Just been dealing with the pharmacy and our health insurance

[xiphias]

Can anyone give me an example of ANY problem that we'd have with socialized medicine that we don't have right now with our current health care system?

I mean, if I'm going to have to go through byzantine, bizzare, arbitrary bureaucracy and have to bang my head against walls and argue with people to have simple, commonsense health care taken care of, I'd like to at least know that it was available to everyone.

Comments

[bimmer1200.livejournal.com]

I hope you'll forgive a longish post.

If you think options are limited now, under a government monopoly they'd be even more limited. Even the most limited healthcare insurance provides multiple choices over a wide geographic area. You may not be able to choose any doctor you want, but you can choose from a set number. For example, my current plan, and it is nothing spectacular, gives me a choice of about ten different doctors in the town where I live. Another four in the city where I work. This ignores the dozens more that are all within 15 minutes drive from both my work and my home. It's maybe half of the total doctors in the area, but that's still dozens. I can, of course, go 'out of system' for a higher co-pay to any doctor I choose.

Compare to a system run the way we run another government monopoly; public schools. You get assigned a clinic by geographic area. You might be able to choose a handful of doctors from that clinic, but you can't go to another clinic. If your local one doesn't offer a service? Too bad. Of course, my taxes have gone up to pay for this, so I have even less money to try and go outside the system if I want to do so. That's presuming it is even legal to do so without going outside the country.

The way to solve this problem is simple:

Currently, employers spend an average of 3965.00 per employee for single employees on health insurance premiums. Of that, 500 and some odd dollars is provided by the employee. This doesn't include the cost of copays and the like, but we'll leave that out.

There are however, HSA. Healthcare Savings Accounts. These are highly regulated and almost impossible for most people to use effectively. But lets say that you and your employer could choose to put those premiums into a savings account. Let's say further that the accounts roll over from year to year and they are in -your- name. So even if you lose your job, that account is still yours. You can still use it for any doctor or procedure or medicine you want. There would also be no cap on how much you could put into that account tax free.

The two requirements would be this: if you use an HSA you must A) buy catastrophic health insurance and B) Pay taxes on the money if you use it for anything except healthcare *twitch*. A is in case you come down with cancer or other major disease. Such policies are relatively inexpensive. Around 80 dollars a year for several hundred thousand dollars coverage, with a 500.00 premium. Of course, part of that price is due to the low numbers of people that purchase such coverage.

Now, how does this help poor people? Well, here's how. It brings down the overall cost of health care. Much of the cost that drives healthcare upward is the increasingly byzantine nature of insurance/HMOs/etc. A local doctor's office that accepts only cash/check/credit cards charges half of what his competitors that accept insurance charge. Now, that won't hold true across the board, but if there's even a 25% reduction in such costs instead of 50% it makes it more affordable for everyone. And for those who are completely without recourse, we already have medicade and medicare.

[cheshyre]

Compare to a system run the way we run another government monopoly; public schools. You get assigned a clinic by geographic area. You might be able to choose a handful of doctors from that clinic, but you can't go to another clinic. If your local one doesn't offer a service? Too bad.

Why do you think that would be the case?

I'm not heavily versed in comparative health care, but is that true anyplace else, or are you making up that idea out of whole cloth based upon notions of public schools?

Unless there's a history of this concept in practice, two reasons why that wouldn't work and thus probably wouldn't be implemented.

(1) America is an extremely mobile society, I think moreso than Europe (where DNA testing found Cheshire man's descendant living within a few miles of the ruins). Even within the same metropolitan area, I've lived in at least four cities, and I know many people whose residences have been even more transient. If part of the point of this is continuous coverage with doctors who can get to know a patient longterm, than this kind of geographical limitation would be counterproductive and makes no sense.

(2) Furthermore, even public schools are no longer as monolithic as you describe, what with magnet programs and school choice... Even though my parents house is across the street from the high school I attended, my younger brother went to a magnet high school at the opposite end of the county. He had trouble with the program academically, so after freshman year returned to our "local" HS. But because he preferred the other school so much, he suddenly developed a burning need for a particular class only offered at that school. And the district let him transfer back.

I may come back to dissect the rest of your comment later, but this point stood out for me like a sore thumb and I couldn't let it stand.

[bimmer1200.livejournal.com]

Because public schools are the only major government monopoly we have other than police, to which there is very little analogy. Minor government monopolies like the USPS, Amtrak, or perhaps the DMV don't offer much more hope.

