Starting a real conversation about health care reform
By Sen David Vitter Posted in Congress — Comments (83) / Email this page » / Leave a comment »
I hear from thousands of Louisianans each year about their struggles to pay for rising health care costs. During this important election year, health care has become an issue of national debate, and this week I joined with six other senators from the 2004 Republican class on an initiative designed to make sure that debate includes discussion about how we can best help individuals and families own their health insurance and prevent government bureaucracy from running Americans' health care for them.
Sens. Jim DeMint and Richard Burr joined me in a kick off discussion at the Heritage Foundation yesterday, and the entire group’s objective is to educate our colleagues, the media and the American people through a series of U.S. Senate floor speeches and in other activities about common sense conservative proposals in the health care debate – including ways to address the rising overall cost of health care.
Now, more than ever, Americans are turning to Congress to fix a broken health care system. Some members of Congress have misconstrued the public’s call to action as a mandate for a government-run health care system. But a federal government take-over of health care will only lead to a system mired in even more bureaucracy and will remove choice from doctors and patients – where it should stay.
Health care must be centered on the doctor-patient relationship, and patients must have the opportunity to choose the most suitable plan for themselves and for their families. There is a clear contrast between a liberal, government-controlled health care system and conservative reforms that can provide American families with choice and control.
Over the next eight weeks, U.S. Sens. John Thune (R-S.D.), Johnny Isakson (R-Ga.), Mel Martinez (R-Fla.), Jim DeMint (R-S.C.), Richard Burr (R-N.C.) and Tom Coburn (R-Okla.) will join me in discussing these conservative health care principles that we know can reform this broken system and bring a patient-centered, high-quality and low-cost system of health care to American families. Our health care is too important to be wrapped in red tape and placed in the hands of a government bureaucrat. This is your health – your family’s health – and the choices you need to make should be made by you and your doctor, not a bean counter. My colleagues and I want to ensure that this power remains firmly in your hands and not in the hands of the federal government.
Senator McCain's plan looks good on paper; even if many details are lacking. How will the rising costs be addressed?
Here are a few things to consider:
1)Allow insurance to compete around the nation
2)Give a tax break on private insurance
3)Create a minimal catastrophic policy with a deductible which each provider would have to provide to everyone with no screening. This could be improved into a better policy by the company for selected clients.
4)Governments can pay part or all of this premium for those who cannot pay.
5)Give private insurance more power to negotiate high charges.
These suggestions are certainly not "free market" but we do not have anything like a free market in health care right now, so let us not pretend that we do. These things would preserve freedom of choice for patients better than an left wing scheme
"Nothing works like freedom, Nothing succeeds like liberty"
Kyle
Dear Senator Vitter, in your post you stated, "...Americans are turning to Congress to fix a broken health care system."
I would present back to you that the context you are addressing this problem is the first big problem in addressing this issue. Am I nit-picking? Maybe. The thing here is that we have the greatest health care system in the world! There is nothing wrong with it!
Here is the problem best stated by you in your post, "I hear from thousands of Louisianans each year about their struggles to pay for rising health care costs." The problem is afford ability and the ability to pay for medical care, not the medical system it self.
Please do not dismiss my post as something from a nut. I am someone who has first hand experience with the huge medical costs a family can endure. I was diagnosed with a very rare blood ailment 4 years ago. There is a treatment for it, but it has such a high rate of death potential, it is safer to just undergo regular therapy to manage the condition.
The therapy I must undergo is very expensive. However, I have found by shopping around that the therapy I need can cost from $7,000 to $1,700 per visit! I have to undergo this every month - do the math! I now go to a private clinic where I now pay the$1,700 per visit.
Why the extreme disparity in costs for the exact same procedure? I did some research into that too. I have found that those providers who are "public providers" such as public hospitals, charge upwards of $7,000 to compensate for the cost reductions forced upon them by Medicare and Medicaide cost caps. Then of course, another factor has to do with their ability to recoup the costs lost by those who cannot pay for medical care, and they are forced to "eat" the loss. So, providers bill at much higher rates for those who can pay to offset the costs. This is at the heart of our "medical financing crisis".
In my opinion that is the dramatic thing about this debate that is upsetting to me. The Republicans in Congress have accepted the Democratic position for starting this debate as a health care crisis, when we have the greatest health care system in the world. Instead it needs to be framed accurately for what it is - It is a health care financing crisis. Try calling it that as a start to your debate.
The problem of this health care financing, based upon my now significant experience and research, has to do with government mandated distortions in the medical financing system.
The government placing caps on what doctors charge for procedures, and judges mandating that emergency rooms cannot turn away people who have a cold, but can't afford to pay for a doctors visit are what is creating the distortions.
My suggestion? I know that this will not happen because Congress doesn't have the stomach for actually imparting a real change, but here it goes....
The best way to remove the distortions in the system is to have Medicare and Medicaide scrapped totally and replaced with a market based system.
