Everyone agrees that healthcare is unaffordable. Where we can’t agree is how to fix it.
We’re tackling a very controversial subject today, and I expect that many of you have strong opinions. I know I do. I always enjoy a good discussion, and opinions different than my own are always welcome. I only ask that comments be kept civil. Comments that directly attack anyone will be removed. Thanks! Now on to the post.
Chapter 7 of Nan Mooney’s (Not) Keeping Up With Our Parents focuses on employer benefits, namely healthcare and retirement. Since those are both very broad subjects, and the issues with both problems are much the same, I’ll be focusing on healthcare in my post today.
Nan Mooney and I actually agree on something today. If you’ve read my previous posts in this series, you know that’s a rare occurrence. America has a healthcare crisis. Healthcare is becoming unaffordable, and unless you have a health insurance plan through your employer, you might have a problem getting health insurance at all.
My husband and I recently experienced this. When Jim lost his job, we tried to obtain private insurance, and my daughter and I were both rejected, due to pre-existing conditions. Pre-existing conditions for which we don’t need ongoing treatment. In fact, neither of us had been to the doctor recently when we applied for insurance. Yet, we were rejected.
So I agree with Nan Mooney that something needs to be done about the availability of health insurance in The United States. Where we disagree is in the solution.
If you’ve read my previous posts in this series, you have probably already guessed that Mooney believes the government should provide some sort of universal healthcare. She embraces Jacob Hacker’s Healthcare for America. As I understand it, Hacker’s plan would extend Medicare to include anyone who needs health insurance. Employers could opt to offer other insurance, but it must meet the same standards as the Medicare option.
While I like Hacker’s plan better than total universal healthcare coverage, I don’t like the government being that involved in my healthcare.
In Oregon we have the Oregon Health Plan (OHP) for low income families. When I was pregnant with my son, I qualified for maternity coverage under OHP. We had additional coverage, but the deductible and co-pays were cost-prohibitive on our meager income at the time.
When I called around to find an obstetrician, I would ask if they accepted OHP. They all said no. It was only after I made clear that I had additional insurance that they would agree to see me.
When I was about 7 months pregnant, I had a pretty detailed conversation with my obstetrician about the problems with the OHP. He told me that the reason physicians didn’t accept patients who were only covered by OHP was because doctors couldn’t afford it. The government reimbursement was so small that having too many OHP patients meant a doctor couldn’t even cover the cost of his malpractice insurance.
I would rather see tort reform, so malpractice insurance goes down. I would also like to see private insurance be made more readily available to groups besides employers. And I believe that insurance should be portable, so that if you lose a job or switch jobs, you can take your insurance with you.
What I don’t want is for the government to tell me what treatments are necessary and what treatments aren’t. And I would rather use my own money to make my own health care decisions than have the government take my money (through taxes) and make decisions for me.
While we’re waiting for healthcare reform in this country, there are a few things you can do to make sure you have good healthcare in the meanwhile.
Never let your insurance lapse. Our big mistake when my husband was out of a job was not taking COBRA insurance. It’s expensive, but we would have been able to avoid the pre-existing condition problem.
Maintain good health. The high cost of healthcare won’t hit you if you don’t have to go to the doctor. This won’t help with accidents, but if you keep fit and eat a healthy diet, you can prevent a lot of health problems.
Work with a good insurance provider in your state. If you have to find your own insurance, work with an experienced insurance agent. The one we worked with was fantastic, and she bent over backwards to help us try to find insurance. When my daughter and I were denied insurance, the agent came up with a backup plan to get us covered. We were in the midst of working through all the red tape when my husband became eligible for insurance through his new job.
Maintain a good relationship with your doctor. Another time when we were uninsured, my then one year old son got RSV. I took him to the doctor, paying cash for the appointment. My doctor worked with me to come up with the least expensive, yet still effective treatment, for my son.
Hopefully at some point in the near future, something will be done about the rising cost of healthcare and the inability of the uninsured to obtain insurance.
Now you have my strong opinion on the subject of healthcare reform and universal healthcare. What is your opinion?
Previous posts in the series:
- (Not) Keeping Up With Our Parents
- The Rise and Fall of the Middle Class
- The Cost of a College Education
- Career Struggles
- Marriage
- The Decision to Have Children
June 2nd, 2008 at 4:23 am
Interesting topic.
