More than any demographic group, American 50 and over are skeptical of health care reform. While those aged 18-49 are equally likely to believe that health care reform will improve or worsen their own medical care, according to a recent Gallup poll those 50-64 are more likely to believe it will worsen their care, 37% to 26%, with the margin even wider (39% to 20%) among those 65 and older.
As health wonks will tell you, there's a certain irony to this. The benefits of comprehensive health care reform are arguably greatest for those between the ages of 50 and 64, who are not yet eligible for Medicare. "I cannot imagine a more vulnerable group of people," Sara Rosenbaum of George Washington University tells me, "who stand to gain more from health reform than almost anybody." If not covered by their employers, people in their 50s and early 60s have to brave the individual market, with its higher costs and limited access, especially for older people with higher medical costs. "If they can get insurance at all, and they may be in a situation where no insurer will sell to them in the individual markets, the price will be absolutely exorbitant," Rosenbaum explains. The health insurance exchange and subsidies included in the tri-committee House bill and most other Congressional proposals would greatly reduce costs for this group. "Those folks are the sob stories of health care. The 61 year-old self-employed worker who can’t get health insurance because of a prior condition, or who is priced out of the market," David Cutler, a Harvard economist and former health care advisor to the Obama campaign, says. "Premiums for those folks ought to fall a lot, they will get more choice in care, and the coverage will be a lot better. This group is one of the single biggest winners."
Why do people who stand to gain so much from health reform opposed it so vehemently? John Rother, the Executive Vice President of Policy and Strategy for the AARP, notes that seniors are already more skeptical of Obama personally than the general public, which may translate into less support for his programs--an argument supported by the Gallup data. But he also emphasizes that seniors, like most of the public, are still unclear on what health reform will specifically entail, and that the media and politicians are not generally helping. "I think for most people this is still early in the debate, and they don’t really understand what’s being proposed, and what they do hear is being, in my view, wildly distorted," he theorizes.
The situation for Medicare beneficiaries is more complicated. Medicare cost-controls are a key element of most health reform proposals, which makes opposition by those 65 and older more understandable. Still, it is doubtful that reform would affect their coverage substantially. "They’re being scared with rhetoric that Medicare is being cut or that it’s going to be a smaller or slimmer program coming out of health reform," says Joseph Baker, president of the Medicare Rights Center. But, as Baker explains, these fears are misplaced. "The cost savings associated with Medicare are cost-savings that make the program more sustainable, that attempt to improve quality in the program at the same time that they lower costs," he argues. Rosenbaum agrees. "The irony here is that all of these changes have been taken to stabilize the program going forward, to make sure that the trust fund remains viable, and instead of people understanding that the changes were made in order to keep the program viable, it has been portrayed as slashing and burning of the Medicare program," she laments. Cutler acknowledges that there will be some reductions in Medicare payments, but argues that these will generally not be noticeable to beneficiaries. "If one wanted to tell the apocalyptic story, you’d talk about access problems that might result, but no one believes those at the levels we are talking about," he explains.
Both Baker and Rother are emphasizing the benefits of health reform to the seniors they represent. Baker focuses on the tangible benefits for Medicare recipients in the Congressional proposals, like increased funding for low-income Medicare recipients and the closing of the "donut hole" in Medicare Part D wherein the program does not pay for seniors' prescriptions. Rother is focused on reassuring AARP members that they will not lose coverage, but believes that Obama needs to focus more on what voters stand to gain from health reform. "I don’t think people understand yet just how much money they would save compared to being in the individual market today," he says. "We’re talking $4,000 to $5,000 a year in savings for some people. Once we get to a point where we can be specific about that, that’ll help people come around."
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COMMENTS (26)
Might have something to do with fact that your analysis ignores the perceived cost. If you subscribe to the theory that there is no free lunch, the savings of $4,000 to $5,000 a year has to be paid by someone. Taking money out of my left pocket and putting in my right pocket doesn't make me a winner, especially if the party handling the transfer is a government bureaucrat.
Might have something to do with fact that your analysis ignores the perceived cost. If you subscribe to the theory that there is no free lunch, the savings of $4,000 to $5,000 a year has to be paid by someone. Taking money out of my left pocket and putting in my right pocket doesn't make me a winner, especially if the party handling the transfer is a government bureaucrat.
What is a "perceived cost"?
What is a "perceived cost"?
Irony,
Hello again. A perceived cost is one which consumers believe that they will have to pay for. I think a lot of people in the 50 to 64 age group "perceive" they are going to get taxed to pay for health care reform.
