Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[glass99]

moltenmetal: 17% of GPD is of course appalling. However, in defense of the current mess:
- America subsidizes the rest of the world for practical drug and device development. When America stops overpaying for drugs, Canadians better get used to their generics at whatever level of development they were at the year the US went public.
- A private system has the possibility of technical innovation, which largely does not exist in single payer systems. If the government just sets the price for commodities, its hard for a young plucky entrepreneur like Elizabeth Holmes to get off the ground. Right now there are gigantic incentives in place for private firms to do better. America was built on techno-capitalism.
- It is not a coincidence that Silicon Valley is in the US and not in France.
- Getting 300 million Americans to agree on a single approach is harder than getting 30 million Canadians on board. Even Obamacare is controversial! What would healthcare in the EU look like if it was one system? They can barely manage a currency. The whole structure of government is geared to make central control difficult. The founding fathers baked in the current deadlock with the congress/senate/president/court demarcation.
- It could be viewed that the primary problem with US healthcare is its market system is clogged. Market forces are blunted by the structure of insurance.

 

[cranky108]

Can I give a negative star?

If Canadian health care is so much better, then why do Canadians come to the US for health care? Or if our health care is so great, why is health travel happening?

In both cases the healthcare system is lacking something, and if free market were really allowed in the US, our insurance would pay for us to seek health care outside the US. The fact is our health insurance is regulated to keep people in the US, and not seek medical care in a free market of the world. Yea there might be risks, but what of the risks here?

Of course I am not talking about emergency care.

And let me say I am not concerned about the poor, I am concerned about myself. The poor can eat cake.

I see that maybe a dual system maybe an answer to this problem. A healthy privite free market system, and an under funded public system. And the public system needs to appear to be underfunded to encurage people to use the privite system when they can.

However, O care was sold as making health care equal for everyone. But apperently the VA did not get the message. Do you supose the White House doctor provides equal care?

 

[rconnor]

I am not concerned about the poor, I am concerned about myself. The poor can eat cake.

...he said while grasping his copy of Atlas Shrugged.

 

[glass99]

I think Ayn Rand would be appalled by the current state of US healthcare.

 

[IRstuff]

"I always worry about putting money into the HSA which I won't use and losing it."

HSA is perpetual, FSA is transitory.

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[beej67]

We should just allow everyone who wants socialized healthcare to pay extra taxes and use the VA.



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[JohnRBaker]

We should just have Medicare Part 'E' (for Everybody).

http://www.commondreams.org/views/2009/09/09/medicare-part-e-everybody

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[swall]

Glass99--my HSA has a $2500 deductible. (some preventative medicine is covered 100% with no deductible, however). The cost of the policy I have is $502. I know that exact amount as I am paying for it currently (via COBRA).The HSA has worked well for me and I have been using the accumulated funds to pay my COBRA premiums. Beej67--Obamacare DID effect HSA plans to some extent. It put some limits on them, i.e. you couldn't have a plan that had like $20,000 deductible.

 

[moltenmetal]

moltenmetal: 17% of GPD is of course appalling. However, in defense of the current mess:
- America subsidizes the rest of the world for practical drug and device development. When America stops overpaying for drugs, Canadians better get used to their generics at whatever level of development they were at the year the US went public.

Prescription drugs are not covered by the Canadian plan, except for the very poor and for drugs given in hospital. But because the governments are a major purchaser and are unafraid to use their purchasing power to negotiate, we all benefit from lower prices. Think of it as a tax on profit. If the US didn't exist, drug companies would still exist, and would still do drug development. What you'd see though is far less peddling of drugs on TV- far less "market building" on the part of drug companies. Those ads you see on US TV- they are absent from Canadian TV entirely. The cost of drugs in Canada also comes with a dramatic reduction in marketing/advertising cost for the drug companies, not by their own choosing I might add.

- A private system has the possibility of technical innovation, which largely does not exist in single payer systems. If the government just sets the price for commodities, its hard for a young plucky entrepreneur like Elizabeth Holmes to get off the ground.

