Matthew Yglesias (May 02, 2007) - Benefits (Domestic Policy)

well, of course!

to add a small side note, when your out-of-pocket increases, that is not picked up in the CPI, and therefore not reflected in our understanding of "inflation," but it sure hits individual households in the wallet.

Posted by howard | May 2, 2007 11:28 AM

Yes, I function as the medical benefits administrator for my family—I use that term because it feels like a part-time job, even though my family is relatively healthy. Maybe it's partly a function of living in a big city and seeking our services in the environment of a huge research hospital complex—in which one physician may work with our insurer while the next specialist we're sent to doesn't but no one bothers to check (even when we ask)—so we get hit in the mailbox with hundreds of dollars in bills. This is beyond Kafkaesque. That and repeatedly getting bills dunning me for payments 250-300% greater than the fees that my insurers eventually pay out once I push the paperwork back on them.

I'm really at a loss for words to describe how much this (and our education system and calendar, and our child-care arrangements, and our crying need for infrastructure modernization, and on and on) have lately made me feel like this country has entered a sclerotic, senile twilight in which we really can't figure out how to tie our shoes or feed ourselves.

Posted by elle loco | May 2, 2007 11:32 AM

Every time I look at the complexity of the tax system, or of the health care benefits options, it makes me wonder. Are there a bunch of wannabe accountants out there who actually enjoy this stuff? For whom the thought of a simple system is frightening because it would take away one of their pleasures in life - that of deciding between all the different options?

I mean, when I've talked to coworkers about how much I hate this stuff, I'm always amazed by how much they seem to get into it.

One of the reasons I'm hoping to never again change jobs is so that I never have to go through the benefits options again.

Posted by Jim W | May 2, 2007 11:40 AM

You're right, of course... but, man, let me assure you that every part of that except the premiums is true in the Great White North as well, and that the provincial government is capable of acting as a more effective gatekeeper to prevent patients from ever seeing medical personnel than any private HMO I ever interacted with in the US.

This doesn't speak to distributional consequences, or overall cost. But on the sheer bureaucratic hell front, I'm finding Canada consistently worse-- not a lot worse, but consistently worse-- than the U.S.

Posted by Jacob T. Levy | May 2, 2007 11:41 AM

I do not understand this term, "health care system." Do you perhaps mean our Medical Interventions Industry?

Posted by calling all toasters | May 2, 2007 11:41 AM

Help make May about health care issues and ideas. Force candidates to stop buying votes and start selling ideas. Support the grassroots campaign...

http://5dollarsforhealthcare.blogspot.com/

Posted by Jim | May 2, 2007 11:55 AM

I agree 100%. I swear the insurance companies' real core competency is to jerk around their customers to weasel out an extra hundred bucks here or there with made up charges.

If had cancer or some other life-threatening disease the frustration would kill me.

Posted by chris | May 2, 2007 12:02 PM

What exactly is a 90/80 (or 90/70) plan? Did you mean 80/20? The plan I'm on is 80/20 for in-network doctors and then something like 70/30 or 60/40 for out-of-network, depending on the kind of procedure. What's worse is that that if you're out of network, the plan pays only a percentage of what they consider to be "customary and reasonable" so your out of pocket expense could end up being more than 50%.

Posted by Justin Grunau | May 2, 2007 12:36 PM

They have two plans. The cheap one is the 100/30 plan, which covers 100 percent of in-network expenses and 30 percent of non-network expenses. The 90/70 plenty covers 90 percent of in-network expenses and 70 percent of non-network expenses. But only after a deductible and with the "customary and reasonable" proviso, etc.

Posted by Matthew Yglesias | May 2, 2007 12:43 PM

I am self-employed. Which means my health care plan is very simple (BCBS) but also means I pay 100% out-of-pocket for my premiums, copays, deductibles, etc. No eye care. No dental. And NONE of it pre-tax.

So quit whining all you who complain about THE FORMS your employer makes you fill out!!!

Our system is broken.

Posted by adam | May 2, 2007 12:44 PM

Call me old fashioned, but I believe that when you're deciding how to spend thousands of dollars per year you ought to spend some time thinking about it.

Posted by ostap | May 2, 2007 1:15 PM

I am self-employed. Which means my health care plan is very simple (BCBS) but also means I pay 100% out-of-pocket for my premiums, copays, deductibles, etc. No eye care. No dental. And NONE of it pre-tax.

My self-employed neighbor told me that he pays $1300 / month for his insurance. Without that burden, the guy could probably hire an assistant....

Posted by sglover | May 2, 2007 1:18 PM

Another pet peeve of mine is health savings accounts, or whatever it is they're called. This is wear you decide how much money to set aside for eyeglasses and things like that, so that you can pay for those things tax free.

Of course, its one more thing you have to keep track of. If you forget to buy new eyeglasses that year, you're screwed because you lose all the money.

What is the point of this? They really want to turn us all into a bunch of small minded accountants.

