Healthcare Overhall

[NYCHoosier]

I read this article and thought it had a lot of great points, but I'd love to get your input. He's basically calling for increased competition, making patients the true consumers instead of health insurance companies (whether they be private or government-run).

http://www.theatlantic.com/doc/200909/health-care

[ladymoreta]

That was a very interesting (and long) article.

You know, I think the author may have hit on a point that has kind of been lingering in the back of my mind, but I could never quite articulate. I know that our insurance system is inefficient (at best) now, but it just seemes better than what I perceive the government could accomplish. However, if we could eliminate the middleman (comprehensive insurance coverage) altogether, maybe that would be a better solution.

It does seem like direct payment for services would eliminate a lot of overhead costs in running clinics and hospitals. An insurance policy that only covers services over a specific amount would probably save a lot of work and money, and it would encourage shopping around for the best price/value. And using HSAs, but making them required and based on income, could be a good solution to making sure people have enough in savings to cover basic medical care for themselves.

But, of course, you have the problem of the health insurance lobbyists... There's no way they'd ever let a bill like that pass.

[MrsC]

I didn't read the entire article - it's pretty long. But, I do want to comment on some of the issues with his father's stay in the ICU. They are indicative of someone who doesn't know a whole lot about medicine.

He complains about constant staff changes during his father's 5 week stay - The hosiptal is a non-profit and assuming that it's a teaching hospital they have residents rotating through. This is a given with a teaching hospital, there are residents being taught and you are going to see new faces. Doctors are human beings too and can't remain in the hospital 24/7.

Infection is a risk with any hospital stay - Older people are particularly at risk once they are admitted and DH sees this time and time again in 80 year olds, they get repeated infections in the ICU. Hygiene is an issue but with all hospital staff, not just physicians.

Many non-profit hopsitals have big issues with supplies. They tend to scrimp and save on instruments and supplies because they don't have a lot of money. Non-profits have far more uninsured patients and often eat the cost for these patients care. At the same time they have to keep up with new equipment, air TV advertisements like everyone else in order to attract insured patients.

While he hits on a few key issues with the current system, what he proposes is not realistic. If people can't afford health insurance, they sure as hell can't afford to pay for even routine care out of pocket. Who pays physicians, nurses? Malpractice? There's so much wrong with this idea, I don't know where to begin.

[BonBon]

If people can't afford health insurance, they sure as hell can't afford to pay for even routine care out of pocket.

I disagree. I went without insurance for EIGHT years, and even though I only made 15-18K per year I still made sure I got my paps/physicals/dental taken care of. I even paid for braces at $100 a month. It can be done, it's all about priorities. Granted, if I had a serious illness I could not have covered it. But I tire of people saying costs are outrageous/can't afford it/yadda yadda. I called around for the price of routine services as well as speaking with the business office to negotiate cost and payment.

ETA: I haven't read the article to hit on the other points yet.

[PrincessFiona]

Re: Healthcare Overhall

But you got lucky, Chris. What would have happened during that time if you had been diagnosed with cancer, MS, had a terrible car accident, gotten pregnant and had a baby in the NICU etc? Your gamble paid off but things could have worked out differently.

My mom took that gamble and was diagnosed with rheumatoid arthtritis during that time. Thank God she was eligible for VA benefits because her current health insurance won't cover it!

Kris


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[PrincessFiona]

Re: Healthcare Overhall

Also, my brother was in a MVA when he had no insurance. He couldn't shop around for the best rates on his ER trip which way back then was several thousand after all tests and hospitalization. He was making ~14,000 a year back then and his bill was pretty much his annual salary. He was never able to negotiate or pay what they wanted andbit went into default and collections. He still sometimes gets letters about it.


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[NYCHoosier]

But you got lucky, Chris. What would have happened during that time if you had been diagnosed with cancer, MS, had a terrible car accident, gotten pregnant and had a baby in the NICU etc? Your gamble paid off but things could have worked out differently.

My mom took that gamble and was diagnosed with rheumatoid arthtritis during that time. Thank God she was eligible for VA benefits because her current health insurance won't cover it!

Kris


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Well, he accounts for that, sort of. He is in favor of catastrophic insurance. He says anything past $50k, whereas I think anything past $5k would be good. Perhaps a better rule would be anything past 10% of your income?

I think the idea is right, though, that if you make the patients the real consumers, other improvements will follow.

[oceanchild]

I think the idea is right, though, that if you make the patients the real consumers, other improvements will follow.

The problem with market arguments generally is that people don't behave with healthcare the way they do with normal markets. I mean, it might be different for those of us with medical people in our families, but I know that if my mom's doctor tells her to do something, she's going to do it. Expenses be damned, in all likelihood. We aren't rational about our own health (or that of our family members).

I certainly agree with his main point that people should be more transparent about the actual costs of things, but I'm not sure it would do much to actually bring down costs.

[MrsC]

But you got lucky, Chris. What would have happened during that time if you had been diagnosed with cancer, MS, had a terrible car accident, gotten pregnant and had a baby in the NICU etc? Your gamble paid off but things could have worked out differently.

