), they have to take Medicare. If they have residents, they have to take Medicare. It goes on.

Medicare sets rates based on dozens of factors, including overheads, geography, local wages, etc etc. Then the insurance industry pays according to the Medicare formulas, but they do pay more. If they press too hard, hospitals and doctors drop the insurer. The insurer and the provider (doc or hospital) are in an ongoing dance - docs want more, and drop plans if insurer doesn't pay. The insurer wants to be as big as possible so if they get dropped, the provider loses business. Balance is reached until Medicare decides to cut all over again.

[TurboFan]

Originally Posted by NoKids

gov't is not going to run healthcare. doctors and hospitals will run it. i believe the government just writes the check, i mean, you will write the check.

Not true. Currently, if you have Medicare or almost any insurance, they decide what will be done and what will be paid. Hopefully you get a doc that will go to bat and argue for what is needed.

You are correct, we will continue to write checks for healthcare, even more so with Obama trying to nationalize healthcare.

[johnnymu]

"Back to the U.S.S.A(United Socialist State of America)"

[Suprane]

TurboFan and JesusFreak Nailed it
:c lap:

[M_Six]

I spent this past Christmas and the next day in the hospital with what we thought were heart issues. My bill for a day and a half came to $11,000. At first my insurance company wanted me to pay $4k of it because I received no prior authorization, but after convincing them that I tried and no one was answering the phones on Christmas day, they relented and paid most of it. One of the bills I got stuck with was a $45 bill for some doctor who was *not associated* with the hospital who "looked" at my chest x-ray. I didn't bother fighting it because it was easier to just pay it, but it exemplifies the "piling on" of bills that occur when you're hospitalized. It's like they advertise to all the doctors that there's a patient here with health insurance, so stop by and look at his x-ray so you can bill him for some time. My x-ray was normal, yet no fewer than 5 doctors looked at it. I mean, WTF? Does it really take 5 highly trained doctors to look at a normal x-ray and declare it to be normal?

My father had heart valve surgery at the very beginning of October last year. It did not go as planned. He nearly died and he just came home this week. He spent over 100 days in ICU and the rest in rehab. His bills top $2million. Luckily he's covered under Medicare and supplemental insurance, but even with those, my folks very nearly lost everything they had saved for their entire lives.

It's examples like these which point to a need for health care reform. I work at a university and have pretty decent health insurance, despite the occasional red-tape fight. My folks had Medicare and could afford the supplemental insurance which saved them. But there are literally millions of people out there who have no such coverage. Some have none because their company went under. Some have none because their company offers no coverage or very expensive coverage and they can't afford it. When these folks have medical issues, it ruins their entire lives. That shouldn't be so. There has to be a better way to handle health coverage. Being self-employed or being a blue collar worker should not mean you never have health coverage. Yet health insurance for a family can cost $1000/mo or more. Sometimes much more. These people can't begin to afford that.

I don't like the idea of gov't run health insurance because the gov't can f**k up a wet dream. But something has to be done to get health care or health insurance under control. Health care should not be a privilege. It should be a right.

[TurboFan]

Originally Posted by M_Six

I spent this past Christmas and the next day in the hospital with what we thought were heart issues. My bill for a day and a half came to $11,000. At first my insurance company wanted me to pay $4k of it because I received no prior authorization, but after convincing them that I tried and no one was answering the phones on Christmas day, they relented and paid most of it. One of the bills I got stuck with was a $45 bill for some doctor who was *not associated* with the hospital who "looked" at my chest x-ray. I didn't bother fighting it because it was easier to just pay it, but it exemplifies the "piling on" of bills that occur when you're hospitalized. It's like they advertise to all the doctors that there's a patient here with health insurance, so stop by and look at his x-ray so you can bill him for some time. My x-ray was normal, yet no fewer than 5 doctors looked at it. I mean, WTF? Does it really take 5 highly trained doctors to look at a normal x-ray and declare it to be normal?