The best way to create the best system, rather than political grandstanding, is to use the model used in the base closure commission. Have Congress pass legislation that institutes a commission to study the problem, develop a solution (a total overhaul) and it can be brought before Congress without any ability to amend or alter the legislation. You can only have a strait up or down vote, nothing more. I would further add that no person who has held elected office at the Federal or State level, or any registered lobbyists can be part of this commission. It can only be professionals in the medical and finance industry who understand how these things work and would not kill our economy or government budget.
That is my two cents on how to deal with this issue. I thank you for stopping by an asking - honestly!
Wubbies World, MSgt, USAF (Retired):
public static void main(String[] args) {
System.out.println(""The only reason that some people get lost in thought is because it's unfamiliar territory.")
... a flat rate 75%. The other 25% is out of my pocket. That is why finding a lower rate provider has saved me a lot of money.
Wubbies World, MSgt, USAF (Retired):
public static void main(String[] args) {
System.out.println(""The only reason that some people get lost in thought is because it's unfamiliar territory.")
I live nowhere near a base and therefore I am not eligible for Tri-Care Prime. I have Standard and that is why I am stuck with the flat rate percentage.
There is a lot to be said for shopping around. It saved me a ton of money. However, the shopping around part educated me on how it all works. I included the total cost of the procedure to be demonstrative of how much things costs and the differences in prices when government distortions are present.
Wubbies World, MSgt, USAF (Retired):
public static void main(String[] args) {
System.out.println(""The only reason that some people get lost in thought is because it's unfamiliar territory.")
I know every once in a while the government tries to screw retirees out of their health care benefit. Glad to hear they are helping out.
We are eligible to retire in a couple of years and will probably be near a base, but I will opt for civilian care. While there are some fine doctors in the AF, I hate the system. It really sucks in terms of customer service.
I'd say much more, but I must get busy packing. It is Spring Break and we are going on a cruise.
...the civilian medical system over the military. That is why I am not complaining about the cost. It is what it is, but I sure did find out a lot about why it is that way.
Wubbies World, MSgt, USAF (Retired):
public static void main(String[] args) {
System.out.println(""The only reason that some people get lost in thought is because it's unfamiliar territory.")
...mandate that hospitals and doctors post there procedure rates instead of them being hidden until the bill arrives. Asking about rates is like pulling "hen's teeth".
Wubbies World, MSgt, USAF (Retired):
public static void main(String[] args) {
System.out.println(""The only reason that some people get lost in thought is because it's unfamiliar territory.")
...tell you how much a procedure costs until they know how much you can pay. If you have good insurance, you pay more to make up for those who can't or won't pay.
Wubbies World, MSgt, USAF (Retired):
public static void main(String[] args) {
System.out.println(""The only reason that some people get lost in thought is because it's unfamiliar territory.")
First, thank you for your service, Master Sergeant.
But also thanks to everyone for the thought-provoking posts and suggestions. I hope to continue this dialogue with your help and the help of my fellow Republican classmates over the next seven weeks. It’s important to remind everyone that conservatives are never short of good ideas to tackle our most pressing problems.
"It’s important to remind everyone that conservatives are never short of good ideas to tackle our most pressing problems."
Freedom of Religion not Freedom from Religion
Unfortunately, if more people read (and took to heart) Thomas Sowell's Risks and Insurance chapter in his book Basic Economics, they would come to the same conclusion. And it doesn't mention one word about health insurance.
www.fairtax.org
Sick of Government Expansion? libertarian-Minded Republican? Check This Out... Republican Liberty Caucus!!!
www.rlc.org http://www.republicanliberty.org/
Wubbie's being too nice, I'll go a step farther and say that the phrase "broken health care system" is a cheap propaganda trick in the class of "big lie told often enough"; it's used by the Dems to bypass the need to justify why a(nother) major aspect of our lives must be turned over to the control government bureaucrats who, by dint of being bureacrats, know better than we do what's best for us.
The Dems use this kind of rhetorical code because they're political opportunists who need to create a continual crisis atmosphere to fuel thier power grabs. I don't know why a Republican would use it (twice!), but for some reason it annoys me even more in this situation. Maybe it's that I expect more from a Republican than the serving up of democrat code phrases in new and unique ways.
Look, we have more people covered by health insurance than at any time in our history, and the system provides excellent care to more people than the systems in England, Canada, and Cuba combined. That doesn't sound "broken" to me. The fact is that it's not that difficult to find a job in this country that provides health insurance (at the least, a high deductible major medical policy), and it's not that hard to find an existing government program to cover you if you simply can't get a job.
Are there people who fall through the cracks? Certainly, and a major illness is going to create a financial problem even with insurance. The system is by no means perfect, as Wubbie pointed out. But I have to ask myself just how many of the "thousands" of people the good Senator hears from are victims of bad life decisions rather than victims of the "broken" health care system.
So, Senator, by all means present free-market alternatives to the grand socialist plans, I'm happy to hear any idea that makes a good system better, particularly if it's not going to make me pay for someone else's health care or diminish the quality of the health care I pay for. But please, don't insult my intelligence by using the same word games as the Democrats.
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"You can't save the Earth unless you're willing to make other people sacrifice" - Scott Adams (speaking through Dogbert)
I'm really new to the insurance debate, I'm failing to see how the "free market" solution is different than what we have now?
