Healthcare reform update

[MichaelB]

The cost of care for the uninsured is already born by those who have insurance.

Correct. But it not evenly distributed among the insured, and the group that pays the most are the uninsured that still have resources.

 

[Automatika]

Whatever happened to "Major Medical"? Is something like that still available? I remember the pay as you go plan and it seemed to work pretty well.

 

[harley]

i'm curious to how my company will react. they are very mum on the matter and basically said, "don't ask any questions, you'll see what happens next month during open enrollment and you won't get to know what changes are made until open enrollment starts, but change is a coming..." (no political pun intended on my interpretation of my company's message)

stay tuned til Oct 19th for the official change. hoping for the best.

My old megacorp was one of the first to publicly talk about this, although I don't think their intention was for it to become public. I hung on for a couple of years after FI in order to be eligible for the retiree health coverage. Not for the cost, just for the coverability. I know W2R and a few others did the same. I know things will work out however they work out, and there are no guarantees, but it would have been nice to FIRE a couple years earlier if they're going to yank the rug out.

AT&T, Verizon, others, thought about dropping health plans - May. 5, 2010

 

[M Paquette]

And it's all working out as intended.

Big health insurers to stop selling new child-only policies - latimes.com

That's just the opening. In California, one of the affected states, there is already a bill on the Governor's desk to require that any firm selling that lucrative individual medical insurance in the state also sell individual policies for children.

Call and raise...

 

[ERD50]

The study found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

From that article I'm having trouble parsing out the difference between "linked to lack of Health Care" and "caused by having no insurance". I know of well insured people who do a number of things in that following chart.

Regardless, if we assume there is a strong cause/effect there, I think it's a real shame that the Government promoted this tying of Health Insurance to our employment so many years ago. Imagine if our car or homeowners insurance was tied to our employment? We'd be seeing headlines "Family loses home to fire, laid-off worker could not afford insurance on the family home", etc.

I'm sure that promoting Health Insurance by our employers through tax breaks was seen by many as wonderful and humane and something only mean people would be skeptical of. Yet, it contained those unintended (but not unforeseen) consequences.

-ERD50

 

[Martha]

From that article I'm having trouble parsing out the difference between "linked to lack of Health Care" and "caused by having no insurance". I know of well insured people who do a number of things in that following chart.



-ERD50

I don't have a link to the study itself that looked at deaths relating to lack of insurance, but I did read it some time ago and it controlled for a wide variety of confounding factors. I thought it was relatively well done.

The graph is just from a survey not at all related to the study on death rates and few conclusions can be drawn other than cost is an issue for quite a few people.

 

[Emeritus]

Here is the sequence of events
1. Private health ins premiums go up for each mandated change
2. Individual and companies reduce or drop health ins.
3. Private health ins premiums go up for #2 - fewer people paying in
4. More people move to the Gov't plan.
5. Private heath ins. premiums go up for #4 - fewer people paying in
6. Number of private health ins companies decline.
7. Private heath ins. premiums go up for #6 - fewer ins. companies; less competition
8. People without any ins rely more upon hospital emergency rooms. Increasing costs for state and local government and insurance premiums - depending upon state.
9. Premiums and/or taxes go up for #8
10. Gov't plan becomes dominate plan in USA
11. People complain that Gov't plan too expensive; Gov't tries to keep premiums artificially low
10. Gov't cuts benefits to control costs and deficits. Taxes may increase.
12. Private health ins. becomes supplemental ins to inadequate Gov't Plan for those that can afford it. The premium goes up as gov't services decline.

It is amazing that every other OECD country has figured out how to do national health insurance. on lots of different delivery platforms. I'm not sure if Americans are not just mentally defective or simply so stupid and greedy that they cannot figure it out

There is enormous waste in American healthcare No one else spends the administrative dollars we do trying to make sure people don't get care.

 

[ERD50]

It is amazing that every other OECD country has figured out how to do national health insurance. on lots of different delivery platforms.

