Tag Archives: uninsured

Preserving Social Security to Pay for Medicare

The Paul Ryan 2012 budget bill and “Path to Prosperity” sailed through House Friday on Republican votes. The GOP plans to spend $3.5 trillion next year, down a whopping $30 billion from 2011 (about eight days of current war spending), by cutting food stamps and Medicaid for the poor, children and the disabled. The Republican bill will still require the Government to borrow more than 40 cents of every dollar spent.

The bill passed is part of the Republican “roadmap” to reduce the deficit by $4.4 trillion* over the next ten years, while:

  • getting reelected;
  • providing $2.9 trillion in tax cuts for their wealthiest supporters;
  • gets rid of subsidies to develop alternative energy sources;
  • raising taxes for those making $20,000 to $200,000 per year;
  • repealing healthcare reform to make sure at least 52 million Americans are without health insurance;
  • in 2022, freezing and privatizing Medicare, Medicaid and the Children’s Health Insurance Program (CHIP);
  • and leaving it up to the states to deliver the bad news to our seniors, the disabled, children and the poor.

Except in calling for “reform,” the plan does leave Social Security intact, at least, so far** – and our seniors will need it. The average Social Security benefit for a retired worker is currently $14,124. In 2022, the additional out-of-pocket cost for Medicare will be $5,744. By 2030, it will increase to $8,833.

Impact of costs on seniors by Ryan budget bill - This was published by the Center for American Progress (http://www.americanprogress.org/issues/2011/04/ryan_medicare.html)

Of course, this assumes that a private health insurance company in 2022 will offer a policy to someone over 65 for $20,513. Best of luck with that —  especially if by that time you have one of those pesky pre-existing conditions.

*Just in case you are keeping track of the mundane things such as this, President Obama’s “Path to Austerity,” plans to reduce the deficit by $4 trillion in 12 years.

**The Republicans have a separate bill making its way to the floor and endorsed by their leadership that will raise the retirement age to 70 and include a means test for benefits.

Health Care: When You'll Get Yours

Updated 3/19/201o to include the House Reconciliation Bill & CBO estimate.

The Democrats say it is going to pass – maybe this week. For those of you who haven’t had a chance to read all 2,009 pages (depending on which version you count) of the Senate’s Patient Protection and Affordable Care Act (AKA: HR 3590) and or even the 74 page summary – and, the 153 page House Reconciliation Act of 2010 (AKA: HR 4872), I thought you might like to know what’s in it for you. And when.

There are some really important things in the combined bill including, according to the CBO, covering an estimated 95% of our citizens – 32 million more than have insurance right now. It corrects many wrongs too long overlooked. It is a good start. Better than nothing, but miles short of wonderful. It isn’t a pretty read. It is filled with technical issues. Way too much of it is really about Medicare, Medicaid, tax policy and deals struck with vested interests (private and public interests) to get the bill passed. Way too little of it is about making health care affordable and keeping it that way for people in the middle who trying to stay there.

It is an improvement on the status quo. It will lay important groundwork for modernizing our system and making it more fair. It will reduce the deficit (while CBO estimates it will cost $940B over 10 years, it would yield a net reduction of our deficit of $138B and reduce it $1.2T over 20 years). It will save lives. And it will take years, as is typical, for it to be interpreted by our bureaucracy into policy and then by lawyers and accountants into loopholes. It is not – not even close to a government takeover – if anything, it is just the opposite – giving private industry yet another shot to heal itself.

What it may do best will also cause the most political damage to the courageous men and women who worked and vote for it: most of the bill is phased in over four years to minimize cost, allow for industry to prepare, and should it be necessary, to provide time for our politicians to fix obvious problems – but it will probably be too late to save those who will have to fall on the sword during the next election cycle for our future.

