To ration or not

[Annie]

Shared here is William Falk's experience with his aging father. Falk is Editor-in-Chief of THE WEEK magazine:

When my father went back to the hospital a year ago, he was clearly close to the end: His lungs and liver were barely functioning, his abdomen was filling with fluid, and he could no longer lift himself out of bed.

The hospital's doctors nonetheless treated him aggressively, punching a hole in his chest to insert a drainage tube, which quickly led to uncontrolled bleeding, an infection, and a plunge in blood pressure.

Within 12 hours, my father was in a coma, with no chance of recovery, sustained only by a ventilator and a tangle of multiple IV drips. He spent four days in the ICU, until I overcame the resistance of two doctors and had the machines turned off, as per my dad's living will.

Medicare paid upward of $20,000 for these last days of my father's life, during which he received little comfort, moments of agonizing pain and fear, and all the medical care in the world, and then some.

In the historic debate over health care reform now beginning in this country, we will hear much talk of "rationing." If health care is rationed, we'll be told, we may be denied drugs or surgeries or treatments based on cost, effectiveness, or the patient's condition of age. It sounds cold and heartless, except when you consider that the only real alternative to rationing is unlimited medical treatment--including a refusal to "lose" the battle with death even when death is near. Unlimited care, of course, requires unlimited spending, which is not viable.

Rationing in some form is inevitable; the only question is when we'll finally be able to admit to ourselves that even in America, there are limits to everything.

The answer to this would be a 'living will' assigning medical guardianship to a family member. DNR's are widely respected, don't blame 'the system' for stupid personal choices.

About rationing and the backlash:

Kausfiles : Fear of Rationing: Obama Asked For It

Fear of Rationing: Obama Asked For It
WaPo's Alec MacGillis notes that Obama's health care reformers
are clearly spooked by the notion that they could be accused of denying, for example, hip surgery to an 80-year-old.
If so, they largely have themselves to blame. They brought it up! It wasn't the Republicans who billed health care reform as a cost saving, budget-balancing measure that would start to deny payments for treatments deemed "ineffective," or (as one acolyte put it) when "a person's life, or health, is not worth the price." And to think when they heard that people started to worry about rationing! Fancy that.
MacGillis also makes it clear that the Obama wonks are hiding the ball on the ultimate decisions their cost-cutting mission might entail:

A senior administration official who requested anonymity to speak candidly acknowledged that while research might point to obviously wasteful practices, the reform would for the time being not get at the "harder question" of what to do "if new technology does work better and reduces risks but costs a lot more, and how to evaluate that."​

Unfortunately voters, who mays deal with expensive new medical technologies every other day, aren't dumb enough not to see this "harder question" coming down the pike. ..

and more:

THE HEALTH CARE PEOPLE REALLY WANT - New York Post

....In fact, a mere 29 percent of respondents agreed with the promise that their premiums would go down as a consequence of reform. And regarding "accessibility," only 9 percent said that in the last five years they were without coverage all or most of the time.

Moreover, when asked, "Who do you think will benefit most from reform?" a whopping 60 percent chose "other people, but not [me]."

Third Way labels this the "what's in it for me?" phenomenon. It argues that Obama must convince the middle class -- which largely has health care and is satisfied with that care -- that his plan would benefit them.

Third Way noted that "For the last 35 years, the health-reform debate has focused almost exclusively on covering the uninsured -- and that often does not directly apply to the middle class."

This doesn't mean that people don't care about the tens of millions without insurance. But, in the end, people are motivated mainly by self-interest. If they feel that this is an issue affecting "other people," then they'll be less motivated to support Obama's extensive and yes, expensive, health-care overhaul.

Health-care reform advocates may dismiss this argument by saying that, unlike in 1992, America is up in arms about health care and that the political will now exists to do something big to fix the problem. Sorry: The Third Way analysis doesn't bear that out.

It finds that "public support for health-care reform is at almost exactly the same level today as it was in 1992. Sixty-three percent of Americans now support reform, compared to 65 percent who supported "national health insurance" in January 1992.

The lesson? Don't confuse "supporting" reform with "wanting" it.

Third Way urges Obama to turn what it calls "passive supporters" into "active advocates." If he doesn't, he stands to lose the battle.

Its recommendation? Promise the middle class "stability."

When asked to choose the best reason to support health-care reform, 34 percent chose "it will provide stable health coverage that can't be taken away." Only 12 percent chose "pay less in premiums," and 7 percent chose "it will grow the economy." Eighteen percent said that "health care is a moral right."

The survey found that "42 percent of people who are currently covered changed coverage at least once in the last five years. For 57 percent of them, this change was involuntary. Among those who are currently covered, 38 percent said they are worried that they will lose coverage over the next five years."

So, Third Way advises Obama to "make a significant offer of personal benefit to the middle class" in the form of "stable coverage, stable costs and stable quality." Obama should "paint a vivid portrait of the consequences of inaction."

It warns: "Opponents of reform paint a picture of the future that is about high costs, government rationing, lack of choice and long lines. Supporters of reform must paint a picture without reform as one of instability -- higher costs, spottier coverage, less control over your health care."

In short, don't let the GOP do all the fear-mongering.

 

[auditor0007]

First of all, there are well over 1000 companies that provide health insurance. As an individual, you can pick a company that meets your needs, it's not like there is one book of rules that all the insurance companies follow. Each insurance company also offers different types of plans.
That gives you 1000's of options.
Or, you could just pay for health care as you need it.

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Well, gee whiz. You mean insurance depends on your circumstances? I guess that explains why my car insurance is higher if I get into an accident than it is if I don't. And I don't notice anyone grousing about what a horrible crime THAT is. It's just reality. Some things happen in life that just suck. Why is it MY job to foot the bill to make YOUR life suck less?

Sounds to me like what we need is more incentive for companies to offer policies for those with pre-existing conditions, so that competition brings the prices down some. What we DON'T need is for the government to take over so it can just tell those people to die quietly because they cost too much.

