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Health care reform: market solutions
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PostPosted: Mon Aug 17, 2009 4:52 pm    Post subject: Health care reform: market solutions Reply with quote

This is an aspect of health care reform that we're not even debating. Market solutions for a market problem. I'm glad that the public option is no longer on the table, but Obama still seems to think that government is the solution.

I offer these three articles for anyone interested in a different approach--one that actually addresses the problems that cause the rising health care costs, lack of choice, and concerns over too much government control. The first one is new, while the last two are articles Ki and I posted in the Fiasco thread (which no one commented upon), to gather all the relevant points in one place. For those actually reading these articles, you might notice some common themes. There are real solutions to this problem. Simply spending more of other people's money isn't the solution.

Quote:
By JOHN MACKEY

“The problem with socialism is that eventually you run out
of other people’s money.”


—Margaret Thatcher


With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become eligible for both, we are rapidly running out of other people’s money. These deficits are simply not sustainable. They are either going to result in unprecedented new taxes and inflation, or they will bankrupt us.

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees’ Personal Wellness Accounts to spend as they choose on their own health and wellness.

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan’s costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

 Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

Although Canada has a population smaller than California, 830,000 Canadians are currently waiting to be admitted to a hospital or to get treatment, according to a report last month in Investor’s Business Daily. In England, the waiting list is 1.8 million.

At Whole Foods we allow our team members to vote on what benefits they most want the company to fund. Our Canadian and British employees express their benefit preferences very clearly—they want supplemental health-care dollars that they can control and spend themselves without permission from their governments. Why would they want such additional health-care benefit dollars if they already have an “intrinsic right to health care”? The answer is clear—no such right truly exists in either Canada or the U.K.—or in any other country.

Rather than increase government spending and control, we need to address the root causes of poor health. This begins with the realization that every American adult is responsible for his or her own health.

Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese. Most of the diseases that kill us and account for about 70% of all health-care spending—heart disease, cancer, stroke, diabetes and obesity—are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.


Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

Health-care reform is very important. Whatever reforms are enacted it is essential that they be financially responsible, and that we have the freedom to choose doctors and the health-care services that best suit our own unique set of lifestyle choices. We are all responsible for our own lives and our own health. We should take that responsibility very seriously and use our freedom to make wise lifestyle choices that will protect our health. Doing so will enrich our lives and will help create a vibrant and sustainable American society.

link

And from an article I posted in another thread, more market solutions from WSJ:

Quote:

What to Do About Pre-existing Conditions
Most Americans worry about health coverage if they lose their job and get sick. There is a market solution.

By JOHN H. COCHRANE
Even if you don't like the massive health-care package being considered in Congress, you have to admit that health insurance and health care in this country are not working well. There are two basic problems:

First, if you get sick and then lose your job or get divorced, you lose your health insurance. With a pre-existing condition, new insurance will be ruinously expensive, if you can get it at all. This, the central defect of American health insurance, explains why most Americans are happy with their current coverage yet also support reform.

Second, health care costs too much. Yes, we get better treatment, but the cost-cutting revolution that has swept through manufacturing, retail, telecommunications and airlines has not touched health care.

The problems are real, but the proposed remedy—even more government intervention—is counterproductive. A market-based, deregulation-focused reform is possible, and it will work.

Health care and insurance are service-oriented, retail businesses. There is only one way to reduce costs in such a business: intense competition for every customer. The idea that the federal government can reduce costs by negotiating harder or telling businesses what to do is a triumph of hope over centuries of experience.

Take the claim that centralized record-keeping can cut costs. In his July 22 press conference, President Barack Obama noted that a new doctor today might run a test again rather than ask for records of a previous result. That seems silly. But maybe it isn't. Maybe the test is cheap, the condition changes, the test can fail, and the cost of setting up an integrated record system between these two doctors isn't worth two tests a year.

The cost-cutting revolutions in other industries didn't settle questions like these with acts of Congress, expert commissions, armies of regulators, or via a "public option"—while leaving in place a system in which consumers have little choice, aren't spending their own money, and suppliers are protected from lower-cost competitors. That approach has never spurred efficiency, and for good reasons. Cost-cutting is painful. Even in Mr. Obama's trivial example, lab technicians and secretaries will lose their jobs to computer programs, and they will complain. Patients might have to get tests at inconvenient times and locations. They will do this when their money is at stake—what people will put up with from airlines for a few dollars is truly amazing—but they will never accept it from the government.

