Get your own damn health care

[Prudence]

Because health care doesn't yet suck enough, the GOP has a plan to make it worse! http://seattletimes.nwsource.com/html/nationworld/2002166569_healthcare01.html

It's all well and good to talk about health care consumers making smart choices, but that doesn't address one of the major problems with health care in this country: insurance companies run as publicly-traded, for-profit corporations. The true "consumers" of health care aren't the patients -- or even the doctors. They're the stockholders. If my deductible goes up because as a nation we're using more health care than we're paying for -- that's fiscal responsibility and gets two snaps. If my deductible goes up to cover golden parachutes, stock options, and dividends, that is approaching unconscionable.

[Ghoulish Delight]

Having started using one of these tax sheltered medical expense deposit accounts myself, I actually like them.

The HMO model is extremely flawed. When it was designed, they never expected people to be using it in the manner that people do. It's not structured to handle the flood of people using the low deductibles and office visit copayments for every little minor cut and scrape. So the HMOs are having to pay doctors for far more visits than they ever anticipated. I don't blame the people who use the system that way. It's there, you're paying for it, use it any way that's legal. I blame the conception of the system.

As a result premiums are high. Astronomically high. And people have come to expect outrageously generous health coverage. And these people that expect this coverage, and don't expect to pay for it, get the shock of a life time the first time they get laid off and see what their Cobra payment would be. Suddenly bitching about having to pay $25 a month for the coverage they were getting seems really petty. And suddenly they realize they can make due with a slightly higher copayment, and fewer visits to the doctor.

Honestly, one of the best models I've seen is one in which groups of employers enter into what's essentially a collective bargaining co-op. Instead of providing insurance, they negotiate drastically reduced prices with groups of health care providers. The incentive for the providers is guaranteed business. The incentive for the employers and employees is that there is zero premium. You pay for the services you use at the discounted rate. Combine that with a pre-tax medical expense account, and it's an excellent system. Medical services begin to work as a competetive buyers' market rather than a price-fixed sellers' market.

[scaeagles]

Blinks....checks own pulse....pinches himself....not dreaming.

OK - what GD said. Nice post.

[Ghoulish Delight]

Oh, and for the record, I believe that there should be a minimum guaranteed level of care provided by the government, but it should be only that, a minimum. It shouldn't be comprehensive, and it shouldn't be the primary choice for most people. There shouldn't be anyone that can't get emergency care, or certain basics like immunizations, but the government cannot be in the business of handing out bandaids because someone cut themselves, or prescribing tissues because someone's nose is running.

[Prudence]

Maybe I live in a fantasy world. I resist going to the doctor with all my might. I have to be bleeding out my eyeballs before I'll go in. Well, maybe not that severe. But I'm busy. I have a life. And I don't intend to spend it in the waiting room. If I absolutely can't treat it with OTC or home remedies (say -- I've got a severe chest cold which is combining with my asthma to make it really hard to breathe even when I'm not moving) then a call to the nurse hotline and sending my husband down to pick up the prednisone works for me.

But I do have one big fear: Cancer. Everyone on my dad's side of the family gets it. Everyone. And they're all different. No convenient histories of breast cancer or colon cancer to screen for. Nope. Blood cancers, bone cancers, lymphomas, we've got 'em all. Heck, my brother had a grapefruit-sized tumor removed from his hip last year and he's only in his mid-20s. Fortunately that was benign, but damn. It's already hit my generation. Frankly I'm terrified that when it hits me it will destroy my family. I'm terrified that I'll have no coverage, or that the deductibles/premiums will be so high that we'll lose our home and our theoretical future children will be shipped off to live with relatives, or that cancer care and/or symptom management has become routine and is no longer covered in catastrophic coverage. I'm terrified that genetics will be used against the insured to deny care for predicted maladies. I'm the primary wage-earner in my family. What happens when I get cancer and can't work? What if it's 20 years from now and all we have are HSAs and that's fine for young workers who grew up with them and put into them for years and have years to go before major expenses, but I've only had access to one for a few years and have little in the HSA and no other safety net?

