What Are They For Again?
John Cole Via Eschaton:
Hell, I can’t, for the life of me, figure out what value the insurance companies add at all. Seems like all they do is skim money off the top, add layers of paperwork, and then screw people when they get a serious illness.
This is correct. More than that, most of “health insurance” isn’t really insurance at all, except for a bit of catastrophic insurance which they try to avoid paying out.
There really is no reason for them to exist.
According to the GOP, death panels are OK as long as the government doesn’t run them. Republicans will take up arms to protect private death panels.
So true, X, but have you read about the Sun Hudson case? Life support was removed from an infant (who would not be able to live) against the wishes of the mother. It was done under a law that George W. Bush signed when he was governor.
Instead of paying $300 or so a month to what is essentially a bank with the payout if tragedy strikes, if you bank it yourself and gain the interest on it, you could cash and carry much of your day to day medical bills and be much better off.
Maybe a high risk insurance policy which amounts to a loan repayment system would be better than the current system of pay until shit happens and then don’t pay anything.
Without some of them, who else would testify to the court (or arbiter) that having a baby is the reason for so much physical trauma suffered from an accident that occurred three years BEFORE the actual birth?
Brian,
$300/mo won’t pay for very much health care, especially if it involves hospitalization. I read a story about a woman who got billed $22,000 for the birth of her baby by the health insurance company. Who can afford that? That’s not even any special care! Also, $300/month is just out of range for some people. I think HSAs are just inadequate to do the job. The nice part about insurance is that it is supposed to pool the risk – if it worked like that. Right now the insurance companies cherry-pick the healthy and throw out the sick.
HSAs are great if you’re young, don’t have kids and are in excellent physical shape. Oh, and if you want to gamble on not getting into a car accident, falling off a ladder or catching swine flu.
Charlie Copeland loves his HSA. Charlie finds he gets good treatment everywhere he goes.
Brian, saving 300$ a month for health care is a great idea. That way, every time you get seriously sick, you can just buy a plane ticket to france.
What happened to the DV thread?
Someone deleted my post. Anyway, he is still let go.
Someone else deleted YOUR post? It’s getting craaaaaazy in here!
There’s nothing going on here . . . Ah, no one is going to believe me anyway.
OK, stop deleting posts! If for nothing else, it’s making me feel way too drunk on an otherwise sober day! *hick*
OK, so DV is gone and DD quit in protest.
I’m pretty confused myself.
anon, car accidents have medical insurance as part of your auto policy.
Blue Cross/Blue Shield has HSA’s, just looked them up, and their highest annual deductible is $3000. Max that out and they pay 100% of the balance. Your new mother would have paid $3000 out of pocket, saved up with monthly contributions to her HSA. $50 here, $100 there, etc. High Deductible plans would have cost roughly $100/month.
People are paying $300/month for health insurance now, talking about redirecting that to a non-insurance type of plan. A savings and repayment type thing.
What I was talking about was a medical loan type system, where you can mortgage out the payments over time and pay them back. This way all of the profit in the system is interest, and it leaves the medical decisions out of the insurance companies’ hands.
Just a thought.
Brian – and when your HSA plan drops you, what then?
What if a meteor falls from the sky and lands on your leg and it’s not covered?
I wasn’t talking HSA’s before, only replying to UI.
I’m not sure where that $300/month comes from, Brian. My employer claims to pay $1800/month plus my $200/month contribution to cover my healthy family. (My employer is the PPO, too).
You go bankrupt, the same as you would if you got cancer twice.
Meatball, your figures match up with mine, and this is the hidden cost of health insurance. People with employer coverage have no idea what health insurance really costs.
When my husband and I had individual insurance ( before kids, over 15 years ago) we paid 1,100.00 a month with a 1,500.00 deductible.
I think it’s about $8,000/yr for a family right now, moving up to $12,000/yr. I think Brian is just gambling with staying young and healthy. Yes, high deductible insurance works ok if you are healthy and don’t go to the doctor that much. It’s when you get sick, have an accident or get a chronic disease that the trouble kicks in.
Let me give you a tutorial. Without people paying for all medical costs as individuals or a government system based on tax dollars there has to be an intermediary entity which revolves around risk and solvency. Thus insurance companies.
You are correct, insurance companies are in the business of rationing care and not providing anymore than they have to, the Supreme Court has verified that fact. As more and more third party payments become the dominating fact of the day insurance companies become the good and the bad, all in one breath.
The key to reform is what we talked about with Delacare last year. We envisioned a basic plan allowing choice within that plan. The basic plan would be decided by citizen and business groups and Delaware would be in one risk pool with every insurance company bidding for our business of almost 1 million people. The insurance company which got the contract would be clerks and that is all.
