Cost of Insurance Lost in Health Debate

[IJ Reilly]

The recent strikes had already set me thinking about this issue, so I was pleased to find this story in my LA Times this morning. Increasingly, labor disputes are centered around health care costs. It's becoming steadily more apparent that the entire system is on the verge of collapse, and is causing greater and greater labor and cost-related uncertainty for industry.

Here's my prediction: Short of some major change in the current trends, calls for a comprehensive overhaul of the US health care system will come from US corporations, who are already accustomed to dealing with government supervised or provided medical care for every employee they hire, in every other nation in which they operate. For instance, the US auto companies are already aware of the cost savings and relative labor stability they enjoy in Canada, and are very supportive of the Canadian health care system as a result. It's only a matter of time before they begin to call for something similar here.

Sadly, it's unlikely that Congress will respond to this growing crisis before then, because as we know our law-makers are far more responsive to the needs and demands of corporations then individuals.

The growing expense of private coverage hits home, but Washington has other concerns.

By Aaron Zitner, Times Staff Writer

WASHINGTON — By leaving buses idled and supermarkets struggling to stay open, striking transit and grocery workers have sent a message across Southern California: The growing cost of private health insurance has become a serious problem.

But angry as it is, the message has been nearly drowned out in Washington by a chorus of other health-care coverage concerns. As a result, lawmakers have given little attention in recent years to the cost of private insurance plans.

Instead, they have worried about shoring up the finances of the giant Medicare system. They have been negotiating over a new prescription drug benefit for seniors. And they have been trying to help the 43 million Americans who have no health insurance.

The rising cost of private health plans "has been like a stepchild to all the other problems," said Len Nichols, a health economist with the nonpartisan Center for Studying Health System Change. "Everyone knows it's there, but no one wants to talk about it."

[...]

http://www.latimes.com/news/nationworld/nation/la-na-health17oct17001431,1,1478646.story

[mactastic]

Yeah, most of the labor trouble I have seen in this area has been due to the rising premiums for health coverage. Half the grocery stores here are picketed, Safeway's management says the workers are seeing the best offer their gonna get, and the workers can't afford to pay any more for the crappy HMO coverage thats available.

Sooner or later a major problem will come from this, but it will probably take down several hospitals, doctors, and corporations (health care or hospitals) before something gets done. Meanwhile more and more people will be unable to afford the health care they need, and when that happens where do they go? To the federal pot. Thats right, when someone doesn't have insurance we don't turn them away, we treat them and either the hospital eats it, or the taxpayer does. So lets just get everyone covered.

[pdham]

Originally posted by mactastic
Thats right, when someone doesn't have insurance we don't turn them away, we treat them and either the hospital eats it, or the taxpayer does. So lets just get everyone covered.

That is not completely true... For example, because of drastic cuts to hospitals in Chicago and Milwaukee (the city I am from) patients with out insurance are often given bus tickets and sent to the Twin Cities. There has been numerous instances of patients turning up unconcious or with ganggrene because of the 6 hour bus ride.

Another example of the growing chorus of the people in power in this country: If you are poor, you just aren't as important

[mactastic]

I could see this get as bad as strikes over health care large enough to have an effect on our economy. Health care costs will become a major issue in American politics, far beyond the traditional senior citizen demographic. If you are spending $700 a month to get your family health coverage, the government might as well be taxing you at a higher percentage. The ones who won't be affected are those in Congress who get great benefits through the government health care package.

On a related note, since Arnold has decided to slash the car tax (which was lowered during the "good times" with the provision that it be reinstated if those should become "bad times") my local paper ran a story about all the fees it was going to have to raise to make up the shortfall. Sounds like that tax cut really helped out.:(

[yamabushi]

Corporations and small businesses in the U.S. would be wise to support a federally funded health care system. Businesses often pick up part of the cost for health insurance, so eliminating that cost could help them put that money to better use.

[Desertrat]

One thing that doesn't seem to be discussed when talking about the high premiums for health insurance is the coverage.

My wife and I were right at 60 when we ran across a bare-bones policy. The combined premium was less than $250 a month; $120 for me and $105 for her. (The premium increased a little bit each year as we aged.) It covered such things as heart attacks and cancer and car wrecks, but not "casual" office visits for colds or stubbed toes. It didn't cover elective surgery.

My personal opinion is that it's stupid to expect total coverage at any sort of reasonable price, but reasonable coverage can be had at an affordable price.

For Old Farts over 65, Medicare Plan B has ten variants of coverage. The premium varies with the company, but they all offer the same plans. For about $200 a month, you get absolute full coverage for co-pay, plus drugs, plus nursing home care during recovery/rehab. The present "Drugs for old folks" thing in Congress is just a vote-buying giant shuck on the taaxpayer.

One misleading thing about the number of folks who don't have health insurance is that a lot of them voluntarily don't have it. They're young and healthy, generally, and absent bad luck or car wrecks, hardly ever use medical services. (I have no idea what's the percentages of this group, compared to "don't have it, and need it" crowd.)