Irony,
Hello again. A perceived cost is one which consumers believe that they will have to pay for. I think a lot of people in the 50 to 64 age group "perceive" they are going to get taxed to pay for health care reform.
dtohmatsu has it right. The oldies are afraid they will lose access to care they value or it will cost them more. The pre-oldies are afraid they will pay more in taxes than they will receive in benefits. Are at least some of these fears overblown? Perhaps. But these perceptions--with apologies to ironyroad--are there, and they have been aggravated by what they have heard from the administration and the congressional leadership. What they think they hear is 1) emphasis on providing, or reducing the burden of, coverage for "others", and 2) a determination to have a single payor system. Reducing "their" costs appears to them to be at best ... view full comment
dtohmatsu has it right. The oldies are afraid they will lose access to care they value or it will cost them more. The pre-oldies are afraid they will pay more in taxes than they will receive in benefits. Are at least some of these fears overblown? Perhaps. But these perceptions--with apologies to ironyroad--are there, and they have been aggravated by what they have heard from the administration and the congressional leadership. What they think they hear is 1) emphasis on providing, or reducing the burden of, coverage for "others", and 2) a determination to have a single payor system. Reducing "their" costs appears to them to be at best a secondary objective, and maintaining a structure to which they are accustomed, and with which they are comfortable, seems at best a fallback. Is this perception selfish? Perhaps. Is it shortsighted? Perhaps. But it's there, and it has been animated by the actions of Democrats, not Republicans. Again, it's a matter of perceptions. They have no illusions about Republicans; they just see them as the brake to the Democrats' accelerator.
As it happens, I agree with your take, lsernoff', by and large, if not with the conclusions. But it seems to me you also buttress my own point that we are in a war of perceptions here, as opposed to real experiential knowledge.
My sense of it is that there has been much talk about (1) but very little about (2). Or, to put it more accurately, people have heard plenty about the desirability of spreading both risk and coverage around, but the main story about the single-payor system is that it is one option, with extensive experience in other advanced nations, but is not being considered as a central proposal here in the U.S. at this point.
The question is, again, why do they -- as yo ... view full comment
As it happens, I agree with your take, lsernoff', by and large, if not with the conclusions. But it seems to me you also buttress my own point that we are in a war of perceptions here, as opposed to real experiential knowledge.
My sense of it is that there has been much talk about (1) but very little about (2). Or, to put it more accurately, people have heard plenty about the desirability of spreading both risk and coverage around, but the main story about the single-payor system is that it is one option, with extensive experience in other advanced nations, but is not being considered as a central proposal here in the U.S. at this point.
The question is, again, why do they -- as you express it yourself -- "think that they are hearing" the oppposite, or at least a highly skewed version of that?
The problem is that the architects of the current reform bill are for the most part all proponents of a single- payor system. Americans by and large are skeptical of big government, and thus they don't trust the motives, explanations, or purported outcomes that are being offered by the reform backers.
The problem is that the architects of the current reform bill are for the most part all proponents of a single- payor system. Americans by and large are skeptical of big government, and thus they don't trust the motives, explanations, or purported outcomes that are being offered by the reform backers.
I worked as a social worker in Manhattan's Jewish Home and Hospital for the elderly for two years many moons ago and adored it.
Developmentally, it is perfectly normal for this demographic to disdain change - to the point where it would be abnormal for them not to. Opposing change is a pretty handy way to feel some control at a vulnerable time, I can empathize and do. Pointing out developmental norms is not condescending - not doing so it. In general, teens can be impulsive, seniors become more religious and hate change - et cetera.
They also consistently receive the best and most expensive care of any demographic in the US - spending much more than they ever pu ... view full comment
I worked as a social worker in Manhattan's Jewish Home and Hospital for the elderly for two years many moons ago and adored it.
Developmentally, it is perfectly normal for this demographic to disdain change - to the point where it would be abnormal for them not to. Opposing change is a pretty handy way to feel some control at a vulnerable time, I can empathize and do. Pointing out developmental norms is not condescending - not doing so it. In general, teens can be impulsive, seniors become more religious and hate change - et cetera.
They also consistently receive the best and most expensive care of any demographic in the US - spending much more than they ever put in to the system, which is fine. But in the richest nation in the world , where we have 50 million without coverage and the seventh largest infant mortality rate in the world, we need to do something that creates parity of care and efficiency in coverage - not take away from *any* demographic.
The glories of the marketplace have given us the most wasteful, harmful, inefficient mess in the Western world and any romanticizing of what it supposedly can do to get us out of this is delusional.
They may be all secret proponents -- I doubt it, to be honest, but I guess there's a a lot of willingness to approve of it in the abstract -- but nobody is PROPOSING it. There is some requirement to deal with reality, if you're engaged in political debate.
Americans are skeptical of government but they also keep wanting government to intervene to fix stuff. And that's ok. Some stuff can't be done by private enterprise, no matter how much "the market" is being invoked like a minor deity.
They may be all secret proponents -- I doubt it, to be honest, but I guess there's a a lot of willingness to approve of it in the abstract -- but nobody is PROPOSING it. There is some requirement to deal with reality, if you're engaged in political debate.
Americans are skeptical of government but they also keep wanting government to intervene to fix stuff. And that's ok. Some stuff can't be done by private enterprise, no matter how much "the market" is being invoked like a minor deity.
Why don't you really look at the facts then dtoh?
If you so distrust "motives" and other emotionally based criteria for judging such a complicated issue, then by all means research facts - check out and actually read reports from the CBO, read health care policy blogs you trust, talk to real players on both sides, demand facts not hysteria from the party you seem to trust (how did you feel about Medicare D under Bush, BTW? 500 billion and counting for that gem).
