A rational discussion about what is wrong with our healthcare system without the politics. (unemployment, interviews)

[nicet4]

I would agree there is one area of health insurance that needs to be addressed and that is those that have preexisting conditions that make it impossible for them to purchase health insurance at any price. That said the problem of preexisting conditions could be solved by simple regulatory changes such as open enrollment periods.

But in examining the problem you first need to get some numbers right.

The Census Bureau puts the number of uninsured at 45,657,000 people.

9.7 million of the 45.7 million uninsured are “not a citizen.” That makes every media claim of uninsured Americans higher than 35.9 million is wrong. I am sorry some people who broke the law to enter the country are uninsured but that should not be a problem if the government did its job correctly with deportation.

The liberal non-profit Kaiser Family Foundation put the number of uninsured Americans who do not qualify for government programs and make less than $50,000 a year between 8.2 million and 13.9 million. (The 8.2 million figure includes only those uninsured for two years or more.)

Twenty percent of the uninsured have family incomes of greater than $75,000 per year, according to the Census Bureau. But this does not necessarily mean they have access to insurance. Even higher-income jobs don’t always offer employer-sponsored insurance, and not everyone who wants private insurance is able to get it.

Many of the uninsured can afford private health insurance but simply choose not to pay it. About 9.1 million of the uninsured have household incomes greater than $75,000, and 10 percent (about 4.7 million) make more than 400 percent of the federal poverty threshold, according to KFF. In 2007, the most recent year of Census statistics, a family of four at 400 percent of the poverty level would have a household income of $84,812 or more.

Forty percent of the uninsured are young, according to KFF. But speculation that they pass up insurance because of their good health is unjustified. KFF reports that many young people lack insurance because it’s not available to them, and people who turn down available insurance tend to be in worse health, not better, according to the Institute of Medicine

First we have the young with represent 40% of this group.

They can purchase insurance easily enough at costs lower than most might think.

They are relatively healthy and don't need insurance to cover every doctor visit or prescription. With planning this group could use a high deductible insurance that doesn't cost an arm and a leg.

We will use Kansas City as an example of what would (should) be affordable for most everyone if only they gave up box wine and cigarettes.

Zip code 66103 using a High Deductible Health Insurance Plan found a this site (just an example).

A single woman age 25 who does not smoke can purchase a HSA 100 plan that has a $5,000 deductible for just $79.06 per month.

Initial Rate Guarantee 12 months (subject to benefit and address changes)
Room & Board, Intensive Care Unit, Operating Room 100% after deductible
Professional Fees of Doctors, Surgeons, Nurses 100% after deductible
Surgeon, Assistant Surgeon, and Facility Fees 100% after deductible
Hemodialysis, Radiation, Chemotherapy 100% after deductible
Cat Scans, MRIs 100% after deductible
Outpatient X-ray and Lab 100% after deductible
Doctor Office Visit Fees 100% after deductible
Outpatient Prescription Drugs 100% after deductible
Mammography, Pap, PSA Tests 100% after deductible

Counting the deductible her total costs for one year, if would $5,948.72 per year (this includes premium payments( if everything went wrong.

If she doesn't like the high deductible she could go with a $1,200 deductible for just $117.63 per month. If everything went wrong her total costs for the year would be $2,611.56 which includes the cost of monthly premiums.

For a young male it would be just $70.39 per month for the $5,000 deductible or $145.59 per month for the $1,200 deductible. For a smoker it would be $95.02 per month for the $5,000 deductible or $196.55 per month for the $1,200 deductible. If he sees the $196.55 as high perhaps he should consider giving up smoking?

For the age 30 and less group the worst it would be is $77.13 per month with the $5,000 deductible and $160.05 for the $1,200 deducible. This is considered "to high a price"? I don't think so considering most spend more than $77.13 per month for a cell phone.

How about that high deductible? How often would you expect someone under 30 to get sick costing over $1,200 per year? Very few. Go with the higher deductible and save the difference in premium costs of $82.92 per month and in five years you would have $4,972.52 set aside to meet a medical catastrophe should one happen.

The way I see it there is no reason whatsoever (save preexisting conditions which I will address) for anyone under age 30 to be uninsured.