'Rat

[IJ Reilly]

First of all, that "bare bones" policy would probably cost half again if not twice that much today, and few people are getting "total" medical insurance policies anymore. As one who's stuck in the individual insurance market, I can tell you that "total" simply is not available to me, even though I'm in good health and not over 50. I've got a crummy HMO for about $250 a month with deductibles and stop-losses up the wazoo. I was "naked" for a long time, and not by choice, and if premiums keep going up and actual coverage keeps going down, I don't know where I'll be in a few years. And if I get sick? Well, then the insurance company may not renew me the next time, or send my premiums through the roof. That's how it's going, so it's hardly worth talking about the few people who "choose" not to be insured, because that "choice" is often a matter of "choosing" between necessities.

[Desertrat]

Well, leaving the cost to a doctor for the staff to deal with paperwork and the cost of malpractice insurance out of the discussion...:)

I've noticed the rise in costs of such things as a simple office visit, as well as insurance premiums.

I've also noticed the advances in medical technology, and I occasionally see articles about the costs of the modern equipment. As I'm going through treatment for colon cancer, right now, I see a lot of this stuff on a daily basis. Colonoscopy, CT scan, radiation treatment, chemo-therapy. Surgery coming in December. (Merry Christmas, 'Rat! :D) They didn't have all that capability, back in the days of low-cost medicine...

What would be the effect on premium costs if health insurance didn't cover transplants or any complications in pregnancy?

Ya wanna play? You're gonna pay. TANSTAAFL.

'Rat

[IJ Reilly]

The United States is not the only country dealing with these issues, we just happen to be addressing them on a high cost, low return basis, primarily because we treat health care as a market commodity. It should be apparent by now that the health care system, as we have chosen to run it, is on the verge of collapse. Something has to give.

[pseudobrit]

Health care, like police and fire coverage, should not be treated as a commodity. They are the services that protect life. Name one other immediate life necessity that is not guaranteed us by the state.

It's a gross overextension of the capitalist system into areas that need to be addressed by a commonwealth.

[Desertrat]

"Health care, like police and fire coverage, should not be treated as a commodity."

Why not? They have been and/or could be provided by the private sector. That's historic.

"They are the services that protect life."

So what? We band together to have a government provide these services, but that's for our own convenience. It's not built in to any natural-law requirement. They're not mandated by the Constitution.

"Name one other immediate life necessity that is not guaranteed us by the state."

Food. Clothing. Shelter. Electricity. Water.

"It's a gross overextension of the capitalist system into areas that need to be addressed by a commonwealth."

That's your own opinion; I'm happy for you to have the freedom to believe it...

'Rat

[IJ Reilly]

Originally posted by Desertrat
Why not? They have been and/or could be provided by the private sector. That's historic.

Because (1) health care should not be a privilege available only to those who can afford it and (2) the present system is unsustainable and (3) it causes us to pay more and get less for our health care dollars.

I can think of others, but this should be enough to chew on for now. Proceeding on the basis of history reminds me of Einstein's definition of insanity.

[Desertrat]

"Because (1) health care should not be a privilege available only to those who can afford it..."

Well, I agree this would be a nice thing, but lemme ask about one thing: If the costs to the taxpayer of a government-provided healthcare system rise beyond the funding capability, will there be some form of rationing? When you add up the present costs of all private insurance, plus Medicare and Medicaid, is there not some limit, somewhere, somehow?

"and (2) the present system is unsustainable and (3) it causes us to pay more and get less for our health care dollars."

I have noticed that as the federal government has gotten more and more involved in our healthcare, the costs have risen much faster than the inflation rate. I won't say it's an absolute that there is a causal relationship, but it would not at all surprise me. The paperwork costs alone are staggering.

Oh: Who pays for malpractice and/or malpractice insurance?

'Rat

[IJ Reilly]

Health care is already rationed -- 43.5 million working Americans have little or no access to it, and that number just keeps on growing.

You might take note that I haven't proposed a solution to this dilemma, but you've jumped right straight in the direction I've seen a thousand times already -- make any changes look impossible and/or worse then the system we have now.

[pseudobrit]

Originally posted by Desertrat
Food. Clothing. Shelter. Electricity. Water.

None of those are immediate life necessities. Fire, police and medical care are.

And the other point would be that the government does provide a safety net for those services too. No one has to starve or be homeless or go without power or water (yet -- we might get another four years of Bushy, an I imagine the poor will suffer the most under his reign).

[Desertrat]

IJ, I'm not trying to make "any" changes look worse. I guess I'm stuck with looking at the various changes that have been proposed, and finding them somehow lacking.

When folks bring up some problem, I'm wired up to do two things: One is to try to analyze how it got "bad" in the first place; the other is how to fix it or make it better. If I am the one to bring up some issue, I try to have some proposed options for dealing with the problems.

The years have given me certain perspectives on the changes in the way we've dealt with various issues. I don't claim to always be correct in my views, but they're generally based on what I think I've observed. :)

'Rat

[IJ Reilly]

'Rat, I always try to start any discussion about health care by flushing out the people who don't believe that we have an actual crisis on our hands, and don't believe that every person should have access to medical care. I have found that people who reject this premise are not worth the effort of debating on the issue. Their basic point of view is, "I've got mine." Of course they'll never add "and to hell with everybody else," but that's essentially the message.

The next step in such a debate is usually an effort to minimize the problem ("some of the people without health insurance don't want it"), and then to start cries of "socialism" before we've even agreed on whether health care is a problem in need of a solution. Another touchstone in the avoidance package is raising this issue of "rationing" health care without an acknowledgment that it's already rationed.

So, nothing personal here, but I'm not in the habit of debating the health care situation with anyone who doesn't admit that the current system is a disaster.

