Health savings accounts
August 8th, 2007 High Income Families Benefit, Study Finds. By Joyzelle Davis
Both my wife and I work, the HSA is one of the few tax deductions that we have. The program has been very beneficial for us. It has allowed us the opportunity to spend money on prevention, hopefully keeping our future medical expenses down.
My did you try and connect those that have no insurance to the Health Savings Accounts. What is the connection? I am tried about hearing about those that do not have insurance As a Firefighter/EMT I care for many injured people. Several weeks ago, a man riding a new Harley crashes his bike, he elected to buy a motorcycle and not purchase insurance. A 49 yr old female, lives in a $600,000 house, two cars, several TVs, cell phones, satellite TV, but elected not to purchase insurance. A member of my own family, retired pretty good retirement, just built a vacation home, yet they elected not to purchase even thou it was available and they had the money. Many of those currently without insurance do have the ability to obtain health insurance.
You should have written, many American benefit from HSAs.
This letter has not been edited.
Excellent letter, Mr. Keegan.
HSA's are not a panacea for our health care system. But, I still don't know why anyone would oppose the program. It allows the middle-class to save, invest and maintain a tax-free savings account dedicated to medical expenses. It also allows folks to afford health insurance.
The same people who oppose health savings accounts also oppose school choice and private Social Security accounts. All of these programs give more power to the middle-class.
Liberalism is the enemy of the American middle-class.
Posted by John II on September 10, 2007 02:32 PMThe reason health insurance costs so much is that it is part of the plan to take down the middle class. As Martha Stewart would say, HSA's are a good thing.
Posted by RP McMurphy on September 10, 2007 02:45 PMJohn II,
I had a health savings account until I had to use it up because of the high deductible on my insurance. Most people don't oppose school choice, they just believe that if you want to pick a fancier school for your kids, you should pay for it. Same goes for social security. If you want more than what social security provides you should have a private retirement plan. The less fortunate should not be abandoned because they didn't all choose to be disabled, born into poverty etc. They need some basics. That's all those public schools and SS provide. No frills basics.
Posted by Stan Broyles on September 10, 2007 05:07 PMStan Broyles,
You had an HSA and you used it up; is that an argument for or against HSA's? The point of an HSA is to cover the deductible.
"Most people don't oppose school choice, they just believe that if you want to pick a fancier school for your kids, you should pay for it."
What does that mean? Who should pay for it? Me? Or the one who wants a fancier school? Vouchers give money to the poor so they can choose the school that meets their needs.
"If you want more than what social security provides you should have a private retirement plan. "
Fine, can I have opt out of Social Security then? I don't want it. I'll save for own retirement. Would you deny me that choice?
"That's all those public schools and SS provide. No frills basics."
Private Social Security accounts would have allowed the poor to build wealth over time. It would have given the poor a chance to own a piece of corporate America and have a larger stake in it's success. It also would have allowed the poor to pass on that ownership to their children. School vouchers allow the poor to have the power to choose from competing schools. School vouchers helps the poor.
So, Mr. Broyles, your government programs trap the poor in government dependency, robs them of educational choice, and limits the amount of money the middle-class can save for their own health care.
Posted by John II on September 10, 2007 05:24 PMWhat is stopping people from saving money and calling it a "health savings account"?
Posted by Sharon B. on September 10, 2007 05:54 PMThe government. HSA's allow workers to put pre-tax money into the account.
Posted by John II on September 10, 2007 06:01 PMFor those who oppose HSA's:
Yes, the account reduces tax revenue, but only in the same way an employer paid insurance plan also uses pretax dollars. Please state why this is wrong?
HSA's are really about access to medical care. Many without insurance show up at the emergancy room because they do not have a doctor to call for an appointment. HSA's can help set up the relationship (HSA's are not just piles of money in an account) and leave the emergancy room for emergancies and not for ordinary nonemergancy medical care.
Posted by David on September 10, 2007 06:24 PMHSA's could save anyone money if a small modification were made so that the "basic" insurance plan and the beginning balance could be paid by some entity like the government for low income workers. Such plans encourage people to save and keep the ones who are healthy in the system so there is less chance someone would end up in dire circumstances.
Regulations on who, how much and other parts of the HSA are up to Washington which put severe limits on them to keep them down.
Any system that makes individuals more aware of health care and its costs is a good thing.
Many of the working poor would find it much easier to take care of health problems if they had an HSA. If the government were to put a 5K HSA in place for every person on Medicaid they could get rid of reams of paperwork and thousands of employees. How much would that free up for medical care not to mention the equal number of people in the private sector employed just to fill out government paperwork? Perhaps, if the people so in love with socialized medicine would take the time to really look at the trouble caused by the government payment system in place now, they would finally begin to trust the ability of the average person to be responsible for health care.