How would a system develop here in the US in its own unique way? What would you like to see? What works? What doesn't? DO you think health care inflation is sustainable? Do you think capping insurance rate ... view full comment
Why don't you really look at the facts then dtoh?
If you so distrust "motives" and other emotionally based criteria for judging such a complicated issue, then by all means research facts - check out and actually read reports from the CBO, read health care policy blogs you trust, talk to real players on both sides, demand facts not hysteria from the party you seem to trust (how did you feel about Medicare D under Bush, BTW? 500 billion and counting for that gem).
How would a system develop here in the US in its own unique way? What would you like to see? What works? What doesn't? DO you think health care inflation is sustainable? Do you think capping insurance rates has ever lowered premiums? Do you think health insurance companies are well run? What do you think of the Kaiser model compared to to other states? Which states have systems that you think work well - meaning covering as many people as possible as well as possible? WHat role does the individual have in taking care of their own health? What do you think of preventative care - which is almost never covered by insurance? Should obese people be charged more?
Take responsibility for learning actual data. This is extremely difficult material and no one will be spoon fed anything but emotionality. Anyone folding their arms and expecting to be entertained, cajoled, given three bullet points to explain everything, is refusing to take personal responsibility.
Seeing a bunch of senior citizen rail against "government healthcare" is the best part of this farce. Let's face facts: seniors are selfish and easily scared. The rest of this is just conversation.
Seeing a bunch of senior citizen rail against "government healthcare" is the best part of this farce. Let's face facts: seniors are selfish and easily scared. The rest of this is just conversation.
Wandre,
My post was merely to comment on why we are seeing such a strong backlash from seniors and other groups.
As to my own views, I've posted them before, but I believe we have two major problems in the U.S..
1) The first is lack of insurance coverage, it's a big problem but not as big as it is made out to be.
2) As a society, we are over-allocating resources to heath care. (I.e we are consuming too much health care and as a result we as a society are spending more than we should.)
I do not believe.
1) That we have poor quality health care in the U.S. I think it is superior to virtually every other country especially those that have single payor systems.
2) That there is any significant number ... view full comment
Wandre,
My post was merely to comment on why we are seeing such a strong backlash from seniors and other groups.
As to my own views, I've posted them before, but I believe we have two major problems in the U.S..
1) The first is lack of insurance coverage, it's a big problem but not as big as it is made out to be.
2) As a society, we are over-allocating resources to heath care. (I.e we are consuming too much health care and as a result we as a society are spending more than we should.)
I do not believe.
1) That we have poor quality health care in the U.S. I think it is superior to virtually every other country especially those that have single payor systems.
2) That there is any significant number of people who are not getting the health care they need in the U.S.
3) That there is a significant disparity in the quality of care for those who are insured and those who are not insured.
I would solve the problem by
1) Require everyone to have a basic plan the benefits of which are defined by the government but which include a high annual deductible and a required annual examination.
2) Require all insurance companies to offer the basic plan to anyone who wants it no questions asked with the premium determined only by age, gender, area of residence.
3) Allow insurance companies to sell additional insurance on any terms they want but only to individuals who have already bought the basic plan.
5) Provide aid to lower income families by having the government subsidize some of the medical costs below the deductible limit of the basic plan.
6) Continue to pay for the poor and elderly with Medicaid and Medicare.
From a policy point of view, I think there are some other things that should be done but are not politically feasible such as eliminating the tax deductibility of employer provided plans that do not have a high deductible, enacting better tort reform, etc.
I also think also think we could improve the health of the country by spending some more money on public health programs but this is a separate subject.
And BTW. Trust me. I have studied this stuff in depth for well over 30 years.
30 years, eh, dtoh? In that case why does your solution/proposition #1 ("a required annual examination") contradicted by your solution/proposition #2 ("no questions asked")? I mean, that's enough time to iron out the wrinkles, ne'est-ce pas?
As for the rest of your assertions, either the evidence is against them or they are non-arguments, e.g. the famous one about the quality of medical treatment in the U.S., which nobody is denying (didn't we go through this already a week or so ago?)
30 years, eh, dtoh? In that case why does your solution/proposition #1 ("a required annual examination") contradicted by your solution/proposition #2 ("no questions asked")? I mean, that's enough time to iron out the wrinkles, ne'est-ce pas?
As for the rest of your assertions, either the evidence is against them or they are non-arguments, e.g. the famous one about the quality of medical treatment in the U.S., which nobody is denying (didn't we go through this already a week or so ago?)
Oh, I've just noticed, in the rush I forgot to edit the other part of the sentence: "is your solution/proposition #1 . . . ?" not "does your . . . . ?" Apologies.
Oh, I've just noticed, in the rush I forgot to edit the other part of the sentence: "is your solution/proposition #1 . . . ?" not "does your . . . . ?" Apologies.
Assume for the sake of discussion the Administration and the Congress discover there is insufficient support for "comprehensive_ healthcare reform, however structured; presumably because a majority oppose, rightly or wrongly, tinkering with the coverages they have now and/or the taxes they pay now. Are there no meaningful improvements the public would support?
