Reform this
If you are an average American, I have a hard time understanding why you do not want to see the health care and health insurance industries reformed. As near as I can tell from listening to my conservative friends, it has something to do with government not interfering with private industry and the haves not being forced to pay through taxes for the health care of have-nots. I sort of get that. I approve of government not interfering in my life and I do not like my money going being given to other people. With that understood, let me give you a peek into my personal finances.
Before we had our second son, we were paying more than $700 a month for health insurance. This is such a high premium. I only wish I had taken more time trying to find the best health insurance for our needs. That was a family plan that still had us paying out the nose for doctors visits, medicine, and the like. It also didn’t cover maternity, so when it came time to pay for the birth of our second son a couple of months ago, the nearly $10,000 it costs to have a child in this country came out of pocket. We were fortunate enough to have prepared in advance for this and had the money to write the checks. Still, despite paying $8,400 a year in insurance premiums, none of the costs of having a baby were covered. I honestly recommend shopping about THOROUGHLY before you settle on a certain policy, whether it’s auto, health or life insurance – do your homework as to what companies offer the best policies, you could start searching around on sites like policyme.
And so with the birth of our second child, our insurance premiums went up to greater than $900 per month. If we don’t change our health care coverage now, we will pay more than $10,000 per year in premiums (and that doesn’t include the money we spend meeting the $1,500 personal deductibles on every member of the house).
I’m not going to go into how much I make per year, but for the sake of easy math, let’s just say I pull in $100,000 annually (and all of these figures are really loose and just for the purposes of discussion, so don’t go pulling out a caclulator on me). With that in mind, I’m paying 10% of my annual income for health insurance. Add another 30% for taxes and 10% for mortgage and there goes half of what I earn in a given year. If I were the kind of guy to tithe, that makes it 60% gone before I start paying for my kids’ education, all the house bills, car payments, and everything else that goes along with getting along in America.
It’s not a whine, because we’ve managed to get by and still save some dough in the process, but it’s getting harder every day and the no-return, barely covering our asses insurance is a real pain in my neck. I can’t imagine how life would be if we had a real medical emergency or longterm illness and had to call on Blue Cross/Blue Shield to bail us out. It’s a low confidence proposition at best.
My brother–a doctor–worries about what a nationalized health care system will do to his potential earnings. He worries about what would happen to the quality of health care in America if doctors suddenly made significantly less money. Where would the incentive be for the best minds to enter medicine? That’s a very fair argument and one I accept is a big issue. But, for those of you who think the free market is handling this just fine and that I should just suck it up and pay for the services I’m getting, consider the following.
When it came time to pay for the birth of our second son, the hospital and related doctors let us in on a little secret. Because we were paying out-of-pocket, it would cost us 43% less than what it would cost an insurance company. That’s right. If we had insurance that actually covered maternity, the doctors and hospitals would have billed our insurance company 43% more than we were billed.
That’s a big hold-on-a-minute for me. I have a hard time accepting that hospitals and doctors have one bill for people who have cash in their pockets and a much bigger tab for insurance companies who are footing the bill. It makes me wonder if that’s not the reason my health insurance premiums are so big.
“But, wait!” say health care professionals. The biggest culprits in this whole issue are the greedy trial lawyers who jump on the slightest hint of medical malpractice. These people cause insurance premiums to go up and doctor bills to be so high. Malpractice insurance is astronomical and it’s gotta get paid by somebody. Even when companies try to provide a fair price for this – a friend of my brother has apparently mentioned malpractice insurance from LeverageRX to him – the availability of this can vary greatly from region to region.
To follow this argument, I have to accept that greedy Americans have fallen prey to even greedier trial lawyers and the lack of tort reform has led to malpractice insurance being too high and doctors having to charge much higher prices as a result. Because of the high costs of practicing medicine and the litigious society in which we live, the average American can’t afford health insurance. So, kill all the greedy Americans and the lawyers with them and we can get back to taking care of America’s health needs. Of course, there are genuine times where the assistance of lawyers would be absolutely necessary because malpractice does still occur nationwide. More experienced lawyers similar to Clayton Hasbrook have the knowhow and expertise to work out when a malpractice complaint is legitimate and warranted. Sadly, not all lawyers have this skill and merely chase small paydays.