I'm just on the way to take my granddaughter to the Wal-Mart clinic for what we though was a cold but she had had a cough for a week and they won't schedule an appointment that fits her school hours at Kaiser. The clinic takes our insurance and will take good care of her. I also have to take my cat to the vet tomorrow. I mention it because I called to check the cost and they had the information at hand both at Wal-Mart and the vet. When was the last time you called a doctor's office to check on the cost? If you have done it recently perhaps you got the stunned silence and a two minute hold while they had to find out from the accounting department. I did when I called a local pediatrician.
Take the average income of a Colorado family, and what percent could they save.? What are they saving now. Can we remove the before or after tax exemption?
If the savings were pre-tax could the average family save $100.00 per month? or more?
Posted by Sharon B. on September 10, 2007 07:59 PMNothing is stopping people from saving money Sharon B. It is called a health savings account because it is attached to a high deductible insurance plan. That is what makes it tax deductible and eligible to be exempt from income taxes on the interest it earns. It only is to be used for medical, dental or vision expenses. Not for your hairdresser.
We have one plus a normal savings account and we save more than $100 per month in each. The big difference is the money in the HSA is only available to use for medical expenses - not for the big screen tv that would look great in my great room. That is what is stopping people from calling a regular savings account an HSA . Get it?
Posted by Jack Bauer on September 10, 2007 09:48 PMYes, Jack and thank you for clearing this up for me. How does the insurance part work out for you? Does it compare favorably with insurance plans you had before?
Posted by Sharon B. on September 11, 2007 12:03 AMSharon,
My husband's company will change to HSA (if the individuals want to do it) The first of the year. We will spend a little bit more for me and a whole lot less for my husband and granddaughter. Right now the cost on insurance plus our out of pocket is about 400 a month of which 200 is for our insurance. With the HSA we will have a catastrophic policy that covers things after a 5000 dollar deductable and we will get a deposit from the company of 200 a month to match our 200 a month. At first it might be a bad squeeze but eventually we will have the best we can manage and I have already talked to the various specialists and they understand that we will be paying "cash" so they have decided to negotiate the cost of office visits and the other things they normally expense to insurance in exchange for cash payments. We have also decided to keep the Kaiser for the first three months which will make it a bit more expensive but will give us a neat transition since we have maxed our out of pocket with them for the year which will end in April.
You can make an HSA what you want it to be by planning and using good sense. The catastrophic will always remain a part of things. I just got a message that I qualify for Medicaid. Now there's a program I'll stay away from until I am unconscious. My DNR is the only thing between me and that bad care then.
IF we could find a place where you and I agree on this issue there is nothing that could survive against the pair of us.
After all, after driving a taxi for 12 years and a truck for 10 I developed what my husband calls a wet mind. Accoriding to him I was born with a warped mind and then it got wet. Someday I'll post my 10 questions on abortion and both sides will want to lynch me, again.
I don't hear anyone talking about those who work but still can't afford insurance or saving $100.00 a month or much of anything else. They work for companies that don't offer insurance programs because they dropped that benefit becase they could not afford it or, because they wanted to increase their bottom line. There are more people out there in the real world trying to make it on their own but still can't afford health insurance or save for retirerment , or put money in a health account. They can barely afford the rent, food, telephone, clothes for their kids and their school expences and a car to get to work in.
They don't want nor would they take government help and if some medical problem or an accident happens their just plain out of luck. Which is just too bad, so sad, but not my problem, according to what I've read in this comments forum.
What about these hard working , honest people, do we just cast them to the winds of fate, ignore them, pretend they don't exist or, do we change the oppressive laws and absurd government regulations that create no help for this to long ignored population segment of society. Their not rich, their not poor, their not middle class. Their just people caught in the social cracks of too much government interference.
Posted by Allen Campbell on September 11, 2007 07:30 AMMedicare is truly broken, this entitlement will either bankrupt America or fail while in the process of doing so. And Ritter's Blue Ribbon healthcare commision's $26 billion annual proposed healthcare "fix" will croak Colorado consumers to the tune of $5,000 each per annum. That is not an alternative, that's a one-way financial ticket to Boot Hill.
We need choices and competition that ensure lower prices and better service. We need the ability for each and every health program participant to have the ability to shop the system and make personal decisions in his or her own best interest. HSAs are just one good way to go.
In sharp contrast, all monoplolies, including healthcare, are hostile to consumers; they produce higher prices with less service.
