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Another attempt to raise our Health Insurance rates

Original post made by Perspective, Midtown, on Mar 28, 2009

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The Senate is looking at how insurance companies set out-of-network charges, with an eye to, of course, regulating this practice from a Federal level.

Great. Add that to paying rates for mandated language translations, chiropracty, and accupressure/accupuncture, and maybe you all start to see what REALLY needs to happen to lower our insurance rates.

BUTT OUT REGULATORS, you just keep adding to what those of us who are responsible enough to pay for our health insurance have to pay!

If you MUST look at Health Insurance at the Fed level, why don't you look at how to allow us to buy Health Insurance

Comments (23)

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Posted by palo alto mom
a resident of Embarcadero Oaks/Leland
on Mar 28, 2009 at 10:47 am

I'm glad you are responsible enough to pay for your own insurance, that means:
you are healthy enough to be allowed to buy insurance or
you are lucky enough to have a job with a company that allows you to buy insurance
you are lucky enough to have enough money to pay for that insurance...

Currently the insurance industry can pay what it considers reasonable and customary charges to out of network doctors - the patient is responsible for the rest. They can arbitrarily decide how much to pay. Additionally, uninsured patients are charged more then insured patients in general since the insurance companies negotiate discounts. So those least able to pay for medical care are forced to pay the most for the same procedure. A little unfair don't you think?

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Posted by Bill Glazier
a resident of Old Palo Alto
on Mar 28, 2009 at 11:07 am

Ah, yes, Perspective, everything to you appears as a liberal conspiracy.

Let's talk about the reality of insurance fraud by insurance companies. My wife, 3 years ago, was diagnosed with breast cancer. She had major surgery. Our wonderful insurance company (HealthNet in this case), said that the usual and customary charge for a 6 hour double mastectomy surgical operation was $600 (the surgeon's bill was $12,000, and she was out of network). We experienced this repeatedly when having to use out of network physicians. We found the method that Healthnet used to calculate usual and customary equated to about 5% of the gross amount billed by the physician. When we probed a customer service rep, we were informed that 'usual and customary' varied in any geographic area daily depending on the amount of claims that had been paid that day, week, and month and quarter to date - i.e depending on what earnings for the company needed to be.

We ended up about $30,000 out of pocket for these 'out of network' charges - and this was purely for physician professional fees - all the hospitals we used were 'in-network'. Despite the fact that the 'maximum out of pocket' for the policy was $5K, the insurance company 'didn't count' what we had to pay the physicians as 'out of pocket'.

Fortunately, a good trial lawyer saw this for what is was - fraud. A Class Action suit was filed, and was settled for $250M - so some portion of our out of pocket costs will be reimbursed.

Yes, we knew full well we were using out of network, and decided we were willing to pay the extra 20% to have access to the physicians we selected. What we never told was that UCR (usual customer and reasonable) for HealthNet was calculated as 14% of what Medicaid would pay for a similar procedure. Then deductibles and co-pays were deducted. So on average when in network HealthNet covered 75% of the gross billed amount for a service, for out of network, they were willing to pay only 5% of the gross billed amount.

Fraud, pure and simple. I paid for health insurance and was simply defrauded. There was no intent to pay usual reasonable and customary for anything out of network. I am covered under a corporate insurance policy. My company was defrauded, and so was I.

Perspective, you couldn't be more wrong. The medical system in this country is completely broken, and insurance company fraud and abuse is at the heart of it. You should just hope and pray you never get exposed to it.

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Posted by We need socialized medicine
a resident of Duveneck/St. Francis
on Mar 28, 2009 at 4:10 pm

"you all start to see what REALLY needs to happen to lower our insurance rates."

Yes, we desperately NEED socialized medicine. Look at those Europeans: they're all covered, great systems, it doesn't break the bank, and much less waste than we have here.

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Posted by Perspective
a resident of Midtown
on Mar 28, 2009 at 4:39 pm

Both posters above have no clue what is happening to the "socialized medicine" health care non-delivery and rationing, drug and medical non-advancement, standards of practice and effectiveness, and non-sustainability of keeping the program up in any other country, do they?