My father had heart valve surgery at the very beginning of October last year. It did not go as planned. He nearly died and he just came home this week. He spent over 100 days in ICU and the rest in rehab. His bills top $2million. Luckily he's covered under Medicare and supplemental insurance, but even with those, my folks very nearly lost everything they had saved for their entire lives.

It's examples like these which point to a need for health care reform. I work at a university and have pretty decent health insurance, despite the occasional red-tape fight. My folks had Medicare and could afford the supplemental insurance which saved them. But there are literally millions of people out there who have no such coverage. Some have none because their company went under. Some have none because their company offers no coverage or very expensive coverage and they can't afford it. When these folks have medical issues, it ruins their entire lives. That shouldn't be so. There has to be a better way to handle health coverage. Being self-employed or being a blue collar worker should not mean you never have health coverage. Yet health insurance for a family can cost $1000/mo or more. Sometimes much more. These people can't begin to afford that.

I don't like the idea of gov't run health insurance because the gov't can f**k up a wet dream. But something has to be done to get health care or health insurance under control. Health care should not be a privilege. It should be a right.

First, I'm glad you are OK, and I'm glad your father came through. Think for a moment how incredible it is that we can replace a heart valve in a human, and have them live a fairly normal life. I also applaud your parents for setting aside the money to buy the insurance they needed, and not piss it away on something less useful as so many do.

I was with you to the very end. Health care is no more a right than a free meal at a restaurant. I agree that a basic level of care should be provided, as we have free soup kitchens to feed the homeless and hungry.

Setting that part aside, lets talk about your experience a bit. Insurance - it's a for-profit game, no matter what they say, and they don't want to pay out. It's no different than your car or anything else. The difference is we are all willing, and it is expected, that you may get multiple estimates for work at a body shop, but when was the last time you shopped around for surgery? Many times you can't, and no one in the field is prepared to make their costs that transparent. As such, the insurance companies are on a high level of alert to fraud, but usually pay quickly when a case is obvious - such was your experience.

As for multiple reads on your x-ray, that's a fantastic case of cover your ass medicine. Let me give you an example:
My wife is treating a patient (yes, she's a doc). An MRI comes in for that patient. The on-call radiologist happens to be a musculo-skeletal radiologist, and drew the short straw for the holiday weekend. So he looks at the brain scan, thinks he sees something, but wants a consult. So he calls doc X to look. BTW, my wife is trained to read, can, and will bill for it. She sees Y in the scan. She and doc X confer, and decide that doc Z should eval, as he has the most experience, because they want to be super duper sure before they either ignore what they think they see, or irradiate the hell out of it. So they call him at home, he logs in and confers. Four people have now looked at a scan. If the patient came in through the ED, add a fifth.

Cases like these occur regularly in every doctors office and hospital in America. The AMA has published hard data on this, but the White House has so far not been interested. The White House believes that electronic medical records and more big brother will fix everything. The docs are telling Obama that they admit to ordering BILLIONS of dollars of unnecessary tests and scans every year and do BILLIONS of dollars in needless procedures just to cover their ass in the very unlikely event that someone would hit that 1 in 1,000,000,000 chance of having a whacky disease. That 1 in 1 billion chance of getting sued means they order it all, because 1 in 1,000 patients will sue anyway, even though the doc usually wins.

BTW, yes the docs are highly trained, but no one doc can POSSIBLY know everything. It is also a science, and not a perfect one. No two patients are the same.

Fix tort law, lower healthcare costs.

Lastly, on the topic of insurance - many people you site CHOOSE not to purchase insurance - they spend the money on cars, clothes, fancy cell phones, cable TV, etc. When you buy a car, you have a minimum level of insurance you must buy. It should be the same for health insurance. When I buy a car, I look at what the insurance will cost, because I need to work that into my budget. Same for health insurance. It needs to be available, but at the end of the day, it needs to be on the person to obtain, and no one else. That said, and as I've previously said, there is certainly a group of people in this country that can't afford food, let alone insurance, and it is up to those of us that have the means to at least provide a basic level of insurance for these people.