Some days I swear the only solution is to run for President. And then I remember that I only got 2.5 hours of sleep last night and it's probably just the heffalumps and woozles talking.

[scaeagles]

My suggestion Prudence, if at all financially possible, is to purchase private disability insurance. It is relatively reasonable in price and is excellent in terms of quelling the fears you have of becoming ill and unable to work. No harm in looking into it. Like everything, it's a trade off - is it worth the money to you monthly for the peace of mind? That's what purchasing insurance is, I suppose.

Catastrophic health insurance is also relatively inexpensive. It is possible to purchase policies, again for relatively small amounts, that pay all medical expenses after a certain amount has been spent by the policy holder.

I'm not an insurance agent - I do not have catastrophic health coverage (I don't require it as my current insurance covers such things), but I do have disability.

[Ghoulish Delight]

So based on that, Bush's plan fits you perfectly.

They would buy high-deductible "catastrophic" insurance policies to cover major medical needs, then pay routine costs with money set aside in tax-sheltered health savings accounts.So you wouldn't be paying premiums to cover the little doctor visits that you don't use anyway, but you'd be covered in case of a serious medical ailment. Sure, it'd be a high deductible, but considering your age, the ammount of money you will save by not paying premiums for HMO coverage (or the ammount your salary would increase due to your emplyer not having to pay those premiums) between now and when you'd need to use that coverage would more than likely cover that deductible.

[Prudence]

First of all -- I've watched the definition of "catastrophic" shift over time. Ooops, that's not covered because we don't know what it is. Ooops, that's now a chronic condition and we don't cover that. Ooops, that now affects so many people that it's considered routine, not catastrophic. I don't want what little coverage I have taken away for ill-defined speculation. I want to know what "catastrophic" covers. I don't want to lose what I have now, see that replaced with high-deductible "catastrophic" coverage, and then watch that whittled away until it's all pay-as-you-go.

And maybe we're weird up here. Our HSA type accounts expire every year. Whatever you put in you have to spend or you lose it. Which is frustrating. Is this the year I need $10,000 in emergency dental work like last year? Or is this the year everything's fine? $10,000 is a lot of aspirin to be buying on 12/31.

I suppose rollover HSAs are beneficial to a point, but it still leaves me with significantly less coverage than a year ago which was less than the year before that, and so forth.

An example: I broke my arm in a car accident 2 years ago. The bone wasn't knitting together very quickly so they wanted to send me to surgery and install pins and put me through another 10 weeks in the cast (after already doing 6). The other option? Put me in a removeable splint because increased activity -- as long as the bone is stabilized -- has been shown to increase bone healing. Traditional insurance covers the former, and I had to fight like hell to get the latter. Which worked wonderfully AND I was able to take showers. Another one of my many fears (it's one of those days) is that in the health care future people will be faced with similar decisions, only with much higher stakes. Do I take the covered, "catastrophic" treatment that's covered but is more painful/takes longer/leaves me out of work/less successful? Or the non-covered and objectively superior treatment that I can't afford? Actually, the system's already like that.

I'm really incoherent today. I should table this until I've had sleep. I'm trying to say that I'm not against the plan in theory. In the past I have advocated for a national system of catastrophic care, and HSAs sound better for other coverage than nothing, but I'm skeptical of how this would actually be put into place. I don't think that "they" actually have my best interests at heart. If I thought for a second that this would open the door to more universal coverage and that lower overhead would lead to lower costs I'd be all over it. But I don't. My gut tells me that it's a way for employers to dump the costs of employee healthcare and shift the burden to employees, who will see neither increased wages (to reflect that "responsible individual" spending) nor decreased health care costs.

But then again, I think people suck. I really need a nap.

[scaeagles]

I think you have a misconception. Employers do not pay one dime of your benefits nor any of your social security or medicare. This is a myth. When anyone is hired, the consideration is not the salary or rate per hour, but the cost of employment. Yes, technically the company pays for it, but it is simply money that you don't see in the form of salary - it's the cost of employment. They cannot hire someone at $10/hour unless they can afford a cost of employment of probably $16. That's a guesstimate.

