- Englewood animal shelter has caring workers
- Resist the DREAM
- McCallin: loose cannon
- A DIFFERING VIEW/Farm Bill’s goal is to put affordable food on the table
- Environmental saviors
- Judge has a backbone
- Trick or treating etiquette
- Homelessness in Colorado
- Politics never meant to be a career option
- Term limits the answer for Congress
Free markets no solution when it comes to health care
In response to Dave Schallert’s comparison between health-care costs and Grease Monkey or Jiffy Lube (“Stripping down the price of health care,” Speakout, Oct. 14), imagine that you are one of the “lucky” ones who is the victim of a disease over which you have no control — Parkinson’s, Type 1 diabetes, lupus, cancer, etc. (We have a choice as to whether to own a vehicle or not and incur such expenses associated with a vehicle.)
Imagine that you are a middle-income wage earner in which chronic-care medical expenses will eat up most, if not all, your monthly income. You are not one of the wealthy nor are you a member of Congress. You are a simple middle-class person who has worked all your life, paid your bills and supported your family. Through no fault of your own, you are the recipient of a disease for which no cure exists, or, if one does exist, you cannot afford it in the “free” market.
According to Schallert’s imagination, “too bad, so sad,” you lose in the game of life because of your economic position and the unfortunate fact that you have a disease that was no fault of your own.
There are economic models in which free enterprise works; health care is not one of them.
Cheryl Redmond Doyle, Littleton
Cheryl,
I am one of those people you described except I am not middle class. I used to be but had to quit work when my diabetes triggered my second heart attack. We have a combined income for three disabled adults and one child of 31,000 a year. We live at the poverty level. I know the pain of being under-insured. It isn't pretty. The cause of this is the fact that I am not permitted to shop for medical services. I must allow my insurance company to set up payment schedules with doctors and other medical care providers. I am then given a set of flat fees for almost everything and a percentage fee to pay for anything else.
Were I permitted, when I was healthy, to pay in to an account, which is what insurance companies do, and then, when I need it, dip into that account to pay my bills. They are called health savings accounts HSAs. I have had 3 major and 5 minor heart attacks, five surgeries for my heart and three because of my diabetes.Our insurance paid for most things. What they did not pay for was the flat deductable amounts of 2500 dollars per year and extra charges for lab tests, about fifty dollars for each set of tests, Some medical services, like four MRI tests on my kidneys in two weeks, were not covered because the insurance company, rightly, said they should not have been scheduled. I was in no condition to argue or they would not have been done.
Point of this is that under a HSA each person handles their own health care choices and payments. An initial deposit is made, often by an employer, and the amount the worker would have paid in insurance, or a smaller amount, is placed in the account each month. The money in the account grows when it is not needed and is available for common things like physicals, doctor visits and medications. You can get a really nice discount from most medical providers by offering the HSA card which pays them immediately. No insurance company paperwork, no delay lower price. Sometimes it is even possible to save money over a prescription plan. One medication I take is not allowed under Kaiser prescription rules. A much weaker, much less effective medication is used which requires three doses a day instead of one. By obtaining a three month supply of the medication in the proper strength and with the extended release feature, I will be paying five dollars more than the same medication costs me now. Yes, I will be insured with a HSA account in January. We will also have, as do virtually every HSA user, a catastrophic insurance plan that basically requires 5000 dollars in medical expense before it kicks in. We will keep our Kaiser plan for one person but overall our insurance costs will drop by 200 dollars a month. We expect that to be further reduced by a hundred dollars a month by medications being replaced with generic versions or discontinued completely.
That is the free market working. It is the equivalent of exchanging the Grease Monkey that tells you to trust them because you only pay ten dollars towards that oil change and your car insurance will pay the rest for the system we currently use. The catastrophic coverage policies allow people to have coverage for a disease or accident without paying for the removal of every splinter. There are less expensive alternatives popping up all over the country. Look at Wal-Mart. They now have clinics in many stores. They're open nights and weekends to provide service to people who work during the day. There are internet pharmacies and the 4 dollar Wal-Mart prescriptions available too.
But allow me to offer the greatest proof that HSA accounts will work for anyone who is willing to take responsibility for their health care. The two groups who have conspired to make the HSA option difficult to obtain and very limited in availability are:
The politicians and the insurance companies. Both sides will lose if anyone can go to an office set up their HSA. (Same arguments against IRAs were once popular too) Pre-tax money goes into the accounts and is not taxed when used for medical expenses. If we also reformed taxes to grant deductions and tax credits to individuals instead of corporations there would be a great deal of weeping in Washington. The best way to judge many things is to see who opposes it. Can't think of a less savory combination than federal representatives and senators mixed with insurance lobbyists. Think about it and hold on to your freedom of choice in medical care with both hands until the laws are changed. If you want to see what government sponsored health care is right now, not some hypothetical plan or promise, go to your local VA hospital. Just watch how long the people wait. Most of them have appointments often having to wait several months to get an appointment. Then imagine that instead of just the small number of people eligible for veterans' medical benefits that same mindset was set in power over us. I offered this bumper sticker suggestion in another post. I repeat:
The compassion of the IRS.+
The courtesy of the DMV.+
The efficiency of the Post Office.=
Government Health Care
There will be a market approach to health care the day there is a demand for being sick.
Posted by Liam on November 5, 2007 04:45 AMThe key to all you say, MommaY, is petitioning the government for redress of grievances resulting from the undue influence and interference by insurance companies in the legitimate interests of the government's and people's best interests. Find out which of those idiot legislators recieved donations from insurance companies and name them in the petition. It is your first amendment right under the Constitution to offer such a petition.
