The 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.
46 responses so far
1 balconesfault // Sep 19, 2009 at 6:45 am
Hey – the insurance industry needs to make up the half a billion it’s spending fighting healthcare reform somewhere! Lobbyists and Senators (of both parties) don’t come cheap.
2 oldgal // Sep 19, 2009 at 8:17 am
People are already dieing prematurely and needlessly: http://prescriptions.blogs.nytimes.com/2009/09/17/harvard-medical-study-links-lack-of-insurance-to-45000-us-deaths-a-year/
3 anniemargret // Sep 19, 2009 at 8:37 am
oldgal: I had already posted that similar link on another thread here yesterday, with nary a response. It was ‘ho-hum’ time from most of Newmajority’s core members. Similar response when they posted how Rev. Jim Wallis (a ‘liberal’ preacher – which means he teaches about helping the poor and the unfortunate/suffering, and not just abortion), was using emotional ‘tactics’ and ‘ploys’ and ‘intimidation’ to remind the anti-reformers that there is an underlying ethical and moral challenge as Americans and as decent men and women.
The fact that I come away with listening to the Republican version of healthcare reform, which basically means leaving the status quo, and listening to their loyal followers (townhall protesters/teabaggers/value voters) is : “I’ve got mine, I’ve got money to pay for my family’ – don’t bother me with anyone elses problem.
Basic, affordable transferable healthcare is a right for all Americans. It is intrinsic to ‘life, liberty, and the pursuit of happiness’ because without the first, you cannot obtain the second. And this selfish mantra that ‘all they have to do is ask for other people to pay for them’ just proves that Republicans, by and large, are consigned to helping their party….not the nation.
And…heartless self-centered to boot. Just tell me they are don’t show up in church on Sundays proclaiming to be ‘Christians.’
4 oldgal // Sep 19, 2009 at 8:48 am
Is it health care that is becoming unaffordable or is it the insurance? Of the health care models I have researched, it is the non-profits that seem to do the best job of cost containment while still delivering excellent care. Perfect? no, but better than the privately insured health care.
5 FosterBoondoggle // Sep 19, 2009 at 8:57 am
Not the insurers – for most people, insured through a family member’s employment – the insurers are primarily middlemen. It’s the fee-for-service system that provides every incentive for doctors to rack up charges for needless tests. Read Gawande’s piece from last spring in The New Yorker (horrors!) But that system is the heart of the right-wing insistence that laissez-faire solves every problem.
6 anniemargret // Sep 19, 2009 at 9:07 am
I know people right now in my own life, family and friends, that are struggling mightily with keeping insurance (earnings have frozen and costs rose too high), or (have a pre-existing condition) or have none at all. I keep hearing from ‘conservatives’ here on this blog, and elsewhere that those without, can ‘go to the ER”… as if the ER, already under mighty strain, is going to provided ‘healthcare’ for those with heart disease, cancer, diabetes, or Lou Gehrig’s disease (of which is particularly scary for me as my two uncles-both brothers-died from the acute form of it in their 50s an 60s). That’s the standard Republican response.
No one is saying reforming for-profit healthcare is easy… but ignoring the issue and pretending it is going away is basically what I’m and millions of other Democrats and Independents are hearing. Non-profit insurance? Well at least those two words go together. To make money off the suffering and deaths of human beings is appalling.
As we know now, the majority of physicians in this country desire a public option or other form of inexpensive national insurance. We are the only wealthy industrialized democracy not with this, and subjecting our citizens to abject fear if they lose their jobs and benefits, stagnant wage and rising costs of healthcare, or slip through the cracks and don’t have an opportunity to obtain healthcare if they are earning too much to apply for Medicaid is appalling.
Sure, tort reform is a good idea, sure, preventative medicine an even better one (Andrew Weil), sure, unnecessary tests should be reduced….all of the above is important, but the main question is whether or not every American has access to healthcare regardless of employment, socio-economic class, or affordability. As I say again to the those that think the opposite: It is a right not a privilege. Those that say it is a ‘privilege’ obviously have gold-plated healthcare for themselves and their families already, or are sufficiently wealthy enough to cover major expenses if that need arose. Who’s kidding who?
This situation is a national disgrace. The fact that Republicans are still talking about the ‘marketplace’ and people’s health in the same sentence – I won’t be voting Republican again anytime in this century.