Posted by Jim W | May 2, 2007 1:22 PM

Oh no, me no likey filling out paperwork. Me no want to pay for services consumed. Me would prefer big brother to take care of all this, because big brother lacks this tendency to turn complex things into a bureaucratic nightmare.

Posted by mike | May 2, 2007 1:32 PM

Not that this is exactly the same situation, but my mom's health insurance seems to switch every few months. Each time this happens, they require a proof of enrollment form, and not just one. For some reason, she has to send form after form. And that's just for me. It's the same for my sister, who will still be in college for a few more years, and for my mom, who is the primary recipient.

Posted by Brian | May 2, 2007 1:32 PM

My self-employed neighbor told me that he pays $1300 / month for his insurance. Without that burden, the guy could probably hire an assistant....

I pay only $160/month, so it's not too bad. But I'm a single 32 year old male with no children. My brother is also self-employed and spends over $1000/month for his family. In fact, I just heard him on the phone earlier with his insurance company trying to sort out some sort of issue and he did not sound happy. Choice quote, "Do you people go out of your way on purpose to make this difficult for your customers!?"

So, while I spend money out of pocket, it's a burden I can easily afford (so far, my rates keep going up 10-20% each year). But the trend in healthcare is bad bad bad.

Posted by adam | May 2, 2007 1:33 PM

This is why "incremental steps" and "for the children" is such nonsense.

As for those who are knee-jerk opposed to universal coverage, cite long waiting lines for hip replacements in Canada, or use the term, "socialized medicine," I really am beginning to believe that such individuals themselves should do without healthcare.

Posted by Duncan Kinder | May 2, 2007 1:42 PM

Me would prefer big brother to take care of all this, because big brother lacks this tendency to turn complex things into a bureaucratic nightmare.

20+ countries save money, and deliver better health care (infant mortality, life expectancy, percentage of life healthy) by letting "big brother" handle it. Our system is awesomely busted. If we could attain Spanish levels of effiiciency in our health care, for the money we spend we could take care of the entire hemisphere, from Point Barrow to Patagonia, and still be healthier.

Posted by dr2chase | May 2, 2007 1:43 PM

"But only after a deductible and with the 'customary and reasonable' proviso, etc."

Matt, just FYI--the PPO agreements that most doctors sign to access a network have a provision that says that if a bill is reduced for exceeding "customary and reasonable" standards, the doctor is forbidden to seek reimbursement of the difference from the patient. It's actually statutory or regulatory in a number of states.

Posted by Joe | May 2, 2007 1:48 PM

Also, please note that if a person is not insured, the health providers charge the individual MORE than they would bill the insurance company (negotiated price). For example, my pharmacy asked for $80 for a prescription; when I realized they did not have my insurance info, they re-calculated the bill for $40, of which I had a $20 co-pay. Crazy.

Posted by Rosie | May 2, 2007 1:51 PM

The current HMO system is already a bureaucratic nightmare.

I swear, there's this blind spot where people don't see the typical corporate structure as a bureaucracy the same way they see government as one.

Posted by Karmakin | May 2, 2007 1:55 PM

My current plan is 90/70 with $250 individual deductibles. That's considered a good plan by most of my friends and family. I have to wonder what kind of insurance you had before?

My wife's company offers a single 70/0 with a $1000 deductible and costs more than my plan, go figure.

(I'm assuming your #/# means percentage paid in-network/out-of-network)

Posted by Evan | May 2, 2007 1:55 PM

seems like a good enough reason to move to a simple national health insurance scheme.

Ya think?

"Do you people go out of your way on purpose to make this difficult for your customers!?"

Yes.

Ever heard the term "pre-existing condition?" It's a set of magic words used by insurance companies to avoid paying for people who need care. It's also, by itself, enough of a reason for us to junk the current system. The economic incentives for private insurance companies will always encourage them to try to insure the healthy and dump the sick. And punish them if they don't.

It's pointless to try to fiddle with this broken system. Dump it and go with what works elsewhere, which is some flavor of single payer.

Posted by jimBOB | May 2, 2007 2:06 PM

seems like a good enough reason to move to a simple national health insurance scheme

Ah, if only there were a simple national health insurance scheme that includes no paperwork anywhere along the way. Perhaps the Lost City of Atlantis has such a scheme. Or maybe the Yeti nation.

Posted by Al | May 2, 2007 2:12 PM

Don't ask how much you or your employer pays in fees per month to manage your health care savings account. It will only raise your blood pressure.

The costs for our insurance has risen by double digits for the last several years. This year it went up by 23%.

Posted by John Gillnitz | May 2, 2007 2:20 PM

Re; I am self-employed. Which means my health care plan is very simple (BCBS) but also means I pay 100% out-of-pocket for my premiums, copays, deductibles, etc. No eye care. No dental. And NONE of it pre-tax.