The clear winners include: seniors (prescription donut hole and no cost preventative care – note: more is expected to come from reconciliation); those over 55 being forced to accept early retirement; those disabled who need care and their families; the working poor and uninsured; all those under 26, students and especially children (OK, and their parents); small business (insurance choices and tax credits); the health insurance industry and providers (30+ million new paying customers – note: physicians and hospitals did not do as well as insurance and pharma, but I suspect, most will be relieved/happy for their patients); software developers, tech support, data managers, etc.; state governments (healthier citizens, few unfunded mandates and a dramatic reshaping of indigent care – note: reconciliation is expected to provide more help to the states on mandated Medicare changes); deficit hawks (saves taxpayer money and sets framework for future changes); and millions of patient advocates, volunteers, social workers, community health clinics and civic organizations who tirelessly help those less fortunate.

The losers: those making over $250,000 a year (.09% wage tax and 3.8% investment income tax, plus some minor changes in deductions) and especially senior health insurance executives or those with exotic medical and compensation plans; lawyers (fewer bankruptcies); and copier companies, copy paper producers and related products. Mostly the losers are those who can’t wait until 2014 – and probably the Democrats.

Was Going To Happen This Year No Matter What

  • Private health care insurance companies will immediately raise rates as high as possible – they would have whether the bill passed or not. Witness: Anthem of California’s rate hike of up to 39%. Get ready, if being ready helps. It will be ugly. There is almost nothing stopping them now or ever. They are bulletproof. A win-win-win. Without competition the market just can’t correct it, and what competition there will be, is years away.
  • Tens of thousands of employers will react to these rate hikes by either raising employee health care costs or quit providing coverage – they would have whether the bill passed or not. Good luck.
  • Millions of individuals will drop their coverage because they can’t afford it (the Robert Wood Johnson research puts the number expected to join the uninsured in the next 10 years at 18.2 million, bringing the total to 67.6 million without insurance) and play the American version of Russian Roulette betting they will survive long enough for the bill to phase in subsidies and benefits. Most would have dropped their coverage anyway. They will blame it on the economy, the private insurance companies and Washington. They should.
  • States, faced with insurmountable budget shortfalls, will cut reimbursement rates to doctors and hospitals, which will cause thousands of providers to drop Medicaid resulting in hundreds of thousands of people going without any health care (your neighbors will be among them), many of whom will die.
  • The midterm elections will be held before almost anything tangibly good in the bill changes anything. There may be hell to pay.
  • The next presidential election will be held before almost anything tangibly good in the bill changes anything, but after the taxes, fees and requirements go into effect. There may be hell to pay.

Immediate (within 90 days)

