The Health Insurers have already won

[IndependentlyPoor]

I can make no reasonable value judgement, because I have no idea of the cost of anything.

I have no interest in the "first dollar coverage" discussion, but I think that there is an even more important point here.

I cannot make a reasonable value judgment about treatment even if I know all of the costs in advance, and that is the basic flaw in the free market approach to our medical system's problems.

I do not have the knowledge or skill to decide whether a treatment is necessary or cost effective; that is why I seek the service of a professional. What is worse, the self-policing medical guild makes it almost impossible to find out whether a doctor is good or bad, wasteful with treatment dollars or a great bargain. Whether a hospital has high rates of secondary infections, good or bad mortality rates, or high or low cost-per-procedure is almost impossible to discover.

A side rant: Keeping tabs and controls on doctors and hospitals is what HMOs and PPOs were supposed to be about. After the scare tactics of Harry and Louise helped defeat the Clinton health plan, we got insurance bureaucrats instead on government bureaucrats inserted between us and our doctors and look how that turned out.
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A free flow of information and knowledgeable consumers are required for a free market to function, and neither exists in the case of medical care. As far as I know, there is no "Consumer's Reports" for doctors and hospitals.

I agree that an insurance company inserted between me and my doctor makes things worse, but I believe that free market economics has almost nothing to offer in solving the problems of our medical system. Shopping for a doctor is not like shopping for an DVD player.

I do not believe that medical care is a right, but I do believe that insurance is a great idea. Spreading risk among a population has great value, and the larger the population the better. OTOH, if insurance companies could not deny coverage for preëxisting conditions, they could not stay in business if young healthy folks were allowed to opt-out until they got sick.

The insurance companies would howl about it, but I do not think they should be allowed to compete on an actuarial basis (read: cherry pick the healthy clients). Once everybody is required to have insurance, the playing field would be level if the first three federal regulations were:

1. Exclusions for preëxisting conditions are prohibited.
2. Insurers may offer any policy features they wish above a required minimum set, and may set any price it wishes for this optional coverage, but the prices charged must be the same for everybody.
3. Policies may be canceled only for non-payment or other breach of contract, not because the client was seriously injured or contracted an expensive disease.
​

Essentially, such regulations would just create one giant group comprising everybody in the country. Insurers would compete to sell policies to the members of this group just like it sells policies to employee groups. Want to raise the rates? Fine, but you have to raise them equally for everybody. Want to change the rules on say, deductibles? No problem, but the changes apply to everybody. There would still be plenty of room to compete. Insurance companies are competing just fine with their employer based group policies now. Why not just extend the existing model? Indeed, the precedent for required minimum insurance already exists in our auto liability policies.

I know that this does not solve all of the problems, but straw men arguments are fun and sometimes useful. As I understand it, this is similar to the Swiss system, and I present it to show that there are potential "solutions" that do not involve a big-brother type government autocracy.

I am not capable of assessing what effect this would have on medical costs, but it would solve many of the cruel and unfair situations that our existing system creates. I contend that it would even reduce costs (although I can't say how much) by eliminating the free and extremely cost-ineffective care hospitals are required to give in emergency rooms, and in uncollectible bills. If I recall correctly, a major hospital lobby group has estimated that universal coverage would save something like 30%-40% (although that sounds high to me) just for these reasons. If somebody insists, I will go Googling for some data to back that up.

I'm recovering from a minor surgical procedure and writing this under the influence of pain medication, so I reserve the right to disavow it after the hydrocodone wears off. However, if I were completely sober, I wouldn't have the nerve to post this.
Anybody know where I can get a good Nomex suit air-freighted to me?

 

[IndependentlyPoor]

My hydrocodone induced screed seems to have brought this discussion to a screeching halt. I didn't want that to happen. Anyway, my discomfort from this week's minor surgery has passed and I have gone cold turkey on the drugs. I must admit I miss the dreamy haze though.

Several of you have said enough with the anecdotes and get on with the specifics. Bingo. I admit that I have been too lazy to dig into the details and you have shamed me into exerting some effort. But I am way to lazy to wade through the original sources, and have little patience with partisan articles from either side. Anybody know of sites with half-way decent summaries; sites with a minimum of hidden agendas? I can handle opinions, but don't want to feel like I have to examine every word like an opposing council.

Something like "Health Care Reform for Dummies".