It seems that whatever regulations we have in place if any have done nothing by skyrocket the price of individual insurance and costs.
I was no insured for a long time before I got my current job, I could not afford to buy my own insurance, not by a long shot.
A tax deduction wouldn't have helped me because I still would have had to pay for my insurance up front and then deduct it from my taxes, how am I supposed to get the money to begin with? The tax rebates or deductions don't do anything to help if you can't afford the insurance in the first place.
I'm not trying to troll, I'm genuinely in the dark about this. I don't want the federal government to take over healthcare, and I'm not one for a hand out, but I know that I'm not the only one who couldn't ever afford to buy my own insurance even with a tax incentive, the bottom line is you still have to pay for it with money that you most likely don't have in the first place...
Now that I have insurance, my claims get kicked out as "above the customary charge". I live in Alaska and doctors in the bush are treated on the same scale as a doctor in Seattle in terms of what is an allowable charge.
It seems to me like we have very little option other than insituting some form of price controls and heavy regulation. The free market has done some amazing things for oil prices. The airline industry is really keeping up its quality work since they've been deregulated, Southwest in particular seems to have done a bang up job. Deregulating the energy market (electricity) was really awesome for most Californians and Enron stockholders. Free market solutions work when the playing field is level for all participants, I don't see how we can get back to a level playing field when it comes to healthcare The person who makes 20,000 a year should have access to the same coverage that a person who makes 500,000 a year does.
The argument that regulation will reduce the quality of care we receive seems like it doesn't follow. Will the doctors get their medical degree quicker with less requirements if they can't charge as much? Will all nurses just be requried to have a GED?
This is going to be a big issue, its one that needs to be solved, I don't think the republicans have it right, and the dems don't either. Both sides holding out for what they want will never get us anywhere. Not on the war, the economy, or this. We need a middle ground on all of the above.
It is not a free market if your employer is paying for your health insurance. They will pay for the cheapest thing they can get away with. Why do they get a tax break when someone who buys it on their own doesn't? It is also not a free market when you pay a flat fee for any prescription drug purchased anywhere. The only people who check the prices are those who have no insurance. Because they are in the minority, market forces are not at work for drugs. The same is true of most medical procedures. Most insurance only allows a small co-pay for all the same procedures in almost every hospital that can perform it. Most people don't pay attention to costs because they pay so little. There is very little market force for Doctors either. Medical schools routinely turn away straight-A students. The supply is artificially kept low.
face enormous restrictions when trying to compete across state lines. Additionally, the government mandates certain coverages. A free market would be similar to auto insurance where you could pick, a-la-cart, what coverage you did or did not need, deductibles etc based on your lifestyle risks.
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"Enlightened statesmen will not always be at the helm." -- James Madison
"The person who makes 20,000 a year should have access to the same coverage that a person who makes 500,000 a year does."
This thought is why our system costs so much. Money and power buy stuff nothing anyone does will ever change that(excepting some divine event.)
The Most that can be asked for is a True cost, and portable policies.
I agree completely. The mindset that everyone must have limitless access to health care is simply unworkable but no one wants to talk about how health care should be rationed. Capitalists would ration it with money while socialists ration out health care by providing it to those willing and able to wait in line. I think capitalism is the way to go myself.
The more money you make the more right you have to health care, and therefore life, correct?
Granted, health care isn't a constitutional right. But damn man, there has to be a degree of compassion here. I'll be the first to admit there is a very thin line between compassion and the slope to socialism, but isn't the premise of our country we're all equal?
It's true there will never be a way change the fact that if you have more money you can get better and more things. We're talking about people here, not cars our houses. If a rising tide lifts all boats, then we should be doing everything in our power to make sure everybody is healthy enough to work and spend their money.
One of my major issues with the Right's take on health care is their "right to life" platform only applies to the unborn.
We Right-wingers maintain that no one should be forced to provide health care. We generally maintain, though, that we should support medical (and other social services) for the needy through charity. Contributions to medical charities nullify the issues of people who can't afford health care.
Though he may not be well-liked, HWMNBN's life story actually illustrates the success of this point. When doctors can afford (themselves) to volunteer (or be compensated) to provide medical treatment for the needy, rather than having the government finance it, we free-marketers are quite happy, and those who need health care have access to it.
According to here and here and here, there is plenty of upward mobility to go wround to the poor today. If the vast majority of Americans (and other free market economies) move up from the bottom 20% in income to the top 20% of income sometime over the following 20 years, they will eventually be able to afford that health care.
If they're young (and supposedly poor), most won't be forever, despite what the class warriors would have you believe. How in the world do 28 year olds survive without health care on demand?
www.fairtax.org
Sick of Government Expansion? libertarian-Minded Republican? Check This Out... Republican Liberty Caucus!!!
www.rlc.org http://www.republicanliberty.org/
and I don't think the Right is against compassion. We don't define compassion as having the government take your money and give it to me though.
I take issue with your contention that there is a right to health care - there isn't. I do think that it's clearly in the nation's best interest if everyone gets good quality health care but that doesn't make it a right.
