Utterly Meaningless

My problem with the uninsured is MANY of them could afford to purchase health insurance but choose to spend the money on boats, brand new cars ect. And then they want someone else to bail them out when they or a member of their family gets sick and they have to pay for it out of pocket.

And I’ll admit it is probably different in different parts of the country.

Alasandra

As one of the uninsured, I can assure you I am not spending money I could use on insurance for a boat or any other luxury. Both DH and I are self employed, and the cost for us (healthy mid-30’s) and our one child (healthy, and has only needed to see the doctor for her annual checkups) was well over $2,000 a month for CATASTROPHIC coverage. That means our deductible starts at $10,000. We cannot afford $24,000 a year, post tax money to pay for health insurance. We make too much(here in NJ) to qualify for Medicare or FamilyCare gov’t type programs.

So we fly uninsured and (I’m not too proud to say it) terrified of a major illness.

Edited to add: We drive a 2000 Windsta with 115,000 miles on it. My husband has his work vehicle, which is 4 years old. Our other car was a 1996 Windstar, but that got totaled by a deer earlier this winter. We aren’t livin’ high over here hoping if something goes wrong the gov’t will bail us out. I don’t know anyone without insurance who is.

I’d like to point out that NJR’s is the poster family for why we need to move to universal health coverage. They’re entrepreneurs, the lifeblood of the economy. Yet they have to gamble and “fly uninsured” because we’ve stupidly tied affordable coverage to employment. How many more would-be entrepreneurs are out there who won’t or can’t afford to gamble that way? How much more vibrant would our economy be if affordable coverage was available to all?

I don’t think we necessarily need universal single payer coverage, but disconnecting health insurance from employment and creating a viable market for health insurance that fills the needs of everybody is mandatory. I’d like to think the free market can do that, but the evidence is waning quickly.

Oh, and this is fine for the wiki.

I’d like to think the free market can do that, but the evidence is waning quickly.

Insurance companies’ overhead chews up 25-30% of costs. Medicare’s overhead is on the order of 1-2%. That 23-28% savings by going to single payer would be enough to cover the whole country.

If the insurance industry is to play a role, they are going to have to run a much tighter ship and accept much smaller profit margins.

Very nice.

Alasandra, I’d love to seem some statistics to back up your claims.

If, in fact, I am entitled to a boat and car, I want to know where to apply. I’ve got the part about being uninsured down.

And, Daryl, I wonder how many more families could afford to be there for their children if Mom or Dad didn’t have to keep that job in order to get the insurance that comes with it.

Nance

Yesterday’s NYT has an article on small business health insurance, or lack thereof.

Interesting. Here in CO, when I was out of work for 6 months, we had insurance. It was crappy and expensive, but it was like $538/mo for the whole family. It was some govt program for people who couldn’t qualify anywhere else.

That was in 2003, maybe it’s gotten worse since then. (checking coverc...e.aspx ) Nope – it hasn’t gotten a worse at all.

With all the griping about what needs to be fixed, how about someone give an amen to out of control lawsuits/court costs/malpractice insurance?

NJ Roadie, have you checked out eHealthInsurance.com? It is through them that I found my own coverage, as well as lower-cost plans for many other folks who had no idea they were available.

With all the griping about what needs to be fixed, how about someone give an amen to out of control lawsuits/court costs/malpractice insurance?

Sorry, no amen from this corner. The Right-Wing Noise Machine would like you to think that the high cost of medicine is due to runaway jury awards. ‘Tain’t so. Kevin Drum, who’s kind of a wonk in this area, has shown in multiple posts over the last couple of years that lawsuit abuse has almost no effect on the overall cost of medical care.

Now, one could possibly argue that it’s not the lawsuits, but the practice of defensive medicine to prevent the lawsuits. Perhaps. But single-payer would take care of that, too, as the gov’t would pick up the responsibility and the cost of malpractice insurance.

Crappy but only $538 a month? Quite a sales pitch. 🙂

Way too pricey for many of us, btw.

Nance

Thanks, Alasandra, for your lovely broad brush technique. Right wing talking points make soooooooo much sense. Don’t forget to damn welfare recipients for their Cadilacs and the fur coats we’re sure they hide in their mansions. Also, black women have babies because their government check gets bigger with each one. Gay people want to steal your children, and women are too delicate to hold real jobs.

Instead of filling out the application at ehealthinsurance.com, could you give us the ballpark price for their coverage, Suze?

And whether it is crappy 🙂 or actually useful.