But what about pre-existing conditions?

A truly effective insurance policy would combine coverage for this year's expenses with the right to buy insurance in the future at a set price. Today, employer-based group coverage provides the former but, crucially, not the latter. A "guaranteed renewable" individual insurance contract is the simplest way to deliver both. Once you sign up, you can keep insurance for life, and your premiums do not rise if you get sicker. Term life insurance, for example, is fully guaranteed renewable. Individual health insurance is mostly so. And insurers are getting more creative. UnitedHealth now lets you buy the right to future insurance—insurance against developing a pre-existing condition.

These market solutions can be refined. Insurance policies could separate current insurance and the right to buy future insurance. Then, if you are temporarily covered by an employer, you could keep the pre-existing-condition protection.

Some insurers avoid their guaranteed-renewable obligations by assigning people to pools and raising rates as healthy people leave the pools. Health insurers, like life insurers, could write contracts that treat all of their customers equally.

The right to future insurance could be transferrable to another company, for example, if you move. You could have the right that your company will pay a lump sum, so that a new insurer will take you, with no change in your premiums. Better, this sum could be occasionally placed in a custodial account. If you got sick but had something like a health-savings account to pay high premiums, you could always get new insurance. Insurers would then compete for sick people too.

Innovations like these would catch on quickly in a vibrant, deregulated individual insurance market.

How do we know insurers will honor such contracts? What about the stories of insurers who drop customers when they get sick? A competitive market is the best consumer protection. A car insurer that doesn't pay claims quickly loses customers and goes out of business. And courts do still enforce contracts.

How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don't have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money.

More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren't we allowed to purchase in another state?

The bills being considered in Congress address the pre-existing condition problem by forcing insurers to take everybody at the same price. It won't work. Insurers will still avoid sick people and treat them poorly once they come. Regulators will then detail exactly how every disease must be treated. Healthy people will pay too much, so we will need a stern mandate to keep them insured. And this step further reduces competition.

Private, competitive insurance markets are a superior way to solve the pre-existing-conditions problem, and the only hope to lower costs.


And finally, the article Ki posted in the same thread:

Quote:
The White House is priming the defibrillator paddles to revive ObamaCare, and its new strategy is to talk about "health-insurance reform," rather than "health-care reform." The point is to make its proposals seem less radical than they are, while portraying private insurers as villains for supposedly denying coverage to the sick.

Sounds like a good time to explain a few facts about the modern insurance market. Start with the reality that nine out of 10 people under 65 are covered by their employers, most of which cover all employees and charge everyone the same rate. President Obama's horror stories are about the individual insurance market, where some 15 million people buy coverage outside of the workplace.

Mr. Obama does have a point about insurance security. If you develop an expensive condition such as cancer or heart disease, and then get fired or divorced or your employer goes out of business—then individual insurance is going to be very expensive if it's available. But what the President and Democrats won't tell you is that these problems are the result mainly of government intervention.

Because the tax code subsidizes private insurance only when it is sponsored by an employer, the individual market is relatively small and its turnover rate is very high. Most policyholders are enrolled for fewer than 24 months as they move between jobs, making it difficult for insurers to maintain large risk pools to spread costs.

Mr. Obama wants to wave away this reality with new regulations that prohibit "discrimination against the sick"—specifically, by forcing insurers to cover anyone at any time and at nearly uniform rates. But if insurers are forced to sell coverage to everyone at any time, many people will buy insurance only when they need medical care. This raises the cost of insurance for everyone else, in particular those who are responsible enough to buy insurance before they need it; they end up paying even higher premiums. And the more expensive the insurance, the less likely people will buy it before they need it.

That's one reason that only five states—Maine, Massachusetts, New Jersey, New York and Vermont—have Mr. Obama's proposal for "guaranteed issue" on the books today. New Hampshire and Kentucky repealed such laws after finding that they soon had an even smaller individual insurance market as companies fled the state.

Another proposed reform known as "community rating" imposes uniform premiums regardless of health condition. This also blows up the individual insurance market, by making it far more expensive for young, healthy or low-risk consumers to join pools—if they join at all. And if the healthy don't join risk pools, then premiums go up for everyone and insurers have little choice but to reduce their risk by refusing to cover those who have a high chance of getting sick, such as people with a history of cancer. This is why 35 states today impose no limits whatsoever on how much insurers can vary premiums and six states allow wide variation among consumers.