??
Self-employed people can deduct their health insurance premiums on their taxes (as long as policy is in the self-employed's name-- not a spouse's and not COBRA). Line 29 on Form 1040. Look into this, You could be paying the IRS a bundle you shouldn't.

Re: My self-employed neighbor told me that he pays $1300 / month for his insurance.

Is your neighbor approaching retirement age, insuring a large family (not just himself), or does he have major health problems? Last time I paid my own health insurance (just a year ago) I had a reasonable plan for $240 amonth (Just myself, I was 39 and had mild asthma but no other chronic health problems).

Re: Another pet peeve of mine is health savings accounts, or whatever it is they're called.

What you've described is a Flexible Spending Acount (FSA) which are very common. In a Health Savings Account (HSA) you never lose the money at the end of the year. Downside is, unlike an FSA you can't spend the money until it's in the account (you can spend your entire FSA amount for the year on day one of the plan and if you quit or are laid off before the end of the year your employer has to make up the deficit in the account. Of course your employer can also keep what you don't spend at the end of the year or at your departure from employment)

Posted by JonF | May 2, 2007 2:35 PM

I had a summer job at IBM's mental health benefits provider. Our job was to decertify as much as possible. Linking the profit motive to bureaucracy in health care is so much worse than anything just linking government bureaucracy to health care could do. Jacob says its worse in Canada. I'm not convinced. I saw over and over that we would take people out of the hospitals when their doctors and relatives were in utter despair over their conditions. Upper management made huge bonuses by reducing costs. At the same time, because it was "cheap" we kept some beneficiaries on once a week therapy...for 25 years...while the people who really needed mental health care got squat.
OF COURSE the insurance companies make it complicated to get us to give up and pay for our own care, even while we pay premiums. Of course they create complex network systems of providers, to bedevil the providers and us as we try to get care. That's just simple market economics.
National health care. Now. The system only works for the top 15% in most situations. And even for some of us, it is unbelievably annoying and time consuming.

Posted by Jerry Mayer | May 2, 2007 2:35 PM

I just wish all these concern/snark trolls and apologists for the status quo would go and read Ezra Klein's recent survey of US, Canadian, French, German, British, and VA health care. I defy them to keep maundering away at their keyboards with inanities and irrelevancies.... (Sorry--no link, fellas: you need to know how to find Ezra anyway, so go now with Godspeed)

Posted by elle loco | May 2, 2007 2:55 PM

My PPO insurance premium (I'm also self-employed, and single, no dependents) went up to $1,118 a month at the beginning of the year (from $800-something). Fortunately I turned 65 the next month and was able to go on Medicare. No major health problems, and I don't believe my age was a factor in the premium because it was a group plan from my professional association via TEIGIT in NYC (I live in NJ).

Posted by Swift Loris | May 2, 2007 3:02 PM

Am in the middle of Maggie Mahar's Money-Driven Medicine. Read it and you can eliminate the hair pulling speculation about why the system is sick.
(Also just finished Cohen's SICK on how we are killing people with our way of doing things.)
Many of you have it relatively well as I at 65 am through ex employer being forced on Medicare Advantage ($6000 year) along with $16,000 for Blue Shield rip off for covering family, coverage that was good enough for all four of us until Medicare being required--so now overinsured at $22,000 a year! Try that on retirement income. At least the Blue Shield executives are making millions a year in addition to their "performance bonuses" for denying coverage.

Posted by D H Lawrence | May 2, 2007 3:24 PM

You think the forms were complex at your company, just try to file for individual medical insurance. You have to explain every medical visit/expense for your family for the last 2 years. I would love to shop around for a new insurance company for my family (wife and 2 kids), but the amount of effort to fill out the forms keeps me from doing it.

Posted by Dennis_D | May 2, 2007 3:31 PM

After reading these accounts I feel very fortunate. My company pays a good portion (about 75%) of my premium. The deductible is very high ($2,500 for a single employee), but they reimburse for the first half of it. In other words, they've crafted a plan that eliminates the economic disincentives to actually using the insurance for primary care-type services. And the paperwork is minimal as well. I just wonder how long the company can continue to be so generous.

Posted by Kurzleg | May 2, 2007 3:32 PM

I don't see how Jacob Levy can say that everything about the Canadian system is the same or worse as the little experience Mr. Yglesias relates. I'm aware there are lots of problems, but as far as bureaucratic hell is concerned, it's at least somewhat different. I have a card in my wallet which I show the Dr's receptionist when I go to the office. That's it. No multiplicity of plans and options, no need to sign up every year or if I change jobs. I've had the card since I moved to this province 20 years ago. I'm a reasonably healthy 50 year old male; over the years I've seen eye and skin specialists and had minor knee surgery. Never any problems, never any bills or paperwork.

Posted by Canadian | May 2, 2007 3:40 PM

"Also, please note that if a person is not insured, the health providers charge the individual MORE than they would bill the insurance company (negotiated price). "-Rosie

Never fear, hospitals and other health care providers are trying to extend the rip-off to the insured as well.