There is no incentive for insurance companies to insure those who are truly sick. There never has been and there never will be. And now the insurance companies are the ones who are telling those with pre-existing conditins to die quietly because they cost too much.

Tell me what incentives can you come up with that would make an insurance company want to take on someone who might cost them a lot of money?

 

[auditor0007]

Denying someone healthcare because it will cut into profits is the ultimate in rationing.

Or how about denying healthcare because of pre existing conditions?

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You are correct; every state has a high risk pool or they force insurance companies to offer a guaranteed issue policy with a one year waiting period. This is what I was offered after moving to a different state. I had health insurance at a reasonable price but couldn't take it with me to my new state. So now, instead of paying $329 per month with a maximum out of pocket of $2000 per year, I now would have to pay close to $900 per month with a maximum out of pocket of $5000 per year. That is the rate for someone between 45 to 50. If I was 60, it would be $1375 per month.

That may sound reasonable to some people but not to me. On top of this, these type of policies have very low maximums lifetime payouts, so if you really get sick, they won't cover everything. For instance, the maximum for an organ transplant is $100,000. Well, the average organ transplant starts out around $250,000, so why bother having the insurance?

Because I've have not been able to work full-time for a while, I don't have that kind of money, plus I need to make certain my kids have coverage. So, they are covered and I will pay out of pocket for all of my treatment, which is actually much cheaper than going through the insurance company. The only issue is that I have no catastrophic coverage now. But hey, who needs that anyway?

 

[auditor0007]

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You should talk to some of those who have been denied.

Have you? Do you know that they have been to the State agency, or are they simply lacking in information? Have you asked those questions? If you did you might be able to offer to help them find coverage they don't know is available.

And if they are financially unable to afford the state rates for people with pre-existing conditions, they might be in a position to qualify for Medicaid. All children qualify. I'm sure there are people who earn too much to qualify for Medicaid, but couldn't come up with the money to pay a policy assigned by the state, a donut hole, if you will. My wife had to go that route and it was not much more than my own "healthy" rate.

But as the government has tampered by adding mandates, the rates have steadily risen. If the government had left the market place alone to make available those coverages that would've been offered because the market would’ve demanded them, people with only a few health concerns would not have had to pay for those they are certain would not ever have applied to them.

Even high deductible policies for catastrophic illnesses were not allowed until the Medical Saving Accounts came into being, and then they were authorized only for that purpose. That was another case of the government looking to keep people from having deductibles that were to high by the politician's reckoning; in reality it was the government levelling out the system. That is the extent of government tampering in the health insurance industry.

Personally I blame the government for almost every bit of the distortion we see in today’s health care market place. First they break it, then they trash it, then they replace it with an inferior product. It will matter to you in the end; just wait and see. Rationing will be the outcome. If at 65 you need a knee replacement so that you can remain productive for another 10 years because you can't live on inflated dollars, thus adding to your social security check so that you can remain a productive citizen; you may be relegated to a "power chair"(if one is considered cost effective). Keep some good reading handy for the boredom....because you may not be able to afford your broadband computer link and your Cable TV. I know, probably 75% of the people here think that will never happen to them. I didn't, but I see it coming now.
.

I've talked to many people in this situation. Most state's high risk insurance programs cost between $1500 to $2500 per month and they are very limited in what they cover. They are priced so high that very few can afford them. It is a way of saying that they are making something available, but it's not realistic. And the worst thing is that most of these people had insurance but lost it because they were no longer able to work due to their illness, or like me, they moved from one state to a different state.

 

[toomuchtime_]

Denying someone healthcare because it will cut into profits is the ultimate in rationing.

Or how about denying healthcare because of pre existing conditions?

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You are correct; every state has a high risk pool or they force insurance companies to offer a guaranteed issue policy with a one year waiting period. This is what I was offered after moving to a different state. I had health insurance at a reasonable price but couldn't take it with me to my new state. So now, instead of paying $329 per month with a maximum out of pocket of $2000 per year, I now would have to pay close to $900 per month with a maximum out of pocket of $5000 per year. That is the rate for someone between 45 to 50. If I was 60, it would be $1375 per month.

That may sound reasonable to some people but not to me. On top of this, these type of policies have very low maximums lifetime payouts, so if you really get sick, they won't cover everything. For instance, the maximum for an organ transplant is $100,000. Well, the average organ transplant starts out around $250,000, so why bother having the insurance?

Because I've have not been able to work full-time for a while, I don't have that kind of money, plus I need to make certain my kids have coverage. So, they are covered and I will pay out of pocket for all of my treatment, which is actually much cheaper than going through the insurance company. The only issue is that I have no catastrophic coverage now. But hey, who needs that anyway?

This problem could be easily solved with sliding scale subsidies based on income and wealth to buy health insurance, and there is no need for a major overhaul of our health insurance system or our health care system to solve it. In fact, all of the problems with our existing system could be solved simply and far more cheaply if we approach them one at a time instead of turning this into a partisan political competition as Obama/Pelosi/Reid have done.

 

[auditor0007]

Shared here is William Falk's experience with his aging father. Falk is Editor-in-Chief of THE WEEK magazine:

When my father went back to the hospital a year ago, he was clearly close to the end: His lungs and liver were barely functioning, his abdomen was filling with fluid, and he could no longer lift himself out of bed.

The hospital's doctors nonetheless treated him aggressively, punching a hole in his chest to insert a drainage tube, which quickly led to uncontrolled bleeding, an infection, and a plunge in blood pressure.

Within 12 hours, my father was in a coma, with no chance of recovery, sustained only by a ventilator and a tangle of multiple IV drips. He spent four days in the ICU, until I overcame the resistance of two doctors and had the machines turned off, as per my dad's living will.

Medicare paid upward of $20,000 for these last days of my father's life, during which he received little comfort, moments of agonizing pain and fear, and all the medical care in the world, and then some.

