Health Care: A root cause analysis.

[Kilarin]

Health Care: A root cause analysis.

There is lots of argument over the health care bill. There is obviously a lot of disagreement on exactly how to \"fix\" the problem, but I think (hope) all sides agree that the system we have is broken. So I feel we might really benefit from looking at the question of exactly WHAT is broken about our system.

In my opinion, the problem is twofold:

1: The Middleman.

As long as we have a middleman standing between the consumer and the medical practitioners, costs are going to keep going up. The insured consumer has no incentive to reduce medical expenses because the vast bulk of the expense is being paid by the insurance company. The medical profession has no incentive to reduce expenses because insured consumers don't pick a hospital based on costs. And the middleman, the insurance companies, are ONLY interested in reducing cost, which means that actual medical needs take a back seat.

Because of the insurance middleman, we have a system in which all three parties have NO interest in the welfare of the other entities they are dealing with. Neither the patient or the medical provider have any reason not to drive up the costs of the insurance company, and to the insurance company, the sick consumer and the medical providers are both expenses to be reduced, not assets to be cared for. It's a system that actively encourages, not only gouging on all sides, but actual fraud.

To see the full extent of the problem, lets imagine if there was such a thing as \"shopping insurance\". Instead of going to the store and buying what you need, you would pay a monthly fee to the shopping insurance company. When you went shopping, you would pick out the items that you thought you needed (after speaking with a store consultant, I am sure), and then present your insurance card to the store. IF your expenses were approved as truly \"necessary\", then the shopping insurance company would reimburse the store for the price of the items.

You can see what would happen. The consumer has no incentive to reduce cost. Now the consumers primary goal is to make certain they are getting the maximum possible \"stuff\" for the price they are paying every month. The store has no incentive to keep prices low. Now the store's incentive is to prove to the shopping insurance company that the consumer \"needs\" as much as possible, at the highest possible price they can sell it at. Now at first glance this may appear similar to the relationship between the store and a direct consumer, but it is NOT. When a store is selling to a direct consumer, they always have to balance the lust for profit with the fact that if they push prices up too far, the consumer will move to a competitor. But with a middleman involved, consumers will no longer be making choices based on price. And, of course, the middleman, the shopping insurance company, will not be making decisions based on what a family actually needs, but on what will reduce their own expenses as much as possible.

2: Advances in Medical technology.

A few hundred years ago, there was a cap on medical expenses, because what we COULD do was limited. Worse case scenario you would have to pay for an expensive surgeon's time, and for full time nursing, and perhaps a seemingly expensive medical concoction. But all of this was limited. The medicines expense was based on the rarity of the components, not an attempt to recover the cost of decades of full time research and testing. The most expensive medical equipment was a bed or pair of crutches. There were no X-rays and no MRIs. Because there were limits on what we could do, there were limits on how expensive it could get. It could easily get more expensive than the poor could afford, but it wasn't the kind of expense that could bring down a whole economy.

Ah, but now we have learned so much more. And we can DO so much more. A serious illness that 100 years ago would have resulted in a few weeks nursing care and then funeral expenses, can now easily rack up hundreds of thousands of dollars (or even millions) as our advanced technology and increased skill works on the problem. And all of that technology may not even really solve the problem. In many cases, we are not curing an illness, but merely prolonging the dying. Can we give the patient another decade of life, or a year, a few weeks, or even just a few hours? It doesn't matter. If we CAN do it, we usually think we should, with no cost/benefit analysis at all.

---

Unless we address these two problems, I don't think we can fix the spiraling cost of medical care. The reason I oppose more direct government involvement is that I think it actually exacerbates problem 1. It adds ANOTHER middleman into the equation.

So, what do *I* think is the direction we should go?

First, I think we address the middleman problem by eliminating him as much as possible. We do that by moving away from insurance and towards medical savings accounts. With a medical savings account, every month you make a deposit and it goes (tax free) into the bank and earns interest just like any other bank account. You can pull money out of that account to pay your medical expenses whenever they crop up. Most people are generally healthier when young. This gives them a chance to build up a nice size bundle in the medical savings account. They can then either choose to reduce their monthly payment, or continue to build up a bigger cushion as they wish. One big advantage of this system would be inheritability. Anyone who died without using up their entire medical savings account could pass it on to their heirs. It also encourages healthy living. Give up smoking and you are saving cold hard cash, since the medical expenses you are saving are YOUR money.

Of course, a medical savings account will not be adequate to cover catastrophic illness. There is just no way to get around the middle man for that case. That's why a small percentage of the money invested into the medical savings account each month goes to cover an umbrella catastrophic illness insurance policy. This is a policy with a huge deductible. It doesn't kick in until AFTER you have actually emptied your entire medical savings account. Of course, that means it will cost a lot less than regular insurance and will cost less each year as you build up a larger savings account.

The Medical Savings account puts the consumer back to dealing directly with the medical provider in most cases. The expense of medical care will go down because Hospitals will have to compete on quality and price, AND, consumers will actually be making medical decisions based on spending their OWN money. There will no longer be a third party involved in the discussion of whether you need that extra MRI. The Doctor will tell you what he thinks, and you will evaluate both the costs and the risks and make the decision.

I think switching from a \"full insurance\" model to a medical savings plan model would go a long way towards helping our country's medical expense problems. Unfortunately, it does NOT solve all of them. Young people with chronic illness will find it very difficult to ever get a medical savings account buffer built up. And for serious catastrophic illness, we would still be dealing with the insurance middleman.

