Why our Healthcare is so Expensive

[Nymeria Sand]

I'm with you here, there are hospitals that are true non-profits, and ones that aren't. I know I took that into account when I was looking for an employeer. Lots of shady dealings out there. Still lots of good work done too. This just illustrates the fact that we don't have a defined healthcare system, rather many small and medium ones that both compete against and help each other depending on the situation at hand. I would recomend only doing buisness with a hospital that has a platform you agree with, but unforunately that isn't always possible. Most people don;t look at hospitals at all, they really don't bother.

Very true, and here, a lot of people don't have a choice. UPMC is metro Pittsburgh's largest employer. More than 50,000 people work there. What choice do they have? If they quit, they might have a really hard time finding a job in their field.

We know that they don't apply under the current health care model. I doubt that the assumption your making here would hold up under a system such as the author of the article outlines. I find your statement here about informed customers to be silly btw.

In the 1970s they thought wage and price controls were a good idea until they didn't work.

I think they were going to enact wage and price controls in health care, but it didn't happen. Everyone from the AMA to the insurance companies to the unions objected to it.

In some states Blue Cross/Blue Shield operates as a not for profit and doesn't operate any differently then for profit companies. IIRC BC/BS of Michigan was a not for profit when I lived there and most people I knew said it was the worst insurance you could have.

It's certainly for-profit here no matter what their tax status says. The local company, Highmark, posts hundreds of millions in profits every year.

http://www.pennlive.com/midstate/index.ssf...patriotnew.html

Ignore the part about their profits shrinking. That's still an obscene amount of money considering they're supposed to be non-profit. Highmark's surplus at the end of 2008 was $3.1 billion, down from $3.5 billion.

Are we supposed to cry them a river?

They were also going to buy out one of the big Philadelphia insurers. Can you say "monopoly"? I don't know if they did, though.

[Guest Raidne]

Brick - the US is a capitalist society. We tend to think "profit", not the "common good". And thank god for that.

Chats, I appreciate your point in general way, but in response to a post about why we don't expect better returns from our government on our tax dollars, it doesn't really make any sense.

Is anyone pretending that what we have now with health insurance is a capitalist system? That's crazy. I believe that as a federal employee I have more health care options than most people, but they are not limitless. Additionally, I have a law degree and I find it difficult to sort through the small print, as, try as you might, even it doesn't include all the necessary information. You have to pick up the phone and call these people to really get answers about what their plan offers. It's very time-consuming, and you have to learn the basic vocabulary to even get started, and that vocabulary might vary depending on whether you're looking at a PPO or HMO or whatever. Most people have even fewer options through their employer - maybe, what, three? It's hardly like buying a car, or even buying car insurance.

So, there's not any real free choice, and limited ability on the part of the consumer to make informed choices about the product. What's capitalist about that? It capitalist at the employer's level, where they are choosing what plans to have available, but it isn't a capitalist endeavor from the POV of the consumer.

Having health care tied up with your job is inherently fucked up, IMO. You can't even make an argument for capitalism in health care as long as that's the case.

Personally, I think all people should have a base level of health care funded by the federal government, and then people should be able to purchase supplemental insurance from private companies operating in a free enterprise environment, divorced from your employment. That covers everyone's basic needs, while still keeping an American character to our health care system. And we should keep the health care savings accounts. Those are fantastic.

[Happy Ent]

Having health care tied up with your job is inherently fucked up, IMO. You can't even make an argument for capitalism in health care as long as that's the case.

This is an interesting point that I’m surprised doesn’t figure larger in the American debate.

Having health care tied up with your job makes the job market extremely inflexible. So even callous, heartless bastards who don’t give a flying fuck about the plight of those who can’t afford health care should understand that Universal Health Care helps unbridled capitalism because it enables a hire-and-fire labour market. That’s a Good Thing for a callous capitalist. You can support UHC and be slightly evil; while job-based health insurance is pure socialism.

[Nymeria Sand]

Having health care tied up with your job is inherently fucked up, IMO. You can't even make an argument for capitalism in health care as long as that's the case.

