Health care in America seems more appropriately like “sick care,” and we need to make sure health, of the proactive variety, is more a part of the equation.
The recent debate raging over what happens, who pays and who’s covered comes at the same time of shocking evidence that we, as a nation, continue to ignore these five simple rules of wellness.
1. Don’t smoke.
2. Exercise almost every day.
3. Eat well (five to nine veggies and fruits a day, smaller portions, few to no soft drinks).
4. Maintain a healthy weight.
5. Drink alcohol in moderation.
Only 8 percent of us adhere to those rules, according to a study in the June issue of the American Journal of Medicine.
Ahh, but all of our failings are by choice, and people inevitably pay for their choices. Yes, many of us share the burden of others’ choices, but we still have our freedom to choose a cola when we want one, or a cigar, or bacon.
For now, Jim, for now. If Obama succeeds in doing for American healthcare what Joe Stalin did for Soviet agriculture, nothing at all will be off the table, behavior-wise, to federal legislation. Nothing.
As they say: never waste a good crisis.
Being old, I remember when HMOs came into vogue, supposedly to effect just this very sea change. We would run to the doctor (actually a clinic) at the first sign of trouble, plus have all sorts of wellness services. This would reduce medical costs associated with catastrophic illness. That worked so well we should extend it to the rest of the country.
In my younger years, I seldom went to the doctor for anything but a checkup, and I don’t remember ever hitting my deductible, before the HMO days. Now, doctor’s drop my insurance in favor of a younger, healthier crowd, more co-pays are applied since the baby boomers are, in fact, a population boom, and blame is affixed on those who eat the things we were raised to eat (meat, fats, and so on).
For the record, I just enjoyed a delicious double-meat greasy-spoon burger with fries for my lunch. Anyone who doesn’t like it can kiss my ample posterior portions.
Hey Jefferson: What do you think of Earl Butz?
If Obama makes health care like the Dutch model, it won’t be that bad. That’s a market model worth emulating.
#1 By Choice? Interesting. Millions of people wake up trying to choose not to like fat, salt and sugar.
[blockquote]Hey Jefferson: What do you think of Earl Butz? [/blockquote]
He’s a swell guy if he’s got three squares a day and a warm place to do his business. I know there’s a point, so why not make it?
[blockquote]Millions of people wake up trying to choose not to like fat, salt and sugar.[/blockquote]
Is that possible? Or will it only be possible with the passage of the current litany of punitive liberal measures? Lastly, will it work as well as Cash for Clunkers did?
I absolutely reject the premise that there is a “crisis” of some sort. My wife and I (in my 60s) have excellent, readily-available insurance through Blue Cross at under $130 per month. Were there children in the home it would still be under $140. Hello? Where’s the problem?
That each of us actually has to decide whether a particular trip for medical care is worth the amount we’d have to pay? What’s wrong with that?
The blunt fact is that I absolutely dread being forced into the [i]existing[/i] government health program, Medicare, which is so desperately bad they have the threaten me with cancellation of my Social Security payments if I don’t go along and sign up with them.
What government already do is horrifically bad.Why would any even halfway sane person hand them the key for doing the same thing to everyone?
make no mistake, this whole fatty unhealthy eating thing was impressed upon us at a very young age. i grew up on wonder bread, log cabin syrup, twinkies, oreos, pickle loaf lunchmeat, kool aid, anything with red dye no.5 and mac and cheese from the box. my mom didn’t know better, these foods were easier and faster to prepare. there is a reason why they taste ‘better’ than non-processed food. i’ve had to train myself to go back to pure maple syrup and avoid those other things like the plague or buy the organic equivalent. i still miss them sometimes but when i do break down they taste wretched.
That’s great Bart but my insurance for my family is $2,500 per month with exposure and increases 30% at renewals. I can’t provide insurance for my employees any more. The possibility for uninsurability exists which would be catostrophic for my family’s net worth. Healthcare is and will bankrupt many families in the near future. There is a crisis in this country you are just very fortunate to not be part of it.
