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July 06, 2007
Universal Health Coverage: A Real-Life Reality Check
It’s high summer, hardly the time many of us think about health insurance. But here in Massachusetts, health insurance is on the minds of many people. That’s because on July 1, a new healthcare reform law went into effect requiring most state residents over 18 to have health insurance or pay a penalty.
While it's too early to determine just how close the mandate will come to achieving the goal of universal coverage, initial reports indicate that it’s done a good job so far of getting previously uninsured low-income residents into free or heavily subsidized plans. People over 65 have Medicare.
But what about those in the middle? That’s where the fault lines appear, demonstrating that even when coverage is mandated, it can still remain unaffordable and far from comprehensive.
A good friend of mine knows this all too well. She and her husband, both educated professionals, now work freelance. Unable to afford the $1,500/month it would have cost to continue her husband’s family health coverage from his last job (which was eliminated) through COBRA, my friend found that the least-expensive plans for which they’re eligible through the new state insurance program cost between $650 and $800 a month. All come with deductibles, some require co-insurance and the cheaper ones don’t cover prescription drugs. The least-expensive plan without a deductible that includes drug coverage costs around $1,000 a month. A plan with no deductible or co-insurance and with drug coverage would cost them about $1,200 a month.
But with two kids, a mortgage, unsteady freelance income and all the usual expenses of daily living, they simply don’t have enough in the checking account every month to cover premiums and out-of-pocket costs that high.
So this year, they're resigned to paying the penalty. They're hoping that by next year -- when the penalty increases significantly -- one of them has a full-time job offering comprehensive insurance they can afford. In the meantime, they're praying no one gets sick.
My friend knows they're taking a chance going without insurance, and she's not happy about it. Nothing in life is guaranteed, including good health. What’s more, a catastrophic medical event is a significant predictor of personal bankruptcy in this country. That means we're all one freak accident or one unexpected, undeserved major illness away from financial ruin.
So I worry about my friend, her family and others like them. If they can fall through the cracks in a state mandating health coverage, so can I. And in a country where nearly 44 million are uninsured, employers are cutting health benefits or shifting more of the cost onto employees, and the number of working Americans without insurance is growing, so can you.
The relative success of the Massachusetts reform bears watching, as do similar efforts toward universal coverage in other states. But for now, as my friend will tell you, the only thing universal about health insurance is the problem.
Read these articles to learn more about the state of health insurance:
- "Condition Critical: A Look at America's Ailing Health Insurance System"
- "The Working Uninsured"
- "Risky Healthcare"
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Posted by Ann on July 6, 2007 at 11:12 AM in Current Events | Permalink | Comments (25) | TrackBack (0)
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Comments
Penalizing the middle class because they can't afford health insurance is a sign of extreme stupidity in the legislative branch of state governments. If you can't afford health insurance, you can afford a penalty? That sounds like something only a government worker could come up with.
Universal health coverage is not only the solution to our healthcare problems; have you ever tried having surgery in a country with socialized medicine?
Everyone likes universal health care because it looks good on paper, but it's not the answer.
Posted by: newhoosier | Jul 6, 2007 4:59:18 PM
Agree that the universal health care situation is full of issues and holes -- check out the raw numbers on the CT initiative near you in Massachusetts: http://www.hrcapitalist.com/2007/04/whats_the_cost_.html.
Additionally, as a VP of HR who sees the bills coming through, it always blows me away the discounts the major insurance companies extract from hospitals and doctors. That's good for our employees, but the sticker price of procedures and treatments that I see is what would get charged to the uninsured -- and the uninsured middle class you describe is a big-ticket item from bankruptcy in many cases.
Posted by: Kris | Jul 7, 2007 11:27:09 AM
One of the most amazing things about universal health care is its universal blindness to cost-effective treatment. Even though recent multi-year studies have shown that chiropractic physicians provide better and more cost-effective primary care than do MDs, none of the universal health plans makes appropriate use -- or provides appropriate reimbursement -- for chiropractic services.
So long as we keep employing expensive, inappropriate drugs to cure illnesses better treated through natural means, health care coverage will continue to be just that: inappropriate and expensive.