There is merit to that argument, but it doesn’t fix it for me. Because, no administration Republican or Democrat has been able to really implement tort reform on a meaningful level and as long as we have lawyers making our laws, it won’t happen. In the meantime, I have to wonder what happens to the people who are truly sick and can’t afford real health care? Do we let them die because Barack Obama is a Democrat? Do we let them die because we’d rather spend our taxes killing Saddam Hussein than saving a middle aged American’s cancer-stricken child? Is that the choice we have to make?
Yeah, I’m annoyed. I’m annoyed that I have to spend so much of the money I earn to cover the gamble that somebody in my family may get gravely ill. I’m annoyed that the doctors, hospitals, and insurance companies have found a way to game the system such that it costs middle class guys like me more than $10,000 a year to keep my family covered. It annoys me that health care is a political issue, that Republicans see it as an issue of overspending, and that the Democrats can’t get their shit together long enough to fix a real problem that’s existed for longer than I have been paying my own insurance premiums. It also annoys me that no matter how confident our President seems tonight, there will be no point in the immediate future that I will be paying any less for health insurance.
But more than anything, I’m annoyed that I live in a country in which more than half of the population believes that good health care should only be available to people who have enough money to pay $10,000 a year for it.
That’s just fucked up, folks.
I agree with a ton of what you say.
However, I have one caveat. Americans as a whole have to be the unhealthiest citizens of any nation. We consume so much and pay so little attention to preventative measures that would reduce our need for health care. We eat too much, we smoke too much, we drink too much.
Off soapbox.
Amen, my brother. You just explained why I don’t have health insurance– why pay “out the wazoo” as my mother would say, for what is essentially a coupon that doesn’t work most of the time.
What I don’t understand is why so many people have their panties in such a wad over the threat of the option –the option!– of public insurance. Because… it might be better? It might be less expensive because it won’t be (shudder) for profit like private insurance?
If public insurance became a reality, I’d be one of those people who would finally be able to afford coverage and not have to sit for three hours at La Clinica de la Mujer to get a simple exam or a prescription. And my 61-year old mother wouldn’t be petrified all the time that her HMO was going to drop her or have to pay $400 a month out of pocket for medications.
Otis for Congress in 2010. I have a political science degree from a well known Southern university and used to work on Wall Street. I’d like to offer up my services for “Otis in 2010” as a campaign financier.
Otis I heart. What I would give to be able to express myself the way he does.
I too support him for congress or whatever he wants to go after.
Thx you hit that bitch right on the head.
And tomorrow I walk into my doctor’s office, who I chose, for an annual checkup. While there I’ll mention that my back has been killing me and off for a couple weeks, and see what we can set up to look into that. I also have some VERY minor surgery to get done (as in a local and 2 minutes of my time to take care of). Then I’ll go back to work.
And it won’t cost me a dime out of pocket. Although it cost me a few dimes out of taxes.
Don’t believe the bullshit those against reform in the US say about us in the Great White North. Our healthcare is top notch. For every story they can dig up without proof of a hospital error or disaster, I can find ten in the US. Talk of “bureaucrats” standing between you and your doctor is crap. You have insurance bureaucrats between you now, and they’re far worse. I don’t have to send a single thing in to my government when I need surgery. I don’t have to worry when I walk into the ER that they might turn me away because my issue isn’t serious enough to warrant “free” care due to a lack of insurance. My folks have had 3 kids, and never had to save up to pay for the birth.
The US has the world’s most INefficient health care system, and they fear that providing a government-handled option would make it worse? Hah.
I will not leave my reply here, for it is too long. My brother, I understand that this is YOUR blog and you can express your opinions. If you would be so generous, I’d like a guest post to offer a different perspective. Just let me know.