Posted by Allen Campbell on November 5, 2007 05:25 AMNice to see all of you again. I think a solution will fall in between a free market approach and something else. i do not support universal health care. But too many also fall through the cracks. I have reviewed my situation with many health care insurance companies and doctors regarding different plans offered, including health savings accounts, and I am stuck. No one has any clue how to get me out of 10K a year in medical expenses for my daughter. A solution will fall in between. As to free market (half of my inlaws are physicians), let's add up all of a doctor's overhead....medical school loans in the six digits, equipment, malpractice insurance (my ob-gyn says he pays 6 figures their annually), employees, rent, SSI matching, etc. How does one think a doctor can go "cheap" in a free market. My insurance company advertises that they can negotiate lower rates as a group. My dentist does NOT give me a discount for paying cash. Doctors and dentists can opt out NOW from accepting insurance and be on the free market system but they don't. Even those procedures not covered by insurance (usually in the body contouring department) are expensive and unaffordable to most of us. Just think what would have to be paid for a required appendix removal. Anyone have 20K or more sitting around to pay for a sudden and unexpected medical emergency?
Posted by cheryl on November 5, 2007 06:21 AMmomma y , I have read alot of your posts and feel for your medical problems, especially insurances companies.
I have a question for you . How is a family making $ 31,000 a year going to have enough in a HSA to cover medical expenses?
Yes you can negotiate price with Dr.'s and services but in todays world anything related to medical is expensive.
I have health insurance but deductables come with that. I'm trying to stay healthy because there is no deductable for regular office visits just a co-pay.
However my breast surgery this past summer was after all said and done about $5,000 in which some of it we had to pay 20%. So we negotiated a lower cost with the hospital about 30% off the rest of the bill,by paying with a 0% credit card.
Luckily what they removed was benign and i've moved on.
momma y , I have read alot of your posts and feel for your medical problems, especially insurances companies.
I have a question for you . How is a family making $ 31,000 a year going to have enough in a HSA to cover medical expenses?
Yes you can negotiate price with Dr.'s and services but in todays world anything related to medical is expensive.
I have health insurance but deductables come with that. I'm trying to stay healthy because there is no deductable for regular office visits just a co-pay.
However my breast surgery this past summer was after all said and done about $5,000 in which some of it we had to pay 20%. So we negotiated a lower cost with the hospital about 30% off the rest of the bill,by paying with a 0% credit card.
Luckily what they removed was benign and i've moved on.
HSA's sound good but how will that stop rising health costs from eating up the money in a HSA?Also it's hard as a middle income family to save money in a savings account let alone a medical savings account.
Hypothetically have you sat down and added up all the Dr.'s visits,all the medical supplies,all the tests,all the surgeries, etc... in just this year. Just doing an estimation on what you think you would have to pay if you had a HSA. How much money do you think you would have needed in that HSA just this year to cover medical you've and your family have already incured?
Even when you were healthy and working .Could you really have saved enough for all the medical problems and the surgeries you and your family has had and have anything left?
Or is the $2,500 a year deductible actually a bargain for the services you have needed just this year?
I couldn't get a small tumor removed from my breast for $2,500.
HSA are for young people starting off ,not what situation we are in now,paying insurance premiums,deductables,and some out of pocket expenses.
Many of us are past the HSA and rely on insurance to protect us.Universal Healthcare is not the answer either.
I really don't have an answer to fix the problem
You've seen Universal Healthcare it's what the VA offers it veteran's and it doesn't work.
I still think HSA's won't solve the problem either.
Posted by Can I get an AMEN! on November 5, 2007 07:10 AMOur current system is fine unless you get sick.
Posted by just sayin' on November 5, 2007 07:42 AMWe can afford the HSA because there will be an insurance policy for me, lower premium, and I will also negotiate lower costs. Overall we pay 600 dollars a month for health insurance. Under this plan we will pay out only 400 and expect to cut between 50 and 150 dollars a month by discontinuing medications that show no benefit. Right now I am on 4 medications to lower blood pressure. Problem is I have a normal blood pressure of 100/60. That makes it really stupid to take the meds. My cardiologist is a wonderful person but too often all doctors prescribe according to the "standard" treatment model. He finally put me in charge of meds. Regular lab tests show everything where it should be so I am going to discuss changes with him. Example is Plavix. A generic exists for about half price. Aspirin also exists for about as much a year as Plavix costs a month. For most people the difference is so small no one would have any problem switching. I'm one of them.
Now to the benefits to doctors. Most doctors must carry a great deal of paper, meaning they may wait a minimum of 90 days to receive payment from an insurance company. If they didn't have to cover that lag nor deal with government paperwork and roadblocks nor spend precious time verifying insurance for each patient, they could reduce staff. One doctor, no longer mine because of insurance, had 3 nurses and five clerks. Most medical offices have as many, if not more, people in the accounting department as they do in the office.
Liam, the supply and demand feature of health care is very simple. There is a demand for being healthy. There is a supply of health care. The obstacles to the market working for both is governmental interference. But, removing that will cause screams of outrage from politicians and insurance companies. I trust insurance companies to go for the profit. Most of them make a profit in health care coverage simply by investing the money and using the return on that money to pay claims. With the old system of medical insurance there was coverage for hospitalization, severe or chronic disease and very little else. That is catastrophic coverage. I got it the day I, a mousey college student, started working nights at Diner's Club credit card company. Today there is a waiting period.
The reasons for this are many but the main one is governmental interference in health care. Medicare and Medicaid made it unnecessary for people to ask the costs of medical care. Employment based health care had to match the "full coverage" of government plans because customer demanded it. Again, no one needed to know the costs. Now we have a situation where people think health care is for office visits and physicals. Health care is for diseases that drain budgets, accidents and chronic or severe illness. We need to re-educate ourselves on this subject. And it is a no risk proposition for those who want universal health care. If we go to HSA coverage we can continue offering Medicare as it is to all and Medicaid as it is to those unable to make valid decisions. It risks almost no increase in government funding and creates a database to study real expenses and savings without letting the foxes count the chickens.
