Posted on 02/14/2006 6:37:40 AM PST by Graybeard58
You can lead a horse to water, but you can't make him drink. It has been well documented that many of the estimated 45 million Americans who do not carry health insurance have access to employer-funded policies or are eligible for public programs such as Medicaid. Rather than try to solve the problem, activists condemn insurance companies as greedy or Americans in general for not caring about the downtrodden.
Now comes a discouraging report from a coalition of employers that sought to bring insurance coverage to contractual, part-time and temporary workers who do not qualify for polices offered to full-time employees. Of more than 900,000 workers eligible for coverage under the National Health Access program, only 5,726 signed up, according to a Feb. 8 Wall Street Journal article. Most of the rest had coverage from another source, such as a spouse, but nearly 15 percent chose not to participate even though they had no other insurance options.
Some personnel managers attributed the lack of interest to the complexity of the employer group's offerings, the Journal said. Companies that required supervisors to discuss the program personally with eligible workers got a better response than those who simply mailed out forms and booklets.
To become attractive to low- and middle-income working people, such policies need to be inexpensive and comprehensive enough to overcome young, healthy workers' temptation to risk going without coverage. Premiums for National Health Access ranged as high as $390 per month and might go higher because of the low response.
"The free-market model does not work in providing health care," writes Mary E. O'Brien, M.D., of New York, in an op-ed column for Knight-Ridder/Tribune. This perspective might be credible if a free market actually existed.
Connecticut, for example, trails only Maryland and Virginia in mandating insurance coverage of specific treatments and procedures, according to Peter Gioia, an economist with the Connecticut Business and Industry Association. Typically, such mandates are imposed not because of public outcry, but because lobbyists promote the mandates on behalf of their well-heeled clients in the care-giving professions. Public-employee unions contribute to the problem by using mandates to fatten their contracts. Connecticut has more than 50 such mandates that inflate the cost of medical insurance.
The National Health Access program, supported by such giants as General Electric and IBM, shows the private sector is trying to put a dent in the ranks of the uninsured. But America will not be able to harness the enormous problem-solving power of the free market until government gets out of the way and lets the customers -- private-sector employers and their workers -- make their own decisions on coverage.
I suspect that an honest evaluation of why health care is so expensive would show that Government Spending in health care is the biggest contributor to the rise in its cost.
It's a complicated matter. The more insurance people have (private, government, or otherwise), and the easier it is to have medical treatment paid for, the more the cost goes up.
It seems like docs these days run every test they can, both because they want the insurance money for the tests, and because someone will sue them if they didn't do everything imaginable.
Case in point; my local doc-in-a-box always does a pulse oximetry on every patient. Even if they just have a splinter. It's 60 bucks to them, and it takes 5 seconds with no costs. Insurance will pay for it, so what's the problem? If they see 100 patients in a day, that's an easy 6,000 bucks extra income for the clinic. Who pays for it? I do, along with everyone else who has insurance.
Has ANYONE determined the price point people are willing to pay?
Seriously what is a working NORMAL family or single person willing to pay per month? $100 per month or $1000 per month? How much co pay?
As always the government is going at this in SNAFU style.
You're right. As long as insurance is something that "someone else" pays for, instead of an out-of-pocket expensive, people will have no incentive to economize their spending. The only difference is that private-sector insurers *do* have an incentive to reduce costs, while government programs ("Megacaid") are not punished for their failures. Very often, they are rewarded with larger budgets.
That only works if you're on Medicaid and/or Medicare. If you're a working person but don't have five grand lying around to pay the hospital, the radiologists, the pathologists, the ER doctors, and any other specialists who might have part of your care, you will be very sorry you went to the emergency room for help. They will ruin your credit rating.
"...the root of the problem is that we have overinsurance"
Exactly. Many employer-subsidized health insurance policies have extremely low deductibles and co-pay provisions, which greatly increase the demand for medically unnecessary office visits and test procedures. When an office-visit co-pay is $20 - or less, in some cases - parents drag their children to the pediatrician for a minor sore throat or runny nose. And the doctors oblige the parents by prescribing ointments, vaporizers, and even antibiotics for a cold virus, all paid ultimately by others in the insurance pool through rising premiums.
I see it all the time, parents who have health insurance covering themselves put their kids on medicaid. Taxpayers need to just say no!
I study this stuff for a living. The problem with "affordable" health care is that when you're sick, you don't want affordable health care--by God, you want that MRI, you want that neurologist to be able to pop your skull and get out that necrotic glioblastoma, you want the latest radiation and chemo protocols, the latest drugs and equipment and the smartest doctors. Cutting corners is okay for some anonymous patient, but when we're sick we all want the best.
Part of the reason our health-care costs have gone up is that our standards for acceptable care have gone up. Forty years ago, if you had a chronic headache and went to the doctor for it he'd recommend that you take some aspirin and relax. There was not that much he could do, and you had to just accept that and suffer. Today you know or hope that something definite can be done for your pain so you may well agree when your doctor orders a CT scan, and if that doesn't pay off a costly MRI, and so on. They'll keep the cash register ringing while they try to fix your problem, and they have a lot of treatment modalities at their disposal.