Ah, yes. Insurance. We, thankfully, now have employer provided insurance. It’s great! However, now that C has her diagnosis, we have to be extremely careful if we were to ever want to change jobs because a new health insurance plan would consider it a pre-exisiting condition. They could choose to not cover the costs. We would then have to pay the $20,000+/year treatment costs out of pocket. I am just glad this didn’t happen when we were providing our own insurance as you are now. That plan cost more than our current plan and covered a whole lot less.
Day in and day out I deal with families who aren’t and can’t get by. Working parents with employer sponsored plans they still can’t afford, yet they are over eligibility for any state subsidized plan. I spend hours going through unreimbursed medical bills trying to apportion the costs between the parents fairly when in reality no one can afford to pay them. Republican? Democrat? Frankly, I don’t give a flying *&^% about the political posturing, this system is broken and has to be fixed.
Two weeks ago, I went to a doc-in-the-box in Hong Kong for a cold-like symptoms. It took less than 30 minutes for the wait and the exam. I was given 3 prescriptions which were filled in-house for 220 HKD = $28.39 US. That wasn’t a copay, it was for everything.
You assume the current “reform” would fix the health system, in fact it will add $600 billion over the next 10 years to our health care bill, albeit distributed through higher taxes for all instead of completely out of your pocket.
As for being dissatisfied with your health insurance, I would seriously consider getting a “black swan” plan. None of your routine medical issues will be covered, only the truly severe medical bills. The benefit? You will pay substantially less than $900/month, unless someone in your family gets a recurring illness, you would certainly pay less than you do now. It would be out of pocket though, and many people hate the uncertainty.
There’s no way govt. ‘competes with private insurance’. It simply kills it. Govt. has a bottomless pit of ‘resources’, while private insurance is held accountable through profit or loss.
So you are ready to trust your healtcare to a government that can’t even cap medical malpractice punitive damages? Sorry, I say no thanks. (that cap would be a great place to start)
Saying those opposed to the Democrat’s (the President doesn’t have a plan, BTW) plan are against reform is like saying that those who oppose private school vouchers are against educating children. It is a false premise.
The system is broken in part because insurance is tied to employment and insurance is too expensive for doctors. Those problems can be fixed without giving the whole deal to the government.
I’m thankful that I’ve been practicing medicine in the largest and most successful HMO in the world – the US Army. I’ve never had to deal with billing and I’ve never worried about reimbursement. I get paid the same no matter what I do. It frees me up to simply do what’s right. You’d think this would be a set-up for lazy doctors to just sham. That does happen, but not very often. As an active duty doctor, I made about $150,000 a year. That’s a helluva lot less than similar specialists in private practice, but the trade off is that all my education was paid for. While my civilian buddies graduated from med school with an average (AVERAGE!) of $300,000 in debt, my debt was zero. There might be something to this.
The real problem is that no one is thinking of this. Seriously. There is no one in Congress who is charged with finding ways of saving money in the long term. You want a big hold-on-a-minute moment? How about this? No one (NO ONE!) in Congress has even read the bills on health-care reform they are trying to push through. Seriously. The president said to get it done and by-golly, that’s what they are gonna do.
And you and I will spend the next decade trying to figure it out.
-DrC
The choice we have to make is to step up and take a stand against insurance companies NOT doing the right thing. And then we get them to do it, no longer needing the government to jump in and take over.
I do not wish any of us to have to endure government controlled healthcare. It will be the largest mess we’ve ever created. As it stands now, our government has yet to prove they can balance a budget, get supplies to people who need them when they need them, prioritize properly, and act with speed when required. If they can’t manage that now, without dying people waiting for treatment, something tells me they won’t be able to do it when they’re in charge.
If this happens…if this healthcare takeover becomes real, I will gladly no longer renew my nursing license in hopes that I’ll someday be able to go back to the bedside to provide care. I won’t work under such a system. The nurses and doctors I know from other countries (Canada, Europe) came here for a reason and that reason was to help in a timely manner. At home, it doesn’t work that way. They remain here because HELPING is what they most want to do.