As for 'making it up whole cloth'. No, I'm not. Many socialized systems of medicines assing you a health care provider. They assign what services are available. In many, you can't even opt to pay for additional services. That wouldn't, after all, be fair to let the rich jump in line. And even when you can go see another doctor, you've got a long wait ahead of you. So, I think the analogy of decreasing choice even further is legit. Is it partly theoretical? Yes. But I don't think it's farfetched either. Unless you've got a specific plan you want to present, it's a bit hard to refute something as nebulous as the original post.

As for your points 1 and 2, mobility has nothing to do with it, nor the example of 'school choice' you give. I'm pointing out that your choices get even further narrowed by government intervention. It is -always- what happens, both with socialized systems abroad and with other fields where we have tried it at home. Show me one system of socialized medicine where people have shorter waits, more treatment options, and more choice in providers than we do here.

America offers the highest quality health care in the world. It isn't perfect, and I'd like to see some changes to make it better. But socializing it isn't going to do that. It will make it worse.

[xiphias.livejournal.com]

Show me one system of socialized medicine where people have shorter waits, more treatment options, and more choice in providers than we do here.

Who do you mean by "we"?

Lis and I had exactly one choice in health care provider for our psych meds. And it wasn't the doctor we wanted to see, it wasn't someone we'd ever heard of.

In what way do Lis and I have choice, when our insurance company directed us to see Dr. Bayard, with no other options?

[bimmer1200.livejournal.com]

By 'we' I mean the U.S. in general.

As for choice in your specific instance? I don't know. Can you choose different insurance provider? You also have the choice to pay out-of-pocket. Under a socialized system, there's no evidence to indicate you'd have more choices. And the OOP option would be diminished as the increase in taxes would eat up some of the income that could make it possible to use that OOP option.

I agree the current system is less than ideal. What do you think of the HSA idea? It would definitely provide you with more options than the current one w/o socializing things.

[cheshyre]

HSAs were first devised by people who thought the problem with healthcare costs was that Americans were overinsured. This is neither hyperbole nor exaggeration, and that faulty premise makes me distrustful of any solutions based off of it.

The notion appears to be if individuals are paying out-of-pocket they'll economize and that individual consumers can negotiate better prices than collective groups. [This cartoon is one of the more cynical criticisms I've seen...]

Group insurance balances out costs among a large patient pool. In the last several years, for-profit insurance has been trying to cherry-pick their clientele, to only attract the healthiest so they can avoid paying for the people who truly need the health insurance. My gut reaction is that this kind of plan appeals most to the young and healthy, who anticipate few health expenses. [What *does* happen if something major happens and the account gets overdrawn? SOL? Or will there be a safety net? Too cruel without the safety net, and if there is an adequate safety net, why do we need the HSAs?]


Ian, if you want to do more reading on this, I've got a mess of links for you, though I haven't sifted them for quality or authority, but we've got some further reading if you're interested.

[bimmer1200.livejournal.com]

This is only a part of the notion. It also provides for flexibility. In Ian's case, he'd have almost 4K (or more if he and Liz opted to put more money into the account)to spend on whatever mental healthcare provider he'd like, as well as medicine that's prescribed. To give an example, I'll use my own life path. I'm going to use some estimates, so take the numbers with a small grain of salt:



My first job with medical insurance came when I was 24. Now, I don't think it would meet the average I sited above so I'm going to assume it was only paying 2k a year in ins. premiums. I was on that job for a year, but I didn't go to the doctor except for a routine check up. The cost billed to the insurance company was 60.00 + my 15.00 co-pay. That's 75.00. There's also the premium for catastrophic health insurance. Let's say around 400.00 a year.





So let's say I had an HSA. I'd have had 2000.00 in the bank because I was young and didn't contribute. I had to take out 75.00 (we're going to assume no price drop due to HSAs) and that left me with 1925.00. I went to the dentist twice at 60.00 per visit. So that's another 120.00 deducted. That leaves me with 1805.00. Take out the catastrophic and we're down to 1405 At this point, I could take the money out and pay normal income tax on it. Or just leave there. I'm going to leave it there.



The next year, I changed jobs. Now, it took 3 mo. for my ins. to kick in. But with an HSA, I'd have been able to keep that 1405.00 and use it if something happened. Nothing did, and at my new job my healthcare contribution was probably higher than average. But I'm going to use the average number of 4K a year. Now, I only got 9 mo. of coverage that year, so that's 75%. That means 3k. My HSA now has 4405.00 in it. Less the same 195.00 for physical and teeth cleanings. That leaves us with 3810.00 after the catastrophic.