Here's your chance. Help me educate myself.

 

[lets-retire]

Unfortunately Congress learned a lesson with the recent health insurance debacle. It was the wrong lesson though. Instead of learning that their constituents don't want a BS bill, they learned that if they don't post the bill they won't have to answer to their constituents. They won't post the bill being debated on the open internet, so really there is no place that I know of where you can read and evaluate what is being proposed for yourself.

 

[Martha]

Unfortunately Congress learned a lesson with the recent health insurance debacle. It was the wrong lesson though. Instead of learning that their constituents don't want a BS bill, they learned that if they don't post the bill they won't have to answer to their constituents. They won't post the bill being debated on the open internet, so really there is no place that I know of where you can read and evaluate what is being proposed for yourself.

Do you mean the finance committee bill? Here is the link to the bill and amendments: Finance

 

[mews]

Coming in late to the bar-fight here -

I received a letter from my employer yesterday - Just letting me know that the cost of my policy is 6,000 a year. I do not contribute - they are really good about this - but I know that my coverage isn't free.

I think everyone should know their number, employed or receiving aid.

( I was raised by a mother who would usually add a snarky 'ha-ha' after the word 'free' in most commercial contexts. (thanks, Mom! ) However, many folks really do believe in the bluebird of freestuff. )

I have Canadian friends & relatives. Their system isn't perfectly perfect, but it works pretty well. Ditto what the Europeans have told me.

We have this idea that the employer-linked coverage is the god-given model, the right, true, and one way, just because it is a few generations old at this point.

Re-engineering a system in use is much harder than building from the begining. With human systems, we get scared.

I have to have coverage - my family does a couple of diseases really well. So far, I'm well - which means I haven't been diagnosed yet.

ta,
mew

 

[quietman]

I cannot make a reasonable value judgment about treatment even if I know all of the costs in advance, and that is the basic flaw in the free market approach to our medical system's problems.

I may not be able to make a perfect value judgment, but that's typical in any medical situation. Sometimes things even get better or worse unexpectedly no matter what you do. I can still make a somewhat informed choice if I am given some information to work with. Withholding cost information because I do not have perfect medical outcome information is nonsensical and harmful.

So here's an example everyone may experience. I need to have a new filling in one of my teeth. It's a little bigger than what I've had before, but not terribly so. My insurance covers only silver amalgam fillings, as they are medically necessary, but will not cover composite plastic materials. They claim this is a cosmetic procedure with no medical evidence it is a superior treatment. I do not really know if this is a superior treatment or not. I do not really know if additional mercury amalgam in my mouth will be detrimental in 50 years. I can ask the dentist my costs to make the choice (I pay 20% of the amalgam filling or 100% of the composite) and then decide what I want to do. Even this decision is somewhat distorted by the different percentages of coverage, but I can still make a somewhat informed choice.

Here's an example a relative recently faced. He suffers from a debilitating and deteriorating condition. Existing treatments are effective in reducing the spread of his illness, but only somewhat, and need to be repeated often. A promising new treatment has finished clinical trials and is much more effective and in some cases halts the deterioration so much that treatments can be given annually. He has insurance, but this new treatment is not on the approved list and although it is being rapidly adopted around the country, his insurance told him it will likely be at least 3 years before they would consider covering it. No guarantee they would cover it even then. It's likely by then his condition would have worsened to the point the new treatment would be pointless. He had to (luckily he can) pay for this out of pocket. It was hugely successful and probably saved his insurance a bunch of money on the old treatments, too.

Insurance companies maintain the lists of allowed and effective procedures as a way to control costs, not as a way to promote effective medical treatment.

 

[Martha]

Coming in late to the bar-fight here -

I received a letter from my employer yesterday - Just letting me know that the cost of my policy is 6,000 a year. I do not contribute - they are really good about this - but I know that my coverage isn't free.

I think everyone should know their number, employed or receiving aid.

We did this at my office too, once a year sharing the cost of all benefits with employees.

 

[CuppaJoe]

We did this at my office too, once a year sharing the cost of all benefits with employees.

I have an individual health insurance plan that was billed to my house. I opened it and physically carried it into the office every month and added it to the payables. At retirement I just switched to paying the bill myself.

My share of the Keogh was under my control and monthly statements were mailed directly to me. Once a year my employer gave me two checks for me to deposit into that account.