New York, New Jersey and Massachusetts have both community rating and guaranteed issue. And, no surprise, they have the three most expensive individual insurance markets among all 50 states, with premiums roughly two to three times higher than the rest of the country. In 2007, the average annual premium in New Jersey was $5,326 for singles and in New York $12,254 for a family, versus the national average of $2,613 and $5,799, respectively. ObamaCare would impose New York-type rates nationwide.

There are better ways to go. Tax credits to individuals to buy insurance would make it more affordable and thus strengthen the individual market. Other tax rule changes could also make it easier for people to join and form their own risk pools beyond their employers, such as through business federations, labor unions or, say, the Kiwanis Club. They would no longer be hostage to one job for insurance.

University of Chicago economist John Cochrane also argues that in a more rational individual insurance market, people could insure not merely against medical expenses but also against changes in health status. This kind of insurance would cover the risk of premiums rising as you get older and your health condition changes.

In turn, that would free insurers to compete for the business of all patients, including those with pre-existing conditions, because then they could charge enough to cover the costs—instead of passing them to others. As for those with rare conditions ("orphan diseases") that require a lifetime of special care and are thus uninsurable, this is where government subsidies could be both appropriate and affordable.

ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."

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PostPosted: Mon Aug 17, 2009 11:15 pm    Post subject: Reply with quote

There is more information about the health care industry in these three articles than we've seen in the entire health care debate. Granted, this debate has been accelerated, given the speed at which Obama tried to ram this reform down our collective throats. But still, it's disappointing that as soon as the debate becomes detail-oriented and specific, suddenly there is silence. Rowdy townhall meetings got more debate than market specifics. Maybe the protesters were on to something . . . if you want to be heard, it's better to be rude and loud than polite and informed.
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Remain faithful to the earth, my brothers, with the power of your virtue. Let your gift-giving love and your knowledge serve the meaning of the earth ... Do not let them fly away from earthly things and beat with their wings against eternal walls. Alas, there has always been so much virtue that has flown away. Lead back to the earth the virtue that flew away, as I do-back to the body, back to life, that it may give the earth a meaning, a human meaning. -Nietzsche
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PostPosted: Mon Aug 17, 2009 11:26 pm    Post subject: Reply with quote

Call me crazy, but I don't think you'd be praising protesters who tried derailing legislation which you supported, especially when they were wrong in many of their claims (death panels, for instance) and hostile in their approach. So don't make principled claims about their methods -- you just like the results. No shame in that at all; just be honest about it.

And do we really need another healthcare thread?
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PostPosted: Tue Aug 18, 2009 3:20 am    Post subject: Reply with quote

No, no, this is great: Let's make a Market solution! We can start by removing Anti-Trust immunity from the insurance companies. Then, we can take away their right to legally bribe legislators.

Then, we can see how real compitition works in an industry with a 30% Administration cost.
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PostPosted: Tue Aug 18, 2009 3:29 pm    Post subject: Reply with quote

At some point I'll probably merge them. But I must admit that it's getting tough to choose what belongs in which one. Very Happy

I would have thought that the government simply suibsidising the insurance payments of the needy would count as a market solution?

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PostPosted: Tue Aug 18, 2009 5:33 pm    Post subject: Reply with quote

The crux of the problem is that people want insurance.. they just dont want to have to pay for it. So even if the govt subsidised the insurance for poorer people then taxes would have to go up to pay for that. Period.

I was reading the other day that because of the downturn of the market and the amount of money not flowing in to SS, that SS has moved the date closer for insolvency.. within the next two years. But in the same article its nothing compared to the medicare/medicaid crisis that is coming.

But again.. many of those that are on-board with wanting some govt solution are fine with that as long as the money is coming from someone elses pockets.

Which goes back to another thread where a question was asked and never answered... For people that cant 'afford' health insurance, how many have thought about taking on a part time job to pay for it? Im betting not many.
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PostPosted: Tue Aug 18, 2009 6:24 pm    Post subject: Reply with quote

That is exactly right... health insurance for anyone who has problems essentially consists of trying to get someone else to pay for addressing those problems.