Which brings us to the second issue: Advanced medical technology exists, are we therefore ethically bound to use it every time we can? I'm afraid that societies answer here needs to be \"not necessarily\". I know a lot of people are cringing right now and thinking about people dying because we wouldn't spend some more money. But consider, we make that decision on other issues every day. Every time you get into an automobile and travel down the road, you are putting your life at risk. We have made vehicles much, MUCH safer than they used to be, but we could make them safer still. We could save lives by spending more resources and more money. BUT, we eventually decide that this is as safe as we can REASONABLY make things right now.

Consider, for example, air bags. Vehicles with good air bags save lives. So, airbags are now required on vehicles produced after 1989. But we didn't outlaw all older vehicles without air bags from driving on the road. We decided that the cost just wasn't worth it. Society could not reasonably afford to replace or retro-fit every old car on the road. The damage done by such a decision would have outweighed the benefit. So in 1990 there were still plenty of cars driving without airbags, and there are actually still some driving today. And sometimes people die as a result.

There is really no difference in making that decision, and in saying that society is not obligated to foot the bill for very expensive medical treatment plans. Just because certain treatments are POSSIBLE, doesn't not mean that they are obligatory. I know that sounds cold and heartless, but in a world where medical technology is always growing in both ability and expense, society simply can NOT afford to do everything possible. Regardless of whether or not you think tax dollars SHOULD go to cover all medical expenses, people on both sides of the debate should acknowledge that our society simply can NOT foot that bill. Even in countries with fully socialized medicine they have to make decisions about what kinds of treatments are affordable. The million dollar treatment that saves one life in the US, could have fed countless starving children in Africa.

The catastrophic coverage plans that are paired with the medical savings account plans should take this into account. There should be more expensive plans for people who want coverage with no limits, but there should also be cheaper plans for those who are willing to say \"Hey, if the cost go over a certain amount, I'm not going to get that treatment\". You make your choice, and you take your risks. And you live, and possibly die, by that choice.

I think the only way to get the US health system back on the right track is a combination of these two things. Get the consumer back to paying directly for health care by implementing medical savings accounts. Cover most of what falls through the cracks with catastrophic illness insurance. AND, recognize that sometimes we just have to say no to very expensive health care. If the individual can afford it, fantastic. If they pay for an insurance plan that covers it, that's good too. If people can donate to charity and cover some of it, great! But it's not unethical to say that if you can't afford that hundred thousand dollar treatment plan, the tax player is not obligated to pick up the tab for it. That's too bad, but it's not unethical.

[Spidey]

You lost me at “lust for profit”…sorry. J/K

Yea, lots of things in there I agree with, I like very much the savings account, with the passing on to your heirs…I was thinking along those same lines. (weird, huh)

Nice post, maybe somebody will actually read it.

[Kilarin]

You lost me at “lust for profit”…sorry. J/K

Just framing it from my own point of view. Profit is good!

[Bet51987]

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[Will Robinson]

...But it's not unethical to say that if you can't afford that hundred thousand dollar treatment plan, the tax player is not obligated to pick up the tab for it. That's too bad, but it's not unethical.

I disagree on the grounds that you're creating classes of people. The politicians and the rich will get the best treatment, while the middle class and the poor will simply go home to die. I find that unacceptable.

Sorry, Kilarin.

Bee

He isn't creating classes of people the lack of communism creates classes of people. If you want it to be "fair" why only health care? Why not housing? Surely you can see that a nice house in a nice neighborhood is beneficial to the livelihood of the people who live there and living in the ghetto is detrimental to the livelihood of the people who live in that environment...

How about education? Shouldn't everyone have the same opportunity? How about level of income? Someone has to pick up the trash and wash the dishes but they will never earn as much as the guy who performs brain surgery....come on make it fair! Or is the creation of classes OK with you as long as the particular reason classes are created don't play into your dogmatic need to defend your party's position in the topic de jour?

You are either in favor of pure communism or you are making lame excuses in order to disagree with Kilarins statement.

PS: Still have no time for the answer to my question in the other thread?

[CUDA]

you are either in favor of pure communism or you are making lame excuses in order to disagree with Kilarins statement.

OOO OOO MR. Kotter, Mr. Kotter, I know, I know

[Bet51987]

.

[Gooberman]

If you want it to be "fair" why only health care? Why not housing? Surely you can see that a nice house in a nice neighborhood is beneficial to the livelihood of the people who live there and living in the ghetto is detrimental to the livelihood of the people who live in that environment...

Or how about the police department? Surely if I am being stabbed, but have none of that oh so precious MONEY, an officer should just walk on by? Or if my house is on fire, if I have none of that MONEY, perhaps we could all roast some marshmellows?

"Life, liberty, and the pursuit of happiness"

Jefferson didn't promise us happiness, which is why we don't get the nice house.

You are either in favor of pure communism or you are making lame excuses in order to disagree with Kilarins statement.

Why the hell must everything be so black and white with you guys?

[Insurrectionist]

Because we are tired of seeing communist grey.

[Tunnelcat]

...But it's not unethical to say that if you can't afford that hundred thousand dollar treatment plan, the tax player is not obligated to pick up the tab for it. That's too bad, but it's not unethical.

I disagree on the grounds that you're creating classes of people. The politicians and the rich will get the best treatment, while the middle class and the poor will simply go home to die. I find that unacceptable.

Sorry, Kilarin.

Bee

I agree with you Bet. But it's not a stable system we have right now. People have this notion that life is a right no matter what the cost. People will fight for this to the bitter end. So what's going happen when the large middle class in this country loses the ability to pay for, or have access to, health care, and they all have this silly expectation that life is so valuable that they're willing to fight for it? A breakdown of society maybe?