In the historic debate over health care reform now beginning in this country, we will hear much talk of "rationing." If health care is rationed, we'll be told, we may be denied drugs or surgeries or treatments based on cost, effectiveness, or the patient's condition of age. It sounds cold and heartless, except when you consider that the only real alternative to rationing is unlimited medical treatment--including a refusal to "lose" the battle with death even when death is near. Unlimited care, of course, requires unlimited spending, which is not viable.

Rationing in some form is inevitable; the only question is when we'll finally be able to admit to ourselves that even in America, there are limits to everything.

The answer to this would be a 'living will' assigning medical guardianship to a family member. DNR's are widely respected, don't blame 'the system' for stupid personal choices.

About rationing and the backlash:

Kausfiles : Fear of Rationing: Obama Asked For It

Fear of Rationing: Obama Asked For It
WaPo's Alec MacGillis notes that Obama's health care reformers
are clearly spooked by the notion that they could be accused of denying, for example, hip surgery to an 80-year-old.
If so, they largely have themselves to blame. They brought it up! It wasn't the Republicans who billed health care reform as a cost saving, budget-balancing measure that would start to deny payments for treatments deemed "ineffective," or (as one acolyte put it) when "a person's life, or health, is not worth the price." And to think when they heard that people started to worry about rationing! Fancy that.
MacGillis also makes it clear that the Obama wonks are hiding the ball on the ultimate decisions their cost-cutting mission might entail:

A senior administration official who requested anonymity to speak candidly acknowledged that while research might point to obviously wasteful practices, the reform would for the time being not get at the "harder question" of what to do "if new technology does work better and reduces risks but costs a lot more, and how to evaluate that."​

Unfortunately voters, who mays deal with expensive new medical technologies every other day, aren't dumb enough not to see this "harder question" coming down the pike. ..

and more:

THE HEALTH CARE PEOPLE REALLY WANT - New York Post

....In fact, a mere 29 percent of respondents agreed with the promise that their premiums would go down as a consequence of reform. And regarding "accessibility," only 9 percent said that in the last five years they were without coverage all or most of the time.

Moreover, when asked, "Who do you think will benefit most from reform?" a whopping 60 percent chose "other people, but not [me]."

Third Way labels this the "what's in it for me?" phenomenon. It argues that Obama must convince the middle class -- which largely has health care and is satisfied with that care -- that his plan would benefit them.

Third Way noted that "For the last 35 years, the health-reform debate has focused almost exclusively on covering the uninsured -- and that often does not directly apply to the middle class."

This doesn't mean that people don't care about the tens of millions without insurance. But, in the end, people are motivated mainly by self-interest. If they feel that this is an issue affecting "other people," then they'll be less motivated to support Obama's extensive and yes, expensive, health-care overhaul.

Health-care reform advocates may dismiss this argument by saying that, unlike in 1992, America is up in arms about health care and that the political will now exists to do something big to fix the problem. Sorry: The Third Way analysis doesn't bear that out.

It finds that "public support for health-care reform is at almost exactly the same level today as it was in 1992. Sixty-three percent of Americans now support reform, compared to 65 percent who supported "national health insurance" in January 1992.

The lesson? Don't confuse "supporting" reform with "wanting" it.

Third Way urges Obama to turn what it calls "passive supporters" into "active advocates." If he doesn't, he stands to lose the battle.

Its recommendation? Promise the middle class "stability."

When asked to choose the best reason to support health-care reform, 34 percent chose "it will provide stable health coverage that can't be taken away." Only 12 percent chose "pay less in premiums," and 7 percent chose "it will grow the economy." Eighteen percent said that "health care is a moral right."

The survey found that "42 percent of people who are currently covered changed coverage at least once in the last five years. For 57 percent of them, this change was involuntary. Among those who are currently covered, 38 percent said they are worried that they will lose coverage over the next five years."

So, Third Way advises Obama to "make a significant offer of personal benefit to the middle class" in the form of "stable coverage, stable costs and stable quality." Obama should "paint a vivid portrait of the consequences of inaction."

It warns: "Opponents of reform paint a picture of the future that is about high costs, government rationing, lack of choice and long lines. Supporters of reform must paint a picture without reform as one of instability -- higher costs, spottier coverage, less control over your health care."

In short, don't let the GOP do all the fear-mongering.

Stable coverage is not a moot talking point. As costs continue to sprial out of control, more and more people will find themselves without coverage. On top of this, more jobs will be moved to countries where the employer doesn't have to pay for the health coverage of its employees. And of those companies that can't move their operations out of the US, many will close their doors. We are literally facing a meltdown of our economy if we do not stabalize costs to a managable level.

 

[Coyote]

First of all, there are well over 1000 companies that provide health insurance. As an individual, you can pick a company that meets your needs, it's not like there is one book of rules that all the insurance companies follow. Each insurance company also offers different types of plans.
That gives you 1000's of options.
Or, you could just pay for health care as you need it.

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Well, gee whiz. You mean insurance depends on your circumstances? I guess that explains why my car insurance is higher if I get into an accident than it is if I don't. And I don't notice anyone grousing about what a horrible crime THAT is. It's just reality. Some things happen in life that just suck. Why is it MY job to foot the bill to make YOUR life suck less?

Sounds to me like what we need is more incentive for companies to offer policies for those with pre-existing conditions, so that competition brings the prices down some. What we DON'T need is for the government to take over so it can just tell those people to die quietly because they cost too much.

There is a world of difference between health insurance and auto insurance.

And exactly WHO would offer those incentives? What would they be? Who would bear the cost subsidizing because that's what "incentives" would likely amount to.

The government.

Not to mention - you seem to keep ignoring the facts. No one is talking about the "government taking over" - they are talking about adding a public plan to cover those not currently covered and to promote real competition. Why are you so afraid of that?