Personally, I think all people should have a base level of health care funded by the federal government, and then people should be able to purchase supplemental insurance from private companies operating in a free enterprise environment, divorced from your employment. That covers everyone's basic needs, while still keeping an American character to our health care system. And we should keep the health care savings accounts. Those are fantastic.

And I could go along with this. That way, if you lose your health coverage through your private insurance, for whatever reason, you still have something to fall back on. Kids can still get their shots and physicals. Adults can still get whatever preventive tests (Paps, mammograms, PSA's, whatever) they need done. And the insurance companies could get away with offering less. That would be for more catastrophic illnesses and such.

Employer-based health insurance has outlived its usefulness. It was a way for employers to attract employees after WWII, and it's now part of the national psyche.

[White Walker Texas Ranger]

Yes, and fire-fighting as private pay-to-use services was replaced by public-funded service for all citizens once people realized that some things are better handled by shared cost of risk.

That's not the best example. Firefighting works as public good because it works as an economy of scale; the cost of expanding the coverage by one more house is relatively low. That's not true for healthcare.

[Shryke]

That's not the best example. Firefighting works as public good because it works as an economy of scale; the cost of expanding the coverage by one more house is relatively low. That's not true for healthcare.

Um .... yes it is.

[TrueMetis]

That's not the best example. Firefighting works as public good because it works as an economy of scale; the cost of expanding the coverage by one more house is relatively low. That's not true for healthcare.

Except that all of the countries with public healthcare show that this is exactly the case. Public healthcare is cheaper and at least as effective as private usally more so.

[White Walker Texas Ranger]

Except that all of the countries with public healthcare show that this is exactly the case. Public healthcare is cheaper and at least as effective as private usally more so.

I'm not saying we shouldn't do it, I'm just saying that's it's going to be a lot harder than setting a fire department.

I am in favor of a single payer system.

[TrueMetis]

I'm not saying we shouldn't do it, I'm just saying that's it's going to be a lot harder than setting a fire department.

I am in favor of a single payer system.

A two tier system would be better because Americans really hate paying taxes.

[Annelise]

A two tier system would be better because Americans really hate paying taxes.

:lol:

“Death and taxes and childbirth! There's never any convenient time for any of themâ€.

[Laron]

Having health care tied up with your job is inherently fucked up, IMO. You can't even make an argument for capitalism in health care as long as that's the case.

Question from an ignorant foreigner:

If an Employee develops a severe medical condition, wouldn't he/she be in great danger of being fired and losing health insurance? Does this happen frequently, or are there any kind of safeguards?

[Nymeria Sand]

Question from an ignorant foreigner:

If an Employee develops a severe medical condition, wouldn't he/she be in great danger of being fired and losing health insurance? Does this happen frequently, or are there any kind of safeguards?

I don't have any stats on that, but I'm sure it does happen. There is the Family and Medical Leave Act, through which you can take unpaid leave if you're sick or need to care for a family member. Your insurance may or may not be paid for that amount of time, though.

If you are fired and lose your insurance, there's COBRA. But that is ridiculously expensive--so expensive that most people don't even bother with it. Here's some info on that:

http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

Q16: If I elect COBRA, how much do I pay?

When you were an active employee, your employer may have paid all or part of your group health premiums. Under COBRA, as a former employee no longer receiving benefits, you will usually pay the entire premium amount, that is, the portion of the premium that you paid as an active employee and the amount of the contribution made by your employer. In addition, there may be a 2 percent administrative fee.

If I needed COBRA, it would cost me $1,000 a month plus 2% administration fee. How many people can do that when they have no income? Most of us don't have savings, and even those of us who do couldn't afford that. That's twice the mortgage or rent payment.

[14th Dragon]

It's really better for all, over time :) IMO.

Brick clearly has his or her own opinions, which vary. I just wanted to point out that some societies value different things, and that neither is wrong, nor better than the other. Saying that one is better than the other depends upon one's perspective.