[Desertrat]

Disastrous for those without insurance who have serious health problems, yes.

43.5 million "without" means some 265 million or so "with". On a nationwide basis, I'd call it bad, but not disastrous.

Is it not federal law that an emergency room must offer treatment, insurance or no; ability to pay or no? That's what I've read, anyway. If so, better debt than death. I read that it's common for those without health insurance to use emergency rooms for non-emergency medical needs--which is a load on the local taxpayers.

Part of my problem with the idea of a federally provided medical system is the fear that we could start having the sorts of problems so often mentioned by Canadians and English about the delays in getting diagnosis and/or treatment. Lengthy waiting periods for non-emergency but necessary surgery, for instance.

Overall, for me, it's one of those deals where I'd like to see less emotion from either side, and evidence that thought has been given to unintended consequences by proponents of change.

'Rat

[Dont Hurt Me]

anything that is ran by the govt is going to cost 3 times as much as private industry. we need a federal backed system of private healthcare for all sort of. not govt ran but govt funded backed up for all. register with approved dr offices period with checks and balances and a voice for the public & dr's and medical profesional. no middleman insurance companies. how much gets sucked up by these guys.

[IJ Reilly]

Once again, your critique of a "federally funded" health care system is premature, since I haven't promoted any solution, let alone that one. One of the key reasons why we (editorially speaking) don't communicate well about this issue is because we can't seem to agree on a definition of the problem, and too many people seem to want to leap over that step to a solution. It can't be done.

I'm prepared to state my principles:

I believe that every American should have access to health care. Nobody in this nation should have to wait until an illness is acute enough to require emergency room treatment, or to hope it "goes away."

No person should be ruined by medical bills.

Hospitals should be able to treat anyone at any time, free from the fear of being crushed into bankruptcy by treating too many people who aren't insured or can't pay.

We should be able to take our health care business to whatever doctor we please, and that doctor should be able to treat us as his best judgment dictates. Insurance company bureaucrats should not be making either of these decisions for us or our doctors.

Other nations, in fact virtually all of them, manage this. So can we. The fact that we don't is a national disgrace, IMO. Not only is the present system is unsound morally, it is unsound economically.

[Dont Hurt Me]

just yesterday the news reported 40 million americans with out healthcare.

[zimv20]

my sister is a dentist. i've learned these things from her:

- not all insurance companies are the same. some reimburse her (for work she's done on insured patients) in a timely manner. others drag their feet.

- many uninsured patients end up not paying, even though funds are due at the end of the visit. the treating doctor (i.e. my sister) eats that cost.

- many of the state and federally-funded insurance plans negotiate a very low rate for procedures. for these patients, working on them may not even cover costs.

- she's thinking of starting her own practice. to make it successful, there are people she'll have to turn away, in favor of those w/ more cooperative insurance companies.

i'm offering no solution to these issues, just more food for thought.

[pseudobrit]

Originally posted by IJ Reilly
Other nations, in fact virtually all of them, manage this. So can we. The fact that we don't is a national disgrace, IMO. Not only is the present system is unsound morally, it is unsound economically.

IOW, they're losing money by trying to be cheaper. Plus it's killing people.

BTW, that was a wonderful summation of what we need in this nation. I'd be hard-pressed to add anything and I doubt anyone could contest a single one of your points.

[Sayhey]

Originally posted by IJ Reilly
Once again, your critique of a "federally funded" health care system is premature, since I haven't promoted any solution, let alone that one. One of the key reasons why we (editorially speaking) don't communicate well about this issue is because we can't seem to agree on a definition of the problem, and too many people seem to want to leap over that step to a solution. It can't be done.

I'm prepared to state my principles:

I believe that every American should have access to health care. Nobody in this nation should have to wait until an illness is acute enough to require emergency room treatment, or to hope it "goes away."

No person should be ruined by medical bills.

Hospitals should be able to treat anyone at any time, free from the fear of being crushed into bankruptcy by treating too many people who aren't insured or can't pay.

We should be able to take our health care business to whatever doctor we please, and that doctor should be able to treat us as his best judgment dictates. Insurance company bureaucrats should not be making either of these decisions for us or our doctors.

Other nations, in fact virtually all of them, manage this. So can we. The fact that we don't is a national disgrace, IMO. Not only is the present system is unsound morally, it is unsound economically.

Amen. Preach on Brother IJ! I used to negotiate health plans for my union and it was a disgrace the amount of money that went off the table and into the hands of insurance companies. When we convinced the management to work with us to get the insurance companies to lower their costs we actually came up with some decent health plans. However, too many folks in this country have no union or any other voice to fight for decent health care -- it is, as IJ said, indeed a national disgrace!

[IJ Reilly]

According to the figures I've been hearing (and have not been disputed, AFAIK), somewhere on the order of 25-35% of our health care dollars end up in the pockets of the insurance industry. Of course none of these dollars goes towards the actual provision of health care; in fact, they go towards the avoidance and denial of health care, as anyone who has seen a claim form knows first hand. This appears to be the single largest reason why the United States spends the most per capita in the world on health care, but still can't seem to provide any for 43.6 million working Americans. It's a system that was designed to fail, especially if you accept as the main goal of the health care industry the task of making people healthy.