As you get older costs go up.

$339 per month purchases a plan, covering both husband and wife at age 40, that has a $10,000 deductible that offers the following:

Maximum Family Deductible per Calendar Year One
Coinsurance Out-of-Pocket After Deductible, In-Network per Year Per family
Lifetime Maximum $3 million per covered person
Initial Rate Guarantee 12 months (subject to benefit and address changes)
Room & Board, Intensive Care Unit, Operating Room 100% after deductible
Professional Fees of Doctors, Surgeons, Nurses 100% after deductible
Surgeon, Assistant Surgeon, and Facility Fees 100% after deductible
Hemodialysis, Radiation, Chemotherapy 100% after deductible
Cat Scans, MRIs 100% after deductible
Outpatient X-ray and Lab 100% after deductible
Doctor Office Visit Fees 100% after deductible
Outpatient Prescription Drugs 100% after deductible
Mammography, Pap, PSA Tests 100% after deductible

If the $10,000 deductible scares you then select the plan with a $3,800 deductible that ups your premium to $565.01 per month.

Personally, if both are healthy, I would opt for the $10,000 deductible savings $226.01 per month or $2,712.12 per year and in just 5 years you would have $13,560.60 set aside for any future catastrophe should one happen.

9.1 million of the uninsured earn more than $75,000 per year and in my mind they are living beyond their means if they can't cough up the $339 a month (representing a maximum of 5.4% of their total income) it would take to get private insurance.

Well over HALF of the uninsured could easily solve the uninsured problem just by paying for their own care and not waiting for the God King Obama to pay it for them. Actually it would be more accurate to say waiting for the God King to force someone else to pay it for them.

I guess the question comes down to costs.

Take a Chicago family of four where parents are each 43 years old and have two children age 14 and 11.

There premiums would be $354.53 per month for a plan with a $10,000 deductible. $81.87 per week which is what my wife and I (we both work) spend on lunch during the course of a work week.

This, in my mind, is not a whole lot of money. Yeah, it sucks but is very doable.

If you have a problem with the high deductible you could opt for a plan with a $2,500 deductible for $939.03 but what would be the point? Why pay an additional $584.50 per month totaling an additional $7,014.00 a year on the off chances of avoiding $7,500 in deductible? It simply does not make any economic sense not to take the gamble of saving $7,014.00 for just one year and be ahead of the game.

For $354.53 per month this doesn't appear to be a bad plan considering a family of four.

Standard Benefits
Maximum Family Deductible per Calendar Year One
Coinsurance Out-of-Pocket After Deductible, In-Network per Year Per family
Physicians (Illness & Injury)
Office Visit - History & Exam (Primary Care or Specialist, in-network only) No charge after deductible
Primary Care Physician / Specialist Referrals Required No
Prescription Drug
Prescription Drugs(Generic/ Brand/ Non-preferred Brand) Preferred price card - no charge after deductible (You pay for prescriptions at the point of sale, at the lowest price available, & submit a claim to Golden Rule.)
Annual Maximum (covered expense, per person, per calendar year) $3000 (No Annual max. plan enhancement available)
Wellness/Preventive Care
Doctor Office Visit (adult or child, in-network only) $35 copay (3 month waiting period, not subject to deductible)
X-ray & lab (in conjunction with the preventive office visit, performed in the doctor office or a network facility) You pay: $0 (3 month waiting period, not subject to deductible)
Child Immunizations (0-18) You pay: $0 (3 month waiting period, not subject to deductible)
Preventive Mammogram, Pap Smear, PSA screening You pay: $0 (no waiting period, not subject to deductible)
Outpatient Expense Benefits
X-ray & lab (performed in the doctor office or a network facility) No charge after deductible
Facility/Hospital for Outpatient Surgery No charge after deductible
Surgeon, Assistant Surgeon, & Facility Fees No charge after deductible
Hemodialysis, Radiation, Chemotherapy, Organ Transplant Drugs, & CAT Scans, MRIs No charge after deductible
Emergency Room Fees - Illness No charge after deductible
Emergency Room Fees - Injury No charge after deductible
Spine & Back Disorders (CAT scan & MRI tests are not subject to this limitation) No charge after deductible (Limited benefit)
Mental & Nervous Disorders (including substance abuse) No charge after deductible (Limited benefit)
Other Outpatient Expenses No charge after deductible
Inpatient Expense Benefits
Room & Board, Intensive Care Unit, Operating Room, Recovery Room, Prescription Drugs, Physician Visit, & Professional Fees of Doctors, Surgeons, Nurses No charge after deductible
Other Inpatient Services No charge after deductible

It appears to me a lot of the problem with the high cost of insurance is the unreasonable low deductibles people sign on to without digging out the pocket calculator and doing a little math.