I have also noticed that more and more insurance people are using HSA. My insurance agent is a bit strange. He keeps calling me and telling me my rates are going down for homeowners and auto insurance. He explained HSAs to me because I didn't really understand them. He spent a good three hours looking over my health care costs and telling us how to set up the payments so that we would get the maximum benefit. He says that insurance companies hate the HSA option because the majority of people don't need health care and the insurance companies make their profits on the premise that more will not need it than will need it. If people could put the majority of the full insurance payment in their health care "mattress" for use when and if they need it, most people will only want catastrophic coverage. The only way they can sell it now is to people with HSAs. Many states have laws preventing it from being sold. I don't know why and he could only guess.
Guess the best way to decide is to try it on for size. But my husband pointed something out that I should have noted:
Wal-Mart is opening clinics inside many of their stores. They are offering 4 dollar prescriptions. Wal-Mart is almost always ahead of the curve in areas that are underserviced. They made a fortune understanding that the American consumer knows a value when he sees it. Why do they think we are capable of taking care of our everyday health care needs while the government thinks we can't?
Monopolies, even health monopolies, are always hostile to the consumer. They always cause higher prices, reduced service and produce an inferior product. Competition and choice, with each consumer shopping the system and making decisions in his own best interest, while using his own money and not someone else's momey, always guarantees the best possible service at the lowest possible price. Competition is always consumer friendly.
Single-payer /single-provider monopolies, by definition, can be dangerous to your health. How would you like to rely on the very same folks who run the post office, the DMV, the folks responsible for maintaing our bridges, etc. for your heart transplant? Think about it.
Posted by Hank on November 5, 2007 07:44 AM
Momma y:
I don't think Walmart offers radiation treatments, chemo, diabetes care, emergency surgery, etc. They offer the basic very simple office visit (which could be dangerous if no tools are available and Walmart overlooks an underlying health issue and just treats the symptoms). Sorry, still not a solution. As the baby boomers age, Walmart will not be able to diagnose and address the ills (hip and joint replacement, eye diseases, etc.).
Posted by cheryl on November 5, 2007 08:13 AMAlan
Any person, business or organization may petition a single representative or a group of them for any reason. Insurance companies pay a great deal to prevent bad government policies from making a mess of health care. Want some really interesting reading? Read the Congressional Record when they were debating Medicare. Most insurance companies objected and their statements were labeled fantasies and fear mongering. Most of what they predicted would be an improvement over what we now have.
I intend to petition Congress to remove the barriers for HSA coverage and allow consumers to make use of them IF they want to do so. I also would advocate a better system, (if you've read my posts on this subject before fee free to skip this paragraph) where tax deductions and tax credits created the ability for people to be in charge of purchasing insurance. Take away the corporate advantage. Let the insurance companies, the ones who know how to advertise for all kinds of insurance or haven't you seen the "hamburger combo plate" ad for Medicare supplemental insurance. When you are the customer, instead of your boss, the insurance company will have to offer you a reason to choose them. People with severe health problems, like mine, will pay more because they use more. If I'd had the HSA option for all those years I didn't use any insurance I'd have enough money to pay all my deductables in my present plan. You can combine an older HSA with insurance later if you want to. But the offering to those on Medicaid of a choice of a card to pay for health care with a specific dollar amount available to "spend" or an insurance policy of their choice makes them the ones in charge. If they are young and healthy enough, well then they should be able to work, but not working in a good job they get the benefit of health care coverage and the option of saving that money until it "overflows", reaches a level where any monies over that amount may be removed for any use. Open more clinics in areas where there are a number of working poor. Don't just keep the clinics open Mon-Fri 9-5 either. Weekend and evening hours make it possible for people who work to see a doctor and NOT lose a day's pay. Just last month my husband had a test to check for tumors in his lower abdomen including liver and kidneys at the VA hospital. He was exposed to some toxins when he was in the service and they had to test all the truck drivers who carried loads during a certain period at a certain place. He had to call and make an appointment on the regular schedule. Took him 13 months to get to the head of the line. They made him wait after the test then told him to come in and speak with a doctor about the test the next day. We expected some bad news. Turns out there was nothing wrong except a cyst on one kidney and there is nothing wrong with having one of those because they just show up sometimes. Their course of action was going to be to check him once a year. For this he lost a full day's pay in addition to the half day he'd lost the previous day. Could have told him right away but the "standard procedure" required that he be told by a doctor or a nurse PA. That is bureaucratic thinking. No thought about what it costs the patient in real life terms like lost pay. That is why we need to make health care available. We don't need to finance everything but if we gave the working poor, and anyone on Medicare who asked for the program, a government financed HSA with a provision for them to add funds to it and gave them a credit card, like for food stamps, to use at any doctor's office or clinic with the provision that the most any clinic visit would cost would be 5 dollars and some, like pre-natal care, would be free, they would make the choices on their own. IF the clinics didn't have closed doors during the hours those people were not working, more would use them.
OK rant over. For the last 25 years of my life I have worked all but the last 2. Tried to work after my second major heart attack. Couldn't do it. Could have qualified for a job. Probably got it too. I would have been protected by the disability laws when I had to miss two weeks or three weeks from work for the minor heart attacks. Bosses hire you to work, not be sick. If they didn't need someone to be there they wouldn't have paid for an ad. One thing I still do teach the women when I get the chance is how to impress a boss and jump over most of the other workers even if their skills are better. Be on time or fifteen minutes early every day. Show up for work every day. By the end of two months you will have come to the attention of every manager and boss in the company. These days that kind of responsible attitude is remarkable.
Posted by momma y on November 5, 2007 08:21 AMMomma y:
You probably would NOT have been protected by the ADA. Walmart won in an ADA complaint. A pharmacist employed be Walmart was fired and was told his termination was because of his diabetes. He was allowed by Walmart to close the pharmacy for a one-half hour lunch so he could eat, given himself insulin and check his blood glucose. A new manager was hired and told the pharmacist that he had to have his lunch between his customers and not to close. The pharmacist stated that his glucose levels changed. He became tired. Then he was fired and was told he was being terminated specifically due to his diabetes (Type 1 not Type 2). He sued and lost. The court found that the ADA only protects those situations where the condition is unmanageable. Evidently, diabetes is manageable...what they don't understand is diabetes can be managed with a schedule. This Walmart was located in a small Nebraska farm town. I won't shop Walmart.