  • Those uninsured who have pre-existing conditions, will have access to a national high risk insurance pool (using private providers or via state high risk pools) with financial assistance (limits out-of-pocket costs for coverage through the pool to $5,950 for individuals and $11,900 for families annually – up to $5B in total subsidies). This is temporary and will be transitioned to exchanges in 2014.
  • Will bar preexisiting conditions on children’s coverage.
  • Will create a new reinsurance program to make coverage more affordable for early retirees (55+) – basically, a subsidy for employee-based plans to continue coverage by paying up to 80% of the cost until Medicare.
  • Gradually closes the Medicare prescription drug gap (Part D “Donut Hole”) until it is eliminated in 2020. Effected seniors will receive a $250 rebate in 2010.
  • Increases the adoption tax credit by $1,000 (begins in 2009) and extends them through 2011 (one of those unrelated to health care bones tossed to the anti-women’s right to choose lobby, before the Senate caved totally).
  • Small business (up to 35%) and small nonprofit tax credit (up to 25%) on employer’s contribution to health insurance for employees.
  • A two-year tax credit (2009 & 2010 – capped at $1B) to encourage investment in therapies that prevent, diagnose and treat acute and chronic diseases. This was an attempt to win support of doctors, hospitals and equipment manufacturers.
  • Tax relief for health professionals with state loan repayments – doesn’t affect you and me, but will give tax help to some physicians in underserved areas.
  • Provides funds to build new and expand existing community health centers, and expands funding for scholarships and loan repayments for primary care practitioners working in underserved areas – some of this is new money, most is refunding existing programs.
  • Expands low-interest student loan programs and scholarships for health students and professionals.
  • Excludes the value Indian tribal health benefits from gross income.
  • Requires creation of a web site that will identify affordable coverage by state, tax credits, and other information of interest to small business.
  • Requires another crackdown and more screening on fraud and waste.
  • Creates another council to promote health policies.
  • Provides money to Health & Human Services (HHS) to figure out and quantitatively measure just how wonderful this program is. Or isn’t.
  • Extends payment protections for rural providers who don’t do enough business to make it on their own, but help a lot of people who couldn’t get help otherwise.
  • Creates a private, non-profit institute to identify “national priorities” and compare the effectiveness of health treatments, which is an attempt to create political cover when facing lobbyists who don’t want their pet projects cut.
  • Finally allows states the option of covering parents and childless adults up to 133% of the poverty level (in some states, not typically Southern, it is felt that the poverty level is too low and their least fortunate citizens a more humane program).
  • Establishes standards and community assessments for new nonprofit hospitals which should give some political cover for local government when facing neighborhood activists in cahoots with real estate developers, bond companies, etc.
  • Gives Blue Cross a special tax deduction as long as this non-profit don’t profit by more than 15%, which was designed to get a couple of votes in the Senate. (Note: this will likely be removed in the reconciliation bill.)
  • Imposes a 10% tax on indoor tanning services because their lobby was not as effective as the cosmetic surgery lobby.
  • Codifies and clarifies economic substance doctrine and penalities (again, not health care, allowable, important).
  • Appropriates $500M a year (2010-2014) for the Community College and Career Training Grant program; creates mandatory funding of Pell Grants, funds College Access Challenge Grants and funding for Historically Black Colleges & Universities; and reforms student loans, limits interest rates and reduces income-based repayment amounts (again, not health care, allowable, important).

Six Months After Enactment (and Beginning with Your Insurance Plan Year)

  • Prohibits rescissions (practice of rescinding coverage when a person gets sick as a way to avoid covering costs) – we all should count down the days and hope we aren’t on the rescind list.
  • Eliminates lifetime and restricts “unreasonable” annual limits.
  • Requires first dollar coverage (generally, no deductible) for preventative care.
  • Allows dependent coverage until age 26.
  • Requires creation of an “effective” appeals process for coverage determination and claims and awards grants to states in order to establish consumer assistance programs in response to complaints (boy, that’s going to work in Georgia).

2011 (lower your expectations)

  • Provides a free, annual wellness visit and no-cost sharing preventive services for Medicare beneficiaries.
  • Begins a 50% discount on brand name drugs for seniors in the Medicare prescription drug gap (Part D “Donut Hole”).
  • Creates incentives for states to cover evidence-based preventative services without cost-sharing for Medicare beneficiaries.
  • Requires Medicare coverage of tobacco cessation services for pregnant women (I’m guessing that this isn’t limited to pregnant women over 65).
  • All health plans must file annual reports showing share of premiums going for care and, should their accountants really screw up, they must provide consumer rebates for excessive medical loss ratios.
  • Provides a 10% Medicare bonus payment to primary care physicians and general surgeons (which they would have done anyway so that they don’t have to actually raise reimbursement rates – permanently raising would make it look as if Medicare was in trouble).
  • Establishes a “Center for Medicare & Medicaid Innovation,” which will attempt to create methods to reduce costs while enhancing care and which sounds like such a great idea, but makes every cynic snicker.
  • Provide several important policy changes related to education slots to increase doctors, nurses and care providers, but they are so tediously complicated I suggest you Bing or Google for the details).
  • Ditto on tax code changes related to standard language, small business cafeteria plans and other technical issues which would only pain you to know at this point, unless you are planning to raid your HSA, which you’d better do before the end of 2010. Oh yeah, your W-2’s will now show the value of your health benefit.
  • Begins the transition away from Medicare Advantage – that famously popular program where we, the taxpayers, give insurance companies 15% more to privately manage Medicare which they used to expand benefits by charging recipients even more. Wonderfully conceived experiment.
  • Imposes a non-deductible $2.3B fee (split based on market share) on big pharma in return for “supporting” this bill and our government agreeing not to negotiate prices or re-import drugs for Medicare or Medicaid which would, of course, bring prices way down for individuals who will have to wait four years to see benefit.