My wife and I have a high deductible ($10,000) but by simply taking the difference in costs between the high and low deductible by simply saving the difference for just two years we would always be ahead of the game.

But there is a problem and that is the problem of the preexisting condition.

Yes, this is a huge problem and don't say it could not happen to you. Have a heart attack, or breast cancer, at age 42 and see how screwed up your life is. Could happen to any of us and this is where we need to focus our cure for the problem.

I would be for an open enrollment with the government subsidizing the cost to the health insurance companies.

[PurpleLove08]

Instead of having the government subsidize health insurance, I'd be open to having a single-payer system or something like the German system. I am a bit leary of the German system because employers are still responsible for a lot of the premiums. If we ARE going to have the government subsidize health insurance, health insurance companies need to be not for profit. I don't want government funds helping health insurance CEOs reap outrageous salaries. Anything over a million is outrageous.

As for a "fair monthly premium" for a family of four, I think 400 should be acceptable with a $10,000 deductible. I know for a lot of people $10,000 is a huge deductible. I'm fine with paying around $100-175 for a monthly premium with a limit of my annual out of pocket costs being $5,000.

While I liked your little quotes, most people know it is just that: A QUOTE. Once the health insurance company digs around into your medical history, they'll jack the monthly rate up. They'll also jack it up if you end up getting a costly illness.

[nicet4]

Originally Posted by PurpleLove08

Instead of having the government subsidize health insurance, I'd be open to having a single-payer system or something like the German system. I am a bit leary of the German system because employers are still responsible for a lot of the premiums. If we ARE going to have the government subsidize health insurance, health insurance companies need to be not for profit. I don't want government funds helping health insurance CEOs reap outrageous salaries. Anything over a million is outrageous.

You don't control costs by artificially capping salaries. How you do it is with open competition such as allowing insurance companies to sell across state lines.

We have recently heard about outrageous increases in premium costs in California. Why are costs going up in California? The answer is because they can.. there is no competition which could be solved simply by allowing portability across state lines.

Yes, we Americans pay more for our medical care system than any other country on the planet but we get more too.

From Stanford University:

Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Are we really willing to trade lower premiums for a 52% higher mortality rate for a German style single payer system? 52% is not an insignificant number.

Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

And here is the big one:

Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

We pay more but but we lead the world and that costs money.

As for a "fair monthly premium" for a family of four, I think 400 should be acceptable with a $10,000 deductible. I know for a lot of people $10,000 is a huge deductible. I'm fine with paying around $100-175 for a monthly premium with a limit of my annual out of pocket costs being $5,000.

Depending on your age $100 to $175 a month sounds fair and when you compare the added cost to lower deductibles it just doesn't make sense to go with the higher priced product.

While I liked your little quotes, most people know it is just that: A QUOTE. Once the health insurance company digs around into your medical history, they'll jack the monthly rate up. They'll also jack it up if you end up getting a costly illness.

Again it needs to be regulated and the market opened across state lines.

We also need tort reform. It isn't the malpractice insurance that is causing costs to skyrocket it's the added procedures that are not medically necessary but the doctor uses to cover his rear end.

[PurpleLove08]

Originally Posted by nicet4

You don't control costs by artificially capping salaries. How you do it is with open competition such as allowing insurance companies to sell across state lines.

We have recently heard about outrageous increases in premium costs in California. Why are costs going up in California? The answer is because they can.. there is no competition which could be solved simply by allowing portability across state lines.

Yes, we Americans pay more for our medical care system than any other country on the planet but we get more too.