 

[toomuchtime_]

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Well, gee whiz. You mean insurance depends on your circumstances? I guess that explains why my car insurance is higher if I get into an accident than it is if I don't. And I don't notice anyone grousing about what a horrible crime THAT is. It's just reality. Some things happen in life that just suck. Why is it MY job to foot the bill to make YOUR life suck less?

Sounds to me like what we need is more incentive for companies to offer policies for those with pre-existing conditions, so that competition brings the prices down some. What we DON'T need is for the government to take over so it can just tell those people to die quietly because they cost too much.

There is no incentive for insurance companies to insure those who are truly sick. There never has been and there never will be. And now the insurance companies are the ones who are telling those with pre-existing conditins to die quietly because they cost too much.

Tell me what incentives can you come up with that would make an insurance company want to take on someone who might cost them a lot of money?

If people who are well were willing to pay higher premiums so that people with pre existing conditions could be insured at standard rates, insurance companies would have an incentive to insure them, but if company A charged a higher rate to everyone and insured people with pre existing conditions and company B charged a lower rate and excluded people with pre existing conditions, healthy people would choose company B and company A would, in effect, become a high risk pool. Insurance companies don't insure people with pre existing conditions at standard rates because healthy people don't want to subsidize them.

 

[Cecilie1200]

You don't have 1000's of options if you have any of a number of "pre-existing" conditions. The few plans that will cover you will do so at rates so high as to be unaffordable to many people if not matched by an employer. I'm not sure how it works in the private sector - because I work for a state university - but we are offered a limited number of plans to choose from where the employer also contributes. Sure...you could just pay for it as you need it and if you are young, healthy, and don't have a family you can afford the risk. But what if you have a pregnancy or children? What if you need prescription medications to stay healthy? The costs of those without insurance can be horrendously high.

Well, gee whiz. You mean insurance depends on your circumstances? I guess that explains why my car insurance is higher if I get into an accident than it is if I don't. And I don't notice anyone grousing about what a horrible crime THAT is. It's just reality. Some things happen in life that just suck. Why is it MY job to foot the bill to make YOUR life suck less?

Sounds to me like what we need is more incentive for companies to offer policies for those with pre-existing conditions, so that competition brings the prices down some. What we DON'T need is for the government to take over so it can just tell those people to die quietly because they cost too much.

There is a world of difference between health insurance and auto insurance.

And exactly WHO would offer those incentives? What would they be? Who would bear the cost subsidizing because that's what "incentives" would likely amount to.

The government.

Not to mention - you seem to keep ignoring the facts. No one is talking about the "government taking over" - they are talking about adding a public plan to cover those not currently covered and to promote real competition. Why are you so afraid of that?

Um, no. I realize that you automatically default to "the government has to do it" on everything, but actually, if you take the government out of the equation, the market offers the incentives. Yeah, people who aren't the most desirable insurance prospects are always going to have to pay more than those who are, because they're going to end up costing the insurance company more in claims.

Once again, look at auto insurance. When it became necessary for everyone to have at least liability coverage, companies offering plans to those who are routinely turned down for insurance proliferated. And then many of the major companies got in on the act, because they could see there was a niche to be filled and money to be made. The same can be said for life insurance to older people and those with pre-existing health conditions.

Right now, there's comparatively little competition in health insurance (compared to other industries) primarily because of government interference. The solution isn't to just throw up your hands and assume only the government can handle things because they've hamstrung everyone else. The solution is to move them out of the way and let the market handle it.

And if you really think "Oh, we're just suggesting a LITTLE more government intervention, not that they take the whole enchilada", then you're too naive to be allowed out without a babysitter. Try listening to your leaders when they talk once in a while, instead of just sighing happily in your pink, fuzzy clouds.

 

[auditor0007]

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You are correct; every state has a high risk pool or they force insurance companies to offer a guaranteed issue policy with a one year waiting period. This is what I was offered after moving to a different state. I had health insurance at a reasonable price but couldn't take it with me to my new state. So now, instead of paying $329 per month with a maximum out of pocket of $2000 per year, I now would have to pay close to $900 per month with a maximum out of pocket of $5000 per year. That is the rate for someone between 45 to 50. If I was 60, it would be $1375 per month.

That may sound reasonable to some people but not to me. On top of this, these type of policies have very low maximums lifetime payouts, so if you really get sick, they won't cover everything. For instance, the maximum for an organ transplant is $100,000. Well, the average organ transplant starts out around $250,000, so why bother having the insurance?

Because I've have not been able to work full-time for a while, I don't have that kind of money, plus I need to make certain my kids have coverage. So, they are covered and I will pay out of pocket for all of my treatment, which is actually much cheaper than going through the insurance company. The only issue is that I have no catastrophic coverage now. But hey, who needs that anyway?

This problem could be easily solved with sliding scale subsidies based on income and wealth to buy health insurance, and there is no need for a major overhaul of our health insurance system or our health care system to solve it. In fact, all of the problems with our existing system could be solved simply and far more cheaply if we approach them one at a time instead of turning this into a partisan political competition as Obama/Pelosi/Reid have done.

That could be a reasonable approach, but how will it stabalize overall costs? The ever increasing costs of healthcare as a percentage of GDP is going to lead to the downfall of our entire economy. In 1970, the cost of healthcare was responsible for around 7% of GDP; today it is 17%, by 2025 it will reach 25%, by 2035 it will reach 35%, and by 2080 it will hit nearly 50% of GDP, with the bulk of spending coming from private care, not Medicare and Medicaid.

http://www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf

If spending on healthcare reaches these levels, there won't be any money left for anything else. Where will all of this money come from? It certainly won't be from the working stiffs who won't even be able to make their rent payment. The problem currently is that most people do have adequate coverage and so they are satisfied.

What nobody wants to discuss is the fact that we are at the breaking point. Costs are going to continue to rise in dramatic fashion unless there are drastic changes, and it is going to leave a great many with the choice between paying for healthcare or everyday living expenses. In other words, we're going to have an awful lot of people without healthcare coverage. The more that becomes a reality, the sooner we will see drastic changes.