It is now routine for them to send letters to patients with itemized lists of costs for services and payments from insurance companies that don't balance. At the end, they have an entry for "Total unreimbursed costs". The letter looks like a bill. They even include a postage paid envelope to make it easier to send them a payment. The thing is, the letter isn't a bill. It just shows the difference between normal costs and the price negotiated with the hospital by your insurer. The patient owes nothing! But hospitals are raking in millions with this scam.

A major lab used to badger me with these letters every time anyone in my family had a blood test. I used to call my insurance company after each one, and get assured that I owed nothing. When I found out what the scam was, I called the lab and threatened to go to the State's Attorney General. They stopped sending me the fake bills.

Posted by Njorl | May 2, 2007 3:58 PM

No offense, Matt, but this is nothing new. The paperwork in the US health-care 'system' is simply a manifestation of the hundreds and hundreds of overlapping layers of bureaucracy: health plans, insurance companies, local regs, state regs, federal regs, tax implications,... It is quite simply insane for this country to handle health expenditures the way it does.

Posted by DNS | May 2, 2007 3:59 PM

There are so many bogeymen and hidden pitfalls in the health insurance system it's like a Dickens-era encounter with the Inns of Court. It's a scandal that this situation has been allowed to continue.

I'm afraid that the brazen criminality of insurers is only going to get worse in coming years. Witness the Blue Cross situation in California. I joined them as an individual just before it was revealed that the company had set up an office whose staff was solely devoted to illegally denying claims. Unbelievable. The fine was ridiculously low, like $1 million. I watch them like a hawk, but there's not much any individual can do if they decide to screw you.

The 'regular and customary' guidelines, now that's another thing to rant about...

Posted by djangone | May 2, 2007 4:02 PM

Echoing what other Canadians have said in response to Levy's comments...
In Canada, you get your health card from the provincial government, then give that card to any and every health care provider when you seek care. That's it. There's no connection to employment, no need to make coverage choices, no need to fill out any additional forms whatsoever. I really don't know what Levy was talking about re: bureaucracy. I sense that is real grievance is about access, i.e. timeliness of access to treatment and/or procedures. Sure, chronic underfunding and understaffing has led to waiting lists, but outcomes in Canada are still better than in the US, and there are none of the paperwork-headaches and none of the chronic anxiety about lack of coverage.

Posted by DNS | May 2, 2007 4:02 PM

A few of the many special things I have recently learned from up close & personal experience about our health care system which I did not know before"

1) Matt says: switching soon to a...plan

Brian says: my mom's health insurance seems to switch every few months.

This is a dangerous situation for the insured who is not spending enough time administrating his own account. Many HMO's no longer do what they were invented to do: micromanage health care accounts. They wait until there's bills. If are in the middle of a health crisis, like many older people, and your group is switched from one company or plan to another, it is your job to inform everyone, including doctors, and to make sure that you are getting services that are still covered and that the right agency is still being billed and has approved. You cannot trust the doctors or the hospital, it's "not their problem." The health insurance company will not even look at the new accounts they just got until bills come in months later. Then they will inform you that you are not covered because it's out of plan or you are in the wrong hospital, out of plan, and must be moved, even like if you just had heart surgery complications and are on a ventilator. Once a big fancy specialist at a hospital takes over your care from a primary care physician, chances are he's not paying any attention to the health insurance, as he's got a good cash flow going on. This is good for your immediate crisis care but bad when the company starts getting his bills and his associates bills later.

2) SPECIALISTS HAVE "UNIONIZED." If you have the bad luck of having a loved one in the I.C.U. for more than a few days, you will figure out the new system that specialist doctors in many urban areas have invented to deal with the system and protect their interests from current health insurance companies and any future changes in the system: they have formed "unions" of specialists in the form of corporations or LLC's. Sitting in the room you will meet a new kidney specialist or pulmonary specialist every other day. You wonder what's going on until you check their names and addresses on the internet and you find that all those kidney guys are in the same office with the same phone number, that they are in a guild where they sub for each other and which gives them clout with the powers that pay and for which administrative expenses are pooled. Down side for the patient: no continuity of care (they have never seen the patient before, haven't a clue what kind of person they are when awake, glance at the chart, and may not care much if it's been a bad day;) there is no easy way in most small cities to get a second opinion, as no specialist is going to go against another specialist in his company.

3) The NURSING SHORTAGE in the country is at crisis level. About 30% of nurses in hospitals are lousy, sometimes even cruel, or just have bad attitude because of overwork. Nursing assistants are virtually unsupervised, they are told to go take blood from a patient and they do it without any knowledge of the patient or checking the chart and come in and ask stupid, frightening questions of family members in the room. In regular wards, they have too many patients. In the I.C.U., they rotate according to shift rules to keep them from quitting, and you rarely have continuity of care. Yes, 70% of them are good or great. It is russian roulette which kind you get when that beeper goes off in your room. The supervisors need nursing bodies and can't be too picky.