Posted by cheryl on November 5, 2007 08:42 AMcheryl
Wal-Mart clinics cover the "simple" health care needs for prices that are one third or less than the cost of a doctor's office visit where you most likely would see that same nurse PA.
No, not everything is covered and not everyone would benefit from the HSA option but removing the government hand from health care would enable a great portion of the cost created by paperwork necessary to collect payments to vanish. Chronic conditions, like those you outline, and mine, require a different plan. Right now I am too old for the average HSA. That is why we will keep a health plan with insurance to cover me. The HSA will cover normal co-pays for my insurance. The major expenses of my past year were covered by insurance but there were many things I found unnecessary. The hospital ran the same MRI over and over again. My insurance company refused to pay for it. I went to the hospital and asked billing, when I was going over the bill item by item and comparing charges to the nurses charts, why there were four orders for the same test. Seems the doctors didn't talk to one another and I was pretty out of it the first week. Result was they removed all the disputed charges.
As the system adapts to a more knowledgeable public, the cost of health care will go down because the discounts the insurance companies get today will end up being offered to all who pay "cash."
And Wal-Mart does offer diabetes care. You can have any of the normal tests like A1C run there at a real bargain compared to most insurance. They can provide prescriptions for oral medications or insulin and offer counseling and information. Those services don't need a doctor hovering. Specialist care is offered now and will continue to be offered by groups of practitioners. The difference is that people can make health care decisions and a part of that decision will be financial. Today the only financial decision associated with health care is usually whether or not to buy the insurance your company picked out for you. I hope for a glorious future where we have as much information on health care costs as we do on the cost of any other consumer item.
Wal-Mart clinics are doing what Wal-Mart does best: going after the biggest sector of a business. Today that is preventive care and minor emergencies. Any reason we shouldn't offer people a choice?
As has been established ad naseum here....our global peers provide better healthcare at lower cost than we do....so no matter HOW we end up paying for the medical services we do use...we should at the very least adopt some best practices of countries who are doing it better and cheaper than we are....
Posted by jay on November 5, 2007 09:03 AMJay,
We could follow the excellent example of the healthcare program in Cuba. The one presented to us by Michael Moore. Wow you are so smart!! If you wish to move to one of those countries please do so, then you can write back and enlighten us to all of the benefits of socialized healthcare. I think a 10 year study on your part would be adequate. See you when you get back.
See jgd there's where your beliefs run aground on the rocky shore of data....once again.
I'll ask the same question I always do when we see the same knee jerk reaction from the far right on this issue.
Why do you believe the US is uncapable of adopting some best practices of countries who are doing healthcare better and cheaper than we are?
Posted by jay on November 5, 2007 09:56 AMThe prestigious journal "Lancet Oncology" has recently released a landmark study on cancer survival rates. Its findings:
The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rate is close to 71 percent. (English data were incomplete.)
For the 16 different types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent.
These data, recently released, are now the best and most current available. They too confirm Giuliani’s point: he was fortunate to be treated here.
Its looks like the Lancet data overwhelmingly favors the competitive American system well above that of the socialized European system. Single paye/single supplier healthcare monopolies can kill you!
Posted by Hank on November 5, 2007 10:02 AMRight now health care is rationed by price.If the government takes over health care it will be rationed by government.Just think of the government deciding who lives and dies.Imagine who the Democrats would favor living.The people that vote for them.If the government makes a mistake on your medical care you will have to ask the government for permission to sue.Right now if someone makes a mistake on your health care you can sue so health care providers are more careful.The real problem is the government mandates and restrictions put on health care providers.These are the things that limit compitition in the market and create a monopoly which drives the price up..It's your choice.
Posted by An American on November 5, 2007 10:08 AMAA...and yet studies have consistently shown that the boogeymen you describe simply don't exist in the real world outside of the Rush Limbaugh fantasy hour.
Oh...and Hank...come on man...if you ever took a college level stats class you know that one particular subset doesn't a well-rounded study make....you know better than that.
Posted by jay on November 5, 2007 10:21 AMIf you're self emplyed, you get screwed. The insurance companies can increase your rates any amountn they like.
Posted by rick on November 5, 2007 11:55 AMJay
Why do you believe the US is uncapable of adopting some best practices of countries who are doing healthcare better and cheaper than we are?
As a graduate of a "college level stats class" you know full well there are lies, bigger lies and stats. Stats gathered by groups wanting to prove we have terrible health care will show we have terrible health care. On the other hand, well you know where I am going with this. Stats are nothing more than distorted truths, kind of like polls.
"Better and cheaper ideas" translates into "Socialized health care" Again I will say thank you but no thank you!!
Posted by jgd777 on November 5, 2007 01:01 PMjgd please disregard the conclusions reached by many different studies at your own peril....the consensus is broad and significant. You can be a Denier on yet another issue...but I'd still like an answer to the question:
Why do you believe the US is uncapable of adopting some best practices of countries who are doing healthcare better and cheaper than we are?
Posted by jay on November 5, 2007 01:13 PMI do not think Jay can comprehend what I posted.He is just another stupid Democrat.
Posted by An American on November 5, 2007 02:17 PMCheryl said: "...medical school loans in the six digits, equipment, malpractice insurance ...employees, rent, SSI matching, etc..."
1. Med school is a rip-off (as is most college) and they chose to get ripped off. Solution - revamp higher-ed pricing to reality of real peole.
2. Equipment costs - partly valid point
3. Insurance problems are caused by lawyers and whiny people. REAL mistakes are lumped in with "he didn't save my arm I stuck in the combine." Solution - fix the laws.
4. Employees, rent, SSI, etc - providers need to move into the 21st century and use technology to work smarter.
".... How would you like to rely on the very same folks who run the post office, the DMV, the folks responsible for maintaing our bridges, etc. for your heart transplant..."
You so silly. Who ever said the doctors would be government employees? They aren't employees of the insurance companies now, are they?
