What is the deal with Health Ins. premiums?!

[Dargo]

I just received what seems to now be my every 6 month price increase for my health insurance. This is getting just stupid! I have a family of 7 and I carry 80/20 coverage with a $1000 deductible per person. I do have a limit of only 4 people have to hit their deductible and then everyone is considered as having met their deductible. I have no dental, optimetric, and very limited prescription coverage. Still, my monthly premium is now $857 per month!!

What is really bad is that even when I had $500 deductible per person, we almost never met the deductibles for the insurance to begin covering. It looks like the last time that the insurance company has ever paid for anything was in early 2004 when I had reconstruction surgery on my right elbow. Even then, the total the insurance company paid was just over $800! Hell, I'm paying $10,200 per year in premiums and then I'm basically also paying for all medical costs over and above that!!

I'm licensed to sell all types of insurance, including health insurance. However, I have not sold any insurance in over 10 years. Still, as I recall, the premiums are supposed to be based somewhat on claims. I know for a fact that if you have high claims or frequent claims, your health insurance premiums rise. In my case, only 5 years ago the same (well, actually better - I only had $500 ded. rather than $1000) coverage cost me $251 per month. In this last 5 year span, our insurance company has not paid out an aggregate total of even $2000 on my family! So, I really am quite pissed about my insurance premiums going up $606 per month in the last 5 years. I'm told that quite a bit of what is paid in premiums are monies to pay hospital bills that are inflated in order to cover the treatment of non-insured people.

So, in this country, we do have government covered health care. All you have to do is not have coverage and not have the ability to cover the hospital bill! Damn this chaps my ass!! The current sky high costs of medical procedures end up coming completely out of my pocket anyway because I never meet my deductibles. There is no way in hell I can lower my deductibles either. That would put my monthly premiums well over $1200 per month!

I just took my oldest son in for 5 stitches last night since he apparently cannot ice skate worth a crap. I passed on an X-ray since it was evident that he did not have a broken jaw from hitting his chin on the ice. Still, he has not been in yet this year so the entire $372 bill comes out of my pocket. It is not likely I will meet the $1000 deductible for him yet this year.

At what point is the system going to completely crash because of workers and employers actually footing the costs simply say "enough"!? The current system is a very selective system in who actually bears the load of this country's medical costs. Your young people don't pay, your illegals don't pay, the old don't pay, and the poor don't pay. That leaves the entire burden on a very small segment of the population. Personally, I'm tired of carrying the damn load!!!! Yes, I'm getting quite pissed that the uninsured, illegal, and poor are provided much superior health care than I can afford. This situation is going to force government sponsored health care. At least that way the government can bring in money for the expenses from a broader segment of the population than are now footing the damn bill. By the time I pay for premiums, deductibles, and "not covered" health care expenses, I'm paying out $12,000 to $14,000 a year. I don't see how the government can milk any more than that out of me for government sponsored coverage!

Our current health care system is simply broken beyond repair. There is no way that approximately 20% of the population can continue to bear the burden of providing health care for this country. Doesn't anyone else see a problem with placing so much of the burden on so few?

 

[OhioTC18]

Another part of the problem is the pay out amounts to the health care providers. If a claim is submitted for say, $300. The insurer will pay out $85 based on the contract that they have with the health care provider. My doctor quit accepting my insurance. Every time I went, he submitted a bill for $75.00, not an outrageous amount in my mind. After all, I have been in personal contact with 3-4 people by the time I leave. They all need paid a good wage. Anyway, the bill gets submitted and the pay out is $35.00. Now I have just seen a receptionist, a Medical Assistant, the Doctor and the billing clerk on the way out. How is he and his staff supossed to make a decent living on that $35 ??

 

[OkeeDon]

Doesn't anyone else see a problem with placing so much of the burden on so few?

(Sigh) Of course.

First, a bit of my own history. You're getting off darned cheap. You must be on some kind of group plan to get those kinds of rates. Betsy and I have always been self employed with no employees to form a group. For several years, while the kids were both in private colleges and things were really tight, we went "naked"; without health insurance at all. Fortunately, we had no health problems and got away with it. When we signed back up, we went with a $2,500 deductible, then later adjusted it to $5,000. With typical co-pays, under our plan we had to get to $9,000 out-of-pocket before the insurance covered 100%. This plan covered nothing but major medical expense -- no emergency room, no doctor's visits, not one penny until the deductible was met.

