OT - A intriguing "open lette"r on health care ...

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Lew Hodgett wrote:

Call Uncle Barak, I guess. Seems your answer to everything else; ask somebody else to take care your responsibilities.
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In designing critical systems (and I think health care qualifies), it is important to consider the failure points before they occur. So I think it was not only a fair question, but an essential one.
Then what? Some *will* be in over their heads. Is there a lifeguard or do they drown?
Both are acceptable answers (ultimately, all resources have limits), but avoiding the question definitely doesn't lead to good solutions.
Governing isn't about finding the easy 90% of the answer.
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Drew Lawson

I only came in search of answers, never planned to sell my soul
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Drew Lawson wrote:

Not according to Lew, apparently.
The problem I see is that the proposed solutions don't actually address the questions but only provide another unfunded mandate similar to the several that are already in place that we haven't yet figure out how to continue to pay for.
I have no problem w/ the idea of somehow making alterations; I simply would like to see the actuarial bases behind the changes a priori as well as how various things such as the electronic records that is being touted as a cost-savings tool (of apparently almost unlimited benefit to hear it sold) is actually going to defray which specific costs to offset the implementation, operation and continuing maintenance costs.
I've heard much rhetoric; little what I would classify as solid information.
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"dpb" wrote:

I'm not sure what the answer is, but the system is broken.
If you are wealthy you can afford to pay for health care.
If you are poor, then the government provides you with health care.
However, if are in the middle, you are SCREWED.
You get to purchase health care insurance that may or may not cover your particular problem when you need it most or have such a large copay that coverage becomes impossible to use.
An unfortunate situation such as an accident or a disease such as cancer, and the next thing you know, it's bankruptcy time, even with the best laid plans of financial advance planning.
There are lots of middle class families that planned ahead, but ended up with copay debt in the 6 figure class and bankruptcy, the only way out.
Allowing the private sector to be the fox guarding the hen house has developed a hodge podge safety net with far too many holes in it to be considered safe.
I'm not in favor of having the government being in the health insurance business, but I am in favor of government being the oversight business which probably does include having government provide "super high catastrophe" coverage and basic low end coverage.
That leaves a lot of room for the private sector to operate; however, some retooling of how they operate will be required.
Lew
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Lew Hodgett wrote:

I'm one of your "in the middle" people. I planned ahead - invested 10% of gross for 35 years and have insurance that I carefully shopped for. The wife had two major medical events in '05 and '06 and I had surgery for colon cancer in '05, all adding up to a large 6 figure billable total. The insurance copays weren't overly burdensome. The insurance company didn't try to get out of anything and there are no max coverage issues. The insurance premiums run a little over $800/month which is easily doable if you plan ahead.
My and SWMBO's folks are gone now, but both of our parents planned ahead and had insurance and were treated well by the medical and insurance folks. We had SWMBO's mom with us for her last four years, but it wasn't because of any financial problems on her part, rather dementia. My mom spent her last years living with my sister and BIL, again not for financial reasons, but debilitating conditions caused by a stroke at age 93.
So, I'm having a difficult time wondering why these folks you mention are in such tough shape if they have planned ahead financially and have good insurance (they looked carefully at the coverage before buying).
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$800/month may be doable for you, but there may be people for whom it is not. Example: 40-odd year-old couple (no kids, no more parents). Both lost full-time jobs. One of them can retain the job, but is only paid 50% as a part-time person. No benefits. Cobra costs over $1000/month.
That can be tough in NY City.
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Han
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Han wrote:

A forty year old couple with no health problems shouldn't have to pay anything like $1000/month. I pay $170 a month. The trick is to not expect insurance to pay for every checkup and the like. I have a high deductible indemnity policy--the deal is that they don't pay a cent until I accrue more than $2000 expenses in a single year, then they pay _everything_. It's old fashioned _insurance. The medical insurance business has moved away from that model to one in which the insurance company pays for every checkup and the like and on that basis there is no way for such a system to cost less than the patient simply paying the doctor for routine checkups.
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Han wrote:

Well, I lost my job in 1998 and my wife didn't work. It was still easily doable because I planned ahead and invested 10% of my gross from the time I started working. 10% is less than what you and your employer contribute to SS, yet if invested wisely, it will provide much more income and not be drained even over a lifetime. Compound interest/earnings are wonderful things.
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"Doug Winterburn" wrote:

Consider yourself lucky you had 35 straight years to build a nest egg.
In many cases a lengthily undisrupted period to build a nest egg was not a possibility for many reasons.
For a family earning say $48K/annum or $4,000/month gross, an $800/month health care premium or 20% of gross is probably a real stretch to handle, especially if you throw in say 35% for ALL taxes, and 30% for housing.
That leaves only about 15% or $600/month to cover all other living expenses.
Highly unlikely that scenario is going to fly.
BTW, the 6 figure unpaid bill referred to previously, was an accumulation of the remaining copay after the insurance company had paid.
Lew
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Lew Hodgett wrote:

"Luck is where preparation meets opportunity."

Why would anyone buy an insurance policy with a 6 figure copay, deductible or a ceiling which would leave you that unprotected? One needs to examine the terms and conditions before selecting a policy.

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"Doug Winterburn" wrote:

From what I was told, it was an accumulation of several events.
Lew
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Doug Winterburn wrote:

...
All it would take in total liability w/ a fairly typical 80% copay would be otoo $500K in billings to leave $100K.
That's why one indeed needs that catastrophic policy that does cover the big ticket items that ordinary/routine policies leave wanting.
Unfortunately, it's all too easy any more to reach upper 6 or 7-digit expenses for extensive treatments (and Lew, before you start, I've never disagreed that costs need some sort of containment, only that I don't see how anything so far proposed is going to help in that regard other than transfer one form of cost for another disguised one).
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As I see it the only way to get a handle on cost containment is to change the focus of how medicine is practiced.
We need to focus on the lower cost preventative medicine rather than the higher cost therapies required after someone gets ill.
To do this requires early like preventative care(prenatal, pediatric, etc) of all the population.
Producing a healthier young population that requires fewer high cost procedures later in life is the easiest way to reduce what are now a totally runaway costs to a more manageable level while at the same time improving over all health of the nation.
Lew
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Essentially, that's the same as saying the entire county population has to undergo a complete lifestyle change. What are the chances of that happening? Sounds good in theory and in practice, but it ain't going to happen in a dozen lifetimes.
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Upscale wrote:

Nor ime is it likely to make any real difference in EOL outcomes as technology continues to improve to extend life and the expectation is that everyone is entitled to receive every possible treatment to extend life as long as possible irregardless of eventual outcome (in the near term sense, obviously). With that increasing technology and the use of it are inherent higher costs.
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The governments WANT people to die young, 70 tops. No pensions to pay, no long-term care facilities. Keep the hospitals open for those who can be put back to work so they can be milked for taxes. An aging population, a sick population is bad for harvesting taxes. So smoke'm if you got'm.
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Robatoy wrote:

...but good for votes if you promise them the moon.

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"Upscale" wrote:

No, not at all.
What I am saying is that a significant portion of the 6 and under population are not receiving adequate preventative health care in their formative years which leads to higher cost medicine in later years.
As far as a change in lifestyles is concerned, a healthier population may want to live a healthier lifestyle, but it isn't something you can quantify.
Lew
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Lew Hodgett wrote: ...

... You're back to the same problem you didn't want to hear earlier--the bulk of those are in that fix because of either sorry parenting or that they're in the part of the society that isn't covered currently and extending that care to them is going to cost more in additional services than it can bring in.
I'd be surprised if it could be showed by tracking cohort studies that most of that same population are the ones actually getting the very high cost extensive care at or near EOL.
Either way, they're not the ones who will bring any resources into the system to help defray expenses.
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Ok, my mistake. I thought you were referring to the entire lifeline, not children in their formative years. And, what you say does make sense, but why are they not receiving adequate preventative health care? Is it solely a financial reason?
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