7 balconesfault // Sep 19, 2009 at 11:11 am
As I say again to the those that think the opposite: It is a right not a privilege.
anniemargret – I still disagree with this point … but on the other hand, I also don’t think having a fire department that will rush over to my house without first running a credit check on me is a right, either …
Instead, universal healthcare is just a good idea for a wise, progressive society to provide to its population. Like a fire department, it promotes economic growth. Like a fire department, it serves as a way of preventing the spread of disasters. Like a fire department, it is much more cost effective across society if provided as a public good, rather than a commodity.
8 midcon // Sep 19, 2009 at 11:12 am
Actually, anniemargret – I read your previous url/post. The reason I have not commented is because I have not read completed reading the entire study and I do generally opine on such things unless I have read/studied the information someone is posting about.
In this particular study, which consisted of 9005 individuals who were ultimately included, there does not appear to be much discussion of the correlation between death and unhealthy living (although they did include data on smoking, alcohol, and exercise). While there seems to be a correlation between lack of insurance and health, the study does not seem to demonstrate causality. That is, the lack of insurance results in increased mortality because they cannot demonstrate that that the results would have different if they had insurance. For example – if they had insurance would they acted differently to manage their chronic conditions or engage in more healthy living? The problem with studies is that we tend to read too much into them and create conclusionary causal relationships that often should be relegated to 3rd or 4th degree rather than 1rst degree.
That said, I believe the study shows there is a relationship but that it is more complex than simply stating that lack of insurance causes deaths.
As an added note, while we value every life, remember that even if the number in the study is accurate (look at the confidence levels to see the error margin), 45000 divided by 300000000= .015% deaths over the whole population as result of a lack of insurance. Further you might want to go to this site and compare this to number of deaths due to unintentional injuries:http://www.nsc.org/research/odds.aspx. Look at the number of deaths from accidental injury (117000) (4 times the number from no insurance). Can vehicle and plane crashes be prevented? Sure, in the extreme, by not flying or driving. But I am sure you will agree that the cost would be too high. But if you did say that, then you would be conceding that economic impacts should be considered when making such decisions. If you do not believe that then, I would assert that you should focusing your attention on the greater harm – accidental injuries which, is killing far more people, even if you agree with the study.
What we all need to do is to put things in perspective and above all read and ponder what you have read.
9 midcon // Sep 19, 2009 at 11:13 am
My url did not post properly:
http://www.nsc.org/research/odds.aspx
10 anniemargret // Sep 19, 2009 at 11:50 am
balonesfault: Instead, universal healthcare is just a good idea for a wise, progressive society to provide to its population. Like a fire department, it promotes economic growth. Like a fire department, it serves as a way of preventing the spread of disasters. Like a fire department, it is much more cost effective across society if provided as a public good, rather than a commodity. ”
I totally agree with your premise here, that it would be more ‘cost-effective” ..etc. This is my opinion as well. Ultimately, it is for the ‘public good’.’ It improves society. It is for the betterment of our nation, rather then achieving brownie points for a political party.
Other nation have already recognized this and resolved it with national/universal healthcare. My own supposition is that they already did so because 1) it is more ‘cost-effective’ 2) it is ethically the right thing to do. I think most countries recognize it as both. Heck I think even Dr. Paul Farmer recognized that Cuba did a better job than we do.
midcon: I agree Americans do not take good care of themselves, with active choices of healthier living which is in everyones responsibility to do so. I wouldn’t mind seeing higher taxes on tobacco, soda, junk food… I believe in ‘preventative’ medicine, but the way we are doing so now, we are sending people to the ER for symptoms of illnesses that can be contained with some meds and lifestyle changes….that is neither ‘cost-efficient’ or for the ‘public good’ because it drives up costs.
Also, Americans in general have unhealthy lifestyles….our fast-paced society, two working parents, kids too much involved in after school activities, lack of sleep, exhaustion, long commute…..leave many people reaching for a ‘quick’ meal, etc . This is also a societal problem. We live to work, not work to live.
11 Chekote // Sep 19, 2009 at 7:15 pm
It is a right not a privilege.
Why not make food a right? Same with water? I mean, how long will you live without water? Perhaps we should forbid food producers from making an eviiiiiil profit. You know what? Fine. Have your little Obamacare so that the rich will be able to go to private clinics while the rest of us will wait forever to see a doctor because everyone will crowd their offices with the first sneeze since it is “free”. Also, under Obamacare the insurance companies will make a killing due to the mandate to buy insurance. This has been tried in MA and the costs have not gone down while waiting periods have gone up. But heck, let’s do it so that everyone can feel good about the fact that we have joined the world in medical waiting lists.