You didn't address the point I was making though. Someone has to ration out finite health care resources against demand. This means you have to say no sometimes. How do you propose that decision should be made? Insurance companies currently get endlessly criticized for making the hard decision and denying treatment - I'm not going to defend their individual decisions but they have to say no sometimes or they're out of business.
...difficult issue.
What you're saying is that every American deserves a basic level of healthcare as a matter of social justice. Quibble with the terminology all you want, but that's the nut of it. (You actually formulated it the other way around: that as a matter of compassion, no one should get better healthcare just because he has more money.)
Free markets are exceptionally good at matching supply with demand. There is most definitely a lot of demand for basic, low-cost healthcare. But as many commenters here pointed out, the current market for healthcare financing is anything but free.
And the lack of market-freedom prevents the emergence of low-cost solutions that provide a basic, minimal level of care.
As Senator Vitter proposes, we can go a long way to allow the market to find its way to that kind of a world.
But it's not going to be good enough for people who think like you, for the simple but critical reason that it will still allow better-off people to get access to better care.
If the goal is affordable healthcare for all, then a free market would be the best solution.
But if the goal is equal healthcare for all, then the government is the best solution.
And that's why Senator Vitter's excellent efforts will ultimately fail.
More money will buy access to better quality care.
"If a rising tide lifts all boats, then we should be doing everything in our power to make sure everybody is healthy enough to work and spend their money."
Again Why is it our job to make sure everyone is healthy?
Thinking like that leads to nonsense like the transfat bans excreta. If people want basic care for all children or better and cheaper access to antibiotics for all there are programs for the first and new free market programs starting for the later (Wal-mart clinics). If what folks want is transplants for all I would say yes they are out of luck.
Lastly you complained about the right to life for the unborn not being extended to all. Well the unborn are total innocents (with no voice) who are being destroyed just because they exist (and mainly just for convenience sake). Adults have made choices throughout their lives and their right to life is not a right to not die.
The rising tide HAS lifted all boats. There are medical procedures today that are commonplace and (relatively) inexpensive that simply werern't available at any price 30 years ago.
_________________________________________
"You can't save the Earth unless you're willing to make other people sacrifice" - Scott Adams (speaking through Dogbert)
....your health care is already being rationed...not by government...but by the insurance company. You likely have some kind of managed care requirement that you contact the insurance company before entering the hospital to make sure the insurance company approves the hospitalization (and people talk about government coming in between a person and their doctor...insurance companies have been doing that for years), your doctor must keep in contact with the insurance while you are in the hospital to make sure that the care your doctor is providing is not excessive in the eyes of the insurance company, you may not use the emergency room for a non-life threatening emergency or you will pay the cost, and you likely have a life time maximum of your health insurance beyond which you are on your own.
And the insurance companies make a tidy profit off this type of arrangement.
Frankly, it seems to me that if we get rid of the insurance company middle men...we could use the money paid to them to provide health care to those who are not fortunate enough to have access to it.
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Health care is rationed under some private health insurance plans, but not all. It is actually not that hard to find insurance that doesn't require precertification, you just need a good insurance agent that is willing to represent more than just the big name companies.
And I should not, that the health insurance company acts in trust for its policy holders. Therefore it is the policy holders that have chosen to ration the payment of benefits. This is very different from rationing health care. You are confusing two different concepts. Even if your insurance company will not pay for a procedure, it does not mean that you do not have access to the procedure. You must, however, provide for alternative funding.
Thirdly, if you can show me where more than 1% of policy holders have ever reached their lifetime maximum I would be incredibly shocked. The minimum that I have seen is $2,000,000. That really is a lot of money.
Please take time to learn what health insurance really is. It is a program designed to help people pay for the extreme circumstances that they would not ordinarily be able to pay for themselves. It is the large group policies that add benefits for everything under the sun that has addicted us to $20 copays at the doctors office and cheap drugs. If you remove those two categories from an insurance policy, the monthly premiums drop by approximately 25%. But try convincing a healthy adult that they are better off paying full price for a doctor's visit when they only go at most once a year.
Fighting for conservatism one day at a time.
....perhaps if it is a mutual insurance company, but if the the insurance company is a stock company, then the insurance company acts firstly in the interests of shareholders, not policy holders.
As far as maximum lifetime limits on health insurance policies, a recent article from the Washington Post stated:
More Hitting Cost Limit on Health Benefits
A small but growing number of American families beset by major medical problems are learning the hard way that simply having health insurance is sometimes not enough.
Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies.
That has left some very sick people facing health-care tabs of hundreds of thousands of dollars or more, prompting their families to seek help from the government, or to scramble to change jobs or even divorce for no other reason than to qualify for new health insurance.
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If health care insurance has any place in a capitalist society it is to cover these extreme cases. Our son also blew through a one million cap due to major trauma (wrong way hit and run driver being chased). He actually went through 2.2 million on the way to recovery (and his life will actually never be the same as it was before). The basis for setting the one million cap is that most trauma accidents that would reach this level in fact kill the victims, but if people are risk adverse I would recommend more than 2 million if you have the option of buying more. Of course many diseases can reach this cap as well, so be a prudent consumer.