October 1, 2011

  • Allows states to offer home and community based services rather than institutional care to disabled individuals through Medicaid.

2012 (lower your expectations even more)

  • Implement payment reforms to gain efficiencies and improve quality.
  • Incentivize quality hospital outcomes and penalize hospitals with the highest readmission rates.

2013 (chances are, this won’t be your year either)

  • Begin paying Medicare physicians based on value instead of volume to promote quality of care.
  • Requires that Medicaid payment rates for primary care services be no less than 100% of the Medicare rates.
  • Mandatory adoption of electronic filing and information exchange (expect everyone to miss that deadline) and establish a pilot program of payment bundling and provider cooperation/coordination designed to save money, and, of course, improve care.
  • Increase the itemize deduction threshold for medical expenses from 7.5% to 10% of adjusted gross income for eligibility.
  • Add a .09% hospital insurance wage tax and a 3.8% investment tax on people making more than $200,000 individuals/$250,000 family.
  • Limits the deductibility of executive (all officers, employees, board members and contract workers) compensation of insurance companies to $500,000 each per year.
  • Sets $2,500 cap on over-the-counter medications for flexible spending accounts (FSAs).
  • Creates excise tax on medical device manufacturers of 2.9% (exempts Class I medical devices, eyeglasses, contact lenses, hearing aids, and any device of a type that is generally purchased by the public at retail for individual use) to raise $2B ($3B in 2012 and beyond).

2014 (finally and outrageous to believe that some of these weren’t done in year one)

  • Insurance companies are prohibited from discriminating based on health status, preexisting conditions, and gender. They still will be able to discriminate based on age, geography, family size and tobacco use, but they are limited to discriminating on rates of no more than three times their lowest rate.
  • Annual limits are eliminated.
  • Insurance companies will be prohibited from dropping coverage of those participating in a clinical trial or denying coverage for routine care.
  • Health exchanges are established in each state (yes, state) to enable people to comparison shop, enroll and determine if tax credits for financial assistance will be available.
  • A multi-state option (really national) will be available offered by private insurance companies and, at least one non-profit.
  • Health care premium tax credits will be available for those above Medicaid eligibility and below 400% of the poverty line (currently $43,320 for individual; $88,200 for a family of four – Alaska and Hawaii are higher). These credits will be for premium and cost sharing expenses and is what will enable most of the uninsured to afford coverage. What does all of this mean? If your income is above the poverty line, but less than 133%, you’ll have to pay 2% of the cost and the tax credit will pay 98%. The scale slides up to 400% of the poverty line and indexed year to year, but basically your share would be: 133% up to 150% – 3.0%; 150% up to 200% – 4.0%; 200% up to 250% – 6.3%; 250% up to 300% – 8.05%; 300% up to 400% – 9.5%.
  • Almost everyone is required to have health insurance or pay a penalty (2014: $95; 2015: $325; 2016: $695 or 2% (increasing to 2.5% in 2016) of income up to national average cap). Families will pay half the amount for children. The only exception is if affordable insurance is not available. Sounds onerous, but they are doing this because it wouldn’t be fair to the insurance companies for an individual to purposely not have insurance, get sick knowing they can get coverage by buying a policy only when they need it – plus, they made a deal with the insurance companies to do this in return for insurance companies agreeing to pay a fee to help offset the costs of the bills.
  • No one receiving a tax credit to buy insurance would be allowed to use it for a policy with abortion coverage. States can ban abortion coverage in plans offered through the exchange. Exceptions would be made cases of rape, incest and danger to the life of the mother.
  • Employers are not required to provide coverage. However, employers with 50+ employees (companies with fewer than 50 employees are except), who do not offer coverage, and have workers who are subsidized by the government, must pay a fee to subsidize those workers – $2,000 annually for each full-time employee (there is no penalty for the first 30 employees, plus, there are a few other caveats based on waiting periods, etc. Bing it). Part-time workers are included in the calculations (two part-time workers equals one full-time worker).
  • The small business tax credit will continue.
  • Workers who qualify for an affordability exemption to the requirement to have coverage, but not for tax credits, can take their employer contribution and join an exchange plan.
  • Medicaid eligibility will increase to 133% of poverty. Childless adults will be included for the first time. For new enrollees, the federal government share will be 100% in 2014, 2015, and 2016; 95% in 2017; 94% in 2018; 93% in 2019; and 90% thereafter (funding the state mandate).
  • Medicare advantage will be eliminated by competitive bidding.
  • Impose fees providers (health insurance companies): $2B ($8B in 2014; $11.3B in 2015 & 2016; $13.9B 2017 and $14.3B after that).
  • There will be more reporting requirements for many providers to measure quality of care as a pathway toward value-based purchasing.