Nance

This discussion reminded me of something I did comparing taxes and health insurance costs for different incomes, Canadian and American. It was on a message board months ago but I reproduced a couple of the posts on my blog if anyone is interested. I found the results a little surprising myself…

daybyd...n.html

As someone who spent 5 years subjected to the military healthcare system, I wouldn’t wish socialized medicine on *ANYONE*. Sure, it was nice not to have a premium, co-pay, cost share, or deductible. However, the quality of service was *TERRIBLE*.

At best, the providers were inexperienced; at worst, they were totally incompetent. There was no choice of doctor- I had to see whomever the Army assigned unless I wanted to pay 100% of the costs out of pocket to see a civilian doctor. Even HMO’s typically let the patient go out of network for a 50% cost share after the deductible. Long wait times were the norm, and many procedures considered routine among civilian doctors such as a 2nd trimester ultrasound were not provided.

Our healthcare system may have its share of problems, but socialized medicine is *NOT* the solution!

Oh, and medical malpractice suits against Army physicians are not permitted. Every military family we knew had a horror story that happened either to them or someone they knew personally. Mine was a misdiagnosis by some quack who thought I had breast cancer at age 23 with no family history. He couldn’t read the ultrasound so he wanted to do a surgical biopsy. I refused and paid out of pocket for a second opinion by a civilian breast oncologist. The civilian dr. could tell right away that the lump was benign and pretty much called the Army dr. an idiot.

Single payer that Daryl is talking about is not socialized medicine. The doctors are not govt employees.

I’m sorry, Crimson Wife, but I’m currently a military dependent and it must have changed since you were. It works more like a HMO for us. My son and I either get seen at the assigned clinic or we can choose from a list civilian, off-post doctors (which is a lot of them in this area). My son sees a civilian pediatrician, for instance. I’m planning to switch my PCP, which is as easy as going down to the Tricare office.

Even the military doctor I saw during my pregnancy was fantastic. His attending, not-so-much, but I never saw him. =)

And anyway, a single payer system wouldn’t be the same.

Assuming the NJ Roadie is in fact in New Jersey, part of her family’s problem is that the legislature here has created the single most expensive individual insurance market in the country by:

1. Mandating a “minimum” level of coverage companies are allowed to offer that would be considered comprehensive anywhere else (i.e., there is no such thing as “catastrophic only” coverage here);

2. Outlawing individual risk rating (i.e., insurance is guaranteed-issue, and *everybody* pays the *same* rate for the same level of coverage, regardless of age, general health, etc.)

3. Systematically reducing the state-backed loss-reimbursement pool (arguable whether this should even exist, but the fact remains that every time loss reimbursement figures change, rates go up and another insurer leaves the market).

Crimson- your experience doesn’t reflect what I’ve experienced here in Canada where we don’t have socialized medicine either…It’s single payer in Canada.

Nance said:

//Instead of filling out the application at ehealthinsurance.com, could you give us the ballpark price for their coverage, Suze?

And whether it is crappy 🙂 or actually useful.//

I would if I could, but the price quotes it spits out are based on your ages and location (zip code) and which companies sell policies in your area.

All you have to fill in for the instant quote is zip code and then DOBs (or close enough), plus check whether a smoker in last 12 months and if FT college student.

By default, it will display the top 12 results and in order of “our top picks.” There is also an “all plans” tab and a “plans with your doctor” tab, and you can rank by price, deductible, rating, or company.

(And, no, I do not have any connection whatsoever with them or with any insurance company. 🙂 )

Here’s an example:

I picked a zip code for a big Florida city and used a family of four with dad/48 and mom/43, and got 63 different plans from four carriers: Aetna, Celtic, Humana, and United Healthcare.

The cheapest non-HSA “best seller” was a major-medical from Humana, costs $299 a month, PPO type, deductible $7,500 ($15,000 total for family), 0% coinsurance. Includes an Rx benefit and covers preventive care (annual health exam, OB-GYN, mammogram, well baby are not subject to deductible). $2 million max lifetime each person.

The most expensive plan was a Celtic plan at $1,276/month, with $500 deductible ($1,500 total for family), 20% co-ins, max out-of-pocket of $2,500/$7,500, and lifetime max pay-out of $7 million each.

Take a couple of decades off mom and dad and the rates go down considerably.

Interesting to note: Not a one of the plans in the sample market in Florida covered maternity.

Note: Suze’s comment popped up as I was composing mine, so please ignore the overlap. My only connection to eHealthInsurance is the one transaction I made with them as described below.