I hear everybody and I agree with you for the most part. What I’m missing in all your responses is the alternative to the current plan. Don’t think I’m all gung-ho about the government getting involved in private industry. I simply haven’t heard any better solutions. Do I think our government works efficiently? No, but I know there is something wrong when the choices I have are:
1) Pay $10,000 per year (something most Americans can’t really do)
or
2) Accept a health care plan that only covers us if we have a catastrophic illness.
And to my brother, the floor is open. Send along your guest post, so long as it’s not why I am wrong and focuses more on whether you think a problem exists and how you would solve it.
A start to your question, Otis, might be what Blinders posted yesterday. While I don’t fully agree with him, he makes some very good points.
Jjok, thanks for the tip. For those wanting to read Blinders’ ideas (some of which actually aren’t that bad), here’s the link. Kudos to him for actually offering alternatives instead of saying “Democrats bad and spend too much money.”
http://blinderspoker.blogspot.com/2009/07/blinderscare.html
Otis, that quote is reserved for his other posts…. Haha
I pity you folk, everytime I see/hear something about US Healthcare. It tears at my heart to think of the agony some have had to suffer both physically, and financially.
The system here just works. Yes I pay taxes and yes I’d have more disposable income without them. The expression “money in the bank” however, seems rather appropriate don’t you think?
One thing is for certain no matter what though, IF they ever decide to create a Healthcare System South of our border, mercy on your souls if they try to re-invent the wheel! That is where concerns such as Special K’s, will surely rear their ugly head.
Well in your case, an alternative is to take that $900/month and put it into a savings account instead of insurance. Since it doesn’t cover doctor’s visits, maternity, drugs, or seemingly anything else that qualifies as a regular medical cost, then you’re betting on an accident or serious illness in the family.
So what are the odds more than one family member gets SERIOUSLY hurt or ill at a time? Outside of a car accident, pretty low. At your family’s age, the odds of a stoke or heart attack are fairly low I’d think, and if you want another kid, you’ll plan ahead.
So instead of paying a company that doesn’t cover much $10k/year, you’re saving it. Say in 5 years you get hit with something that has a large bill – you have $50k + interest in the account. If your family stays relatively healthy for 10-20 years, you’ll have hundreds of thousands of dollars saved instead of unused by an insurer.
And you can withdraw from it for things like those regular visits, drugs, and maternity costs.
Or, if you’re looking for system-wide reform, the answer seems easy to me. In Canada, we’ve fought against two-tier health care for years because it subtracts from the universality of the current system. But in the States, two-tier is an additive change. Basic coverage for everyone – doctors visits, necessary treatments and surgery, emergency visits, etc.. But if you want to pay an insurer on top of that to get better or faster coverage and care, then you have that option. It cuts insurance costs dramatically because the basic and necessary stuff is covered. It controls overtesting by doctors because the test that isn’t really likely won’t happen for months, but the more likely scenarios will be screened quickly. And if you really want that likely useless test done tomorrow? You can pay for it.
For years I have dreamed of a wonderful life for my family and myself. Within that dream, my wife and I have made tough decisions to work for companies and indviduals who offered insurance plans that would provide adequate health care and safety when necessary. We stumbled over many documents that were difficult to understand. And we opted to take significant deductions in our paychecks to insure that we were ready for any illness or problems that might affect us. We sought higher education to earn that piece of paper, and made dramatic financial sacrifices that continue to keep us humble. We made choices, as have the “self-pays or have-nots” that enjoy that 43% discount. I recently underwent a surgical procedure that took less than one week from diagnosis to the knife. How? Because we have made decisions along the way that contributed to a successful reconstruction and extended therapy. Quality healthcare, by qualified medical professionals like your brother and my wife. Please show me a reform package that will continue to allow me to make decisions for myself and my family. I respect your intelligence, and know that you are probably one of the coolest cats I know personally, but with regards to this arguement, this “have” is wanting to “keep”, and if that means I am of the “conervative elite”, I am ok with the label applied.