Start with Medicaid. Is there nothing more we can do to encourage, educate, help those who are eligible but not enrolled to enroll? Can we do nothing more to encourage the development and staffing of "urgi-care" clinics to deliver more care to Medicaid enrollees in environments other than emergency rooms ... view full comment
Assume for the sake of discussion the Administration and the Congress discover there is insufficient support for "comprehensive_ healthcare reform, however structured; presumably because a majority oppose, rightly or wrongly, tinkering with the coverages they have now and/or the taxes they pay now. Are there no meaningful improvements the public would support?
Start with Medicaid. Is there nothing more we can do to encourage, educate, help those who are eligible but not enrolled to enroll? Can we do nothing more to encourage the development and staffing of "urgi-care" clinics to deliver more care to Medicaid enrollees in environments other than emergency rooms?
Second, what about the people who have lost coverage due to loss of employment? What can or should we do to enhance COBRA? What can or should we do to make sure that these people don't lose their chance for new employment because of prior conditions or lose their coverage for such conditions under the new employer's benefit plan (particularly where the same insurer that covers the new employer covered the former one).
Third, why can't millions of self employed people, and the small numbers of people they each may employ be more effectively organized into large pools that qualify for attractive group rates and terms of coverage. If they can, why hasn't it happened? What are the impediments?
Fourth, can we develop something approximating a consensus estimate for the costs of health care delivered to free riders. The public ought to know what percentage of their premiums reflect the cost of treating others who CHOOSE to pay no insurer's premiums and no provider's bills. Want to get some steam behind mandates? Serve up the hard facts.
Somebody please educate me on these coverage questions. Then we can move on to other cost issues.
Irony,
The physical would not be a requirement for enrolling in the basic insurance plan. It would be a required benefit of the plan. For other stuff you would have to be over the deductible before the insurance pays, but the physical gets paid for no matter what. This helps to insure that everyone is getting good preventative care.
As for the quality of care, the only arguments ever cited for poor quality in the U.S. are infant mortality and life expectancy at birth. I think it had been shown that these are fully explained by factors (traffic fatalities, etc.) that have nothing to do with birth. The available data that do have a relationship with the quality of health care (i.e. survival rate ... view full comment
Irony,
The physical would not be a requirement for enrolling in the basic insurance plan. It would be a required benefit of the plan. For other stuff you would have to be over the deductible before the insurance pays, but the physical gets paid for no matter what. This helps to insure that everyone is getting good preventative care.
As for the quality of care, the only arguments ever cited for poor quality in the U.S. are infant mortality and life expectancy at birth. I think it had been shown that these are fully explained by factors (traffic fatalities, etc.) that have nothing to do with birth. The available data that do have a relationship with the quality of health care (i.e. survival rates for cancer, stroke, etc) all show that the U.S. provides better health care.
I did not approach this with the view of finding data to support my political or policy prejudices. Rather my views were formed after looking at a lot of data and thinking about various policies options.
Would be happy to discuss this further in a civil manner.
Isernoff,
Just a couple of comments on Medicaid.
1) If you are on Medicaid you don't have to go to an emergency room to get care. It pays for regular visits to doctors, clinics, etc.
2) There are three main reasons people do not enroll in Medicaid. First, if they aren't sick or don't have a medical problem there is no reason to so. You can easily enroll after you get sick. Second, most hospitals are non-profit community or city hospitals. If you go to one of these you usually get treatment even if you don't pay for it. If it is expensive treatment, the hospital you usually get you enrolled so they can get reimbursed. If not, the hospitals don't bother. Third in some states, there are state prog ... view full comment
Isernoff,
Just a couple of comments on Medicaid.
1) If you are on Medicaid you don't have to go to an emergency room to get care. It pays for regular visits to doctors, clinics, etc.
2) There are three main reasons people do not enroll in Medicaid. First, if they aren't sick or don't have a medical problem there is no reason to so. You can easily enroll after you get sick. Second, most hospitals are non-profit community or city hospitals. If you go to one of these you usually get treatment even if you don't pay for it. If it is expensive treatment, the hospital you usually get you enrolled so they can get reimbursed. If not, the hospitals don't bother. Third in some states, there are state programs to reimburse hospitals for treatment to non-insured poor/low income patients. In some cases the reimbursement rates are more favorable than Medicaid so the hospital will not push Medicaid enrollment.
If you are below the poverty line and qualify for Medicaid you actually get pretty good treatment in the U.S.
I didn't think I wasn't being civil, dtoh, but I apologize if I went too sharp in my remark. A certain amount of rough-and-tumble is expected on TNR, however, and most regulars know where the parameters are. But I have to say that I remain confused about the original contradiction and your explanation/resoluton of same. If your annual examination is required not only as preventative care but as a qualification to remain in the basic plan, how is that "no questions asked." I mean, I'm not saying that you can't have a plan with a required examination but the requirement has usually some other aspect than pure altruism.
