RSS Feed MenuThe Detroit Free Press recently reported that thousands of customers of Blue Cross of Michigan received notices that their premiums would increase 22% next year. A retiree friend of mine told me yesterday that his premium for a medicare supplement will be going up a similar percentage to over $3300 per year. Numerous studies have reported that many households not currently experiencing a medical “situation” will consider opting out of health insurance when their total out-of-pocket costs reach 12% of income. It all boils down to affordability. The goose only has so many golden eggs.
When healthcare (insurance premiums, co-pays, deductibles, pharmaceuticals, etc.) becomes unaffordable, as housing did in 2006 despite the froth in that market, a crash soon follows. If it can happen in housing, it can happen in healthcare as well. When it happens, some people will die prematurely and needlessly.
Overall costs must come down! That will threaten incomes and revenue streams. Those interests will not stand by and watch that happen without a fight. As that fight stretches out into weeks, months, or maybe years, Rand’s notion of greed as a virtue will be sternly tested.
balconesfault // Sep 20, 2009 at 9:33 pm
Speaking of the food industry …
After all the recent complaint about illegals even being able to buy into a public option (imagine – paying for healthcare!) I’m wondering when we’re going to start making it illegal for illegals to purchase food in America.
mara123 // Sep 20, 2009 at 9:58 pm
tort reform is a must, buying insurance across state lines, other country’s get there meds cheaper, whats up with that? regulated insurance company’s, get rid of the unions,illegals need to go home an secure our borders, so they cant come back, after all this is in place sit back an see how it goes an then tweak it.
mara123 // Sep 20, 2009 at 10:01 pm
oh obama has a solution to that, just make them legal.what a joke.
SFTor1 // Sep 20, 2009 at 11:43 pm
cwillia11 says: “The study shows that government medicine is wildly out of control due to perverse incentives.”
Yet a survey off all comparable industrial nations shows that they deliver superior health care, to all, for less money, through government programs or programs heavily regulated by government. Are we saying that the United States is incapable of managing its own affairs?
Are we talking about the same country that won WWII and went to the moon?
oldgal // Sep 21, 2009 at 9:40 am
Sinz54: Based on your arguments, why hasn’t Kaiser Permanente driven out the other insurers in California? If the public option would be so awful, why would folks or companies opt for it?
sinz54 // Sep 21, 2009 at 9:52 am
oldgal: Based on your arguments, why hasn’t Kaiser Permanente driven out the other insurers in California?
Because Kaiser Permanente can’t draw on California state tax revenues to subsidize its premiums to well below market rates.
Here in Massachusetts, the public option, Network Health Forward, is heavily subsidized by tax revenues. Hence it can offer premiums of only THIRTY-FOUR dollars a month–less than a tenth of what the private insurers offer. The only reason it hasn’t taken over the entire market is that by law, it can only accept applicants who are around the poverty line. It can’t take middle-class or affluent applicants.
But liberals in Congress want the public option to be open to just about anybody except maybe the rich.
You want a public option? Fine. Then let it operate like Kaiser Permanente–it should receive not ONE DIME of tax revenue, forcing it into the same kinds of efficiencies that the private sector is. Indeed, such a proposal has been floated by centrist Democrats–a not-for-profit corporation, rather than a Government program. That might be reasonable. But liberals don’t want it.
Read Jonathan Chait’s column today. Liberals want that public option implemented now, so that in future years they can feed it bigger and bigger Federal subsidies, driving down its premiums to ridiculous levels and eating up 80% of the insurance market. That would be only 20% away from a single-payer system.
sinz54 // Sep 21, 2009 at 9:57 am
sftor1: The health care “market” has failed.
Public opinion polls don’t show this. They consistently show that around 78% of Americans are satisfied with their health care coverage. White-collar workers in giant corporations generally are satisfied with their group insurance.
Obama knows this. That’s why he keeps promising that “if you like your current health care plan, you can keep it.” If the system had truly “failed,” then he would say that most or all citizens will need to change how they get health care.
You liberals aren’t acting with your convictions here. First you indict the entire system as having failed–then you promise the 78% of Americans who want to keep their existing health care plan that they can do so! It can’t truly have “failed” if 78% of it will remain the same.
What you REALLY believe, of course, is that all those Americans who like their Blue Cross (I’m one) or Harvard-Pilgrim (which has one of the highest satisfaction scores in the nation) should be forced off those programs and into single-payer. But you’re afraid to say it.
Am I getting warm on any of these?
sinz54 // Sep 21, 2009 at 10:05 am
sftor1: Yet a survey off all comparable industrial nations shows that they deliver superior health care, to all, for less money, through government programs or programs heavily regulated by government. Are we saying that the United States is incapable of managing its own affairs?
We Americans certainly recognize there’s need for reform–but we seem to be incapable of reaching consensus on which direction we want to go.
That’s because the United States is a much more diverse nation than any of the European ones you want to cite as role models. And because unlike Europe, socialism was NEVER accepted in America as an ideal. Unlike Europe, Social Democracy would be highly unpopular here as a goal. In America, unlike Europe, “socialism” is a dirty word.