Posted by Mac on November 5, 2007 02:38 PMJay,
I've told you before that there are NO improvements in socialized medicine, only lowering some costs because of denial and rationing of treatment. But there are things we can adopt from European systems to lower health care costs.
We can make use of tort reform to eliminate nonsense lawsuits and victim trolling on the part of the bottom feeder lawyers. In the European systems there is no reason to try to sue any medical care provider. No punitive damages, no contingency fee lawyers and no multi-million dollar windfalls to people via the lawsuit lottery.
Jay I apologize. There are things we can import from the European systems. Just not the government making decisions on what care is appropriate via the purse strings.
Posted by momma y on November 5, 2007 03:45 PMjay, "our global peers provide better healthcare at lower cost than we do"
You've repeatedly used the term "myth" in other threads. This is a true myth.
Last year, the Prime Minsiter of Italy needed heart surgery. He didn't get that care in Britain, France, Germany, Canada, or even his own country of Italy. He got it here.
A whole new industry has sprung up in Canada called medical tourism designed to book patients for healthcare outside of the country, chiefly the U.S., because they cannot get the treatment they need in Canada. Just recently, one of these patients was a member of the Canadian Parliament who needed treatment for breast cancer. She got that treatment in California, not Canada.
This year alone, it's estimated that about 70,000 patients are leaving Britain for treatment outside of the country, because they cannot get the treatment they need under the British NHS.
If their model for healthcare is superior to what it is here, why would all hese people be fleeing that model in favor of ours?
Posted by Dave on November 5, 2007 05:03 PMDave as we've established ad naseum here...yes...our global peers provide better healthcare at lower cost
http://www.msnbc.msn.com/id/18674951/
Posted by jay on November 5, 2007 05:10 PMMac,
The problem isn't that government will be at the bedside. Government will stand at the caregivers elbows, all of them, including doctors, and decide what they will pay and how much. It is the inevitable result whenever any large bureaucracy makes decisions on complex subjects with multiple components. Works very well in business. For your appendectomy it might work well as that is a standard procedure. For a heart patient with multiple health problems needing an implanted defibrillator with complications of diabetes and advanced kidney disease there will be multiple decisions to be made. In Canada, that patient will wait an average of a year in the absence of another heart attack. Mine was implanted within two weeks of the doctors determining the need. An explanation I was given was that my condition was not really common but the treatment for the heart problems was necessary because the most common result without it is going to sleep and not waking up. Mine was implanted in July, in September and October the defib function kicked in while I was asleep. I never knew about either until the doctor's office called and told me the unit "messaged" the central monitoring company with the information of time and repeats. Last night it "jump-started my heart again. Had I been made to wait the standard Canadian wait, I would be dead. The expense of my care from September is due to my being alive. Going to be a large amount as my kidneys are failing and I was told to expect to need dialysis before 2009. (Same doctors told me I wouldn't be here for this Thanksgiving) That is how socialized, centralized or single-payer insurance saves money. The most expensive treatments and diseases are for people who are in danger of death. It is not an intentional decision to "let them die." It is the result of looking to a central authority instead of letting individual doctors and patients deal with situations. It is also part of a money based decision making process controlled by a central authority leaving most individuals no choice. Those with enough money can buy any health care they desire. Only the poor and middle class will be subject to that authority.
Doctors aren't employees of the insurance companies but if your insurance policy does not permit a procedure, like a heart transplant, most often the doctors won't do it. If it were the government paying the bills, there would be more layers of approval and some might get the transplant. More would not get it because the decisions the doctors make would be based upon guidelines put out by bean counters. Today those bean counters work for insurance companies. Many times individuals have difficulties because they don't read their insurance policies, we were guilty of that. The insurance companies only have to sell to one customer, the corporation or businesses. There is little incentive to offer extra benefits because most of those offering insurance do so in order to offer a benefit that costs less than pay raises. Employees accept the situation because the alternative is to use after tax dollars to buy a health plan that is more expensive because the employer gets a tax deduction for his contribution to the insurance. Employees have to spend an amount over a floor of 2% of income before any tax deductions are permitted. Only self-employed workers may deduct any part of the cost of insurance.
This is why it looks better in other countries until you check out the total tax burden and add the unemployment and job stagnation into the equation.
My suggestion of the HSA is the answer for self employed people because they can use it determine their own health care destiny. The change from employment based incentives to individual incentives is essential so that people will become the customers. Insurance companies will have to compete in the individual marketplace. The different needs of individuals will provide variety in the plans offered meaning more choices. Tax credits for the working poor, the non-working poor will always need government health care, will give them the same freedom of choice.
Governments don't tell car insurance companies how to insure cars but individual states have mandates on how much coverage is required. Check it out for yourselves. In states where the levels of coverage are lower the add-on policies cost, you know, I'll let you all do the math yourselves.
Government, nor any overlarge bureaucracy, cannot manage individual decisions without a pattern, plan or guidelines. The ones setting those guidelines are going to do so on a monetary basis. Rare care needs, my word for them, will not be in a general plan and will require an individual decision. That requires time, information and many other things including checking for prices, availability and other factors used in the decision. Delay can equal denial in medical care. That is a complaint about our system but it is a major factor of all socialized medicine.
The oncology statistics are something that measures several things in medicine including the availability of quick treatment, aggressive treatment and a variety of treatments available. Sometimes a very short delay can create a higher rate of death because the amount of treatment needed increases. In a centralized system this becomes a cycle of delay that can be fatal. That would be an explanation for the difference in survival rates. The medical treatments available are the same everywhere. The medications, procedures and all other features necessary for treatment are available in all countries. The reason for the survival differences is..what do you think?
Posted by momma y on November 5, 2007 05:36 PMJay,
The Commonwealth Fund? Yeah, that's an unbiased organization.
The question remains; why should I be forced to participate in a program that I don't want to participate in?