4) There is a movement afoot in hospitals to get a "DO NOT RESUSCITATE" for any seriously ill person over a certain age. The medical profession in crisis care have all fixated on the heart stopping as the "natural death," not on brain death. It appears to be an easy philosophical out for them in those sticky situations where money and machines are being spent on an iffy patient. The family that refuses to put on a D.N.R. gets lectures about "quality of life" and pressure ad nauseum from every doctor that comes in the room to the point where it seems the doctors wish to kill your loved one. (Some are pretty damn terrible at bedside lecturing.) The problem is that enough patients whose heart is restarted go on to have a few more years "quality of life" and were already dealing with other "machines" or difficult measures to keep them alive, so they are used to a lower quality of life and are not ready to go away. Whatever society decides to do about this, pressuring grief-stricken families under stress is probably not the best way to go about it. This is not a single anecdotal incident, ask anyone who has experienced the situation: they have given up on the extending life thing if you have multiple expensive illnesses at a certain age.

5) HEALTH SAVINGS ACCOUNTS are great in principle for some self-employed people. They are also pie in the sky for many self-employed--there are not that many companies rushing to provide that high-deductible insurance that is required to take part. In some states, there is no one offering it for individuals, you must have a group. The "market" is not taking care of it.

6) A couple of MEDICARE age in the Midwest can easily be paying $10,000 a year for the SUPPLEMENTAL insurance. They need it, as Medicare does not pay for any extended hospital stays, few doctors will accept "Medicare only" patients, and there is a day limit on hospital stays which varies according to the state as well as a lifetime limit. After that, you are a charity patient or on the street.

7) There is a new type of hospital that was created by the market for care of the acutely ill who have been in the hospital too long (when nursing homes are not paid for) that tries to get Medicare money for extended acute care: "LONG TERM ACUTE CARE HOSPITALS." The trick: the patient is labeled as having a chance of improving, so it's considered "rehab" and laws have been written so they can get Medicare money that nursing homes cannot. They are for-profit companies; Kindred and Select Specialty are the largest. Select Specialty simply leases floors in "real" hospitals around the country. (They, too, push the family for a "D.N.R." when the patient gets to be too expensive or the Medicare has run out without supplemental.)

Posted by artappraiser | May 2, 2007 4:04 PM

I used to think the same thing. Then I lost my job, my COBRA expired, and I had to (try to) get insurance on my own. And it got much, much worse.

I am also a "single, childless, male individual in good health". But I have a nagging foot injury from running. I am still managing to cover five miles a day, but there are occasional trips to the podiatrist (plantar fasciaitis). And for a while I had "palpable" swelling on my thyroid of 1 CM that "out of an abundance of caution", the doctor had needle biopsied - not cancerous. A completely benign goiter. But because it was not removed, I am an automatic rejection for any and all insurance companies in California.

So the way I like to say it is, because I am a runner and because I DON'T have cancer, I am not able to get normal health insurance. I can only get catastrophic coverage (ie. hospitalization... yes, office visits ...no).

Posted by Robert Earle | May 2, 2007 4:09 PM

"I don't see how Jacob Levy can say that everything about the Canadian system is the same or worse as the little experience Mr. Yglesias relates. "

I don't see how the Canadian plan could be worse. They simply are not paying enough in bureaucratic costs up there to cause enough trouble. Bureaucrats don't screw you over for free, you know. They have to be paid.

Out of each dollar spent on health care, 32 cents goes to bureaucratic costs. That isn't just people filing papers and checking boxes. That is also payments to someone who's job it is to prevent you from getting an MRI that you'd have to wait for in Canada. It is payments to someone who finds a legal justification for not covering that cancer treatment that a Canadian has to be shipped to the US to get. A small but non-negligible part of our healthcare costs are spent expressly for the purpose of denying ourselves healthcare.

Posted by Njorl | May 2, 2007 4:13 PM

I too will be very curious to see if Jacob can back up his comments about Canada. What always gets me in confronting health care costs is that I'm a pretty smart guy. I teach statistics and politics, so neither the math nor the policies should be daunting, but the task is always immense. And so I always wonder--what do people with less time and training than I have do? What about sick people who do their own paperwork? I really suspect that a lot of them just throw their hands up, and pay out of pocket or go without treatment they are entitled to get. Every time they do that, somewhere, an insurance company's profit goes up $50, $100, $500+++. Another facet for Jacob to ponder--we pay almost twice what Canada pays, and we have 47 million who are uninsured. Much more of our costs go to paper pushers. And the endless battles among providers, patients, insurers, other insurers, etc, as to who will pay. Then the lawyers get involved...National health care. Now.