From Stanford University:

Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Are we really willing to trade lower premiums for a 52% higher mortality rate for a German style single payer system? 52% is not an insignificant number.

Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

And here is the big one:

Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

We pay more but but we lead the world and that costs money.



Depending on your age $100 to $175 a month sounds fair and when you compare the added cost to lower deductibles it just doesn't make sense to go with the higher priced product.



Again it needs to be regulated and the market opened across state lines.

We also need tort reform. It isn't the malpractice insurance that is causing costs to skyrocket it's the added procedures that are not medically necessary but the doctor uses to cover his rear end.

Germany doesn't have a single-payer system. It helps if you know the facts.

As for competition among health insurers, it won't lower costs. There is a reason that big companies do better. They can negotiate lower prices with hospitals, doctors, etc because of the number of people they represent. Have you ever heard of economies of scale? This is why single-payer can offer much more savings because it's just one payer. You cut out all the administrative waste that goes on with multiple companies.

Why More Competition Won’t Fix Healthcare - Rick Newman (usnews.com)

^^^^^^^^^ Have fun.

I'm fine with a higher deductible plan when I'm younger. I hope to obtain a well paying job that enables me to save for future health care costs. We have to keep in mind those that don't make enough to save money for health care or can't afford health insurance. We also have to keep those with a chronic illness in mind. High deductible plans don't really work for them since they'll be going to the doctor a lot.

If anything, we need more competition among hospitals and doctors. Who can provide the best care at the cheapest price?
Increases in the prices hospitals and doctors charge are what drive the increases in health insurance. Getting away from fee for service would help a lot.

[Boompa]

One in five dollars in our economy goes to Health Care, of that 30% goes to executive salaries and Lobbying.

[nicet4]

Originally Posted by PurpleLove08

Germany doesn't have a single-payer system. It helps if you know the facts.

As for competition among health insurers, it won't lower costs. There is a reason that big companies do better. They can negotiate lower prices with hospitals, doctors, etc because of the number of people they represent. Have you ever heard of economies of scale? This is why single-payer can offer much more savings because it's just one payer. You cut out all the administrative waste that goes on with multiple companies.

Why More Competition Won’t Fix Healthcare - Rick Newman (usnews.com)

^^^^^^^^^ Have fun.

I'm fine with a higher deductible plan when I'm younger. I hope to obtain a well paying job that enables me to save for future health care costs. We have to keep in mind those that don't make enough to save money for health care or can't afford health insurance. We also have to keep those with a chronic illness in mind. High deductible plans don't really work for them since they'll be going to the doctor a lot.

Of course they don't and I wasn't advocating someone with chronic conditions opt for a high deductible either. For some high deductible insurance, in effect making yourself partly self insured, makes economic sense. For others it would prove to be a disaster.

What concerns me most is covering people with preexisting and chronic conditions. Unless you know someone that has been there this is a real monster because you can be working for someone, have full insurance, if Joe or his wife suffers a heart attack or breast cancer and you will find you can never leave just because of health insurance.

What happens if the company goes under? Joe has a real problem if that happens.

If anything, we need more competition among hospitals and doctors. Who can provide the best care at the cheapest price?
Increases in the prices hospitals and doctors charge are what drive the increases in health insurance. Getting away from fee for service would help a lot.

I wasn't sure what Germany had and didn't bother researching it.

One system I like that is never mentioned is the Australian system which is a combination of government and private insurance.

[Tasse]

What kind of poll is this? 10 k deductibile?? Hello?

And Germany does have a single payer system. Not everybody can get private insurance. Single payer just means that the entire population is covered and not just a specific group ( like the elderly in Medicare).

[nicet4]

Originally Posted by Boompa

One in five dollars in our economy goes to Health Care, of that 30% goes to executive salaries and Lobbying.

Are you sure about that?

Interesting.

Patient Power

Because your health care is too important to be left to politicians.

Where does your health insurance dollar go?
January 20th, 2009 | by Brian Schwartz |

How much profit do they make? According to a recent study by PricewaterhouseCoopers, just 3 cents on the dollar. This is pretty small compared to those in other industries.