So any health care solution for America must NOT look like “socialism,” it must NOT look like rationing, it must NOT force patients into clinic-type atmospheres with long waits to see specialists or get MRIs, it must NOT force affluent patients into decrepit health clinics where they rub elbows with the underclass, it must NOT force patients out of private hospital rooms and into wards, it must NOT cover the 12 million illegal aliens, and it must NOT make public economic tradeoffs about the final years of life.
That’s a harder problem.
sinz54 // Sep 21, 2009 at 10:21 am
balconesfault: Then again, the dirty little secret is with … a new wave of healthcare cost increases… Americans can’t be guaranteed that in a few years they won’t be required to accept less or worse care regardless of what healthcare bill passes.
That’s true–and that says that we need to reform the practice of MEDICINE, not just how it’s paid for. Because the practice of medicine isn’t keeping up with the 21st century.
Example: In a nationally famous hospital in Massachusetts (where I stayed for a while), all patient records are still kept in hand-written loose-leaf notebooks. You can imagine the problems with coding errors, lost notes, etc. (Once they lost one of my notebooks and they spent hours running all over the hospital trying to find it!)
The doctors and nurses told me that at least 55% of their work load involves such hand-written record-keeping. They spend more time filling out loose-leaf notebooks than they do treating patients.
A completely automated “paperless” hospital could dramatically improve the productivity of the medical staff. At least in the case of that particular hospital. (They have plans to get there–in ten years.) But I’ll bet many other hospitals are the same way.
cwillia11 // Sep 21, 2009 at 10:37 am
sftor1,
Medicare is a peculiarly perverse example of government medicine. Why is a good question. Part of the reason is that it covers only part of the population and is able to shift massive costs onto the rest of us in a way that is politically invisible. Medicare is carefully crafted to disguise the fact that it rations health care and prevents people from easy access to care they wish to pay for with their own money. At the same time it incentivizes over reliance on expensive procedures. This intimidates senior citizens into thinking that the health care they truly need is vastly more expensive than what they could ever afford. So you have vocal constituencies hysterically attached to a dysfunctional program and negative spillover effects on the medicine practiced on the rest of us.
balconesfault // Sep 21, 2009 at 10:45 am
But liberals in Congress want the public option to be open to just about anybody except maybe the rich.
But liberals in Congress don’t want to set premiums at such a ridiculously low level that the program is unsustainable without massive levels of subsidization. The premiums for the close-to-poverty line Massachussets policy is a different creature – because there is no intention to make it available to middle class consumers. Most plans for a “Public Option” include a government subsidy for those close to the poverty line – but not for the boogeymen of middle-class workers whose companies drop coverage for you fear so much.
balconesfault // Sep 21, 2009 at 10:48 am
cwilla11: This intimidates senior citizens into thinking that the health care they truly need is vastly more expensive than what they could ever afford.
Yeah – that’s the problem with Medicare. It’s been a tool used by the elites to convince senior citizens that they wouldn’t be able to afford care without that coverage.
If we just did away with Medicare, the free market would quickly eliminate rationing and give every senior easy access to highly affordable and effective treatments that are currently unavailable to them because of wasteful bureaucracy and … umm … intimidation. Yeah, that’s it. Seniors are intimidated into beingn forced to use Medicare.
Jim // Sep 21, 2009 at 11:01 am
Public goods and Constitutionally enshrined individual rights are not the same thing. Please remember that.
balconesfault // Sep 21, 2009 at 11:49 am
Public goods and Constitutionally enshrined individual rights are not the same thing. Please remember that.
Absolutely in agreement. That is my point exactly in #7.
crtune // Sep 21, 2009 at 1:46 pm
I see someone opined that increased costs in health insurance would somehow affect the profit of individual companies as these costs increased. That doesn’t exactly compute for this former accountant. Perhaps we are thinking that more industries or clusters of competitors will attempt to provide no insurance for staff? The usual situation is where a number of companies all vie for the workers they need. One of the ways they compete is by offering health insurance. Because of the silly way health insurance is regulated and is sold, companies have very limited choices right now in terms of how many competing health plans they can even consider. Usually the group is roughly three or four at most. Then the company decides what level they want to provide (usually with lots of input from employees) and then story over.
Profit will derive from the companies other actions independent of this above choice. These choices are already priced into our product offerings and will not fluctuate based upon competing with other competitors in our industry. Another way of looking at it is that health insurance cost is “semi-fixed”.
Incidentally, according to classical economics, the current situation in the healthcare industry is not “competition” rather it is constrained and highly regulated, with extreme barriers to entry. Think about all the filings and petitions that must be made to open a new hospital. Think of all the licensing needed for doctors and nurses. Think of the US FDA trials that must occur for pharma. How much of the cost of medicine derives from existing regulation? Do we know for sure, with accuracy?
crtune // Sep 21, 2009 at 1:54 pm
As regards “paperless” as a serious cost reduction, think twice about this. My GP is like many I’ve run into (particularly the younger docs) he has absolutely everything in handheld accessible and networked computer storage. All my patient data is in a DBMS based system as is his practice recordkeeping, billing system, and his PDR. This is in a Burbank, CA based practice. The doc is in his fifties. I admit hospitals may vary as regards level of automata. Likely newer hospitals are more paperless, older ones are more likely to need updating.