Posted by Mike on November 5, 2007 07:04 PMmomma y,
Your premise is okay, but you really are missing huge pieces of the picture. I'm in the business and I don't know what gives you the idea that you could ever, ever, ever save enough money in an HSA to cover even a "minor" major illness. And as long as the insurance companies are still in existence, people with HSAs will have to suffer from the same overpriced, non-competitive health care they have now. If they save DILIGENTLY, they might be able to afford getting a broken leg set.
I wrote a LONG answer (about like yours) explaining all this but the website wouldn't take it. (is it my imagination or is this site poorly made?). Anyway, I'm too tired to retype it. Sorry. You might want to look at the book "Redefining Health Care". It explains alot.
Posted by on November 5, 2007 07:28 PMJay,
I read over the article that you had linked and it raised more questions than answered.
First, as previous stated. A study by the Commonwealth fund that shows Canada, Australia, New Zealand and Britain all doing better the the rest of the world, minus Germany. Can you say biased?
Infant morality.. Does Britain count all children or are they like Sweden who only counts children who have died after reaching the age of 10 days?
Emergency Rooms.. Does Britain have the same level of illegal immigrates as the US. The illegals flood our emergency rooms so naturally the wait would be longer. Take the illegals out of the equation and then do your study.
Medical expenses... Does that include the money paid by foreigner coming to the US for medical treatment, but figured into the cost per capita of the US.
Medical expenses... Do the numbers reflect the cost of malpractice insurance that have to be paid by the doctors who in turn have to charge higher rates.
Personal physician.. How many people are obtaining medical treatment from companies such as Kaiser, where very seldom do you get to see your personal doctor?
And how convenient that surgeries like hip replacement or cataract surgery are not included.
Least wired.. If I am not mistaken, isn't there a big issue about having our medical records on electronic devices. Something about tracking personal information and the possibility of someone hacking into the files.
Sorry Jay, but your smoking gun on the cost of health care in the US compared to the rest of the world turns out to be a water pistol.
Posted by jgd777 on November 5, 2007 08:16 PM7:28
Yeah. I always do a Control C of anytthing before I post. I've lost a lot of long posts. Why can I post to the Denver Post in seconds yet this one takes long minutes?
My personal experience is that the cost of health care can be managed and, right now, I can get discounts for health care if I pay from an HSA. There is a lot of non-essential expense in health care but leaving that alone why do you think it would cost so much to get a leg set? The catastrophic coverage would kick in at a set level, in my case 5 K but usually half that, thereby permitting people to be insured without paying for splinter removal.
One idea is to think of our current health care system as a gas station where there is no self-service pump. You see no price on that pump. When the service techs come out they charge you a set fee of say 40 dollars to fill your tank. They also offer "services" for additional payments with the excess billed to your car insurance company. Ignore everything else if you will but a flat rate to fill every tank would mean that those with 12 gallon tanks and those with 50 gallon tanks would pay the same. The insurance for those with big tanks would eventually go up to cover the problem.
My calculations and decision to change over were very carefully reviewed by myself and my insurance agent, and he didn't sell me my health insurance. We take a small chance that the cost to us will be greater than we can afford. Under insurance policies it most certainly was. Many times we can save ourselves money by thinking and asking questions. Check and see how much it would cost you to pay for your prescriptions online. You might also factor in buying a larger dosage pill and cutting it. Most of the time you will find savings.
I suggested to the insurance company that they could do a PR good for themselves as well as a service to their subscribers by offering a rebate of say 20% of everything saved by the purchase of medications. The savings would be based on a list of prices for medications. Do your own self test. Call up and ask how much it would be for a visit to a minor emergency clinic for a broken leg. Then call an ER. Expect both to be puzzled by the question because most people do not think of planning for "in case" situations.
The HSA is NOT a cure-all. It solves the problems by letting payments go into your own account for future illnesses and needs. If we don't need to use the account for more than a thousand a year. Twice what our total expense was except for me. I will retain an insurance policy with an HMO. Not the best but you can't buy roast beef at hamburger prices.
Posted by momma y on November 5, 2007 08:19 PMHank weighed in:
Monopolies, even health monopolies, are always hostile to the consumer. They always cause higher prices, reduced service and produce an inferior product. Competition and choice, with each consumer shopping the system and making decisions in his own best interest, while using his own money and not someone else's momey, always guarantees the best possible service at the lowest possible price. Competition is always consumer friendly."
Just like the de-regulation of the power industry in California...
And another Don Quixote daydream bites the dust.
Posted by Charles B on November 5, 2007 10:04 PMjay,
You haven't answered the question. If their model for healthcare is superior to what it is here, why would all these people be fleeing that model in favor of ours?
Posted by Dave on November 5, 2007 10:36 PMCheryl,
You're assuming that under a free market, health care would be at least as expensive as it is now.
But that just isn't the case. Take for instance vision correction surgery, a medical procedure delivered by the market place. The result is that it's become almost routine, the quality has improved, and the price has fallen. If that can be done with eye surgery, there's no reason it cannot work equally well for knee surgery or heart surgery or any other medical procedure.
Apparently, Charles B would prefer his health care to be run by the same kind of people who run airport security.
Posted by Dave on November 5, 2007 11:01 PMI'd rather sickness not be a profit motive for corporations to make money. In a private market system, corporate entities have a vested interest in a larger supply of sick people. The more sick there are, the more money to be made.
I'm not for a socialized system either, but until the middleman is removed (i.e. insurance companies), health care will continue to be costly.
Posted by Dan on November 6, 2007 12:02 AMDave,
I would like to have a face life (at 48, I feel gravity pulling), some fine tuning lipo (despite my workouts, some areas just don't seem to go away). These are expensive. Please don't try to tell me that MRI's, surgical procedures, chemotherapy (my husband's drugs out of pocket - got reimbursed AFTER purchasing them because we did not wish to wait 2 days for approval) was over $8,000 for a week's supply. I kid you not. We put it on a credit card), tumor removal, etc all are doing to decrease to ranges within everyone's income. NOT. Doc's don't hvae to take insurance. Why don't they start doing that now and lowering their prices. Hospitals don't have to take insurance. Why don't these guys drift to the free market if it is going to be so lucrative for them. Because it won't. They will end up with unpaid charges to patients. The there is the issue of quality of care. I do not want to take my 12 year old Type 1 juvenile diabetic to a Walmart clinic for her treatments. I want to take her to the Barbara Davis Center for Juvenile Diabetes (This is one reason I will never choose Kaiser as my health care provider). Will the free market determine the level of care one gets? (It does now anyway I guess. I just don't see this changing - poorer people get clinics and tests that may miss an underlying illness. The wealthy get the stops pulled out.). The answer lies somewhere in between and not with health insurance companies who are going to continue raising premiums as the baby boomers age and there not being enough healthy people to subsidize the premiums of the elderly.