For this, we were privileged to pay $1,191 per month for two people. Then, the company decided they were no longer going to write individual health policies in Florida, and gave us a list of other insurance companies. When we investigated, the least expensive of the other companies was going to be $2,300 per month!!!!!!! We eventually found a company that would write us a major medical policy for only $900 per month, but they achieved that in a simple fashion -- they refused to pay legitimate bills! Long story best left for when I don't get so worked up about it.

Now, I'm darned glad I had any kind of coverage at all, because the bills for my 5 days in 2 hospitals, tests, and installation of an internal defibrillator, was over $150,000.

I'm also glad I'm able to afford $900 or $1200 or even $2300 per month if it had come to that, and I had any kind of coverage at all.

If they do not work for a corporation or government entity that can afford to pay a portion of their health insurance, many people -- probably most people, in raw numbers -- could not afford coverage. In fact, the number is pretty easy to figure. Take the total population. Subtract the people who, like me, can afford to pay for individual coverage. Then, subtract the people who are covered by their employers. What's left are the people without insurance -- somewhere around 40 Million people the last time I looked at the numbers.

Of these, perhaps 10% are the ones you conservatives are always yelling about -- the ones who don't want to work, the ones who take advantage of the system. That leaves 36 Million decent, hard-working, proud folks who are living in anguish because they are priced out of our current health care system. These are the store clerks, garage mechanics, lawn service folks and countless others you depend upon each day, with whom you might even have a friendly conversation at the PTA meeting, but who you do not realize are living with an axe over their heads.

Something has to be done to cover these good people.

Next. look at the corporate world. GM is in trouble over benefits. Delphi just declared bankruptcy, essentially over benefits. Their CEO said something like, "We are reaping the harvest of our government's policy of more and more of people's needs being dumped on corporations." (I posted the exact quote somewhere else on the forum). Health care costs are rising for corporations, as well, and they are feeling the pinch. Something has to be done to ease this burden.

Then, there is government. Federal, state and local employees receive some of the best benefits available. For decades, it's been known that if you want the best health coverage, best vacation plans and best retirement plans, get a job in the government sector. Sanitation worker, teacher, cop, state bureaucrat, post office, FEMA representative, whatever it is, you'll make out. Of course, all the REST of us pay for that.

Then, there is Medicare. Thank God for Medicare, or I don't know what kind of life we would have.

We finally have our health care under control. We joined a Medicare Advantage Plan, and HMO that cooperates with Medicare. It works like this: we still pay our $78.20 (each) per month for our Medicare premium (that's $156 per month combined; some employees and most government workers pay less for more coverage). Our HMO receives a fixed amount from Medicare for every enrollee. That amount is currently about $966 per month in our region. Out of that amount, the HMO must pay ALL of the costs of all of it's members, all of the operating expenses and still make a profit. We do NOT pay any additional premium, and we do receive much of our coverage free, lower co-pays for out-of-plan doctors, lower co-pays for hospital stays than standard Medicare, and free prescriptions within a generous limit. Of course, most of our working lives, we paid a Medicare premium in the form of a tax that paid for other folks' care, now it's our turn.

Now, here's the cool thing: they DO make a profit, and that's after providing excellent care to a bunch of seniors, all over 65, who have some of the highest health care costs of any group!

Let's put all this together. The total amount of money spent on health care in the United States in 2003 was $1.7 Trillion. It was projected to increase to $1.8 Trillion in 2004; I wouldn't be surprised to see it hit $2 Trillion in 2006. That's the total of all amounts regardless of where they came from: Medicare, Medicaid, health insurance, private payers or tax supplements. The current population is almost 296 Million; no doubt it will hit 300 Million in 2006. So, simple math says that we are already spending, one way or another, almost $6,700 per person, per year, for health insurance. That's about $560 per person per month. Now, that's less than the $966 my HMO is getting, but consider that it covers many people with no problems. That's the way cost-sharing works. By the way, Dargo, insurance IS cost sharing, so the amount your premium goes up has no relation to the amount expended for your family.