Some additional thoughts. Transfer of data and error due to inaccuracy of data are also important. An XML flavor for the entire healthcare industry would be a good thing, and is likely already in development. Thing to do would be for an org like ISO, or ANSI to establish and grow a standard.
SpartacusIsNotDead // Sep 21, 2009 at 3:46 pm
Sinz wrote: “So any health care solution for America must NOT look like “socialism,” it must NOT look like rationing, it must NOT force patients into clinic-type atmospheres with long waits to see specialists or get MRIs, it must NOT force affluent patients into decrepit health clinics where they rub elbows with the underclass . . . ”
Why do you keep saying things that simply aren’t true? France is a perfect example of a more “socialist” system that proves you dead wrong. France has an extremely diverse population, it has the best healthcare system in the world and it has avoided ALL of the problems you just described. The French system is much better than ours and it costs a heck of a lot less, but for some illogical reason, conservatives prefer the current American system to the French system because it’s . . . socialist?
Grow up! Who cares what the system is called or that it is not an unregulated free market? Free markets are nothing more than a means to an end. They are not the end in and of themselves. And, the free market system has proven incapable of solving our problem. If the French system can solve our problem and save businesses and state and federal governments a lot of money, you’d have to be either an ideological idiot not to try to adopt their system.
anniemargret // Sep 21, 2009 at 6:25 pm
sinz54: “The doctors and nurses told me that at least 55% of their work load involves such hand-written record-keeping. They spend more time filling out loose-leaf notebooks than they do treating patients.
A completely automated “paperless” hospital could dramatically improve the productivity of the medical staff…”
Before I do what I do now, I was a medical transcriptionist, both clinical and hospital-based, for almost a decade. One of the theories at that time, was that doctors would no longer need to use real live human beings to transcribe operations and patient summary reports; that a new transcribing system would ‘auto-transcribe’ the doctor’s dictations. Wrong. If you have every listened to a doctor’s dictation, you would know immediately how difficult it is to transcribe the human voice particularly when that voice is using medical terminology and new PDR standards of generic/non-general pharmaceuticals. A real live human being is always needed to transcribe, and verify…over and over again to make sure the dictation is accurate. A slip of the wrong medical term could cause immense problems.
Some automation is necessary, but this is an area I hope and believe will remain human-connected. There are virtual printoffs, but the basic need remains a real person.
“….it must NOT force patients into clinic-type atmospheres with long waits to see specialists or get MRIs…”
An MRI is often given only in time of great need, not as a routine service. I had a very dizzy spell last year out of the blue, so bad that I was literally hugging the wall when I got home for fear of falling. The ER did an immediate MRI on my brain to rule out an aneurysm or other brain abnormality; luckily it was not a brain problem.
However, long waits are another matter. My sister was dx’d last year with the possibility of CA in her endocrine glands, and not even her own internist could get her to see an endrocinologist for almost 3 months….she had to wait that long. Obviously it was a fearful time. It happens more often than you think right here in the USA. It will depend more often on the quantity of that specialist in the region you live. Obviously, if you live in or near a major city, your chances are better, but many people must wait inordinate amount of time to see specialists, EVEN IF, they are facing serious medical issues.
And I agree with sparticusisnotdead…. I don’t much care a whit what something is called. It is the system it delivers. If France or other countries have developed a better serviced and less costly manner of delivering than here, then the word ’socialism’ becomes less of a dirty word. Perhaps it should be rephrased….pragmatism.
Jim // Sep 21, 2009 at 7:34 pm
Sinz’s assessment of what the system must NOT be (viewed from the perspective of a committed conservative) is spot on. Of course, if the Dems have the votes, they can pass anything that they want. That still doesn’t mean that hardcore socialized medicine doesn’t trample on the spirit of the Constitution.
SpartacusIsNotDead // Sep 22, 2009 at 1:14 am
Jim suggests that socialized medicine tramples on the “spirit” of the Constitution.
I’m not sure what specific parts of the Constitution you are referring to. Something either violates the Constitution or it does not. And, I don’t know if you’re included in this group, but for strict constructionists there is no “spirit” of the Constitution to trample. Only the literal words of the constitution matter.
SFTor1 // Sep 22, 2009 at 1:40 am
Here is something I don’t understand about Sinz’s argument: “That’s because the United States is a much more diverse nation than any of the European ones you want to cite as role models.”
So diversity makes it harder to deliver health care? How?
As far as whether I would like to see a single-payer system: of course. I have said so on several occasions. I believe it is impractical to nibble around the edges on this one. Private insurance companies can have a role in selling supplemental insurance to those who want it, but they are, in general, not needed.