The latter presents the possibility of us being forced to rely on the very same crowd who repair or bridges, run the post office and secure our borders with our healthcare. Ouch!
Allen,
While some of those without insurance are truly in the category you mentions there are others who would consider it nonsense if someone told them they had to choose between the cable TV and health care. Some might have to make different choices in other areas but an affordable health care system is only going to be possible if we start some kind of competition so that the individual has the ability to exercise control over their health care costs. People have to choose to be responsible. If they make a wrong choice we have to allow them to have the consequences. What to do about children in such cases is something we need to decide. Perhaps the answer will come via the offerings of the insurance companies. Time to start working toward a solution.
Right now the prices are invisible because insurance companies and the government pay for things and people can choose to pay for insurance or not but there is no incentive for the providers to compete for the health care dollar. Their focus is on the paperwork to obtain payment.
Why that is has been stated more times but the solution is not going to be easy. The ultimate solution is to take the power of the market and put it in the hands of the consumer. People can choose their own car insurance and that makes the market consumer based. Give the poor a choice of insurance programs or a health savings account tha twill permit them to make their own choices. Basic health care and catastrophic care can be separated or combined according to the wishes of the individual.
Until we find a way to do these things, and the best way is to offer tax benefits including tax credits for all those who make too little for the taxes they pay to cover their expenses, we can make it possible for people to buy insurance without making it employer based. We can make more of the local clinics extend their hours so that people can go in the evening or weekends. For other suggestions we need to study the non-insurance based parts of health care and so we can see what kinds of benefits we will gain.
Sometimes we can work quickly. In this we have too many different things to do. The one thing we must NOT do is allow the government to take any more control.
One suggestion, in need of work, is to have the state make the original HSA deposit for the poor and to offer the catastrophic coverage at a sliding scale determined with actualrial tables. Then the people can choose the health care for themselves.
Posted by momma y on September 11, 2007 11:17 AMmomma y,
I undersand what you are trying to say. You keep talking about choice but you have no choice. We are all paying for your health care. Insurance is NOT HEALTH CARE!!! It is a way to take money from others people's pockets and put it into the insurance's bank account. I rather have you stealing from me than an insurance company.
Posted by Stan Broyles on September 11, 2007 07:42 PMIs Allen Campbell the only person who can make a tangible statement?
Posted by Stan Broyles on September 11, 2007 07:52 PMStan the only money I share in is the pool of insured. If you are in the pool, insured by Kaiser, we share otherwise we don't. Insurance is a service. If you eat at the same restaurant as I do neither of us is subsidizing the other. Your hatred of insurance companies is noted. Since the only function of an insurance company in the health care business is to spread the risks out and make a profit while doing it, I fail to understand why you would substitute the government's greedy and inefficient hands for the insurance company's. Insurance companies have to obtain and keep customers or there is no profit so their first loyalty is the their customers. Today that primary customer is the business owner.
In order to have choice in health care we must first be in control of the money and the only way to do that is to make the insurance companies base their policies and other decisions on individuals not corporations. That is where there will be choice. We cannot choose our diseases or accidents. We have to choose what we want as a balance between total coverage and no coverage. Now we only have the choice of taking what our employers want to offer or not taking it.
Many people might refuse the plan offered by their company but would spend the same pre-tax dollars if they were able to do so on a plan of their choosing.
I promise you I have far too much experience with both government and health care and insurance companies. Fortunately I am a capitalist so I know that any workable plan will also be capitalistic.
Posted by momma y on September 11, 2007 09:52 PMHealth care costs are fungible. The pool you're in shares in the same costs as all the other pools. I know the insurance companies spend a lot of money on advertising and lobbying to brainwash people into believing they have to have health insurance. But if you don't pay, you still get healthcare.
Posted by Stan Broyles on September 12, 2007 11:43 AMmomma y,
And don't you ever bring up your BBQ or I'll have to go to kitchen again and find something to cook! Government approved, of course.
Posted by Stan Broyles on September 12, 2007 07:59 PMIt is the honest, hard working peole who need the help. They can't afford insurance for themselves and their family, on the one hand and, on the other, they don't qualify for any, nor do they want , government assistance. They just want a fair way to insure their health care. This can be done if the insurance companies would pay for preventive medical treatment instead of waiting for a problem to arise. Wellness insurance makes more sense to the public needs and insurance companies financial future. Treatment for medical problems early on costs less than the alternative of waiting until the problem becomes chronic.