You mention that you want affordable health-care for low income people which would mean pretty close to free. However, you said you don’t want any government involvement. You can’t have it both ways - private industry will never ever offer cheap affordable health care to low income people because there would be no profit - they just won’t offer it to them at all which is the case now.
Universal health care is not a perfect system by a long shot however it does guarantee that low income people (and others) don’t have to worry about the money aspect when they are getting treatment for something. A medical emergency is not a financial disaster.
Another point which relates to low income people is that they typically don’t pay much taxes to begin with, so they are the biggest beneficiaries of a universal health care system. Is that fair to higher income people? Maybe not but that’s how the universal system works. If you think about it, most aspects of the US government is a universal system (ie roads, defence, IRS etc) so why should health care be any different?
Mike
June 2nd, 2008 at 4:44 am
There are lots of ways that the US could improve their healthcare system such that no one is without health insurance. Inevitably, as Mike said it does mean that the taxpayer is going to have to foot the bill for the poorest people, it doesn’t have to mean that the government gets involved in decisions about care, just as private health insurance doesn’t have to mean that the insurance company does.
As a beneficiary of the most comprehensive state healthcare system in the world, I can assure you that there’s no way that I (or anyone else over here) would want to move away from healthcare paid for by those that can afford it and given to those that need it.
June 2nd, 2008 at 5:05 am
Yes, interesting topic for sure.
I am in Canada and we have universal health care here. Whether one is rich or poor, we all have the same access to health care. I can’t imagine something so important as health care being run like a business, where one has to be able to pay in order to receive the service.
My heart goes out to you in the situation you wrote about your son having RSV and you being uninsured. Not only did you have a sick child to worry about (which is stressful enough), you had to worry about how you would pay for that. I think of the times I had to take a sick child in….I can’t imagine having the extra stress of how am I going to pay for this visit/treatment.
You did mention you don’t want the gov’t telling you which treatments are necessary and which ones aren’t — I’m not sure what you mean by that. Here it is the doctor who tells you what treatment is needed. Unless you are talking about uninsured services vs insured services. If that is the case….then we are free to ‘pay’ for those services extra services ourselves, although almost everything seems to be covered. I can only think of one thing in my whole life that wasn’t a covered service (and that was a blood test that ‘may have been useful’ in pointing out future problems, but hadn’t been proven to be 100% reliable. That test cost us $25.00)
I know our system has it’s flaws, but for me the security in knowing when and if I have an emergency, I will have access to a Dr. who will help me, regardless of my financial status far outweighs being without universal health care.
June 2nd, 2008 at 5:11 am
One further thing, I’m not exactly sure of the break down here as to where every last cent of the funding comes from. I do know that employers pay a big portion in the form of an Employer Health Tax (which is a percentage on their payroll).
June 2nd, 2008 at 5:58 am
The whole malpractice thing speaks volumes, really. If you want more affordable health care, there needs to be a break there as well. Plenty of doctors would love to be able to extend care to everyone who needs it, and plenty of not-for-profit hospitals are struggling because they do it. Not only can the doctors not afford to take on uninsured or under-insured patients, but the rate of malpractice suits are actually causing many potentially bright doctors to avoid the field altogether.
It’d be a great start to give some doctors a break with malpractice insurance. It’s ridiculous the amount of malpractice suits filed each year, and ridiculous that people immediately blame doctors for their problems. (After all, they’re just people too, and people often make honest mistakes in their lives.) If American society weren’t so “sue happy,” malpractice insurance wouldn’t cost so much and then doctors could take on more uninsured or under-insured patients, which would ease this crisis we’re in.
Just my two cents, though. I’m fortunate enough to have the good old government footing my own health care costs, so I haven’t had to worry about not being able to get treatment when I’ve needed it. (Though even without it, we probably could afford halfway decent insurance since it’s just my husband and me.)
June 2nd, 2008 at 6:50 am
I certainly don’t pretend to have an answer to this problem, but I understand your point about not wanting the goverment to tell you what treatments are necessary. The problem is that insurance companies do that now.