Posted by cheryl on November 6, 2007 06:43 AMHank,
I passed your compliments on to the editorial staff at The Lancet, and I am sure that they will find your attribution very interesting.
Next time the discussion turns to estimates of excess mortality in Iraq, please be sure to remember how prestigious you hold The Lancet to be.
As an aside...SICKO is out on DVD (if anyone cares!). Even if one has insurance, it is no panacea (spelling?) for health care's ills.
I have had to fight one too many denials (have won every one of them, also!) with the insurance companies. They deny and hope that their premium holders don't put up a fight!
Cheryl, "I would like to have a face life (at 48, I feel gravity pulling), some fine tuning lipo (despite my workouts, some areas just don't seem to go away). These are expensive."
Actually, plastic surgery is another area that's more market driven, and its prices have come down too.
"Why don't these guys drift to the free market if it is going to be so lucrative for them. Because it won't. "
It's because what we have more of a forced market than a free market. When people don't have to compete for customers (patients) by lowering their prices or raising their quality, they won't bother. They know they're going to get paid no matter what happens. So, their prices continue to go up.
Posted by Dave on November 6, 2007 08:26 AMCheryl, "Even if one has insurance, it is no panacea (spelling?) for health care's ills."
It wasn't intended to be. The only purpose for health insurance is to insure that people in the medical profession get some money out of it.
Posted by Dave on November 6, 2007 08:32 AMcheryl,
The changes necessary to make health care a market driven product will require that the government and insurance 800 lb gorillas leave the room. The way to evict them is to make the consumer the customer, not the business owner. Make it possible for people to get insurance policies to cover only major expenses not splinters.
Yes, it will not solve all problems. Cheryl will continue to have to choose between her Wal-mart hate and saving money. She wants the Barbara Davis Juvenile Diabetes center as a health care provider. I would like to drive a Hummer. Each of us is limited in our choices by our incomes. Health care is included in this and will NEVER be equal for all. Those with money will be able to pay for whatever health care they want. People without unlimited resources buy insurance because it is supposed to be a way to handle major illnesses, severe injuries and chronic conditions. Sometimes we don't get what we want.
Insurance reform is mandatory. Question is will we reform it or just cover it with another layer of excuses. Again the answer is not in government, it is in individual choices.
1. Remove the employer advantage in health insurance by granting those deductions to individuals.
2. Make HSA accounts available to anyone who desires to open one.
3. Remove the obstacles to insurance companies selling catastrophic insurance.
4. End Medicaid and Medicare enrollments. Give anyone 50 or older the option of the old system of insurance with co-pays.
5. Give all those currently enrolled in Medicare and Medicaid the option of choosing a HSA account. Also give Medicare "switchers" the additional option of an insurance policy to work with the HSA and the right to change back to the old system at any time in the first five years after changing.
6. Give any switching from Medicaid a 25% extra initial deposit and match all deposits made by the individual for the first five years.
7. Tort reform. Punitive damages permitted but paid to the state instead of the plaintiff. No contingency fees over 25%. No expense or other charges permitted to be charged by the attorney instigating the suit. Contingency fee to be only on actual damages, not pain and suffering, lost income nor any other award including punitive damages. Loser pays for lawsuits. Class action lawsuits limited and regulated by these same rules.
8. Government whether state or federal should open or contract with those who have already done so, clinics where people can receive treatment for minor injuries, preventive care and basic medical tests and evaluations.
9. All health care providers shall post or provide a listing of their charges to all patients. This information shall be clearly identified in each facility or office.
10. Tax credits for all low income workers using the same basic system as is presently used for Earned Income Tax Credits. Chronic or acute medical conditions shall be factored to grant a benefit, which is permitted to exceed the total amount of taxes paid by the individual or family.
11. HSA accounts shall be set up for all qualifying for assistance. These accounts shall include a catastrophic coverage policy for critical conditions. The amount of assistance required shall be determined and the initial amount of money paid in to the account adjusted accordingly. For the first year the government shall add up to 300% of the amount of each individuals monthly contributions to their account. For those unable either physically or mentally to manage such an account, the alternative shall be an insurance policy with benefits and co-pays to be decided on an individual basis. Those entering the low income health care assistance program shall have the ability to choose such a plan instead of the the HSA.
12. When any low income sponsored HSA account reaches a set amount and had been in place for no less than 7 years, any amount in the account over a pre-set total, but not less than twice the total yearly deductable of the insurance policy it is paired with, shall be refundable to the individual for their own use.
The outline is there. Offer a choice but always offer and have available the HSA. Require health care providers to make their prices public. Give the tax benefits to individuals. Get the government out of the pay system for health care. Limit the insurance industry's ability to dictate coverage by giving individuals choices. Get the slimeball lawyers out of the picture by making sure the plaintiff's award is protected. (Some attorneys charge 50% of the total award and add expenses that can take more than half of the remainder. Think 5 dollars a page for photocopies.) Give the poor responsibility and opportunity.
Full range of options for all. Won't appeal to those who want a government cure-all. Will work without raping the taxpayer or ignoring the poor. Will have enemies in government, insurance and the cradle to grave socialist camps. Will appeal to those who think for themselves and want to be responsible for themselves.
Posted by momma y on November 6, 2007 11:57 AMIsn't it funny that the same Democrats that say the government" wrongfully" took us to war and are running the war" badly "want the government to run our "health care".What is wrong with this picture?