In a discussion about insurance, options like these should be offered at increased cost. My view is that we actually have a very good system provided people make logical and statistically correct choices. (Too many programs do not offer enough choices in the area of lifetime caps, annual deductables, and the ability to kick in more for a specialist when the insurance company does not agree.) How do we go about educating the people about their choices? I would be very interested in a good survey about what people think will happen if they get hurt or sick. My guess is that many people assume that the government will not let them suffer, but I would also guess that they really don't think about the consequences.
When young and healthy people believe that they will never need health care they are being foolish, but if they want to opt for a basic high deductible extreme care policy they often cannot find it. So they take a risk and fall back on the safety net when they get unlucky. If products were more widely available and people were counseled appropriately my view is that the market health insurance would work the way it was intended to.
....a $5,000 hospital bill would be an extreme case. And the current health care system does not recognize that or consider it to be much of an issue at all..
should be available for these people to purchase. No one is immune to health concerns, and people should be responsible for their lives.
If for example a $5,000 bill would break the bank then the family should be aware of where these limits could be exceeded, (car, home, health) and these should all be covered with enough insurance to keep the family solvent if these things should happen. (I am not opposed to some safety net, but people still bear the greatest share of the responsibility.)
...isn't it.?
You see the issue as simply one of recognizing that a $5,000 hospital bill would break a family financially...and one simply plans for that via sufficient insurance.
I see the problem as a family is well aware that the $5,000 hospital bill will break them, but the lack the financial resources to purchase insurance to protect them from that possibility. They do not take that risk (no insurance or inadequate insurance) because they want to, they do so because they have no choice.
because there are affordable policies out there designed to help individuals who are stuck in the middle (too rich for Medicaid but can't afford a major medical policy)
People like me, insurance agents, need to do a better job getting the word out that just about everyone can afford a policy. Problem is that most agents are too lazy to do the work to find other carriers than the big names.
Fighting for conservatism one day at a time.
Why is there no choice? We are not talking about when the problem occurs, we are talking about a lifetime of dealing with the issue. Not enough money? Well, there are solutions to this. I for example would like more money so I am applying for a job. (I know I am of retirement age, but I still have something to offer an employer.) I said that I was not against a government safety net, but a safety net is only there for a short term tight situation. I don't accept that people can't resolve their financial problems given the time and energy to solve it. I appreciate that the insurance industry needs to educate the consumer with the policies that can help and these policies need to be available. I don't mean to be unsympathetic, but hard things happen to everyone sometimes. The key is what you do about it. (And by "you" I don't mean the government.
what it was designed to do, that is a bad thing? Definitely not. I blame two people: The families for not purchasing enough insurance ($1MM...I don't even carry a policy that is that small) and the agent selling the policy for not having the guts to tell people that $1MM is small potatoes.
What would their situation have been if they were uninsured? A lot worse. They would have been looking to the government a lot earlier. Or even worse than that, they may not have been seeking medical treatment at all. That sounds like a much better situation, sure!
And your article gives nothing other than anecdotal evidence to support that those reaching their caps is on the rise. Besides, as someone who sells health insurance, the premium difference between $3MM and $5MM is roughly $7-10 a month...yes that little a month for $2MM extra in lifetime benefits. Quite frankly, I tell people that they would be stupid not to purchase the additional protection given the ridiculously low cost to upgrade.
As for your contention about the stock vs. mutual company, while technically true, really couldn't be further from the truth. Companies know that they must keep their clients/patients happy otherwise they will go somewhere else. That wouldn't make their stock holders very happy would it? I'd have to add it up, but I would say that roughly 40-50% of the sales that I make is because a company ticked off one of my clients so they look to switch to another company. The companies are getting the message: I have seen a flood of new products hit the market in the last 6 months that are designed to help just about everyone get some form of insurance. And I can bet that the trend will continue for quite some time.
Fighting for conservatism one day at a time.
....you might be seeing a "flood" of new health insurance products from insurance companies now is because the insurance companies are scared stiff. They see the writing on the wall with voters putting health care reform at the top of their lists of concerns for the upcoming election.
People are FED up with insurance companies and their arbitrary rules..even to the point of insurance companies canceling coverage when people get sick. People are looking for the federal government to step in and administer some stability and humanity to our current health care system which are now sorely lacking.
And that reform does not include offering some bogus health care spending account "self funded" with monies that long ago were spoken for to pay for the increased price of gas and food.
would be valid except for the fact that it has very widely been accepted in the market. Consumers love it. It has become incredibly popular and is receiving good reviews from the people that I talk to that have had it for a few years. People like paying less for their insurance and being able to keep that money that they don't use.
As for your notion of scared stiff...that is the market at work. The market is reacting to the public. How is that a bad thing? This is exactly what we want. The companies are responding to the publics demands for new products that fulfill needs that weren't being fulfilled before. Everyone is going to win as long as people in my position make sure that they are educated on the new products and aren't afraid to recommend them and challenge people on their stupid notions (of cheap copays at doctors offices, cheap drugs, etc when they may not use these benefits buy once or twice a year.)