I also knew exactly what the all-important fresh brewed coffee benefit cost.

 

[Bestwifeever]

....I also knew exactly what the all-important fresh brewed coffee benefit cost.

I hope you had "first-cup" coverage, Joe!

 

[Gone4Good]

Who decides what is covered and what isn't covered?

As we're talking about a government plan, the government would be the "decider".

 

[youbet]

We have this idea that the employer-linked coverage is the god-given model, the right, true, and one way, just because it is a few generations old at this point.

Not true mew. Apparently you have this idea that the eimployer-linked coverage is the god-given model........

But WE don't. Not by any means.

 

[youbet]

As we're talking about a government plan, the government would be the "decider".

Although Obama has vowed there would be no "panels" deciding what procedures would be covered or who qualifies for them.

 

[Gone4Good]

A free flow of information and knowledgeable consumers are required for a free market to function, and neither exists in the case of medical care.

This is a market design problem, not a market problem. And this design flaw is intricately linked with 1st dollar insurance.

You don't have the information you want because you don't need it. The doctor says "I think you should have an MRI" and you say "Sure". The doctor doesn't care that it is a $3,000 test and neither do you. You don't know whether the test is absolutely necessary, or whether a less expensive alternative is available, because you have no reason to ask. Nobody knows. Nobody cares.

If you were talking to a car mechanic instead of a doctor the conversation would be completely different. That's true even for people who can't tell a piston valve from a mitral valve. There are all kinds of things I'm not expert in. That doesn't prevent me from engaging in a free market for services.

And just to be sure, I'm not talking about trying to force people to comparison shop for a heart transplant. At ~5% of AGI, most people's deductible is going to get chewed up pretty early on by any large procedure so market forces stop working at that level anyway. It is for those larger, more complicated, and more expensive items where the government needs to employ comparative effectiveness research (a.k.a. "Death Panels") to hold down costs.

 

[Gone4Good]

Although Obama has vowed there would be no "panels" deciding what procedures would be covered or who qualifies for them.

I don't believe Obama is posting on this message board (pssst . . . I'm not Obama) so what I'm suggesting really doesn't have any bearing on what he may, or may not, support.

I happen to be a proud supporter of "Death Panels" if that term, as it has been used recently, is defined as government actually measuring the benefits of its programs against their costs. That, BTW, is something "conservatives" used to support too.

Besides, nowhere did I see a prohibition, in either my comments or in any healthcare bill pending before Congress, against people either buying supplemental insurance or paying out of pocket for those things not covered by a government plan. So someone will have to explain to me why if the government doesn't provide something that people can still get on their own, it amounts to a death sentence. I guess by that logic, I've been sentenced to starvation because the government doesn't buy my food, but yet, somehow I still eat.

 

[Martha]

Although Obama has vowed there would be no "panels" deciding what procedures would be covered or who qualifies for them.

Has he? Someone has to decide what is covered and what is not covered. The example I gave earlier is that I don't want goofy treatments paid for with government dollars, such as chiropractic treatments for allergies.

 

[youbet]

Has he?

Yes. Empathically. Now whether he gets what he wants or not is open to question.

 

[youbet]

The example I gave earlier is that I don't want goofy treatments paid for with government dollars, such as chiropractic treatments for allergies.

Using "goofy treatments" as examples understates the problem. How about some examples where solid justifications can be given for allowing or not allowing some given treatment for a specific individual under specific circumstances? Who will make the decisions on all the "close calls?"

 

[haha]

I want Charles Rangel to decide. He may have memory problems regarding real estate investments and taxes, but the man dresses well. Geithner is qualified as to tax irregularities, but he falls short on the all-important clothes criterion.

Ha

 

[youbet]

what I'm suggesting really doesn't have any bearing on what he may, or may not, support.

.

That, for sure, is the understatement of the day!

But, what he does support might just be what happens......... or not.......

 

[modhatter]

Saw this guy on TV. and was impressed with him. Don't remember if it was on Book Review or not.
His name is T.R. Reed. He has a book out called:

"The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care "

Sounds like a very informative book for the members here "obsessed" with the current discussions on health care. (as I am) You can read all the reviews on Amazon. He has traveled the world to uncover the truths, and false conceptions of each countries health care system. He has also been a patient himself in six of these countries.

