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.
I only came in search of answers, never planned to sell my soul
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.
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
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
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.
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).
$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.
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.
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.
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
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
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).
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.
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
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.
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.
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
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
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.
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
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