Kilarin, the big problem with our 'supposed' free market system is that costs are not transparent to the customer. Different people get charged different prices for the same treatment and demand for that treatment is mostly inelastic, they're willing to do whatever it costs to live. Now there's no way to change the inelastic demand part because all humans have the will to survive.

But cost now, that's something that should be addressed in ANY part of ANY solution and nowhere in the Dems Health Reform efforts have I seen ANY kind of cost or price transparency reforms. No one's talking about how to ration costs for all, and yet we are demanding health care for all. Not everyone can spend a million dollars on end of life treatments or expensive medical procedures, but everyone seems to expect it, without thought to cost. But cost is the problem and it will either bankrupt individuals or the government, depending on who gets stuck with the bill.

The problem is that our health care doesn't seem to get cheaper over time with advancements in medicine or productivity improvements like other industries do. Instead, it's been getting steadily MORE expensive, even though we have much better technology and drug treatments for care. Why? I've generally thought that improvements in technology or business pratices led to more efficient and cheaper products. Not so here.

The right-wingers want to do it via the method that those who can pay, get what they want or afford, individual responsibilty. The lefties want all of us to pay for everyone else's health care for all of society equally, societal responsibility. Neither system is fair to everyone, so there's no good solution. So what IS fair to all, hmmmmmmm?

[Kilarin]

I'm sorry I brought the trolls to your thread Kilarin

Not a problem. I've got no problem replying here. I'll duplicate to a PM if you aren't reading this thread anymore.

I disagree on the grounds that you're creating classes of people.

You are right and wrong at the same time. This system doesn't "create" classes of people, but it doesn't completely level the existing classes either.

In a Capitalism, there WILL be those who are richer than others, and they will be able to afford better things. Back to my car example. The rich can buy expensive cars with every possible safety feature, and even hire expert drivers to take them from place to place. The poor must make do with less. This decision really is the same as with health care.

The ideal, whether with health care OR cars, is to arrange the system so that the average, or even a poor person, can afford something that is reasonable safe.

I think a move towards medical savings account would really help most people to be able to afford basic health care. It would reduce the cost of the basic care that the vast majority of people need to affordable levels. And give them an organized way to save money tax free to pay those costs. Basic catastrophic coverage would be far cheaper because of the enormous deductible, and that means that even MORE people could afford more expensive treatments when they are needed.

With a system like this, even someone earning very little money could get the basic health care they need. Someone rich will always be able to get something better.

The only way to eliminate rich people having access to better health care is to flatten everyone's income, which has proven to be a very unpleasant system to live under.

One of my favorite quotes on that topic is from an old book called "The Virginian:"

"It was through the Declaration of Independence that we Americans acknowledged the eternal inequality of man. For by it we abolished a cut-and-dried aristocracy. We had seen little men artificially held up in high places, and great men artificially held down in low places, and our own justice-loving hearts abhorred this violence to human nature. Therefore, we decreed that every man should thenceforth have equal liberty to find his own level. By this very decree we acknowledged and gave freedom to true aristocracy, saying, 'Let the best man win, whoever he is.' Let the best man win! That is America's word. That is true democracy. And true democracy and true aristocracy are one and the same thing. If anybody cannot see this, so much the worse for his eyesight." --Owen Wister in "The Virginian," New York: Grosset & Dunlap, 1911.

Just to point to one example of why the insurance based system does not work. My wife suffers from TMJ. She went to a surgeon to determine treatment options. The surgeon informed her that there were two possible treatments. One a very minor surgery, and the other a major surgery that would cost $50,000. He informed us that the minor surgery would be completely inadequate in my wife's case and she absolutely had to have the major surgery.

Then our insurance company told us that it did not cover the major surgery. Next meeting the exact same doctor sat in a room with us and told us that the minor (and much less expensive) surgery would be exactly what she needed and would almost certainly solve her problem.

The middleman system doesn't work. Eliminating the middleman will allow everyone to afford better treatment.

And THANKS for reading my long post. I do appreciate it.

[Will Robinson]

If you want it to be "fair" why only health care? Why not housing? Surely you can see that a nice house in a nice neighborhood is beneficial to the livelihood of the people who live there and living in the ghetto is detrimental to the livelihood of the people who live in that environment...

Or how about the police department? Surely if I am being stabbed, but have none of that oh so precious MONEY, an officer should just walk on by? Or if my house is on fire, if I have none of that MONEY, perhaps we could all roast some marshmellows?...

your analogies don't work.
The Police are not there because the government owes us 'protection', the police primarily respond to law breaking and punish the offenders. They take it upon themselves to prevent where they can because they have to do something in between responses and they even allocate their manpower disproportionately among the poorer neighborhoods because it maximizes their potential to catch criminals.

As to the fire department, they are not there to keep your house from burning they are there to stop your house from burning so it won't burn down the whole village/town/city of chicago etc.

It isn't because of a 'right to protection' that we have, as a whole, agreed to pay tax to fund fire and police operations. Those operations are means to reduce damage to self and property thats why we pay that tax. And the budget for those operations is never without adjustments based on the municipalities ability to pay for it and NOT their ability to simply print money and send our grandchildren the bill to pay for it with interest!!

So...while we would, as a whole, agree to pay for some healthcare reform as well we won't pay to get screwed over! Blowing smoke up my rectum does not a colonoscopy make.