I am amazed that insurance companies stay stuck in their ages old rut of waiting until they have to pay then, more than likely, paying lawyers to figure out how they can get away with paying the least for a claim and, the claimant get a lawyer to fight for the most. All this does is make money for the lawyers. If these blood suckers were removed from the equation, the costs to both the insurance companies and the consumers would, I believe, drop dramatically. Efficiency is gaged by how much unnecessary confusion is involved. The more confusion the less effciency and, can anyone name me anyone who promotes confusion more than the lawyers who write contracts no one can decipher then. present themselves as the solution to the problem they created.
Posted by on September 13, 2007 05:12 AMIt is the honest, hard working peole who need the help. They can't afford insurance for themselves and their family, on the one hand and, on the other, they don't qualify for any, nor do they want , government assistance. They just want a fair way to insure their health care. This can be done if the insurance companies would pay for preventive medical treatment instead of waiting for a problem to arise. Wellness insurance makes more sense to the public needs and insurance companies financial future. Treatment for medical problems early on costs less than the alternative of waiting until the problem becomes chronic.
I am amazed that insurance companies stay stuck in their ages old rut of waiting until they have to pay then, more than likely, paying lawyers to figure out how they can get away with paying the least for a claim and, the claimant get a lawyer to fight for the most. All this does is make money for the lawyers. If these blood suckers were removed from the equation, the costs to both the insurance companies and the consumers would, I believe, drop dramatically. Efficiency is gaged by how much unnecessary confusion is involved. The more confusion the less effciency and, can anyone name me anyone who promotes confusion more than the lawyers who write contracts no one can decipher then. present themselves as the solution to the problem they created.
Posted by Allen Campbell on September 13, 2007 05:13 AMMost insurance plans pay for doctor visits which is what preventive care is supposed to be part of. Most people don't use it that way. I expect it won't change.
If I were in charge I'd immediately put into effect laws that
1. Allow insurance companies to sell catastrophic coverage policies.
2. Exchange the money from the state Medicaid program for one providing voucher cards, like food stamp cards, that permit the people who have them to pay for general health care expenses anywhere. Doctors will be required to post the charges for services provided under the card because the card will be an instant payment for them. NO paperwork.
3. All medical expenses including insurance will be deductable from your state taxes Working poor will qualify for tax credits that are determined by income and by health conditions and might be in excess of the amount of taxes paid. The credit will be added to the voucher card.
4. Insurance companies which offer policies that are affordable, which means they cost less than half of what the voucher card beginning average is, or who automatically cover pre-existing conditions will receive a deduction that can be carried forward. Those companies offering HSAs to the workers can deduct 110% of all unmatched employer contributions to the account and 75% of all matching funds. This is a one time deduction which is only good when the companies offer the HSA option. The same deductions will apply to all new accounts for new employees and will include every employee who was at the company at the time of the offer for two years. (this will permit people who have maxed out their co-pay and shares to stay with an old insurance company)
5. I'd institute tort reform to cap pain and suffering, limit lawyer contingency fees to no more than 25% of the actual damages. Lost income would not be subject to lawyer fees either. Lawyers would not be allowed to charge contingency clients for expenses. Punitive damages would be paid to the state to be used for health care. Loser pays would be instituted. I'd love to fine attorneys for filing them but that would never be possible.
6.Insurance companies would be given a chance to "bid" for the state insurance policy to give catastrophic coverage to the working poor. There would be a small co-pay with a maximum total of 100 dollars per person yearly.
7.Offer more neighborhood clinics or sign a contract with Wal-Mart clinics to open neighborhood clinics in specified areas with longer hours and weekend hours on both Saturday and Sunday.
8.Use the old Medicaid offices to open up a health care fraud investigative force. Use part of them to investigate complaints against insurance companies as well as any fraud concerning the voucher cards. Have state PR people keep the investigators in the public view especially when they find a cheater.
9.Set up a system of fines for insurance companies who wrongly deny coverage. Increase the fine by multiplying it by the number of days it takes to resolve the issue. Double that fine if that insurance company is found guilty of more than than a set number of violations in a set period of time. (I'd make it more than three violations in a month)
10.Keep track of things and make the program flexible enough to change or improve and firm enough to resist meddling for political gain.
OK, back to normal. Or whatever that is for me.
Stan, I'd stay away from the Denver Post discussion on Easier to not Work
And Stan..Stop reading now.
BBQ report: It's up to 25 lbs of ribs, 10 chickens, two whole pork shoulders and four briskets with two bushels of fresh corn, 25 pounds of potatoes and five dozen hard boiled eggs for potato salad. Am heating the smoker as I type.Will start with the pork shoulders and the briskets. They brined yesterday and marinated all night.
As I posted at the Denver Post, everyone is welcome. Just find a blue Dodge Neon with this sign in the back window:
We call her Constipation
She can't pass anything.
