Sicko

[JustMeUC]

I have to say that of the medical professionals, including doctors that I have spoken to, most every single one of them wants this change. Most don't think their salaries will be cut much by the time they figure in the benefits that the change will bring about. Do you realize the extra office staff they have to have to handle just this crazy insurance?

 

[Rustic23]

On the surface, I would think Doctors would be for a single payer system, however, their actions don’t necessarily bare this out. There are many doctors that don’t accept Medicare assignment, and if you are x-military, you will find that a great many doctors that don’t accept TriCare or TriCare Prime. So I have a feeling the doctors are saying, let me practice medicine my way, cut down on all this office staff, and by the way get rid of this mal practice insurance and life will be great. But, will a new UH system do this. I don’t think the doctors will be happy.

Now, that may or may not be a bad thing. The problem is, we look at only one part of the problem or solution at a time, and as usual, it depends on whose ox is getting gored as to what you think of the solution.

 

[mykidslovedogs]

I have to say that of the medical professionals, including doctors that I have spoken to, most every single one of them wants this change. Most don't think their salaries will be cut much by the time they figure in the benefits that the change will bring about. Do you realize the extra office staff they have to have to handle just this crazy insurance?

Just me. There's really no black or white answer to this problem. Both systems have their advantages and disadvantages. IMO, our current system has fewer disadvantages when it comes to critical illness. Check out this Canadaian website, dedicated to advertising wait times for cancer surgery. Can you imagine something like that in the USA? Look at the picture of the woman smiling. Can you imagine smiling when you find out that you have to wait a month for a biopsy when a lump's been found in your breast? ...or how about finding out that you have to wait 100 days for a CT scan when your doctor suspects a brain tumor? In the understanding wait times section, you can pick a link that asks "Why do we have wait times?" Take a look at the explanation.
Ontario Wait Times Strategy : Introduction

Granted, in America there will be a certain percentage of people who just don't have the money, and lack access to service because of that, but what if you had the money and wanted to jump the Ontarian queue? It doesn't matter. Everyone has to wait their turn, regardless of whether you have the means to pay or not. Which system is worse? It's hard to say. Some would say they'd rather wait or even risk dying while waiting rather than having to pay for their own services. Others would rather be able to pay for faster service. Which would you prefer?

Just out of curiosity, what kind of doctors have you spoken with? I think most primary care doctors would advocate a single-payor system. On the other hand, I think most specialists would favor a private system.

 

[Martha]

Rustic, a number of the issues and questions you raised have been discussed. Here is some information I have gathered:

1.The number of uninsured is increasing. Current Census estimates show that, in 2005, 44.8 million people, 15.3 percent of the population, were without health insurance. (This is a drop from earlier Census estimates of 46 million.) The Census only counted people who were uninsured for at least an entire year.

2. A 2004 study from Families USA found that 81.8 million lacked health insurance at some point in 2002 and 2003 and most were uninsured for more than 9 months. Adding to these numbers, the Commonwealth Fund has found 16 million adults were under-insured in 2003. This is a problem we haven't even begun to talk about.

3. About 20% of the uninsured are children according to the Robert Wood Johnson Foundation. The foundation found that about 70% of those children would be eligible for SCHIP or Medicaid, but parents often are unaware of the eligibility or daunted by the paperwork. There is no one out there advertising these programs.

4. Medicaid is administered by the states. States divide low income people into three groups: children, parents of children, and non-parent adults. In 40 of 50 states non-parent adults are not eligible for Medicaid at all, even if they do not have a penny to their name, unless they are fully and completely disabled. The remaining 10 states provide some coverage but it is very limited. Look at the Kaiser Family Foundation website, it reports a lot of this information about Medicaid.

5. In 14 states, more than 1/3 of non-elderly people had no health insurance for all or part of 2002 and 2003. Texas and California were the worst.

6. The National Academy of Sciences has found that lack of insurance causes about 18,000 unnecessary deaths a year. About 1400 is from undiagnosed high blood pressure. Chronic diseases and cancer do not get treated in the emergency room. Here is an interesting article on Houston's problem with one million uninsured and the inability for many to get treatment for cancer:

http://www.click2houston.com/investi...14/detail.html

7. From the 2004 Census, it appears that families with incomes between $50,000 and $75,000 is the fastest growing group of uninsured. Also, from the Kaiser 2005 employer health benefits survey, the percentage of employers offering insurance has decreased every year for the past six years, almost entirely in the small group market, with 40% of employers not offering any health insurance. Interestingly, 98% of employers which have 200+ employees offer health insurance. A lot of this is about bargaining power.