[M_Six]

I'll be the first to support the idea of getting lawsuits under control. I realize doctors get sued for things which they could not possibly have prevented. I disagree with Obama in this instance. He refuses to support tort reform for doctors and I think he's very wrong in that respect. And I also realize that's why 5 doctors looked at my normal x-ray. Although it still seems to me that they go oevrboard with this stuff. The case you cited was not a normal x-ray. Mine clearly was. If the CYA is that bad that 5 docs need to define something as normal, then we really have a problem.

To put the insurance thing in perspective, my Dad is a retired truck driver. Blue collar to the bone. Mom work a few part-time jobs after we all left high school, but essentially she never had a career. Their "wealth" is a direct result of the other financial disaster this country brought upon itself; the housing bubble. They sold a house for which they paid $12k for over $200k. That's their retirement account. Between that and my Dad's pension, they scrape by. The supplemental insurance was something Mom managed to eke out after the monthly bills were paid. And thank God she did or they'd have lost everything.

Not everyone can afford that extra insurance, though. For my folks, since it was supplemental, it was only a few hundred a month. For folks who are not covered by Medicare, it can run into the thousands for a family. That's where we need to figure out a solution. I disagree with you about health care in that I feel it *is* a right. No one should have to die because they couldn't afford an operation or insulin or whatever. If the only current answer is insurance, which is a for-profit venture, then we need to change that.

I worked for UPS in Germany for a while. Germany, as you may know, has universal health care. I paid a bundle out of every paycheck in taxes, some of which went to health care. UPS also paid into the system as does every company doing business in Germany. I personally only had a few instances where I needed health care, but it was quick and efficient and easy. None of this horror show stuff you hear about the Canadian system with long wait times and so on. The German system seems to work. They have strict tort laws though which protect doctors. So maybe that's where we need to start.

[TurboFan]

Originally Posted by M_Six

I'll be the first to support the idea of getting lawsuits under control. I realize doctors get sued for things which they could not possibly have prevented. I disagree with Obama in this instance. He refuses to support tort reform for doctors and I think he's very wrong in that respect. And I also realize that's why 5 doctors looked at my normal x-ray. Although it still seems to me that they go oevrboard with this stuff. The case you cited was not a normal x-ray. Mine clearly was. If the CYA is that bad that 5 docs need to define something as normal, then we really have a problem.

To put the insurance thing in perspective, my Dad is a retired truck driver. Blue collar to the bone. Mom work a few part-time jobs after we all left high school, but essentially she never had a career. Their "wealth" is a direct result of the other financial disaster this country brought upon itself; the housing bubble. They sold a house for which they paid $12k for over $200k. That's their retirement account. Between that and my Dad's pension, they scrape by. The supplemental insurance was something Mom managed to eke out after the monthly bills were paid. And thank God she did or they'd have lost everything.

Not everyone can afford that extra insurance, though. For my folks, since it was supplemental, it was only a few hundred a month. For folks who are not covered by Medicare, it can run into the thousands for a family. That's where we need to figure out a solution. I disagree with you about health care in that I feel it *is* a right. No one should have to die because they couldn't afford an operation or insulin or whatever. If the only current answer is insurance, which is a for-profit venture, then we need to change that.

I worked for UPS in Germany for a while. Germany, as you may know, has universal health care. I paid a bundle out of every paycheck in taxes, some of which went to health care. UPS also paid into the system as does every company doing business in Germany. I personally only had a few instances where I needed health care, but it was quick and efficient and easy. None of this horror show stuff you hear about the Canadian system with long wait times and so on. The German system seems to work. They have strict tort laws though which protect doctors. So maybe that's where we need to start.

They decided the scan was normal, at this point its an unusual but normal formation. The body does these things, but you sure don't want to ignore a tumor as normal biologic.

Again, your parents spent that last bit of extra cash on insurance, not a boat, or a time share, or that car they always wanted. Smart people.