Is there a better way to use that money? Let's consider that currently, the charges are being computed by tens of thousands of health care providers, and are being paid by tens of thousands of insurance companies, individuals and government bodies. No one is coordinating the costs, and none of the payers have the individual clout to bring the costs into line.

Further, we have allowed ourselves to become such a litigious society that the costs of frivolous medical lawsuits have driven up the cost of health care beyond all reason. There isn't room here to document all the ways, such as higher malpractice premiums and increased diagnostic testing, that these suits are irresponsible.

To me, the answer has to be in at least 2 primary directions. We have to lower the costs of health care, a large part of which can be accomplished by lowering the costs of frivolous lawsuits. However, I do NOT agree with the Republican approach of lowering all tort awards. This does little to reduce the number of suits (they'll still be filed; something is better than nothing), it hurts those who have legitimate cases and deserve a large settlement, and it simply puts more money back in the pockets of those who provide truly poor care. The answer is to reduce the number of frivolous suits. That can be accomplished; we simply stop letting the lawyers police themselves.

The second direction can be to consolidate the health system into a single payer that has the clout to stand up to pharmaceutical companies and health care providers, and work with them to reduce costs. Of course, that will never happen as long as we have a majority government that is supported by those highly profitable companies. Instead, they will use lies and misdirection to convince people that if you change the way the health care is paid, somehow you'll change the way it is provided.

Under my theories, the total cost per person (which you are already paying, one way or another!) can be reduced and we can continue to provide the high level of care for which we are known, at a lower total cost for each person.

Now, heaven forbid, that might cause an increase in taxes -- a new medical tax that is dedicated to that task, like the Medicare tax but extended to everyone, not just seniors. However, it should result in a total lowering of your burden. Your health insurance premiums would be eliminated, corporate and tax-supported premiums would be eliminated, more money would be available for your paycheck, everyone would have preventive coverage like I get, and total costs would go down because there would be no patients using the emergency room as their primary care physician.

I don't have room or time to expand this to cover all the objections I know will be raised, but the simple fact is this WILL work, we would have better care at a lower cost.

 

[Junkman]

Fast way to eliminate all frivolous law suits is to make the looser pay the legal costs of the winner. That is the way it is in many other parts of the world. People would think long and hard before filing. Lawyers would consider cases differently if they had an inkling that they wouldn't get paid if they lost. It would fix a problem quickly. It won't happen, since the state and federal legislators are mostly lawyers. Judges are lawyers also. The deck is stacked....

 

[Junkman]

I suggest that you just bank the insurance premiums and then purchase a catastrophic policy that starts to pay after a very high deductible. That way, you will be self insured and in the event that something very expensive comes along, you will be covered. I have a friend that has never had health insurance since he feels the same way as you do. He is in his mid 50's and calculated that he has saved over $50K so far. He doesn't even have fire insurance on his house, since the premiums for a $1.5 M home is very high. No mortgage and so far, he has saved over $30K in the last 5 years on the building. He feels that the risk is worth the savings.

 

[Melensdad]

OK call me crazy but I blame the insurance companies, the drug companies and the trial lawyers.

First, if the insurance companies don't put limits on their coverage then you can ask for and get more treatment than you really need. The doctors are AFRAID not to give it to you for fear that they will be sued. The insurance companies are afraid to limit treatments (too much) out of fear they will be sued. And the drug companies are advertising lifestyle drugs, pain meds, allergy meds, etc that are no more effective than most generics to get you to request those drugs from your doctor.

Now add all that crap up and your premium goes through the roof because you broke your arm and your doctor wanted to give you a simple $79 X-Ray but you ended up with a lawsuit proof Cat Scan that cost a couple thousand dollars. Then for the pain, when a simple Tylenol 3 would work, you got the next greatest thing that they invented and now advertise on TV, but really doesn't do anything extra.

Enjoy paying the high premiums. The other option is crappy care under some sort of "universal" or "socialized" health care program that would create even more problems. Me, I hate the premiums but it is far and away the lesser evil.

 

[buy_25]

wow- I pay $3,200 per year for a family (with dental)...I can have 1 kid or 10, Price is still the same. That is with $500 per person deductible, co-pays $20, drugs are 80% with a $16 max.. Dental is 3 cleanings per year for free with x-rays.