8. Numbers regarding illegal aliens are hard to come back and tend not to be accurate. For example, the estimate that there are 20 million illegal aliens in the US is highly questionable. The Census Bureau estimates that: [FONT=Palatino, Book Antiqua, Times New Roman, Georgia, Times] 43.6 percent of non-citizens in the U.S. are without health insurance. In addition, 33.6 percent of those born elsewhere are without coverage. [/FONT]
[FONT=Palatino, Book Antiqua, Times New Roman, Georgia, Times]By contrast, 13.4 percent of native-born Americans are without health insurance. And 17.9 percent of naturalized citizens are without coverage.[/FONT]

 

[Martha]

From a 2002 Commonwealth Fund survey, here is the percentage of adults in the US with health problems who did not do the following in the prior two years because of cost:

28 percent didn't get medical care
35 percent did not fill a prescription (odds are this has dropped because the survey predated the medicare drug benefit)
26 percent did not get a recommended test, treatment, or follow-up
40 percent did not get dental care

 

[Martha]

Last bunch of figures and I will give it a rest:

From Johns Hopkins Bloomberg School of Public Health in a 2005 issue of HEALTH AFFAIRS, the estimated expense of defending malpractice claims, including awards, legal costs and underwriting costs, is less than .5% of US total health care spending. The authors note that defensive medicine may contribute to increased costs but it is too hard to quantify as defensive procedures may be medically appropriate.

 

[mykidslovedogs]

Last bunch of figures and I will give it a rest:

From Johns Hopkins Bloomberg School of Public Health in a 2005 issue of HEALTH AFFAIRS, the estimated expense of defending malpractice claims, including awards, legal costs and underwriting costs, is less than .5% of US total health care spending. The authors note that defensive medicine may contribute to increased costs but it is too hard to quantify as defensive procedures may be medically appropriate.

Martha, do you have any stats on the average percent of income doctors and hospitals spend on malpractice insurance?

 

[mykidslovedogs]

Here's a very interesting study that was referenced in Wikipedia:

http://www.pnhp.org/canadastudy/CanadaUSStudy.pdf

According to the study, the USA has a slightly higher percentage of the population with unmet healthcare needs, but it didn't break down the stats into the kinds or severity of unmet needs. It would be interesting to see a breakdown as to what kinds of needs are unmet in the USA vs. Canada.

 

[FinanceDude]

Martha, do you have any stats on the average percent of income doctors and hospitals spend on malpractice insurance?

It depends on th state. Wisconsin has had a huge influx of specialist from all over the country due in large part to our affordable malpractice insurance premiums.

One doctor I know said he paid $150,000 a YEAR in Rhode Island..............

 

[Martha]

Martha, do you have any stats on the average percent of income doctors and hospitals spend on malpractice insurance?

Tough one because of huge variations regionally and between different practices. Here is some interesting info:

It is questionable as to whether caps on damages will reduce malpractice insurance premiums. This is from the Congressional Budget Office regarding increases in malpractice insurance premiums:Limiting Tort Liability for Medical Malpractice


Medical Malpractice
Medical malpractice premium rates differ widely by medical specialty and geography. Premiums paid by traditionally high-risk specialties, such as obstetrics, are usually higher than premiums paid by other specialties, such as internal medicine. Premium rates also vary across and within states. Across states, for example, a large insurer in Minnesota charged base premium rates of $3,803 for the specialty of internal medicine, $10,142 for general surgery, and $17,431 for OB/GYN in 2002 across the entire state. 12 In contrast, a large insurer in Florida charged base premium rates in Dade County of $56,153 for internal medicine, $174,268 for general surgery, and $201,376 for OB/GYN, and $34,556, $107,242, and $123,924, respectively, for these same specialties in Palm Beach County. In addition to the wide range in premium rates charged, the extent to which premiums increase over time also varies by specialty and geographic area. Beginning in the late 1990s, malpractice premiums began to increase at a rapid rate for most, but not all, physicians in some states. For example, between 1999 and 2002, the Minnesota insurer increased its base premium rates by about 2 percent for each of the three specialties, in contrast to the Florida insurer that increased its base premium rates by about 98, 75, and 43 percent, respectively, for the three specialties in Dade County.