I agree that the only way to get real sanity into cost control is to put the onus of payment back on the consumer. For the low income and the disabled who need subsidies, I'm thinking something like government-issued debit cards that can only be used for health insurance and medical expenses. Let the consumers manage that money rather than create new government bureaucracies to dictate their treatment. Pliss complains about insurance company administrative costs. Explain to me how that's going to be different for a government bureaucracy that has no incentive to keep costs under control. The point is there are going to be administrative costs either way. Given that, I'd rather give the business to the enterprises that at least have an incentive to watch the bottom line.

For everyone else, it's time to get creative as the above articles go into detail about what can be done. Tort reform, drug pricing reform, health care savings accounts with fewer limits and with rollover capability, high deductible plans, creative insurance plans to deal with pre-existing conditions, insurance plan portability and salability, they should all be on the table.

But what everyone needs to get is that the cost of health care is coming out of YOUR pockets no matter what. Whether it's in the form of higher taxes (look at the UK tax rates and you'll get some idea where we could be headed) or it's in the form of payments to insurance companies and health care savings accounts. There is NO free lunch. At least in the latter scenario, the individual has the opportunity for more control of his own treatment options and their costs.

Single payer has been/is being tried already in several other first world countries and its costs and outcomes are in some form of trouble in *every* one of them. Further, no one can explain well enough how that's going to be different here. Insanity is doing the same thing over again and expecting different results. We can't be going there too.
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PostPosted: Tue Aug 18, 2009 10:30 pm    Post subject: Reply with quote

EVeryone I konw of who ahs DIRECT, PERSONAL, FIRST-HAND experience witht eh British and Canadian systems vastly prefers theirs to ours. The people in question are my great great aunt, an uncle, three people I went to college with in Port Huron, Michigan who came across the border from Sarnia, and a friend's fiancee who is emigrating from England to get married this fall. NONE of them say their system is perfect, or the ideal, They freely admit to some flaws. But listening to them describe their experiences, in comparison to my own, my family, and friends in the US system, the US is DISTINCTLY second-best.

The current system is broken, badly. A reform/replacement that fixes it does NOT have to be single payer, a la British NHS. All things being equal, I'd prefer a non-government answer. But no non-government answer that I have seen any real information on fixes things. Thus, I support the government option system. The extended quotes resolve some issues, but in my mind they don't make the substantive changes necessary to fix it. As I said in at least one other thread...I see the government option system as best of a lot of poor choices of health care reform.
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PostPosted: Wed Aug 19, 2009 12:41 am    Post subject: Reply with quote

I lived in the UK for nearly a year and I found that the only thing that works well over there is emergency care. Everything else is screwed up: the waits, the access to specialists, the lack of freedom to try alternative treatments, the supergerm problems in many hospitals, the runaway costs leading to higher tax rates.

Are your Canadian friends happy with the rationing that takes place there? Are they happy with the outcomes their elders face? Are they happy with lack of timely treatment for cancer and other degenerative diseases? I have several families of Canadian cousins (numbering about 40 persons in all covering 4 generations) who have issues with all of these. They think the US system is flawed in allowing the uninsured to slip through the cracks, but they love us for the alternatives they can come here for when their own system is failing them. Heck, Seven, did you catch the Canadian Medical Association admitting that their system needs fixing? Several of my elder cousins who could afford it have had to come to the US for timely treatment when they couldn't get quick enough access to specialists on their side of the border.

Finally, we already have considerable experience here in the US with government options with Medicare, Medicaid and the VA. None of these have been able to get their costs under control. Seven, what do you think is going to be different this time? Sorry I'm sounding like a broken record, but I keep saying insanity is trying the same thing again and expecting different results... It's time to think outside the box as the articles above suggest.
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PostPosted: Wed Aug 19, 2009 12:48 am    Post subject: Reply with quote

Lord Mhoram, your post has nothing to do with market solutions to health care costs and access.

Plissken, do you have anything of substance to add? Or just more bitter sarcasm?

Avatar, having the government give people money to purchase health insurance wouldn't solve the problems of rising cost, lack of portability, lack of competition and choice, and lack of coverage for pre-existing conditions. The solutions I presented above address those problems with specific solutions.

And this thead does have a distinct purpose. I was hoping we could discuss here a conservative solution, in contrast to the liberal government "solution."

SB and FS, thanks for keeping it on topic.