Everyone has their own health care nightmare stories, I'm sure, but the one that has me hot under the collar at the moment is no longer being able to go to the doctor of my choice. The general practitioner I'd been seeing for over 20 years finally got so disgusted with HMOs telling him how to treat his patients, that he decided not to take their customers as patients any longer. So the insurance company assigned me like so much chattel to another doctor.

[IJ Reilly]

Another article about this appeared in the LA Times this morning.
Ronald Brownstein: Washington Outlook Universal Coverage Is Within Reach, If the Pain Is Shared Equitably

Ten years ago, a vicious cycle of rising prices and declining access forced health care to the top of the national agenda. Now that destructive spiral is spinning again — with the same result.

Everywhere signs are proliferating that the health-care system is breaking down under the same pressures that inspired President Clinton's ill-fated crusade to guarantee universal coverage.

Three consecutive years of double-digit increases in health insurance premiums are straining employers and igniting conflicts with employees asked to bear part of the burden. Health-care costs have become a growing factor in labor confrontations, like the two bitter strikes underway in Southern California.

The rising costs are also compelling more employers to stop offering health coverage at all — and more employees to decline it even when it's offered. Since President Bush took office, the number of Americans without health insurance has soared by 3.7 million, to 43.6 million, the biggest two-year increase since his father was president.

These problems of cost and access are inextricably connected. It's easy to see how rising costs translate into reduced coverage. But the reverse is also true. The growing number of Americans without insurance means that doctors and hospitals have to provide more uncompensated care that must be subsidized by the premiums of those with insurance. As Bruce G. Bodaken, chairman and president of Blue Shield of California, put it in a speech last winter: "In essence, we are charging the private health-care system a hidden tax, a tax that can't be sustained"

[...]

http://www.latimes.com/news/nationworld/nation/la-na-outlook20oct20,1,4421102.column

[Frohickey]

Originally posted by yamabushi
Corporations and small businesses in the U.S. would be wise to support a federally funded health care system. Businesses often pick up part of the cost for health insurance, so eliminating that cost could help them put that money to better use.

I do not see why I should pay someone else's health care cost out of my taxes. If you think that its businesses that are paying for the cost of health insurance, and putting this into government, you are seriously mistaken.

The cost of health care insurance is paid by the employer on the behalf of the employee. If employers were not obligated to offer health care insurance, employee salaries would be higher.

The advantage of the system now is that large businesses can negotiate for lower rates than individual employees could on their own.

[Frohickey]

Originally posted by IJ Reilly
Everyone has their own health care nightmare stories, I'm sure, but the one that has me hot under the collar at the moment is no longer being able to go to the doctor of my choice. The general practitioner I'd been seeing for over 20 years finally got so disgusted with HMOs telling him how to treat his patients, that he decided not to take their customers as patients any longer. So the insurance company assigned me like so much chattel to another doctor.

Couldn't you cancel your policy and offer to pay your doctor yourself, instead of through an intermediary (HMO)?

There are multiple relationships here. Two business, one medical.
Business relationship is between the doctor and the HMO. Another is between the HMO and you. The medical relationship is between the doctor and you.

Somehow, everyone has gotten used to the idea that when you involve a middleman, that things are supposed to cost less. In every other business endeavor, putting a middleman into a relationship means that more money is taken by the middleman.

What really is required here are non-taxable accounts whereby people can save income into an account that could be used for medical procedures and checkups. But with human nature the way it is, rare are the ones that have the discipline of the ant. Most everyone is a grasshopper.

[IJ Reilly]

Originally posted by Frohickey
The advantage of the system now is that large businesses can negotiate for lower rates than individual employees could on their own.

And if you don't happen to work for a large company, you're pretty much screwed. File this comment in the aforementioned "I got mine" category.

[IJ Reilly]

Originally posted by Frohickey
Couldn't you cancel your policy and offer to pay your doctor yourself, instead of through an intermediary (HMO)?

No, and if you've ever been without health insurance for any length of time, you already know why this is not a plan worth considering.

Medical savings accounts are another smoke-and-mirrors game played by people who want to look like they really care about the uninsured, but... well, they really don't. The reasons why are blindingly obvious.

[Frohickey]

Originally posted by IJ Reilly
And if you don't happen to work for a large company, you're pretty much screwed. File this comment in the aforementioned "I got mine" category.

If you read my post, the statement is fact. Not any 'I got mine' sentiment.

Also, since when was it my responsibility to give others free health care? I'd much rather give myself health care. Everyone else can get their own health care.

Sounds to me like another rant for wanting socialized health care system that penalizes the rich for being rich, and rewards the poor for being poor.

[mactastic]

Originally posted by Frohickey
If you read my post, the statement is fact. Not any 'I got mine' sentiment.

Also, since when was it my responsibility to give others free health care? I'd much rather give myself health care. Everyone else can get their own health care.

Sounds to me like another rant for wanting socialized health care system that penalizes the rich for being rich, and rewards the poor for being poor.

But you are ALREADY paying tax money to uninsured people. You don't think the hospitals get money from the Gov't when someone screws them on their uncovered visit. Hospitals aren't allowed to turn people away, so someone has to pay. Cities probably have higher fees because we don't cover everyone, and as for hospitals go - you don't really think aspirin costs $35 do you? One could call that kind of overcharging a "tax" as well.

So if you are already paying, lets just codify it and remove the stigma from the uninsured.

[IJ Reilly]

Originally posted by Frohickey
If you read my post, the statement is fact. Not any 'I got mine' sentiment.