Why don't we learn from their mistakes, and do something completely different, instead of repeating history? Let's make it so that we can CHOOSE to buy less expensive, less "high end" insurance, like we used to do before lawsuits and regulations made it exhorbitant to purchase health care insurance.

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Posted by Bill Glazier
a resident of Old Palo Alto
on Mar 28, 2009 at 6:04 pm

Let's be clear, Perspective. Because my wife had cancer, there is no private coverage available at any price for our family. Where are your 'efficient markets'? Or is my family just a statistic that doesn't matter to you? I assure you your 'individual' policies you claim I can buy cover less, cost more, and are less reliable than any corporate group policy. If my family had been covered by an individual policy, they would have cancelled us within 30 days of diagnosis (or raised our rates 10x). Or do efficient markets to you mean great care for the wealthy, and not much for anybody else?

I think truly you must be one of those paid shills who post on behalf of a conservative think-thank, and get paid by the post. That is the only explanation for why you dominate these boards with so many postings.

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Posted by palo alto mom
a resident of Embarcadero Oaks/Leland
on Mar 28, 2009 at 7:08 pm

Bill - I'm sorry about your wife and hope she is healthy again. I think Perspective may just not have ever had the "pleasure" of a sick family member or friend. Or trying to find health insurance with even diabetes or asthma. Or watching someone filing bankruptcy because their mother's medical bills were so great. Or having a child get sicker because you have to choose between medical visits and rent.

In addition to the insurance related issues, I totally do not understand our City Council's attitude toward Stanford Hospital. We are blessed to have such great health care in our backyard. A dear friend had a sick child (now healthy!!!) who was at Children's Hospital for months, we are so lucky to be able to be close enough to provide support for sick family and friends. It was heartbreaking to see the small children who were there on their own because their only parent needed to be back home in Modesto taking care of other family members. We should be grateful and supportive of Stanford - not trying to get them to pay for our lack of fiscal responsibility.

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Posted by Pammy
a resident of Adobe-Meadow
on Mar 28, 2009 at 10:10 pm

It's hard not to sympathize with those like Mr. Glazier who have had difficulties with insurance companies. But in any reform, we must be careful not to tamper with what is uniquely good about our health care system.

Mr. Glazier's care for his wife cost him $30,000 - a high sum to be sure, and about 1/3 of the yearly income in Palo Alto. But for this he got to choose his doctor and the level of care she received. He doesn't complain about the care he got - only about dealing with the insurance company. (And I don't minimize the stress of doing this at a time of health crisis...)

Compare his experience to what his wife would have experienced in the UK where they DO have socialized medicine. The UK health service recently decided NOT to cover certain drugs for breast cancer not because they aren't effective, but because the bureaucrats decided they cost too much. Stories about long waits for treatment and lack of choice of doctors in the UK are legend.

Canada has many of the same problems, and many Canadians who can "escape" to the US for treatment when they have life threatening conditions.

We need changes in our health care financing system to be sure. But let's not go down the road to socialized medicine like these other countries.

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Posted by Bill Glazier
a resident of Old Palo Alto
on Mar 28, 2009 at 11:16 pm

But let's revisit your comment, Palo Alto Mom. How is this 'OK' if it cost me $30,000? Yes, I could pay for it (but I am darn glad that I am getting some of my money back via the court system). But I would venture to say that the overwhelming majority of Americans, if placed in a situation where they found themselves with $30K in medical bills, would face extreme financial hardship and/or bankruptcy. We were fortunate this was treated with surgery. What if it had required bone marrow transplants, chemotherapy and radiation? This easily could have been $100K or more out of pocket. Are you saying it is only important that our health care system work for people of wealth?

I was sold an insurance policy which said my max out of pocket was $5K for my entire family per year. I was told any Out of Network charges would be paid based on a % of Usual, Customary, and Reasonable Charges for private physicians in my area. I was defrauded on both counts.