Secondly, and while it is not meant to sound harsh, why is it the responsibility of anyone to provide for the health care of anyone else? I don't think it is. I do not come from a position of great family health or personal health. My mom died of lupus and the process put our family in the poor house. I am now blessed to be able to have insurance or my family, so with three C-sections, a gall bladder removal, a hysterectomy, and 2 more medically required surgeries coming up in my family soon, I am very happy to pay the premiums.

While hard on the family, it was not the responsibility of anyone else to pay for the health care of my mom. It is a sad but true reality, but I am not meaning to sound heartless.

I do wish you the best, Prudence, and hope you never have those huge catatrophes you are referring to. They suck even with insurance.

[Ghoulish Delight]

I think it's the responsibility of the government to provide a certain minimum level of health coverage. A government's reponsibility is to protect its citizens. A healthy populace is a strong populace. Notice the first item on a rather famous list..."Life, liberty, and the pursuit of happiness." A society that does not adequetly ensure the health of its citizens is one that will pay a great price down the road.

[Prudence]

I think you have a misconception. Employers do not pay one dime of your benefits nor any of your social security or medicare. This is a myth. When anyone is hired, the consideration is not the salary or rate per hour, but the cost of employment. Yes, technically the company pays for it, but it is simply money that you don't see in the form of salary - it's the cost of employment. They cannot hire someone at $10/hour unless they can afford a cost of employment of probably $16. That's a guesstimate.



I am perfectly aware of how my health care benefits are obtained. Yes, my employer does pay a portion of my health care premiums. Every year they hand out the cost per employee sheets. Unless they're lying, I see how much of the premium is paid by my employer on my behalf. These amounts are not reported on my income tax forms as income, but rather by the company as expenses. So I respectfully suggest that you are mistaken and that a portion of my medical insurance premiums are paid by my employer. (And I'm also perfectly capable of reading a W2 and noting the various deductions, which were not under discussion.) And if in this magical system my employer gives me the full $16 "cost of employment" to apply to HSAs or premiums or whatever, then fine. But what I expect would actually happen is a great cry of "Goodie!" from the administrative offices as they no longer have to pay $6/hr for me, but I still take home $10. And now I purchase coverage, assuming I can afford it, on my own.

I'm asking for a basic level of care, in the same way most people expect a basic level of fire or police services. Am I to assume you believe that if someone can not afford life-saving treatment that we say tut-tut, not our responsibility, and let them die? So sorry chemo's expensive. Too bad you didn't earn enough to pay for it all yourself. How civilized. The rich get health care and the poor are completely expendable.

[Prudence]

Additional note: I actually don't intend for anyone to pay any portion of my future health care needs. I intend to work my ass off and stash away every penny I can in anticipation of that inevitable rainy day. That's why I spend my days working full-time and my nights in law school. Because I don't intend to rely on anyone other than myself. Heck, I don't even rely on my spouse to take care of me. Still, if a chunk of blue ice nails me on the way to the car and I end up on a ventilator, I hope I'll be taken care of even though I'm still young and poor and not left on the mountainside as carrion.

[scaeagles]

Prudence, you are of course technically correct. Your employer does pay the insurance premium or portion of the social security and medicare withholding, etc. But it is all smoke and mirrors. They only pay that because you are employed there. If you were not employed there, they would not incur those costs.

I really respect your gumption and willfulness in putting money away for that rainy day. If more people had that as a goal, fewer would find themselves in need of help they could have provided for themselves with better planning. Does this mean everyone could? No. But I beleve more can than currently do. It is an issue of prioritization. If I choose to spend a couple Gs on my DL vacation this summer with the family, that's 2 Gs less I have to put away for that rainy day. When that rainy day comes, if it does, it could be that I could have used that 2 Gs for something more important. My choice, my responsibility.

Perfect system? No. BUt the fact of the matter is we live in a market driven economy in all aspects of life. Those with the money can afford nicer cars, homes, whatever. Of course those with more money can afford better quality health care. The government here in AZ does provide health care for the poor. There is medicare and medicaid on the federal level, and hospitals by law cannot turn away anyone who needs emergency assistance.

[Ghoulish Delight]

Yes, they can't be turned away, but they can be put in horrific debt that will they will never get out from under, simply because they had the gaul to want to live.