2018

  • Impose the Cadillac excise tax of 40% on employee plans costing more than $10,200 for individuals and $29,327 for families of four (indexed for high cost states, high risk professions and for the elderly).

2020

  • Medicare Part D (prescription drug plan) increases to a 75% discount on brand name drugs for seniors and completely eliminates the “Donut Hole.”

That’s it. Hard to believe, isn’t it? Seemingly, our entire government has spent a year developing that? Every news channel, newspaper and most blogs have spent a year reporting and debating that? Republicans could spin endlessly for a year that this, often in the same sentence, would turn us into Nazi Germany or Stalin’s Russia? Hundreds of millions spent lobbying against that? Democrats could trade all the hope and power that comes once in a generation, for this? Yes.

If it weren’t passed now, we’d just have to go through this again some day not soon enough.

___________

Acknowledgements:
Information, reference and documents used in this story include those from:

And others too numerous to mention. Thank you.

Southern Rankings








Here are the current Southern (as defined by the Southern Governors Association) rankings for population, unemployment, percent of population in prison, median income, population receiving welfare or foodstamps and percentage of population without healthcare insurance.

Click on the label in the top row to sort by each category.

States Population Unemployed Prison
Population
Median
Income
Receiving
Welfare
Receiving
Food
Stamps
Uninsured
AL 23 34 06 47 31 12 29
AK 32 16 22 49 39 10 41
DC 50 44 51 20 01 05 16
FL 04 41 07 36 45 28 49
GA 09 40 02 22 49 16 42
KY 26 39 17 48 19 07 27
LA 25 10 01 50 48 06 47
MD 19 18 26 02 29 40 24
MS 31 37 04 51 37 01 46
MO 18 33 18 37 12 02 22
NC 10 48 28 43 41 20 37
OK 28 09 05 44 42 15 44
SC 24 50 08 42 32 08 36
TN 17 37 15 45 04 03 28
TX 02 14 03 38 46 21 51
VA 12 16 13 08 34 38 25
WV 37 12 41 46 22 04 32

The chart is based on the most current figures available from the following sources:

Here are the raw numbers:

Population:
AL: 4,661,900
AK: 2,855,390
DC: 5,918,333
FL: 18,328,340
GA: 9,685,744
KY: 4,269,245
LA: 4,410,796
MD: 5,633,597
MS: 2,938,618
MO: 5,911,605
NC: 9,222,414
OK: 3,642,361
SC: 4,479,800
TN: 6,214,888
TX: 24,326,974
VA: 7,769,089
WV: 1,814,468

Unemployment Rate:
AL: 8.4%
AK: 6.6%
DC: 9.9%
FL: 9.4%
GA: 9.3%
KY: 9.3%
LA: 5.7%
MD: 6.7%
MS: 9.1%
MO: 8.3%
NC: 10.7%
OK: 5.5%
SC: 11.0%
TN: 9.1%
TX: 6.5%
VA: 6.6%
WV: 6.0%