Seven Words, I am not saying that our current system is ideal. I'm talking about reforming the current system. Do you have any opinions of the reforms I've posted? Simply saying that "no non-government reform you've seen fixes things" is a completely unsupported statement. Do you have any problems with any of the specific solutions I listed in the opening post?
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Remain faithful to the earth, my brothers, with the power of your virtue. Let your gift-giving love and your knowledge serve the meaning of the earth ... Do not let them fly away from earthly things and beat with their wings against eternal walls. Alas, there has always been so much virtue that has flown away. Lead back to the earth the virtue that flew away, as I do-back to the body, back to life, that it may give the earth a meaning, a human meaning. -Nietzsche
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PostPosted: Wed Aug 19, 2009 2:11 am    Post subject: Reply with quote

Seven Words wrote:
EVeryone I konw of who ahs DIRECT, PERSONAL, FIRST-HAND experience witht eh British and Canadian systems vastly prefers theirs to ours. The people in question are my great great aunt, an uncle, three people I went to college with in Port Huron, Michigan who came across the border from Sarnia, and a friend's fiancee who is emigrating from England to get married this fall. NONE of them say their system is perfect, or the ideal, They freely admit to some flaws. But listening to them describe their experiences, in comparison to my own, my family, and friends in the US system, the US is DISTINCTLY second-best.

The current system is broken, badly. A reform/replacement that fixes it does NOT have to be single payer, a la British NHS. All things being equal, I'd prefer a non-government answer. But no non-government answer that I have seen any real information on fixes things. Thus, I support the government option system. The extended quotes resolve some issues, but in my mind they don't make the substantive changes necessary to fix it. As I said in at least one other thread...I see the government option system as best of a lot of poor choices of health care reform.


Everyone has a story, don't they? You've said before about your aunt having cancer and the insurance company didn't pay for something you thought they should've. Well, I have a story too. A true story and one that is incredibly painful to relay, but, I think it is important for you to know why I am so against government run health care.

My father, a World War II vet, died b/c of the poor quality care he received from the VA. He coded RIGHT IN FRONT OF MY MOTHER b/c the overworked, understaffed nurses at the VA couldn't or didn't check on him enough to determine that he had fluid building up around his heart after he had undergone triple bypass surgery, which btw, was performed at a private hospital b/c the VA didn't have the time to do the surgery.

Just so you have the entire story, the doctors were able to save him after draining the fluid, but he was in a coma for weeks. They had to put him on a ventilator, which if anyone here knows, an elderly man on a vent in a germy hospital....it's pretty much a death sentence. He ended up dying of MRSA pneumonia a few months later in a nursing home. He had a tracheotomy, which was permanent. All b/c of the poor quality of care that he received at the VA.

He would write on a notepad to my mother how much he wished he could eat. He wanted to talk but he was too embarrassed to put his finger over the opening so he could speak. If he had remained at the private hospital, he might be alive today. The private hospital sure wouldn't have let fluid build up on his heart following triple bypass surgery.

I was pregnant at the time with Malik Jr. My father never got to meet his grandson. He did get to feel him kick a week before he died. My mother didn't fare well after Dad died. He was her best friend. She said, he was her rock. During this time, my mom developed cataracts. She too was a vet (a Marine) and they wouldn't perform her surgery. She was all alone in the home she had once shared with my father and she was going blind. In desperation, I wrote a letter to the governor of our state and pretty much begged that he do something to allow my mother to have the surgery. That worked. She had the surgery, but it didn't fix her cataracts...usually, it does, but no, not the surgery performed at the VA. She died in a car wreck 13 months after my dad died.

I just figured since we are going to share anecdotal personal experiences to justify healthcare reform, maybe you should know mine too.
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PostPosted: Wed Aug 19, 2009 12:27 pm    Post subject: Reply with quote

I was unclear, and I apologize.

Anecdotal experiences are NOT proof, and I was not presenting them as such. I apparently phrased myself poorly.

I was trying to be as clear as possible about exactly what direct knowledge I had of national health care systems. I was trying to be clear that I claim NO expert knowledge in the healthcare field.
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PostPosted: Wed Aug 19, 2009 1:00 pm    Post subject: Reply with quote

So Seven, do you have responses to malik's conservative solutions? I guess you believe they wouldn't fix things, why?

I saw Deeprak Chopra on CNN last nite, talking about the need for public option, and how badly current system is broken. Then he went on to talk about the need for public awareness that diet, exercise and stress management are 3 most important things anyone can do to improve health, reducing heathcare costs, and all for nothing. I'm thinking, if we spend some money, or incentivize these activities (for a hell of a lot less than heathcare costs), it would be a HUGE, uncontroversial, first step.