Maybe not so amazing. From the stats I've seen, every other OECD country has figured out how to do public schools, on less money and with better results.

I'm not sure if Americans are not just mentally defective or simply so stupid and greedy that they cannot figure it out

I suppose there are many causes/reasons. I won't rule out the two you mention.

There is enormous waste in American healthcare No one else spends the administrative dollars we do trying to make sure people don't get care.

There is enormous waste in American public schools. No one else spends the dollars we do to get poorer results.

I'm not attacking the school system in those statements - I'm just saying it is probably a reasonable comparison. I'm agreeing with you, we seem to get less for our dollar here in the United States. I'm not sure there is reasonable evidence that taking the HC system public is going to change that. Though I certainly agree that some changes are needed, it's a broken system as it is.

-ERD50

 

[FinanceDude]

Just passing along data, not into speculating today.

Another update:

Uninsured Rate Soars, 50+ Million Americans Without Coverage - Kaiser Health News

In a reflection of the battered economy, the number of people without health insurance rose sharply last year to 50.7 million — an all time high — according to data released Thursday by the Census Bureau.
That pushed the rate of uninsured Americans to 16.7 percent last year from 15.4 percent in 2008, when there were 46.3 million uninsured. It was one of the largest single year increases since the Census starting tracking the figure in 1987.

Nearly every demographic and geographic group posted a rise in the uninsured rate — with the exception of children, who remained stable at about 10 percent.

If unemployment was not almost 10%, that number would drop...........not many folks in America who are unemployed can afford insurance........

 

[M Paquette]

It is amazing that every other OECD country has figured out how to do national health insurance. on lots of different delivery platforms. I'm not sure if Americans are not just mentally defective or simply so stupid and greedy that they cannot figure it out

There is enormous waste in American healthcare No one else spends the administrative dollars we do trying to make sure people don't get care.

I'd tend to agree. Yes, in some countries there are fiscal problems related to funding health care, but in many others, it's working well, or the 'problems' they have related to funding are trivial compared to our existing Medicare imbalances.

The Swiss healthcare coverage system is actually one of the closest to the current US target model (private insurers, minimum coverage specified, all persons required to participate), but it does so with substantially fewer 'moving parts', all the odd little clauses, gotchas and oddities packed into the recent US legislation.

I'm pretty sure we are no longer capable of having a fact-based rational discussion on the future of health care and its potential problems in this country. Now, if there were a 30 second sound bite to get people deathly afraid of what would happen if we didn't do something reasonable, then we might get somewhere. Until somebody else makes up something even scarier against it, anyway.

There's a force at work beyond rational discussion. Once Idiot America gets it's pointy little head focused on the issue, the sheer volume of Crazy dumped into the conversation will drown out any rational discussion.

 

[FinanceDude]

My old megacorp was one of the first to publicly talk about this, although I don't think their intention was for it to become public. I hung on for a couple of years after FI in order to be eligible for the retiree health coverage. Not for the cost, just for the coverability. I know W2R and a few others did the same. I know things will work out however they work out, and there are no guarantees, but it would have been nice to FIRE a couple years earlier if they're going to yank the rug out.

AT&T, Verizon, others, thought about dropping health plans - May. 5, 2010

I guess you won't be able to keep your own insurance plan like the POTUS said..........small wonder.........

 

[NW Landlady]

It is amazing that every other OECD country has figured out how to do national health insurance. on lots of different delivery platforms. I'm not sure if Americans are not just mentally defective or simply so stupid and greedy that they cannot figure it out

There is enormous waste in American healthcare No one else spends the administrative dollars we do trying to make sure people don't get care.

One of the major differences between the US & other countries is the Tort Liability System. Much of the cost of Healthcare is the cost of Malpractice & liability insurance built into it. We are talking really large sums of money here. Many doctors & facilities cannot afford it or build it into the cost of medical services. The new HC Bill does very little to reduce the cost of medical services, (there is a small sure-to-fail-pittance given to the states for Tort Reform which is doomed IMO given the funds/strength of the BAR & such). Drugs & medical devices are expensive in the US for the same reason. The US is flooded with ambulance chasing attorneys encourage potential litigants to sue for "bad" drugs, etc.

