Health Insurance Degeneration Continues

[vern_humphrey]

BTW, there is no free health care. Somebody, somewhere, pays for it.

Amen!

Those who can pay, should pay. Those who can pay something, should pay their share, with some help from the rest of us. And we should provide for who cannot pay – which we can’t effectively do if everyone is feeding out of the same trough.

That is why I support true Medical Savings Accounts – the only system I know of with a chance of lowering medical costs.

The fundamental principle behind Medical Savings Accounts (MSA) is that you buy cheap, high-deductible catastrophic health insurance, and then save an amount each year with tax-free dollars to cover any medical expenses up to the deductable. You roll any unused dollars over at the end of each year into your IRA. The institution holding the MSA would issue a credit card, and this card would be used to pay for health care. This would have several important impacts:

1. Paperwork makes up from one-third (in private health plans) to two-thirds (in government programs) of the total cost of health care. The use of this credit card approach would dramatically reduce the paperwork and result in lower costs.
2. The current systems of paying for health care have long delays built in. The pay-on-the-spot approach would allow care providers to further lower costs.
3. MSAs provide an incentive for people to bargain for health care – when people spend their own money (and know they can keep all they save), they have an incentive to bargain for better rates.
4. MSAs provide an incentive to avoid over-consumption of medical care.

People who cannot afford MSAs can apply for assistance, based on their most recent tax return, and would receive proportionate assistance – not an automatic 100%. They would get help with insurance premiums and with each payment from their MSA – so they would always have the chance to save something by bargaining and not over-consuming.

Young people would especially benefit from this – since they could build up substantial savings in their healthiest years.

 

[rwoehmke]

Half of my six children were living and working in Germany for some time. Everyone had health care provided through the government as the payer. The care did not extend beyond the boundaries of Germany so if one took a trip, say to the US, a short term policy to extend coverage was paid for out of pocket. If one had an income above a certain level it was possible to buy this extra coverage for the whole year. The hospitals had doctors on staff and one’s physician would not be in attendance at the hospital. Each out of hospital doctor had a private office for ordinary day to day care. Hospitals had an emergency department to handle emergencies and tourists on weekends. All three have been back in the states for several years and state a preference for the German way.

 

[whatevergirl]

Just what do you mean that we Americans are so afraid of each other?
I am of the opinion that you don’t know what you are talking about.

Hospitals are NOT run by insurance companies. I don’t know where you ever got that idea. There are some hospital systems that own their own insurance companies. University Hospitals in Cleveland and the UPMC Health System in Pittsburgh are both hospital systems that own their own insurance companies.

Our education system is a huge local/state/federal government controlled money-hungry monster that always falls for the latest fad and is accountable to no one. Private schools have to produce results or the students are disenrolled and the schools close.

Waiting lists in the US are primarily for organ transplants, not for needed procedures. My mother had to wait five days for open heart surgery because the hospital she was admitted to had no immediate openings for the surgery she needed.

Certain private hospitals reserve the right to turn away patients who do not pay. Hospitals owned by states, cities or counties must treat all who need care. Catholic hospitals do not turn away the needy.
Just because someone does not have health insurance does not mean that someone can not receive health care.
Twice in my life I went for a year with no health insurance. If I needed to be hospitalized I would have worked out a payment plan with the hospital and that would have been it.

The Canadian government run health care system works so well that Canadian snowbirds buy American health insurance in order to get treatment they have to wait months for in Canada. Dr. Walter Williams wrote a book about the issues of Canadian health care - where a dog can get an MRI faster than its owner.

BTW, there is no free health care. Somebody, somewhere, pays for it.

You are right on with your last statement.

 

[vern_humphrey]

Half of my six children were living and working in Germany for some time. Everyone had health care provided through the government as the payer. The care did not extend beyond the boundaries of Germany so if one took a trip, say to the US, a short term policy to extend coverage was paid for out of pocket. If one had an income above a certain level it was possible to buy this extra coverage for the whole year. The hospitals had doctors on staff and one’s physician would not be in attendance at the hospital. Each out of hospital doctor had a private office for ordinary day to day care. Hospitals had an emergency department to handle emergencies and tourists on weekends. All three have been back in the states for several years and state a preference for the German way.

That’s fine but:

1. Government-paid health insurance is paper-work heavy. About 2/3 of the cost of healthcare in government programs is paperwork (vice 1/3 in private health insurance.)
2. The cost only appears to be reasonable – because you can’t tell what is being spent, and you don’t feel it come out of your pocket.
3. Single payer systems are monopsonies – which are as economically inefficient as monopolies.

 

[Dale_M]

Hmmm…that’s probably due to underfunding.

Yes, the VA has been chronically under-funded. What is shameful is that we have a war going on, with disabled troops being medically retired to the VA system, and we haven’t adequately budgeted for this.