Follow it to the party Sunday. BBQ starts about noon Sunday AFTER my herb garden is harvested and mulched and the apples are picked and sorted. If you find the car remember to bring garden gloves and shears.
Posted by momma y on September 13, 2007 06:20 AMmomma ya, considering that malpractice costs account for approx. 2% of overall healthcare spending in this country - and the majority of claims show medical error occured - why in heaven's name would limiting Americans' access to the courts be one of the items on your "punch list"?
And what is your beef with Medicaid? Do you have any proof, other than anecdotal, that it's a poorly run system? From what I understand, their administration costs alone are far, far lower than that of the privatized insurance companies. And people are getting good care with Medicaid. Why do you want to dismantle that program?
Also, I can't help but point out the irony of your proposed BBQ menu. Could there possibly be a connection there and your bad heart condition.
You might want to revisit your list and put something down for preventive healthcare measures.
-shakes head-
I'm sorry. I know I'm being snippy, and the truth is, I think you're a lady with a wonderful spirit. But I also think your positions on healthcare are based on an extremely misguided belief that capitalism is a noble cause worth sacrificing everything for - even your own life. I saw in another post that you actually qualify for Medicaid and you refuse to even try it out. You have a family that depends on you. For their sake, can't you even try the program out for a few months? It could really make a difference for you. You've contributed to Medicaid funds all your working life, you would NOT be stealing from your fellow Americans if you participated in the program!
Argggg, I should go to your party and tell you this stuff in person. :)
Posted by mytwosense on September 13, 2007 11:55 AMmytwosense said:
"momma ya, considering that malpractice costs account for approx. 2% of overall healthcare spending in this country - and the majority of claims show medical error occured - why in heaven's name would limiting Americans' access to the courts be one of the items on your "punch list"?"
I find it odd that you keep offering these same points even though they've already been refuted numerous times.
Have you figured out what constitutes total health care spending in this country? If I buy aspirin, does the count towards the total? What about a routine teeth cleaning? That 2% figure is highly misleading. It also fails to take into account the psychological effects on doctors. How many doctors are avoiding malpractice risky practices because of the fear of a malpractice lawsuit?
The fact that the majority of malpractice lawsuits showed medical error is irrelevant. There is a difference between errors due to gross negligence and unfortunate accidental errors. I've told you numerous times that limiting malpractice damages does not limit "Americans' access to the courts". It simply reduces the damages a medical office would have to pay. As long as humans are administering medical practices, medical errors will always happen. But, we shouldn't scare the hell out of good doctors who fear the slightest mistake will result in a career ending lawsuit. This just serves to raise medical costs and limit the amount of doctors who open private practices.
By the way, mytwosense, I just found an interesting piece of information. Total health care spending is $2 trillion. Guess how much of that total is attributable to government-managed health care? $1.3 trillion. Of course, if the government is going to throw over a trillion dollars into the health care spending hat, malpractice lawsuits will seem minuscule compared to government spending. I knew there was something wrong with that 2% figure.
http://www.ncpa.org/pub/ba/ba586/
John II, the points I cite about malpractice costs haven't been refuted, to my knowledge. I know you've tried to muddle the issue several times with odd questions demanding impossible answers such as "How many doctors are avoiding malpractice risky practices because of the fear of a malpractice lawsuit?"
And you continue to try and muddle the issue, this time with strangely fuzzy logic. For example, the numbers you cite about government spending on healthcare. John II, who is spending healthcare dollars is an entirely separate issue than what those health care dollars are being spent on. As a self-proclaimed financial wizard, I would expect you to know that! So your comparison is faulty to begin with, and still doesn't refute the 2% malpractice cost number at all.
And by the way, speaking of the numbers you cite - can't you ever be bothered to get your statistics from neutral and objective sources? The NCPA is yet another zealous anti-government "think tank" that believes every last public resource in this country should be privatized. At least when others attempt to engage in debate with you, they search for somewhat unbiased sources, or I know I try to, anyway.
Moving on to your statement: "The fact that the majority of malpractice lawsuits showed medical error is irrelevant. There is a difference between errors due to gross negligence and unfortunate accidental errors. I've told you numerous times that limiting malpractice damages does not limit "Americans' access to the courts". It simply reduces the damages a medical office would have to pay. As long as humans are administering medical practices, medical errors will always happen. But, we shouldn't scare the hell out of good doctors who fear the slightest mistake will result in a career ending lawsuit. This just serves to raise medical costs and limit the amount of doctors who open private practices."
First of all, the degree of gross negligence that a medical error is based upon is exactly what it's up to the courts to decide - not you, I, politicians, or insurance company lobbyists who want to curtail our access to the courts.