The eHealthInsurance.com quotes are zip code specific. When you enter in your zip code and family info (just use January 1 and a year close to birth for each family member to preserve your privacy), the site spits out a list of all programs (eHealthInsurance itself does not insure anyone, just acts as an agent) available in that zip code. Out of curiosity, I put in two random NJ zip codes and a hypothetical couple in their mid thirties with one eleven year old child to see what NJ Roadie might be facing. In one zip code there was only one plan available for $1200 a month and in the other zip code there were several plans including with the lowest price being about $550. Of course, I have no idea what part of New Jersey that NJ Roadie lives in or the age of the child (not sure if that affects the price).

Having seen those prices, I feel very lucky. My family is traveling for a year, so I enrolled us (mid thirties, two kids, all healthy) for catastrophic coverage (family deductible of $6000, out of pocket limit of $9500, no Rx, no maternity, $2 million lifetime) with a lesser known company through eHealthInsurance.com back in August. Our plan (one of many available for our zip code, all with different prices) was $222 per month, but the price quickly jumped to $286 in January. COBRA for the insurance provided by my previous employer would have run well over $1000 per month if we still had a mailing address in the same state. [It was also interesting that we were asked if we had been without insurance and were warned about a gap between plans. I never investigated that much because it didn’t apply to us, but I wonder if that has an affect on the price or if the approval process becomes more involved.]

Daryl’s comments about entrepreneurs sound exactly like what went through my mind back in August. When I saw the price of HMO coverage for my family, I realized that if we ever wanted to start a business, it would most likely happen while one of us was employed with benefits elsewhere. The way things are now, only healthy families that are willing to gamble or those that are already wealthy and can cover their medical expenses get to play the entrepreneurial game. Then again, maybe that’s the idea – it sure eliminates a lot of potential competitors. So much for equal opportunity. Portability is another issue. When we designated my parents address as our mailing address after leaving my job and our apartment, it was my understanding that even if we were interested, COBRA would not have worked out for us because the insurance was tied to the state my ex-employer was in.

I wonder how many potential entrepreneurs just toss the idea and remain trapped as employees when they see the cost of health insurance. Maybe there’s a study out there somewhere, if there isn’t there should be. We might be suppressing all sorts of creativity with our current system, that vibrancy Daryl mentions. And all of this researching potential insurance plans, negotiating contracts, paper work, waiting on the phone, etc. has to be diminishing productivity in the US for both business and individuals (not to mention health care providers). Not all of that will go away with universal coverage, but it would have to help, wouldn’t it?

I switched from BCBS to Tricare in the middle of my last pregnancy when Hubby got put on active duty (National Guard). BCBS is 100 times better/easier. The system may be broken, but a government provider is not the answer.

robertogreco said:
//It was also interesting that we were asked if we had been without insurance and were warned about a gap between plans. I never investigated that much because it didn’t apply to us, but I wonder if that has an affect on the price or if the approval process becomes more involved.//

I think that is just about making sure (1) that people know not to cancel any existing policies until after confirmation of an actual start date of an actual, confirmed policy, and (2) that they understand that they don’t have coverage under the new plan until that start date.

There are so few providers in Jersey that ALL available plan options fit on three pages total. Take a gander:

Basic & Essential (the plan I tracked through the regulatory process and put all my hopes on back when we were insurance-less in Jersey, only to find the family minimum was still going to be nearly $700 a month): state....be.pdf

Standard: state....sp.pdf

Dawn, your post with the tax comparisons was great. I was thinking of doing something like that for the Thinking Parents thing. I’d done a little comparison work myself several years ago, but it was essentially comparing what we paid in taxes as opposed to what I used to pay for group insurance when I was in the states. Let’s just say that even now, when my income is considerably more than it used to be (and thus pay more in $$), what I pay in taxes still doesn’t come any where close to what I would have paid in insurance ALONE, not to mention I’d still be paying taxes on top of that.

Oh, and I’ve always felt I and my family (extended family included) have received excellent health care services here in Canada.

Lisa- my DH was in the Army from ’99 to ’03 so it wasn’t all that long ago. We were required to use the Military Treatment Facility because we lived within a certain number of miles of it. We were only permitted to see a civilian provider if *THEY* referred us out to one. Perhaps different branches have different rules on that or maybe things have changed for the better in the past 5 years…

Crimson Wife, from what I’ve read on Mothering.com that’s exactly how it still is in all branches. If you are on Tricare Prime, you must get a referral from your MTF before you can see a provider from outside that MTF.