Pregnancy is a good example of how this wouldn't work....not a catastrophic event but it still costs between $2000 and $15000 for pre-natal visits and the delivery.

And for those who have chronic, non life-threatening conditions and need medications on a daily basis and bi-annual doctor visits/tests. I'm thinking Crohn's Disease, Diabetes etc.

[BonBon]

It wasn't a gamble...I simply could not afford to purchase the standard insurance and I did not qualify for medicaid. Rock, meet hard place. My point being that a healthy young person who cannot afford insurance yet claims that they cannot afford standard preventative care is FOS. Note that I also said this:

Granted, if I had a serious illness I could not have covered it.

[ladymoreta]

Pregnancy is a good example of how this wouldn't work....not a catastrophic event but it still costs between $2000 and $15000 for pre-natal visits and the delivery.

Actually, $2000-$15000 isn't that bad. Insurance coverage for a married couple for one year is pretty close to $15000, so a year of saving into an HSA account would just about cover it. You have to remember that with the author's plan, we wouldn't be paying for comprehensive insurance anymore, only catastrophic, but people would be required to contribute to their own HSA.

He also mentions that you could "borrow" from your HSA. For example, if you had an unplanned pregnancy, you could obtain care, but you would be carrying a balance on your HSA. Over the next few years, you would continue to contribute to it, and eventually you would pay it off.

I agree that the catastophic coverage should begin lower than $50,000. Probably somewhere around $20,000, so that you wouldn't be owing your HSA for years.

I have no comment....just sayin...

RB

[Amiens]

Actually, $2000-$15000 isn't that bad. Insurance coverage for a married couple for one year is pretty close to $15000, so a year of saving into an HSA account would just about cover it. You have to remember that with the author's plan, we wouldn't be paying for comprehensive insurance anymore, only catastrophic, but people would be required to contribute to their own HSA.

He also mentions that you could "borrow" from your HSA. For example, if you had an unplanned pregnancy, you could obtain care, but you would be carrying a balance on your HSA. Over the next few years, you would continue to contribute to it, and eventually you would pay it off.

I agree that the catastophic coverage should begin lower than $50,000. Probably somewhere around $20,000, so that you wouldn't be owing your HSA for years.

(I lurk in here, but don't comment very often, so I am going to don my fire retardant suit to protect my at times thin skin)

My sister inlaw and her husband did this with their 2nd child: saved money up. They knew they wanted to have another child. Health insurance premiums, deductible and copays were going to be more than the actual prenatal visits, and was going to be more than out of pocket. They carry catastrophic insurance, and pay for well-checks themselves. For them it is much cheaper than doing premiums, plus in the state they live in only a handful of health insurance plans are available, I think something like 3 plans to choose from. I read somewhere that there is around 1500 insurance plans available, but due to interstate commerce laws, plan A that is offered in say Nebraska and is cheaper than Plan B offered in Kansas, the consumer cannot buy Plan B, b/c of interstate insurance commerce law.

Dh and I discussed somewhat on the same topic that if people had insurance for just that insurance in case something bad happens, instead of expecting everything under the sun be covered- well-checks, immunizations, all the stuff that you know you need to take care, and have insurance to cover surgeries, cancer treatments, etc. Dh used the analogy of car insurance. Car insurance doesn't cover oil checks, servicing the transmission, replacing the brakes, but wreck your car, need a major overhaul and insurance is there. There, too, your insurance can drop you. I didn't say it was perfect. Just gave me something to think about.

One thing that concerns me a bit: Immigration & the bill. My mom is an immigrant, kicked out of her home by her father in Canada at age 15. Came to the US, deported back to Canada b/c she was here illegally, and when she turned 18, she went through the necessary steps to come here legally. It took her 25 years, but she became a citizen, jumping through all the legal hoops. Anyway we have experience with care in Canada and here. My mom and her family members have received better care and quicker than in Canada. She had a cousin who was going to have to wait 18 months from time of injury to get an ACL fixed, his quality of life was really poor, and in a lot of pain, whereas here in the US he could've had the ACL fixed within the month. Another cousin had a brain tumor, and had to wait 6 months to get an MRI, only to find out that if he had gotten the MRI earlier, could have been treated sooner, and the tumor wouldn't have been as bad.

I know there are people out there with out health insurance who desperately need it. I have a friend going through this right now. I have a hard time with the rushed nature, and adding to the deficit which is already skyrocketing.

In the bill it says that "Nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States." From what I have read of the bill, my understanding is that this is the only exclusion of illegal immigrants receiving benefit from the bill, and it is only from this section. This piece in section 246, applies only to this section not the entire bill, is my understanding. I have coming across articles that say hospitals are going bankrupt or doctors suing state dept of health services because of unpaid Medicaid benefits or Medi-Cal in CA, where illegal immigration is a problem. By law hospitals cannot turn people away. It seems like a no win situation- darned if you do, and darned if you don't. Apart from medical tort reform that I wish Obama would at least address, I would like to see more restrictions in the bill in regards to illegal immigrants.

(going back to lurking)