I disagree with the statement in the article that what we have is “sickness insurance”. That’s precisely what we DON’T have. Insurance is more than willing to pay for the health related oil changes, tune-ups, and tire rotations, but balks at the big stuff. THOSE are the circumstances that are getting people in financial trouble. If I get cancer (OK, choices make a difference, but some people do get lung cancer that never smoked or were around people who did smoke, if you get my point), THAT’s precisely when I NEED insurance. Not to pay for my blood pressure check-ups and meds. What good is it if my insurance has paid for mammograms for, lo, these many years, but will not pick up the cost of treatment if I DO get breast cancer?
I also don’t think the onus for coverage should be put on employers. Give everyone the same tax break the gov’t gives to companies who provide health coverage (I won’t use the word “insurance” ). Tort reform would be helpful, and lifting state mandates on health coverage would also lower costs. If you need coverage for, say cleft-palate work, then you should be able to get it, but EVERYBODY in a particular state shouldn’t have to be covered for it. I’m sure there will be some sharing of costs all the way around, but this would be a start.
Lee — you have the wrong insurance. You cannot possibly be spending anything like $30 grand a year on medical care unless all of you are already very, very sick. Pending a really good explanation, I’m not a bit sympathetic. I own a business, and pay my employees quite well so they can choose their own medical coverage. It’s not [i]my[/i] responsibility as their employer.
The core problem is that people have come to expect first-dollar, third-party coverage for every single thing related to our health. What would you pay for house insurance if you expected it to fix a clogged toilet? What would you pay for auto insurance if you expected it to cover oil changes?
For Pete’s sake, people, take some responsibility for your own lives.
Frankly, Bart your comment is misinformed, arrogant and condenscending. I pray that you do not become seriosly ill or are involved in a car wreck tomorrow because then you will likley become uninsurable but then again a bit more humble.
Lee: misinformed? I’m going on the basis of your numbers.
Arrogant? To pay my employees well and have confidence in their own ability to choose what is best for themselves.
Condescing? Lee, our insurance rate includes a history of cancer, which for most people will count as “seriously ill.” As I say, this is Blue Cross. That is nothing esoteric or unusual, and it takes no special (arrogant) skill to uncover it.
Is it “misinformed, arrogant and condescending” to dread being forced into one existing example of government-managed health care? Medicare in 1968 cost $30 Billion per year in 2008 dollars; by 2007 it came to $436 Billion. Are you suggesting our old people were ten times better cared for in 2007?
Or we can look at Medicaid. Federal costs of $12 Billion in 1968 (again, in 2008 dollars) and $191 Billion in 2007. Federal dollars covered half the expense. Are you suggesting our poor people were ten or fifteen times better cared for in 2007 than forty years earlier?
My father-in-law is a physician. After he retired it took more than four years for the last of his bills to the government to work their way through the system and generate a check. He certainly would not say the government are doing a ten times better job than in 1968. He’d make the opposite case, and this is a guy who drove 55 miles one-way to do clinic work in a very tough inner city neighborhood, so it’s not like he was a greedy so-and-so.
Of course maybe Medicare and Medicaid are aberrations. Those other government managed health systems, the Veterans Administration and the Indian Health Services are shining examples of government at its best, aren’t they.
There are also five basic of financial wellness for controlling medical insurance costs:
a) Be responsible for your own wellness by controlling influential lifestyle factors.
b) Carry very high-deductible catastrophic medical insurance for those times you’re badly injured or very sick.
c) Think very carefully about how and when you use medical services, and become an aware, active, consumer just like you are in the rest of your life.
d) Use your insurance’s network to drive down the price of what you pay out-of-pocket.
e) Set aside some of what used to be a high premium for a low deductible, preferably in a tax-favored Health Savings Account.
Simple … but apparently the same as lifestyle issues, not so easy for a majority of people to pull off. Please, however, don’t expect me to pay for it, and especially via a bloated, inefficient, and corrupt government bureaucracy.
Bart, what are those wonderful employees of yours paying for their health care? Bet it’s not $130.