Prison Population:
AL: 40,561 (0.87%)
AK: 47,974 (1.68%)
DC: 3,552 (0.06%)
FL: 148,521 (0.81%)
GA: 92,647 (0.96%)
KY: 30,034 (0.70%)
LA: 51,458 (1.17%)
MD: 35,601 (0.63%)
MS: 27,902 (0.95%)
MO: 41,461 (0.70%)
NC: 53,854 (0.58%)
OK: 32,593 (0.89%)
SC: 35,298 (0.79%)
TN: 43,678 (0.70%)
TX: 223,195 (0.92%)
VA: 57,444 (0.74%)
WV: 8,043 (0.44%)

Median Income:
AL: $49,901
AK: $39,452
DC: $50,318
FL: $46,383
GA: $49,692
KY: $40,029
LA: $39,418
MD: $63,552
MS: $36,499
MO: $45,924
NC: $42,219
OK: $41,578
SC: $42,477
TN: $41,521
TX: $58,950
VA: $57,178
WV: $40,800

Receiving State Welfare:
AL: 41,849
AK: 19,689
DC: 39,267
FL: 87,632
GA: 37,983
KY: 58,124
LA: 19,545
MD: 57,601
MS: 23,714
MO: 101,916
NC: 49,653
OK: 19,170
SC: 38,050
TN: 144,705
TX: 115,690
VA: 65,546
WV: 22,927

Receiving Federal Food Stamps:
AL: 61,377
AK: 387,956
DC: 92,288
FL: 1,694,649
GA: 1,139,309
KY: 663,591
LA: 687,571
MD: 402,892
MS: 472,537
MO: 949,404
NC: 1,012,481
OK: 432,642
SC: 636,698
TN: 977,109
TX: 2,651,370
VA: 582,494
WV: 285,242

People Without Health Insurance:
AL: 632,000
AK: 485,000
DC: 64,000
FL: 3,698,000
GA: 1,658,000
KY: 569,000
LA: 807,000
MD: 761,000
MS: 543,000
MO: 723,000
NC: 1,469,000
OK: 640,000
SC: 705,000
TN: 830,000
TX: 5,687,000
VA: 1,031,000
WV: 268,000

Turning an Opportunity into a Problem

mccarthy_complexshitThe storm must have seemed perfect. An issue that had matured since Nixon first introduced it in 1974. An overwhelming Democratic majority in the house. An almost filibuster-proof Democratic majority in the Senate. A Democrat in the White House with 60%+ approval ratings. And polls showing an overwhelming majority of the American people, Republicans and Democrat alike, in favor. Decades of horrific cost increases. A terrible economy. New pressures on business to be globally competitive. A new “transparency” sure to limit the influence of lobbyists. The health insurance industry must have been preparing for the worst. Not a chance.

The health insurance industry wants to turn their problem into an opportunity by turning our opportunity into a problem. The recipe is all too simple.

▪ Provide a dash of spin to the party of no that re-defines “universal healthcare” into a requirement for all Americans to buy private health insurance.
▪ Add equal amounts of cost-fear to business and decreased-benefits-fear to the wealthy, pensioners and the unions.
▪ Mix in gracious amounts of campaign money to incumbents.
▪ Chop up some populist talking heads on cable news and discard.
▪ Mix finely grated experts with talk radio.
▪ Let the mixture sit in a dark, smoke-filled room until the odor rises and forces opponents to run for cover holding their noses.
▪ Season to taste with government subsidies to states to provide their legislature’s version of coverage for their uninsured and the uninsurable.
▪ Heat and serve.
▪ Creates servings for some (the biggest portions to shareholders of the health insurance industry), but far from all. Does, however, ensure that the health insurance industry will live a long, happy and profitable life, safe from single payer universal healthcare for Americans, unlike like the short, miserable, and destitute lives of those who will never be able to afford it.

More reading on the issues involved from Wikipedia (where you can also view supporting links and citations):

The following is a listing of universal health care pros and cons as argued by supporters and opponents.