As a kid I had chronic throat/tonsil infections. My doctor wanted to take my tonsils out, but the insurance wouldn’t pay for it because, according to their formula, I wasn’t sick enough. I went through my whole life sick until finally, at age 29, a specialist said I absolutely had to have my tonsils out. I’ve been healthier in the past 18 months than I’ve ever been in my life. Because of an insurance company formula I had a low quality of life for nearly 3 decades. And I can tell you that recovering from that surgery as an adult is no picnic!
June 2nd, 2008 at 7:23 am
The healthcare crisis is definitely a concern of mine since my family doesn’t have health insurance. In the past, we’ve relied on the gov’t medicaid for pregnancy and the children’s care and the local health dept. for shots, etc. Now, we
are in the place financially where we have to pay for any health care out of pocket. Thankfully, we’ve all been healthy enough to not need a doctor in a couple of years, but it still makes me nervous to not have insurance. We have an emergency fund, and I’m relying on that and prayer to get us through. Basics like dentist and eyecare, we’ve had enough to pay for the visits. Like you, Lynnae, I don’t want a govt. run healthcare system, but affordable alternatives. We’ll see what happens in the next few years.
June 2nd, 2008 at 7:27 am
Unless big changes are made to the way the government currently runs healthcare, via Medicare and Medicaid, doctors will be run out of business with universal health care. I worked for a doctor who had to discontinue seeing Medicare and Medicaid patients due to the double whammy of very low reimbursement rates and the inability to bill the patient if the government decided that the office visit wasn’t “medically necessary”. The fact that the patient made the appointment and asked for care didn’t mean that the service was necessary, and the doctor was responsible for the costs if, after the fact, the government didn’t want to pay for it. To get around this, we could do a ton of extra paperwork to have waivers signed for each and every visit “just in case”, but small practices don’t have the time or staff necessary to deal with this. Plus, why should they deal with it when commercial plans don’t require such billing restraints? If Regence or Premera don’t cover something then the patient can be billed for it. There is also the tendency for people who pay nothing at all for their healthcare to overuse the system and visit their doctor (or the ER) for minor complaints, at taxpayer or healthcare provider expense. I think we need to change the way government plans are run now before we even think of expanding them.
June 2nd, 2008 at 8:34 am
Slightly off topic, but not really -
One of the things that really concerns me about health care is how many people feel stuck in working in jobs they hate, just so they can have some kind of health care. Private insurance is so high and even COBRA doesn’t last forever. I think this hurts American entrepreneurship - people can’t afford to go into business for themselves anymore. Forget about getting employees and offering them any kind of care - they themselves don’t dare quit their day job. It undermines us in so many ways even beyond making sure people are well cared for.
June 2nd, 2008 at 8:35 am
Everytime I start to consider the possibility of moving to the states next, I read a post on the horrors of the healthcare system and I realise I probably couldn’t afford it!
Coming from the UK and currently in Canada I see the benefits of universal healthcare so clearly. Yes neither system is perfect but I have always received treatment when needed and have never had the additional stress of finance added to it.
Like Plonkee says I really don’t want to ever move away from this system having seen it in action.
June 2nd, 2008 at 9:17 am
Will work for Health Care Insurance…. that’s what I’m doing. I could be a nice retired stay at home Grammi, but I can’t afford the private rates for Health Insurance - so I found a 4 day/wk job - just enough to provide the employer paid health insurance.
And that actually was a leverage point for me with the new employer - I told him the wages did not matter, but having fully paid health insurance coverage did…. so he pays it all, and I gladly accept a lower wage for the job, and feel GREAT about it! I saved him money, so he could afford to hire me, and I got my health insurance fully paid. Worked for me anyway.
I bet there are a lot of others in this predicament - frugal enough to retire, but not without affordable health insurance… I just wouldn’t want to be without…just in case….
June 2nd, 2008 at 9:20 am
There is no need for torte reform. Malpractice insurance is not the reason medical care if unaffordable.