And of course, somebody has to pay the hospital that spent a million bucks on a new piece of machinery. The company that developed that machine has to be compensated for the research costs involved in developing it and bringing it to market. And they all have to be compensated for their ENORMOUS insurance premiums because somebody will sue them if there is a medical outcome that's not absolutely perfect!
Single Insurance, I'm sure.
4,700 per year, 24,000 for 5 years. Money down the DRAIN if nothing happens. I'd take my chances.
So, because government spending on health care causes providers to jack up prices to take advantage, you get a situation where no one can afford health care if they don't have insurance. But premiums are getting jacked so it's harder and harder to afford insurance. So the Government steps in and coerces a) people to have insurance, and b) insurance companies to charge less which of course means they are willing to pay for less.
We shouldn't ignore the coming of the myriad maintenance medications and the rise of (Mommy, mommy!) advertising for prescription medications that make the patients go and harass their doctors for scripts.
I haven't noticed this lately. At one time yes, but now the doctors do the testes the insurance companies will allow them to do and no more.
Americans want three things when it comes to health care: (1) freedom to pick their doctors and specialists, (2) health coverage for everyone in the country and (3) low cost.
We can only have two of these things at a time.
No matter what hospitals charge, Medicare and Medicaid pays for it. Medicare, despite the costs has, strained the capacity of hospitals, with it's beneficiaries showing up at ER with every sniffle. The costs are not seen by the end users because it is "covered" by insurance etc. Only when you see the real costs do you get an idea of the massive scale of theft involved.
I would flip though my elderly mother's bills that went to Secure Horizons. It was unbelievable. There were always expensive and uncalled for procedures. I am guilty for not raising a stink.
Last year, I got to see it even closer on my own. I had some radiology work done, followed by surgery. I had some free time while recovering and checked, just for grins, the cost of equipment used on me. I could have literally bought all of the equipment second hand and built a room for less than what the hospital charged me. I could have rented a suite at any five star hotel, bought all needed equipment and hired a private nurse for less than the price of a hospital bed. I was quadruple charged for the procedure by the radiologist and hospital. The billing was all done in vague billing codes so you don't even know what you are being charged for.
Health care was once affordable -- Not cheap but affordable. Health care costs are what they are because it has been removed from the free market by regulations and subsidies like Medicaid. Lawyers don't help much either. If any other industry was run this way, the perpetrators would be in jail but for hospitals, we call it non-profit.
That's what I meant by over-insurance. The patients are insured for a pulse oximetry, so they get it. They don't need it, but insurance pays for it. So then the cost of insurance goes up. And then a lot of people can't afford insurance.
Of course, you DO have to pay for it. If you are employed and receive it as a "benefit", your employer calculates it as a cost of employing you so it is in effect part of your pay (labor cost). If you buy anything, part of the product cost and tax goes to health care expenses for the producer and the government. If you are involved in any kind of monetary exchange, part of the money finds its way into health care. Everything is interrelated.
Among the cost drivers is complexity. If you buy a wrench at the hardware store, you exchange money with the storekeeper for the wrench. If you buy health care, you pay a copay to the provider's office. That office employs people (costing labor dollars) to manage the payment and collect the remainder from your insurance provider, who is paid by your employer. All these extra people and accounting systems cost money -- the complexity of the system drives costs.
Also driving costs is the legal profession. Although not providing health care, they drive cost by ensuring that health care providers manage excessively high levels of documentation, conduct excessive testing, err on the excessive care side (defensive medicine), and reduce care quality because providers avoid decision making in situations of uncertainty. This requires extra staffing and management systems. Insurance costs are high and good health care providers are often distracted from practice by legal challenges.
We have excellent health care in the U.S. However, it could cost less than it does. If you paid for your routine care and insured yourself for catastrophic events, your health care costs would be LESS than you pay now.
About 15 years ago I had a colostomy and 9 months later was reconnected. Since that time I have had 4 hernias repaired that were directly the result of the surgery.
The real problem however is that 2 times I have been to the emergency room because of partial bowel obstruction steming from scar tissue as a result of the original surgery. There were no other options available since the onset of pain happened both times on a Sunday night.
My surgeon will not operate to remove the scar tissue because he says it would most likely cause even more scar tissue than I already have and my obstructions would likely be more frequent than the 2 I have had in the past 15 years.
When the pain hits me it's almost more than I can stand, I live with a certain amount of fear that it will happen again and when it does I will be at the emergency room again for what is essentially pain control. I can also be certain that the emergency room doc will insist on xrays and my drinking that putrid barium mix and having a ct scan.
I already know what he will find as a result of those tests, what I need and need immediately is the I.V. injection that will give me blessed relief until the blockage clears, which it always does within 4 to 8 hours.
Why not prescribe that narcotic injection for me to have with me and I will give it to myself when neccessary?
It would save the insurance company thousands and give me a little peace of mind.
I know I pay for it, I simply meant that I don't pay for it directly. It's part of my compensation. If I didn't have it then in theory I might be paid more as direct compensation.
If I dont insure my car I'm not allowed to drive it, If I dont insure my health... Something here is really messed up.
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