Also, since when was it my responsibility to give others free health care? I'd much rather give myself health care. Everyone else can get their own health care.

Sounds to me like another rant for wanting socialized health care system that penalizes the rich for being rich, and rewards the poor for being poor.
Methinks the gentleman protests too much.

Sorry, but it sounds to me like you are virtually the poster child for the "I got mine" attitude. You can't deny it and then express it vividly all at the same time. Making wildly contradictory statements doesn't fly with me, that's for sure.

You've also managed to dash for the other leg of the denial stool, the classic socialism gambit. That's right, we don't even have to talk about the problem if we already know the solution...

[Frohickey]

Originally posted by IJ Reilly
[B]Methinks the gentleman protests too much.


Yep. I got mine. And I got it for myself. I'm actually proud of the fact that I did it on my own.

Maybe we can have it so that its voluntary instead of mandatory. Give people a choice.

[Frohickey]

Originally posted by mactastic
So if you are already paying, lets just codify it and remove the stigma from the uninsured.

In for a penny, in for a pound?

[mactastic]

Originally posted by Frohickey
In for a penny, in for a pound?

You (and I) are both in for more than a penny already.:p

[Sayhey]

Originally posted by IJ Reilly
According to the figures I've been hearing (and have not been disputed, AFAIK), somewhere on the order of 25-35% of our health care dollars end up in the pockets of the insurance industry. Of course none of these dollars goes towards the actual provision of health care; in fact, they go towards the avoidance and denial of health care, as anyone who has seen a claim form knows first hand. This appears to be the single largest reason why the United States spends the most per capita in the world on health care, but still can't seem to provide any for 43.6 million working Americans. It's a system that was designed to fail, especially if you accept as the main goal of the health care industry the task of making people healthy.

Everyone has their own health care nightmare stories, I'm sure, but the one that has me hot under the collar at the moment is no longer being able to go to the doctor of my choice. The general practitioner I'd been seeing for over 20 years finally got so disgusted with HMOs telling him how to treat his patients, that he decided not to take their customers as patients any longer. So the insurance company assigned me like so much chattel to another doctor.

Having had some experience with insurance companies involved with health care, I rate them right below pond scum. I wish unions and employers would both recognize that on this issue they have more in common than differences - they are both getting screwed by the insurance companies. Time to work together to both either put pressure on the insurance thieves to lower their rates or better yet get rid of them entirely.

I've heard many stories like yours IJ, in one case we forced the Company to keep open a plan that only had two people in it to help a fellow worker stay with a doctor he needed for a particular illness he had. It worked for 4-5 years but finally he had to move on to a new doctor. It takes a lot of work and a lot of organization to get these monsters to deal with real human beings' health needs. If you're by yourself you basically get the shaft.

My own little pet peeve with the insurance companies is how come they feel they have the right to change a medicine proscribed by my doctor? I got a prescription from my MD that when I went to pick it up had been change to a different medicine because my insurance company had decided that they would not pay for that particular medicine. All without one word to my doctor or myself.

The only real remedy is a national approach that deals with health care on the basis of principles like you talked of earlier. I'll be watching the candidates to see which one comes closest.

[Frohickey]

How about having companies contract with doctors, or groups of doctors, just like a company would retain a law firm. Here, all the employees of the company would go to the doctors group for all of their medical needs.

[IJ Reilly]

Originally posted by Frohickey
How about having companies contract with doctors, or groups of doctors, just like a company would retain a law firm. Here, all the employees of the company would go to the doctors group for all of their medical needs.
You think this is a new idea? One of the largest HMOs in the nations started in precisely this way -- it's called Kaiser, started by the Kaiser Steel Company.

But you are still avoiding several major factors in the affordability picture. First, not everyone works for somebody else. In fact as a group, the people who don't work for somebody else is one of the fastest growing in the economy, and this medical insurance crisis is a lead weight around the neck of the small business sector. Second, if any business choses not to insure their employees, these employees will be cast into the unaffordable private insurance market, or be forced to do without.

Well, at least you've dropped the pretense of caring. I guess some people just haven't earned access to health care, like you have.

[yamabushi]

I did some work for a major US health insurance company a few years ago. I was disgusted by the inefficiency and waste built into the system for informing doctors about which drugs and proceedures would be covered on a case by case basis. Everything had to go through several people and be signed off despite the fact that decisions were made upon a universal set of rules. I was busy improving their database when I suggested that the entire department could be eliminated if the database was connected to a web site for use by doctors. I was promptly encouraged to keep my mouth shut and leave at my earliest convenience.

[Desertrat]

As PACs were hailed as the solution to campaign finance, lo, those many years ago, so were HMOs hailed as the solution to the rising costs of medical help.

All I know is that when the government starts helping folks, the costs go up faster than the normal rate of inflation, and the quality goes down. That hasn't changed in forty years.

The Golden Rule always applies: "Them with the gold, rule." The government's funding of any program for any purpose comes with rules and regulations which go far beyond the basic purpose of the program. A relative few are indeed helped, true; but the overall costs have always risen. The usual question: How hard to you want to bite the economic middle class? They're in enough trouble for buying power, already.

As far as lambasting insurance companies, and claiming some "35%", a better way to judge is to look at the balance sheets as to their profitability. Barron's; the WSJ; even the Web. If you find one with a P/E of 15, you better buy in. That's 6.67%.