Unless what you are saying is that e ... view full comment
I didn't think I wasn't being civil, dtoh, but I apologize if I went too sharp in my remark. A certain amount of rough-and-tumble is expected on TNR, however, and most regulars know where the parameters are. But I have to say that I remain confused about the original contradiction and your explanation/resoluton of same. If your annual examination is required not only as preventative care but as a qualification to remain in the basic plan, how is that "no questions asked." I mean, I'm not saying that you can't have a plan with a required examination but the requirement has usually some other aspect than pure altruism.
Unless what you are saying is that everyone will be entered into the plan without question, but once inside it they will have to have the examination but without danger of expulsion, then that can be stated fairly simply. And it's not a bad idea at all. Indeed, my next question is, why would a good idea like that be damaged by any particular model of reimbursement? I find the obsession with demonizing single-payor systems very strange. It's not the only option, but why treat it as something crazy when several advanced countries on a par with the U.S. have gone with that model?
Again, however, I find it quite irritating that this canard about the quality of care in the U.S. keeps resurfacing. And -- I hope I'm not being uncivil -- you are the main poster bringing it up again and again even when others have effectively countered your argument. So, once more with feeling: nobody is claiming that the quality of treatment in the U.S. is bad or defective. The claim -- borne out by the evidence -- is that the mix of for-profit insurance models, lack of universal coverage, employment-based coverage, discrimination against non-employment enrollment, and cost expansion, means that people can be denied care (even in life-threatening situations), the risk pool is artificially skewed, and there is no motivation to control costs because such costs are, somewhere, somebody's profit.
To put it very simply:
If one peson gets great treatment for a medical condition, and someone else is kicked off their insurance company's rolls when they report that same medical condition, the quality of care for that condition cannot be evaluted on the first individual's experience only. One has to consider the absence of care for the second person. That is the basic problem of the American health care system that the administration is trying to solve.
Irony,
So what I am proposing is that the annual physical be a legally mandated benefit for the basic plan and it can not be used to refuse insurance. Everyone would be required to enroll in a basic plan and every insurer would be legally required to offer one.
To elaborate a little further, you require the basic plans to have high deductibles because this helps to restrain the rise in medical costs. It's not perfect but it helps and maybe it helps a lot.
My objection to single payor is twofold. First it requires the payor to set pricing which in effect puts the government in the role of allocating medical resources. I don't think the government is very good at this because it's very complicate ... view full comment
Irony,
So what I am proposing is that the annual physical be a legally mandated benefit for the basic plan and it can not be used to refuse insurance. Everyone would be required to enroll in a basic plan and every insurer would be legally required to offer one.
To elaborate a little further, you require the basic plans to have high deductibles because this helps to restrain the rise in medical costs. It's not perfect but it helps and maybe it helps a lot.
My objection to single payor is twofold. First it requires the payor to set pricing which in effect puts the government in the role of allocating medical resources. I don't think the government is very good at this because it's very complicated. I had a summer job in high school writing Medicare reimbursement software for a hospital... the list of ailments when printed out is a foot high and includes everything from tarantula bites to spacecraft accidents. This list of treatments is equally long. This pricing problem is very hard and complex no matter how good the commissions and bureaucrats. It gets a lot harder and a lot worse though because politics come in to play and you have to give the seniors everything they want, and you have to accommodate the pharmas on the deal they cut with the President, and you have some senator who gets contributions from the nurses' trade organization, etc., etc. I think the market does a better job of pricing and allocating the resources... not perfect but better.
My second objection to the single payor system is empirical. Having lived in two countries (UK and Japan) that have single payor systems, I have to say they don't work too well. In fact they are disastrous. Even in Canada, where they are reported to have a good system, there are waits for treatment, i.e. rationing. I also think that you can get some short term cost benefits from single payor systems by cutting reimbursement, but that the ill effects of these policies don't show up for a long time because the supply of hospital, doctors and other medical provides is pretty inelastic over the short term. What looks good at first is not sustainable.
It sounds like we are in agreement that medical care is pretty good in the U.S. I also agree with you that we have a problem with the way insurance is structured and the ill effects it has on coverage and costs. That being said, however, I do think there are much more effective ways to deal with the problem than the current proposals being considered. I also don't think there is a serious problem with people being denied treatment.... they do get denied insurance but rarely are they denied treatment for life or limb threatening conditions.
Be interested to hear your further thoughts.
dtoh - thank you for your response.
Although, I didn't see many of my questions answered directly. After 30 years, I honestly think you'd have good answers. Again - do you think health insurance inflation is sustainable or tied to outcomes in any way? Have you ever seen any proof that caps on damages lower health insurance premiums (check out New Jersey and Texas on that and let me know if you've seen anything else anywhere)? What are your thoughts on the Kaiser model (which I think is terrific)? Is there a state whose system works in a way you prefer?
Also, as a social worker, I would dearly love to see how this suggestion of yours would work and who would decid ... view full comment
dtoh - thank you for your response.
Although, I didn't see many of my questions answered directly. After 30 years, I honestly think you'd have good answers. Again - do you think health insurance inflation is sustainable or tied to outcomes in any way? Have you ever seen any proof that caps on damages lower health insurance premiums (check out New Jersey and Texas on that and let me know if you've seen anything else anywhere)? What are your thoughts on the Kaiser model (which I think is terrific)? Is there a state whose system works in a way you prefer?