Posted by: Dr. Avery Jenkins | Jul 13, 2007 4:29:51 PM
Kris, you are incorrect. The price that you see billed to an insurance agency is not always the same as that which an uninsured person would be billed directly. I moved back to the US from Europe several years ago and never bothered to get health insurance upon my return. Now when I go to the doctor, they happily accept a lesser amount ($50, for example), equal to what they would receive from health insurance, which is far less than what they have to bill the insurance ($150) to receive a payment of $50.
Forcing people to have health coverage or pay a penalty is taking away their freedom to choose. If one does not want health insurance, one should not be forced to pay for it. There must be a lot of under-handed politics involved in that ridiculous law. Who benefits from this new law? The insurance companies and no one else !
Posted by: Lori | Jul 17, 2007 8:12:49 PM
Sounds like most of the posters on this board need to see "Sicko" before they write another post. The Massachusetts plan is not adequate. This must be done at the federal level and administered seamlessly like Social Security. Universal health coverage is designed to eliminate the private insurance industry from health care coverage all together. The Single Payer System such as in Canada, all doctors and hospitals are still private. Only the payment system is public.
I personally have been treated in UK and Germany. Both experiences were top notch. I could not believe how easy it was to see a doctor without the snarling and hostility while I was in pain of "Do you have an insurance card?" "How are you going to pay?" that we often get here nowadays in the the U.S. BEFORE the doctor can see you. These issues never came up in either place. Prescriptions were paid as a low flat rate. See the film. It is 100% accurate. If there is any waiting for surgery because of something not being done in a certain way in these systems we can learn from it and correct it...after all we're Americans and can solve any problem.
By the way there was a German woman in my office who refused to use the U.S. insurance we offered (Aetna and Blue Cross) because her German government insurance had no deductibles or copayments and was good worldwide. Remember, this is YOUR health we're talking about. You are not a commodity.
Posted by: Joe R | Jul 17, 2007 8:57:15 PM
Another example of government not solving a problem with a program. When will people realize that government, state or federal, is not the answer? It may sound good what they tell you but when the final outcome is done it is worst. Look at England and Canada for two examples.
Posted by: Joe Discher | Jul 17, 2007 10:57:59 PM
A state's individual efforts to provide and/or require its citizens to have health insurance will come to naught, because it includes health insurance companies, and health insurance companies are dedicated to accumulating as much as possible and paying as little as possible. If an individual state attempts to force insurance companies to include every citizen at an affordable premium, the insurance companies threaten to cancel all policies and leave the state, as happened some years ago with no- fault auto insurance.
The only way to provide health care coverage to every citizen is through nation-wide insurance financed by the Federal Government and paid for through tax dollars. This will greatly displease those who, till now, have benefited from the current non-system: the health insurance companies, whose gravy train has been derailed; the pharmaceutical industry that gives the consumer the choice between his money or his life; the "I'm all right, Jack, to hell with you," mega-rich, whose taxes will be increased to the pre-Bush tax cut level; and politicians, who receive hefty campaign contributions to keep the health care non-system exactly as it is.
Posted by: Gael Gibney | Jul 18, 2007 3:00:22 AM
Ask someone who has worked here and then moved back to a country with Universal/Socialized medicine and ask them what they think of it. Many of my friends who complained about the health systme here are singing a different tune now that they are in the E.U.
The answer to the insurance crisis is to rein in these ridiculous lawsuits and settlements that add to the cost of healthcare and medicine. We are already seeing doctors avoiding certain specialties which lawyers see as cash cows. Of course since most politicians are lawyers by trade, they may be leery to get to the real source of the problem.
Posted by: Veritas | Jul 18, 2007 11:20:00 AM
What makes you think Medicare is such a great bargain? I pay $75 a month out of my social security check for the "privilege" of getting Medicare. When I go to the doc, he up charges me to $118 for a ten minute visit for which Medicare pays only $38 and I have to pay the rest.
Living on only Social Security, that leaves me short for the month. Some bargain.
In Yuma, Arizona, the medical profession has the retirees between a rock and the proverbial hard place. Confiscatory fees, predatory pricing practices and an almost certain Sherman anti-trust violation going on within a closed dental field would made Teddy Roosevelt nuts. Any YOU complain about the middle class? C'mon down to the retired, bottom run, abused, over 65. At least the sun is out 365.