As I pointed out to Bee in another thread, America was all in favor of Obama and Congress bringing on meaningful reform and no Republican could have stopped it.
It is all the crap hidden the trunk of the car they tried to run us over with that lost them the majority of support.
Obama ridiculed Hillary during the debates for having tried to put into action a healthcare plan mandating citizens buy insurance back in the Clinton administration....now he shoves the very thing he was going to save us from down our throats! Didn't you just tell me the other day, siting those very debates, it was no secret what he was going to do, that we shouldn't be acting surprised!?!

[AlphaDoG]

a bunch of sense!

Ty sir!

[Krom]

The thing I think many of you are missing is that you are blaming all the junk on the President, and Democrats/Republicans in Congress and the House, when it is the Democrat and Republican parties themselves that have contributed the most to the mess. No matter who you elect the same garbage would still make it to paper in Washington because the major parties don't change even when the candidates do. All the people who are supposed to be in charge making the decisions on both sides of the isle have more than amply demonstrated they completely obey the commands of the party and absolutely do not think outside the box the party tells them to think in.

The parties are so powerful that the system is rigged from the beginning. When was the last time you looked at a ballot? You can simply check \"Democrat\" or \"Republican\" and the system will automatically apply your vote to all of the candidates under that party. There is no option for \"Independent\" that would allow you to vote for all independents on a ballot automatically. This leads to candidates being forced to choose and obey a party in order to get elected at all, and it completely sabotages the effectiveness of the election process.

So if you enjoy wasting your time and my time and everyone's time by all means continue to rage all you like on the individuals, the \"Democrats\", \"Republicans\" and \"Obama\", while the real problem; the idea of organized political parties itself freely continues to give crooks all the openings they need to exploit the system and ram through junk legislation you don't like. It is the organized party system that props worthless individuals into office. They are the foundation that enables the vast majority of corruption in our political system. Demand that your candidates completely abandon the organized parties, and tell people that a vote for either party is a vote for corruption.

[Kilarin]

Or how about the police department? Surely if I am being stabbed, but have none of that oh so precious MONEY, an officer should just walk on by? Or if my house is on fire, if I have none of that MONEY, perhaps we could all roast some marshmellows?

I think Will Robinson made some great points on this. But let me add one more.

Lets compare the fire department analogy to the helath care system. Houses still burn down. We could stop that better than we do. We could put a fire station on every street. We could put fire suppression systems in every house. If we were willing to spend a LOT more money, we could save lives. But just because we CAN spend that much money, doesn't mean we are obligated to. Adding fire suppression systems to every house would make affording a house VERY expensive. It would cut out a lot of people from ever being able to buy a house at all. It would increase expenses for renters as well, of course. And putting a fire department on every street would cost so much of the city's budget that they would have to tax everyone an enormous amount.

Society makes a compromise. They go for a system that provides reasonable safety at a reasonable expense. People who want to spend more, can, of course. But the average home is not a fire trap. And the fire department can save a lot of lives and property without dragging the economy to a stand still.

Healthcare needs to be treated the same way. We need to bring down the expense so that the average person can afford most care. And we need to recognize that we don't HAVE to pay for every treatment just because they are possible.

Kilarin, the big problem with our 'supposed' free market system is that costs are not transparent to the customer. Different people get charged different prices for the same treatment and demand for that treatment is mostly inelastic,

VERY valid point. It all comes back to insurance. One price if you have insurance, and another price if you pay cash, and another price if you are on Medicare. Stupid. And it increases costs. To give another example from my wife's life. She went to get an X-Ray once. We were covered by a company policy, but the company was complaining continually about how high expenses were going and begging people to reduce medical expenses. My wife is the kind of person who actually pays attention to that kind of thing. So when it came time to pay, she asked if there was a discount for paying cash. The hospital said there was, it was about 1/4 of the price if you paid cash instead of going through the insurance. So, instead of filing right there, my wife paid cash, and filed on the insurance at home.

The insurance said they had a special contract price with the hospital that was even less than the 1/4 my wife had paid. Nothing over that contract price would be paid by the insurance. So my wife went to the hospital and said, "You told me the price was X, but I would save money by paying cash. That wasn't true. You knew what insurance company I was with, why did you lie to me and can you give me back the difference?" And the hospital said, "Tough luck kid, you negotiated, we've got the money, and we are KEEPING it."

My wife never tried to save the insurance company (or the hospital) any money again. The fact that there is a middleman involved means no one is ever sure what the real price of anything.

The problem is that our health care doesn't seem to get cheaper over time with advancements in medicine or productivity improvements like other industries do. Instead, it's been getting steadily MORE expensive, even though we have much better technology and drug treatments for care. Why? I've generally thought that improvements in technology or business practices led to more efficient and cheaper products. Not so here.

Compare it to Vet bills. Veterinary science has ALSO progressed by leaps and bounds, but did NOT show the kind of cost increases that human medicine has. This can be attributed mainly to two facts. 1: The consumer negotiated directly with the vet, no insurance involved in most cases. 2: People are willing to say "That's too expensive" with veterinary medicine.

Now that pet medical insurance has started to be popular, I expect vet bills to start going up.

Ty sir!

Welcome!

[CUDA]

I think Will Robinson made some great points on this. But let me add one more.

Lets compare the fire department analogy to the helath care system. Houses still burn down. We could stop that better than we do. We could put a fire station on every street. We could put fire suppression systems in every house. If we were willing to spend a LOT more money, we could save lives. But just because we CAN spend that much money, doesn't mean we are obligated to. Adding fire suppression systems to every house would make affording a house VERY expensive. It would cut out a lot of people from ever being able to buy a house at all. It would increase expenses for renters as well, of course. And putting a fire department on every street would cost so much of the city's budget that they would have to tax everyone an enormous amount.

