Health Care

[Sirenesque]

Cody has inspired me to post a question to everyone regarding the issue of Health Care.  Essentially what I am looking for is what your opinions are on the current status of health care in the United States.  Do you support an HMO system, HSA's, national health care programs, it's all on the table. 

Part 2:  Is health care a fundamental human right, or a privilege afforded to only those who have enough income to pay?  What responsibility, if any, to we as citizens have in providing basic health care for all members of our society? 

I may have exposed my slant a bit, but I am genuinely interested in the views of this community which is generally out of the norm in regards to taking health and fitness seriously. 

[Cody Draper]

I have been researching this topic up to my eyeballs lately and I am going bonkers.  Here are my thoughts.  The current most common system of HMO's/PPO's is great for the few that have major health issues.  I have been on the receiving end of this at a couple of points in my life so I speak from experience here.  However, when I access how much I actually pay for my current plan (even with employer matching my premium) I have a heart attack.  At the stage I am in my life with a reasonably healthy family, I get upset knowing that +90% of the population is paying more than they are receiving in care.  I am frustrated at the cost of health care and as a result the cost of insurance.  I will never argue that it is not necessary, only that the cost is outrageous.
I have been researching HSA's in particular and I like many aspects of that plan.  I like to have the patient have ownership of their plan.  That way they have an incentive to not go to the doctor for every little thing and drive up costs.  I also agree that the patient should be more accountable for their own coverage for the same reasons.  I do think that it is necessary for someone to have a "coinsurance" type of insurance so that they do receive help when the costs get too high.  That is why I am switching to a HSA for my family, even though it is not offered by my employer.  It is still cheaper in all aspects (with comparable coverage for incidents).  The exception is maternity.  This particular plan does not have maternity benefits (not an issue at this time) but that one difference should not account for the huge price discrepancy.
Bottom line...Health care is a frustration, and I think more people should look around at all the options (including HSA's) as they are a great alternative method to take care of your family while keeping money in your pocket.

[Jon Allen]

I'm a free market kind of guy, so I'm generally opposed to government provided things (such as health care), or anything mandatory.  That being said, I think health care needs to be made much more affordable.  From my understanding, fear of lawsuits and liability insurance have gone a long way toward greatly increasing the cost such that it is very difficult for families to get insurance other than through their work.  In addition, while I think it is good that ER's provide services to everyone, people who are uninsured sometimes abuse this and will delay simple care (i.e. stuff you would easily solve at the family doctor) until it is serious and go to the ER, making people with insurance pay more.  I've also had a few doctors tell me that fear of being sued for missing anything will make them prescribe what they view as almost unnecessary and very expensive tests, procedures, etc.

My ideal scenario?  Well, nothing is simple.  But I can envision something where everyone can afford catastrophic insurance (i.e. high deductible) and where the general cost is reduced.  Then make peope choose if they want coverage or not.  I know being young and healthy, I sure subsidize a lot of people, including those 95-year old grandma's getting $100,000 hip replacements.

I'll be curious to see what others think, especially some of the doctors and other medical people on the blog.

[Sasha Pachev]

We have catastrophic insurance for which we pay $268 a month. Not bad for a family of 7. Our deductible is $5000 per person and I believe $10000 for the whole family. I do not even know for sure and too lazy to check because we've never maxed it out. The insurance offers a few nice surprise benefits from time time such as adjusting the service payment or covering immunizations.
Before we got it, I tried to find a provider that would reward our healthy life style. No avail. Everybody said, you are 30+, you are a statistic, we will charge you like a regular 30+ year old. I was furious. I said, test me, and you would not know I am not 18 if I did not tell you! It upsets me that just by virtue of age I drive up the insurance premiums for my family.
I agree with Jon about lawsuits. I think we need to adjust the concept of the "cruel and unusual punishment". Anybody who sues a doctor who was doing his honest best and made a mistake deserves to be publicly whipped. Or should be harnessed to a car on a daily basis for a year, 10 miles each day at a fast pace, if he does not run, he eats the ground.
Overall, we should take more responsibility for our health (something I hope to contribute to with this site). I do not mind paying for hip replacements of a 95-year grandma, in fact, I am more than happy to, I consider this to be my duty and privilege. I look forward to paying for the health care of somebody's handicapped child.  I vehemently object to having to pay for the health care of somebody who knowingly and defiantly makes poor health choices. I object in the same manner to having to pay for the frivolous lawsuits of those who keep imagining they have been wronged by the medical system.

[Jon Allen]

Sasha- if you think health care costs due to your 30+ age are bad, just wait.  My father (a runner) was appaled that his medical insurance went up several hundred per month just for him when he turned 50.  No other reasons, just turning 50.

[Sasha Pachev]

This illustrates the fundamental flaw of the current health insurance system. You are charged by the statistical probability of you having a problem in the simplest possible model rather than by the effort you are making not to have problems. I think this is one place where the government should step in and say you cannot do that. I am for free market in the ideal world, but in real life there should be strict rules of the race because it is natural human tendency to cheat. In a true free market with negative aspects of human greed unbridled by strict laws, the 95-year-old grandma will be left to die on the side of the road. A business will take a dirty shortcut when it can. A bigger business will take a dirtier shortcut.
One thing I like about running is that we do not compete just for the prize. A decent runner does not feel good about accepting a prize that did not come with reaching a certain level of excellence. Unfortunately it does not happen very much in business. There are deadlines to meet, investors to impress, customers to trick, and the idea of quality and excellence goes out the window. To our own doom, we have figured out that you make more money  creating the perception of value than the real value itself.

[Dallen]

 Nobody wants to pay for it.