'Rat

[mactastic]

Another interesting tidbit is the amazing difference in how my wife and I are treated now that we are on a Blue Shield PPO instead of the HMO we were on last year. HMO patients are definetly second class citizens in doctors offices.

[IJ Reilly]

Originally posted by Desertrat
As far as lambasting insurance companies, and claiming some "35%", a better way to judge is to look at the balance sheets as to their profitability. Barron's; the WSJ; even the Web. If you find one with a P/E of 15, you better buy in. That's 6.67%.

What? If you are referring to the estimates of the insurance industry take of the health care dollar ranging from 25-35% -- these are not profit figures for the insurance companies. Denying health care to policy-holders costs serious money, and they spend it on armies of paper-pushers.

Incidentally, you have once again jumped over the problem to a solution (which I at least have not proposed). It's interesting that none the people who were unwilling to sign onto my set of stated health care principles have expressed any of their own. All I've heard from them so far is a bunch of generalized fear-mongering about government involvement. It's no wonder problems like this never get solved -- if I were in Congress, I'd wouldn't be feeling much pressure.

[Desertrat]

"I believe that every American should have access to health care."

Several ways of looking at "access". Do you mean able to afford (via personal billfold or insurance) to get anything up to and including transplants? If so, sure, I agree.

"Nobody in this nation should have to wait until an illness is acute enough to require emergency room treatment, or to hope it "goes away.""

No argument with that.

"No person should be ruined by medical bills."

"Hospitals should be able to treat anyone at any time, free from the fear of being crushed into bankruptcy by treating too many people who aren't insured or can't pay."

Both sound good to me...

"We should be able to take our health care business to whatever doctor we please, and that doctor should be able to treat us as his best judgment dictates. Insurance company bureaucrats should not be making either of these decisions for us or our doctors."

Well, once upon a time...Trouble is, we've done this to our selves, insofar as the bookkeepers designing medical treatment.

Still, there's gotta be some way to achieve these goals, and some way to pay for them. Enumeration is but a start...

For every proposed solution to each part of your deal, ya gotta figure out whose ox will be gored, if any. A "solution" is not a solution if it's not politically feasible. I got a good education about that little item with the Coastal Zone Management Program, back in the '70s. We put a pretty good evironmental protection/industrial development package together in about two years, and folks were still squabbling, ten years later.

'Rat

[pseudobrit]

Originally posted by Frohickey
Also, since when was it my responsibility to give others free health care? I'd much rather give myself health care. Everyone else can get their own health care.

Do you call yourself a Christian?

[IJ Reilly]

Originally posted by Desertrat
For every proposed solution to each part of your deal, ya gotta figure out whose ox will be gored, if any. A "solution" is not a solution if it's not politically feasible.

Of course, but the definition of political feasibility is not constant. My prediction at the start of this thread was along these lines -- that we'd see a change in the political climate when the corporations decide that the situation had gotten out of control. At that point, you'll find labor and management more or less on the same page on health care issues. It's a damn shame, but we'll never see serious health care reform without the corporations giving their members of Congress permission, but that's the system as we know it today. The Clinton effort certainly demonstrated that sad fact of life.

[Desertrat]

I won't say I believe I'm absolutely right about HillaryCare, but I think that ""We should be able to take our health care business to whatever doctor we please, and that doctor should be able to treat us as his best judgment dictates. Insurance company bureaucrats should not be making either of these decisions for us or our doctors."" was not included. Substitute "government" for "insurance".

'Rat

[IJ Reilly]

I hardly remember all of the details, either -- the Clinton plan was massively complicated. Why? Because Clinton attempted to mollify the insurance industry, making it an intimate part of the planning -- and when he failed to mollify them sufficiently, the industry turned on him like a pack of rabid dogs. Then the Republicans and talk radio started chanting "Socialism! Socialism!" right on cue, and it was all over.

Ever since, health care has been on the furthest back burner, as completely ignored as Congress can manage. And that's precisely where it will stay, until the corporations begin telling Congress they've had enough labor strife over health care. That's when something meaningful will happen, and not before.

[mactastic]

And it will get much worse before it gets better methinks.

Saw this yesterday, and I found it interesting that the majority of working uninsured are working for the largest corporations. I bet their CEO's have good health benefits.

Link (http://www.msnbc.com/news/983140.asp?0si=-)
A third of the nation’s workers without health insurance are employed by large companies, a study says.Thirty-two percent of all uninsured workers in 2001 were employed by big companies, up from 25 percent in 1987, according to the report released Tuesday by The Commonwealth Fund.
Researchers cited as factors soaring health care costs, declines in manufacturing and union jobs and the changing structure of large corporations — those with more than 500 employees — and the benefits they offer.

“Policy-makers seeking solutions to the growing uninsured problem must look beyond workers in small firms, or they risk leaving out a large group of low-wage uninsured workers,” said Jeanne Lambrew, an author of the study and an associate professor of health policy at George Washington University.

The study also noted that seven out of 10 uninsured workers at large companies were not offered health insurance, and 15 percent were ineligible. Low-income workers were the most likely to be without coverage.

So if companies are already being forced to pass the costs of health care on to employees because they can't afford to pay any more, how can anyone make the arguement that salaries will go up enough for the workers to afford individual care when they can't afford the group rates that their employer offers now? The employer obviously gets a discount for buying coverage in bulk, so it would actually get MORE expensive, and the worker would have less money if we cut the health benefits and gave them the difference.