Roger F
Yuma, Az
Posted by: Roger F | Jul 18, 2007 12:31:46 PM
I have sympathy for uninsured folks. However, my eyes were opened when my 16 year old got a job for 10 hours a week at the local grocery store (ununionized). He was offered health insurance at a cost of about $15/week. It wasn't the greatest insurance in the world, but for a young person without insurance, working part time several nights a week is a bargain to get access.
Posted by: cincinnati mom | Jul 18, 2007 1:59:21 PM
My brother who was 86 just passed away from Alzheimer's. I started taking care of his bills about a year ago. He had a fall at home in June 2006 and went to the hospital. He was diagnosed with a hairline fracture at the top of the humerus (right arm). He said he couldn't walk when the doctor sent us home. The attendants put him in the car and I then drove home. Upon arriving, he couldn't get out of the car. I took him back to the hospital and after waiting another 30 minutes there, the medics put my brother in an ambulance. The medics put him on a stretcher and brought him in the house. Six months later, he received an additional bill from the office of the doctor that saw him in the emergency room for almost $300. My brother never went to this doctor's office! He only saw the doctor in the ER. Personally, I think the doctor should have kept him in the hospital until he could walk again on his own. I don't think the doctor deserves to be paid. Medicare took care of his ER bill.
Posted by: Marian Coffman | Jul 18, 2007 6:21:16 PM
I too am concerned. It's not meeting the middle-class mark and the cost to do business is forcing employers to "downsize on their staff and benefits." This is not a Massachusetts alone situation. More to the point, leaving a big corporation with all those benefits put them in the company of many others. Not pretty.
Universal is an ambiguous term. Follow the money when you hear that term. If you think "universal" insurance is expensive, try insurance only for the rich. See what happens to the economy then. Hooray for those states that call a spade a spade and start digging themselves out of the high cost health care hole. Of course, every system has its shortcommings; like democracy, it's not perfect but I wouldn't want to live under any other form of government. I am equally for capitalism and the pursuit of happiness.
How else is one able to pursue happiness if the cost of competion in the for-profit market makes health costs unattainable for the majority (which is what we have now)? Look at the cost to forego health insurance reform and market drugs, VIPs (i.e., lobbists, politicians, doctors, associations, hospital administrators, advertisements etc.) Therein lies the rising cost to do business. There are those who would let you believe it is the 45% uninsured that are the cause of high cost; however, monetary evidence does not support this position
Hmmm 100% insured in Massachusetts versus 65% insured on a national average. A large portion of the 65% insured is one major illness away from "medically insured" bankrupcy for the middle class from increased rates due to "pre-existing conditions." I applaud Massachusetts and other states that have taken the initiative to call a spade a spake and dig in to thwart the inevitable collision course on the national's welfare of its citizens and financial catastrophes that befall those who fall victim not only to illness/accidents and cannot sustain themselves/families medically due to unaffordable premiums or worst denied coverage for "high risk" or "pre-existing."
Proposed Model for Solution:
The model I, (as well as a professor on NPR from the University of North Carolina,) like is the one used in Australia where everyone recieves "adequate insurance" and those opting for more benefits can choose private insurances.
I like the Down Under hybrid. The consumer gets adequate health care, the private insurers continue to profit and the politicians are less likely to get caught with their hands in "that" cookie jar. Everyone puts into the kitty (somewhat like auto insurance -- high to low risk all "adverse selection" is accounted for and covered.) This is a very simplified example. The health care system is very complicated and convoluted but you get the gist of it.
The goal is everyone wants adequate, affordable health care and everyone wants to be able to pay their bills. I know we can do this. I know there is room for growth. I mean a collective conscious awareness by all parties concerned. With 45% of the citizens not having adequate, affordable health care we do not have to go very far within our circle of family and friends to feel their pain. No need for shame and blame, dig in to win the game by bringing us closer to the goal.
This my perspective as a life, health, property and casualty insurance agent and a mental health/addictions therapist who desires only the best for all.
Posted by: Lisa | Jul 18, 2007 7:15:10 PM
Lori is absolutely right. "Sicko lays things out how they really are." The only way we will be able to clean up our health care system is to take insurance companies out of the picture.
Posted by: Erica | Jul 18, 2007 8:31:27 PM
We are in the miserable median. We have too much to get any kind of help, but make too little to pay for everything ourselves. We have cut out all extra expenses and still do not have enough for health insurance. We work full-time jobs, have two kids and rent the least expensive place we could find near our jobs. I am going to college as well to obtain a higher-paying job in the future (which a lot will go to pay off the student loans). We did qualify for health insurance through the state for the kids only.