The contract winner would be for 5 years and the plan would be based on BCBSDE. Overhead and admin costs would be limited and part of the contract.
http://delawarerepublican.wordpress.com/drtv/
Mike Protack
Best analogy for HC reform is allowing the gov’t to sell you water instead of the bottled water companies.
I love that, VC!
Folks, we are not dealing straight up with this problem!
The problem that none of us have solved is rationing.
For example, if a person, seriously injured and comotose, is delivered to the emergency room, what should the response be.?
Pull out all stops to stabilize the patient? Then what?
Provide extraordinary care using the latest technology? Then what?
Provide hospitalization or extended care for as long as it takes? Then what?
Decisions have to be made, and nobody, except those awful insurance companies, is willing to step up and make it as long as a family member is weeping in the waiting room.
How about if there is noone weeping?
Does it matter whether or not the patient has health insurance?
If the patient has money, no problem. What if the patient is not wealthy and without adequate insurance or no insurance at all, then what?
The idea of a death panel under certain circumstances is a requirement, simply because medical resources are limited, just like anything else!
If everyone were required by law to have an end-of-life document, this would help. Then the patient is his/her own death panel.
If a person wishes to have all extraordinary measures implemented to save his/her life, then there must be insurance coverage or independent wealth to pay the bills. If there is a cap in the policy, when the cap is reached, that’s it, the plug gets pulled, unless a family member comes up with the cash.
If there is no insurance, and/or no family member steps forward, the plug must be pulled.
Should a wealthy person get better treatment than others because they can afford to pay out-of-pocket for any procedure, or pay very high premiums for the best of coverage.
My guess is, and meatball can comment intelligently on this, the plug is pulled quietly more than any of have ever known. Who really knows what is going on behind those closed OR doors? If true, is this the solution we continue to implement? Are the docs the death panel after all?
Nevertheless, I am interested in the views of others on this dilemma that we allow to go forward unresolved. And by the way, on top of patient and family impact, there is a huge insurance impact as well, depending on how we decide to handle this in the future.
Why me Perry, ’cause I’m a chicken farmer?
Anyway, most often in cases with no chance of recovery, even when “living wills” or other advanced health care directives are clearly and legally delineated, the patient’s family makes the decision of whether or not to persue more “aggressive” care. I can honestly say that in nearly 20 years of practicing critical/intensive care medicine, I have never seen a patient taken off of “life support” at the behest of an insurance company. That doesn’t mean the insurance company reimburses the hospital for services rendered to an otherwise terminal, zero quality of life patient.
The closest thing to death panels I have witnessed are usually called ethics panels or committees and are made up usually of hospital administrators, critical care MDs, Chief of Staff, an ombudsman, and certain memebers of the public. Care is not withdrawn without specific brain death criteria being tested and rediculously, meticulously documented.
Instances when these ethics committees convene for such cases are extremely rare. The second most often decider in such cases is the patient themselves. Often, critically ill patient continue to deteriorate (duh) despite all the power and might of the “Greatest Healthcare System in the World”. These patients often become resistant to resusitatation efforts and after say an hour of family witnessed CPR even the most unrealistic of families can agree to withdrawing care to preserve at least some part of dignity and peace for the patient.
That’s enough about work though, hell, as my wife reminds me I’m on vacation. Three beers down by 1600.
So Perry, what it sounds like you’re getting at (and I admit I haven’t thought this through), is that people should get a discount on their insurance if they have a living will that states no heroic measures, or some such thing. Or, on the flip side, you pay more if you expect the doctors to do everything to keep you alive (or you haven’t stated). You can already get a discount if you’re a non-smoker, so I don’t see why it would be discriminitory since it’s a choice (as opposed to age or sex).
There has to be a reason why this is a bad idea. Anyone?
p.s “nobody” dies in the OR.
Scott, sometimes critically ill people do get better.
meatball — “Scott, sometimes critically ill people do get better.”
That’s an argument against advance directives (or at least for having it done well). I was thinking more along the financial side. The idea that if you have one that “declines extra care” so to speak, you will cost less if you end up in that state, therefore your premiums should be lower. Honestly, just a thought that popped into my head. But with a discount, it might incentivize people to do it (like defensive driving classes).
Insurance company middle men have NO value. They dont contribute a dime to health care. We don’t need them, which is why 30 civilized, industrialized nations think americans are the dumbest people on the planet. Its a hold up every day without a gun. Anyone listening to Rick Jenson, thinking he is giving them the full story on health care should have another drink. That guy is a complete and utter fool with his “canadian system is going bankrupt”, or “canadians are waiting in line for care”. This man couldnt tell the truth if his life depended on it. He is a total and complete supporter of for profit corporate everything.