I would disagree, in so much as for it to actually be benefit you have to start at the assumption that competition is going to force a change to the better. The competition forcing everyone to do thier best. Unfortunatly as we have repeatedly seen, competition also invariably brings out the worst in people. It will also encorage short-cuts, and nasty buisness practice, if not out right illegal behavior in order to improve the bottom line.

Now I am not terribly enthusased about the prospects of a US single payer system simply because of the politics of it. The only way it would work is with some bottom line thinking price controls. Otherwise with our current demographics there is absolutly zero way the healthy individuals would be able to cover the expenses of the unhealthy. The ratio is not a favorable one. But given teh size and importance of the +65 crowd as a voting block any sort of price contorls would be killed in a hot second. Look at the racous over the possibilty of setting up an indepenent review of the effectiveness of treatments.

The problem with governemtn health care IMO, is that it is being run by a group of people that are beholden to voting blocks and campaign donors. Which means that the general population will get screwed. Same reason that public education is so screwed up.

[Guest Raidne]

Question from an ignorant foreigner:

If an Employee develops a severe medical condition, wouldn't he/she be in great danger of being fired and losing health insurance? Does this happen frequently, or are there any kind of safeguards?

I have an example for you - my friend's father was a senior attorney at a reputable firm with a high-paying job. She grew up fairly wealthy. Then, he had a pretty severe stroke, that he has, thankfully, mostly recovered from. Nevertheless, he was unable to continue on at his old job. He lost his job, and thereby most of his insurance (I think he kept some minimal amount for awhile through his severance package). His care bankrupted the family. My friend, who thought she'd be going to Stanford, like her father, ended up going to whatever school she could get a scholarship at. Her parents still have to disclaim inheritances and other gifts so they get passed on to her and not seized by their creditors.

There are no safeguards. You're employer cannot terminate you for taking your FMLA leave, but that is only 6 months (and the leave is unpaid). You might have disability insurance, or some other measures set up, but you have to have the foresight to pay extra for that, and, as is clear in my friend's father's case, it doesn't do much to cover catastrophic medical bills.

Yet another reason why it is absolutely brainless to have our health care tied up with our employment. It only lasts for as long as you keep the job.

If it's not too personal, I would like to ask Chats and others like her why they are so sure this couldn't happen to them. My friend's Dad had 8 months salary in savings, a half a million dollar house, all the right coverage. What is there to prevent this from happening to you?

And I won't even get into what health care costs have done to GM.

[Annelise]

The problem with governemtn health care IMO, is that it is being run by a group of people that are beholden to voting blocks and campaign donors. Which means that the general population will get screwed. Same reason that public education is so screwed up.

How do you feel about non-profit co-opts providing the competition? Because that appears to be the direction we are heading in.

*********************

On the personal front...

Called our GP, left a message inquiring about a medical necessity letter to appeal the insurance company's denial on our tests. He calls back and asks what's going on. So I tell him that it's not a covered benefit and he asks if we've been feeling tired and so on. I reply, "Sure?" And he says they will resubmit the claim under a different code and to call them back if it's denied again.

Hubby was prescribed 6 sessions of PT as part of the investigation into his 20+ year chronic back pain. The PT calls us back saying our deductible is quite high, did he still want to come? Now, turns out that his company set the high deductible on purpose because it's cheaper for them to reimburse us for 80% of said deductible once we reach our 20% of it.

[Elrostar]

I remember hearing an interesting thing about how back when the unions were negotiating with GM and the other big automakers about benefits (in the 50s), the unions really wanted to push for universal coverage. The idea of employer-based coverage was sort of a make-shift solution which was what was reached because the big three were so desperately opposed to having 'socialized health care'.

But the strategy of the unions was to push for more and more concessions from the employers until eventually the CEOs would pressure the government to get some kind of nationalized system, since it would be obvious that an employer-based system was untenable in the long run and was counter to their own interests.

However, because the CEOs weren't ultimately concerned about the long run (I guess), they were willing to give in to these demands again and again, rather than worry about long-term reform, which is what led ultimately to the companies' downfall.

Just an interesting side-note.