People should not be penalized if they can not afford health insurance; that is just crazy. Before penalizing for anything like that, government should look into how to fix the problem not make things worse. What are they going to do if you cannot afford the penalty either? Throw you in jail and put the kids in an orphanage? (Well, at least we would have free everything then, ha ha)
Posted by: Frances | Jul 18, 2007 10:33:06 PM
To Newhoosier -- While the penalty may seem counterintuitive and overly harsh, it serves a purpose. Penalties incentivize the program. The fees collected help to offset the costs incurred when people without health insurance incur catastrophic losses and cannot pay. The state foots part of the bill and the hospital or provider absorbs the loss. Federal ERISA laws prohibit denial of needed care based on ability to pay. The individual must be assessed and stabilized before being redirected to charitable care.
To Dr. Jenkins - You and I both know that primary care is outside the scope of practice for a chiropractor's license. Your own professional lobby acknowledges that fact and uses it to argue for diminished malpractice coverage requirements for chiropractic 'physicians.' You cannot prescribe pharmaceuticals or perform laboratory tests (blood tests, etc.). You sure do a lot of X-rays, though. Has anyone ever done a long-term study on the effects of this radiation on long-term chiropractic patients? I think not. It makes me think back to the days when they used to use fluoroscopes to fit shoes. If chiropractic care is so cost effective, why charge for an office visit AND an adjustment AND massage AND myofacial release AND hot & cold packs AND exercise AND e-stim AND traction AND biofreeze for each and every visit AND have the patient come in 2 or 3 times a week at $350 a pop? Please explain how temperature studies serve either a therapeutic or diagnostic purpose? The so-called "natural" supplements that you prescribe (and sell at a markup out of your office) are at best ineffectual and at worst toxic if taken in excess. None of them are subjected to standard scientific double-blind studies that provide evidence of efficacy and safety. As problem-plagued as the pharmaceutical industry is, the herbal/natural supplement industry is even more so. Chiropractic care is no solution for the problems dogging our healthcare system. Since when does spinal manipulation treat ADHD or AIDS or correct myopia? Would you prescribe spinal manipulation for meningitis? Would you be able to distinguish meningitis from a really bad headache?
To Lori - Kris is absolutely right. The amount that is billed is what would be charged to the uninsured patient. A provider or facility will often give prompt pay discounts or write-off a percentage if the patient is unable to pay the full amount. However, there are laws that prohibit a doctor or hospital from CHARGING different amounts to different payers. The Charge Master must be consistent. The physician may be willing to accept $65 as payment in full on a $100 charge, but the bill will still say $100. Blue Cross and United Health Care may have negotiated a contract with that doctor that says they will pay $35 or $45 for that same service, but the billing form that Blue Cross or United Health Care receives will still say $100. A facility may offer a 25% discount if the bill is paid in full within 60 days or they may arrange for financing, but the amount on the bill will still be the same regardless of your ability to pay or if your insurance company has negotiated a discounted rate or pays based on the DRG.
To Joe R. - While "SICKO" is certainly compelling cinema, Michael Moore is guilty of exaggeration and omission for dramatic effect. Even in single payer systems like in Canada or England, there is private health insurance that pays better than the state system does, which results in two standards of care: one for the haves and one for the have-nots. The only way these systems work is by rationing care. If you weren't dying of a heart attack (acute condition), but had debilitating angina and couldn't climb a flight of stairs (chronic condition) would you be willing to wait two years or more for by-pass surgery? Would you be willing to risk sudden death from a ruptured aortic aneurysm because some bureaucrat decided that your condition could wait for surgical intervention? In order to make a system like that work, we would have to change how all Americans think about and what they expect from the healthcare system. This is no small task and cannot be accomplished simply through legislation. We have to change the way we educate doctors. We have to change the collective psyche of healthcare consumers.
Do you know exactly how much a doctor's visit is going to cost before you see the doctor? I'm not talking about the $20 or $30 co-payment for each office visit. I'm talking about knowing exactly what that visit is going to cost before you make the appointment. That Charge Master I referred to above is usually a closely guarded secret. You never know what it's going to cost until after the services have been rendered. There is no free market here. You don't pick your doctor based on how much he or she charges for an office visit or a venipuncture or a pap smear. Those things are either covered by your insurance or are a big surprise when the bill arrives (or is handed to you on the way out the door when they expect you to pay up).