Posted by Jerry Mayer | May 2, 2007 4:32 PM

What are you Matt, some kind of communist? Do you hate our freedoms? Real Americans are self-reliant individuals who can take care of themselves and don't ask the Mommy State to do it for them. Being an American means being a competent part time accountant, actuary, stock broker and money manager. All of those forms are your title deeds to the ownership society. They prove that you are not a decadent European ward of the state, but fully on your way to stand-up American dadhood.

It only gets worse. Welcome to liberty.

Posted by Dan Kervick | May 2, 2007 4:43 PM

A small but non-negligible part of our healthcare costs are spent expressly for the purpose of denying ourselves healthcare.

I'm sorry, but they don't deny anyone healthcare in Canada? I was unaware that Canadians got unlimited healthcare, as long as they waited. That's awesome; I have 58 MRIs I want to have taken, none of which are medically necessary, but since they are not denying healthcare up in Canada and I can wait, I'll have to move there.

Posted by Al | May 2, 2007 4:48 PM

Jacob T. Levy makes the obligatory 'diss' of the Canadian healthcare system - and it looks like he's just making stuff up.

As a Canadian who has had a couple of operations and various medical issues over the years, I personally have NEVER filled out a form at any Doctor's office, hospital or for any insurance purpose.

Yes, there are some flaws in the Canadian healthcare system and no doubt some bureaucracy. But to suggest that Canadian healthcare requires one to fill out any forms is pure bullsh*t.

Posted by Michael | May 2, 2007 4:53 PM

Duncan Kinder: "As for those who are knee-jerk opposed to universal coverage...I really am beginning to believe that such individuals themselves should do without healthcare."

I wouldn't go that far. Just send them to a McJob and let them deal with the fallout. I'd love to see George Will do a "Nickeled and Dimed" like Barbara Ehrenreich did.

Posted by ThresherK | May 2, 2007 4:57 PM

So Jacob Levy has to back up his claims, but none of those criticizing the U.S. system have to back up theirs.

Let's start with the very first comment, where Howard says that increases in out-of-pocket medical costs are not included in the CPI. Howard, please substantiate this claim.

Posted by Bilbao | May 2, 2007 5:13 PM

Anyone self-employed should set up a sub chapter 'S' corporation. Then health insurance is tax deductible.

Ask your accountant. Or get another accountant.

Posted by JB (not John Bolton | May 2, 2007 5:47 PM

A 'national health insurance' won't reduce paperwork sufficiently. To sign up, one would presumably fill out the same paperwork at some point.

The subsequent inter-clinic, referall, order, lab paperwork between competing interests in the health field would still have the same amount of paperwork - all in the name of 're-imbursement' from the national health insurance.

A 'national health system,' on the other hand, would markedly reduce the total amount of paperwork. (and there would be no reduction in the quality of health care if the NIH and academic centers are continually funded by federal funding.)

Posted by Adi | May 2, 2007 5:49 PM

Jacob T. Levy is full of crap. When my wife broke her arm skating at Christmas we drove to the nearest hospital (half an hour away, we were in the country). We showed them her provincial health card, they took x-rays, gave here a shot of morphine, checked her in and scheduled her for surgery in the morning. She's still going for physiotherapy twice a week (it was a really bad break...) Hasn't cost us a penny out of pocket, except for painkiller prescriptions (refundable at tax time) and apart from a signature or two there was no paperwork.

My mother was diagnosed with colon cancer last year; had surgery a week after diagnosis, a private room for a week and two months of home visits from a nurse. No cost, no worries about increased premiums, no need to mortgage the house, no fighting with insurance company hacks to get approval for treatments, no one telling us which doctors to see.

The system up here isn't perfect, but care and outcomes are roughly equivalent to or slightly better than in the US and for less than 60% of the cost per capita.

Posted by A Hermit | May 2, 2007 5:57 PM

"a simple national health insurance scheme"

rofl. Why not wish for a "simple private insurance scheme" instead? What makes you think that a state insurance scheme would be simpler?

Posted by a | May 2, 2007 6:56 PM

Why not wish for a "simple private insurance scheme" instead? What makes you think that a state insurance scheme would be simpler?

Because instead of hospitals and doctors' offices having to deal with the rules and reimbursements of 10 different insurance companies, they'd only have to deal with 1 payer.

My husband works in healthcare and they have people who are dedicated solely to figuring out how to get all of the different insurance companies to cough up the money that the companies owe them on a timely basis. You need people to specialize in two or three companies because every company has not only completely different rules, but completely different computer systems for submitting claims.

And that's not even mentioning Medicare Part D, which all healthcare providers hate with a burning passion since it doubled the paperwork. If you know anyone in healthcare, ask them what happens if you accept a Medicare Part D patient on a weekend and watch them start to weep.

Posted by Mnemosyne | May 2, 2007 7:55 PM

You don't have this sort of paperwork in single payer systems. In the US system the health care providers are mostly for-profit, and so the insurance companies and the government that are paying them are deathly afraid they will get overcharged, and so they demand documentation of every detail. In addition the insurance companies are themselves for-profit, and so they try their hardest to get someone else to pay for every bit of service.