The public system reduces the maximum profit attainable from such innovation but by no means does it prevent innovation entirely.

Right now there are gigantic incentives in place for private firms to do better. America was built on techno-capitalism.
- It is not a coincidence that Silicon Valley is in the US and not in France.

All this "innovation" your country is built on isn't making your healthcare cheaper for one simple reason: healthcare is not a market commodity. It's not an IPad you can choose to buy or not buy.

- Getting 300 million Americans to agree on a single approach is harder than getting 30 million Canadians on board. Even Obamacare is controversial! What would healthcare in the EU look like if it was one system? They can barely manage a currency. The whole structure of government is geared to make central control difficult. The founding fathers baked in the current deadlock with the congress/senate/president/court demarcation.

There are three core reasons your system is screwed:

1) You aren't a totally compassionless country and hence you have a parallel public system- just a totally messed up one which is fragmented into several disparate programs. This fact limits competition- sets a floor for the prices of services etc. But it's impossible to avoid, unless you surgically remove compassion
2) Your political system, like all others but moreso than most, is subject to the power of money. 7% of GDP buys a lot of political power to prevent government "innovation" which might take away private profit
3) You are a nation that from its founding has feared its own government. You don't view government as something you do collectively for each other's benefit- something you can do better together than any of you can do independently. Hence government is always viewed as an evil- by some among you, not even as a necessary evil. You therefore push things onto the private sector that it cannot efficiently provide

- It could be viewed that the primary problem with US healthcare is its market system is clogged. Market forces are blunted by the structure of insurance.

No, the fundamental problem is that the "commodity" of healthcare isn't a commodity- it's a human right. Accordingly the market cannot function to minimize its cost through competition. The insurance companies are a symptom of this problem- they are private entities set up to intercept the necessary and unavoidable flow of money from people needing care to the care providers, and take away as much of that for themselves as possible. They are, by definition, parasites.

 

[TenPenny]

Since Ayn Rand was a user of Medicare, I'm sure that she would be appalled.

I've often wondered how anyone could take her seriously, but many do.

 

[swall]

Moltenmetal--how is health care a human right?

 

[moltenmetal]

swall: see my post previous to this one, with three LPS so far. 2nd paragraph.

 

[swall]

Moltenmetal--yes, I just reread your post. I see your examples of treatment of the indigents being acts of a good Samaritan, but I just can't make the leap to healthcare being a human right.

 

[IRstuff]

I don't think that MM said it that it was a human right, just that we, in the US, treat it as such, because we have mandated that the indigent be treated, regardless of cost or ability to pay for it.

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[glass99]

moltenmetal: If healthcare is such an inalienable human right, were Canadians abusing said rights for the majority of their history were they spent less than 5% of GDP on healthcare? Is the extra 5% of GDP Canadians now spend really a human right, or is it a bunch of exotic treatments which push more folks into extreme old age? At some point which we probably passed a while ago, health care has a component of luxury. It is not your right to have the full resources of the state deployed to extend your life to 100. End of life care gets confused sometimes with a sick kid or a single parent with cancer.

 

[moltenmetal]

glass99: there is much room for debate and discussion about where the rights end and entitlements begin. Some things that are covered, probably shouldn't be. Other things that aren't covered, probably should be. There are better ways to promote wellness rather than providing health care, to provide healthcare for less money with less expensive staff, and to provide a disincentive to wasting the provided services merely because they're "free". That's true in any system. However, my argument was more about the effectiveness of the market in setting prices for such services versus providing the services publicly as a benefit of citizenship.

Care obviously becomes more expensive when we can do more- and when people live longer. That expense grows faster than the economy and there has to be a limit- somewhere. But that growth in cost doesn't explain the difference in % GDP expended between the US and Canada for essentially the same outcome NOW. That difference is almost entirely explained by the inefficiency of the combined private/public model in the US relative to the single payor public-only model in Canada.