“That each of us actually has to decide whether a particular trip for medical care is worth the amount we’d have to pay? ”
My son’s (premature) birth and nicu stay was about $1M, and we’re still paying off the $15k insurance didn’t cover. At what point should we have said, “yaknow, I just don’t think this is very cost-effective?” But, “It is not this baby’s [man’s] sin or his parents’ sin that made him be early [blind]. This baby [man] was born early [blind] so that God could use him to show what great things God can do.” A bad paraphrase, but it’s certainly true that God has done great things for us!
My wife’s sister is uninsurable as an individual because she’s a cancer survivor; she’d love to start her own business but can’t leave an employer health plan so she’s stuck. If only her ovaries had planned better or been more responsible.
Clay .. In the one case I know for sure (she thanked us for pointing her to Blue Cross) the employee is paying $78 per month, but she’s single and somewhat younger. Same sort of catastrophic coverage as we have, though with a somewhat lower deductible.
Bart I have seen Blue Cross jump in and out of the market over the years and I don’t see it as being the great company that you do. I had a serious illness a decade ago and by God’s grace I’m doing well now. I have very few options. The numbers I quoted are real and if my group drops me I am uninsurable except for my state’s insurance pool. Your comments are arrogant because by the grace of God you are not in the situation thousands if not millions of Americans are faced with as you really don’t understand insurance. None of A-E are even relevant to the discussion. I am not advocatiing Obama’s plan, but at least he is bringing the issue to the table.
BTW, as a side note, I have 4 friends who are MD’s and two who are DD’s. Trust me none of them are starving.
Clayton I would love to hear your story about your son. I suspect it has tons of spirtuality associated with it. One thing that strikes me and it is common is the 1m cost. I’ve heard it many times.
Bart – just for some perspective – if I used the only insurance offered by the small non-profit that employs me, I would pay $1,940 per month to cover myself and my family ($23,200+ for the year) – this does not take into any consideration for our health except our genders and ages. Fortunately, my spouse is employed by a Big Box home improvement store – the Orange One – and the premium she pays is $200/two weeks or about $5,200 per year. So unlike Lee, we have a choice …… but lots of folks don’t – and they go without to eat.
We need to be able to to create larger groups – across employers and across state lines. Like auto insurance there has to be a minimum policy that every insurance company must offer – so we can have GEICO, Progressive, Nationwide, & ALL STATE competitive like pricing. And, we need Tort reform.
Jefferson, you are probably aware that if it weren’t for government subsidies, our meat would be more expensive. If the government stopped subsidizing corn, water, and forced farmers to graze on public land and market level, people would be eating far fewer burgers.
My point? Thanks to government, you have more fat, sugar and salt at your pleasure. Go get yourself a burger, and thank the department of agriculture for such cheap food.
Bart Hall, how do you measure that medicaid and medicare are disasters? Polling seems to indicate that people are more satisfied with them than with private care.
D Hamilton you get it. Thanks. One thing that might surprise you, it did me, in states that have tort reform, insurance costs have not gone down. I’m working on understanding this.
Another thing to think about. We are all one group. That is, our country is about all American citizens. Why do I pay for excellent health care for my govenment employees (extraordinary quality) and I can’t afford the same plan for my own kids?
The reason tort reform makes so little difference is that it affects very few medical disciplines and perhaps no more than 5% of the total. I have seen numbers as low as 2%. There is just not much financial leverage there, as politically popular as it might be on the right.
John — I farm for a living, meaning no jobs off-farm and not one dollar of subsidy money. Our government should stop subsidising all such nonsense. As to the “disaster” of Medicare … one very anecdotal example: my neighbor needs an oxygen machine, which he could buy for under $1000. Medicare instead requires that he [i]rent[/i] this particular model for $600 per month, year after year after year. A one thousand dollar machine costs our system $7800 per year until Ed goes to meet our Maker, which could be very many years. Financially that’s a ‘disaster’ for our nation, not because Ed is “ill-served,” but because when multiplied by millions it is so horribly inefficient.
Don’t even talk to me about a national system — and I lived under one such system for more than twenty years — until you prove you can make what we [i]already[/i] have work so well that you don’t have to threaten me with the loss of my Social Security if I do not choose to participate.