 

[auditor0007]

Well, gee whiz. You mean insurance depends on your circumstances? I guess that explains why my car insurance is higher if I get into an accident than it is if I don't. And I don't notice anyone grousing about what a horrible crime THAT is. It's just reality. Some things happen in life that just suck. Why is it MY job to foot the bill to make YOUR life suck less?

Sounds to me like what we need is more incentive for companies to offer policies for those with pre-existing conditions, so that competition brings the prices down some. What we DON'T need is for the government to take over so it can just tell those people to die quietly because they cost too much.

There is no incentive for insurance companies to insure those who are truly sick. There never has been and there never will be. And now the insurance companies are the ones who are telling those with pre-existing conditins to die quietly because they cost too much.

Tell me what incentives can you come up with that would make an insurance company want to take on someone who might cost them a lot of money?

If people who are well were willing to pay higher premiums so that people with pre existing conditions could be insured at standard rates, insurance companies would have an incentive to insure them, but if company A charged a higher rate to everyone and insured people with pre existing conditions and company B charged a lower rate and excluded people with pre existing conditions, healthy people would choose company B and company A would, in effect, become a high risk pool. Insurance companies don't insure people with pre existing conditions at standard rates because healthy people don't want to subsidize them.

That is correct. What is interesting is the reaction of those who were once healthy, who then find themselves with a pre-existing condition and in that same boat as so many others. And with more advanced genetic testing, we're going to see much more of this down the road. Should a woman get a genetic test that reveals she has a high risk for developing breast cancer? It sounds like a good idea, but she might then have to start paying much more for her health coverage is the test is positive.

I have hemochromatosis. The disease only manifests itself after a very long period of time, and only if it is not discovered early on. For instance, my kids may have it, and if they do, they can stop it from becoming a problem simply by donating blood a few times per year. If they do this, the complications of storing too much iron will never become a problem because the blood removal will keep their iron levels normal. But guess what? If the insurance company finds out they have the genetic marker for hemochromatosis, they will be denied coverage. That is assuming they want to purchase a private policy. Of course, they could get coverage through an employer, but only because that is mandated by the goverenment.

So, this genetic mutation, that causes no problem at all if found early on, is reason enough for the insurance companies to deny coverage. Just imagine what they will do for those with greater risks. And as for hemochromatosis, it is estimated that over 1 million Americans have the markers for it, but most don't realize it. With more genetic testing, three quarters of our population will end up in high risk pools eventually.

 

[toomuchtime_]

You are correct; every state has a high risk pool or they force insurance companies to offer a guaranteed issue policy with a one year waiting period. This is what I was offered after moving to a different state. I had health insurance at a reasonable price but couldn't take it with me to my new state. So now, instead of paying $329 per month with a maximum out of pocket of $2000 per year, I now would have to pay close to $900 per month with a maximum out of pocket of $5000 per year. That is the rate for someone between 45 to 50. If I was 60, it would be $1375 per month.

That may sound reasonable to some people but not to me. On top of this, these type of policies have very low maximums lifetime payouts, so if you really get sick, they won't cover everything. For instance, the maximum for an organ transplant is $100,000. Well, the average organ transplant starts out around $250,000, so why bother having the insurance?

Because I've have not been able to work full-time for a while, I don't have that kind of money, plus I need to make certain my kids have coverage. So, they are covered and I will pay out of pocket for all of my treatment, which is actually much cheaper than going through the insurance company. The only issue is that I have no catastrophic coverage now. But hey, who needs that anyway?

This problem could be easily solved with sliding scale subsidies based on income and wealth to buy health insurance, and there is no need for a major overhaul of our health insurance system or our health care system to solve it. In fact, all of the problems with our existing system could be solved simply and far more cheaply if we approach them one at a time instead of turning this into a partisan political competition as Obama/Pelosi/Reid have done.

That could be a reasonable approach, but how will it stabalize overall costs? The ever increasing costs of healthcare as a percentage of GDP is going to lead to the downfall of our entire economy. In 1970, the cost of healthcare was responsible for around 7% of GDP; today it is 17%, by 2025 it will reach 25%, by 2035 it will reach 35%, and by 2080 it will hit nearly 50% of GDP, with the bulk of spending coming from private care, not Medicare and Medicaid.

http://www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf

If spending on healthcare reaches these levels, there won't be any money left for anything else. Where will all of this money come from? It certainly won't be from the working stiffs who won't even be able to make their rent payment. The problem currently is that most people do have adequate coverage and so they are satisfied.

What nobody wants to discuss is the fact that we are at the breaking point. Costs are going to continue to rise in dramatic fashion unless there are drastic changes, and it is going to leave a great many with the choice between paying for healthcare or everyday living expenses. In other words, we're going to have an awful lot of people without healthcare coverage. The more that becomes a reality, the sooner we will see drastic changes.

Health care costs are rising because our population is aging and this has created a market for expensive treatments to prolong life and to improve the quality of life. Nothing in the current circus in Congress addresses this issue. Certainly there are some economies to be had, but as long as our population continues to age, health care costs will continue to rise and the only way to stop it is to ration health care by denying expensive treatments to some people. Inevitably, this will mean that in the future people who can pay for these expensive treatments out of their own pockets will get them and people who rely on their health insurance, public plan or private plan, will not.

 

[toomuchtime_]

There is no incentive for insurance companies to insure those who are truly sick. There never has been and there never will be. And now the insurance companies are the ones who are telling those with pre-existing conditins to die quietly because they cost too much.

Tell me what incentives can you come up with that would make an insurance company want to take on someone who might cost them a lot of money?

If people who are well were willing to pay higher premiums so that people with pre existing conditions could be insured at standard rates, insurance companies would have an incentive to insure them, but if company A charged a higher rate to everyone and insured people with pre existing conditions and company B charged a lower rate and excluded people with pre existing conditions, healthy people would choose company B and company A would, in effect, become a high risk pool. Insurance companies don't insure people with pre existing conditions at standard rates because healthy people don't want to subsidize them.