[Jaime L]

Yeah, I think it's not only absurd we associate our healthcare with our employment, but that the current winds out of Washington indicate a desire to double-down on this and make it mandatory for employers to provide healthcare to their employees.

For chrissakes, get healthcare out of business. Even beyond the obvious argument that tying healthcare to employment creates a scary high-wire act without a net for anyone happening to be unemployed at any moment (i.e.: 16% of the country right now), there's a million and a half pure business reasons why it's stupid, most glaring of which, it forces company to waste time and money on something outside of its core business. Let's stop imposing another level of administrative costs on companies. Let's stop building middlemen into our system at every turn. Billing specialists at doctor's offices, claims evaluators at insurance companies, HR benefits professionals at companies...it's like the administrative assistant full employment act. And none of it's necessary. None of these people are contributing anything in the way of value to our economy, and through its existence and inefficiency, actually take jobs away from businesses that run less smoothly due to administrative bloat.

I just want to see one intellectual honest argument emerge from the right or one shred of political courage from the left.

[14th Dragon]

How do you feel about non-profit co-opts providing the competition? Because that appears to be the direction we are heading in.

You the worst of both worlds. An entity with niether bargining or regalatory power? It is a ridculas concept centered around how can we extend coverage without addressing why coverage was short in the first place.

At this point I think the only way to make this work is get a bunch of just retired doctors/adminstators/health care providers etc, maybe an economist or two and have them write this legislastion in a secret bunker. Then just have yes/no votes on them. When we get to one with 70% yes. Then we enact that and call it good.

I hate the phrase, with a passion, if we starting from scratch we would do... Well why are we not starting from square one? Instead the argument is always we cannot start from square one since there is too much investment into it. Well anyway you play it, someone is getting screwed. Right now it me and my children that are going to take it head 15-20 years down the road here. So lets start with some clean sheet stuff, wipe the whole board clean and start over. We might need some provisions for those who are going to have the deal changed, but I think a fundmental redesign is absolutly neccesary.

[Nymeria Sand]

You the worst of both worlds. An entity with niether bargining or regalatory power? It is a ridculas concept centered around how can we extend coverage without addressing why coverage was short in the first place.

At this point I think the only way to make this work is get a bunch of just retired doctors/adminstators/health care providers etc, maybe an economist or two and have them write this legislastion in a secret bunker. Then just have yes/no votes on them. When we get to one with 70% yes. Then we enact that and call it good.

I hate the phrase, with a passion, if we starting from scratch we would do... Well why are we not starting from square one? Instead the argument is always we cannot start from square one since there is too much investment into it. Well anyway you play it, someone is getting screwed. Right now it me and my children that are going to take it head 15-20 years down the road here. So lets start with some clean sheet stuff, wipe the whole board clean and start over. We might need some provisions for those who are going to have the deal changed, but I think a fundmental redesign is absolutly neccesary.

Well, this is water under the bridge, but speaking from professional self-interest, had public health not dropped the ball and allowed private companies to take over our turf, health care in the US would look very different. The problem was a lack of funding from state and local governments combined with a refusal on the part of doctors to treat those who couldn't pay. (Hence, the modern insurance system was born.) We focus on prevention and health promotion. We focus on ALL people as recipients of care, not just a select few. We have a world or community view of public health because it's recognized that the health of the population as a whole is more important than that of a few. It doesn't take much to get an entire community sick, and this is what we try to prevent. OUr health care system focuses on disease treatment and does nothing to prevent people from getting sick in the first place.

Any reform of the health system has to have disease prevention and health promotion at its core.

Just my two self-promoting cents. :)

[Iskaral Pust]

If it's not too personal, I would like to ask Chats and others like her why they are so sure this couldn't happen to them. My friend's Dad had 8 months salary in savings, a half a million dollar house, all the right coverage. What is there to prevent this from happening to you?

I hope everyone here has some very good long term disability (LTD) insurance, even if you have to pay for it privately. This is must-have insurance. Your chances of disability that impairs your earning potential and requires significant medical costs is much, much higher than you realize - trust an actuary on this. Buy this before you buy term life insurance if necessary.