Also, he quoted numbers about how bad Americans' health is, which I think is a tricky stat b/c it may have nothing to do w/healthcare, but how we live our lives, which he had mentioned the 3 things are lacking. I think its some of this confusion that makes people think healthcare reform is a crisis. In same interview, one can talk about 3 simple things to improve your health, and also how healthcare industry is in a crisis. Maybe it wouldn't be if people took care of themselves? Which is it?
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PostPosted: Wed Aug 19, 2009 1:26 pm    Post subject: Reply with quote

Cybrweez wrote:
So Seven, do you have responses to malik's conservative solutions? I guess you believe they wouldn't fix things, why?

I saw Deeprak Chopra on CNN last nite, talking about the need for public option, and how badly current system is broken. Then he went on to talk about the need for public awareness that diet, exercise and stress management are 3 most important things anyone can do to improve health, reducing heathcare costs, and all for nothing. I'm thinking, if we spend some money, or incentivize these activities (for a hell of a lot less than heathcare costs), it would be a HUGE, uncontroversial, first step.

Also, he quoted numbers about how bad Americans' health is, which I think is a tricky stat b/c it may have nothing to do w/healthcare, but how we live our lives, which he had mentioned the 3 things are lacking. I think its some of this confusion that makes people think healthcare reform is a crisis. In same interview, one can talk about 3 simple things to improve your health, and also how healthcare industry is in a crisis. Maybe it wouldn't be if people took care of themselves? Which is it?


First, an apology...I thought I HAD posted my opinion on them.


I don't think they'd fix things completely. Most of them, I agree with as excellent solutions to aspects of the situation. The ones I don't agree with are....

High-deductible plans. For families living paycheck-to-paycheck, high deductibles are beyond their means. Making them more easily available is fine, but we have to have low-deductible options as well. The lower cost to employers of the high plans will almost certainly (profit margin consideration) lead to those being the only ones most employers will go for. The Whole Foods pay-in to individual accounts paired with HSA's would indeed address that issue, IF the Whole Foods system was the standard.

Required coverage. In the name of cost-cutting, without government regulation over mandatory coverage, cancer treatment would be an expensive option a lot of profit-minded businesses would not go for. However, some aspects of current "required coverage" should definitely be re-examined at the very least.


The other ones I feel are good ideas (especially tort reform). But the root problem, the high cost of health-care, needs to be addressed. I do realize just HOW expensive it is for a company to bring a drug from laboratory to human trials. And they absolutely SHOULD make money off that investment. But the FDA (I admit, overly-influenced by the more extreme liberal Democrats) has made it too difficult to bring these drugs along. The guidelines are too stringent on unacceptable side-effects. Many medications created and used since the 50's would NOT make it past the FDA today. This feeds back into tort-reform, and also into cost controls. For instance, a Sharpie marker used to mark the points where the arthroscope is to be inserted into the knee should NOT cost $39. But the one used on my knee did, according to my bill in 1997. It quite literally WAS a regular Sharpie like you can get at Wal-mart, 3-pack for like a buck and a quarter.


If my two points of contention were addressed,and some method of cost-control measures were emplaced, then using Whole Foods as the archetype for all private insurance in this country would absolutely fix 95% of the health-care system in the country. A bill to do exactly that would have my enthusiastic support, irrelevant of which party introduced it.
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PostPosted: Wed Aug 19, 2009 1:37 pm    Post subject: Reply with quote

Malik, in general, I think several of the conservative ideas presented above have merit. There is one, however, that gives me pause, as I think it could easily be abused by the unscrupulous corners of the industry:
Malik's Article wrote:
•Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

I think many of the existing insurance regulations cause more problems with competition than they cure, and market forces can do great things, but completely de-regulating what is/isn't covered could easily become so excruciatingly complicated that consumers would have to become insurance experts to navigate the schedules of what is/isn't going to be insured. I am *not* talking about pre-existing conditions here, either. The issue I'm concerned with in a completely unregulated arena is the gotcha moment after customer buys insurance, thinking they are covered for something when in fact they are not -- or a situation analogous to credit card offers, where they can bait you in, but then print dozens of innocuous little changes in terms that water down or reduce the coverage you get, but without reducing your premium.
I know, caveat emptor, and customer idiocy should be its own reward.... and (theoretically) a free market should eventually punish the insurance companies that practice that type of gotcha non-coverage. However, I'm not talking about idiocy here, but the fact that a person's ability to know what they're buying can easily be hampered by abusively complicated fine print, extremely large schedules of covereds / noncovereds that use medical terminology, etc. all in the attempt to obfuscate and hide the truth. That kind of gotcha might be OK when you realize your cash advance APR is 3.9% versus 19.9%, but whether your surgery aftercare is costing you $1,000 out of pocket versus $17,500 -- that's a little more than a gotcha.