Society makes a compromise. They go for a system that provides reasonable safety at a reasonable expense. People who want to spend more, can, of course. But the average home is not a fire trap. And the fire department can save a lot of lives and property without dragging the economy to a stand still.

Healthcare needs to be treated the same way. We need to bring down the expense so that the average person can afford most care. And we need to recognize that we don't HAVE to pay for every treatment just because they are possible.

I think this may be the best anaolgy I've heard to date

[Top Gun]

Lets compare the fire department analogy to the helath care system. Houses still burn down. We could stop that better than we do. We could put a fire station on every street. We could put fire suppression systems in every house. If we were willing to spend a LOT more money, we could save lives. But just because we CAN spend that much money, doesn't mean we are obligated to. Adding fire suppression systems to every house would make affording a house VERY expensive. It would cut out a lot of people from ever being able to buy a house at all. It would increase expenses for renters as well, of course. And putting a fire department on every street would cost so much of the city's budget that they would have to tax everyone an enormous amount

Many states are now enacting national building code standards that would require sprinkler systems in all new residential structures constructed after a certain date; my own state is among them. I'm all for this proposal, personally: we have a century-old technology that is flat-out proven to save lives, and yet for whatever reason, we've never implemented it in the residential sector, the place where (I'd assume) most fire-related deaths occur. I know I'd put far more faith in such a system to save me than a 9-volt-powered alarm, and it might have the added bonus of minimizing damage to my house if a fire were to occur. Depending on how you spin things, one can create an interesting analogy back to the question of how much care should be considered "standard."

I may not know exactly what sort of healthcare system would be the most cost-effective and efficient, but what I do know is that our current system is badly flawed. We pay far more per capita for healthcare than any other nation on the planet, yet our rankings for infant mortality rates, average life expectancy, and healthcare standards fall below many other first-world nations. There's something seriously wrong there. I'm generally a fiscal conservative by nature, and certain aspects of the bill that just passed admittedly make me uncomfortable, but as a whole, I'm glad it made it through. There's finally an attempt at a solution in-play, and while it may not work completely as advertised, and may even need substantial re-writing and tweaking down the road, at least it's a start. And for those unhappy that the Democrats "railroaded" it through, as I've seen mentioned several times, the Republicans never presented a viable full-fledged plan of their own; the phrase "put up or shut up" starts to come to mind.

[Bet51987]

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[AlphaDoG]

*EDIT* I wanted to add this. In my town, and I'm sure it's true for every town, the school system is paid for by taxes. Every single taxpayer in town pays for the development of it's school children even if they have no children themselves.

This is what should take place with health care.

That being said, the taxes for said local school district is collected by the state and THEN forwarded to the FED's who THEN decide WHICH school district is MOST deserving.

Should I show you the tree of tax collection?

Which as I think of it is entirely f**k Tarded!

[Kilarin]

Many states are now enacting national building code standards that would require sprinkler systems in all new residential structures constructed after a certain date

How much will it cost? Will they install it in mobile homes? Will it increase the price of the house enough to keep some people from being able to buy? How many people? Will the added rent to cover the owners expense cause families to do without other important things? How much will it reduce fire insurance rates and will that counter act the added up front expense?

I don't know the answer to those questions, but those are some of the questions that need to be asked. Just because a technology is possible, and can save lives, does NOT mean it is wise to use it everywhere. You do have to consider the costs.

Although I understand where you're coming from I couldn't help but think of my friend who has Crohn's disease. He's 22, my age, and has treatments once every month for two hours. It's done at the hospital out patient cancer center where it's delivered by IV.

I understand because I had a friend with the same condition.

How does he, and the hundreds of thousands like him, fit within your plan. There is no way that the middle/low class can afford that with a savings plan.

Treatment is somewhere between $36,000 and $48,000 a year. Pricey. But remember that the medical savings account is a two part plan. A percentage of every months payment goes to purchase a catastrophic illness insurance policy. This policy will be MUCH cheaper than most insurance plans, because it only kicks in if you use up all of your medical savings account. That means that the vast majority of people will never draw upon it. But the small percentage of people who have a major illness CAN use it. That's how insurance is supposed to work. Lots of people pay in, only a few draw out.

I DO think that different levels of catastrophic coverage should be available, and which one is chosen should be up to the consumer. Now note, these plans, even for MAJOR catastrophic coverage, should be pretty cheap, at least as compared to ordinary insurance most people use today. But, and here's where the harsh part comes in, if you choose not to pay for the more extensive coverage, and then get hit with an illness that takes you over your limit, I don't think the tax payers are obligated to pay for your treatment. Voluntary charity, YES, but involuntary tax dollars, no. We simply do not have enough money to pay for every possible treatment that we CAN do.

*EDIT* I wanted to add this. In my town, and I'm sure it's true for every town, the school system is paid for by taxes. Every single taxpayer in town pays for the development of it's school children even if they have no children themselves.
This is what should take place with health care.

This is a very good argument. The problem is, I'm not real happy about the public school system. They do a poor job of educating compared to private schools, and are terribly wasteful of money.

On the other hand, they DO ensure that everyone at least has access to education of a sort. I've seen VERY poor families manage to put their children through private schools, but most parents simply do not have the dedication to make the kind of sacrifices required.