Just a few things. For your particular case, I have to agree with Astin. Put it in the bank. It’s a gamble, sure, but your family is healthy so the odds are drastically in your favor. Option #2, have wifey get a pt job at The Gap. Much cheaper insurance and great discounts on cool clothes. Okay, maybe not The Gap, but you know what I’m saying.
As for your opinions about out-of-pocket pay v. insurance pay, insurance premiums, making things right, etc., I tend to agree for the most part. I believe universal health care for all –driven by taxable income– is the way to go. Provide for all at the same price per services. Allow the pride one takes in ones profession of choice to weed out those who don’t belong. Allow households without taxable income to pay debts with community service or by enlisting in the armed services.
Tort reform needs to happen. If it does, insurance companies will suddenly drop premiums to something acceptable. Monkeys will then fly out of my butt.
Those who live by the dollar will stop at nothing to tap your wallet for every single penny that they can.
Now, let’s gain a little perspective.
We are the richest people in the world. The poorest in our city is exorbitantly more wealthy than 90%(ish) of the world population. Does anyone have just one TV and/or monitor? Everyone with a $300+ device sitting within arms reach raise your hand.
So crunch some numbers and change those things over which you believe that you control. Keep in mind, however, that you have family who love you and friends who pick you up when you fall. That alone makes you the richest man in the world…with our without insurance.
Otis, part of the reform that has been offered but ignored are the attempts to create collective pools for small businesses to become part of to lower costs and mimic bigger plans. There should be a way for families (hundreds or thousands) to get together to buy into a plan that most companies offer as part of the pay packages.
You know the real sham here? People who say silly things like “People in American are free to NOT have health insurance!” ignore the fact that people WITHOUT health insurance just show up at the ER and get it anyway.
Wouldn’t it make more sense to force EVERYONE to contribute to health care if EVERYONE is going to get it anyway?
Public option is the only reasonable answer. I would happily debate any expert, anywhere, anytime in any format.
I will win because I’m smarter….and I’m right.
We have sort of a pay as you go health plan. Health savings account or something like that. We pay the first $5,000 for anything and the insurance will pay 100% of everything else. It costs us about $400 a month, I think. I really want the universal health plan. I don’t mind some of my tax dollars going to help a sick child on welfare, or a sick mother who lost her job due to cancer or whatnot……..it’s all a good idea to me. I’ll take the good with the bad.
Speaking with my sis, a 2nd year resident, she tells me that a huge part of her job is making sure that she writes up the tests that she is ordering in “just the right language” in order to ensure that she gets paid by her patients’ insurance. This is something that her administration is constantly training their doctors in doing. Forget quality health care. If hospitals can make more money by ordering a strep test instead of sending someone home with orders for lots of fluids and rest, then they will instruct their physicians to order the test.
Each health insurance company has its own language that it requires doctors to use in order to qualify for payment. My Dr. Sis must grapple not only with her patients but with the bounty of insurance plans out there. Each plan has its criteria for accepting a course of treatment. If she wants her patient to get the care he or she needs, she needs to make sure it is documented in the language the the insurance company accepts. Each plan accepts a different “language.” So Patient A with Cigna, may have to have a write up that says, she presented with runny nose, fever, and diarhea in order to get the swine flu test paid for. Patient B with Blue Choice, must have it written up as a runny nose, fever, diarhea, and stomach cramps. Leave out the “stomach cramps” part and the swine flu test doesn’t get covered and Patient B gets stuck with a crappy hospital bill. (This comparison is completely made up. What she has to document is often far more complex, but you get my meaning). In short, my sis spends a HUGE portion of her time trying to keep track of all of these different codes and nuances in language just so she can get paid by these insurance companies. What she should be focused on is what is most important – what is best for the patient. Just simplifying the system so that a plethora of insurance companies are not dictating the terms for which treatments get paid for and which do not could have a major impact on the quality of care we all receive. I, for one, don’t want a for-profit insurance company pressuring my doctor into what services they can and cannot order for my care. Do we need reform? Damn straight, we do. We don’t solve any problems with the current system by sticking our heads in the sand and hoping things will get better. Instead of writing about what we fear will happen, let’s reform what we know is wrong and legislate what we know is right for all.