[blockquote]Jefferson, you are probably aware that if it weren’t for government subsidies, our meat would be more expensive. If the government stopped subsidizing corn, water, and forced farmers to graze on public land and market level, people would be eating far fewer burgers.
My point? Thanks to government, you have more fat, sugar and salt at your pleasure. Go get yourself a burger, and thank the department of agriculture for such cheap food.[/blockquote]
But if I’m paying those subsidies from my taxes, then it’s a wash, no? Actually, it’s less than a wash because subsidies always get laundered through bureacracies that skim off a large percentage of the loot. So while I might pay $500 less for my meat, etc. every year because of the subsidy, I still pay probably $800 to drop the price.
How about we cut all subsidies, John, and let the market sort it out?
I work for the state and our benefits started getting cut after 9/11. My premium is paid, but I know family coverage is pretty expensive. I’ve been told federal benefits aren’t what they used to be either (for employees, not the politicos). A guy I know told me his wife, a federal probation officer, paid her own premiums, although I question that.
I’m guessing that “rent” means that Ed isn’t responsible for maintaining his own equipment. Oxygen suppliers have someone on-call 24 hours a day to deal with problems; the machines are complicated and require regular attention. Most oxygen patients aren’t up to handling it as a DIY project.
I have been trying to figure out why these comments upset me so much this afternoon; I think it’s that, on an individual level, we really have little control over our health. Sure, we have the things mentioned in the original article, and those are all good and will benefit your life in many ways. But, they’re not talismans. Anyone can find a bad lump or a scary mole or get some unsettling test results or fall getting out of their own bathtub, at any time (ok you have to be in the bathtub for the last one). It’s not a question of taking responsibility or shirking responsibility. We can all get sick, even if we do everything Right. If there is anything more powerless than wondering if your child will live through the night it’s…well, sitting at the foot of the cross is pretty darn close, I suppose.
Even if what we have right now is working for you right now, it’s not working for plenty of other people, people who haven’t done anything wrong and haven’t failed to take responsibility and haven’t spent their health insurance money on lattes or whatever else the excuse is. The system just isn’t working, and it’s not because of the rules about oxygen machine contracts.
[blockquote]My point? Thanks to government, you have more fat, sugar and salt at your pleasure. Go get yourself a burger, and thank the department of agriculture for such cheap food.[/blockquote]
I was just thinking about this and it struck me how contrafactual it truly is. Yes, the federales subsidize beef production to a small extent via low grazing fees, etc., but it also picks the American pocket in myriad others for other foodstuffs. We pay more for dairy, wheat, corn, soy and, especially, sugar because of federal price support programs (as I recall, Americans pay roughly four times the market price for refined sugar as a result of this federal boondoggle). Imports are heavily regulated so as to not undercut the government-set price.
I wonder what your sources are on all this, John. I dont think you’re at all accurate in your claims.
I run a small business – construction – Even in this environment we charge employees less than $150 per month for insurance – it costs us about $1000 for a family.
A few observations – A law that says small groups are evaluated as a whole rather than individually is helpful ie we are not looked at each year based on our group’s experience but as all small groups in the state. We can’t be dropped if there is a bad year. second – the best savings on insurance has been HSA’s younger people join – once its explained – since they get to keep the $ they don’t spend which lowers the average age and thus the whole groups cost. Also the total cost is less even with the company paying the deductible than a low deductible plan (which works because people pay attention to what they spend). Note that all I have read out of congress eliminates these.
If congress would start by focusing on a few ways to make health insurance more available and affordable rather than 1000 pages of ways to control our lives much could be accomplished. This won’t pay off enough groups/lobbyists. What I have read so far is a disaster in the making.
#24: My husband is a civil servant, and we pay $185.34 for health insurance premiums every two weeks – that’s $4808 per year. And the gov’t is picking up the rest of the cost of premiums. I’m not sure of the ratio. We also have an HSA to cover deductibles, co-pays, dentists, and eye care that is not covered. As I look at the choices of insurance each year, I still cringe at the thought of a catastrophic illness or injury to any of us. I would gladly pay more for the nits and grits, for the peace of mind that if the unthinkable happened, we would be covered.