[mcrain]

I find it fascinating that people worry about the costs of government running healthcare. They point to how everything costs more if the government runs it. Ok, I challenge you to actually back that up.

The US government runs medicare and oversees medicaid. Both of those programs provide expensive and necessary healthcare to the segment of the population that needs and uses it the most, and yet they do it for FAR less than ANY insurance company or HMO or anyone else could do. Far less.

So, what has happened? The people who used to be the most profitable (elderly and the disabled) now have to be treated inexpensively, so what do doctors and insurance companies do? They jack up their prices on the rest of you.

Here's a thought for those of you who think they don't want to pay for someone elses insurance... you already do!

Everytime you buy just about anything made in this country, you are overpaying by somewhere between 25 and 60% just to pay for the insurance of the company selling the product. I've heard statistics that you could buy a $25,000 car for about $17,000 (or something like that) if health insurance was nationalized.

There's way more to this argument than saying it's going to be too expensive, the government is inefficient, I don't want to pay for you, or whatever else you want to say... this is a brewing national crisis, and we have to deal with it.

[IJ Reilly]

What's the argument for tying health care to employment? This is the question I'd expect to be raised more often in the coming months and years.

[Desertrat]

Dunno if it's "truly true", but I've read that FoMoCo spends more on employee health insurance than on the steel for its vehicles.

Dunno about the current situation in Florida, but about a dozen years back, the annual malpractice insurance for ob/gun doctors was as much as $250K a year. I talked to one orthopedic surgeon here in Thomasville, GA, who told me that when he hit the office on Monday morning, he was $1,000 in the hole. His malpractice premium was $1,000 a week. What do you reckon numbers like that do to the cost of an office visit?

The extra staff needed to deal with the paperwork of insurance companies, Medicare and Medicaid adds payroll costs, as well. Even in this low-pay area, that's another $500 a week plus SS and health insurance costs, per doctor.

In just 20 years I've watched the cost of a simple office visit in relatively low-cost areas rise from $15 to $20 up to the present $50 and $60.

My wife's receptionist is married to a guy whose company provided full-bore coverage in the health insurance. That woman would haul her kid to the outpatient clinic for treatment of stuff that would have been a self-applied bandaid when I was little. For that sort of coverage, the premiums must be out of sight.

And so I found an affordable, bare bones policy. They're out there, but few people seem interested in looking for them.

'Rat

[IJ Reilly]

Once again, bare bone is just about all that's available anymore in the private market, so please don't talk about what people are interested in finding. The problem is, bare bones now costs $3,000.00 a year or more, and is rising in price at double digits every year. That's what I've got, so I know.

[Desertrat]

Okay, IJ, so why not start your own insurance company?

'Rat

[IJ Reilly]

It isn't like you to be so trivial. If you prefer not to discuss this issue any further, just say so.

[Desertrat]

I was only halfway joking.

When you identify a widespread problem, you immediately cause two questions to arise: What can or should society do; and, what can I do?

I note that in the arena of bank loans and credit in poor neighborhoods, people have gotten together and created a bank which caters to those needs. If one person can instigate the creation of a bank, why not an insurance company? The opportunity then exists to provide coverage without the high costs brought about by greed.

No one average guy can do it alone, but he can be the source of inspiration to others...

'Rat

[mactastic]

It's all those damn attorneys, and the irresponsible people who use the system that ruin it for everyone huh? The for-profit HMO system would have nothing to do with it? Or is it possibly due to a combination of these factors, plus some others? People who pick and choose their boogeymen are looking to make political hay, not solve the problem.

I would be willing to talk about reasonable caps on malpractice suits if there was any sign of a willingness to compromise on the part of the insurance industry. Unfortunately, they are some of the largest lobbyists, along with the trial lawyers. So nothing will happen until the people are in near-revolt because of a lack of decent health care.

Oh yeah and the idea that only the working deserve health care is bogus. Everyone deserves health care. Just as we deserve life, liberty, and the pursuit of happiness.

[zimv20]

Originally posted by Desertrat
what can I do?


the average person can take a little more responsibility for their own health. quitting smoking, getting more sleep and/or eating better should be considered.

it also means getting better educated. i'm really tired of my friends getting a cold, going to the doctor, getting antibiotics, and making no changes to their sleep or work schedules.

(just last week i watched a friend w/ a cold get drunk, then have to come home from work sick the next day. she wasn't interested in the sleep/echinacea/vitC regimen i recommended)

i'm also tired of doctors prescribing antibiotics for something that is likely viral.

i'm in relatively good health but self-employed. i consider myself lucky to get health care for $350/mo. -- many of my friends are without. and that's BS.

[IJ Reilly]

What the world certainly does not need is another health insurance company. Fundamentally, the concept of insurance is antithetical to the delivery of health care, and I think it was a fairly horrible mistake to ever have connected the two. Insurance is designed to recompense the policy holder in the event of a loss of some catastrophic nature. The objective of health care is to prevent the catastrophe from occurring in the first place. Most health insurance policies place burdensome roadblocks between the policy-holder and preventive health care, through deductibles and co-pays. They often prevent doctors from treating their patience as their best medical judgment dictates.