With a single payer system there NO need for malpractice insurance! One of the major reasons the majority of doctors and nurses want it. With the living will, YOU decide specifically what you want for end of life care, if you have a car accident or hit with a bomb..you have decided. When all our medical records are on the electronic records system you can be anywhere and doctors/hospitals will have your living will on record. There is no death panel. Medicare doesn’t have a death panel. Medicare doesnt tell you what doctors/hospitals/labs you can go too…you decide. Thats the beauty of a government ADMINISTERED program. Medicare for all…a single payer system works well. The problem is within medicare doctors are more fearful of lawyers. Should they make a mistake they could be sued. Heart/OBGYN’s are paying millions of dollars in insurance! Thats why Physicans for National Health Care want the for profit beancounter (MBA’s) over ruling your doctor out of their treatment solutions. The MBA’s are not doctors but get a huge commission everytime they over rule you on behalf of their fat cat bosses reaping billions.
Everyone should have a living will no matter how old you are. I agree that the living will provision should be left in. Been to the Doc lately, they barely spend 20 minutes with you. If you want a clear understanding of what you want in your living will, you have to take the time to go over everything to make sure what you want is what you get. No family member, no hospital, no doctor can over rule your wishes.
Decisions have to be made, and nobody, except those awful insurance companies, is willing to step up and make it as long as a family member is weeping in the waiting room.
Why not just mandate living wills and be done with it?
Sorry, single payer is flawed.
Overhauling health-care system tops agenda at annual meeting of Canada’s doctors
By Jennifer Graham (CP) – 4 days ago
SASKATOON — The incoming president of the Canadian Medical Association says this country’s health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country – who will gather in Saskatoon on Sunday for their annual meeting – recognize that changes must be made.
“We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” Doing said in an interview with The Canadian Press.
“We know that there must be change,” she said. “We’re all running flat out, we’re all just trying to stay ahead of the immediate day-to-day demands.”
Mike Protack
“No family member, no hospital, no doctor can over rule your wishes.”
This is simply NOT true. I have seen family members over-ride living wills literally hundreds of times. My spouse and I have seen hospice patients’ family members over-ride the patient’s legal living will many, many times.
All it takes in a critical situation is one family member to say “do it” and the critically ill, dying patient is placed on a ventilator with all the life support drugs necessary to keep them alive (dead).
“With a single payer system there NO need for malpractice insurance! One of the major reasons the majority of doctors and nurses want it.”
Sure, because when doctors and nurses work for the government, there’s no such thing as malpractice, only regrettable mistakes – it’s like friendly fire.
Actually, G Rex. That’s not true. Sorry. In a single payer system, doctors and nurses do not work for the government, any more than doctors who accept Medicare work for the government. You’re thinking of a nationalized system, like Britain has. When anyone in Congress starts debating a bill like that, that’ll be a great argument. So you just hold on to that one, huh?
Actually, what is odd is the republican forces backing the insurance industry. Or, well, I suppose it is just fighting anything the dems offer up.
Brian Shields: “Why not just mandate living wills and be done with it?”
I agree, but that is not enough. What about the resources to support an individual’s living will?
My conclusion from this discussion is that end-of-life decisions are a question of individual responsibility and accountability, thus belongs to each of us with regard to our own eventual demise.
Just like filing income taxes, end-of-life wills must be mandated for every adult. The government should be responsible to make resources available to assist people in making this will. It is then the responsibility of said adult to provide the resources (insurance) to support his/her end-of-life will.
Meatball’s insight is an inside view of how nebulous the decision making process is, with family members often overriding the living will of the patient. This must stop! The patient’s wishes must always be honored.
If the resources are not there, then the plug gets pulled, unless someone steps up with the resources, but not the government, and not by default the providers.
I realize this sounds cold-hearted; but I see no other viable solution to this problem. To have others pay for the negligence of a few is not a solution, in my view. We must have the courage, the intestinal fortitude, to step up to this issue. No more sliding by with no decisions.
What about the poor? What about those without resources? That’s where the government comes in. It should be the government’s responsibility to provide basic insurance coverage for these people so that basic healthcare and emergency treatment can be administered and paid for.
What about extraordinary treatment for these people?
That’s where we will have to draw a line in the sand, unfortunately. Unless some volunteer organization is willing to step up on their behalf, the plug will have to be pulled.
Another end-of-life decision, another individual responsibility, is the issue of euthanasia, whether or not an individual has the right to legally terminate his/her life. I think there is that individual right, and I suspect it would pass Constitutional muster if ever tested. Provision should be made for practitioners to legally assist people who wish to end their own lives.
“…add layers of paperwork, and then screw people…”
So, let’s have the same people who gave us the indecipherable tax code, $2,000 toilets and a $2-billion deficit run our health care system.
Brilliant.
Ronald Reagan?