This is the best one we have too, and I think it is high.

I was paying $500 per year for even better "stats" 2-years ago and $1100 last year for me and the wife (better coverage then now). They are going up like everyone else in the world. Nothing new....

 

[OkeeDon]

The other option is crappy care under some sort of "universal" or "socialized" health care program that would create even more problems.

Why do you think this is true? I have "universal" or "socialized" health care right now, as does every senior on Medicare. There are few complaints. The care is not "crappy".

We have the finest health delivery system in the world. Why should that change just because we change the way we pay for it? Aren't they the same doctors and nurses and hospitals?

Nobody is proposing a system like they have in England and other places, where the health care professionals are government employees. It should not matter whether John Doe, XYZ Insurance Company, Podunk County, Medicare or the National Health Fund pays the bills -- the care should be the same.

What I'm proposing is no more than an accounting change. You pay the insurance company or you pay the national health fund. Your employer supplements your payments or gives you a raise so you can afford them. The raise comes out of insurance and tax savings. The insurance company pays the doctor or the national health fund pays the doctor. The important ingredients, YOU and the CARE GIVER, remain precisely the same. How and why is that crappy?

On the plus side, everyone gets the same care. Since no one is being denied, preventive care will go up by leaps and bounds. This alone will lower the costs. Our present system, where we deny care to a significant portion of the people until they get so sick it costs us more, is ludicrously stupid.

By vowing to pay higher premiums rather than fund universal care, you are literally cutting off your nose to spite your face. That is one of the reasons I accuse conservatives of selfishness, greed, and just plain meanness. You'll pay more rather than letting one red cent of your money go to someone who could benefit. I don't care what you give away; that statement alone puts you in the Scrooge column.

 

[Junkman]

Don........... since you seem so generous, could you send me $4500 so I can have my old car painted? I promise to give you a ride in it whenever you are around here. I will even repay you in about 10 years, if I have the money. thanks Junk..

 

[Dargo]

That is one of the reasons I accuse conservatives of selfishness, greed, and just plain meanness. You'll pay more rather than letting one red cent of your money go to someone who could benefit. I don't care what you give away; that statement alone puts you in the Scrooge column.

Hang on now. I'm more than quite aware that insurance is no more than sharing the risk. The way it is now, a few are paying to cover the risk of many. I am advocating some sort of method to have everyone pay their fair share. I do have a big time issue with quite a few paying nothing though. I don't agree with the current fact that quite a few pay nothing. Most every single case I've ever seen of people saying that they can't afford coverage are cases where they most certainly could pay some.

Every single person I personally know who pays nothing for their health care can still afford cigarettes, liquor, movies, vacations, tickets for sporting events, cable TV, cell phones, 2 cars, etc. I've not seen a single situation where the people could not afford to pay some for their care. I have to do without certain luxury things because of medical expenses. Why should I have to budget for medical expenses and others not?

What method is best, I don't know. However, it is not right now that there is a fairly large contingent group of people who abuse our system and receive free medical care on the backs of us who pay bloated premiums to cover their abuse. If everyone paid some, they would be less likely to abuse the system and there would be more money with everyone paying their fair share. Obviously some would pay more than others, but everyone should pay their fair share. Let's face it, there are no free rides in life that last. If there are too many parasites, the host is killed. Right now that host, the paying segment of the population, is being bled to death. What are the parasites going to do when they kill their host?

We will have a huge flood when they kill their host. All their tears will flood the land when they learn that they actually have to pay for their fair share. That is what will happen. Since we can't have that flood, we must find a solution. It only makes sense to spread the risk to all those who benefit from the system. How that is accomplished can be argued. To me, what cannot be argued is that more people must participate in funding health care. As Don pointed out, it does not have to cost working people a fortune and their life savings.

 

[Melensdad]

Why do you think this is true? I have "universal" or "socialized" health care right now, as does every senior on Medicare. There are few complaints. The care is not "crappy".

Don . . .Why do I think this? . . . because I have been to several foreign countries that have some form of this and found that their wealthy (even their upper middle classes) come here because they get better care here, with shorter wait times, and their odds of survival are greater.