Furthermore, insurance delivers its product on the basis of risk, either refusing to sell the product to people at high risk, or raising the premiums to cover the calculated risk. The net effect of this is to deny access to medical care to the people who are most in need, the people with actual health problems. It's a fundamentally flawed system, and I honestly don't see how it can be made sensible with a bit of tinkering here and there.

[Taft]

Originally posted by Desertrat
My wife's receptionist is married to a guy whose company provided full-bore coverage in the health insurance. That woman would haul her kid to the outpatient clinic for treatment of stuff that would have been a self-applied bandaid when I was little. For that sort of coverage, the premiums must be out of sight.

And so I found an affordable, bare bones policy. They're out there, but few people seem interested in looking for them.

'Rat

It seems your view of healthcare is that most people are paying for more coverage than they need.

Let me give you a scenario. This might hit home to you, considering you are being treated for cancer right now.

Lets say we have a family without healthcare or with a "bare bones" plan that only covered emergency situations or "really bad" medical conditions. Now lets say the father of the family feels a small lump on the inside of his mouth. He is otherwise in perfect health. That lump could be cancer. But it just as easily could be a benign growth. What is the father to do?

He could get it examined, but if it isn't cancer, his healthcare wouldn't cover it. How much would that cost him? $100 for the doctors visit? More money for the biopsy? What if he can't afford that much?

What ends up happening is that people with no (or very poor) coverage end up avoiding checkups and treatment which could prevent serious illness down the line. This leads to more lives lost.

People in this country need to be able to rely on regular doctors visits. If they can't afford them or their insurance won't pay for them, people won't go to the doctor. This causes more serious problems later on. Have a horrible sore throat? It could be just a cold. But it could be strep-throat, which, if left untreated, can cause heart damage. Do we tell parents to stop bringing their children in for sore throats? Ear infections? Lumps? Breast exams? Yearly checkups?

I understand that overuse of the healthcare system can be bad. It strains hospital resources and degrades the overall quality of service. But to completely lack preventitive care is not an option I'd like to see employed. The human cost would be much too great.

And given our current healthcare system, that is the way we are headed. The more people without adequate coverage, the more people who abandon preventative care, the more people who die. Simple as that, really.

Taft

[IJ Reilly]

And, ironically, the lack of access to primary and preventative care ends up creating a greater cost to the system. This, together with the 25-35% overhead needed to sustain the insurance system are the main reasons why we pay more for our medical care system in the US and get poorer results.

I'm pretty uncomfortable with placing any of the blame on people who "abuse" the health care system. While surely these people do exist, I don't feel prepared to stand in judgment of anyone else's medical issues. That should be between them and their doctor.

While we're speaking of abuse, though -- how about the families with double coverage, through the employers of both working spouses? People lucky enough to be in the situation are really in fat city. Go ahead, tell me that's an efficient use of our medical care dollars.

[zimv20]

Originally posted by Taft

People in this country need to be able to rely on regular doctors visits. [...] to completely lack preventitive care is not an option I'd like to see employed. The human cost would be much too great.


remember when HMOs first came out? the whole business plan relied on helping people to live healthy lives so the bigger expenditures (i.e. unchecked and/or catastrophic diseases, et. al.) could be kept in check.

seems it hasn't worked out too well.

who's to blame? was it a bad business model? do people not take enough responsibility for their own health? did the HMOs cut costs too much and do they cover too little?

[pseudobrit]

Originally posted by zimv20
remember when HMOs first came out? the whole business plan relied on helping people to live healthy lives so the bigger expenditures (i.e. unchecked and/or catastrophic diseases, et. al.) could be kept in check.

seems it hasn't worked out too well.

Then the bean counters saw a nice profit margin increase if they cut simple checkups and many maintenance drugs out. So they cut them.

Their logic was that when the catastrophic stuff give you symptoms, they'd hope you were so far along you'd just die quickly and cheaply.

I guess the plan worked and they still make a profit killing people, because they're still doing it, meaning they've abandoned the "healthy clients are affordable clients" strategy for a "keeping healthy clients healthy costs more than letting sick clients die" one.

[Desertrat]

Somebody correct me if I'm wrong, but it seems to me that somebody who can't afford an infrequent $100 for some medical cost is likely eligible for Medicaid. At least, that's my understanding as to why we have that very-expensive program. (Ten or so years back, the Tallahassee "Democrat" had an article which stated the Medicaid cost in the state budget had risen from an initial $50 million per year to some $500 million. Dunno what it is, today.)

Another sorta-unknown thing: I read somewhere that the non-profit HMOs have a much higher level of satisfaction than the for-profit ones. Anybody know about this?

'Rat

[pseudobrit]

I have a monthly need for medications that cost over $250 at the pharmacy.

I'm not eligible for any government assistance, and I wasn't when I was unemployed for four or five months this year. My new health care just kicked in for my new job.

Right now I'm out of meds, not feeling very well, plus flat broke from paying bills and little things like eating lunch and living a life.

So I (anxiously) wait for my new card to show up.

What's that about the infrequent $100 expense?

[pseudobrit]

Originally posted by Desertrat
Another sorta-unknown thing: I read somewhere that the non-profit HMOs have a much higher level of satisfaction than the for-profit ones. Anybody know about this?

'Rat

Goes for banks and regular health insurance companies too. I love my credit union/hated my bank. I remember when Blue Cross/Blue Shield was non-profit and they were great. Then they went for-profit and went to hell.