12 Chekote // Sep 19, 2009 at 7:20 pm
Heck I think even Dr. Paul Farmer recognized that Cuba did a better job than we do
Is that why head of states head to Cuba for treatment? Is that why thousands of people board boats to Florida every year? To get away from their wonderful healthcare? Pleeeease. Look at the cancer survival rates between this country and the rest of the world. The problem is that Americans want 21st century care at 1950s prices. But let’s have Obamacare. So that we can join the rest of the world and have 50% of men suffering from prostrate cancer die.
13 sinz54 // Sep 19, 2009 at 8:20 pm
oldgal:
It’s health care itself.
The profit margins made by insurers today are no higher than they were 20 years ago. It’s not like they were making 5% profit 20 years ago and now they’re making 100% profit.
Yet health care costs continue to escalate. Just check your own hospital bills BEFORE the insurer reimburses the hospital.
In fact, health care costs are outpacing both the rate of inflation and the rate of GDP growth all over the Western world, even in countries with single-payer systems.
It’s “the nature of the beast”: Aging populations, increasingly effective (but increasingly expensive) medical technology, the failure of medical research to cure many chronic illnesses, and various social pathologies.
100 years ago, treating kidney failure was cheap: You sent the patient home to die, often within a month or two. Today, my kidney failure is being treated successfully–at a cost of $90,000 a year.
Most of the progress in medicine came with the treatment of acute illness, particularly infection, which used to kill so many children–with the discovery of antibiotics and vaccines. So now we live long enough to pick up chronic illnesses, for which we have no cures, and for which treatment is very expensive: Kidney failure, heart failure, arthritis, Alzheimer’s.
14 sinz54 // Sep 19, 2009 at 8:23 pm
Chekote:
We did.
Public water fountains are free. Virtually every city in America has a municipal water supply that is paid through taxes.
And for food, there are food stamps.
15 sinz54 // Sep 19, 2009 at 8:33 pm
anniemargaret & chekote:
Health care is a finite resource. There are only so many doctors, hospitals, and clinics. So no matter HOW a country deals with health care, it has to deal with apportionment of a finite resource to a population which (for obvious reasons) doesn’t want to trade off health for something else. (Very few people will volunteer to die of cancer or a heart attack, just because their treatment would cost too much.)
In many states in America, we allocate by ability to pay, frankly. If you’re poor, you have to accept urgent care from a clinic or Emergency Room, every time you have a crisis. But if you have a disabling chronic illness like arthritis or Alzheimer’s, or you have a serious chronic illness like cancer or heart disease, you have to go begging to government or private charities.
The hard truth is that if we give EVERYONE in America the exact same level of care, we can’t make that as GENEROUS as the affluent currently enjoy without bankrupting the nation. That means that the affluent may need to accept the kinds of restrictions that the poor have lived with: Long waits; clinic type environments where you’re jammed in with 200 other people; and rationing of treatments when the chance of extending life expectancy by many years is slim. Those are the kinds of complaints you hear about the British National Health Service, for example. The NHS will simply refuse to pay more than $40,000 for any medical treatment that fails to extend a decent quality of life more than six months.
anniemargaret:
I have confronted the advocates of single-payer systems (the type they have in Canada, for example) about this many times. I have asked them if they can promise that those Americans who currently have generous health care plans that they enjoy won’t be required to accept less care or worse care, just so the uninsured can get care. They said that can’t be guaranteed.
Case closed.
16 ProfNickD // Sep 19, 2009 at 8:34 pm
Racists.
17 oldgal // Sep 20, 2009 at 10:32 am
sinz54: My insurer is non-profit and owns its own hospitals. The cost of my insurance is 20% -50% less than the other employer based options and the coverage is broader e.g. preventative care, acupuncture, psychiatry, on-line access to test results and educational material, etc. They provide an actual health care delivery system – something the claims based pay by procedure insurers have no incentive to do.
18 Chekote // Sep 20, 2009 at 11:56 am
Here is free enterprise at its best and an effective way to reduce costs and promote health:
On-Site Clinics Help Companies Manage Health Care Costs
19 sinz54 // Sep 20, 2009 at 1:08 pm
oldgal:
I agree.
But if ObamaCare provides a heavily subsidized government “public option” that can charge unrealistically low rates, then even your non-profit insurer will lose customers to the public option and eventually go out of business.