That is correct. What is interesting is the reaction of those who were once healthy, who then find themselves with a pre-existing condition and in that same boat as so many others. And with more advanced genetic testing, we're going to see much more of this down the road. Should a woman get a genetic test that reveals she has a high risk for developing breast cancer? It sounds like a good idea, but she might then have to start paying much more for her health coverage is the test is positive.

I have hemochromatosis. The disease only manifests itself after a very long period of time, and only if it is not discovered early on. For instance, my kids may have it, and if they do, they can stop it from becoming a problem simply by donating blood a few times per year. If they do this, the complications of storing too much iron will never become a problem because the blood removal will keep their iron levels normal. But guess what? If the insurance company finds out they have the genetic marker for hemochromatosis, they will be denied coverage. That is assuming they want to purchase a private policy. Of course, they could get coverage through an employer, but only because that is mandated by the goverenment.

So, this genetic mutation, that causes no problem at all if found early on, is reason enough for the insurance companies to deny coverage. Just imagine what they will do for those with greater risks. And as for hemochromatosis, it is estimated that over 1 million Americans have the markers for it, but most don't realize it. With more genetic testing, three quarters of our population will end up in high risk pools eventually.

Having a genetic marker for a disease is not dissimilar to having a family history of this disease. Insurance companies multiply the probability of having the disease by the expected costs of treating the disease to determine their risk exposure. Insuring a child with a genetic marker for such a disease is vastly different from insuring an adult who already has the disease because even if the child never did anything to prevent the onset of the disease, the costs of treating it would be spread over so many years that the difference in risk would be small. In fact, discovering the genetic marker early in life would on average make such a person a very low risk for developing the disease and I'm sure insurance company actuaries understand this.

 

[Coyote]

Um, no. I realize that you automatically default to "the government has to do it" on everything, but actually, if you take the government out of the equation, the market offers the incentives.

Um, no. You don't - because you don't know me.

I not a blind believer in the market shall be the bearer of all good things. The market only offers incentives where there is a profit. Incentives do not equal a moral compass and that is what this sort of problem needs to be resolved. A good example of "incentive" here was the link posted by another poster, to an article where patients were abandoned on the street. There's market incentive for you.

Not every undertaking is going to be profitable - or, at best in order to be profitable some group ends up excluded. Traditionally the government takes on those unprofitable tasks. I see insuring certain groups of people as falling within that category.

Yeah, people who aren't the most desirable insurance prospects are always going to have to pay more than those who are, because they're going to end up costing the insurance company more in claims.

Exactly - even though that may not be any fault of their own but only a matter of statistics. Or, they may fall into an economic gap where they aren't covered or are undercovered. Those who are "undesirable" risk prospects may also be those facing large medical bills and poor employment prospect - not exactly in a good position to pay the substantially higher premiums required.

Once again, look at auto insurance. When it became necessary for everyone to have at least liability coverage, companies offering plans to those who are routinely turned down for insurance proliferated. And then many of the major companies got in on the act, because they could see there was a niche to be filled and money to be made. The same can be said for life insurance to older people and those with pre-existing health conditions.

True, but life insurance is strictly optional and you can do just fine without it. In terms of auto insurance - because it's mandatory if you are a driver - some option must be available for every legal driver but you can't force companies to insure people they feel are too high a risk even with higher premiums. As a result the state steps in to fill the gap and offers insurance for those who can't get it otherwise (at a higher cost probably).

Right now, there's comparatively little competition in health insurance (compared to other industries) primarily because of government interference. The solution isn't to just throw up your hands and assume only the government can handle things because they've hamstrung everyone else. The solution is to move them out of the way and let the market handle it.

Like the market handled the financial industry? No thanks....I think we've seen what a bad idea it is to have insufficient oversight.

And if you really think "Oh, we're just suggesting a LITTLE more government intervention, not that they take the whole enchilada", then you're too naive to be allowed out without a babysitter. Try listening to your leaders when they talk once in a while, instead of just sighing happily in your pink, fuzzy clouds.

I think it's a bit naive to trust everything to the market given the events of the past year (representative of some 25 years of systemic de-regulation and a hands-off philosophy).

 

[Coyote]

You are correct; every state has a high risk pool or they force insurance companies to offer a guaranteed issue policy with a one year waiting period. This is what I was offered after moving to a different state. I had health insurance at a reasonable price but couldn't take it with me to my new state. So now, instead of paying $329 per month with a maximum out of pocket of $2000 per year, I now would have to pay close to $900 per month with a maximum out of pocket of $5000 per year. That is the rate for someone between 45 to 50. If I was 60, it would be $1375 per month.

That may sound reasonable to some people but not to me. On top of this, these type of policies have very low maximums lifetime payouts, so if you really get sick, they won't cover everything. For instance, the maximum for an organ transplant is $100,000. Well, the average organ transplant starts out around $250,000, so why bother having the insurance?

Because I've have not been able to work full-time for a while, I don't have that kind of money, plus I need to make certain my kids have coverage. So, they are covered and I will pay out of pocket for all of my treatment, which is actually much cheaper than going through the insurance company. The only issue is that I have no catastrophic coverage now. But hey, who needs that anyway?

This problem could be easily solved with sliding scale subsidies based on income and wealth to buy health insurance, and there is no need for a major overhaul of our health insurance system or our health care system to solve it. In fact, all of the problems with our existing system could be solved simply and far more cheaply if we approach them one at a time instead of turning this into a partisan political competition as Obama/Pelosi/Reid have done.

