Editore"s Note
Tilting at Windmills

Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Sign up for Free News & Updates

January 24, 2007
By: Kevin Drum

DECONSTRUCTING THE BUSH HEALTHCARE PLAN....Two people who are smarter than me explain why Bush's healthcare proposal isn't a starting point for compromise, but instead an invitation to step off a cliff. First, Paul Krugman:

Now here's the thing: in the name of consumer-directed health care theory, Bush is proposing changes that would essentially encourage people to move into the individual market -- which wastes a lot of money, and doesn't and can't work for those most in need -- while undermining the employer-based system, which isn't wonderful but is still essential. In particular, healthy high-income people would be encouraged to drop out of employment-based plans, leaving behind a sicker risk pool, driving up rates, and pushing employer-based care in the direction of an adverse selection death spiral. [Bush's plan] doesn't sound big enough to have catastrophic effects, but it's a step in the wrong direction.

And Jonathan Cohn, whose book on the American healthcare system I'm eagerly awaiting:

At least on health care, the speech I saw was not an invitation to bipartisan cooperation. On the contrary, for all of the evening's rhetoric on bipartisanship, the policy grist was strikingly similar to what he's said in past State of the Union speeches -- an effort to remake medical care along the lines of conservative ideology.

....Yes, the Bush administration put itself on record as supporting a tax increase -- and that was part of what made the proposal seem like such a breath of fresh air....But then the rest of the details started to come into focus -- chief among them the fact that, in encouraging the demise of employer-sponsored insurance, the administration had no plans to create a suitable alternative in its place. After all, a lot of people are going to have a hard time finding insurance in the individual market. Not only do costs run higher there, because the administrative overhead is higher, but insurers offer coverage and adjust premiums based on health condition--to the point where people with preexisting medical problems simply can't get decent coverage at all.

....Serious proposals to improve access to health care generally take this problem head-on....The administration plan--as fully fleshed out tonight -- offered nothing along these lines....[It] is classic conservative ideology, which insists that private insurance is always preferable to public -- even though public insurance is actually more efficient and, particularly when it comes to the financially and medically needy, the only reliable option.

Read 'em both to get a better idea of what's really going on here.

Kevin Drum 2:31 PM Permalink | Trackbacks | Comments (40)

Bookmark and Share
 
Comments

Kevin, Thank you so much for your focus on this issue.

Have you seen a serious discussion AGAINST Health Care for Everyone. Because it really seems to me (and more and more others everyday) that Medicare for Everyone would work:

We've got the agency: Medicare. Just raise the tax. And add everything that's covered in our Congressional plans. And

Cover Everyone.

Tweak if necessary.

Did I leave something out? Besides the Hero.

Posted by: katiebird on January 24, 2007 at 2:44 PM | PERMALINK

Skull and Bones has given him his orders. John Kerry has announced that he will not run in 2008.

Posted by: R.L. on January 24, 2007 at 2:47 PM | PERMALINK

A decade ago this fast-moving deconstruction would not have been possible. In hours you can have world-class economists and other informed folks weighing in on the bamboozle society in motion. We have an antidote of sorts to the Republican noise machine.

Posted by: bellumregio on January 24, 2007 at 2:54 PM | PERMALINK

Again, the answer is staring us in the face. Lift the ceiling on FICA tax. Don't limit it to the first 94K.

There are trillions of dollars in untaxed wages out there. Lifting the ceiling would enable us to extend Medicare to all Americans, and take businesses out of the loop entirely. That way, no one need fear a change/belt tightening from his or her company. And, if they leave their job, they take their health care with them.

Medicare would then have the largest "group" in history . . . and could negotiate for lower prices, thus saving more.

The amount of additional tax funds would be staggering. They would be many times the current revenue stream . . . which would ALSO enable the government to cut the overall rate significantly, and STILL make sure SS and Medicare were solvent for many generations to come.

So, by spreading the hit to all wage earners, regardless of wages . . . everyone could get coverage. As a part of being a citizen in this country.

And, businesses would have far less reason to outsource or cut jobs. Their costs per employee would go down dramatically. Hiring would probably go up.

It's a win/win scenario. In effect, most Americans would get a tax cut, and receive free healthcare to boot.

Posted by: Cuchulain on January 24, 2007 at 2:59 PM | PERMALINK

Not only do costs run higher there, because the administrative overhead is higher, but insurers offer coverage and adjust premiums based on health condition--to the point where people with preexisting medical problems simply can't get decent coverage at all.

indeed. my wife is a cancer survivor, and as such, she simply cannot get individual coverage. so, at least one of us has to be employed, always. not that we're likely to both lose our jobs at the same time, but, if it did happen, the consequences would be far worse than simply having to dip into our savings to make the mortgage for a couple months.

Posted by: cleek on January 24, 2007 at 3:00 PM | PERMALINK

Give yourself more credit, Kevin. You're smarter than Krugman. So is Inkblot, for that matter.

Posted by: Brian on January 24, 2007 at 3:03 PM | PERMALINK

Kevin

This might sound funny, but the two experts confirmed what many of the commentators at this site concluded during the course of the last two health care threads.

I still think the president's proposal is an open invitation to start the health care discussion. No need to wait for the next election. The President needs a legacy and will probably sign anything that will sound historic.