Can’t wait till all the “Boomers” start falling down stairs. Just watch those premiums go, up, up, up……I’ll stick to playing the lottery. Anyone got a buck to spare?
Blue Cross was my first provider. It cost $30 a month. Average wages at the time were around $100/week with high rollers making 10-12K a year. I had my appendix out on that plan and it was under $400 total cost.
Look at Blue Cross today. It went from a co-operative company to privately held. Those who were using Blue Cross got a nice chunk of stock.
Why is health care lucrative? It is a regulated industry. The people in control are economists and accountants. In such an environment, the purpose isn’t health care or providing electricity. The purpose is gaming the system for greater rewards — personal and corporate.
Now you think that getting the government involved providing more regulation can solve this. You think the PAC’s will just close up shop and head home with a well done letter with you and I benefitting?
Meanwhile, while they are doing all this, I got an investment plan that will return the free money adequate to cover all your medical needs and you’ll get free passage across the bridge.
Here is two cents from a mean-spirited conservative.
My friend your health insurance will cost something. Of the $10,000/year, let’s say that $2,000 goes to the cost of the uninsured and $2,000 goes to inefficiencies. Is $6,000/year too high for the health care of a family of four? I think the Greenville medical system is pretty good. Excess capacity and emergency services for $1,500/year per person seems reasonable to me if you get decent coverage.
The $2,000/year for the uninsured will be there under the current system or any new private/government system. If the US goes to a government system, then the $2,000/year will be hidden in taxes.
The $2,000/year of inefficiencies is a good place to target reforms. Part of the inefficiency is due to competition between multiple processes, companies and governments. Part of the inefficiency is due to lawsuits, incompetence, and fraud. Part of the money goes to subsidize Medicare. Maybe the amount could be reduced to $500/year.
Health care by its nature gets rationed. Health care in the US is expensive because it is good and because of the way it is rationed. My father was over eighty and got diagnosed with cancer. He received hundreds of thousands of dollars in health care over the following eighteen months. Was this the best use of funds from the point of view of the government? Probably not. It was worth every nickel to me. If you are young and healthy, maybe the Canadian system works better for you. If one day I receive some jarring news from my physician, I will be glad to be part of the backward and inefficient US health care system.
Here are some of my nutty reforms:
1. Each hospital, clinic and emergency room should have its own posted rates which apply to all patients. Insurance companies should not pay less for the same services as a single uninsured patient.
2. Medical lawsuits need caps. The punitive and compulsory amounts would to be separated. A rich doctor would pay 400K to the patient and 2M to a general fund. A poor doctor would pay 400K to the patient and 100K to a general fund.
3. No medical lawsuits can be sealed. If a doctor settles out of court, all of the records would be public.
4. Every body is required to carry a minimum level of health insurance. The government would issue vouchers to the very poor. The poor and unemployed can be required to repay medical bills via community service. I would appoint G-Rob as “get you ass covered” health insurance czar.
5. Employer and government health plans would require preventative medical exams at least once every two years.
It is not simply the insurance premiums (although for sugical subspecialties and OG/GYN 6 figure premiums are not uncommon), but the threat of lawsuits that causes many doctors to practice expensive “defensive” medicine by ordering expensive diagnostic tests to rule out the rare, esoteric diagnosis. Woe to the doctor who gets on the stand in their defense and has to explain why they didn’t order the DC-MRI AND the nuclear stress test after someone comes to the office complaining of shoulder pain after a day of 4 softball games…and then suffers an MI 2 months later.
Yep.
But giving the government complete control isn’t likely to make it much, if any, better.
Enjoyed the read.