And actually what you have is a hybrid system that is a long way from socialized or universal care. Medicare is a government guarantee to pay doctors that is overlayed on top of a private health care. Medicare is a very long way away from socializing medicine.


Dargo . . . back to your premium, my raw costs for family care, under the group policy I provide to my employees costs me about $825 per month, out of that amount I charge the employee (with family) a bit over $100 per month. Its an 80/20, we just raised the deductable to $1000 (was $500 until Oct 1 when he renewed the policy with a 10% rate increase). Individuals, Individual w/kids, and married couples cost less that $825 and they pay less. I believe most employees who get health insurance have no clue how much of a benefit they are actually receiving.

 

[OkeeDon]

Junk, that looks like a funny statement, if I could understand it. I honestly don't get it.

If you're trying to say that changing to a single payer health system is somehow the same thing as throwing money away, I respectfully ask you, what the hell do you think you're doing now? Dargo's (and everyone else's) high premiums are partly due to what he said, the hospitals raising their bill to the insurance companies in order to pay for the indigents. Also, check your local government budget. In our County, a substantial amount of tax money goes to hospitals every year to supplement certain trauma expenses that aren't covered any other way. That comes out of everyone's taxes. Then, there is Medicaid, which is essentially coverage for indigent patients, and which we all pay. There are a lot more examples.

The point is, everyone gets sick, gets hurt, etc., needs a doctor, needs a hospital, needs 911 service (paramendics, etc). The cost for all of this, regardless of who is paying it, comes to at least $1.8 Trillion and heading towards $2 Trillion. You pay for that right now, just like I do, but not everyone pays. You're already paying for them, either in taxes or increased medical costs. The money to treat them doesn't come out of thin air.

Here's what's wrong with that. When people have to way to pay for their own medical care, they put it off. They don't get checkups, They don't get treatment early, when it might be easy and cheap to treat them. Instead, they put it off until they have to go to any emergency room. This is without a doubt the absolutely most expensive treatment anyone can get. It isn't free. You're paying for it, now. Why on earth would you want to continue paying for that most expensive treatment when you could put these people in the system, get them regular car, and save beaucoup money? Anything else is just madness.

How do I know that would work? Like I said earlier, I belong to a Medicare Advantage Plan HMO. They have a fixed amount of money in which they have to treat all their members, pay their own expenses and make a profit. The first thing they do to make a profit is negotiate fair and reasonable payment for local hospitals, doctors, specialists, diagnostic services, labs, etc. In return for a discount, they can guarantee a solid patient base and provide prompt payment.

The next way they make a profit is to get a handle on treatment costs. There are two ways to do this. Many HMO's got a rotten name because they made a profit by denying service.My HMO takes the opposite approach. They figure if they can catch our ailments early, they can save enough money to make a profit. The diagnostic services they offer are fantastic. Everyone gets complete physicals. Within a few months of starting, everyone gets a colonoscopy. Regular blood work, regular xrays and a lot more cost them money now, but save them enormous amounts later. They have their own evening and weekend treatment centers for minor emergencies to keep their members out of the expensive emergency rooms.

If these same procedures were offered to every single American, regardless of their ability to pay, our healt care costs would be cut dramatically. I would venture to say it could go down 25% or more, even while providing dramatically better health care.

I just can't understand why everyone can't see this. Take the blinders off!

 

[OkeeDon]

And actually what you have is a hybrid system that is a long way from socialized or universal care. Medicare is a government guarantee to pay doctors that is overlayed on top of a private health care. Medicare is a very long way away from socializing medicine.

Aha! Exactly! You said in a very few words precisely what I've been trying to say. What I'm proposing is no more and no less than extending the Medicare system to every single person. It remains a private health care system with fantastic delivery; the only thing that changes is how it is paid. It's an accounting change, period.

You take all the money that is now being paid one way or another and throw it in a pot. Then, you make sure everyone gets absolutely first class preventive care. Costs drop as a result, and the pot doesn't have to be as large. The share paid by employees, employers, governments, individuals, etc., goes down because the pot doesn't have to be so big.

As the cost drops, more and more people can afford to pay their fair share of it, like Dargo has discussed. The more people that can afford to pay their share, the more money goes into the pot, and the smaller the share everyone else has to pay to fill the pot. Pretty soon, it actually gets manageable, and even the folks who had no hope of having an private insurance policy can afford to pay into it.