Also, as a social worker, I would dearly love to see how this suggestion of yours would work and who would decide who gets the goodies included in that word "some" you use and why the rest of us middle class saps get left out:
"5) Provide aid to lower income families by having the government subsidize some of the medical costs below the deductible limit of the basic plan."
Also, would you mind please backing up these statements with the facts you used to decide your position? BTW - I really am asking this respectfully:
"2) That there is any significant number of people who are not getting the health care they need in the U.S.
3) That there is a significant disparity in the quality of care for those who are insured and those who are not insured."
ALso, as Irony says - this isn't about theorectically having good medical care, which Murdoch and US Senators technically do. This is about the fact that the only people who have access to it are people with lots of money - as in cash. My doctor doesn't even take insurance anymore and she only accepts wealthy old people as patients. She only sees me because I've known her for 20 years. This is happening all over New York City.
I think we've all read at least some of the thousands and thousands of stories of people who pay a fortune for health care insurance (which I hate to even legitimize by calling it that, to me it's a racket that in no way resembles a legitimate business) and who are denied reimbursement for almost everything. Let's not even go in to families trying to get coverage for pre-existing conditions after losing their jobs.
Has that ever happened to you? Have you ever been told by a bureaucrat that you can't have care for a sick child? It doesn't sound like it, but maybe it has happened to you. WHat did you do if so?
What are you thoughts on the doubling of medically based bankrupcies every year?
My own personal experiences of the British and German systems is that they are very good, and the German system is a regulated insurance model rather than single payor. I had no complaints with the British system, however, but that was back in the late 70s and I was never in hospital under it. My experience of the German system was very positive.
I agree that wait time is a resource allocation, but (a) every system needs such allocation, and (b) in most cases a wait time is not a problem -- I don't believe that in the UK or France or wherever real emergency cases are fobbed off by insurance companies, as they are here, or treated and then hit with crippling bills afterward.
I'm gla ... view full comment
My own personal experiences of the British and German systems is that they are very good, and the German system is a regulated insurance model rather than single payor. I had no complaints with the British system, however, but that was back in the late 70s and I was never in hospital under it. My experience of the German system was very positive.
I agree that wait time is a resource allocation, but (a) every system needs such allocation, and (b) in most cases a wait time is not a problem -- I don't believe that in the UK or France or wherever real emergency cases are fobbed off by insurance companies, as they are here, or treated and then hit with crippling bills afterward.
I'm glad also that we agree that medical care is pretty good in the U.S. But I have to reiterate that nobody has ever said otherwise, and it's a complete straw man to persist in bringing it up as if it were a controversial question. The problem the administration is trying to deal with is a complex of access, cost explosion, and economic dysfunctionality. When people mention the infant mortality rate (whether or not it's a legitimate measure) they don't mean that American doctors don't know how to save infants' lives, and it's nothing short of disingenuous to keep implying the opposite.
I'd also be interested in your thoughts on the observation in my last para in the previous post.
Sarah Palin: "Obama Wants to Kill My Baby!"
Sarah Palin: "Obama Wants to Kill My Baby!"
Thanks dtohmatsu for the information on Medicaid. Thanks also to you, ironyroad and others for a most interesting thread.
I was struck by wandreycer1's note that her Manhattan physician no longer accepts insurance. Have heard the same from my daughter, son-in-law and sister-in-law in Manhattan (whose Ob/Gyn delivered her last baby early in the Reagan administration, but wants cash only--lots-- for current gynocological exams). Down here in "God's Waiting Room" we haven't seen that, but more and more Internists are setting up boutique practices. Glad to accept Medicare and the high option supplements from the alte cockers. But practice is now limit ... view full comment
Thanks dtohmatsu for the information on Medicaid. Thanks also to you, ironyroad and others for a most interesting thread.
I was struck by wandreycer1's note that her Manhattan physician no longer accepts insurance. Have heard the same from my daughter, son-in-law and sister-in-law in Manhattan (whose Ob/Gyn delivered her last baby early in the Reagan administration, but wants cash only--lots-- for current gynocological exams). Down here in "God's Waiting Room" we haven't seen that, but more and more Internists are setting up boutique practices. Glad to accept Medicare and the high option supplements from the alte cockers. But practice is now limited to 500 patients, each of which is expected to cough up $1,500 out of pocket for the privilege of seeing the good doctor at all.
The more I read, the more I am convinced that we have arrived at an extremely complicated mess and that there are no complete or uncomplicated solutions. Since my prior post on this thread, I have read an interesting post on weeklystandard.com by Yuval Levin which may be of interest to those open to the thought that Republicans might have some thoughts on the topic beyond just say no. It spoke to some of the issues I asked about in my immediately prior post on this thread. Many of you will disagree, but let's discuss.
Thanks dtohmatsu for the information on Medicaid. Thanks also to you, ironyroad and others for a most interesting thread.