I’m on Prime Remote, and they *still* haven’t paid for the birth of my baby who was born the first week of November 2007. They admit they should (finally), but keep coming up with reasons they can’t. At first, they said they couldn’t accept my referral (to the midwife who I’d been seeing before my husband was activated) because they couldn’t prove I’d been seeing her. They wanted me to change providers the day K- was born!

Suze posted:

Here’s an example:

I picked a zip code for a big Florida city and used a family of four with dad/48 and mom/43, and got 63 different plans from four carriers: Aetna, Celtic, Humana, and United Healthcare.

The cheapest non-HSA “best seller” was a major-medical from Humana, costs $299 a month, PPO type, deductible $7,500 ($15,000 total for family), 0% coinsurance. Includes an Rx benefit and covers preventive care (annual health exam, OB-GYN, mammogram, well baby are not subject to deductible). $2 million max lifetime each person.
***************

Thanks for the examples, Suze.

But what we have here in this example is basically catastrophic coverage.

DH and I are a bit older so for over $300 a month I could have an annual health exam and catastrophic coverage, starting after we pay $15000. Which we don’t have.

How is that better than nothing? Really. If I had $300 every month to set aside for healthcare, I’d be better off doing that.

Except in the case of a catastrophe.

So is that all we expect from health insurance coverage now?

I know that’s all I expect from homeowners’ insurance. I know it’s a total waste unless something truly awful happens to the house. Like another 2-year stretch of hurricanes.

But I am required to have this overpriced and useless insurance because I have a mortgage.

I am not required to have the same sort of health insurance.

If Congress can ever manage to chew gum and walk at the same time and pass something like universal healthcare coverage, is this the best we can expect?

Nance

As a family member of a retired soldier, I use Tricare (standard). I haven’t had any major problems with payments or referrals, and about the only irritant was the disapproval of an MRI for my knee. Tricare would approve only an Xray. Other than that, I haven’t had any problems with the service provided, but there haven’t been any significant problems other than the need for a sleep study.

My mother is still covered by the survivor benefits from my dad’s military retirement and has Tricare for Life as she’s of Medicare age. She, too, hasn’t had any problems having her multiple health issues treated (she’s 85).

I can’t say much about whether I liked or disliked military health care because it’s just about the only health care I’ve had all my life. I will say that some of the doctors could have been less abrasive — no apparent worries about customer satisfaction — but the care was adequate and appropriate. There was that stint in England when I was a small child where the British health care system paid for glasses for me, and an appendix episode which didn’t materialize into anything, but other than that I’m pretty sure it’s been military just about all the way.

My (adult) kids, on the other hand, have to jump through all the usual civilian health care hoops, balancing this against that, and trying to find care they can afford.

If Congress can ever manage to chew gum and walk at the same time and pass something like universal healthcare coverage, is this the best we can expect?

Nance,

We already have single-payer in this country. You just have to be 65 to get it. The goal would be to extend Medicare for all. Studies show that seniors are far more satisfied with their health insurance coverage than the rest of the population.

Ah, but how about asking the providers of Medicare health care whether they’re satisfied?

ama-as...3.html

Anecdotally, for the seniors I know, the only thing that makes Medicare tenable is supplemental coverage by private providers.

The AMA has called for universal coverage similar to Hillary’s and Obama’s plans. The problem with that is that there is no reduction in overhead costs. Such a plan would be a huge boon to the insurance industry– a boon we cannot as a society afford.

If the doctors find that they cannot make a decent living on the Medicare schedule, they’ll exit the market. Until that happens, I view the AMA’s complaints as just another form of lobbying.

And I have absolutely no problem with the industry offering supplemental policies. It’s no different than the Canadians coming to the US for unapproved services.

Medicare doesn’t have to cover every possible medical procedure to be a vast improvement over 50 million uninsured.

Could the Medicare model could still be single-provider but with say, three tiers of different costs instead of just one basic plan that has to supplemented from private provider options?

This is not my policy field AT ALL so I only have questions, no answers. But my personal family coverage ironically has always been while working for government, which would negotiate our group coverage through private insurance companies. . . does that relate at all to how this would work in the Dem plans?

Man, I wish my blog got this many hits.

Ahh well, I just wanted to tell Dawn that I’d like to be directed to where I sign up for my boat and fancy car, cuz I sure as hell don’t see those things in my drive-way right now.

toni