Arbitrary means that they are made up as they go along. The rules are carefully crafted based on statistics and ensure the integrity of the companies financial status. If a company approved every treatment available, that company would either go out of business or be forced to raise premiums sky high to cover the costs (remember health insurance is pooled risk. That means that everyone would pay to cover for someone else's experimental surgery) You can call it heartless if you want, but it makes a lot more sense than potentially bankrupting the company.
Fighting for conservatism one day at a time.
I have had a good experience with insurance through my employer at the various jobs I have had, but one thing that always looms in the background is concern about what happens if you get laid off.
Fortunately you don't lose your insurance outright- you can at least keep the same coverage through a COBRA for an extended period of time. But the problem is that a COBRA will cost $2,000+ per month for coverage (for family coverage), vs. maybe $300-$400 monthly out of pocket for the same coverage while you are employed.
So the problem is that as soon as you are in a situation where you are cash strapped (you lose your job), your cost of insurance goes up by 400% or more.
There are two ways to address- 1) shift away from the employer based system to allow people to own lower cost, high deductible polices that they pay themselves or 2) If the employer coverage system will remain basically intact, mandate that your employer has to continue your subsidized coverage for some minimum period (at least 3 months) if they terminate your job.
But the purpose of COBRA is to continue coverage until another coverage plan takes over without leaving the insurred person with a "break in coverage" which can result in prior conditions not being covered. COBRA corrects a major flaw in the prior coverage issue for people who have insurance and then need it. The high cost of COBRA is worth the price for this reason.
A better approach than those you have named would be to provide a medical health care account to pay for the COBRA coverage if you lose your job. Of course if you lose your job because you come down with a health care problem it is a double whammy but it is not the employer who should pay for this. Perhaps insurance policies should have a COBRA rider that can be purchased in the event that a health problem results in job loss? This seems like something that insurance could be designed for, since there is a statistical relationship that would define the cost of COBRA insurance continuation.
contribute to Health Savings Accounts (HSAs) while you are employed as they do with 401Ks. These accounts, coupled with high deductible insurance can ensure employees coverage whether their employed or not, since the employees own the HSA. The premiums for these high deductible plans should be tax deductible and for those who are at a certain level of poverty, they should get a tax credit/subsidy to help pay for the premium For those who become unemployed and own an HSA they should automatically qualify for a full premium credit. I think according to John McCain's plan that credit would be about $3000 per year.
Could you keep building it up over the years as you are employed? Or would it be of a size that grows with inflation?
Erik
Such an account will grow like any type of investment account, depending on the type of investment (your risk tolerance), but more importantly your health. If you adopt healthy habits, your account will grow by virtue of the fact you're not spending it. Of course from there you can envisage insurers giving account holders benefits for not smoking or for adopting an exercise regiment, etc (reducing moral hazard). So the accounts would grow however you wish, assuming the government places no limits on what you can invest in. To be sure, those investments should mostly be liquid investments, but it would not be unreasonable to have a portion of the account, say 20% devoted to long term health care expenses, i.e., health care in your senior years. Those investments I would put in stocks to grow over the long term.
I was thinking about the HSAs similar to flexible child care accounts. If you don't spend it all, you don't keep it at the end of the year.
Erik
I mean you don't get to keep the money you put into the before-taxes account. It "vanishes".
I would prefer to be on an HSA - would have saved me a lot of money over time.
Erik
Unlike FSAs (flex savings accounts), even with an employer contribution. I think this sort of insurance arrange is a win, win, since it benefits the insurer in reducing moral hazard and having the insured adopt more healthy habits. It benefits the insured, by providing them funds for routine care and a growing investment if you manage to stay healthy. Of course these plans can be exotic and can include mandatory checkups or other services covered by your monthly premium. Finally it allows for individuals to purchase the insurance the can afford. If you can afford a higher deductible or lower deductible, higher premium or something in-between then it will be your choice to see what you're comfortable with.
but I am concerned that like always, this conversation will be confined to our little conservative blogger/activist community.
Just how, I am curious, do you and your colleagues plan on informing the American people of this discussion? This is the biggest problem that we conservatives have. The media obviously cannot be counted on to cover it, we have to find creative new ways of exposing large amounts of people to our ideas and arguments.
pertains to malpractice litigation? Also, I'd like to know what your position is regarding pick and choose health insurance. I feel that insurance could be much cheaper if I didn't have to pay for things that will never apply to my family's situation. Thank you sir,
Tim Schieferecke
Senator Vitter for starting the conversation.
Go De La Salle Cavaliers!
when we're in the minority. Maybe if we get a Democrat President, we'll finally be able to reform social security & secure the border too!
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"If we want to take this party back, and I think we can someday, let’s get to work." – Barry Goldwater
There was a nice little cottage industry of shirt and bumper sticker sales in the back pages of the American Spectator.
1993 led to the Rush boom, Fox news, the beginning of the conservative internet and radio outlets, the emergence of Newt Gingrich, the foundations of the Contract of America, the recruiting quality candidates for the historic landslide of 1994, conservative unity, remarkable fundraising, and middle America's rejection of the liberal agenda being aggressively pushed by Bill and Hillary.