As for health care as a right, there is a line between basic health care and the "pay to play" market that is rapidly expanding in Canada. Lets face it, there are some treatments that are simply too expensive at this point. I'm sorry, I hate to say it, but that's the case. We don't give livers to people who show alcohol in their system during random tests. Why should we spend tens of thousands per year on people who don't give a shit about their health anyway and will continue to dine on Hostess and Budweiser no matter what we give them??

Someone smoked a pack a day for 30 years, and the taxpayer should cover their $500/day healthcare now? Hell no. Give them comfort care, but that's it. People need to own up to their decisions in life and deal with the consequences.

Before you call me a cold, heartless bastard, I do believe that in a civilized society we should provide a basic standard of care to anyone. That includes basic meds like insulin and arthritis treatments and such, but a $1000 / month blood pressure / heart disease drug cocktail is a hard one for me to swallow for someone that continues to eat crisco fried in bacon grease 3 meals a day.

How would I pay for this? Simple. Most people have to take a drug test to get their job to make the wage that pays the taxes to cover wellfare. So, if you need my welfare dollars, you clearly can't afford drugs, so you need to pass a drug test to get wellfare. Screw your privacy too, you need to stand in front of me and piss in the damn cup.

[M_Six]

Hmm, I'd be careful slinging around the "Crisco fried in bacon grease" statements. We all take risks. Should society pay for people who ride motorcycles? Or ski? Or skydive? Or drink wine? Or indulge in less than healthy meals? At what point do you deem someone "responsible" enough to warrant publicly funded health care? In my younger days, I worked for an asbestos abatement firm. Should I be denied future health care because I chose a risky occupation?

What about the blue collar family whose kid develops diabetes? Should they be forced into a life of poverty because they can't afford the insurance, which would now be prohibitively expensive with a pre-existing condition?

Health care should not be a perk of the well-to-do. It should be available for everyone. Sure, there will be those who put themselves in a position to need extensive health care, but where do you draw the line on responsibility? Which habits are taboo and which are ok? Where do you set the bar on risk?

[sayemthree]

Originally Posted by TMNT

If you have your own health insurance via an employer, you have nothing to worry about...you'll get to keep your healthcare coverage.

If you're poor, jobless, employed without health insurance, or a small business owner who can't afford the premiums then this plan is being devised to help you.

As long as it doesn't F*** with my shit, I'm not worried about it.

DOH!!!! you will pay the taxes for the poor, jobless, employed without health insurance, or a small business owner who can't afford the premiums. when they print more money you pay more taxes.

[TurboFan]

Originally Posted by M_Six

Hmm, I'd be careful slinging around the "Crisco fried in bacon grease" statements. We all take risks. Should society pay for people who ride motorcycles? Or ski? Or skydive? Or drink wine? Or indulge in less than healthy meals? At what point do you deem someone "responsible" enough to warrant publicly funded health care? In my younger days, I worked for an asbestos abatement firm. Should I be denied future health care because I chose a risky occupation?

What about the blue collar family whose kid develops diabetes? Should they be forced into a life of poverty because they can't afford the insurance, which would now be prohibitively expensive with a pre-existing condition?

Health care should not be a perk of the well-to-do. It should be available for everyone. Sure, there will be those who put themselves in a position to need extensive health care, but where do you draw the line on responsibility? Which habits are taboo and which are ok? Where do you set the bar on risk?

All very good questions and points. Of course it's impossible to set guidelines for all aspects, but I do believe people should be held accountable for their decisions.

One aspect that I find very interesting in proposed legislation, and has been supported by insurance companies, is if everyone is required to buy insurance, no one could be dropped, and pre-existing conditions become a thing of the past. I do wonder if rates would be raised a bit, like having traffic tickets when you have to get car insurance, but they say no.

As for hazardous occupations, employers should pay into a general fund to guarantee long term health care for exposed employees.
Details must be worked out, but I am on board 100% with full health coverage for kids under 18. I believe that if kids had access to care, we could stop lots of problems before they get out of hand as adults.

However, I will pose this back to you - why should I pay for someone that has made chronically poor decisions, when I have chosen to limit my risk with better decisions?