I stay in the same position for another year. I get the full 4K and I haven't used any of that money again that year, save for the same check up and teeth cleanings. So I'm at 8005.00. Then, disaster strikes. I lose my job. Fortunately, that 8005.00 is mine. I start doing contract work, so my real dollar income is up, even if my benefits are down. I don't add more to it, reasoning I don't know if this contract thing is going to work out and I need to pay my bills. I forego one teeth cleaning and the checkup, so I'm still at 7910.00. Maybe not too smart, but I'm 27 and healthy and in reasonably good shape so I take the gamble.

(More coming in an additional reply)

[bimmer1200.livejournal.com]

I find a new job with UPS. Benefits are better than average so I'm going to say 5K a year on this one, and that they pay the catastrophic for me. Benefits also start after three months though. And oh, shit. I got a kidney stone and have to go to the ER to take care of it. I racked up like 4500.00 in bills. Now, i've got a choice. I can pay my catastrophic premium of 1000.00 and let the catastrophic cover the rest. Or I can pay all 4500.00 out of my HSA. I decide to do that. the Catastrophic has a lifetime limit of 1 million and I want to make sure if I get cancer or gangrene or something fucked up I don't have to work. So that leaves me with 3410.00. I have no more health problems during the year though, and I'm back to my regular check-up and teeth cleanings of 195.00 a year. So I'm down to 3215.00. UPS kicks in though, and I get my 3750.00 from them which brings me up to 6965.00.



My next year at UPS, I go to the doctor once for a sore throat. So that's an extra 80.00 visit added to my normal 195.00. So I'm down to 6690.00. Add in my annual 5k and I'm up to 11,690.00. That's a pretty good little hedge.



I change jobs again. My insurance is about the same as UPS and kicks in after 30 days. That was almost a year ago so I'm going to assume the year is finished for purposes of this example (and because this is getting long). This year I've been to the doc. twice besides a checkup. That's 375.00. I spent another 300.00 on a chiropractor. So that's 675.00. I only get 4583.00 this year due to losing a month. That leaves me with 15,990.00 sitting in HSA.



Now, I've not bothered figuring interest. Or taking out costs of meds as I didn't really spend that much on meds. I think, once since I started working 7 years ago I got a prescription medication, so I'm going to call that even. Regardless, I'd be sitting with almost 16K in an account and should I start having medical problems I can use that, and if it gets near the bottom, I can use my catastrophic insurance, say if I get cancer or have a heart attack or something like that. This ignores my wife's income and insurance. My point though is this: if people have it, they have their 20s which are typically low health-care expenditures to build up a cushion so that as later in life problems get more serious/expensive/likely, they are better prepared to handle it.

Now, I don't know Ian's finances or medical expenses. But his major complaint seems to be choice. And HSA would undeniably give him more choice than he currently has, at no additional expense to himself or to anyone else. It's just removing some of the blocks on money that's already there, freeing it up to go where it is treated best, as defined by Ian instead of a pencil-pusher in the gov't or at some insurance company.

[xiphias.livejournal.com]

You're making a number of assumptions here.

First is that "young equals healthy."

There has never been a year of my life in which I've consumed less than a thousand dollars of health care. And most years have been significantly more. My medications are over $200/month alone. And have been for most of my life.

In addition, I've never earned more than $10,000 in a single year.

Under your plan, I'd be dead.

Now, this may or may not be a downside of your plan from your point of view, but I assure you that, from my point of view, it is. I'm afraid that I cannot support any plan under which I'm dead.

Another assumption that you are making is that I have the ability to make better decisions about my own health care than a pencil pusher in the government or at some insurance agency.

Why? Actual assignment of health care risk is a significantly complex technical specialty. Why would I be better at it than someone trained in it?

[bimmer1200.livejournal.com]

I'd say you being dead is a downside, yes.

Why would you be better at it than a pencil pusher? Precisely because it would be your life on the line. I think you're perfectly capable of picking a doctor or other health care provider that will meet your needs.

I did make a presumption though, that if someone has insurance of some kind from their work, they'd be able to use that money for an HSA. Or to choose their own healthcare instead of having to go with what their employer provides.

Another point I didn't make is that if someone with an HSA takes money out for non-medical purposes, they'd have to pay an income tax on it. As benefits of this kind are currently taxed, that additional revenue could be channeled into helping people who are having trouble. You well know I'm not fond of taxes, but I'd find that tolerable as a) the subsidy is self-selecting b) the self-selectors are people taking risks of their own choosing.