Rather than throw around inflammatory words like socialized medicine, and make general statements about long wait times, lets look at the real details of what we have in this country, where hundreds of thousands of people each year file bankruptcy due to insurance shenanigans around serious illness. I would gladly have discussions about the relative outcomes (life expectancy, infant mortality...) of our health care system versus other countries. I like to say in response that the longest wait time of all for treatment is when you don't have the insurance or the money to see a doctor.

Just like the investors who bought credit default swaps on Wall Street, and were defrauded by companies like AIG who held no reserves to pay potential claims, I was defrauded by a financial rogue for-profit health insurer who chose to place profit above people. The game they played to pad the bottom line this time was with reimbursement for out of network, but once that loophole is closed, they will search some other place.

This thread started with Perspective, the spokesperson for all things conservative, saying the current system was more than well enough, and we needed to stop these ill-advised attempts to regulate health insurance companies more. Our current system is broken. For wealthy and well insured people, it is wonderful. For most Americans, without extraordinary savings to weather a medical crisis, it borders on being a disaster. For the millions of Americans without insurance, it is a disaster.

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Posted by Conservative = Wise with Money
a resident of Another Palo Alto neighborhood
on Mar 29, 2009 at 12:10 am

If the insurance industry were truly subjected to free market principles, the entire industry would have gone out of business years ago (and spared us this cracking of our national piggy bank from the industry's latest, greatest shakedown). People who call themselves conservatives prop up an industry that behaves more like organized crime and besmirch the free market equating the two. All of their proposals and defenses of the industry are based on an idealized concept of how insurance should behave, and it never does really behave like that. (It never was a good idea to let insurance get into bed with banking - anyone who really understands the modus operandi of the insurance industry would have seen this coming. As they say, you lie down with dogs...)

It's time people who are true fiscal conservatives (Republicans and Democrats) stood up and pointed out the difference between rackets and legitimate business in a healthy marketplace, between bank robbers and honest healthy banks. Until now, we've all been forced to treat them as one and the same, lest we be accused of being communists.

If we (true fiscal conservatives) care about the benefits of the marketplace, we'd better get busy with the reality check, or the pendulum really will swing to socialism, because people are already equating markets with corruption and rackets. Who could blame them, the Right has been all about that since Ronald Reagan. It's been corrupt, not conservative.

If we don't begin with the reality check, we will also never regain our standing in the world economy. And most importantly, we will never end this outrageous shakedown of our nation and citizens by an industry that has grown more powerful and corrupt than any crime family in our nation's history.

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Posted by Perspective
a resident of Midtown
on Mar 29, 2009 at 7:36 am

Bill, I am sorry you have had such troubles. However, my experience with acute and chronic illnesses is not limitied to the occasional cold either. The choices we make concerning the kind of health insurance we buy or the kind of jobs we take affect our health insurance consequences and outcomes.

I do not want anyone to be uninsured. I want us to continue to have the greatest health care system in the world, one where you can have access, through your insurance, to the best medicine can offer for any illness. Therefore, I want us to get away from ever more regulation concerning what ridiculous extra "health care" and language services insurance companies MUST provide, and away from the ever growing notion that somehow we must punish the pharmacies for their profits on drugs, so that they can continue to create life saving drugs such as the cancer drugs coming out now.

Therefore, I want all people to be required to show proof of health insurance in order to get a driver's license, and all people to have access to health insurance they can afford, not just health insurance that State legislators have decided must be the only kind offered in "their" State. They don't have to live within the rules they create, and are too busy doing "feel good" legislation not sound sense, and are saddling us with ever more ridiculous items we MUST pay for, regardless of whehter or not we would ever use it.

Imagine that a few simple things happened in our country, the FIRST country to do so, ( now this would be REAL change, instead of just taking the path to destroying health innovation and access like many other countries before us).

1) If someone doesn't have health insurance, they can't have a driver's license. Same as what we used to enforce for car insurance.