Look at Medicare. Currently, spending for Medicaid and Medicare accounts for about 45% of all health care dollars. All the rest of you are in the other 55%, plus your taxes help pay for the CMS (Centers for Medicare and Medicaid Services, a quasi-governmental agency, which actually administers all the Medicare and Medicaid spending). By law, the premiums paid by seniors for Medicare cover about 25% of their costs. So, the rest of you are already paying for 75% of my care and everyone else on Medicare, and pretty much 100% of everyone on Medicaid. I can't find the exact number, but a little interpolation and a SWAG indicates that taxpayers are paying about 85% of the CMS bill. In numbers, that's about 85% of the 45%, or about 32% of the total health care. Now, add that to the 55% that you're paying for non-CMS care, and you're already paying, one way or another, 87% of the health care costs of the nation. You won't be paying an extra cent if the system was switched tomorrow; and the results would more than likely be beneficial.

Here are some more potential savings. Administration of health care payments is expensive. Just keeping up with the billing to all of the myriad insurance companies is very expensive to health care providers. Their costs would drop dramatically if there was a single payer. Each individual insurance company maintains their own administration. They don't release the percentage numbers, but it has to be high. It's also high for CMS; about 35%. That's a common complaint about Federal programs; too much of the money goes to administration. But, how much is going to separate administration centers in hundreds of insurance companies? How much is going to commissions to insurance sales people? How much is going to advertising? Add all that to the administrative costs on the billing side, and it's got to be much higher than CMS.

Which leads us to the REAL reason why this will never happen as long as there are Republicans with clout. Follow the money. Insurance company owners and leaders don't want to lose their gravy train. Those leaders support Republican politicians because Republican politicians are willing to support their companies in return. There is a guy named Rooney who was owner of Golden Rule Insurance and is now owner of Medical Savings Insurance, the outfit I ended up with before going on Medicare, the outfit I mentioned that spends more time getting out of paying than they do fulfilling their obligations. Rooney is a HUGE Bush administration supporter; the entire medical savings plan passed by Congress is his baby, because he could see a way to make a LOT of money out of it, at the expense of good health care. He started the Medical Savings Insurance Company to take advantage of the new law. I was a member for a year; I'll give the details of the finances I went through to anyone who asks on a PM.

If we went to a single payer system, total costs would go down, but the insurance industry would take it on the chin. Probably the best compromise would be for CMS to allow the companies to bid on regional or state administration. They already do that for Medicare; BC/BS is the administrator for the State of Florida.

I didn't think all this up by myself, of course. CMS themselves recognize the sense of it and had this to say: "As CMS has said repeatedly, the rapid growth in utilization of services shows that Medicare needs to move away from a system that pays simply for more services, regardless of their quality or impact on beneficiary health. Medicare payments should provide better financial support to doctors and other health professionals in their efforts to achieve better health outcomes for Medicare beneficiaries at a lower cost. CMS is working closely with medical professionals and Congress to increase the effectiveness of how Medicare compensates physicians and other health care providers. CMS is also conducting demonstrations and pilot programs that pay providers more for better quality, better patient satisfaction, and lower overall health care costs." (my emphasis).

Stop letting the lies and misdirection of politicians guide your thinking and open your mind to this. It makes sense.

 

[OkeeDon]

Dargo, in my reply to Bob, I suggested that if the costs of health care were lowered to a point where more people could afford to pay them, then more people would pay, and those costs would drop even further on a per-person basis. and yet more people could afford their share.

There will always be some who legitimately cannot pay. Surely, even you will acknowledge this. Identifying those people is a difficult task. The current method is to look at income in comparison to a so-called "poverty level". I can't think of a more efficient way to administer it. Yes, there will be people within the poverty status who will make poor choices about how they spend their money. The fact that they are in the poverty status in the first place is probably a result of poor choices. You have to remember, however, that not everyone is as smart as you and I. Not everyone is capable of making good choices. In fact, I suggest that they further down the economic ladder a person is, the less chance there is of making good choices. For example, I bet you have never acquired a TV through a "rent to own" outlet; I know I never have. That's a poor economic choice. But, if you have a lousy job, have rotten housing, are sick most of the time, probably the only outlet you have for some kind of entertainment is a TV. If you have no good way to get a TV, and someone dangles Rent To Own in front of you, you will likely make the wrong choice. You have to put yourself in their place; sometimes the wrong choice is the only choice.