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PostPosted: Wed Aug 19, 2009 2:25 pm    Post subject: Reply with quote

Seven Words, that’s more like it! Finally, we get to debate the specifics of a market alternative to reform.

High deductible plans. Yeah, they suck at first. But when combined with a health savings account, this cost can become negligible, especially the younger you are when you start adding to your HSA. An 18-yr-old cashier at Whole Foods isn’t going to need a lot of health care. And given the fact that Whole Foods pays 100% of their premiums (!!) (that’s as close to “free” as you can get, people), and gives them an additional $1800 per year in a roll over account, they can have their deductible saved up by the time they are legal drinking age. For older people, this might be more difficult. But in the end, a $5000 deductible in order to get a $200,000 surgery (for instance) is a pretty good deal. It might be rough for some families, but it wouldn’t bankrupt them like a $200k bill. And if it means the difference between having health insurance and not having it, suddenly it puts *quality* health insurance in reach of every American. Who can’t afford free premiums? The government can’t even offer that without adding trillions to our debt.

On the required coverage laws (this is in response to Dukkha, too), I think there is some misunderstanding. The government currently does not require everything that insurance companies cover. If you need an antibiotic, there is no law that specificically spells out “you’ve got to cover antibiotics for infections x,y, and z.” They have to pay for care that is industry standard, as defined by professional, scientific community. But coverage policies are written up by the insurance companies, not the government (again, this is what Ki does).

We do have a few laws, however, that require insurance companies to cover specific types of care that has *not* been determined on the basis of effectiveness, but rather by pressure from lobbying groups. Like chiropractory. This has raised the cost of health care for everyone, merely to pay for an unproven type of care. If we repealed laws which mandate these kinds of coverage, health care would be both cheaper and more effective.

New medical technologies enter the market every single week. There is no way the government could keep up with the rush of technology if they were trying to write a law to cover every single one. The consensus of medical scientists and private industry professionals decide what works and what doesn’t. Not the government. We don’t need laws dictating coverage as long as insurers are bound by a general law to “pay for what works.” That’s all the regulation you need.

You mention cost control . . . that’s exactly what this is all about. Should the government control those costs, or should informed, empowered consumers? Part of the reason that Sharpie costs $39 is because the government mandates Medicare reinbursements, i.e. dictates the price. When they pay doctors less, the doctors have to make it up elsewhere with customers in the private sector. So hospitals charge you $39 to make up for Medicare patients or patients who have no insurance and use the ER for free.

The government can’t control the economy. It can’t even control its own budget or its debt. The only force we know that successfully reduce prices while increasing quality is Adam Smith’s Invisible Hand. Free market competition. Transparency. Supply and demand. These are broken in the health care industry, partly because of government regulations. I won’t list them again here (they are in the opening post), but there are *specific* laws hampering the private sector right now, that the government could reform.

What I’d like to know is, where the hell are the Republicans on this? They should be working on a bill that utilizes all these solutions.
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PostPosted: Wed Aug 19, 2009 2:50 pm    Post subject: Reply with quote

Recently, the state of Texas quietly passed a mandate that insurers pay for CT angiography (a test to determine coronary artery disease) for screening. Even the American Heart Association does NOT recommend that the test be done as a screening test. It was the medical device company that lobbied for that law.

I know that in general people in favor of health care reform want to paint the picture that insurance companies don't pay for care b/c of cost. Maybe some insurers do that. The ones I have worked for and the one I currently work for do not. We make coverage determinations based on recommendations from professional medical societies as well as evidence as published in medical peer-reviewed journals.
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PostPosted: Wed Aug 19, 2009 3:04 pm    Post subject: Reply with quote

Ki wrote:
Recently, the state of Texas quietly passed a mandate that insurers pay for CT angiography (a test to determine coronary artery disease) for screening. Even the American Heart Association does NOT recommend that the test be done as a screening test. It was the medical device company that lobbied for that law.