I suppose that is an argument for universal coverage. There would be less passing of the buck, if people no longer said “oh that’s someone else’s problem, not mine.”

 

[vern_humphrey]

Medicare operates with a rate 2% overhead and there’s little problem for people with Medicare getting the services they need. Private insurance runs at up to a 30% overhead (huge CEO salaries, dividends and advertising are SPENDY!) and do everything they can to keep from paying for services.

Please explain that.

Let me point out that all paperwork is mirrored in any system – the doctor or hospital generates, the insurer checks.

 

[mary_bobo]

We had our 3rd baby in July and I’m just now figuring out the last of the paperwork. I’ve got a pretty good PPO insurance plan at work. We followed the rules, picked an OBGYN on the PPO list, made sure the hospital was on the preferred list and asked the doctor to coordinate benefits prior to being admitted. So far, so good.

Trouble comes at the hospital. All the specialists aren’t hospital employees, they are outside practices with hospital contracts. Go have a baby and you will see the OBGYN, an anaesthesiologist, a pediatrician and possibly a contract doctor intern. You have no say on who the others will be, but if they happen to be NOT in your PPO network, you get stuck paying the out-of-network fees (which are large!).

I used to think a PPO was better than an HMO. Not anymore. The in-network hospital used to require their contract doctors to honor the PPO committments the hospital had made. Not anymore.

Somebody had better get busy with some reform ideas with real teeth or the socialists are going to be getting more and more traction on this issue all the time!

Is this private insurance you have or insurance provided by your employer? Employer paid insurance is whatever the company is willing to pay for. Many companies find it cheaper to use PPOs or HMOs, others do not do that. It is a problem no matter which way it is. But I don’t think health care that other countries will fly with most of us. It won’t with me because I have had the misfortune of being gravely ill in Canada, a situation that would never happened in the States.

 

[mark_a]

Somebody had better get busy with some reform ideas with real teeth or the socialists are going to be getting more and more traction on this issue all the time!

Why would we worry about health care when we have more important issues like flag-burning?

 

[DL82]

That’s fine but:

1. Government-paid health insurance is paper-work heavy. About 2/3 of the cost of healthcare in government programs is paperwork (vice 1/3 in private health insurance.)
2. The cost only appears to be reasonable – because you can’t tell what is being spent, and you don’t feel it come out of your pocket.
3. Single payer systems are monopsonies – which are as economically inefficient as monopolies.

1. I have no idea where you get this figure. It may be true of the American system, where government officials outsource to private insurance companies, meaning they have to pay government bureaucrats and private bureaucrats together. It is certainly NOT true in the UK.

The truth is, as soon as you move away from the claim=blame model, you get massive savings, because you don’t need an administrator to go through all the paperwork to check that each separate treatment is authorised. You simply buy an MRI machine, and hire a radiologist to operate it, you don’t also need to hire a lawyer to decide whether each individual’s case merits its’ use, an accountant to bill them all, and another lawyer to follow them up for their non-payment.

1. The total cost of EVERYTHING we get from our government in the UK (schools, Universities (which get 80% of their funding from public funding, not from fees), hospitals, dental care, prescription drugs, care for the elderly, roads, police, fire, ambulance, the courts, prisons, the armed forces, rubbish collections, pensions, disability benefits and jobseekers benefits, civil service, agricultural subsidies, etc, etc…) is around £10,000 a year. People on the basic rate of income tax here pay about 2% more than the Federal income tax rate for the USA, and people on the higher rate pay LESS than in America.
2. The UK system has introduced all kinds of artificial markets and target-driven systems, as well as tight budgetary and professional standards regulation. This combination overcomes the fears Americans have of Soviet-style old big government.

It comes down to another question - would you rather have your healthcare requirements managed by accountable policymakers at a local level, who you can democratically remove if they fail in their duties, or would you rather these requirements were dictated by an unaccountable private company who are only concerned with their shareholders’ profits? It comes down to the question of whether democracy works at all.

 

[manualman]

Interesting that somebody cites the UK as an improvement over the US system. My father-in-law had a grave car accident in Wales about 8 years ago. He was rushed to the loal hospital where they did a great job of stabilizing him, resetting broken bones, stopping the bleeding, etc. He was then put in a room with FIVE roomates for recovery. For a week or so he improved, but then began to regress. He had increasingly severe back pain, but nothing showed up on the X-ray and the doctors there decided he didn’t meet the criteria for an MRI.

My wife managed to beg an American Airlines into allowing him on an airplane (not usually allowed in his condition), got him back into a hospital at home where an MRI promptly revealed a strange mass inside his spinal column, a sample was removed, tests found he had a staph infection and locally administered antibiotics took care of it. Doctors told him the infection was so bad that he was days away from suffering permanent nerve damage in his spine, possibly leading to loss of use of his legs!