From a Medscape article that I can't link to because it requires a subscription:

Nationally, malpractice premiums increased from 6 percent of total expenses in 1970 to 11 percent of expenses in 1986, then decreased to 6 percent in 1996.Premiums decreased to 6 percent in 1996. Premiums increased to 7 percent in 2000 (Exhibit 4). The decrease in premiums as a percentage of total expenses between 1986 and 2000 was attributable to a decline in premiums combined with increased spending for other practice expenses. During this period, while premiums for all physicians declined from $20,106 to $18,400, a decrease of $122 per year, total expenses increased from$185,981 to $246,600, an increase of $4,330 per year. From 1986 to 1996, office expenses increased 27 percent (from $44,767 to $56,861), and nonphysician personnel expenses increased 36 percent (from $60,969 to $83,096). Spending on rent, medical equipment and supplies, furniture, and utilities also increased sharply.

 

[Webzter]

It depends on th state. Wisconsin has had a huge influx of specialist from all over the country due in large part to our affordable malpractice insurance premiums.

One doctor I know said he paid $150,000 a YEAR in Rhode Island..............

You know, I had a realization just this year.. since I was a kid, I've always had this mental image that doctors and lawyers make the most money. However, at least as far as doctors are concerned, once you factor in school debt, a delayed entry into the workforce, insane hours, and malpractice insurance, I think I actually get paid quite a bit better than them. Granted, I'm not making nearly as great of an impact on the world, but it is something to think about.

 

[FinanceDude]

You know, I had a realization just this year.. since I was a kid, I've always had this mental image that doctors and lawyers make the most money. However, at least as far as doctors are concerned, once you factor in school debt, a delayed entry into the workforce, insane hours, and malpractice insurance, I think I actually get paid quite a bit better than them. Granted, I'm not making nearly as great of an impact on the world, but it is something to think about.

I know a resident anethesiologist whose now making $65K a year working 90 hour weeks. He will make clost to $200K once he gets through the residency, but has $140,000 in medical school debt, and is facing about $35,000 a year in malpractice..........

He needs this forum..........

 

[Webzter]

I know a resident anethesiologist whose now making $65K a year working 90 hour weeks. He will make clost to $200K once he gets through the residency, but has $140,000 in medical school debt, and is facing about $35,000 a year in malpractice..........

He needs this forum..........

Granted, his job is pretty secure from outsourcing... but, he's now making what I made my third year out of college. Once he gets done with residency, he'll make what I'm making now while working 65 hours a week. Oh, and I graduated with $2k in student loans and only need to pay about $3k a year in general liability.

On the other hand, at least he's helping people.

 

[Rustic23]

I’m going to start this by saying “If you are one of the 18,000, or a friend or family member, then Universal Healthcare would have saved you loved one”

Eighteen thousand is a big number, until you put it into perspective. That is .00006 percent of the nations population. (I used 3 hundred million, it was in another post somewhere).

I bring this up, because it is somewhat at the root of the problem. Taken on a personal basis, it is a tragedy, taken as a whole it is a very small percentage of the population. I admit this only looks at one statistic, and it is the worst case of no insurance.

Of the other figures the figure that shows that in 2005, 15.3% is worth considering. How many of those are without by choice. I know this is antidotal, but on ‘Ice Roads’ last night, I know a stupid show, one of the drivers got sick. He went to the clinic and quickly ran up a $12,000 bill, and he was without insurance. However, it was by choice. The show revolves around how these truckers leave there regular trucking jobs for a short time to make more money, $1,000 a day on average. In his case he could have afforded insurance, he was rolling the dice.

Your other numbers I have a hard time getting my mind around. Statistics and how statisticians twist them, have always been a thing with me. So the number from Family USA being twice the 2005 number, I question. Is it for two years, 2002 and 2003, or are they saying it is due to job loss? If so did those who lost their job not take Cobra. If not we are back to personal choice.

It most likely comes through in my post, but I am in the 84.7% of the population that has, and have had insurance, and I want to make sure that the quality and cost of health care I get is not effected by any change.

At any rate, thanks for the first run at statistics. It would seem we are looking at 31% of the population. (15% no insurance 16% under-insured) .