PS To the parents of the premature baby – I think you got off easy. $15,000 out of $1M is a very small percentage. Don’t get me wrong, having $15K around for emergencies is not chump change, but people are paying a much higher percentage of the total costs of their critical care elsewhere.
PPS My prayers are that your baby is doing fine now, and growing like a weed!
Hi Crabby, thanks for sharing. Is this for just you and your husband only? How large a deductable? Why do you cringe at the cost of a catastrophic illness relative to the coverage? That is does the plan not cover it after the deductables? Do you get any coverage for dental, eye care etc. This is really good data!
[url=http://new.kendallharmon.net/wp-content/uploads/index.php/t19/article/24647/]Something[/url] that should be a consideration as to the timing. I’m not opposed to the objective, but to the how and to the current process.
This recess, ask your congressional delegation if they have read the proposed legislation – most have not – it is 1,000 pages. I wonder what kind of national discussion we can have on health care when legislators haven’t read the legislation, and the preeminent concern seems to be to get something passed before the threat of the 2010 elections…
🙄
Just reading the posts about $1 million for a premature child, we all need to realize that the inflated hospital cost here amounts to cost shifting. That is, this huge price tag really goes to pay for the large number of folks who will never pay their bills at the hospital. Basically those who have been stuck with these large bills are footing the costs for other people’s procedures. So when we hear about uninsured people going without medical care, we need to remember that nobody goes without care at hospitals when they are in dire need. Also, $15 K may seem like a lot for your child, but many people spend more than that on their cars, so I think you need to keep it in perspective. Heck, my husband and I spent over 30K 15 years ago on in vitro procedures. It sounds like you got the better end of your child’s financial transaction. BTW, best wishes for the baby’s happy life.
Lee: To answer your questions. Premiums are for family. You only get the choice of individual or family, no matter how big or small. We have two boys and me. Deductibles are $700 per person or family. Great for the nits and grits, as I said. For major stuff though, there is another deductible that is per year, some stuff is only covered on a one time coverage basis, and it gets very complicated to figure out what would come from out of pocket. As a major medical insurance plan, it has enough loopholes to make me very uncomfortable. Dental and eye coverage can be purchased separately, but my experience with these plans in the past left me cold. Would rather pay for good work myself. I suppose I could claim that I need to see an ophthalmologist instead of an optometrist, and get coverage under my main plan, but will that keep down costs? I don’t like playing the system. My dentist won’t use any of the gov’t plans, because they pay so little of his costs. He’s good, I will pay him what he is worth. Now, does that mean that I have a pretty big HSA withholding? You betcha. Do I feel secure if something REALLY bad happened? Not so much. But if it was my husband, thank you, he has enough sick leave built up to keep getting paid for a year. One good thing about the gov’t – you won’t get rich, but they are very generous with vacation and sick leave.
Hope this answers some of your questions. My basic stance on health coverage, is like the auto insurance analogy. It should be bought by the individual, and cover the MAJOR stuff, I will get the oil changed, the engine tuned up, tires rotated and replaced, windshield replaced (yeah, I know insurance will cover that, but my deductible is more than the cost of it), and drive them into the ground – God willing – and after many, many miles! May I go the same way!
Lee: With all due respect, you can’t just drop a number like $2,500 and not provide some explanation. That is $30,000 a year in premiums for health insurance. It’s not uncompassionate to ask for the details of your situation, as you are the one who volunteered it. I for one am interested to see why you are wrestling with a cost that astronomical. I agree it would be inhuman! Please share more details so we can understand.