Common arguments forwarded by supporters of universal health care systems include:

▪ Universal health care systems, in an effort to control costs by gaining or enforcing monopsony power, sometimes outlaw medical care paid for by private, individual funds.

▪ Health care is a basic human right or entitlement.

▪ Ensuring the health of all citizens benefits a nation economically.

▪ About 59% of the U.S. health care system is already publicly financed with federal and state taxes, property taxes, and tax subsidies – a universal health care system would merely replace private/employer spending with taxes. Total spending would go down for individuals and employers.

▪ A single payer system could save $286 billion a year in overhead and paperwork. Administrative costs in the U.S. health care system are substantially higher than those in other countries and than in the public sector in the US: one estimate put the total administrative costs at 24 percent of U.S. health care spending.

▪ Several studies have shown a majority of taxpayers and citizens across the political divide would prefer a universal health care system over the current U.S. system.

▪ Universal health care would provide for uninsured adults who may forgo treatment needed for chronic health conditions.

▪ Wastefulness and inefficiency in the delivery of health care would be reduced.

▪ America spends a far higher percentage of GDP on health care than any other country but has worse ratings on such criteria as quality of care, efficiency of care, access to care, safe care, equity, and wait times, according to the Commonwealth Fund.

▪ A universal system would align incentives for investment in long term health-care productivity, preventive care, and better management of chronic conditions.

▪ Universal health care could act as a subsidy to business, at no cost thereto. (Indeed, the Big Three of U.S. car manufacturers cite health-care provision as a reason for their ongoing financial travails. The cost of health insurance to U.S. car manufacturers adds between USD 900 and USD 1,400 to each car made in the U.S.A.)

▪ The profit motive adversely affects the cost and quality of health care. If managed care programs and their concomitant provider networks are abolished, then doctors would no longer be guaranteed patients solely on the basis of their membership in a provider group and regardless of the quality of care they provide. Theoretically, quality of care would increase as true competition for patients is restored.

▪ A 2008 opinion poll of 2,000 US doctors found support for a universal health care plan at 59%-32%, which is up from the 49%-40% opinion of physicians in 2002. These numbers include 83% of psychiatrists, 69% of emergency medicine specialists, 65% of pediatricians, 64% of internists, 60% of family physicians and 55% of general surgeons. The reasons given are an inability of doctors to decide patient care and patients who are unable to afford care.

▪ According to an estimate by Dr. Marcia Angell roughly 50% of health care dollars are spent on health care, the rest go to various middlepersons and intermediaries. A streamlined, non-profit, universal system would increase the efficiency with which money is spent on health care.

▪ In countries in Western Europe with public universal health care, private health care is also available, and one may choose to use it if desired. Most of the advantages of private health care continue to be present, see also two-tier health care.

▪ Universal health care and public doctors would protect the right to privacy between insurance companies and patients.

▪ Public health care system can be used as independent third party in disputes between employer and employee.

▪ Libertarians and conservatives can favor universal health care, because in countries with universal health care, the government spends less tax money per person on health care than the U.S. For example, in France, the government spends $569 less per person on health care than in the United States. This would allow the U.S. to adopt universal health care, while simultaneously cutting government spending and cutting taxes.

Common arguments forwarded by opponents of universal health care systems include:

▪ Health care is not a right. As such, it is not the responsibility of government to provide health care.

▪ Universal health care would result in increased wait times, which could result in unnecessary deaths.

▪ Unequal access and health disparities still exist in universal health care systems.

▪ The performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.

▪ Many problems that universal health insurance is meant to solve are presumed caused by limitations on the free market. As such, free market solutions have greater potential to improve care and coverage.

▪ The widely quoted health care system ranking by the World Health Organization, in which the US system ranked below other countries’ universal health care systems, used biased criteria, giving a false sense of those systems’ superiority.

▪ Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates. As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare’s spending. Large market-based public program such as the Federal Employees Health Benefits Program and CalPERS can provide better coverage than Medicare while still controlling costs as well.