Read this article which covers a Harvard study on malpractice claims: Study Casts Doubt on Claims That the Medical Malpractice System Is Plagued By Frivolous Lawsuits, Harvard School of Public Health, May 10, 2006 http://www.hsph.harvard.edu/ne.....02006.html
Medical malpractice myths by Tom Baker, director of the Insurance Law Center at the University of Connecticut School of Law: http://www.amazon.com/gp/produ.....roduct_top
This is a also a good article (would be better if it was less personal, and stuck more to the facts) that covers alot of the reasons why the medical industry has its priorities in the wrong places, see all the links at the bottom
http://www.nowpublic.com/healt.....alpractice
June 2nd, 2008 at 10:03 am
There already is a type of universal health care and it’s called Medicare. It’s just that those of us younger people can’t tap into it. Model it on this system and it might actually work.
The rich and the poor have programs in place to help them, but it’s really the middle class who is getting shafted when it comes to health care.
Here is our story: my toddler son had a rare brain tumor and received brain surgery at 9 mos after a long and persistent fight to get our HMO that was offered by his university, Blue Cross of California, to cover the medical bills. They finally did, thank goodness. However, now he’s done school and we switched insurance to one offered by my husband’s work. They only cover $100 a month, so we pay a whopping $850 a month, just for insurance (don’t even get me started on our ongoing medical bills.) Just to have insurance is nearly half of my husband’s take home pay!
We don’t qualify for CA State programs because his employer offers insurance, and we can’t get individual insurance because of my son’s pre-existing condition. I’m not sure what the right answer is, but something has to be done. We are going broke and it’s not fair, because we work.
June 2nd, 2008 at 10:15 am
I forgot to add that in response to your comment about not wanting the government to tell you what is medically necessary: the insurance companies do that now! I fought our medical group and insurance company for months to prove brain surgery for our child was necessary. It will be the same, just a different entity writing the checks.
June 2nd, 2008 at 10:26 am
A universal system does not have to be completely government run or funded. It does however need government regulation at a minimum to force insurance companies to cover people who can’t afford the premiums (people who can afford premiums will pay more).
Mike
June 2nd, 2008 at 10:43 am
I’m an American with an English husband, and we live in England. I absolutely love our national health service. Two situations:
1) while visiting in the US my husband was helping my mother with some kitchen remodeling and sliced his hand with a knife. He missed the veins in his wrist by less than an inch, but he still needed treatment, and we were absolutely terrified as we had no insurance. I ended up calling a friend who is a doctor who agreed to treat him. My brother drove us to the hospital and we sneaked into a research lab where my husband was treated.
2) Last summer I was in a car accident here in England. I was on my bike and went through the car’s windshield. An ambulance was called and I was taken to the emergency room. Three hours later, I was back home having had an x-ray, over 40 stitches and a consultation from a plastic surgeon. It cost me nothing - they even offered to pay for my taxi home (I declined).
I know which system I prefer!
June 2nd, 2008 at 11:54 am
HI
I’m from the UK and as you know we have the national health trust. Now there has been lots of bad press about this over the years but let me just say i recently lost my mother who spent two weeks in an intensive care ward and i have never seen such great nurses and care. They looked after her so well and they had all the latest equipment, they couldn’t have done more for her. You couldn’t pay for better care.
I really think that a national system does in the long run benefit all and if you happen to have more money than others and you want a private room well then pay for private care, but you can’t let people suffer just because they have not got as much money as the next person.
June 2nd, 2008 at 12:41 pm
It never ceases to amaze me how millions of people living in the RICHEST country in the world can have no health coverage at all. Your health system, be it private or public is obviously not working, with many people making big bucks just to be intermediaries. And that doesn’ take into account that the US actually spend 3 times more money on health than any other country!! It´s also outrageous that you don´t qualify for health insurance for… not being healthy!
June 2nd, 2008 at 12:49 pm
I could write a book. But I will just write this -
I live in a state where malpractice costs etc are more “controlled” because of the medical review board being a peer review board. However, it makes the doctors untouchable almost. My son had surgery at 13 months old. The doctor operated on the wrong side of his body. We tried to sue him, and couldn’t, because he didn’t cause irreperable harm to our son (thank goodness). But, at the same time, he didn’t fix the problem he was having surgery for, and he also performed a totally unnecessary operation on a 13 month old baby.
But he’s untouchable because of how our medical review board in our state is set up. He can go on to screw up on other kids (he’s the only pediatric surgeon in this immediate area). If that’s the “cost” of lower malpractice insurance, I don’t want it.