Here in Massachusetts where I live, RomneyCare created a subsidized public option, Network Health Forward. Its subsidies enable it to offer premiums of only $34 (that’s right, thirty-four dollars) a month. No private insurer, even a nonprofit one like Kaiser Permanente, could compete with that. The only reason the private insurers haven’t gone out of business is because Network Health Forward is strictly means-tested. Only the truly needy and truly poor qualify for it.
A subsidized public option is the first step toward a national single-payer system, which we conservatives firmly oppose. And that’s why we’re fighting it tooth and nail.
20 cwillia11 // Sep 20, 2009 at 2:27 pm
It is government policy that drives up health care costs, sometimes in collusion with health care providers but more often not.
21 Chekote // Sep 20, 2009 at 2:52 pm
And that’s why we’re fighting it tooth and nail.
Is that why you are fighting Sinz? I am fighting because I am afraid of “death panels”.
/sarc
22 balconesfault // Sep 20, 2009 at 6:18 pm
That means that the affluent may need to accept the kinds of restrictions that the poor have lived with
Or … they can buy policies that guarantee, or simply purchase out of pocket, better coverage.
Sheesh – such little faith in the free market!
I have asked them if they can promise that those Americans who currently have generous health care plans that they enjoy won’t be required to accept less care or worse care, just so the uninsured can get care.
Of course not. Then again, the dirty little secret is with companies laying people off, and a new wave of healthcare cost increases likely to have employers raising copays, raising deductables, raising employee contributions, accepting caps on coverage, in order to keep from insurance taking even a bigger bite of their profits – 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.
Unless you’re able to pay for medical procedures out of pocket – there are no guarantees. Although you can always use the emergency room.
23 cwillia11 // Sep 20, 2009 at 6:50 pm
A commenter mentioned Gawande’s study published in the New Yorker. This study shows huge disparities in per capita MEDICARE spending between similar communities. What the study means is that our single-payer system for senior citizens is grossly mismanaged. The problem is not fee-for-service, the problem is single-payer without any effective administrative controls over what providers do. The study by no means shows that there is a potential to save money in private medicine by employing “best practices.” The study shows that government medicine is wildly out of control due to perverse incentives.
24 anniemargret // Sep 20, 2009 at 7:39 pm
On site employer-based medical clinics? Sounds great…… truly….
…for those companies employing over 1000+ employees. Super great if you are working for Google, Microscoft or Goldman-Sachs. Are you imagining a company like my husband’s who employs about 50 employees is going to be able to offer the same? There is also a risk for any employee to break privacy laws, which could put some employees at risk, especially in ‘at will’ states.
Again….how does this address the core problem of the millions of uninsured – those who have lost their jobs? Job loss percentages are rising, not falling.
http://blogs.wsj.com/economics/2009/09/18/labor-market-pain-spreads-unemployment-rates-by-state/
The rank and file of the uninsured is rising as we speak, as well as the poverty levels, which are already straining government run Medicaid and S-CHIP. Median household income is @ $50,000.
http://blogs.reuters.com/felix-salmon/2009/09/10/the-depressing-income-and-poverty-data/
25 SFTor1 // Sep 20, 2009 at 8:23 pm
Chekote says: “Perhaps we should forbid food producers from making an eviiiiiil profit.”
The point is that a largely free market, properly regulated, works in the food industry. That has been proven over the last decades. You can disagree with some of the products the food industry makes available, but there is ample choice to obtain wholesome, nutritious food for one’s family.
The health care “market” has failed. The products have become more expensive and more limited over the track record of the health care “industry.” It has pushed the United States bill of health well down in international comparisons. We see today that health care does not work as a market. That’s the difference.
26 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.
27 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.
28 mara123 // Sep 20, 2009 at 10:01 pm
oh obama has a solution to that, just make them legal.what a joke.
29 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?
30 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?
31 sinz54 // Sep 21, 2009 at 9:52 am
oldgal:
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.
32 sinz54 // Sep 21, 2009 at 9:57 am
sftor1:
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?
33 sinz54 // Sep 21, 2009 at 10:05 am
sftor1:
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.
34 sinz54 // Sep 21, 2009 at 10:21 am
balconesfault:
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.
35 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.
36 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.
37 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.
38 Jim // Sep 21, 2009 at 11:01 am
Public goods and Constitutionally enshrined individual rights are not the same thing. Please remember that.
39 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.
40 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?
41 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.
42 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.
43 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.
44 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.
45 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.
46 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.
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