The profits would be less if there were more competition. That is, if the tax code didn’t favor employer-provided insurance, which makes it difficult for consumers to change providers and encourages people to buy more insurance than they otherwise would. It also doesn’t help that mandated benefits regulations force people to pay for coverage they may not want, like infertility treatment, treatment for alcohol abuse, etc.

[PurpleLove08]

Originally Posted by nicet4

Of course they don't and I wasn't advocating someone with chronic conditions opt for a high deductible either. For some high deductible insurance, in effect making yourself partly self insured, makes economic sense. For others it would prove to be a disaster.

What concerns me most is covering people with preexisting and chronic conditions. Unless you know someone that has been there this is a real monster because you can be working for someone, have full insurance, if Joe or his wife suffers a heart attack or breast cancer and you will find you can never leave just because of health insurance.

What happens if the company goes under? Joe has a real problem if that happens.



I wasn't sure what Germany had and didn't bother researching it.

One system I like that is never mentioned is the Australian system which is a combination of government and private insurance.

I haven't done a LOT of research into the Australian system but from what I've heard, it isn't that bad.

What exactly concerns you about pre-existing conditions?
I'm a bit confused. I do think it's pretty messed up one illness can pretty much mess up your chances for ever getting health insurance. There are people out there just crossing their fingers they don't get sick or any sicker before they qualify for Medicare.

Here are some things about the German system:
Why More Competition Won’t Fix Healthcare - Rick Newman (usnews.com)

Mention European health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care.
It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies.
German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted.


..........


The health care system that took such good care of Sabina is not funded by government taxes. But it is compulsory. All German workers pay about 8 percent of their gross income to a nonprofit insurance company called a sickness fund. Their employers pay about the same amount. Workers can choose among 240 sickness funds.
Basing premiums on a percentage-of-salary means that the less people make, the less they have to pay. The more money they make, the more they pay. This principle is at the heart of the system. Germans call it "solidarity." The idea is that everybody's in it together, and nobody should be without health insurance.
"If I don't make a lot of money, I don't have to pay a lot of money for health insurance," Sabina says. "But I have the same access to health care that someone who makes more money has."

German sickness funds are very much like our insurance companies. However, they can't deny claims and they have to accept everyone.


FRONTLINE: sick around the world: interviews: karl lauterbach | PBS

1. First and foremost, the sickness funds are nonprofit entities; they exist to pay people's medical bills, not to pay dividens to shareholders. Thus, they don't have the same incentives that the U.S. insurance industry has to limit the people they cover or deny claims; in fact German insurance plans are required to accept all applicants and to pay any claims submitted by a recognized doctor or hospital. They don't have to pad their premiums or pay for claims-service bureaucracy or to allow for profit. The result: The sickness funds have about one-third the administrative expenses that are normal in American health insurance. That makes the whole german insurance system much cheaper.

2. While insurance is purchased and paid for through payroll deductions, Germans don't lose their coverage when they lose their jobs. Government unemployment benefits automatically cover the insurance premiums, so the has the same insurance coverage while he looks for a new job- no matter how long it takes to find one.

3. Unlike American workers, who are restricted to the selection of insurance plans offered by their employers, Germanscan sign up with any sickness fund in the country and can change to a different plan almost anytime they want. To a large extent, the funds mimic one another. They are all required by law to offer the mandated package of benefits, from cradle to nursing home. Since the premium is a percentage of pay, the premium stays the same, no matter which fund a worker chooses. And yet there is heated competition among these nonprofit insurance plans. Some comepte my promising to pay all claims within five days; some offer benefits beyond the basic package, like Exotic asian therapies or free neonatal nursing care in the home after a baby is born or longer stays in those health spas.

This comes from the book: Amazon.com: The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (9781594202346): T. R. Reid: Books

[nicet4]

Originally Posted by Tasse

What kind of poll is this? 10 k deductibile?? Hello?

And Germany does have a single payer system. Not everybody can get private insurance. Single payer just means that the entire population is covered and not just a specific group ( like the elderly in Medicare).

For most people $10k deductible is the only insurance that makes any sense at all but I am not saying it makes sense for everyone.

As I pointed out not everyone can obtain private insurance, such as preexisting conditions, and while it needs to be addressed we shouldn't be to fast to throw everything overboard.