In contrast, with a single-payer system, the state just pays salaries to the health care professionals who work for it, and assigns them a bunch of patients to treat. No records are needed beyond hours and payroll, plus medical records needed for treatment. The result is that administration takes only about 10% of expenditures, as opposed to 30% in the US.

Posted by bobo the chimp | May 2, 2007 7:58 PM

Just imagine how much fun you'll have with the paperwork if you actually go to the doctor! I just got a bill, today, presumably for a visit in January, with just one line: my name, account number, a date in January, and four different dollar amounts: "Charges", "Payments", "Adjustments" and "Balance".

Do I have any way to know what is/isn't being charged, and if it is correct? No. Is there any way for me to know if the Balance they want me to pay is correct? Is there an explanation of what "Adjustments" are, and why I trust their calculation? Maybe I'll be able to cross-reference the statements from my insurer. Often not.

Feh.

Posted by biggerbox | May 2, 2007 8:55 PM

Re: Jacob says its worse in Canada. I'm not convinced.

Depends on what you are talking about. Certainly there is never an issue of losing coverage or going broke trying to pay for it, and that's very important to most of us. But there seems to be this weird illusion that public plans (including America's Medicare etc.) are simply old fashioned fee-for-service plans with no complications, no mind-numbingly-complex fee schedules, no multiple tricks-of-the-trade for cutting payments, no precerts or auths, and no managed care. This is absolutely false. Although the users of these plans rarely see it, public plans are often far more complex than private ones, it's just the providers that have to deal with the red tape. And these plans are far better at limiting what they pay out than any private insurance company. Maybe this is better, but overall it is not simpler.

Re: There is a movement afoot in hospitals to get a "DO NOT RESUSCITATE" for any seriously ill person over a certain age.

I really don't have a problem with DNRs. My father in his last years loudly and often informed everyone and anyone that under no circumstances was he ever to be put on life support as his illness (emphysema) ran down to its conclusion. That seems to me the sensible thing to do. Why buy an extra six months of misery while meanwhile others may benefit from the care more? The opposite extreme (represented by Terri Schiavo) seems to me a far greater horror.

Re: There is a new type of hospital that was created by the market for care of the acutely ill who have been in the hospital too long

There's also Hospice for the dying who need maintenance but whose conditions are hopeless. And generally I think they do a good job. Medicare, I believe, generally pays for hospice care.

Posted by JonF | May 2, 2007 9:23 PM

I run a 2 person s/w business and pay $1,000/month for the two of us plus my husband. That is for a HSA with a 5K deductable.

This is insane.

Posted by lb0313 | May 2, 2007 9:45 PM

Health care in this country is a disaster. But like so many things, Corporate interests have the deep pockets to lobby congress and fund elections to get the legislation they want. NOTHING will change until the impact of corp money is greatly reduced.

I strongly suggest supporting Clean Elections efforts in any state, even if it isn't your own.

Posted by M | May 2, 2007 10:28 PM

I work in healthcare. I lived in the UK with the NIH. The NIH ain't perfect but it does provide a bronze standard of care for everybody and if you want gold standard, you can pay out of pocket and get it. Meanwhile, in the US about 15 percent of us get gold standard care. 15 percent get zip. Pro bably another 30 get above average care and 20 get crappy care and another 20 get bronze standard care.I would take bronze for 100 percent rather than the current system. I run across at least one person a month who doesn't have any insurance and while you can blame them because some could get it if they switched jobs etc. etc. why should someone have to switch jobs to get insurance. What would help would be to absolutely force businesses to offer reasonable insurance to all their employees - whether they are part time, per-diem or full time and employees should be forced to take the damn insurance whether they want it or not(or provide proof they have it.) Why? Because its the damn insured who pay for the uninsured at the end of the day. No different than auto insurance.

Posted by jane dough | May 2, 2007 11:07 PM

That was my newspaper column this week. With the mix of letters and numerals, I feel like I'm buying a Mercedes or a Beemer, not getting health insurance.

Posted by SocraticGadfly | May 2, 2007 11:32 PM

We need to get rid of insurance as the basis of health care. The mere concept of insuring for health is absurd. Insurance companies are in the business of making money and will simply avoid paying out if they can possibly do it. A primary way for big corporations to make money is to shift their responsibilities to someone else -- whether that be polluting, consumer safety or health care.

I am self-employed. My family (myself, wife and daughter) have a policy through a group. Our premium just went up to $1,667 per month. Fortunately our group just got some other policy options -- now I can get a policy for only $1,100 a month that pays for 75% of our health care. Yippee! Prior to being a member of this group, we couldn't get insured at all -- at any price.

We need a national health care system along the lines of the VA. If you want a gold-plated plan that's better than the VA, then go ahead and buy a policy for it.

National healthcare now.