I brought up the illegal alien question, because, The numbers for Houston, Texas, and California, just don’t make since if it is not including them. I can not provide data, but employers in Dallas, Houston, Austin, and other major cities offer health insurance as a part of their employment packages. Last time I looked Houston had a 3.6% unemployment rate. It seems strange that a MSA with a population of 5M in 2006 could have 1M uninsured with a 3.6% unemployment rate. On the other had that is about 20%, which would make it’s rate 33% higher than the nations rate.

Again, thanks for the stats, and for a thoughtful answer. It is appreciated. I hope that my replies are inline with a discussion and not an argument.

 

[mykidslovedogs]

Martha, would the cost of medical malpractice (lawsuits and insurance) go away in a universalized system?

 

[mykidslovedogs]

You know, I had a realization just this year.. since I was a kid, I've always had this mental image that doctors and lawyers make the most money. However, at least as far as doctors are concerned, once you factor in school debt, a delayed entry into the workforce, insane hours, and malpractice insurance, I think I actually get paid quite a bit better than them. Granted, I'm not making nearly as great of an impact on the world, but it is something to think about.

....and they'd make even less money in a universalized system. Any ideas on how that might impact supply of care to our entire population?

 

[Rustic23]

Here is an article in the Houston Biz Journal. It uses some of Martha's statistics, and it seems that the answer to the difference in some of the numbers for Houston, may revolve around Employers that don't offer insurance.

Health insurance industry confronting crisis of the uninsured - Houston Business Journal:

 

[Martha]

Rustic, I have not seen good figures on the number of uninsured by choice. I think it would be hard to quantify. At what point is the cost so high that the choice is meaningless?

For example, COBRA payments can be very high. If you just lost your job and have limited funds, odds are you will forgo COBRA. That was my experience with many staff employees when I was an employer.

The most disturbing statistic to me is the increasing numbers of small employers unable to offer health insurance because of cost. And those which do offer insurance benefits are passing more and more of the cost on to employees. Unless your family is in mighty good health, insurance may very well be unfordable for that family if they end up having to purchase on the non-group market.

So, not only do you have to look at numbers of uninsured, you have to look at cost.

 

[Nords]

40 percent did not get dental care

That seems like a whole 'nother gray area since dental insurance is so expensive relative to the worst-case scenario.

We don't carry insurance and I personally only go to the dentist every 2-2.5 years. Our kid gets the twice-yearly checkups but between that and the orthodontist's followups she can't get far off the path.

Not that the dental-insurance bureaucracy is any better than the medical. When we told the pediatric dentist that we had no insurance his staff shouted "Hallelujah!" and immediately gave us a 20% discount.

 

[Rustic23]

I had a similar experience with my Doctor. I am not without insurance, he just does not accept Tricare. When I told him I was paying cash, he not only loaded me up with a month or so of meds, but cut his fee.

We also have no Dental insurance, and, I would not be surprised if that is not the next issue to go national.

 

[mykidslovedogs]

Here is an article in the Houston Biz Journal. It uses some of Martha's statistics, and it seems that the answer to the difference in some of the numbers for Houston, may revolve around Employers that don't offer insurance.

Health insurance industry confronting crisis of the uninsured - Houston Business Journal:

Rustic...Colorado has been playing around with healthcare reform a lot over the past several years. Due to modified community rating, Colorado lost a HUGE number of covered lives in the small group market starting in 2000. A couple of years ago, us conservatives were able to get legislation passed that allowed for rating flexibility in the small group market. The result was a flattening in loss of insured lives! Unfortunately, the democrats took office and reversed the decision. Here is a report on how the "old" legislation helped bring healthy lives back into the small group market with discount incentives and how that resulted in a flattening of lost covered lives and a slight upturn in 2006. We were just starting to make headway when they reversed the legislation.

As of next year, healthier groups will no longer qualify for discounted rates....the democrats felt that would be unfair to the unhealthier groups. Therefore, rates will be going up substantially for everyone (including the unhealthy) starting next year, and we will start losing more covered lives again. Great move, Governor!

Here's the link:

http://www.dora.state.co.us/insurance/pb/rateflex07.pdf

 

[JustMeUC]

Rustic, I have not seen good figures on the number of uninsured by choice. I think it would be hard to quantify. At what point is the cost so high that the choice is meaningless?

For example, COBRA payments can be very high. If you just lost your job and have limited funds, odds are you will forgo COBRA. That was my experience with many staff employees when I was an employer.