This would immediately increase the sheer numbers of uninsured by at the very least 10 million in the USA. ( For numbeerse of uninsured who really can't afford it versus numbers who are choosing to not buy insurance and can afford it...Web Link)

This would increase the risk pool, bringing in primarliy young, healthy, uninsured by choice "nothing will ever happen to me" people. And, of course, lower health insurance rates.

2) Allow us all to have access to health insurance that covers what we want to pay for. Do you want to pay insurance rates for language translation services, accupuncture, chiropractic, etc? Why can't I buy health insurance that works like Medicare? Or, if you want to argue that this is only made for the older, so doesn't apply, then why can't I buy health insurance like Medi-Cal? This provides basic health prevention care and health problem care. I don't want or need fancy insurance, and am forced, as we all are, into choosing between not buying any insurance or paying very much more than is necessary for our needs. I resent it deeply and want Ford level access, not just BMW choices.

3) Decouple the tax breaks from being ONLY for businesses, and make it so that it is for individuals, so that people own their own insurance, and aren't "job bound" by their insurance. This takes out that darn COBRA which is viciously expensive, and allows us more freedom to move from job to job, not stuck because of insurance. It also means that we still have insurance even when we quit a job to care for a loved one or to fight our own medical problems, as long as we keep paying our insurance premium.

4) No person can be denied health insurance because of prior problems, and at the same time, no health insurance company can be required to take on more than a certain percent ( I don't know what that would be) of its insured clients with "prior" categories. This would open up the door for those of us with 'uninsurable" bodies to get health insurance and pay our own way. It would also allow more health insurance companies to open their doors and compete, because they would have the assurance of a ceiling of risk.

These changes would allow competition, lower health care costs as individuals started shopping for where to go for elective surgeries based on cost, not just locale, doctors started vying for health insurance rates and so on.

We can not keep veering toward bureacratic control of our health care, or we will become like all the other struggling "managed" health countries..NO THANKS. I like having access to great health care, and I want all of us to keep that choice.

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Posted by Walter_E_Wallis
a resident of Midtown
on Mar 29, 2009 at 9:35 am

Walter_E_Wallis is a registered user.

Go to the source of this problem and TAX ALL BENEFITS AS ORDINARY INCOME. Then insurance companies will have to compete on service and accommodation to demand.

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Posted by Bill Glazier
a resident of Old Palo Alto
on Mar 29, 2009 at 10:03 am

We have come full circle. Perspective now admits the insurance system is very much broken, and needs substantial changes.

I enjoy when this Forum engages in rationale discussion, and not sound-bite politics. There is a discussion to be had about what form these health care changes might take. What role should the insurance industry have in the new world of health care?

I would suggest a few things:

1) Our administrative costs in our for-profit medical and insurance industries are extremely high. Because insurance companies create such complex billing and reimbursement guidelines for medical providers, layers of additional billing and insurance processing employees exist to manage this mess. Just compare the cost of managing Medicare versus private health insurance in this country. There are many studies, sponsored by people on both sides of the matter, that suggest the difference is 5-10% or higher

2) The health insurance industry is very profitable. This adds another 7-14% of revenues to the cost base that must be reimbursed by payers (i.e. us). One would argue that from a social point of view, trading off health outcomes for our citizens or coverage for more private industry profits is a pretty bad deal.

3) The health care industry has been unwilling to come to the table for decades to solve the problem of the uninsured. If anything, they are more aggressive than ever at screening out segments that have higher underwriting risk. The uninsured problem multiplies the cost problem, because people who do not have basic coverage avoid routine and first level care, which means the medical problems become far more advanced and expensive to treat once they develop.

To suggest that somehow the industry will now come to the table and be a rationale and not a self interested and politically motivated actor seems to stretch the imagination. The most cost-effective way to cover the costs of providing health-care to a large population is through a single payer system (Perspective admits this, but suggests it be done in larger risk pools through mandated coverage through the private sector). Insurance companies may have well developed back end claims processing systems that may be of some value, but the games they play in managing risk and maximizing profit are a negative drain on the entire system. I am glad to reproduce their back end systems from scratch with digital health records systems and internet-based claims processing systems if I do not need to pay them 20% on the health care dollar for administration and profit.