If you knew that it was going to cost $60 to see the doctor for that sore throat--and that it was going to get better in 3 to 5 days whether you saw the doctor or not--and that $140 prescription for antibiotics you got just in case it was strep may be doing more harm than good--would you think twice about that visit to the doctor or the emergency room? I bet you would.
If you were aware of physicians' charges the way you are aware of gas prices would the choices you make be different? You change your oil and keep your tires inflated because it saves gas, right? You get a tune up and change your spark plugs and get the occasional alignment because it makes your car run better, last longer, and use less gas, right? Does your auto insurance pay for preventive maintenance? No, it doesn't.
We need to treat our bodies with the same respect most of us treat our cars - good fuel with a healthy diet and keep things tuned up with regular exercise. Each of us has to assume as much responsibility as we expect the government and our physicians to.
Fixing the healthcare system has to start with the consumer, then with how the industry regards the consumer and then fix adversarial relationship between the provider and payer that leaves the patient in the middle. The government is at best a referee.
If the government ran healthcare the way it is running the war in Iraq where would we be? Would we let Halliburton decide who gets surgery and who doesn't? Government can't manage healthcare and it is costing the taxpayers a fortune. That's why states contract with private managed care plans to take care of their Medicaid patients -- better outcomes for fewer dollars. The same goes for Medicare Advantage. It's not perfect and it doesn't make very many people happy, but it's better than a free-for-all with the government picking up the bill and passing it back to the taxpayer.
Posted by: deecember | Jul 18, 2007 11:08:15 PM
Having spent 10 years managing physician groups, patients and working with hospitals and insurance plans, and having grown up with my family in Great Britian and Canada, I see one very important point. There is no perfect system. Any system requires that everyone, the government included, work together to provide coverage and care for all American citizens, regardless of income. This also means that the politicians need to stop padding their pockets and campaign funds with monies from drug companies. It also means that we consumers need to stop telling physicians to prescribe the latest wonder pill that we have seen advertisements for or demanding services and care that are not "medically necessary" under current guidelines. I have also seen that the physicians need to be brought under a reasonable fee schedule. I have worked with many, from struggling pediatricians trying to provide good care and keep kids healthy and immunized, to highly specialized surgeons who demand excessive and often ridiculous charges simply because they can. Physicians quite rightfully deserve to be fairly reimbursed for the work that they do.
I am also a firm believer in managed care -- yes the dreaded HMOs. When run well with the health of the person being served kept in mind, an HMO gives fantastic care while managing the costs involved. It is also very likely that America is far too large for a single, federally run system to be effective. That said, the federal and state governments would be best to come up with individual, statewide systems that require income-based contributions from all legal residents with some federal subsidies to assist the poorest residents and those residents who are unable, due to age or disability, to contribute.
Posted by: Joy | Jul 18, 2007 11:19:43 PM
The almost 50 million uninsured Americans have no coverage and will remain exposed, risking their health and employment if they get sick, as long as we want to pretend that universal coverage is impossible. More are sick, the sick get sicker and we pretend this can't be changed. Bull. This will change whether we like it or not.
What is impossible is what we have now. It is time for this country to wake up and handle this broken health care system. We have heard all the malarky already from all the usual suspects and it changes nothing. Business cannot sustain the costs of health care access and individuals cannot afford it in this age of poorly paid labor and mass unemployment in many areas of the country.
It is time for all the uninformed to get informed and start to realize the situation many working people face every day. No one knows if they will inherit a disease or get hit by a truck. Your child may get seriously ill. Would you want to bet against the house that none of these things will ever happen to you or your family? Medical bankruptcy is not an answer to any illness.
Anecdotes mean little to any of us. We need an intelligent way to deal with the uninsured and the uninsurable in this country. We have nothing as it is and it shows. And for all the shock and surprise re: the movie "Sicko," those people were insured. If they hadn't been paying their premiums, they would not have done as "well" as they did.
If you have no interest in your own life and well-being, act for others who may care about themselves and their families. America is not the better for ignoring this medical crisis. On the contrary, it weakens our own productivity and strength as a nation. This is 2007 and it is time to wake up.