June 2nd, 2008 at 12:53 pm
Lynnae you mentioned that OHP didn’t cover it so how did you pay for it. And what are you doing for healthcare now.
Just a note, in countries with universal healthcare it’s the doctors not the goverment that makes the medical decisions.
June 2nd, 2008 at 1:13 pm
Lots of good discussion here! I like it!
Paidtwice - I agree there need to be safeguards in place to prevent doctors from screwing up on lots of patients. But I was on the other side of the high cost of malpractice. Before I moved here, I lived in a small rural county. One of our obstetricians had two multi million dollar settlements against him. Because of this, our county was seen as a county that was quick to hand out high malpractice judgments.
The malpractice of all the obstetricians in the county tripled. 2 obstetricians moved, and 3 stopped practicing obstetrics, because they couldn’t afford it. Mine was one of them. The entire county was left with 3 obstetricians. My friend, who went to the same OB I went to, had to switch OBs when she was 34 weeks pregnant. Instead of being seen every week at the end, she was seen every other week, because the doctor had too many patients. He didn’t even remember her name.
Fortunately for me, that’s about the time we were in the process of moving. I commuted 90 minutes to my OB appointments for 3 months before we sold our house and moved. It was really sad.
Rob, the doctor basically didn’t get paid for what OHP would have paid. Since OHP was acting as my secondary health insurance, my primary insurance covered most of my care. The primary insurance covered enough to make it worthwhile for my doctor. If OHP had been my only insurance, the doctor would have taken a loss on me.
But OHP does not cover everything. It covers most common procedures that 95% of the population would need, but if you need something outside what it covers, you’re up a creek. There was a gal several years ago who needed a heart-lung transplant. They’d cover a heart transplant or a lung transplant, but not both. Fortunately for the girl, it was a huge story, and people raised the money for her to have the surgery, but I don’t believe OHP ended up paying a dime.
June 2nd, 2008 at 1:14 pm
Rob, I forgot the second part of your question. My husband has insurance through his new job. It’s expensive, but at least we’re covered.
June 2nd, 2008 at 2:13 pm
I don’t want anyone controlling my health care either. But I’d rather the government than private insurance companies (as is the case right now).
I don’t think it’s malpractice that is making health care so expensive either. It’s the fact that it’s a for-profit business (and companies like to keep costs down) and the cost of having so many people *without* decent health care coverage (which is tied in with our lack of emphasis on prevention).
June 2nd, 2008 at 7:31 pm
This is a really debatable topic, but I still think you portrayed it well.
If you wouldn’t mind checking out my blog, I just wrote a few tips about how to deal with stress.
http://zenplease.com
June 3rd, 2008 at 12:17 am
The government may not be perfect, but a basic need like health care cannot and should not be in the hands of for-profit business. The single-payer government plan of nearly all rich countries besides the US has worked reasonably well. We already have a model of what works: there doesn’t seem to me to be any need to reinvent the wheel.
I don’t think you would advocate, for instance, that public education be dismantled and access to schooling be available only to those who can afford it.
June 3rd, 2008 at 6:26 am
Thanks Lynnae
It should be noted that unlike Canada Europe has public (universal coverage) AND private health care. Regarding Brits, private health care is usually part and parcel of any benefits package. In moving to Spain we signed up for private health care to have access to English speaking doctors.
I tell you nothing keeps out of the doctors office like a language barrier. I showed up at the “English” hospital, the one were all expats go and the intake staff didn’t speak any English! But I digress
June 3rd, 2008 at 9:07 am
One reason that health-care costs so much more nowadays is that there are so many more options available — it was cheaper when people died easier. Now we have all sorts of life-saving and life-extending and life-improving care that we didn’t have in our parents’ generation and especially our grandparents’ generation. Brain surgery comes at a high cost, as does treatment for heart attacks, strokes, high blood pressure, etc.
We’ve come a long way since “take two aspirin and call me in the morning” — and that takes a lot of money.
June 3rd, 2008 at 10:32 pm
Lynae, Have you ever heard of health care sharing ministries like Samaritan? (http://www.samaritanministries.org/)
I was skeptical of them at first, but after hearing several acquaintances tell me about their great experiences with Samaritan (and having our family health insurance premium go WAY up), we felt we should try it.