Yes, I know. If you were that bad off, you'd do without TV. So would I, at least, that's what I tell myself. But, I've been down, and I understand the mentality quite a bit. The truth is, I don't know that I could exercise that much self-discipline if I was that bad off. I respectfully suggest that you shouldn't be so quick to judge unless you've been there. I'd be surprised if you have.

 

[Junkman]

Dargo, in my reply to Bob, I suggested that if the costs of health care were lowered to a point where more people could afford to pay them, then more people would pay, and those costs would drop even further on a per-person basis. and yet more people could afford their share............

Are these the very same people that sit at home waiting for their welfare checks to arrive each month?? You know, the same ones that live in public housing and are presently on the third generation of welfare????? My gut feeling is that no matter how cheap health insurance is, there is a large segment of the population that just wouldn't buy into the program, because they know that the government is going to take care of them no matter what.

 

[Melensdad]

I suggested that if the costs of health care were lowered to a point where more people could afford to pay them, then more people would pay, and those costs would drop even further on a per-person basis.
​

Unfortunately that really misses both the truth and the point of the problem. Getting more people into the "pool" will marginally drop the rates, but not enough to really make much good because at some point the statistical averages come into play. Any group insurance policy will see this as the group increases the premium decreases, but only to a point, and then it stops. The decreases stop simply because the averages, the economies of scale, etc all come into play.

Add to that, the fact that it does nothing to address the points I made earlier about the trial lawyers, the doctors being afraid to be sued, the drug companies, and the desires of the patients. There is virtually no accountability in the health insurance field, except in the cosmetic health area. But leaving elective procedures aside, patients have no reason to ask for fiscally sane treatment and doctors have no reason to provide it. Generic 'Claritin' can be had over the counter for less than a 75-cents a day, it is a cheap and effective allergy medication that treats many of the most common allergies but on TV they are advertising 'improved' versions at substantially higher prices, they are only marginally more effective and even then only for some specific conditions, but the public is led to believe it is the next magic pill and no doctor will deny the prescription. That is a very simple example but one that is repeated 1000 times a day, every day. And things like that are why costs are out of control. Go back and read what I wrote about simple X-Rays vs Cat Scans. Same thing applies, same problem is repeated. Then go look at the extraodinary care that is given to premature babies and to the elderly and yes it sounds cold & heartless to say these things but at some point compassion must over rule the technical capablilities to keep people alive that have no chance for recovery.

You want to control costs or even reduce them, then the simplistic answers of increase the pool size to spread the burden are really not going to work because they miss the real points.

 

[OkeeDon]

Junk, yes, some of them are the people who are sitting and waiting for their welfare checks and live in public housing and are in the thrrd generation of welfare. What's your point? These are the people who are getting their care by going to the emergency room, the treatment costs are astronomical as a result, and you're already paying for it. That's my point! It doesn't matter whether they pay a penny or how terrible their lifestyle is. What is important is to get them onto some sort of rational plan where their health is improved. THAT is what will reduce costs.

Let me say it again, you're already paying for them, at the most expsensive possible level. If you have to pay for them, wouldn't it be better to do so in a rational, less expensive way?

What's your alternative? Let them die? Shoot them? Gas them? The movie Soylent Green was just a fantasy -- or is that what you're proposing?

 

[OkeeDon]

Bob, I'm not missing the point. I realize I'm writing such long responses that it's difficult to read and assimilate it all, but way back in an early message I addressed concerns like medicine costs, excessive diagnostic testing and the legal system versus health care. The point I made was that under the current system, we are NOT improving that situation. In fact, I suggest that we cannot improve it, because none of the individual entities -- corporations or insurance companies or individuals -- have the power to do anything about it, because they are so splintered. What I suggested was that a single payer, such as CMS, can set the procedures and prices they will pay. If there is a cheaper alternative to Claritin, they simply won't pay for Claritin. Poof -- cost disappears.