I'd also presume that necessary medical treatment would be provided as it is now. The problem with socializing systems like this is that it doesn't bring the people at the 'bottom' up, it just drags the people in the middle down and makes it even worse for the people at the 'bottom' and I don't think that helps anyone.

[cheshyre]

Quality only for those who can afford it.

One of Gladwell's commenters made an excellent point:

I have a question. What would happen to the lines for health care in this country if the 40 million people currently uninsured were suddenly insured and got in line (and remember that many of these people are poor and perhaps in greater need of health care than the average person)? Wouldn't the lines for health care provision get a lot longer? So in that sense, maybe the quickness with which Americans can access care has something to do with the large portion of the population that has no access.

So which is preferable: everybody gets (say) 70% of what they want, or the top 1% gets 100% of what they want because they have the money for it, most people get (say) 60-80% of what they want, and 20% of the population gets nothing

Mind you, the richest of the rich will always be able to get what they want. That's true in medicine, that's true in other aspects of life. Even when abortion was illegal, wealthy women could fly abroad to get abortions, while poor women without those opportunites couldn't, regardless of who had the more meritorious case.

Also, the costs of insurance in this country, private and company-provided, are rising faster than inflation. Just to break even, companies are increasing the amount the employee pays anad reducing the benefits. We're all paying more for less. And why? One of the reasons is because insurance is a for-profit industry. Their primary goal is making money, not public health. Another reason healthcare costs are so high is because of all the uninsured people, who can't afford preventative maintenance so only get care when matters become acute enough to require a (much more expensive) emergency room visit. And since they can't afford that either, those costs are distributed to the rest of the patient population.

One last point: employer-provided healthcare puts us at an economic disadvantage with foreign competition. Domestic manufacturers must pay for their workers' insurance, which invariably means they have to charge more than foreign companies whose healthcare costs are absorbed by the government...

[bimmer1200.livejournal.com]

The 40 million number, much like the '10,000 women a year dead from illegal abortions before Roe', and the 'spousal abuse increases during the Super Bowl' is largely horsefeathers. First and foremost, most of those in that number are transitorily uninsured. That is, someone loses a job and is temporarily out of insurance. The average being 5.6 months. Further, a large chunk of those that aren't insured are people between the ages of 20 and 30 who make 40,000 a year or more. People like me, who in my 20s, didn't have insurance. I kept the money in my paycheck and paid OOP because I almost never went to the doctor. So most of those '40 million' are already in line.

As for the 'for profit' motive, name me a government program that has decreased in costs over the years? Yeah, didn't thinks so. That argument won't carry any water.. There are problems with the current insurance scheme. I've suggested an alternative that won't cause scarcity the way socialized systems proveably do in every case.

The largest problems with increasing healthcare costs are the overhead from filing insurance. This is a bureaucratic cost that a government run system would only increase. The second is from people like the Prell Girl who file ridiculous lawsuist, use junk science to award their clients millions and thereby drive malpractice insurance costs through the roof, and lastly the cost of uninsured emergency room visits. HOWEVER, the largest chunk of those who use the ER for healthcare and are driving costs up there are illegal immigrants. Not poor citizens who are eligible for medicaire and medicade.

Lastly, where the hell do you think the money comes from for 'the government' to pay for that healthcare? Do you think the congress can just defacate the extra money into their hand? That money has to come from somewhere. Which means taxes. Which means that more money is taken from the wealthy and corporations that already pay more than their fair share. And that's money that isn't invested in capital and expansion and innovation and research. The increased costs of regulation and the stifling effect on innovation that government run systems always create would far outstrip any competitive drag healthcare costs are having on our companies. Besides, the HSA solution answers this far more effectively than would socializing.

Further, if we follow this line of thinking, why not just close down the grocery stores and turn that over to the government. Everyone needs to eat, right? How about housing too? Let's make that government run. Then we can all live in wonderful places like Bed-Stuy or Cabrini Green. Oh! Oh! Clothing, let's let the government handle clothing all of us. We can all be dressed in the latest Wal-Mart fashions then.

The biggest reason not to socialize healthcare is this: It isn't the government's job to provide for your needs. When government tries to do more than that it is immoral, because it must take from one group to give to another. And that's wrong. Wether you're pushing fundie christian biblical precepts or east coast progressive social justice, using the force of government to make other subscribe to your morality is immoral.