I have two physicians in my immediate family. 15 years ago they were both violently against any fundamental change in the health care system or the insurance industry. Now, they are both firmly convinced the health care system needs to be completely overhauled, primarily due to the greed and fraud of both the insurance industry and unfortunately some medical professionals and providers (i.e. for profit hospitals) who have succumbed to gaming the insurance system for their own benefit.

I personally think there could well be a very important role for markets in a new health care system (for example, I would like drug companies to compete for our business, and provide volume discounts to the US Government like they do for every other government around the world). But when people start the conversation by pleading to keep the same corrupted actors on the stage who have brought our health care system to the current state, it is easy to see how the message will get drowned out in a chorus of boos. Revolutions happen when reasonable people with reasonable grievances get ignored or shouted down by those who occupy the seat of power.

My advice to Perspective and others is to stop shouting, and start working to get real change to happen. Cries of socialism ring hollow to people who are a victim of the current system.

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Posted by stephen levy
a resident of University South
on Mar 29, 2009 at 10:30 am

Thanks for the post and for the general tone of the back and forth.

This is a really important discussion as health care costs are critical to address for preventing very large federal and state budget problems in the future. And many people's lives are affected by our hodge-podge system of coverage and cost incentives.

I think there is a lot of merit in both what Perspective and Bill Glazier have suggested. Personal responsibility and expanding choices are important along with fairness in finding agreement re our future health care system.

I agree with Bill "I enjoy when this Forum engages in rationale discussion, and not sound-bite politics."

My view is that this kind of discussion invites people into the conversation rather than raising the risk that responders will be subject to ridicule or personal attack and chasing people away.

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Posted by Perspective
a resident of Midtown
on Mar 29, 2009 at 3:51 pm

Bill, this is not a "full circle" on my part. I have worked in health care for 30 years, and have seen the effects of laws and regulations on our health care practices, liabilities, reimbursements, incentives, patient responsiblity etc. So, no, I do not now "admit" that our system is broken. I have watched it breaking for years. I am saying that almost every move we make to regulate it for "protecting" the consumer knocks consumers out of the loop to be able to afford their care. Be it not having ANY disincentive at all for ambulance chasing attorneys to sue ( like if they lose a case, they have to pay for all costs of the lawsuit themselves), forcing us to pay for ever more ridiculous types of coverage, allowing people who are quite capable of paying for health insurance to not pay for it, not devising a way to better risk share etc. We have tended toward making ever more rules without thinking through the consequences, and I am increasingly discouraged. Whenever a good and real idea comes up, it is frankly attacked by the very people it would help the most,and I have been quite discouraged by the amount of manipulation being done to the scared and ignorant.

I am not shouting, I have never shouted. The problem with "my side", really, is that we DON'T shout, we are too civilized, and therefore are continually outshouted in the media, on TV, on these forums, and by supposed "consumer protection" groups that have only one goal, regardless of the consequences,...and that is European/Canadian govt health care. I will never accept that as the best solution, and I believe that, frankly, we have to shout louder to be heard above the constant and unending drumbeat toward socialized medicine.

The solutions you have just seen me post I have been posting in various forms for well over a year, along with posting websites with research to support the solutions, along with an occasional squeak from a political leader who is quickly drowned out by the various shouting lobbying groups like AARP, govt unions, chiropractors, DNC, "immigrant" groups etc. The problem is that there is very, very little access to most people for these ideas to be given out on, since the vast majority of media outlets are self-avowed liberal, and have been taught throughout school that the ends justifies the means, and therefore they have to shut out non-"Liberal" ideas by not telling people about them, ridiculing them, and mischaracterizing them.