And speaking of which, Momma Y wants to not only limit damages, she wants to implement "loser pays" - if you don't think that will sharply curtail Americans' access to the courts, you're dead wrong.
I also strongly disagree with you that its "irrelevant" that the majority of claims reveal medical error. And frankly I'm surprised that even you would make such a statement. This evidence is the very basis of why Americans shouldn't be deterred from the courts. Please believe me when I say that if the evidence showed otherwise - that the majority of claims were based on frivolous suits - I would agree we need to take a close look at our current tort system.
You seem to strongly believe that malpractice costs are behind increased medical/healthcare costs. I assume you believe the number is high enough to warrant major changes in our tort system. Perhaps for a change you could support your position with some actual facts and figures, instead of just nebulous guessing. We're talking about Americans' rights to the courts here. Before you lead the cavalry that these rights should be limited, and yes, the "reforms" you and momma y advocate would result in limiting our protection via the courts, you better put a damn strong case together for doing so, John II.
"John II, the points I cite about malpractice costs haven't been refuted, to my knowledge. I know you've tried to muddle the issue several times with odd questions demanding impossible answers..."
Odd questions such as what constitutes total health care spending? Does purchasing aspirin count? Laser eye surgery? Routine dentist/doctor visits?
"For example, the numbers you cite about government spending on healthcare. John II, who is spending healthcare dollars is an entirely separate issue than what those health care dollars are being spent on. "
Of course, they both matter. Included in that $1.3 trillion number is tax breaks to employers. Tax breaks to employers! Tax breaks to employers is included in total health care spending. Plus, government-managed health care will always inflate spending. The government is essentially saying to a certain segment of society, go ahead and consume all the health care you want, we'll pay the bill. Well, of course, with the full backing of the United States of America, health care spending will be extravagant. Government spending at such an enormous level wildly distorts the health care market.
"And by the way, speaking of the numbers you cite - can't you ever be bothered to get your statistics from neutral and objective sources?"
First of all, there's no such thing as a neutral and objective. Second, their viewpoint should not matter if you trust the facts. I see no reason to doubt the numbers they cite. We can disagree on what those numbers mean but I don't doubt the accurateness of the data.
"First of all, the degree of gross negligence that a medical error is based upon is exactly what it's up to the courts to decide - not you, I, politicians, or insurance company lobbyists who want to curtail our access to the courts."
Of course. But, that is not what you said originally. You just said medical error. Medical error includes gross negligence and accidental errors. Either way, I'm not suggesting folks do not have a right to sue for either type of error. Currently, a jury decides the monetary damages. I favor reforming the system so the judge determines the damages. The jury simply determines the verdict.
"And speaking of which, Momma Y wants to not only limit damages, she wants to implement "loser pays" - if you don't think that will sharply curtail Americans' access to the courts, you're dead wrong."
I am undecided about loser pays. There are obvious downsides to that proposal.
"I also strongly disagree with you that its "irrelevant" that the majority of claims reveal medical error. And frankly I'm surprised that even you would make such a statement. This evidence is the very basis of why Americans shouldn't be deterred from the courts. Please believe me when I say that if the evidence showed otherwise - that the majority of claims were based on frivolous suits - I would agree we need to take a close look at our current tort system."
It is irrelevant in regards to our discussion about malpractice reform. I never said a patient should be denied the right to sue for medical errors of any kind. My argument is simply that the type of error should be taken into account when determining damages. A jury of laymen may be too Draconian in their determination of monetary damages. Let's put things into perspective and assign more reasonable damages to plaintiffs.
"You seem to strongly believe that malpractice costs are behind increased medical/healthcare costs. I assume you believe the number is high enough to warrant major changes in our tort system."
There is no doubt that malpractice lawsuits, malpractice insurance, and the fear of malpractice lawsuits increases the cost of health care. This argument should be exoteric. I believe our argument revolves around the degree to which malpractice lawsuits affect health care costs.
There are numerous factors that increase medical costs. This is just one factor. Having a third party pay for one's medical expenses is another factor. That is where HSA's come into play. I'm much more in favor of tweaks to the system than to completely scrap the current system in favor of something completely different. So, two of those tweaks are: Health Savings Accounts and Medical Malpractice Reform. Another tweak is to eliminate the tax breaks for employers that provide health coverage. This will allow more private groups to rise to fill the void. Private groups will allow consumers to keep their health insurance regardless of job changes.
Posted by John II on September 14, 2007 12:41 PMjohn II and mytwosense
My experience with Medicaid comes from my sister and my stepson, who is dying from aids. I also have a grand daughter that we had on Medicaid until we could legally cover her with our insurance.