The most disturbing statistic to me is the increasing numbers of small employers unable to offer health insurance because of cost. And those which do offer insurance benefits are passing more and more of the cost on to employees. Unless your family is in mighty good health, insurance may very well be unfordable for that family if they end up having to purchase on the non-group market.

So, not only do you have to look at numbers of uninsured, you have to look at cost.

I can tell you about my company. We have 45 employees currently. We get bids every year for insurance and every year it has gone up up up, so much in the last few years that the company went from paying 100% of premiums for employees to paying 50%. It was either that, or drop it altogether.

Our current plan:

United Healthcare

$2000/deductible

I write the checks so yes, I am sure these figures are correct

Employee only $528/month
Employee/spouse $ $940/month
Family/ $1486

I only know of one person who has left the company and done Cobra in the last few years.

We are getting ready to start getting quotes again in a few weeks, it is very very scary.....

If it is too high, our companies owners have talked about just dropping it and giving everyone across the board a $200 month raise like that is going to make up for it. The owners just went on medicare so they are covered. Some like myself, will leave the company I love and have worked at for many years, some will just do without insurance.

Yes, at some point the cost becomes so high that some will just go without.

 

[mykidslovedogs]

I can tell you about my company. We have 45 employees currently. We get bids every year for insurance and every year it has gone up up up, so much in the last few years that the company went from paying 100% of premiums for employees to paying 50%. It was either that, or drop it altogether.

Our current plan:

United Healthcare

$2000/deductible

I write the checks so yes, I am sure these figures are correct

Employee only $528/month
Employee/spouse $ $940/month
Family/ $1486

I only know of one person who has left the company and done Cobra in the last few years.

We are getting ready to start getting quotes again in a few weeks, it is very very scary.....

If it is too high, our companies owners have talked about just dropping it and giving everyone across the board a $200 month raise like that is going to make up for it. The owners just went on medicare so they are covered. Some like myself, will leave the company I love and have worked at for many years, some will just do without insurance.

Yes, at some point the cost becomes so high that some will just go without.

Have you thought about offering a dual choice option to your employees? Many insurance companies will do that for your size group. You could offer one high end copay plan and a second choice could be an HSA (maybe with a 2500 embedded deductible. Often times, the premium savings on an HSA are enough to allow you to fund your employee's HSA accounts with 1/2 or more of the deductible each calendar year, without having to spend much more than a 5% increase over the prior year. This would be money that your employees could use first dollar towards medical expenses. Just a thought.

A lot of times when employees leave the company, they'll go for either individual coverage or short term major medical to get them by in between jobs. The overwhelming majority of people can qualify to do that. The only people that usually elect Cobra are ones with medical problems who can't qualify for individual coverage or who see the risk of not having insurance as greater than the risk of paying for it.

 

[mykidslovedogs]

Rustic,

Here's a good Kaiser Foundation report about who the uninsured are. It gives a very detailed breakdown.

http://www.kff.org/uninsured/upload/2005DataUpdate.pdf

Notice that there are about 20 million non-us citizen residents included in the figures, and of them 40-50% are uninsured. That nearly 25% of the uninsured population...not a very attractive statistic.

There are also 143 million people with household income of more than $40,000/yr and of them, approx 7% are uninsured......that's 10 more million people who could potentially afford at least major medical coverage coverage who go without.

***these stats are on page 11 of the link.


...and here's another just real quick breakdown:

A recent study1 analyzed the uninsured population and divided them into three categories:

Percentage Number Income Above Medicaid/SCHIP But Can't Afford Coverage = 56% of the Uninsured = 26,320,000
Uninsured but eligible for Medicaid/SCHIP = 25% of the Uninsured = 11,750,000
Uninsured But Likely Able to Afford Coverage On Their Own = 20% of the Uninsured = 9,400,000
47 million uninsured total
1 Health Affairs, Nov 2006, "The Uninsured and the Affordability of Health Insurance Coverage".

 

[Martha]

MyKids, I don't see the 20 million non-us citizens you mention. I see 2.5 million non-citizens who have been here less than 5 years and 6.7 million who have been here more than 5 years comparing to a total of 35.1 million citizens who are uninsured. I believe this is census information which requires at least one full year of no insurance before you are counted as uninsured.

According to table 15, 600,000 of those making more than 40k are uninsured. (Though other studies says this population is growing). In contrast, 22 million making less than 20,000 are uninsured.

Thanks though for the Kaiser information, I forgot about it.