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"If we want to take this party back, and I think we can someday, let’s get to work." – Barry Goldwater
Yeah, after fifteen more years of academic, mainstream media and Hollywood brainwashing and a whole new generation of dumbed downed American voters. The more success we had, the more vicious the opposition became.
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"If we want to take this party back, and I think we can someday, let’s get to work." – Barry Goldwater
I might be able to, but I wasn't alive. I do remember how despondent I was in the winter of 92/93 and how excited I was during the winter of 93/94. A remarkable year. Truly historic for the conservative movement.
...resulted in the last time either party had a 2/3 majority in the Senate, making it unlikely that any filibuster would succeed as well as providing the necessary votes for a veto override, although with one party controlling the House, Senate and the Presidency, that would not likely have been an issue.
recover from the twin maladies of the Great Society and the war in Vietnam, and there is plenty of evidence that the recovery isn't complete.
Our people in Congress need more experience as the majority. This requires strong discipline, as in providing primary opponents to RINO's and general opponents to D's. Then, let a fully-experienced R majority and an R president return our nation to its roots!
For a conservative viewpoint, why not take a look at this in terms of supply and demand? In particular, the supply can be increased.
While it's great that we have high standards, it's not at all obvious that getting an M.D. and completing internships have to be quite so burdensone. There's an appearance, at least, that the AMA has chosen to restrict supply to keep prices high. In other countries, without this union, medical fees are far lower. Making sure medical schools have incentive to graduate larger classes would be minimal government interference for great gain.
In the shorter term, the only purpose of insurance is to reduce risk - specifically, of costs that are too much to bear. It should NOT be the basis for routine care. Subsidizing it is just a gift to insurance companies at taxpayer expense. If welfare payments are unable to cover basic preventitive care, then there's something wrong with welfare payments.
the theory is people should have a choice, if they want to pay less for someone less qualified, then they should have that right. You have to give the AMA credit, I think they have made that option unthinkable in most people's minds, hence, they have control of supply.
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were paid what their patients could afford. They might get paid with cash one day, or a few chickens the next. The reason aspirin can cost $5 and an nights stay in a hospital $400, it BECAUSE of insurance. If we limited insurance to only catostrophic injuries, and not countless trips to the doctor for colds, we would greatly reduce medical costs.
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Molon Labe!
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but you will have a very hard time convincing the public that they aren't entitled to a $25 copay at the doctors office. Trust me, I deal with that attitude on a daily basis. I will have someone tell me that they haven't gone to the doctor in years, but when I suggest changing to a policy that is much cheaper but has either a higher copay or no doctors visit coverage, they go ape stuff on me. People have a feeling that they are entitled to those benefits. That really came out of the desire by corporations to provide better benefits for their employees. When the catastrophic end of things got over-fulfilled, the companies had to start adding in other benefits (dr office copays, Rx copays, dental, etc).
Fighting for conservatism one day at a time.
but I will ad one more "prescription". They should get rid of the idea that companies pay for insurance. We all know that insurance payments are just part of what a worker is paid, the worker should be allowed his full salary and be forced to fork over the insurance costs on a monthly basis. If that happens, people will wake up to what they are paying and demand some changes. Also, it is stupid to tie health coverage to work in the first place. We should all be self insured just like we all pay our own gas bills etc.
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but most people don't realize just how ridiculously expensive COBRA can be if they ever leave their employer. Anyone who has diabetes, Crohn's Disease, cancer, etc. really should never leave corporate America under our current system. They would never qualify for anything other than either a HIPPA sponsored plan or one of the many state insurance pools. The problem is that those plans are usually 5 times the cost of a healthy individual (because they are issued on a guaranteed basis). Most states require that you exhaust your eighteen months of COBRA before you can join the pool if it is made available to you.
More people really should be taking their health insurance into their own hands. It really is a better way to protect your future. The only thing stopping it is the fact that a lot of big companies pay a portion of the premium and individuals usually have to pay with after tax dollars. [There are ways to get around the tax advantages, but it doesn't mean that the individual owns the policy. If they leave the company they still end up being offered COBRA and the tax advantages disappear.]
We MUST pass the recommendation that President Bush has made the last two State of the Union Addresses and allow individuals the ability to purchase insurance on a pre-tax basis. It won't solve all problems, but it is definitely one step in the right direction.
Fighting for conservatism one day at a time.
YEARS ago, my sister sprained her ankle severely, requiring a trip to the emergency room. Hew husband, a teacher's union bigshot had 100% coverage -- not even a co-pay.
When the bill came back, all paid of course by the union insurance policy, she examined the bill. Under surgical supplies was a $50 charge. That $50 bought the insurance company a $.50 Ace bandage. The hospital knew it could charge $50 because the insurance would cover it without question and the patient would never see the cost.
My sister was outraged, but of course, the insurance company did not care.
THAT is what is wrong with the cost of medical care.
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I think it is a pretty common practice for doctors to charge uninsured cash payers less. Since most people don't really pay their bill (except in increased premiums every year), the doctors can charge an arm and a leg.