I just went on line to see if it was available on Audiobook, but I guess it is too new for audio yet. I am leaving on a long............. drive on Sunday, and have no time to order the book from Amazon. Would hate to have to pay $25 at book store for it, when I can get it for $15. Anyway, thought some of you other folks may be interested in it, as the subject matter of the book has been argued extensively on this thread.

 

[Gone4Good]

How about some examples where solid justifications can be given for allowing or not allowing some given treatment for a specific individual under specific circumstances? Who will make the decisions on all the "close calls?"

The whole discussion of government bureaucrats denying coverage is a canard that assumes a false choice. In the "new" system a panel of government bureaucrats who deny coverage will replace the existing panel of insurance company bureaucrats who deny coverage. So what.

And for those who want ridiculously heroic end of life care and fear the government may (rightfully) not pay for it, I'm sure ridiculously-heroic-end-of-life-care insurance will be available from private insurers, just like Medi-gap insurance exists for those things not covered by Medicare.

 

[youbet]

Your comments are unrelated to what I said. Perhaps you meant to quote another post?

 

[lets-retire]

Do you mean the finance committee bill? Here is the link to the bill and amendments: Finance

I don't see many details in that proposal. That is where the problem lies, the details.

 

[Martha]

Using "goofy treatments" as examples understates the problem. How about some examples where solid justifications can be given for allowing or not allowing some given treatment for a specific individual under specific circumstances? Who will make the decisions on all the "close calls?"

Then I favor coverage.

I assume that there will be some restrictions and there needs to be. For example, my risk pool has formulary and non-formulary drugs and I will pay a lot more going off of the formulary. Clearly experimental treatments are unlikely to be covered. They aren't now. (If you seek that kind of treatment a trial may be the answer). If a provider prescribes a treatment that does not have good evidence to back it up, maybe the provider should have to justify what they are doing to get reimbursed. Rightly or wrongly, insurance companies do some of this now. What insurance companies don't have prior authorization before surgical procedures? Does such a review system fall under the term "panels?" Are they currently effective at reducing uneccessary care or error or are they just a pita for the provider? What exactly was the President refering to? I would like to know the context.

I know that there are difficult lines to draw. I favor allowing treatment (that has evidence to back it up) provided that there is clear communication of the facts with the patient and the family. My grandniece had a newer procedure to lengthen her intestine. It wasn't so much experiemental as rare, costly, risky and the odds of success were low. It was covered by Medicaid. From talking to a poster who is an MD in Canada, this procedure likely would have been approved there as well. In that kind of case I think medical professionals need to not just assume surgery is the thing to do but talk over with the family all the ramifications. There wasn't enough of that. This is far from being a "death panel" but instead is getting all the facts and being realistic. But this isn't something to mandate, but to encourage discussion.

The whole issue of necessary vs unnecessary care is where we need a lot of help from medical providers to help figure out ways to get quality care but not unnecessary care. Working on alternative incentive systems may help. Strengthening our primary care system may help. I have read that there are better outcomes when primary care doctors have the time and resources to quarterback care by other providers.

I do not have a feel for how much real waste there is in the system.
But I do feel that there is a lot of high cost just because cost can be high. People too often feel expensive is better.

 

[youbet]

I assume that there will be some restrictions and there needs to be. .

Of course, and the examples you give seem reasonable and, in fact, typical of our private insurance system today. But we're flaunting change here, so many of us who are satisfied with the current system understandably wonder what the future holds, especially with regard to the availability of medical service and what allowed coverage will be as compared to today.

You used phrases such as "encourage discussion" and "help from medical providers." Can't argue with those and I'm happy that's the situation I'm in today. I hope going forward new "systems of control" aren't put in place to interfere.

I think that the sooner the govt proposals include significant detail about what the new system will look like, who'll call the shots and how we'll pay for it (free of hocuspocus numbers please), the sooner people who are likely to give up some level of benefits will feel more comfortable doing so.

The fact that Medicare is a govt program and tens of millions of citizens are already enrolled is ofter thrown out in these discussions. Well, let's apply the Medicare example to the question of coverage and who is allowed to have what. If the new govt health plan covers the same procedures, treatments and drugs as Medicare today and the rules are determined in the same way, does that sound good to you? Or are you saying the future plan needs to be more restrictive than Medicare with more limitations applying to certain people in certain situations?