There is no doubt in my mind that he was denied an MRI because there were too few to go around. Some call that rationing. To be fair, he was never billed a nickel by the UK health system and he had great things to say about the people and the basic care he got there. They just lacked adequate resources of cutting edge medicine to treat his problems.

 

[vern_humphrey]

A while back, we were discussing education. Someone from Britain said they had a 99% literacy rate. So, suspicious old codger that I am, I checked. Yep, they do have a 99% literacy rate.

But being a little more suspicious than the average codger, I checked a little deeper.

In the United States, “Functional illiteracy” is defined as “Unable to read the label on a package of food, unable to read a simple child’s story, and unable to fill out an application form.”

In Britain, “Literacy” is defined as “Has attended five or more years of school.”

Since then, I have been very leery of statistics from the British government.

 

[Joe_Kelley]

. . .
In the United States, “Functional illiteracy” is defined as “Unable to read the label on a package of food, unable to read a simple child’s story, and unable to fill out an application form.”
. . .

Close to what a high school teacher told me some time back, and he was only half kidding: They should be able to read the TV Guide and fill out a welfare application bby the time they graduate.

 

[vern_humphrey]

Close to what a high school teacher told me some time back, and he was only half kidding: They should be able to read the TV Guide and fill out a welfare application bby the time they graduate.

And sadly, many who graduate cannot. And of those who enter high school, 29% do not graduate.

Why in all the howling over social justice, healthcare and so on, does no one demand a quality education for every American child? If we could provide that, most of our other problems would solve themselves.

I guess education ain’t sexy.

 

[JW10631]

The level of health care that exists in the United States exceeds that of anywhere else in the world.

What we argue about is the means to pay for health care when one needs it.

I wouldn’t challenge, not for one second, the idea that the means of paying for health care cannot be improved. Health care is such a huge issue that it just isn’t likely to see improvement because there are so many parties involve who want to protect their turf.

Most people have no idea just how involved the federal government already is in health care. HIPAA, CMS (the agency that administers Medicaid and Medicare), and other federal regulations place a burden on hospitals, doctors and insurers alike.

Every state has a state insurance department that enforces the insurance laws and regulations of that state. these laws and regulations apply to for-profit stockholder held insurance companies and nonprofit insurance companies. In addition, most states have a Department of State or Department of Commerce that regulates for-profit insurers. The Securities and Exchange Commission also regulates for-profit insurers.

to be fair, providers and insurers have been working together to eliminate paperwork in processing claims and other data. Much of what we do at my employer regarding this is electronic and updated in real time.

I do not and will not believe any report that insurance companies have administrative costs of 20-30% of their total expenses. The states would not allow this and I have seen no audited financial statements to support these claims.

The best way to put the squeeze on health care sots is for the American public to use the system less often to treat illnesses and do more preventative medicine - as well as maintaining healthier lifestyles - to keep from getting sick.

 

[vern_humphrey]

I do not and will not believe any report that insurance companies have administrative costs of 20-30% of their total expenses. The states would not allow this and I have seen no audited financial statements to support these claims.

Administrative costs come from two sources. Processing the paperwork (which is done by the insurance companies) is one source. The other is creating the paper work (which is done by the health provider.) The latter source is not audited, and is necessarily **equal to or greater than **the insurance company costs (since small doctor’s offices cannot take advantage of economies of scale.)

Nor does a state audit cover administrative costs which occur outside the state – say, in the home office of the insurance company.

 

[pontoon]

The socialist have the idea. free health care for all including the illegal aliens. Last Sunday the deacon in my church during his homily said he did not understand American who want to build walls to keep people out of this country.

If those are the feelings of Catholics I think the church should step up and have free health care in all Catholic hospitals for everyone.
Next the church should have free Catholic school education at all levels for everyone. We would all like to go to Notre Dame for free. This way the Catholic church can rescue the public school too.

To pay for this the church just increases the collection and covers the expenses from the donations.
Of course we will need more Catholics to attend Mass so there will be larger collections. Therefore we should allow everyone to become a Catholic with one universal baptism and the church grant amnesty to all divorced and ex-communicated catholics. Do you think the church can affford it?

 

[Joe_Kelley]

Administrative costs come from two sources. Processing the paperwork (which is done by the insurance companies) is one source. The other is creating the paper work (which is done by the health provider.) The latter source is not audited, and is necessarily **equal to or greater than **the insurance company costs (since small doctor’s offices cannot take advantage of economies of scale.)

Nor does a state audit cover administrative costs which occur outside the state – say, in the home office of the insurance company.