That's the way my Medicare Advantage Plan HMO works. They give me up to $100 per year of over-the-counter remedies from aspirin to vitamins to bandaids. They pay 100% of generic prescriptions. They pay most of the cost of certain prescriptions that have reached their "approved" list; these drugs carry a minimal $15 co-pay. They pay some of the cost of any prescription, but the co-pay is around $50. That's enough to discourage anyone from asking for the expensive drugs. The doctors know how the system works, as do the pharmacists, so they automatically prescribe the lowest cost option that will do the job. There is a limit to the prescription benefit, but it is a generous $825 per quarter; that works out to $275 per month, but accumulates and rolls over for 3 months, when it starts over. I call it generous because it covers the prescription costs of most patients. It's certainly a better plan than the joke that is being pushed by Bush & Company.

The point is, these costs CAN be managed if the payer has enough clout to demand it. There would be little point in advertising a drug if the CMS says it will only pay for a less expensive alternative.

Of course, if the purpose is to protect the profits of the pharmaceutical and insurance industries, like the present prescription drug program, it will be doomed to failure. The only way I can see that we will get a rational program is to elect a moderate administration of either party.

How many of you actually understood the details of the Clinton health plan I have heard derided so much? It was derailed by scary ads from the health care industry who needed to protect their excessive profits, and it was castigated by Bob Dole when he was Senate leader, because he simply couldn't politically afford to let the Democrats win. They all used lies and misrepresentation. If you truly examined the plan, you'll find that it was remarkably similar to the HMO to which I belong, offered to everyone, with a single payer.

 

[Dargo]

Let me say it again, you're already paying for them, at the most expsensive possible level. If you have to pay for them, wouldn't it be better to do so in a rational, less expensive way?

What's your alternative? Let them die? Shoot them? Gas them? The movie Soylent Green was just a fantasy -- or is that what you're proposing?

Actually Don, make sure you are sitting down, I agree with you on this statement; mostly. I know I am now paying for them at the most expensive rate. And, I missed the quote in an earlier post but, no, I don't propose letting people suffer or making those who truly cannot afford coverage to pay. And, I realize quite well that it is not only abuse by people who do not pay that is killing our current system. I think that abuse from lawyers filing suits against physicians, hospitals, drug makers and other health care workers also raise our costs.

Every physician I know is concerned about a bogus malpractice suit or a bogus wrongful death suit. In our local paper yesterday there was a long article about a family who won a landmark suit against a OB/GYN physician. These people who won the law suit (yes, it is being appealed) did not ever pay for their services and never had coverage. They filed a wrongful death suit against the physician because the physician did not check the mother for drug use and drug abuse at the time of delivery. She was doped up at delivery time and the baby was born with multiple birth defects. The child died a few years later.

The family that filed suit claim that since the OB/GYN physician did not properly check for drug abuse, the baby suffered unnecessarily from withdraw, lack of oxygen, and other related issues. Even though Indiana caps these suits at 750k, the jury awarded the family 6.2 million dollars. The family filing the suit is a "minority" family as was 8 of the jurors. I quoted "minority" because I have to wonder at what point the minority is not the majority?! When there are more people of that race, how are they still considered a minority? But, that's another issue.

Anyway, I don't have the answers but, I do think the current system is a run away train heading towards a crash. To strap people who pay with medical expenses of over 12k annually is just simply not going to work. You indeed will get a huge amount of people moving over to the "free" plan and not pay. We just had a horrible tornado in our town a couple of weeks ago and, there are numerous fund raisers for people who are in the hospital and have no medical insurance. Quite a few of these people are not people who could not afford coverage. They simply opted to not have coverage because it is too expensive. Seeing their life styles plastered on TV, it is obvious they still enjoy quite a bit of relatively expensive luxury items and expenditures yet they have no health insurance. Yes, I have spent time and money helping these people but, it is disconcerting that it is okay for me to spend my money for health care yet it is not okay for these people to do so. Their free ride is not free.

I don't think anyone believes any single change will fix our health care system. Making more people actually pay what they can honestly afford for health care will not be a magic bullet and completely fix the system but, it is one aspect that needs to be addressed. Bogus law suits would be another major factor that runs up our expenses. I'm sure that several major factors can be easily identified. They all need to be addressed to make things work.