 

Intended Unintended Consequences of Co-Pays

Healthcare Prescription

Co-pays work really well for the chronically well and the chronically well off. Averaging about $40 for a doctor visit or outpatient procedure, $20-$40 for prescriptions and a little more for hospital admission. Might not sound like much every now and then. Insurance companies do this to prevent what they call a “moral hazzard.” I don’t know about you, but I’m convinced that my healthy friends would spend as much time as possible in a doctor’s waiting room if were not for co-pays. Great way to catch up on your reading from, say, 4 years ago. Plus, everyone loves a good colonoscopy and what woman wouldn’t prefer an extra mammogram or two a year? Surely, the typical mother of three who makes minimum wages has no problem working 20 or so extra hours to get her kids an annual check up. Great idea. This is America, for god’s sake. Pay to play. There’s no free lunch here.

It even works great for the fully employed and chronically not as well. Seeing a doctor a couple of times a year to get a script so you can get your Lipitor is just the price of being able to eat at McDonald’s or have a little Häagen-Dazs. No big deal. But what happens as you age? Say you add high triglycerides to your cholesterol, maybe it leads to diabetes. Your blood pressure shoots up. You fall down the stairs and injure your back. You find a lump or aren’t preforming as well in bed. Your snoring gets worse and fear sleep apnea while your partner can’t sleep at all for fear of your snoring. You get depressed about it and need something to mellow you out before you are tossed out at work. Your bowels stop moving, but your bladder can’t stop. Then, you get the flu. Pick any four and multiple by $40 for the visit and $40 for your drugs. Now $320 a month isn’t so bad until you do it for a year and realize you’re out almost four grand. Then your spouse hits for the cycle and it’s now eight grand, plus the deductibles, plus the cost of the policy. But that’s just for maintenance.

Once every decade or so in middle age, odds are you’ll have something that will put you in the hospital. God forbid if you are self-employed or part time. Miss some work. Lose some paychecks. Do some caregiving for your spouse and your world will begin to unravel. Visa will find out and raise your rates to 33% while lowering your credit limit. Now you’ll have to choose: do I see a doctor and get my meds or pay Visa? Do I buy my kids new shoes or play Russian roulette with my heart? Do I pay my life insurance or risk dying? Or better yet, do I pay my health insurance and join the 47 million who don’t have it or use it one last time? Decisions. Decisions. Decisions.

  • AP says “the ailing economy is leading many Americans to skip doctor visits, skimp on their medicine, and put off mammograms, Pap smears and other tests, a trend that physicians worry will result in sicker patients who need more expensive treatment later.” The Kaiser Family Foundation found that 36% of U.S. residents have delayed medical care in the past year because of cost. AARP reports, “Nearly half of Americans now report that someone in their family has cut back on their medical care or prescribed medications—postponing checkups, recommended tests and procedures; cutting pills or skipping doses of required medications; or not filling new prescriptions.”
  • The National Coalition on Healthcare says, “Retiring elderly couples will need $250,000 in savings just to pay for the most basic medical coverage. Many experts believe that this figure is conservative and that $300,000 may be a more realistic number.” Of course, there’s always Medicaid once you and your family are destitute.
  • This is pretty odd when you consider what that a study by GlaxoSmithKline (big pharma) says, “High prescription drug co-payments are associated with lower medication adherence and higher total healthcare costs.”

It seems almost silly to say that this can’t be healthy for our nation. It’s cruel, immoral and un-all-faiths, but is how we age in America. Well done insurance industry lobbyists. Well done. Makes us all proud.

Let me leave you with something from TomPaine.com, “Right here in the U.S., Medicare demonstrates that we can eliminate some 17 percent in administrative expenses alone through a publicly administered system.” I know. I know. I know that universal care is a dead issue in the US and that statistics aren’t reliable unless they are on Fox News, but isn’t pretty to think that some of that 17% (works out to about $250 billion) could reduce co-pays?