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Posted by Perspective
a resident of Midtown
on Mar 29, 2009 at 4:04 pm

And, again, Bill, please read the link I posted to the Health Care Myths in my post to help you understand how it is not true that govt billing, like Medicare, is less expensive to "administer", than private health insurance, as well as to understand the effect of Medicare "billing" rules on provider delivery services ( ie, fewer providers, therefore longer lines, less access to care etc).

What you are saying is what is repeated continually in our media and by the Dem leaders who are seeking expanded govt power. You, of course, are free to believe whatever you wish, but think about the motivations of who is doing your "research", and how well peer-reviewed these pieces are. In addition, you believe that the private health insurance industry is selfish and won't self-regulate, and I agree with you. How much more so with a bureacracy that has NO competition, unfettered opaque power, and NO incentive to be efficient, such as in the model you always prefer.

At least in keeping insurance private, there is a check and balance between competing companies, so I can choose the more honest one. You may not realize this, but a lot of dishonest, inefficient, frankly despised by health care providers, companies have gone belly up, and have left the better ones. I would rather tweak the ones that are remaining to keep them comptetitive than turn everything over to a govt monopoly and let bureaucrats play politics with our health care and destroy it.

Allow us to choose fewer options for less expense across state lines, tie buying your health insurance to a privilege like driver's licenses to increase the risk pool, accredite only insurance companies that accept 10% of their population as high risk...etc. Keep our health care choices open, don't create another monopoly.

Look at what a great job govt does with Social Security, MedicAid, Disablitiy insurance, education, managing our State and Fed budgets etc, and ask yourself if you REALLY want to give anybody the idea that they should rely on govt for their health care also. We are a better people if we learn to be responsible for our own choices, rather than make us dependent on others.

A govt big enough to give you health care is big enough to take it away. No thanks.

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Posted by Conservative=Wise with money
a resident of Another Palo Alto neighborhood
on Mar 29, 2009 at 11:48 pm

"At least in keeping insurance private, there is a check and balance between competing companies, so I can choose the more honest one."

Hopelessly naive. Like I said, supposed conservatives base all of their arguments on idealized behavior of the industry, which just doesn't work that way.

Insurance companies compete only to sell you a promise. When you need delivery of the product -- the coverage in the event of a catastrophic loss -- you are then just a small, costly, and (most importantly for them) vulnerable subset of the snowed majority, and they are most definitely not competing to do a good job for you. They only do enough of a good job for an even smaller subset so they can give the appearance of fulfilling their contracts, all the while the main thrust of their business is to avoid fulfilling the rest in order to make more money. Hence the increased administrative costs, as the industry uses the paperwork to overwhelm and cheat sick people. The administrative burden (on us) is their INVESTMENT in greater profit-taking. This tactic is identical to the one that fire and casualty uses against disaster victims, and have for decades.

When you need delivery of that product, guess what? There is no competition for your business then. You don't like how you're being treated? You're free to choose another carrier (ha, ha), they'll only be too happy to see you go now that you're sick. And try to get another carrier to take you! And guess what? A lot of you can't sue anymore, either (FEHBP, ERISA, etc.), and you don't even realize it. And guess who is at the root of those changes?

You can make all the regulations you want about requiring insurers to take people with pre-existing conditions, they just figure out ways to make things "medically unnecessary" when you need coverage. For everything you think will make them behave, they already have a hundred strategies worked out to thwart it, and have already put ten in place.

Stop denigrating our military and our men and women in uniform! In spite of all your cynicism about government (and Bush's attempts to undermine our military with expensive mercenaries), we still have the greatest military in the world. If I had to choose, I'd much rather keep our military, the NIH, CDC, and FDA, than any private interests that (??) serve (??) compete (??)