That could be a reasonable approach, but how will it stabalize overall costs? The ever increasing costs of healthcare as a percentage of GDP is going to lead to the downfall of our entire economy. In 1970, the cost of healthcare was responsible for around 7% of GDP; today it is 17%, by 2025 it will reach 25%, by 2035 it will reach 35%, and by 2080 it will hit nearly 50% of GDP, with the bulk of spending coming from private care, not Medicare and Medicaid.

http://www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf

If spending on healthcare reaches these levels, there won't be any money left for anything else. Where will all of this money come from? It certainly won't be from the working stiffs who won't even be able to make their rent payment. The problem currently is that most people do have adequate coverage and so they are satisfied.

What nobody wants to discuss is the fact that we are at the breaking point. Costs are going to continue to rise in dramatic fashion unless there are drastic changes, and it is going to leave a great many with the choice between paying for healthcare or everyday living expenses. In other words, we're going to have an awful lot of people without healthcare coverage. The more that becomes a reality, the sooner we will see drastic changes.

Has anyone really pin pointed the reasons why the costs are rising so fast?

 

[auditor0007]

If people who are well were willing to pay higher premiums so that people with pre existing conditions could be insured at standard rates, insurance companies would have an incentive to insure them, but if company A charged a higher rate to everyone and insured people with pre existing conditions and company B charged a lower rate and excluded people with pre existing conditions, healthy people would choose company B and company A would, in effect, become a high risk pool. Insurance companies don't insure people with pre existing conditions at standard rates because healthy people don't want to subsidize them.

That is correct. What is interesting is the reaction of those who were once healthy, who then find themselves with a pre-existing condition and in that same boat as so many others. And with more advanced genetic testing, we're going to see much more of this down the road. Should a woman get a genetic test that reveals she has a high risk for developing breast cancer? It sounds like a good idea, but she might then have to start paying much more for her health coverage is the test is positive.

I have hemochromatosis. The disease only manifests itself after a very long period of time, and only if it is not discovered early on. For instance, my kids may have it, and if they do, they can stop it from becoming a problem simply by donating blood a few times per year. If they do this, the complications of storing too much iron will never become a problem because the blood removal will keep their iron levels normal. But guess what? If the insurance company finds out they have the genetic marker for hemochromatosis, they will be denied coverage. That is assuming they want to purchase a private policy. Of course, they could get coverage through an employer, but only because that is mandated by the goverenment.

So, this genetic mutation, that causes no problem at all if found early on, is reason enough for the insurance companies to deny coverage. Just imagine what they will do for those with greater risks. And as for hemochromatosis, it is estimated that over 1 million Americans have the markers for it, but most don't realize it. With more genetic testing, three quarters of our population will end up in high risk pools eventually.

Having a genetic marker for a disease is not dissimilar to having a family history of this disease. Insurance companies multiply the probability of having the disease by the expected costs of treating the disease to determine their risk exposure. Insuring a child with a genetic marker for such a disease is vastly different from insuring an adult who already has the disease because even if the child never did anything to prevent the onset of the disease, the costs of treating it would be spread over so many years that the difference in risk would be small. In fact, discovering the genetic marker early in life would on average make such a person a very low risk for developing the disease and I'm sure insurance company actuaries understand this.

You would think, but that is not the case. With hemochromatosis, if you have the genetic marker, you will not be accepted for a private insurance policy. It doesn't matter whether or not you are young or old, or if you have actually developed any complications. You are a risk, therefore you are denied.

 

[toomuchtime_]

That is correct. What is interesting is the reaction of those who were once healthy, who then find themselves with a pre-existing condition and in that same boat as so many others. And with more advanced genetic testing, we're going to see much more of this down the road. Should a woman get a genetic test that reveals she has a high risk for developing breast cancer? It sounds like a good idea, but she might then have to start paying much more for her health coverage is the test is positive.

I have hemochromatosis. The disease only manifests itself after a very long period of time, and only if it is not discovered early on. For instance, my kids may have it, and if they do, they can stop it from becoming a problem simply by donating blood a few times per year. If they do this, the complications of storing too much iron will never become a problem because the blood removal will keep their iron levels normal. But guess what? If the insurance company finds out they have the genetic marker for hemochromatosis, they will be denied coverage. That is assuming they want to purchase a private policy. Of course, they could get coverage through an employer, but only because that is mandated by the goverenment.

So, this genetic mutation, that causes no problem at all if found early on, is reason enough for the insurance companies to deny coverage. Just imagine what they will do for those with greater risks. And as for hemochromatosis, it is estimated that over 1 million Americans have the markers for it, but most don't realize it. With more genetic testing, three quarters of our population will end up in high risk pools eventually.

Having a genetic marker for a disease is not dissimilar to having a family history of this disease. Insurance companies multiply the probability of having the disease by the expected costs of treating the disease to determine their risk exposure. Insuring a child with a genetic marker for such a disease is vastly different from insuring an adult who already has the disease because even if the child never did anything to prevent the onset of the disease, the costs of treating it would be spread over so many years that the difference in risk would be small. In fact, discovering the genetic marker early in life would on average make such a person a very low risk for developing the disease and I'm sure insurance company actuaries understand this.

You would think, but that is not the case. With hemochromatosis, if you have the genetic marker, you will not be accepted for a private insurance policy. It doesn't matter whether or not you are young or old, or if you have actually developed any complications. You are a risk, therefore you are denied.

If that's still true, it's only because so few people have yet been identified as carrying genetic markers for diseases that the insurance companies have not yet figured out what the true costs are for insuring them. The fact is that turning away people who on average will not cost them significantly more is turning away profits, and we both know insurance companies don't want to turn away profits.

 

[auditor0007]

This problem could be easily solved with sliding scale subsidies based on income and wealth to buy health insurance, and there is no need for a major overhaul of our health insurance system or our health care system to solve it. In fact, all of the problems with our existing system could be solved simply and far more cheaply if we approach them one at a time instead of turning this into a partisan political competition as Obama/Pelosi/Reid have done.