But, that is all really beside the point, because there is a VERY important and fundamental difference between public education and public health. Whether we SHOULD pay for public education through tax dollars is debatable, but there is no question that we CAN pay for it. Even with the massive waste and administrative overhead of the public school system, it only costs so much to get a kid through high school. We not only can pay for it, we can even pay for it while balancing the budget. Medical expenses have no cap. They get higher every year as what we CAN do increases. They keep growing throughout your life instead of ending after you graduate.

Paying for health care through tax dollars will result in an EXPANSION of the middleman problem. We can't pay for Medicaid and Medicare already. Add more into the mix and the problem (and quality of care) gets worse.

Thats why I think you would actually get MORE people, higher quality and less expensive medical care by reducing the role of both of the middlemen, insurance and the government.

[Spidey]

*EDIT* I wanted to add this. In my town, and I'm sure it's true for every town, the school system is paid for by taxes. Every single taxpayer in town pays for the development of it's school children even if they have no children themselves.

This is what should take place with health care.

Yes, and state (taxpayer) funded education for the most part ends with 12th grade, therefore ensuring a basic education, further education is your own responsibility after that. (for the most part)

Continue the analogy….

[CUDA]

not to mention how crappy our state run education system is compared to most of the 1st world countires. I'm sure state run health care will improve along the same lines

[Will Robinson]

Hey Bee, in your town do you pay for 100% of Nebraska's education for ever so they won't have to? Did they take 100 million dollars out of your towns school tax and give it to Senator Landriue of Louisiana to bribe her to vote for a bill? does your towns school tax include thousands of other things that have nothing to do with education in your town but have everything to do with empowering the democrat party?!?

Sorry for being such a troll as to actually challenge your position but some people might like to think about this stuff...

[snoopy]

Kilarin,

I like the post. I disagree on a few points.

First, what I agree with and an example:

I think the HSA model is the way to go. In fact, I have one and have been signed up for it for the past fours years. Instead of an \"all of your HSA account\" deductible, I have a high, fixed deductible that goes along with my account. I think the high, fixed deductible model is the better way to go. Here's why: There are a lot of HSA-eligible expenses that validly don't count against my deductible... e.g. Braces. If you just make people empty their account, you encourage them to spend it stupid stuff that they don't really need but want, like braces- the same \"middleman\" problem. A second problem with HSA's as they stand right now: the yearly limit on what you can put into the account is pretty low (in the range of 10k, I think)- I think that limit needs to be increased. I'd like a model where people are encouraged to stash as much as possible away; that doesn't punish people who carry a higher balance. It does make you think a lot more about where you go, and what you really need to do.

What I disagree with: I'd like a clearer line to be drawn between three \"cases\"- 1. Life-saving conditions, 2. Life-extending (<10 years) conditions & end of life comfort, 3. Life-quality conditions.

I don't think that we need to skimp on the first. I say go all out to try to save the victim of an accident, or something of the sort. I'm talking about a case where it's either over today, or the person gets another 10+ years. Make this 100% covered.

I think the second is kinda the middle ground, where shared fiscal responsibility should be shared. Say, 100% covered after deductible. Make it so people don't just take it for grated, be keep it within anyone's reach if they're willing to make some sacrifices (I.E. give up their saving and #3). That probably sounds cold, but I think the consumer needs to make a decision about it, not take it for granted.

The third should be even more heavily on the consumer. 80-50% covered after deductible. This is where I think medical costs can really be controlled. We take all medical treatment for granted... make people wait a day or two to see if they get better before they go see the doc.

[Lothar]

My current health care plan (just enacted this month):

1) Health Savings Account. We put the maximum amount in every year (I think it's about $5000 for the family), tax-free.

2) High-deductible insurance. This behaves the most like actual \"insurance\" out of any health plan I've seen. Once I've spent a total of I think $6000 out-of-pocket in a given year, it covers 100% of remaining costs.

3) Direct primary care. I spend $54/month, out of the HSA, to have direct access to a physician through Qliance. I get same-day appointments, direct e-mail access to my doctor, vaccinations at-cost, etc.

The net result of this is that, for significantly less than what my previous health insurance cost ($14,000 per year for two of us), I get better care: direct, fast, no-fee access to a physician for routine care; the ability to go to any doctor and pay for the care I need out of my own account (theoretically, this saves money since I don't need to involve 35 different accountants from the insurance company); insurance to prevent me from going bankrupt if I happen to have some expensive health complication. The only thing that's missing is up-front, fair pricing from medical providers.

If we could just make that a law -- getting rid of Medicare's \"we require a discount, which actually means we get charged the normal rate and everyone else pays extra\" in the process -- this would be a nearly-perfect medical care/payment system. Provide an appropriate safety net for those who truly can't afford health care (using both government and charities) and we're golden.

[AlphaDoG]

getting rid of Medicare's "we require a discount, which actually means we get charged the normal rate and everyone else pays extra" in the process

This is exactly how medicare and medicaid works.

The government pays a "normal" price, the price you should pay if you were to pay cash. Everyone else, regardless of whether you pay cash, or have insurance, pays for the R&D, the lobbying of YOUR elected officials, etc.

[Bet51987]

.

[CUDA]

And Lothar. Don't use the word "law, government, and health" in the same sentence less you get rocks thrown through your window from republicans. (sorry)

Bettina

or shot at and recieve threatening voice mails by Democrats

[Lothar]

Don't use the word "law, government, and health" in the same sentence less you get rocks thrown through your window from republicans. (sorry)

Was this really necessary?

You should really stop trolling.