I was struck by wandreycer1's note that her Manhattan physician no longer accepts insurance. Have heard the same from my daughter, son-in-law and sister-in-law in Manhattan (whose Ob/Gyn delivered her last baby early in the Reagan administration, but wants cash only--lots-- for current gynocological exams). Down here in "God's Waiting Room" we haven't seen that, but more and more Internists are setting up boutique practices. Glad to accept Medicare and the high option supplements from the alte cockers. But practice is now limit ... view full comment
Thanks dtohmatsu for the information on Medicaid. Thanks also to you, ironyroad and others for a most interesting thread.
I was struck by wandreycer1's note that her Manhattan physician no longer accepts insurance. Have heard the same from my daughter, son-in-law and sister-in-law in Manhattan (whose Ob/Gyn delivered her last baby early in the Reagan administration, but wants cash only--lots-- for current gynocological exams). Down here in "God's Waiting Room" we haven't seen that, but more and more Internists are setting up boutique practices. Glad to accept Medicare and the high option supplements from the alte cockers. But practice is now limited to 500 patients, each of which is expected to cough up $1,500 out of pocket for the privilege of seeing the good doctor at all.
The more I read, the more I am convinced that we have arrived at an extremely complicated mess and that there are no complete or uncomplicated solutions. Since my prior post on this thread, I have read an interesting post on weeklystandard.com by Yuval Levin which may be of interest to those open to the thought that Republicans might have some thoughts on the topic beyond just say no. It spoke to some of the issues I asked about in my immediately prior post on this thread. Many of you will disagree, but let's discuss.
Wandrey,
Let me try to respond to your questions.
1. Health insurance inflation. As long as heath care costs keep going up, the cost of insurance will keep going up. As we become more affluent we tend to spend (and want to spend) more of our income on health care. Maybe we'll hit some medical breakthroughs where we can stay healthy for much lower costs, but I don't think health care inflation will go away. That being said, I do think that spending is rising faster than it should. High deductible insurance policies have the potential to reduce the RATE of growth of spending, but I still think spending will rise faster than inflation generally, but that this is not necessarily a bad thing if it ... view full comment
Wandrey,
Let me try to respond to your questions.
1. Health insurance inflation. As long as heath care costs keep going up, the cost of insurance will keep going up. As we become more affluent we tend to spend (and want to spend) more of our income on health care. Maybe we'll hit some medical breakthroughs where we can stay healthy for much lower costs, but I don't think health care inflation will go away. That being said, I do think that spending is rising faster than it should. High deductible insurance policies have the potential to reduce the RATE of growth of spending, but I still think spending will rise faster than inflation generally, but that this is not necessarily a bad thing if it is because consumers are voluntarily choosing to buy more health care.
2. Caps on damages. I assume you are talking about lawsuits. I haven't really looked at this because I think politically it is not that likely that we will see any major changes. The Democrats are pretty closely allied with the trial lawyers so we're unlikely to see reform. The Republicans like to use this a club to hit the Democrats with, but while there are clearly some abuses I don't know how much it would really save.
3. Kaiser. In the 70's because of the success of the Kaiser Permanente system, a lot of people thought Health Maintenance Organizations would solve most of our heath care problems. As I understand it however, it turned out to be hard to replicate, and other HMOs have not been nearly as successful and there has been a lot of patient dissatisfaction. From everything I've heard though Kaiser continues to be a very good system.
3. Who gets the goodies. I think you largely solve this problem with the solution I have suggested which is to have a government defined and mandated basic high deductible plan which every insurer has to offer and every individual must enroll, you largely solve this problem. Everybody gets the same basic care. If higher income families want to buy supplemental insurance that pays for private hospital rooms, brand name drugs instead of generics, etc., I don't have heartburn with this as long as everybody has equal access to the same basic care.
4. Subsidies for lower income families. Right now depending on the state and whether it is a single parent household, Medicaid kicks in for families whose household income is in the low to mid $20,000 range. What I am suggesting is that if you had a high deductible plan and you didn't qualify for Medicaid but you made less than say $35k, you would be eligible for a reduced deductible (say $2000 instead of $5000) on your basic plan with a private insurance company. Any payouts the insurance company made between the $2000 and $5000 (i.e. a maximum of $3000) they would just send a bill to and get reimbursed by the government. You would have a sliding scale so that at or near the poverty line, you have close to a zero deductible and this scales up to $5000 depending on your income.
5. People don't get care, disparity of care. Good question. Part of my original interest in health care had a genesis in a desire for social justice and came with an assumption that poor and lower income families we're not getting the health care they needed. So this is hard to quantify but the data at the time showed that there were no disparities in care based on income for certain basic measures of utilization just as days in hospital or physician visits per year per 1000 people. Beyond this, there is not very good data. I have not looked at this recently but I suspect it has not changed. Also given the level of interest in the health care debate, I am almost certain that the proponents of the current proposal for reform would be repeatedly publicizing any statistics that showed that lower income or uninsured families were getting less care of having worse outcomes. The absence of any such data leads me to believe that there is in fact no significant difference in care.