And I would much rather have the government handle insurance than a bunch of self-interested criminals who act like they hate our country (would sooner see it fail than reform their behavior). Hey, whenever insurance gets to a casualty that they can't absolutely game, such as flooding/numerous chronic illnesses, they turn over the risk to the federal government anyway. Socialize risk, privative profit. The industry gives no value added, and in a real free market, would have disappeared long ago. At least if there is a problem we all have with single-payer, we can ALL gang up to try to correct it. Try getting anywhere when you are sick, the insurer is wearing and shaking you down, and you have no leverage to sue. And if you can sue, do you think you will change the system (you won't get to even talk about it if you want your settlement). They make everything as complicated as possible so that you can't easily generate public outrage (they are masters at this).

The existence of private insurance drains more than just our health care system. The drain of this racket on our judicial system isn't even being monitored, but it is just as great if not greater.

Man, how bad does it have to get before you people who think you are conservative get out of your self-deluded fog?

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Posted by Perspective
a resident of Midtown
on Mar 30, 2009 at 5:44 am

CWM: Please look at the data in Europe on health care results from what you call "ganged up correction" and compare to the results here from our method of millions of individuals with vested interests making decisions.

I prefer methods with proven results, not methods of proven destruction.

I prefer fewer cancer and heart problem deaths and faster turn around for surgeries, like total hip replacements, that let me get back to my life.

Plenty of Canadians around here to talk to. Ask them why they are here and how it is going for their aging parents back home, from the "ganged up" solutions you think work so well.

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Posted by Conservative=wise with money
a resident of Another Palo Alto neighborhood
on Apr 1, 2009 at 12:26 am

Um, Perspective, I believe the greatest percentage of hip and knee replacements in this country are covered under MEDICARE, our government-run insurance.

No one is proposing that we nationalize CARE delivery. Just insurance.

I have compared European systems such as in Switzerland and France, and they are getting better results for less money. Including with wait times.

You can always fish for a few horror stories in any system. Statistically, we aren't anywhere near the top in any healthcare measure, just costs, just bankruptcies and lives ruined by medical costs, lives lost for lack of care, and productivity lost because of the administrative burden that eats up 25% of our healthcare economy, largely because of private insurers.

I do ask friends from foreign countries, and I hear many of them saying that things even in England are not as portrayed here. No, not perfect, but who says we have to aim for systems that aren't near the top?

Don't let the perfect be the enemy of the good. (Nor ideology be the enemy of true conservatism.)

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Posted by Bill Glazier
a resident of Old Palo Alto
on Apr 1, 2009 at 7:12 am

The Frontline series on PBS did an excellent piece last night on this problem. The issues are both universal coverage and the elimination of costs in the system. The insurance industry does have a great deal of inefficiency and added costs, but the piece was also clear that there are other economic actors who are responsible for our trouble as well.

Web Link

Given the current system has proven itself unable and unwilling to manage and address the problem, we need a new approach, not a tinkering of what we currently have. This is probably the single greatest challenge facing our generation. I hope we are up to the task.

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Posted by Perspective
a resident of Midtown
on Apr 1, 2009 at 8:26 am

I will watch the piece, but I will right now say up front that I fully expect all the "data" in anything sponsored by PBS to be presented in a way that the only conclusion of any kind person would be to say "yes we can' to Universal Health Care. I am willing to bet that nothing in it referred to the horrific regulation that insurance companies are now obliged to live under, and pass the costs to consumers.

As for the "current system" being unwilling or unable to "manage itself", please go back even 30 years and recall before State and Fed govt started "managing" health insurance by ever growing regulations, and punishing doctors/hospitals through ever growing malpractice idiocies, ..somehow we also managed to all have health insurance and get great care.

We need to allow us, as individuals, more freedom to choose our health insurance without State govt interference in what we must pay for as a minimum, and we need to eliminate frivolous lawsuits.

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Posted by Perspective
a resident of Midtown
on Apr 1, 2009 at 8:28 am

And CWM: Not fishing for horror stories, look at the data of death rates and surgery waiting times in Canada, England and France. Do you want that?

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Posted by Anna
a resident of Downtown North
on Apr 1, 2009 at 9:32 am

Uncharacteristically for this forum, this thread is turning out to be a relatively measured and thoughtful discussion.