Bart: In large measure you are absolutely right, and I have been saying so for years. Part of the so-called “crisis” is that that government began meddling in providing health care (through Medicare and Medicaid) back in the 1960s, causing a whole set of economic dislocations and inefficiencies. The rest of the “crisis” is that we as a Nation view health insurance not truly as insurance against unforeseen catastrophes, but almost as a prepayment for all medical care. If we returned to treating health insurance like we treat auto and home insurance (i.e., not expecting it to pay for routine maintenance, fender-benders, etc.) the cost would drop dramatically. I have a policy with a $3,000 deductible (effectively $7,000 because even after the deductible, there is a co-insurance requirement of 30% which then caps out after I’ve paid a total out-of-pocket of $7,000) and I pay $318 a month for 2 people. I place $3000 a year in a Health Savings Account and use that money for routine treatment (e.g., my recent dental exam and cleaning, eye exam and new glasses, annual physical, allergy shots, and prescriptions).
With a annual median household income of $75,000, you can’t tell me most homes can’t buy into this arrangement. Of course, it would require some discipline of making sure family members didn’t smoke, lost weight if necessary, and took other steps within their power to be insurable at a reasonable rate. It would also take discipline for the family to put away $3,000 a year to cover expenses up to the deductible.
Now before the bitching commences, add up how much you spend on Christmas, vacation, cable TV, the kids’ soccer crap, and tell me this can’t be done. Alternatively, add up how much you spend on maintaining your car (separate and apart from what you pay to insure it) — e.g., oil changes, car washes, new tires, new brake pads, shocks, struts, etc. and tell me why it’s a National Crisis if we’re expected to treat our bodies the same way.
#33 I believe if you’ll read my post you will see that I said $30,000 in exposure. I have a $10,000 deductable and $20,000 in premiums per year. Between children who play sports, pharmaceuticals etc. we always hit the $10,000 as you can simply look at a hospital and/or physician and spend $10,000. In any case for poor quality health care I spend $2,500 per month. This is my only option. Trust me there are thousands of families just like mine out there.
By the way, I was one of the first to start a MSA which evolved into the HSA product. It does not and will not work. Before I explain why it is not the answer I would like to here your comments.
Let’s get to the essence of the problem — 90% of the time the person receiving medical service is not the person paying for it. Talk about a perverse incentive structure!
We will get absolutely nowhere on the issue as long as medical consumers really don’t have any skin in the game. There’s no reason whatever to think twice about medical expenditure when the bill goes to somebody else. A government payer program will make this problem worse, not solve it.
So here’s Bart’s quick and oversimplified approach, recognizing that there are some existing-condition situations and such that must be addressed …
a) all medical insurance provided by an employer should be taxed just like any other income, removing the incentive for low-deductible insurance on somebody else’s nickel.
b) employee’s opting out of the company program receive a salary increase equal to two-thirds of their previous medical benefit. Both the company and the employee are financially ahead.
c) maximum HSA deductible is increased to $10,000 from the present $2,500.
d) the employee subscribes to a very high deductible HSA at about one quarter of the pay increase and puts another quarter in the HSA until the deductible plus 50% is met.
e) incidental medical expenses are met from the extra 50% and subsequently replenished. By going to an in-group provider the patient receives the insurance-negotiated rate for the service, usually under 40% of the nominal rate.
Currently proposed legislation mis-identifies the problem (which is that nearly all people do not pay for basic medical services themselves, leading to a huge run-up in prices); specifically prohibits HSAs (page 145, IIRC); and puts our medical care under the direction of the most inefficient people in America.
This is about power, not reform — autos =9% of the economy, banking =9%, medical =17% of the economy — so the present administration are thus attempting to put an additional 35% of the economy under their direct control.
No thanks, eh …
Bart, it’s not absolutely what I’d pick, but it’s close enough to get my vote. I’m not about to let the perfect be the enemy of the very good.
#35: Subscribe
#33 I’m not looking for your compassion but I appreciate it. I’ve been in much tougher fights. Bart the problem with the increase of deductible is that the decrease in premium is not commensurate. Moreover, every time a a cost saving is applied, it gets “gobbled up” by one of the big three. Once upon a time a deductible meant a real decrease in cost. Not so , now. Your points are admirable but don’t you think a bit simple? What about the Health Provider side and the legal community
I must tell you that Obama will bring the players to the table. I don’t understand his plan yet and I don’t think he does either but I believe we will have a two tiered system before we are through.
Let’s just see.