I spent 20+ years in the insurance industry, and the cost of liability insurance in other countries is very small (even when provided by a US INS CO). Why? Because of their legal system and viewpoint of compensation for losses.

 

[ERD50]

The Swiss healthcare coverage system is actually one of the closest to the current US target model (private insurers, minimum coverage specified, all persons required to participate), but it does so with substantially fewer 'moving parts', all the odd little clauses, gotchas and oddities packed into the recent US legislation.

Yes, I was surprised how little attention the Swiss system got in this whole debate leading up to what we got. I could be 'sold' on the Swiss system, and I'm a tough 'sell'.

Makes me wonder - how did the Swiss manage to do it?

-ERD50

 

[FinanceDude]

One of the major differences between the US & other countries is the Tort Liability System. Much of the cost of Healthcare is the cost of Malpractice & liability insurance built into it. We are talking really large sums of money here. Many doctors & facilities cannot afford it or build it into the cost of medical services. The new HC Bill does very little to reduce the cost of medical services, (there is a small sure-to-fail-pittance given to the states for Tort Reform which is doomed IMO given the funds/strength of the BAR & such). Drugs & medical devices are expensive in the US for the same reason. The US is flooded with ambulance chasing attorneys encourage potential litigants to sue for "bad" drugs, etc.

I spent 20+ years in the insurance industry, and the cost of liability insurance in other countries is very small (even when provided by a US INS CO). Why? Because of their legal system and viewpoint of compensation for losses.

Tort reform has eben attempted for over 30 years, but the lawyer's lobbyists always beat it back.

 

[M Paquette]

Tort reform has eben attempted for over 30 years, but the lawyer's lobbyists always beat it back.

That has always surprised me. It's really a side issue, though, as the cost of litigation and malpractice insurance is around 1% to 1.5% of health care costs, and with defensive medicine added in, is around 2.4% of costs.

Tort reform would be a good thing, but it's not going to have a significant impact on the costs of health care on it's own.

 

[Martha]

One of the major differences between the US & other countries is the Tort Liability System. Much of the cost of Healthcare is the cost of Malpractice & liability insurance built into it. We are talking really large sums of money here. Many doctors & facilities cannot afford it or build it into the cost of medical services. The new HC Bill does very little to reduce the cost of medical services, (there is a small sure-to-fail-pittance given to the states for Tort Reform which is doomed IMO given the funds/strength of the BAR & such). Drugs & medical devices are expensive in the US for the same reason. The US is flooded with ambulance chasing attorneys encourage potential litigants to sue for "bad" drugs, etc.

Before you blow a gasket at the evils of the BAR, step back and look at the data. Here is a study which shows that about 2.4% of our healthcare costs is due to malpractice related items: National Costs Of The Medical Liability System -- Mello et al. 29 (9): 1569 -- Health Affairs. Most is defensive medicine and that may not disappear if malpractice is dealt with differently.

There are states, like Wisconsin, where malpractice insurance costs are low in part due to caps and due to a compensation fund. Health care still costs a lot in Wisconsin.

(I find it interesting that we want to cap malpractice for doctors and we have short statutes of limitations for the claims. But legal malpractice claims get no caps and long statutes of limitation for malpractice. I guess we like the medical profession and not the legal? )

 

[RonBoyd]

I'm not sure if Americans are not just mentally defective or simply so stupid and greedy that they cannot figure it out

Are you thinking of the Metric System proposal?

 

[MichaelB]

Yes, I was surprised how little attention the Swiss system got in this whole debate leading up to what we got. I could be 'sold' on the Swiss system, and I'm a tough 'sell'.

Makes me wonder - how did the Swiss manage to do it?

-ERD50

They don't get sick as often. When they do, more of the care is provided by the family doctor.