I refuse Medicaid because I have seen my nephews and my sister told they need one medication by a doctor only to receive a message from the pharmacist that the prescription has been changed to a different drug because of Medicaid rules. When the medication failed, they got the one prescribed first but in the meantime one of my nephews lost three weeks of school instead of one.
I also have a history of talking to doctors and getting to know the office staff. My doctor is a typical one so there were often long waits before I could see him. One day they were having trouble with a new computer because they couldn't get it to communicate with the network. I watched and made a few suggestions. In the end, I was the last person to see the doctor that day because reconnected the computer and settled the software conflicts. I used to design databases and most of the boxed ones available are very predictable. That one was and it only took about two hours to get it working. That and tracing back to see where they misconnected a cable. I heard the receptionist tell the doctor that Medicare had refused a prescription. I"m nosey so whenever I was in the office I listened. I'd sometimes hear him fighting with them on the phone. He would state a medical reason why the specific drug was necessary. Then he would have to continue arguing. Once he told a nurse to have a patient go to the hospital because the only way to get the right treatment was to start there. I also have personal experience with VA which is so frustrating I actually had to turn over the paperwork to my husband even though it means he spends at least one hour a month on a cell phone to get the mistakes corrected.
But, let's suppose Medicaid really was a good plan and worked well. I'd still refuse it for as long as possible. (I have applied for Medicare disability as that is something I paid in to.)
I support giving everyone, especially the poor, the means to be responsible for themselves. The government will have to help. That is why I suggest a voucher card system with catastrophic coverage as a backup. They will be able to choose their own doctors, make their own decisions and their own mistakes. Since the card will have an upper limit, which I would set on a sliding scale depending on medical conditions and overall health, they will have to shop for care. It would actually give them an advantage over people with insurance because the doctors will offer discounts to those paying up front with a method that doesn't require paperwork. Eventually the insurance companies will find a way to do the same thing because it maintains care levels while reducing costs. The statistics on Medicaid are compiled by the same government that administers the program. I treat that like I treat the foxes' report on the chickens. There will always be some people who don't take responsibility or who complain about any effort required from them. This program won't change that. It won't even make much of a difference, but for the majority of poor people, including me, standing on both feet instead of leaning on the government is more comfortable if a bit more difficult. Most of the poor aren't poor because they made the choice to be poor or because someone else is keeping them down. Circumstances, errors and bad luck are as much a part of it as bad decisions, irresponsible behavior and natural disasters. These people deserve to be given the authority over and responsibility for themselves.
I am responsible for me. Turning to the government when I still have some ability to take care of myself is wrong. It is part of a problem we are going to have to solve because too many people honestly find no problem with putting out a hand to government. That is not the role of government to me and never will be. What kind of person would I be to hold that belief and still be so selfish as to make myself an exception because that would be the easy way out.
As for the amount awarded in malpractice cases, it is not the total cost of having so many cases. You must add in the cost of insurance, the cost of extra medical tests and procedures done to protect the doctor. That is the true cost. If isn't just the cost of insurance and the cost of settlements which is all that is calculated to come up with that 2%. Again I see foxes counting hens.
The problem with the current legal system is that the old standard of reason was just that, reasonable care or what a reasonable person would consider adequate care. Accidental results that could not be predicted or other considerations that normally would not be taken into the matter were not considered reasonable. It was changed, by a judges decision to permit one lawsuit that admitted it couldn't meet the reasonable standard, to allow that case to proceed. The judge ruled the damage to the victim was the sole consideration not whether the error met the standard of being intentional or neglectful. That's why a local lawyer advertises on TV for people whose children have Cerebral Palsy to call his office to sue the doctor or hospital to "get the money due them for the injury." The person who is truly harmed by a neglectful or wrong action of a medical provider does have the right to go to court to receive payment for the damages done to them. The current laws encourage "trolling for victims" and "shotgun charges." A lawyer can file fifteen lawsuits in a few hours. Whether or not they have any merit is irrelevant. (I used to work, if you can call five hours or so every few weeks working, for a personal injury attorney. Her standards were that not only must a person be injured but that it be from a deliberate act or omission. She never made a lot of money. She said she had to live with herself,not her bank account. Most of the ideas and suggestions I post on this subject came from her.)