Posted by: M | Jul 19, 2007 2:56:33 AM
Just some of my own experience:
After eleven years of company health, I took a plunge into my own business and health care. All was going well here in western Montana until I discovered that groups of doctors had pulled out of the major medical (Blue Cross Blue Shield). Montana prices are more than Tennessee, Colorado and California. Paying insurance AND the radiologists (and anesthesiologist) too was just a kick in my butt at the annual exam which cost $3,000. Prices like $200 for a mammogram were too much. I dumped the plan, which was only costing $250 per month at the time (two years ago). And have since taken classes at the university, and although it is still Blue Cross Blue Shield, I only pay $135 per month.
But my point is, I am still not really covered for that big accident because I end up paying for those xrays and surgery (anesthesiology) full price. Not reduced! Full price! I would be better off economically without insurance because then I would get a cut rate. But, people without insurance are not given the same health care.
I should add that I was very confused when I arrived for my mammogram and the receptionist tried to get me to pay upfront for a reduced price. In retrospect maybe I would consider that. I don't remember what her price was at the time.
All the best of health to all of you. That is your best protection against the rising cost of health and a solution that won't be too soon in coming.
Posted by: Sarah | Jul 19, 2007 5:02:33 PM
How can it possibly make sense to have for-profit (insurance companies) controlling the health care system? They jack up the premiums to people like me (yes, I was bitten by that same COBRA), but then look the other way when the doctors and hospitals charge exorbitant amounts to patients that they know have insurance and blindly pay these bills with the money from the high premiums. (Insurance companies have a limit for most procedures, but they were set way too high initially because doctors were smart enough to see that coming and rightfully raised prices because they needed to make money themselves). Meanwhile the insurance companies still NEED to make a huge profit, so they hike up premiums to businesses and drive them out of the state (CA).
The problem is so obvious here in CA, millions of uninsured (most here illegally) have sucked up all the resources forcing closings of many health care centers that can't stay in business treating people who can't pay and aren't insured. Some serious auditing needs to be done and healthcare providers should have realistic pricing mandatory -- enforced by Arnold (the Governator) himself if necessary!
If a doctor saves a life, he or she should be well compensated, but just not so much that Joe Middleclass has a monthly medical premium almost as much as his house payment! I thought I elected somebody to figure all this complicated stuff out. If not, what are they doing?
Posted by: Rand Kenyon | Jul 19, 2007 7:34:50 PM
I have been without health insurance for many years. My past experience is if you are not completely healthy or have one visit to the hospital, you will be denied coverage. However, the insurance company that denied you will give you a letter of denial so that you can go through your state pool insurance and pay double that of what you applied for. What good is that?
Posted by: Karin | Jul 22, 2007 4:23:08 PM
Dr. Jenkins' observation about politics shaping the Massachusetts health care law is pretty accurate. The Massachusetts plan was the result of a combination of political motivations coming together in a "perfect storm" scenario. They were:
1. The need for the state to meet federal guidelines to reduce Medicaid costs. So, the state reduced Medcaid cost by changing their eligilbility standards, effectively cutting off all but the poorest citizens.
2. Gov. Mitt Romney needed a major accomplishment to bolster his presidential campaign. He got the initial boost he sought when the bill was signed, but I notice that he makes little mention of it in the campaign. Perhaps his handlers are realizing that mandating people to buy insurance when they can barely afford to pay rent every month has little appeal to conservatives or liberals?
3. Lobbying by the business community to reduce the "free care pool," which all employers fund as a surcharge on their helath insurance premiums, has been on the lobbying agenda of employer trade groups for years. Likewise, the hospital industry sought a more reliable and robust form of reimbursement for the free care they provide. Under the direction of Blue Cross Blue Shield and other major Massachusetts-based insurers, these groups came together to provide the "private-sector" cover/pressure that legislators respond to.
Unfortunately, this "reform" will not reduce the cost of health care; instead, it simply shifts costs from the federal to the state government (which has been happening for years), which, in turn, is shifting the cost onto those citizens who can least afford to pay the price of insurance.
The net result is a system that will cause more people to go without adequate, routine care. And when they finally receive treatment in an emergency room, the cost will be far higher.