 

[ziggy29]

Tort reform would be a good thing, but it's not going to have a significant impact on the costs of health care on it's own.

I think there are a lot of things which make relatively minor differences on their own, but collectively make a big difference. The problem is that half of these things are opposed by one side of the public policy debate, and the other half of these things are opposed by the other side.

And since the tendency is for neither side to give the other what they want (that would be defeat -- or worse, compromise) -- we get little of the things that will really matter in terms of cost control.

 

[teejayevans]

If unemployment was not almost 10%, that number would drop...........not many folks in America who are unemployed can afford insurance........

The meat of this bill doesn't take affect until 2014, in the what have you done for me lately, this bill is a total bust.
TJ

 

[NW Landlady]

Before you blow a gasket at the evils of the BAR, step back and look at the data. Here is a study which shows that about 2.4% of our healthcare costs is due to malpractice related items: National Costs Of The Medical Liability System -- Mello et al. 29 (9): 1569 -- Health Affairs. Most is defensive medicine and that may not disappear if malpractice is dealt with differently.

There are states, like Wisconsin, where malpractice insurance costs are low in part due to caps and due to a compensation fund. Health care still costs a lot in Wisconsin.

(I find it interesting that we want to cap malpractice for doctors and we have short statutes of limitations for the claims. But legal malpractice claims get no caps and long statutes of limitation for malpractice. I guess we like the medical profession and not the legal? )

Your link does not say more than a paragraph & a statement, not criticizing, just curious as to what the other 97.6% of the costs are attributed to. Does anyone know?

Here is a comparison online (take it with usual grain of salt) by country. Note the $ per capita difference between US & other countries with better healthcare: Healthcare Costs Around the World |

 

[Rich_by_the_Bay]

just curious as to what the other 97.6% of the costs are attributed to. Does anyone know?

Unnecessary or unproven high tech imaging and testing, aggressive end-of-life care for elderly or chroniically ill patients with no meaningful hope for recovery in any event; tens of millions of uninsured or underinsured who uses the hospital ER for primary care, pandemic obesity; untreated hypertension, diabetes and other diseases with effective treatment available; pharmaceutical abuses and numerous "me-too" drugs of no added value to old stand-by drugs; a 25-30% administrative cost on every dollar of services; neglected prenatal care; rampant violence in certain locations requiring massive trauma care; lack of primary care physicians who can deflect a reflex referral to subspecialists (who often a buck-stops-here approach which is costly and is sometimes avoidable with no adverse consequences.

I'm just getting warmed up, but I'll give it a rest.

 

[REWahoo]

I think someone struck a nerve... but that's only a non-medical opinion.

 

[M Paquette]

The meat of this bill doesn't take affect until 2014, in the what have you done for me lately, this bill is a total bust.
TJ

The Swiss system didn't go fully into effect until five years after the bill was passed. They had to go through a similar series of transitions. Some of the changes were significantly larger, such as the basic care insurance being forced to become organized as a non-profit. (Optional care packages and various add-ons continue to operate as for-profit insurance sales.)

When Switzerland relied on U.S.-style for-profit health insurance, many people were denied coverage altogether. Many others had to fight constant battles with insurers to get their bills paid. In the new Swiss system, essentially everybody has insurance, and the companies are not allowed to deny a claim. (In fact, they generally pay all claims within five days.) The Swiss people are happier with this system than with what they had before.

The trick in the US will be to somehow force failure early in the transition process, before benefits of any changes are seen by most folks, so as to convince the populace that 'change is bad.' Toward that end, we have actions such as several large insurers are taking today. If we allow the US transition to proceed to the point where people see the benefits, and the fringe fears (death panels, soylent green, etc) fail to be realized, then it will be much more difficult to undo the changes.

 

[travelover]

....... aggressive end-of-life care for elderly or chronically ill patients with no meaningful hope for recovery in any event; .............

See? I told ya they were gonna kill my grandmother!