[Kilarin]

Instead of an "all of your HSA account" deductible, I have a high, fixed deductible that goes along with my account.

I think this makes sense.

A second problem with HSA's as they stand right now: the yearly limit on what you can put into the account is pretty low (in the range of 10k, I think)- I think that limit needs to be increased. I'd like a model where people are encouraged to stash as much as possible away; that doesn't punish people who carry a higher balance.

Oh, absolutely. Raising (or eliminating) the limit is mandatory for this plan to really work.

I'd like a clearer line to be drawn between three "cases"- 1. Life-saving conditions, 2. Life-extending (<10 years) conditions & end of life comfort, 3. Life-quality conditions.

I don't exactly disagree with you, those categories should effect our decisions. But even for life saving I don't think we can settle on "no limit". We could always save more lives by having more ambulances ready. Cost has to be a factor when considering what treatment is reasonable, under any circumstances.

My current health care plan (just enacted this month):

Sounds like a great plan. We just need to remove the limit.

For my friend, and those like him, his contributions won't match what he takes out.

That is how insurance is supposed to work. Consider fire insurance, for example. People who pay fire insurance do NOT expect to get back the money they put in. They hope to never collect on it at all. Lots of people pay in, and only a few people collect. Therefore there is enough money to cover claims and still make a profit.

The catastrophic insurance should work just like that. Lots of us paying in, a much smaller percentage actually needing to make any claims.

What should be done for the thousands of people who get sick very young and don't build up enough.

That's why I mentioned that very problem in my first post. But I think its a problem thats solvable. Ideally children will be covered by their parents plans, and if a young couple doesn't have time to build up a savings balance, they should still be covered under their catastrophic plan. The catastrophic coverage does NOT require time to be built up, its just a yearly fee.

And, like Tunnelcat said. It's not getting cheaper.

I think for BASIC health care a Health Savings Account system could actually change that. Basic health care should start getting cheaper once the consumer is dealing directly with the medical provider. BUT, medical care will ALWAYS get more expensive on the extreme ends, because we are always discovering new and fantastic things we can do.

[AlphaDoG]

I've already said it, you want to change the price of health care, pay it out of pocket. Kilarin spoke it \"THE MIDDLEMAN\" obscures your vision. Now not only do we have the \"Insurance Industry\" perverting the system. We now have the \"Federal Government\" perverting the same system.

Just exactly how does THAT reform the system?

[Top Gun]

Because now the federal government is (theoretically) putting the screws to the insurance industry regarding certain of those perversions, e.g. being able to deny coverage due to pre-existing conditions or set lifetime limits on coverage. I don't know how well the system will work in practice, and I'm sure insurance companies will find some other loophole to pervert the system, but it's at least a start. Realistically speaking, there's no way we'd be able to dump the concept of a powerful insurance industry completely, so the best thing we can do is try to limit its more negative aspects.

I do like that Kilarin and Lothar took the time to lay out some pretty detailed plans, though I'm not familiar enough with the mechanisms of insurance to know how much I agree with them. For me personally, the biggest frustration with watching how this entire bill progressed was the fact that unanimous ideological opposition was the only response, instead of a legitimate counter-proposal like this. As we are stuck in the two-party system at least for the time being, I'd greatly prefer to see both parties at least attempting to hash something out, instead of one of them just burying its collective head in the sand like there's no existing problem. I may have ideological differences with certain elements of the bill as-passed, but again, at least it's something.

[Lothar]

Because now the federal government is (theoretically) putting the screws to the insurance industry regarding certain of those perversions

... while strengthening some of the other perversions or even inventing new ones.

Like AlphaDog the newlywed pointed out, the last bill took the "middleman" problem and made it worse.

the biggest frustration with watching how this entire bill progressed was the fact that unanimous ideological opposition was the only response

There were legitimate counter-proposals like these in the early days. At some point, the Democrats quit allowing Republicans to even be present in the meetings where the big HCR bill was being discussed (though they put a lot of Republican suggestions from the mid-90's and more recently into the bill), and Republicans quit giving serious suggestions and became simply 100% opposed. I don't know which side acted first or "who started it", but I do know that just a few weeks into the process it got turned into a partisan ideological fight. And that's not a good way to write a bill of this level of significance.

[Kilarin]

For the Girl Genius fans out there.
This (fan modified) comic comes from the Girl Genius Yahoo news group:


<edit>Never mind, the pic WAS there, I swear it, now its gone. Such is the web.</edit>

[woodchip]

So let me understand how Obama Care is going to save us all money:

1) First off, we start paying for something we don't get for at least four years. Those that couldn't afford the cost of a bare bones package will now have the IRS pounding on the door to collect the 750 dollar penalty which the poor can't afford either.

2) With every item from tongue depressor's to pacemakers now having a new tax, who here thinks the insurance companies will now charge lower premiums?

3) Will business now be more profitable with the new Obama Care? If it means we can now all afford health care then why:

\"AT&T, the biggest U.S. carrier, announced $1 billion charge from its first quarter on March 26.

After Verizon’s announcement, Boeing Co. also announced a charge of $150 million where as Lockheed Martin Corp. announced $96 million charge.

Apart from these companies, the other companies were AK Steel Corp., Caterpillar Inc., Deere & Co., 3M Co., Allegheny Technologies Inc., Illinois Tool Works Inc., Honeywell International Inc., Ingersoll - Rand PLC and Goodrich Corp.