I know that in general people in favor of health care reform want to paint the picture that insurance companies don't pay for care b/c of cost. Maybe some insurers do that. The ones I have worked for and the one I currently work for do not. We make coverage determinations based on recommendations from professional medical societies as well as evidence as published in medical peer-reviewed journals.


that second paragraph strikes me as in response to my costs statements, and if so reflects a minor misunderstanding of what I was saying. Insurance companies will cover anything, just about, but they set a price on said coverage. The cost of coverage would not deter insurance companies for covering it, but rather the purchasers of the policies from buying those coverages due to cost.

Malik--

We're just going to disagree about the cost-control. I agree government is not going to be very good at it, but otherwise it will devolve into "charge all that the traffic will bear", which is the hallmark of unbridled free market. I feel that SOME governmental oversight is necessary, but it should be kept to the minimum necessary. I recall you agreeing with that sentiment, but we disagree on exactly WHERE that minimum lies.
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PostPosted: Wed Aug 19, 2009 3:23 pm    Post subject: Reply with quote

Seven, I agree that some regulation is necessary (I just posted about that topic in the other thread). But you can't regulate cost. Cost is determined by real world factors, not by bureaucratic good intentions.

Competition for customers is the only thing that can bring down cost. You have to provide an incentive for costs to come down, or they won't.

There is nothing in the House bill that even attemtps to control cost. And Obama has proposed nothing, either. The CBO found that the Democrat plan will add to health care costs, not lower them.

[Edit: actually, I was wrong to say that competition for customers was the *only* force that controls cost. This presents only one side of the equation--an oversight that has the potential to create the impression that we have to passively wait around for doctors to lower their prices.

There is another way consumers can control costs without shopping around for the cheapest doctor. It all has to do with the difference in the conversation you have with your doctor when you have a low deductible plan, vs a high deductible plan.

For instance, Ki went to the doctor today for a sprained ankle. It has been hurting for weeks, and she was worried it might be a hairline fracture. So the doctor recommended an MRI because hairline fractures can be missed in an X-ray. If Ki had her old low-deductible plan, she would have shrugged her shoulders and did what the doctor recommended. But instead, she said, "MRIs are $3500, while X-rays are $40. Is your treatment plan going to change by giving me an MRI?" And the doctor said, "Probably not." Either way, they'd recommend immobilizing the ankle.

Boom, $3460 savings from a two minute conversation. And the only difference was in Ki's mindset. When your health costs are your responsibility, you think differently.

How many of you would have asked if the doctor's treatment plan would be changed due to an MRI?]
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PostPosted: Wed Aug 19, 2009 3:47 pm    Post subject: Reply with quote

Malik23 wrote:
Seven, I agree that some regulation is necessary (I just posted about that topic in the other thread). But you can't regulate cost. Cost is determined by real world factors, not by bureaucratic good intentions.

Competition for customers is the only thing that can bring down cost. You have to provide an incentive for costs to come down, or they won't.

There is nothing in the House bill that even attemtps to control cost. And Obama has proposed nothing, either. The CBO found that the Democrat plan will add to health care costs, not lower them.


I believe that, without some kind of external regulation, prices will shoot up, as there isn't really a competitive marketplace for health care. In a monopoly on a VITAL resource, there is no incentive for costs to come down. I realize nothing to control costs is in the bill. That is from lobbying and special interests. Medical technology companies (like the heart device one Ki mentioned), big pharma, and hospital systems made sure of that.

Current costs are NOT driven by real world factors, for the most part. Cost can be regulated, within reason. if it costs X to build medical device Y, and Y can save over 150,000 lives a year just in Emergency/Trauma rooms, the company building Y is certainly entitled to make money from it. But if they decide to charge so much that only 30% of the places where it WOULD be used can AFFORD it (say, 8X)....An extreme liberal would say that would make the company guilty of complicity in murder, and so on, they should simply provide it free, or at least at-cost.....which is BS. A reasonable return on their investment is one thing, price-gouging is another. If a price of, say, 3X would bring it down to where 95% can afford it....there's still a healthy piece of profit there. Granted, first we need to clear out the things you mentioned, such as Medicaid, and uninsured-ER-as-Primary Care Physician, to determine realistically what costs are.

And also, as I said...If, IF a bill using the Whole Foods system was the archetype for ALL private insurance coverage in , I would absolutely support it, and vehemently oppose the bill in Congress right now.
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