6. Medical bankruptcies, denied coverage for children, denied coverage for existing coverage, etc. I completely agree, these are all bad things that need to be fixed and I think the way you do it is with a system that requires all insurance companies to offer a basic high deductible plan and for all individuals to be required to enroll in such a plan.
A few other random comments.
Health care is expensive and will continue to be so. No getting around that.
I think it is important to distinguish between being denied treatment and being denied payment. I don't think there is much of the former and I am not saying that the latter is not important, but it is important to understand and distinguish between the two when you are trying to craft a solution.
Finally I think you need to put medical bankruptcies in context. I haven't seen any number on this, but if you look at the number of people who are uninsured or under-insured and then you take away those who don't have any assets (and therefore would not be hurt by a bankruptcy) and you take away those that have a lot of assets (who aren't likely to be bankrupted by medical bills) and then you look at the percentage of that group who have catastrophic medical expenses, you still have a big number in absolute terms but as a percentage of the population it's pretty small and pretty manageable to society in terms of its overall cost. As I have suggested I think you can largely eliminate this problem as well with mandatory basic insurance plan I have suggested.
Sorry for being long winded in the response. Appreciate your good questions.
Irony,
Rationing. I agree its needed, but I think you need to and can minimize the amount of rationing that takes place and rely more heavily instead on a market mechanism, which is one of the reasons I favor a high deductible minimum care plan. Under this type of plan, most routine non threatening care below the deductible would be priced and allocated through the normal interaction of consumers and providers. In addition, if the basic plan was defined not to include things like private rooms or non-generic drugs, then the pricing and allocation of private rooms and branded drugs would rely more on a market mechanism.
Sorry for incorrectly suggesting that you believe health quality is bad in ... view full comment
Irony,
Rationing. I agree its needed, but I think you need to and can minimize the amount of rationing that takes place and rely more heavily instead on a market mechanism, which is one of the reasons I favor a high deductible minimum care plan. Under this type of plan, most routine non threatening care below the deductible would be priced and allocated through the normal interaction of consumers and providers. In addition, if the basic plan was defined not to include things like private rooms or non-generic drugs, then the pricing and allocation of private rooms and branded drugs would rely more on a market mechanism.
Sorry for incorrectly suggesting that you believe health quality is bad in the U.S. You clearly are not the culprit, but I can not count how many posts I've seen that are basically "Americans pay twice as much for health care that is not as good." If we don't understand the problem we are not going be able to solve it so these kind of uninformed posts really irk me. Sorry for blaming you though.
As to the last paragraph in your earlier post, I agree this is a problem that we need to fix and having a mandatory high deductible plan would largely solve this problem with minimal government involvement. I do think it is important however to distinguish between getting kicked off the the insurance rolls and not getting treatment. I don't think the latter is actually a big problem in the U.S, but in any case a requirement for mandatory high deductible basic plans would solve both problems.
dtohmatsu:
I have noticed that you frequently make claims such as " I think it [US healthcare] is superior to virtually every other country especially those that have single payor systems."
What is the data that you are basing this claim upon?
"The available data that do have a relationship with the quality of health care (i.e. survival rates for cancer, stroke, etc) all show that the U.S. provides better health care."
Actually since survival rates are really meaningless when compared to mortality rates, the data shows no such thing. People "survive" in the US longer, because conditions are often found earlier, we as do perform more regular screenings. H ... view full comment
dtohmatsu:
I have noticed that you frequently make claims such as " I think it [US healthcare] is superior to virtually every other country especially those that have single payor systems."
What is the data that you are basing this claim upon?
"The available data that do have a relationship with the quality of health care (i.e. survival rates for cancer, stroke, etc) all show that the U.S. provides better health care."
Actually since survival rates are really meaningless when compared to mortality rates, the data shows no such thing. People "survive" in the US longer, because conditions are often found earlier, we as do perform more regular screenings. However people in the US die at about the same time, or even earlier, in the aggregate, than people comparable countries from those same conditions. So the outcomes are no better.
"As for the quality of care, the only arguments ever cited for poor quality in the U.S. are infant mortality and life expectancy at birth."
The recent findings of groups such as the Commonwealth fund are regularly cited (this is a NYT link, but it does not mis-represent the findings www.nytimes.com/.../12sun1.html).
Independent comparison studies are rare, but all of the ones I am aware of have consistently shown that the US trails in outcomes and other measures. Here is the 2005 WHO ranking (www.who.int/.../en). It's a good read, but the spoiler is that the winner isn't us, and they only spend 11.5% of GDP on healthcare, although about 80% of that is from government sources.
Also, the US does not have have superior life expectancy even at age 60 (www.healthandage.org/.../page13.html), so the life expectancy argument is still instructive.
So given that we do spend more (yes, about twice as much), and get less, and distribute what we do get in a particularly pernicious and illogical fashion, I'm not sure what is wrong with the argument "Healthcare is worse in the US". You are correct that Americans are not really paying twice as as much for health care that is not as good, but that's rather splitting hairs at the end of the day. We pay a lot (both individually) and as a society (opportunity costs, loss of productivity) and get less for it.
However if you are familiar with bias' or methodological flaws in the Commonwealth or WHO reports, I am quite interested in hearing them.