Posted by An American on November 6, 2007 01:00 PMAgain folks....if other folks are doing it better and cheaper (and momma the myth about denied care has been debunked many times over, but thanks)...why again can't we learn from their successes?
Posted by jay on November 6, 2007 01:32 PMchoices between cars is different than between a choice as to whether a person lives or dies because of what health care they can or cannot afford. As I have stated, if free enterprise in health care would benefit both doctors and patients, why are not doctors and hospitals opting out of insurance and setting their own prices outside of insurance? No one says that docs and hospitals MUST take insurance. They can do business in cash. (Why? Procedures would cost too much and they would be left holding the unpaid bills which in turn would result in higher prices to cover the default rates and paid by the rest of the consumers.) Does anyone know of any country that has pay as you go free enterprise, Adam Smith, type of health care. If so, does anyone know how health care is apportioned in those countries and the type of care afforded. I am curious.
Posted by cheryl on November 6, 2007 01:51 PMJay,
I would like to see your response to the post directed to you at 8:16 last night.
Posted by Mike on November 6, 2007 04:31 PMFree enterprise in health care is impossible without getting rid of a few things we have added to it.
First we have to remove the government from the picture as provider, decider and overall sugar daddy. People used to think of insurance as the backstop. If things got really really bad ...let me use a real time example.
We all have homeowners' insurance. There is a deductible and then we ask the insurance company to pay for the rest. We expect to be repaid for expenses after a fire, a tornado or a major loss or damage. If we have a stopped up sink, we pay to get it fixed. If the furnace breaks, we pay to fix it. Broken toilet? Pay to fix it. Is any of this cheap? Convenient? NOPE. But no one thinks or considers it to be necessary to offer, or require insurance companies to offer, a whole house policy that covers everything that can go wrong in a house. If they did, can you imagine the costs?
Health insurance used to be for major expenses. Medicaid and Medicare changed it to a full coverage system. They provided a comprehensive, full coverage system. The poor could now afford to see a doctor so they wouldn't need to use the ER for basic health care. Government paid for it all. Working people looked at that and wanted to know why the poor had better health care than working people did. Employers asked insurance companies to offer something comparable. Beginning of spiral into the confusion we have now.
The result is that there is no connection between the one paying the bill and the one creating it in most parts of health care.
Used to be that people paid the doctor in the office for each visit. No one ever thought twice about that. In the mid 1980's I paid, ran across an old ledger so I know, 35 dollars for an office visit. Paid cash, got a receipt. Today a visit to that same office, same company but the sons, grandsons of the original doctors charge over a hundred dollars for the same visit. Look at it in terms of minimum wage. Call the 80's minmum wage 4 dollars an hour so the visit cost 10 hours. Today the minimum is about 7.50 so call it 8, easier math for a visit costing 120 dollars. 15 minimum wage hours of work. The extra five hours cost are easily explained by higher overhead. Most of that is created by paperwork. Insurance paperwork, government paperwork and CYA paperwork just in case one of the patients decides to try the legal lottery of malpractice.
Creating a marketplace system is not possible when a doctor cannot avoid insurance companies or government reimbursements. A few who do avoid the government end of things have been punished with laws demanding that they take Medicare and Medicaid patients. Result is that it is possible, right now, for people to pay less with an HSA but they have to look for the price reductions, ask for them and be prepared to go elsewhere to find lower them.
I had to leave the doctor who specialized in diabetic foot care and surgery because he was willing to accept payment from Kaiser but Kaiser was not willing to pay him. Lost the foot after that.
The cardiologist I use is going to charge me a much lower amount than he charges Kaiser. He is also going to reduce the number of tests he runs (EKG to be precise) because they won't show anything unless my implant has already notified them something is wrong. That is what I mean. The majority of the "business" right now is with people who have an insurance company or the government paying the bills. Doctors will have to keep that large office staff until there are more people who pay at time of service than use insurance for "minor" matters. You can't reduce the cost of cancer treatments. You probably can manage to reduce the cost of an office visit. If we adopt tort reform we can start to work on the cancer costs. You probably will have to use insurance for them but, as you have stated, the costs are high enough that a catastrophic policy would already be working. The problem for most of us is that we don't plan to get sick. We really don't even want to think about it. We just wait until we are sick or hurt to read that insurance policy. By then it's a bit too late to try and get coverage for rehab or plastic surgery repairs.
Removing the routine, non-emergency part of health care from insurance is not possible right now. What is possible is to turn on the American inventiveness and use it to reduce costs by reducing use of the insurance and increasing involvement. The more people know about their own health care the better prepared they are to deal with situations. Cheryl provides a perfect example in her statement about care denials being all reversed after she worked on them.
Several months ago a poster gave a link to a study that divided people into three groups and monitored them. The groups only difference was that one group had a low co-pay and no minimum threshold. The second group had a higher co-pay and a small, 500 dollar, threshold before health insurance kicked in. The last group had a high co-pay and a thousand dollar individual threshold before insurance took over. Result:
For emergency or critical situations there was no statistical difference between the groups. For routine care and office visits the breakdown was that the higher the co-pay the fewer the office visits.
We can continue to muddle along in between those who think they want the government in control, remember, "He who pays the piper calls the tune.", those who want the power such control will give them, those who want some middle ground and those who want a strict pay for it yourself or shut up, kill the insurance company mentality. Or we can stand up and declare that we are free Americans who will not submit to government control, rationing or care denials to pacify those who desire that power.
No matter how loud they deny it, those in favor of socialized medicine can't wish (or lie) away the twin facts of people going out of system for health care and systems having to forbid private health care by law. If their system was as perfect as they want us to believe there would not be a need for laws to prohibit private health care because people would want the government's version. There would also be no need to go outside their system/country to get treatment.
Our imperfect system can be repaired. If will never be perfect. Nothing in the real world is perfect. Unfortunately, we can't live in the fantasy lands socialized medicine promises. We're stuck with the real one...and gravity too.