We weren't always there: healthcare was once entirely a combination of private and church/charitable provision in Canada. We won the battle to put in place a public single payor health insurance system by fighting the doctors in one province- Saskatchewan - in the early 1950s. Many doctors left the province, but replacement doctors who believed in the system, came in to replace them. Eventually it spread to other provinces- once Tommy Douglas's CCF did the heavy lifting and prevailed, showing that the predicted end of the world and people dying in the streets didn't come to pass. Regrettably, the battle to have such a system for auto insurance was lost in most provinces- only a few have provincial auto insurance, and they pay vastly less for car insurance than we do here in Ontario .

Now we hear US media reports about how everyone in Canada is dying in a waiting line, how we ration the provision of essential health care etc. It's sickening how a distorted view of our system is presented in the US by people with a vested interest in maintaining the status quo. 7% of GDP buys a lot of airtime...

 

[glass99]

moltenmetal: The US contingent who make fun of Canadian healthcare tend to be pretty unsophisticated. Everyone fetishizes all things Scandinavian in my neck of the woods. As it stands, Canadian healthcare is definitely better than the US system simply because its so much cheaper.

Canadian success notwithstanding, its not clear to me that a Euro style single payer system is right for America. I think America will forge its own path. In a bunch of instances where its looked like America was hopelessly behind, people start saying the US needs to become more like Japan/Norway/Germany/wherever, but the US comes from nowhere and invents its own stuff that turns out to be better. I remember a bunch of conversations from 2000 to 2006 about how much better Japanese cell phones were than US equivalents. All kinds of techno gloom post 2000 bubble bursting. Then 2007 rolls around, and Mr Jobs shows up with the iPhone. Had the government said that mobile communications are a human right, and that they were going to reimburse cell phone manufacturers at the cost plus 10%, we would still be carting around Blackberry's (sorry Canada) and thumbing out SMS's on a number pad. There is no way that a government bureaucrat could have picked Apple as the winner that they turned out to be.

This kind of entrepreneurial activity is the only thing which moves the needle of economic growth at scale. Like Norway, Canada has become a liberal petro-state - all manner of largess is financed by the tar sands of Alberta distributed among a small population. Much of the Euro breakup crisis of 2008 was a function of their governments having gigantic fixed costs with a shrinking tax base. Its arguable that the current sclerotic economy of France, Italy and Spain is due to their addiction to being taken care of. Frankly I would rather be a sick American with bad health insurance than an unemployed Spanish twenty-something living with grandma and contemplating suicide because there is no opportunity.

 

[TenPenny]

"Frankly I would rather be a sick American with bad health insurance than an unemployed Spanish twenty-something living with grandma and contemplating suicide because there is no opportunity."

I have a tendency to believe that there might be more options than just those two.

 

[cranky108]

And why do I need electronic records of my medical history? Where is the benifit to me?

In places in South America you don't need a note from a doctor to buy medicines from a pharmacy. Which is really nice if you know what you problem is, you don't need to visit a doctor. And in many cases you know what you have. And maybe that is part of the problem, we are expected to see a doctor when we already know what problem we have. After all how many times has someone OD on butt cream. It is regulated for what reason?

So now, if I have a sinus infection, a visit to the doctor. A case of pink eye, a visit to the doctor. A rash, a visit to the doctor. An ear infection, a visit to the doctor. So the real problem really appears to be regulation, and not the cost of medical insurance, or a shortage of doctors.

So why can't I pay the pharmacy directly and get the medication perscribed by the nurse who usually gives the flu shots.

 

[moltenmetal]

The primary reason we have nearly run out of effective antibiotics is that people overprescribe them- even when physicians are in charge of the prescription, their patients demand them and the docs are reluctant to say no. If we let individuals decide, everybody will be taking antibiotics all the time...The regulations over prescriptions exist for reasons- good ones- and the profession of pharmacy similarly exists for good reasons.