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I am not qualified to enter opines yet. Will recc you include Senator Corker from Tenn. He is able and willing to help. Will pass this to him.
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If Insurance were owned by the individual instead of being tied to your job, you would not be faced with COBRA shock and lapse in coverage you find yourself in when trying to find that next job.
I provide my own Catastrophic coverage for my Family and am self employed. If I ever decide to go back to work for another Company, I'm not sure I want to take their coverage.
I have a $5000 deductable and spend about $300/month for coverage. And, I do get better pricing on Doctor visits when paying Cash.
The problem is lack of choices in policies. Jobs offer insurance as an inducement to attract and retain good workers, there is nothing wrong with this. But workers should have the option of seeking a different policy, (like those available to the self employed) and keeping the money that the employer would spend. Also different levels of deductibles, coverage, lifetime caps, and office visit copays should be offered int he mix. Too many people having too few choices makes the system work in unintended ways. (Such as charging the insurred more to cover for deficits elsewhere.)
It is amazing how many people will be shocked by that last sentence. It really is the truth though. Many Drs are very willing to work with their patients to help them afford the costs of medical care. In many cases, the doctors may make more money off this arrangement because they don't have to pay someone to file the claim, follow up with the insurance company or bill the patient anything owed.
But, as I said in other spots on this discussion, it is incredibly hard to convince someone that they don't have a right to a low copay at the doctor's office.
Fighting for conservatism one day at a time.
is that we would see wages rise if individuals were purchasing their insurance and not the corporations and businesses.
Not that overall compensation would rise, but wages would. Maybe then we wouldn't have to hear union bosses complain about low-paying jobs. Wages have been suppressed because companies have been willing to pay more in benefits.
According to the Department of Labor Statistics, from 2004 to 2007 overall compensation has risen from $24.95/hr worked to $28.11/hr worked for civilian occupations which includes workers in the private non-farm economy excluding households and the public sector excluding the Federal government. That is a 12.6% rise in total compensation [The measure of wages plus benefits.] In that same amount of time, wages have risen from $17.71/hr worked to $19.62/hr worked. That is a 10.8% rise in wages. Benefits rose from 29% of total compensation to 30.2% of total compensation in the same period. Government employees saw similar changes.
Fighting for conservatism one day at a time.
Click on 2004 forward (NAICS basis) under Get Detailed NCS - Compensation Cost Trends Statistics: Most Requested Statistics
Fighting for conservatism one day at a time.
This goes with my Department of Labor Statistics post above.
Fighting for conservatism one day at a time.
I have only seen one reference in the current discussion to what I and my wife, an RN, believe to be one of the major contributing factors to the rising cost of health care.
When you have your discussion, please give attention to tort reform. I'll spare you the rant on malpractice insurance rates for health care workers and inordinately high awards for spurious lawsuits with the attendant huge profit for the legal professional. You've probably heard them.
It's time to take a serious look at how a litigious society such as we have has caused a situation where we have higher costs, with minimal or no return in the form of improved care.
Thank you.
"Government of the people, by the people, for the people."
A. Lincoln
Not only do doctors pass the costs of litigation on to their patients, but we are seeing many doctors going out of business because of sky-rocketing liability premiums.
Fighting for conservatism one day at a time.
I am an acute-care pediatrician. My malpractice insurance is paid through the health plan who employs me; the yearly amount would immunize a thousand children against tetanus.
I have a colleague who is a pediatric neurosurgeon (one of the best in the world, actually). HIS insurance premiums would pay my entire salary, with room to spare for that thousand children.
Neither of us has any significant history of negligence or unusual circumstances - it's just what you pay in a "tax" to keep the predators at bay so you can practice medicine.
Who do you think really pays that money? Hint: neither of us have printing presses in the basement that create money from nothing.
And let's not consider the downside - the OB/Gyns who no longer practice at all because of insurance, or the providers who won't take new patients, or the defensive medicine we all practice to avoid setting ourselves up for litigation. There's no such thing as an honest mistake, and "no harm, no foul" long since ceased to apply to doctors.
It's not the only cost driver, or even the worst one. But it's one with absolutely no upside - medical practice is scrutinized so many ways by so many agencies that by the time the lawyers start circling, the peer review, risk management, and quality assurance folks have all been and gone. Patients aren't guarded AT ALL by vigilant plaintiff's attorneys, unless you are of the opinion that no medical care at all is better than the risk of bad care.
As I've said before, medicine is drowning in cost. But if you want to save it, you need to get the plaintiff's bar to let go of our ankles.
Under the "free market", that there are other options for health care than pills and scalpels. The corner on the market that the AMA got, through employers, came about because of WW II wage controls, as we know, and has not been broken.
There really are health benefits to be derived from chiropracty and accupuncture, not to mention gyms and nutrition. We can't go back and take government out of the picture entirely, but a broad-based, tax-free (curse the income tax anyway) HSA system would let the consumer decide whether a sore throat deserves a $75 ENT MD visit, a $25 PA, or a $10 bottle of Vit C.
getting a conversation going that does not include the Federal government as a source for the fix.
Freedom of Religion not Freedom from Religion