Three basic premises of the insurance business are:
1. Cost containment.
2. Spreading the risk across the broadest possible base.
3. Collecting enough premium to cover the true cost of the service.
The Massachusetts plan does not address any of these factors. Universal insurance in this country can only be achieved when we:
1. Regulate the cost of prescription drugs.
2. Create a risk pool large enough to make the insurance system function at its highest effeciency.
3. Provide adequate funding.
The closest we have to that is Medicare/Medicaid, which my parents and in-laws tell me works well for them. Theoretically, the Medicare concept could be adopted to cover all citizens, but it would require the government to put the interests of its citizens before the interests of the health care business. That didn't happen in Massachusetts. It won't happen nationally until enough citizens demand change from Congress and elect a president with the vision and political skill necessary to lead the way.
Posted by: John | Jul 23, 2007 2:27:01 PM
This is an unbelievably complex discussion with many facets. Understand that the United States has the most advanced medical care in the world -- and it's because (for the most part) we allow the free market to be exercised. In the health care arena, people generally want all the benefits -- the latest medicines, procedures, etc. -- but the uninsured balk at paying the price, which can range up to $1,000 per month and more for a family policy. The market works when it comes to auto insurance; it works when it comes to life insurance; it works when it comes to homeowners insurance. Are we supposed to think that for some reason it doesn't work in health insurance? Of course the market works; people just don't want to or can't afford to pay the full costs.
And for those who think that for-profit companies are the root of the problem -- get a grip. For-profit companies make everything in and around medicine that make us better. They make certain that they compete for business, deliver services in a manner that returns value to both the consumer and stockholder, and do their best to protect their reputation. It's probably tough to strike a perfect balance, but most insurance companies have a lower ROI than typical for-profit companies, and their stock price and market capitalization reflect the lower future earnings potential of the class of business.
Check out the vast numbers of Canadians and Europeans coming here for complex surgeries. What's the waiting time for heart bypass surgery in Canada? Up to 18 months -- about 17 months too late. Universal health insurance could work for the mundane, typical health events; for time-critical operations it's a disaster. Medicare is the closest thing we have in the US to universal care, and it's a time bomb bigger than Social Security.
There are no easy solutions to this host of problems, but we need to make certain that we don't get in a hurry to do something about it -- and make the problem worse.
Posted by: Eric | Jul 25, 2007 10:47:00 PM
We have universal health care now. If you are sick or injured and go to the emergency room, you will be cared for. Unless it is life-threatening, you may wait for hours. You will be billed, and if you can't afford to pay, you may be driven to bankruptcy. Nonetheless, you will be cared for.
Posted by: jj | Aug 1, 2007 9:44:39 AM
Medical insurance in the US sounds like a real nightmare. I live in Canada and I sleep with ease. I have been researching health insurance for the past several weeks. Here we usually pay no more than $50/month maximum for healthcare insurance. How much does it cost to be covered in the US individually? I have gotten many replies to postings that vary greatly depending on what anyone is covered for specifically. Just wanted to have a ballpark figure for being able to go see a doctor and be taken care of in the hospital (example: heart operation).
Posted by: fran | Nov 22, 2007 1:50:45 AM
I have been unemployed for five years now due to the state of the job market, current administration policies, and suffering from Generalized Anxiety Disorder. I have no assets, and have no income. Earlier in the year, I had to have my gall bladder out, my first surgery. When the bill arrived in the mail, I simply shrugged and ignored it. After all, I have an inherent right-to-life that trumps any entity gaining money as a priority over my continued life.
Even when I was employed and making a ton of cash with good benefits, the deductibles are ridiculous. The overwhelming majority of people live paycheck-to-paycheck in our country, and can't save any money.
I have no loss of sleep over "stiffing" a medical professional for such a large bill. After all, they all have insurance that pays such write-offs in the end, and they don't lose the money anyhow.
We need desperately to move to a nationalized healthcare system -- forget insurance, forget premiums, all of it is pointless. Medical treatment should be available to all our citizens and paid for by the government through our taxes. Not enough in the budget? Stop wasting cash on unnecessary activities like invading and occupying other countries. We need to focus on US first, then the rest of the world.
In the meantime, I know if I have a health issue, I have the right to treatment, and therefore, don't let the lack of ability to pay bother me. If I were responsible for my situation I'd feel different, but that is not the case, as it isn't in many millions of other cases in our nation. This is why we need Clinton in the White House -- at least she will start moving us in the right direction.
Posted by: Always With Wisdom | Dec 31, 2007 7:28:20 PM
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