These costs are likely to reduce the corporate profits by $14 billion.\"

Now I know some here think reducing corp profits is a wonderful thing, but of course you fail if you do.
Corp profits are what keep pension plan paying out to retired folk so if you are against corp profits you are against retiree's having additional income and a modicum of comfort (see I can play that equate game also).

Additionally this 14 billion write off (multiply this by 100's of thousands of business's) means the govt. will get less taxes. Henry \"Bat Boy\" Waxman is so disturbed he wants to haul the CEO's of these corp. up to a gula....er inquisi...er hearing on Capital Hill to find out what the meaning of this is. I mean, how dare these corporations do anything so unseemly. I'm still trying to understand just who will benefit from the New World Order in health care? If the poor cannot pay for a plan and pay the penalty fee by buying purina dog chow instead oatmeal, who is going to insure them? Or will they still go to the emergency room for their choking fit when they understand how royally they just got screwed.

[CUDA]

this plan cannot possibly help the poor.
the poor are poor because they have no money. DUH

But now our Government forces these poor people that have no money to purchase a mandated insurance policy that they cannot afford AND if they dont purchase it, then they fine them more of what they already know they dont have!!!!!

it sounds like the banks when someone bounces a check

[Spidey]

Well you do know that the government is going to offer taxpayer funded subsidies to help pay for these nice new policies?

And, we all know only the rich pay taxes…right?

So, there you have it…all nice and purdy like…the rich are going to pay for the poor’s insurance…

Surrrre…

[AlphaDoG]

BEGIN TRANSCRIPT

RUSH: Sergio in Brooklyn. Welcome, sir. Great to have you on the EIB Network. Hello.

CALLER: Yes, Mr. Limbaugh, right to the point. A few years ago I was forced prematurely to retire from industrial construction. A truck crushed both my kneecaps. So I had a vision about going into the toothbrush business, and I invented a toothbrush, it was in a package of 12. Each toothbrush said the month --

RUSH: Wait, wait, wait, wait.

CALLER: -- January, February --

RUSH: Sergio? Sergio, slow down just a second here because I want to comprehend this.

CALLER: All right.

RUSH: You were in essentially industrial construction, heavy construction?

CALLER: Yes.

RUSH: And a truck crushed you? Did you work in construction or just in the construction business?

CALLER: Thirty years. Thirty years.

RUSH: Okay. So a truck crushed both of your kneecaps, and you --

CALLER: Right.

RUSH: -- had a vision of going into the toothbrush business?

CALLER: Correct. And my toothbrushes were being sold in package of 12, with January, February, March, April, May June, so that people know when to change their toothbrush: Once a month. I hooked up with a first generation Chinese fellow in Baltimore who hooked me up with a manufacturing entity in China and what we did is, I named it Calendar Brush. I got the toothbrushes after years of jumping through the hoops and the US patent stuff. They arrived in Baltimore and I was following my toothbrushes saying, "Yep, yep. There they are." We had everything up ready to go, and I'm ready to take my toothbrushes over to customs into Baltimore and my friend Terry calls me up and he says, "Stop. You're not getting your toothbrushes," and by that time I was out about 75 large. Well, for those in Rio Linda, that's 75 grand. All right?

They said, "The Food and Drug Administration is now classing your toothbrushes as a medical device number. Now you've gotta go back to the FDA, which is the Food and Drug Administration, and come back around. We're not releasing your toothbrushes until you produce us this medical device number." Now, I turned around and pretty much that was a death sentence. But what I did was my brother Vinny jumped through the hoops for five or six weeks, eight or $9,000 later I got my medical device number, and now my toothbrushes are here, and I'm just trying to get started. It's a little rough getting started. Calendar Brush, that's my toothbrushes. Yesterday I was reading. There's a couple of bills that are going through Congress right now, Congress and the Senate. And how are they going to pay for this health care? And guess what? It hit me like a ton of bricks. It said they're going to tax medical devices.

RUSH: Oh, yeah. This includes tampons, Sergio.

CALLER: Oh, yes! And you had to see the nurse in the restaurant when I was showing her last night about my toothbrushes being taxed, and she said, "You know what I'm going to do? We're going to get a bunch of us nurses, and we're going to go down to Washington and wave our tampons and say, 'Don't tax our tampons!'" But in any event, that's obtuse and off the track.

RUSH: What a rally! What a rally that would be!

CALLER: Yeah! (laughing)

RUSH: Waving the Tampax around, "No! No! No tax on tampons." Oh-ho!

CALLER: But now --

RUSH: It's a shame Senator Kennedy is not alive to see that.

CALLER: (laughing) Now here I am with my toothbrushes now. I have 120,000 toothbrushes here, I'm just getting going, and it's my understanding now that now I'm going to get my toothbrushes taxed! But it's just to go to show you that if they're going to hit me -- the small guy, just starting out -- how the heck am I going to pay my taxes on my toothbrushes and what am I going to have to charge? Guess what? Everybody in this nation, wake up! Pick up your toothbrush -- remember Calendar Brush, of course -- but pick up your toothbrush and, you know what? (laughing) After January 1 when this thing gets through, you think you're going to buy your toothbrushes for two three bucks whatever? Guess what? It's a medical device. You are going to pay taxes on that or "a fee."

RUSH: Good point. Sergio, I hate to shut you down here, my man, but the constraints of the programming format require it. Thanks much for the call.

BREAK TRANSCRIPT

RUSH: Hey, folks, you remember, you remember how upset the media and the Democrats got when people started waving tea bags around in protest. Can you imagine the reaction when women start waving around these tampons? Ho-ho-ho! We have got to encourage this.

END TRANSCRIPT