Posted by ShockedISaid | May 3, 2007 2:03 AM

Just to give you a point of comparison. I live in the UK, so my healthcare is all free from the NHS and paid for through taxes.

I'm on about £20k ($40000) and my total tax bill is somewhere about $900-1000 per month (I can't remember exactly what my council tax (property tax) bill is - so that's NHS, state pension, armed forces, trash collection, etc as wekk. The only payments I ever have to make myself are £6 for each drug prescription.

Most routine dental work and optical work aren't covered but I think my last check-up at the dentist was £20 total. The NHS covers some glasses (I think), but since I don't need glasses I don't know the details.

Think I've only had to fill out forms when I moved cities and needed to change my doctor.

Posted by Tim (UK) | May 3, 2007 4:10 AM

Well, it seems that Jane Dough and Mnemosyne have "backed up" those who see possibilities in national health care systems abroad and the red tape problems in our own system. Great posts, with facts and experiences. Still waiting to find out what is so bloody terrible about Canada. I'm shocked that no one has brought up the hip replacement story that Kevin references.
What I think is the appropriate answer to Al (to the extent that any answer is ever appropriate) is that many national health care systems rely on the professionalism of doctors. Doctors, like all humans, are imperfect, and they will sometimes request unnecessary procedures or fail to request necessary ones. But do you REALLY think you will find a doctor who will prescribe 50 MRIs?

If you don't, then what is the point of your post? No one is advocating, not here or anywhere else, a system in which we just walk in and can take all the prescriptions and surgeries we desire. Your point is not reductio ad absurdum--it's just absurd.

Posted by Jerry Mayer | May 3, 2007 8:35 AM

"I'm sorry, but they don't deny anyone healthcare in Canada? "

I was unclear. I only stated my case in words that someone willing to understand them would understand. I should have said:

"A small but non-negligible part of our healthcare spending is dedicated to denying healthcare to those who warrant it and are entitled to it by those who know that the care is warranted."

Al, are there no real arguments to be made by your side? Are you reduced to intentionally misconstruing other people's points just because it is possible? If someone tells you, "I have to go to the bathroom", do you assume that they are being dragged to a bathroom by an unseen force that they are incapable of counteracting? I suppose that must be so, otherwise they would have said, "I would be best served by urinating in the near future, therefore I shall proceed to the bathroom."

Posted by Njorl | May 3, 2007 9:41 AM

While the forms, choice of plans, etc. are all a complete headache, the biggest problem with our health care "system" (if it can be called such) is that this country sees health care as a privilege, not a right.

For some reason, though, the issue is usually framed as an economic issue rather than a moral or national security issue. I think the latter pair would get a lot more results.

Just my 2¢ ... keep the change.

Posted by Mark D | May 3, 2007 12:08 PM

JonF, $1000+ monthly health insurance premiums for a family are not at all rare. For example, my sister's family: both she and B-I-L are self-employed and have three children, sis and 2 of the children have chronic but completely manageable ailments, their monthly premium is about $1200 (more than their mortgage payment). That's for a marginal plan as well, they still have a few thousand dollars in out-of-pocket costs every year. As people go they're pretty fortunate, as their net family income is probably around $75,000. The downside is savings for college or retirement are both close to nil because they are paying $15K+ in medical expenses every year.

Bobo the chimp: There are different kinds of single-payer plans and, AFAIK, the ones where the providers are actual employees of the state (e.g.: UK's system) are the exception rather than the norm. In other countries the state provides only the insurance and most of the hospitals, doctors, nurses, etc. are private sector employees just like in the good ol' USA.

Posted by Joe Bob | May 3, 2007 2:23 PM

41 year old self-employed male, and I pay $189/month for a high-copay policy (not that high, $25 per doctor visit, more for a hospital stay). I'd much rather have the deal I have that the Canadian or British system.

Posted by cf | May 3, 2007 6:27 PM

Having moved to Canada from the States a couple of years back let me add my agreement to all the other Canadians who laugh at Levy's characterization of the situation up here. The difference between the US and Canada at a day to day level couldn't be starker: I call up my clinic, they schedule me for later in the day, I go in, see the doc, get a scrip, and leave. I never see a scrap of paper (after the initial registration with the clinic). The health personnel are always polite and professional. With the prescription benefit I get from my employer, drugs typically cost me $2.

Posted by Potato Head | May 3, 2007 7:40 PM

Re: JonF, $1000+ monthly health insurance premiums for a family are not at all rare.

For a family, yes. I was talking about a plan covering a single person. My $240 x 4 would be about $1000 after all.
By the way, the total premium of my workplce policy (not what I pay, the sum total) form myself and my partner is $760. I know this because I have to pay income tax on my partners' half of that, including on the money my employer pays for him.
By the way, my employer has an almost socialist way of setting insurance copays and out of pocket limits: The more you make the higher they are.

Posted by JonF | May 3, 2007 10:25 PM

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