A few reasons why healthcare is so expensive.

1. Everyone wants the best health care available. The very best health care is very expensive. 20 year old medications are cheap. The newest multicolored pill is expensive, but nobody wants the old one. Since insurance is paying, we get the expensive pills. If you were paying out of your pocket would you buy the $5 pill that lowers your blood pressure by 10, or the $100 pill that lowers it by 12.

2. We already have a national health care sysyem. Everyone gets treated at the hospital whether they can pay or not. We cannot turn anyone away. Who pays for this? Not the hospital. You do. Those xx milion uninsured Americans and xx milion illegal immigrants are indirectly insured by you and me.

3. Lawyers. I bet that at least 25% of the CT scans I read are completely unnecessary. Doctors just order them to protect themselves from lawyers.

As a side note, I do not think that health care is significantly less for a young healthy family like Sasha's than for a young fat sedentary family. Young people are generally healthy. In fact the active family might cost more because they may be more likely to get sports related injuries. (Active old people are a completely different issue.)

[Michelle]

Dallen definatly hit in on the mark with a lot of things....I work in the ER and could tell you one story after another that would help you understand the rising costs we are facing.  For example a pt. that comes in the middle of the night for her child that threw up one time 30 mins ago, or for a hangnail that they came in at 2:00 A.M. because they knew that the wait would be less than going to the clinic.  People who have medicaid and abuse it, they come to the ER up to 5-8 times a week and we try to report the abuse and nobody does anything about it.  We also have poeple that call an ambulance for a sorethroat that started 2 hours ago, I had a mother a few nights ago that came to the ER for her childs "emergency" and when we went to give her the presciption and the pharmacy was closed asked if we could give her a sample which we did not have. I told her that she could actually buy the product over the counter and she said that it could wait till morning when the pharmacy was open.  I could write a book about the stories of abuse, as anyone who works in the medical field could.  Add in the Lawyer aspect and the doctors that order thousands of dollars worth of tests that are to cover them from law suits.  It's such a no win situation for them.  After all that, many people know that if they complain about the care loud enough they get the bill written off, and who do you think pays for that?
On the other hand I have a child with a special needs and requires a lot of medical care and although I pay high premiums I would be bankrupt without my insurance and as far as looking for private insurance, my family would be uninsurable. No one would touch us.
It's too bad that there is not more done to prevent the abuse of the healthcare system or even reward those who don't abuse the healthcare/insurance systems, but I feel there is little being done about this and we are all paying the bill!

[Jon Allen]

It's just sad how abusive and uncaring people are- they figure just cause they don't pay for it, they should abuse the system.  One reason I think a national health care system won't work- too easy to abuse.  You need to shift responsibility to lower levels and back to the individuals (i.e. make them pay some).  I read an article the other day about companies in Miami that bill Medicare for millions of dollars of fake services. 

Ambulance for sore throat?  ER for hangnail?  Just sad.

[James Winzenz]

I agree.  Personally, I avoid going to the ER for anything that is not life or limb-threatening for myself, although I am a bit more paranoid when it comes to my children.  I thought one of the purposes of having "urgent care" clinics was to take some of the load off the ER's for problems that really do not justify going to the ER.  I am lucky enough to have such a clinic fairly close to my home that is open from 10 AM to 10 PM.  Almost always, this is the place I end up going if I need care, because they are open after business hours.  I hope that something can be done with the healthcare industry to make things fairer for everyone and to crack down on abuse.  BTW, my employer is actually doing something called MyHealthIQ that is designed to help individuals identify and lower their health risk factors.  Those that choose not to participate in the program will be paying higher premiums this year.

[Craig Green]

Wow- sounds like we're all on the same page here.

My company offers a couple plans through United Healthcare. I just switched this year from the traditional plan ($250/month for the family) to the high deductible plan (about $50/month). I can't remember the exact cost, but I save around $200/month. With the high deductable plan, we have set up an HSA. We had a Flexible Spending Account, or FSA, previously, which is a little different because you can only put in a pre-determined amount into the account and you have to use-it-or-lose-it at the end of the year. Both are tax-free accounts, only with the HSA you put in post-tax money and then you write off anything that comes out of that account.

Ok so here is the kicker- the high deductible plan rates actually went down a little bit this year, and the standard plan rates went up. They did this to encourage employees to be subscribe to the high deductible plan and be accountable for their medical expenses (thus helping to lower health costs in general). We did the math, and even if we reach the family deductible for the year, it is still only going to cost us like $200 more than if we chose the standard health plan. That is the worst case. The most likely case for a healthy (or semi-healthy) family is that you go through the year without coming close to the deductible and you save yourself money on the high deductible plan. Additionally, the money in the HSA is yours, and you can actually invest that money long-term if you don't use it on health-related costs.

Bottom line: I think HSA high-deductible plans are gaining in popularity and are a great tool for people to use and cut health care costs, once they understand them. And you're right- having a high-deductible plan doesn't mean everything comes out of your pocket. Medical expenses such as immunizations are fully covered, etc...

[Jon Allen]

Because of the high premiums for the non-HSA coverage selections at work, it is actually cheaper to choose the HSA for me.  I save tons of money over the normal coverage as long as my medical bills are less than 30-40k, and even at higher rates I only end up paying slightly more.  I really like how you don't lose HSA's at the end of the year, too.  Maybe the government and free market are finally finding a way to save money for us.

[Paul Petersen]

Interesting Huckabee podcast on The Final Sprint. About half of the discussion is about health care and touches on some of the points that other people made in this thread.

http://www.thefinalsprint.com/2008/01/tfs-podcast-best-of-series-republican-presidential-candidate-mike-huckabee/