My husband still has health insurance through his job (he’s had health problems, so we felt we’d like to maintain as much coverage as we could afford) but my 3 kids and I are covered only under Samaritan. We’ve only been members with them for 6 months, and we’ve already had a $1,600 “claim” completely paid for through other members shares.
I couldn’t be happier with our situation, even though “technically”, my kids and I don’t have medical insurance.
June 4th, 2008 at 10:30 am
I completely agree with your views on government health care. Universal health care sounds like the compassionate and reasonable thing. But whenever govt gets involved, the bureaucracy kills the whole system, and there is no accountability for the costs incurred.
June 9th, 2008 at 8:46 am
I am from Canada and enjoy the previleage of having universal health care.
I agree with the options that you have put forward. One of the important things that needs to be considered for insurance is the portability of employer insurance to personal insurance. I understand that this may drive up the cost of insurance but it will definetly add a lot of support especially to people who do not buy personal medical insurance and only depend on the employer provided insurance.
I also agree with the point of view that the government should not be the one to decide as to what treatment should be provided. But this point itself comes with the mass abuse of the system that we used to see in Canada.
June 9th, 2008 at 6:26 pm
What I find scary with the American system is all the money spent on administrators who have to deny so many claims just to pay for their own existence, not to mention turn a profit for the HMO. Something like a full third of the American healthcare spending goes into administration which is double what Canada spends on admin.
Jim Jubak wrote something recently on, believe it or not, Walmart possibly driving down the admin fat out of the healthcare system through competition and productivity tools such as electronic records.
http://articles.moneycentral.m.....hCare.aspx
July 2nd, 2008 at 11:26 am
Emily, this is how Brits feel about the NHS now. It’s not pleasant reading, even the most staunch supports have moved to private health care.
I came across this researching finding an English speaking doctor in Spain.
Safety of the NHS´- WHAT SAFETY???? I am a retired intensive care nurse. We moved to Spain after my husband suffered very badly at the hands of the health service in Worthing and after I witnessed the most diabolical standards of nursing care at Worthing hospital. Since moving here seven years ago, we have had to call on the Spanish health service a number of times, including eye surgery for my husband in Rosell hospital in Cartagena, Murcia and we have nothing but praise for the standards of care here.
True, it is necessary for relatives/friends to provide for the basic needs of the patient, washing, toiletting etc. but as far as the doctors and nurses are concerned their care is far, far in advance of the NHS and the hospitals are definitely a great deal cleaner.
Equally so, the speed with which you can get to see a consultant is far better than the UK, I personally got to see a consultant recently within two weeks and although, in his opinion, there is nothing seriously wrong with me, he has ordered numerous tests and investigations to make absolutely certain all is well. Try getting this service in the UK. There are drawbacks obviously, the need for relatives being involved, a general lack of after care and having to pay for such items as crutches, physiotherapy etc. but on the whole, if we are going to be ill, we would much rather it was here in Spain than in the UK. Our local health centre is open 24 hours a day with a doctor on duty at all times for emergencies and our own doctor speaks fluent English.
However, it is not difficult to obtain an interpreter if you don’t speak Spanish and in a neighbouring town the local council have provided free interpreting services on one day a week. Spain is not perfect, but where in the world is? To anyone with doubts about the standards of health care here I would say the following :-
It’s much better than in the UK, a sad admission from an ex-nurse who has seen standards of nursing, cleanliness etc. go down and down until it seems to have become positively dangerous to go into hospital in the UK. Incidentally,
I have researched the incidence of MRSA in Europe and the latest statistics state that in terms of all hospital acquired infections, the UK has a 48% incidence whilst Spain has 27% - not perfect, but a great deal better. Apparently, if you want to be in safest place you have to live in Norway, which has a 1% incidence! I hope this will reassure anyone who has doubts about care in Spain.
August 16th, 2008 at 2:36 pm
I am old enough to have grandparents who recall that when having the influenza meant your chances of dying at any age were rather high. As of the 1960 US Census, the average age of death was around 49yrs old. When did the entitlement to live until 100 yrs come into effect? Why are invasive measures required as rights to health care for all citizens? Pain management and viral infection management, as a whole, are rather affordable. What was wrong with the old timers reality of acceptance for God’s Time and Will?