There are certain things that, for the viability of the society, should not be left to an open market. A minimum level of education and a minimum level of health care are tops on that list. Money is supposed to be a tool, not a method for weeding out those that deserve to live and those that don't. Whether I have a nice car, a big TV, an expensive home, and luxurious vacations are luxuries. Life should not be a luxury.

[scaeagles]

Life should not be a luxury.

Never said it should be. I am not against medicare and medicaid and the Arizona system called AHCCCS (pronouced "access"). These are necessary and good.

And they can get out from under such debt, GD. This is what bankruptcy protection is all about.

[Ghoulish Delight]

Oh yeah, because bankruptcy is such a joy and wonder. Bankruptcy is hell, don't kid yourself.

Medicare and medicaid are very limited in who they cover. Medicare is only for the elderly. Medicaid only covers the young, the old, or pregnant women except in VERY rare cases. They are hardly sufficient.

[scaeagles]

I am aware that bankruptcy is hell. My dad declared when I was in HS (primarily due to the aforementioned lengthy illness of my mom). My dad now owns a home again and has rebuilt his credit - took quite a few years. It is not a perfect solution, but it is what it is. Protection from creditors when you have nothing.

I'm a safety net kind of guy - I really am. I just think that there are people who do not and will not take responsibilty for their spending choices and then expect others to take care of them when it is needed.

[Ghoulish Delight]

Yes, bankruptcy is the best tool for the situation it's meant to resolve. However, to say, "It's okay, there's always bankruptcy" is hardly a solution.

As is often the case, I'm a moderate on this issue. I don't want to see full national health care, a-la Hillary Clinton. But I think that the current programs are horribly inadequate.

I know there are people that won't take the necessary responsibility, but oh well. I do not want to live in an unhealthy nation. Helping to provide for the nation's health is in my best interest. As you well know, and agree, it would be unconscionable to have a system where people are turned away in emergency situations because they can't pay. But without some level of coverage beyond simple catastrophic coverage available to everyone, the likelihood of more people needing to take advantage of things like AHCCCS increases, and the likelihood of people having to default on payments through bankruptcy increases, and therefore in the long run will cost more than if the catastrophic medical events are prevented in the first place.

[scaeagles]

I do not want to live in an unhealthy nation. Helping to provide for the nation's health is in my best interest.

To what extreme does this go to, though? I realize you are not saying such a thing, and I am simply playing devil's advocate, but why not completely ban tobacco? Or food with a certain fat content? Or transfatty acids? Or any number of things that make us unhealthy.

So many ailments are completely avoidable. Should the government ensure that circumstances that can contribute to those situations are eliminated? No. I do not believe, then, that I should be held in anyway responsible, nor should the government be held responsible, for choices made that lead to health problems.

There are, of course, situations which are not a matter of choice. I am much more sympathetic to those, as i am sure everyone is.

I have an acquiantance who had a child with some health problems and the benefits at his job were not adequate. So he took a second full time job at - gasp - Walmart. Did it strictly for the health program he was able to get. This was 18 months or so ago, and I am not sure of the status of things.

Tough times suck. Big time. But I believe that there are outs that people do not consider because they are not easy enough. For every one of those, there are others who have no alternative but to have government assistance, and I am all for it.

[Ghoulish Delight]

Timing is everything, here's an article that underscores the sad state that current private health coverage is in...

http://www.msnbc.msn.com/id/6895896/

[alphabassettgrrl]

I agree that health insurance is dismal these days. Even when you have coverage, often you have to get approval for procedures, or even office consults. That can sometimes take a very long time, if you get it at all. I saw many "medically necessary" procedures turned down when I worked with referrals.

My uncle was in the hospital for a few days several years ago; no insurance at all, as far as I know. Took him a long time to pay it off. Lucky he lives with his dad and has few expenses.

One benefit (so to speak) is that often doctors will give a discount to those paying cash, with no insurance. My husband was watching a show about doctors who (I forget where) don't take insurance at all, and only charge a low rate, everybody pays cash. I could go along with that kind of system, paired with catastrophic coverage (provided that continues to actually cover you).