This is especially surprising given how complex the topic is. The trade-offs between government intervention, fuller coverage, innovation, and most importantly for most Americans with insurance now: access to the best care are not simple.

There is an especially good set of columns and discussions on the Atlantic Magazine website which was started by one of their authors, Virginia Postrel, who has had a recent first experience with breast cancer.

The start to one of her columns is provocative:

>If I lived in New Zealand, I’d be dead.

That’s the lead my editor wanted me to write, and I have to admit it’s great. Alas (for this column, at least), it’s not exactly true. But neither is it false. And the ways in which it’s partly true matter greatly, not just to me or to New Zealanders but to anyone who might get cancer or care about someone who does.

The American health-care system may be a crazy mess, but it is the prime mover in the global ecology of medical treatment, creating the world’s biggest market for new drugs and devices. Even as we argue about whether or how our health-care system should change, most Americans take for granted our access to the best available cancer treatments—including the one that arguably saved my life. ..."

Her full column and discussion by a pretty savvy group of readers is here: Web Link. A follow up column which discusses the issues raised by readers' comments to the first column is perhaps more informative: Web Link

Postrel compares her experience to what she might have expected in New Zealand, where the public health service in attempt to hold down costs, chose not to cover the treatment that ultimately saved her life.

If you're going to spend time watching the PBS documentary, posters her might also wish to spend a little time reading Postrel's column for balance and contrast.

When I did, I came to the conclusion that there is no free lunch in health care reform. We cannot expect that any national health care system will provide wider coverage, lower costs and easy access to cutting edge medical technology. Neither can we expect the pace of medical progress to be unaffected by changing to a national system that holds down costs. There are trade-offs.

What trade-offs people make when deciding what kind of system we wish to have is in large measure a matter of individual values and choices. But anyone trying tell you that there are no trade-offs is selling snake oil.

Like this comment
Posted by Perspective
a resident of Midtown
on Apr 1, 2009 at 11:40 am

Extremely well said, Anna. I choose to keep cutting edge medical care for all. Not one person is ever denied life saving medical care in the USA, regardless of whether or not he/she is insured. That is one of the myths constantly spread, as if anyone dies from lack of medical care in our country.

What DOES happen is that people can lose all but their home and some amount of their savings if they chosse to not pay for health insurance.

People choose to not buy health insurance for a variety of reasons, one of them cost, one of them being young and foolish, one of them taking a risk of being uninsured "for just a few months" while changing jobs or insurance companies.

How to fix this?

1) Let Insurance get cheaper: Allow us the freedom to choose health insurance that is less expensive: don't force the "minimum" insurance to available to be the Mercedes level, when some of just want a Ford level. Let me peruse policies from across the nation for me to use here.

2) Hook incentive up to buying health insurance. No proof of health insurance? No driver's license. Anyone who can afford a car should buy health insurance. Anyone who is eligible for SCHIP or Medi-Cal who wants to renew their driver's license will have to enroll, and not wait until they land in the ER to be enrolled by the Social Worker. That will capture all the 18-34 year olds who are choosing to not buy insurance, and can easily afford it ( just one night less of partying and there you have it!), or those who are already eligible for govt health insurance

3) Can't legislate out risk taking foolishness, so I don't have a solution for those who choose to go a few months in between being covered by jobs etc.

As for those of us stuck because of pre-existing conditions, I hesitate to support any govt solution, but unless someone can come up with a reason why it would be bad for our country's future, I would support regulation which spreads the risk of all of us out to ALL the insurance companies. A shared pool that all high-risk or already diagnosed folks pay into? Met with every insurance company paying 10% of annual profits toward the pool? A law that has every insurance company required to enroll 10% high risk people? don't know..

I do know that I will not support losing the best health care system in the world. My kid would not be alive today if we had lived in Canada, and I will forever be grateful to a system which saved him ( under health insurance I had bought, instead of relying on what I used to think of as a great system in Canada, where I my son would have died).

I do not want any bureacrat rationing my health care.

Sorry, but further commenting on this topic has been closed.

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