Note there are two sources of cost in **creating **paperwork. One is the actual cost of providing the paperwork. The better place to attack cost is the creation of the need for the paperwork. That is under the controll of the insurance companies. I think they could save a lot if they reviewed the need for much of the paperwork. I have gone through an awful lot of letters on occasion to get them to pay something where there was really nothing added to the original information.

For example: they once paid a doctor to prescribe a treadmill, another to administer it, and another to evaluate the results, but refused to pay for the treadmill as not necessary. After six months of letters, and the assurance of the same three doctors that it was needed, they paid.

 

[vern_humphrey]

Note there are two sources of cost in **creating **paperwork. One is the actual cost of providing the paperwork. The better place to attack cost is the creation of the need for the paperwork. That is under the controll of the insurance companies. I think they could save a lot if they reviewed the need for much of the paperwork. I have gone through an awful lot of letters on occasion to get them to pay something where there was really nothing added to the original information.

For example: they once paid a doctor to prescribe a treadmill, another to administer it, and another to evaluate the results, but refused to pay for the treadmill as not necessary. After six months of letters, and the assurance of the same three doctors that it was needed, they paid.

Did I post the plan for Medical Savings Accounts here? That would eliminate almost all paperwork.

When I was running for Congress in '04, doctors used to tell me horror stories. One of them told of a woman who came in with a cold. The insurace company rejected her claim as a “pre-existing condition.” The doctor explained that a cold is hardly a pre-existing condition!!

So they sent him a stack of papers to fill out. He contacted them again, and protested. They said, “No paper, no pay.”

So he told them they would have to pay him for filling out the paperwork. They agreed, and paid him more for the paperwork than he charged for the original visit!

Now, from start to finish, what do you think all this cost – considering what the doctor’s time was worth before the the agreement? About three times the cost of treating the lady’s cold.

 

[DL82]

One thing I’d like to draw attention to:

Everyone says America leads the world in medical research because of its’ private healthcare system. This is patently untrue.

Look at the argument over stem-cell research. Embryo research is not outlawed by the US government, but no Federal funds can be put into funding it. Those who are pro-embryo-research say that this will lead to America falling behind the rest of the world.

Leaving aside the rights and wrongs of embryo research for a moment, this proves that the major investor in medical research in the United States is the Federal government!

That’s the same in any country. No medical insurance company, and no private hospital, and no University have the kind of money needed (tens of billions) to carry out leading-edge research in biochemistry in the 21st century. Therefore the premiums Americans pay for their healthcare clearly don’t directly fund leading-edge medical research.

Private medical treatment made sense in the 1950s, when family doctors earned average white-collar salaries, the main hospital treatment was bed-rest, most surgery involved removing big lumps of guts with a scalpel, and most drugs could be discovered and produced by a couple of guys in white coats in the kind of laboratory you would find in your average chemistry workshop in your average community college. The overheads for the cost of a hospital stay was the cost of a bed, a nurse, your food and a daily visit from a doctor, about the same as the cost of a stay in a nice hotel.

When you get into the complexity and expense of the kind of medical equipment in a modern hospital, the ethics of whose needs justify access to the most expensive equipment and drugs, the extent of specialist training needed by even basic nursing staff, in a 21st century healthcare system, it becomes impossible and unaffordable to bill individuals for the costs of specialist equipment and complex surgery used to treat them. We need to spread the cost, and spread the entitlement, otherwise the standard of treatment most people can expect to afford is lower than it was in the past.

 

[vern_humphrey]

Leaving aside the rights and wrongs of embryo research for a moment, this proves that the major investor in medical research in the United States is the Federal government!

Except that’s not true – do you have data to back that up?

Next, in what areas does the government invest in medical research? I think you will find that there is a disease most of us will never contract – and it gets more funding than several other diseases that most of us will die from.

That’s the same in any country. No medical insurance company, and no private hospital, and no University have the kind of money needed (tens of billions) to carry out leading-edge research in biochemistry in the 21st century. Therefore the premiums Americans pay for their healthcare clearly don’t directly fund leading-edge medical research.

No one said they did. But private industry does a lot more than the government.

When you get into the complexity and expense of the kind of medical equipment in a modern hospital, the ethics of whose needs justify access to the most expensive equipment and drugs, the extent of specialist training needed by even basic nursing staff, in a 21st century healthcare system, it becomes impossible and unaffordable to bill individuals for the costs of specialist equipment and complex surgery used to treat them. We need to spread the cost, and spread the entitlement, otherwise the standard of treatment most people can expect to afford is lower than it was in the past.

You miss one important point; Someone must pay.

That someone is not a government bureaucrat, it’s an ordinary wage-earning American. He’s the guy that funds everything. If he cannot pay, the debt will not be paid.