That could be a reasonable approach, but how will it stabalize overall costs? The ever increasing costs of healthcare as a percentage of GDP is going to lead to the downfall of our entire economy. In 1970, the cost of healthcare was responsible for around 7% of GDP; today it is 17%, by 2025 it will reach 25%, by 2035 it will reach 35%, and by 2080 it will hit nearly 50% of GDP, with the bulk of spending coming from private care, not Medicare and Medicaid.

http://www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf

If spending on healthcare reaches these levels, there won't be any money left for anything else. Where will all of this money come from? It certainly won't be from the working stiffs who won't even be able to make their rent payment. The problem currently is that most people do have adequate coverage and so they are satisfied.

What nobody wants to discuss is the fact that we are at the breaking point. Costs are going to continue to rise in dramatic fashion unless there are drastic changes, and it is going to leave a great many with the choice between paying for healthcare or everyday living expenses. In other words, we're going to have an awful lot of people without healthcare coverage. The more that becomes a reality, the sooner we will see drastic changes.

Has anyone really pin pointed the reasons why the costs are rising so fast?

There are a multitude of reasons, and one big one is that our population is aging, but it is not aging nearly as fast as many other countries with much lower overall costs. Also, we are paying for the rapid advancement in new technologies and new treatments. The problem with many of these new technologies is that they are extremely expensive because they aren't used all that frequently.

What does bother me though is the idea that greater demand and more competition will reduce prices. What we have seen over the last three decades is an aging population which has led to the need for more medical services than ever with more doctors and hospitals than ever to treat those people and create the competition necessary to control prices. But it hasn't worked out that way.

Based on normal rules of capitalism, providing a service or selling a product to more people almost always reduces costs, but not so in healthcare.

 

[toomuchtime_]

That could be a reasonable approach, but how will it stabalize overall costs? The ever increasing costs of healthcare as a percentage of GDP is going to lead to the downfall of our entire economy. In 1970, the cost of healthcare was responsible for around 7% of GDP; today it is 17%, by 2025 it will reach 25%, by 2035 it will reach 35%, and by 2080 it will hit nearly 50% of GDP, with the bulk of spending coming from private care, not Medicare and Medicaid.

http://www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf

If spending on healthcare reaches these levels, there won't be any money left for anything else. Where will all of this money come from? It certainly won't be from the working stiffs who won't even be able to make their rent payment. The problem currently is that most people do have adequate coverage and so they are satisfied.

What nobody wants to discuss is the fact that we are at the breaking point. Costs are going to continue to rise in dramatic fashion unless there are drastic changes, and it is going to leave a great many with the choice between paying for healthcare or everyday living expenses. In other words, we're going to have an awful lot of people without healthcare coverage. The more that becomes a reality, the sooner we will see drastic changes.

Has anyone really pin pointed the reasons why the costs are rising so fast?

There are a multitude of reasons, and one big one is that our population is aging, but it is not aging nearly as fast as many other countries with much lower overall costs. Also, we are paying for the rapid advancement in new technologies and new treatments. The problem with many of these new technologies is that they are extremely expensive because they aren't used all that frequently.

What does bother me though is the idea that greater demand and more competition will reduce prices. What we have seen over the last three decades is an aging population which has led to the need for more medical services than ever with more doctors and hospitals than ever to treat those people and create the competition necessary to control prices. But it hasn't worked out that way.

Based on normal rules of capitalism, providing a service or selling a product to more people almost always reduces costs, but not so in healthcare.

In fact, services and procedures that were available thirty years ago and are still in use today are cheaper and safer. On the other hand, health care today is a very different package of services than it was thirty years ago. In theory, price competition for the same product will increase efficiency and that will tend to drive prices down to a level where alternative uses of capital and labor will bring no greater rewards, and that has happened for those procedures, such as cataract surgery or joint repair, etc., that have been around for a long time, but newer procedures that require newly discovered or invented drugs or the purchase of new diagnostic or therapeutic equipment will always be more expensive because of patents and investment costs that have to be recovered.

Health insurance creates the market for these new expensive treatments that then drive up the cost of health insurance.

 

[American Horse]

Denying someone healthcare because it will cut into profits is the ultimate in rationing.

Or how about denying healthcare because of pre existing conditions?

Health care is not denied because of pre-existing conditions. Not even health insurance is denied because of pre-existing conditions. Every state has an agency with assigned risk health insurance policies available for virtually any pre-existing condition.

You are correct; every state has a high risk pool or they force insurance companies to offer a guaranteed issue policy with a one year waiting period. This is what I was offered after moving to a different state. I had health insurance at a reasonable price but couldn't take it with me to my new state. So now, instead of paying $329 per month with a maximum out of pocket of $2000 per year, I now would have to pay close to $900 per month with a maximum out of pocket of $5000 per year. That is the rate for someone between 45 to 50. If I was 60, it would be $1375 per month.

Just to take on your figures, because they obviously vary state to state. Six years ago my spouse had first to drop a policy with a well known name to get away from it and into the Indiana "risk pool"; With a rare syndrome with unknown medical risks no one realy wanted to insure for. As her prior insurer knew her conditon, the insurance she needed to drop was costing $1,100/month, and the insurance available in the risk pool was $323/month with a $1,500 deductible. She was 58.

I was 4 years older, a male, and I changed policies to a well known company (Anthem-BlueCross/Blue Shield) and got mine for just $153/month with a $1,000 deductible. Of course that was then and those prices have changed drastically. My comment above in an earlier post (post #100) applies to why I think the government is primarily the cause of that change.

Now I'm on Medicare and SS at 68. My total medicare costs are now $326. no deductible but with co-pays and my insurance takes up almost exactly 27% of my SS check. This means of course that I have to stay in good physical condition to keep some income coming in while drawing down a small part of my savings hoping it all will work out to a big zero in about 15 years on the outside. My physical condition is of primary concern to me.

If all states had all insurance providers available, and of course if the states did not promote government mandates and other costs on an insurance co more onerous than Indiana does, a better situation would prevail nation wide.