It does not harm those truly damaged by act or omission to limit damages to actual losses and projected losses like lost wages and benefits. Capping pain and suffering awards is reasonable as it is a kind of bonus on top of actual costs. Punitive damages, I've already explained, are a fine and fines should go to the authority responsible for enforcing the statutes or standards that were violated. The only real changes would be an end to the practices of attorneys charging 50% of the total award plus expenses. I'll give an example of some expenses: a dollar a page for making photo copies in the lawyer's office, fifty dollars for every court filing plus twenty dollars for every phone call including those with the client or twenty dollars letter sent out. These changes would only hurt lawyers who depend on filing dozens of cases and settling them quickly. Some cases are even settled for less than the actual costs to the patient. (Not common but there was one lawyer written up in the paper years ago that did this more than once and he wasn't alone. That was legal. I think he also stole money from some old sisters and sent one to Mexico. He got jail time for that. Last I heard he was accused of arson.)
Making lawyers limit what they take from clients is fairer to the clients who are actually hurt. Imposing a loser pays statute would reduce the number of lawsuits to those with merit because the ones without any real damage or any real neglect would be unprofitable and dangerous. It might be possible to make a loser pays statute merely fine the attorney or be subject to the judges discretion. This would lower costs to doctors and hospitals because the legal costs of fighting lawsuits, insurance and unnecessary tests and treatments are not calculated as a total.
The entitlement mentality tells us to get ours. It declares we are entitled to things and rewards just because we exist. I disagree. We are entitled to fairness in treatment, equal opportunity and freedom to fail as well as freedom to succeed. We take on the responsibility to accept the consequences of our actions and decisions. The entitlement mentality started out to remedy real problems of discrimination and unlawful treatment. When the remedies became law and unlawful treatment became unfashionable as well as unlawful it was addressed and punished. That left many looking for a cause to support. Others kept on with their original causes finding new problems and victims to champion. Good people, good intentions and horrible results for too many are the outcome of that.
My condition is terminal. I can fight to stay alive and as healthy as possible by my own actions and decisions. Extra medical care might extend my life but life to me is more than existence or presence. I want to be able to participate. Right now my participation is limited to mixing spices for the BBQ and sharing recipes and techniques.I developed over the years and kept secret.
The BBQ is a family tradition that gets all of us in one place once a year without the additional burdens of gifts or holiday traditions. My former diet probably did a great deal of damage to my health. I've gone from 340 pounds to 175 pounds in the past decade. My cholesterol has never gone above 140, my normal blood pressure is 100/60 and I have diabetic ancestors for at least three generations on both sides. I am a diabetic as is my husband. You must have missed the 10 chickens on the menu. They will be spit roasted and grilled with different recipes for the different tastes in our families. My husbands and my part of the meal will be according to the American Heart Association guidelines. I will not eat my favorite rib, pork roast or brisket dishes nor will I have butter on my corn. The real feast for me is the conversation and company. The menu is part traditional and partially depends on what others contribute. My husband and I contribute our barrel grill, our three smokers and our style. My neighbors have helped my stepson set up the picnic tables on the lawn and driveway and their yards and driveways as well. If I could, I'd invite many here to attend but the risk of revealing that information is too great. You two would be at the top of my list with Sharon B, Deicide, Old Grouch and Can I Get an Amen. Throw in KW too. But look on I-25 Sunday morning for the blue neon with that sign. Follow it here and I'll set you guys in the good chairs.
momma y,
You mentioned your condition is terminal. I probably missed where you explained what your condition was? Could you repeat it for me?
I would love to come to your BBQ this weekend. It sounds like a lot fun. But, I'll be in Estes Park for the weekend. Perhaps, another time?
Have you ever read Epictetus? He was a crippled slave/philosopher that wrote about Stoicism. His teachings were documented by his students in a writings called The Discourses. His writings have influenced my own personal philosophy greatly. I think you might appreciate his thoughts on life.
Posted by John II on September 14, 2007 04:57 PMmomma y, sounds like it will be a fun party! I guess we're going to have to agree to disagree about the quality of Medicaid programs. Although, John II might take note that the program as you describe it certainly doesn't seem to be an extravagant or wasteful one.
Speaking of which, John II...we're probably going to have to continue this exchange on various threads, because this weekend I'm slammed, and some other things coming up will probably keep me off the forums for a while. But, I didn't want to ignore your last message and came on just now to at least acknowledge it. I understand your preference to not want to dismantle an entire system (I feel the same way about public schools). I am open to hearing about incremental changes, but I am very skeptical about the ones in particular you advocate as having any kind of measurable effect on reducing healthcare costs.
Oh, and I'm still not clear on how you're defining the relationship between that malpractice percentage figure and government spending on healthcare. Maybe if you could phrase it in more mathematical terms at some point, instead of just reiterating your opinion that government spending is wasteful.
Posted by mytwosense on September 14, 2007 10:15 PM