Posted by: Ron Byers on January 24, 2007 at 3:04 PM | PERMALINK

You know, I think this thread is as good as any to throw two things out there for discussion that are inline with the topic:

1. Can someone name another industry in which the costs to the consumer are not disclosed up front? Granted, those of us with insurance know the limits – deductibles, out of pockets maximums, etc. – but not the actual cost. And if you don’t have insurance, it’s not like the doctor gives you a price list. Does any other industry do this? Seriously … I have yet to see one.

2. In what other industry do you get eleventy hundred bills for one service? If you have surgery, you get one from the doctor who did the surgery, one from the anesthesiologist, one from the hospital, perhaps one from the physical therapist, another from the pharmacist, yet another from a doc who happened to walk by your room that day … it’s insane. If I get my car fixed, I don’t get a bill from the mechanic, another from the guy who took the car around the block for testing, another from the store they got the parts from … Why does the medical industry do this?

I ask these questions because maybe if consumers knew upfront the often ridiculous costs associated with their care, there'd be more of a public outcry to fix the system to the benefit of everyone, rather than half-assed measures like the ones proposed by Bush Co.

Of course, there's a chance that if they knew upfront, they'd choose not to have a needed procedure done, so ...

Posted by: Unholy Moses on January 24, 2007 at 3:05 PM | PERMALINK

Read all of Krugman at Tobias:

http://www.andrewtobias.com/

today. Scroll down.

Posted by: Gore/Edwards 08 on January 24, 2007 at 3:09 PM | PERMALINK

The Democrats should drive a truck through the opening created by Bush suggesting that raising taxes is necessary to fund health care.

Let Republicans try to defend why they are willing to raise taxes only for an unfair plan. They've admitted it will take tax money to fix the health care problem so lets play some politics and accept their offer of money but recraft the solution so it actually will be a step in the right direction.

Posted by: Curt M on January 24, 2007 at 3:13 PM | PERMALINK

I've seen catastrophic coverage mentioned a few times in these threads. I priced some a few years ago. A $10K deductible plan was going for almost $400 per month. I don't know what it costs now; I'm afraid to look.

Posted by: annie on January 24, 2007 at 3:30 PM | PERMALINK

Ron Byers: the two experts confirmed what many of the commentators at this site concluded during the course of the last two health care threads

Let's face it, we're all having too much fun shooting fish in a barrel.

I still think the president's proposal is an open invitation to start the health care discussion.

Yes, it starts like this: President Bush's proposal, like all his proposals, is a steaming pile of shit. Let's not waste time debating whether he's being dishonest or is just an idiot. Instead, here are some intelligent ideas ...

Posted by: alex on January 24, 2007 at 3:53 PM | PERMALINK

I always get a slight boost of confidence when I'm able to anticipate Dr. Krugman's diagnosis before he makes it. Sort of like when you watch House and know what the sick kid is dying of before Wilson or Cuddy do.

My original thought is this - individual health insurance might work if the government did the following things:

* Required all individuals to buy health insurance.

* Required all insurers to take any comer at a reasonable price (and required community-rating).

* Gave vouchers a/k/a handouts - not silly little tax deductions - to people in need.

It may not work as efficiently as single-payer (what would?) but it would have a fair chance of working. I doubt Bush is willing to advocate any of these essential elements, though (he of "voluntary greenhouse gas reduction" fame).

But my gut tells me that by the time a comprehensive national plan based on self-purchasing were made to work, it would make HillaryCare look downright simple and libertarian.

I seem to recall John Stuart Mill - probably in his last book, "On Socialism", saying something to the effect of, "look guys, sometimes it's better for liberty if the government just does it one simple step." It's too bad health care is going to be jeopardized for Bush's penchant for unbelievably slow-moving dipping mechanisms (unnecessary Austin Powers reference).

Posted by: Jim D on January 24, 2007 at 4:03 PM | PERMALINK

"I've seen catastrophic coverage mentioned a few times in these threads. I priced some a few years ago. A $10K deductible plan was going for almost $400 per month. I don't know what it costs now; I'm afraid to look."

It depends largely on your age. I had one a few years ago and it was $54-60 a month (thats how much it went up in the year I had it) with a $3000 deductable for one male non-smoker 27 or so years old. I beleive it was something like $300 a month for a sixty year old.

Posted by: jefff on January 24, 2007 at 4:21 PM | PERMALINK

It depends largely on your age.

Actually, it depends largely on your pre-existing medical condition, followed by age. I have a history of both mild depression and mild asthma and am a 37-year-old nonsmoking woman. That means about $500 a month for a high-deductible policy.

If you have no pre-existing conditions and are under 30, you can get a reasonably priced policy. The rest of us ... not so much.

Posted by: Mnemosyne on January 24, 2007 at 4:31 PM | PERMALINK

As someone who's about to move to her third medical plan in two years (temp agency's plan to company's plan and back to temp agency's plan), it would be REALLY nice to have some continuity of care. At the moment, I'm seriously considering staying on COBRA and paying $350 a month because I may be re-hired by the same company. Otherwise, I need to switch back to the temp agency's plan, which is a lot cheaper (about $50 a month) but offers a completely different set of doctors.

I hate health insurance.

Posted by: Mnemosyne on January 24, 2007 at 4:34 PM | PERMALINK

Yes, the Bush administration put itself on record as supporting a tax increase
A Republican call for a tax increase is not bipartisanship, it is a dig at the "Tax and Spend Democrat Party".

Posted by: Bill Arnold on January 24, 2007 at 4:45 PM | PERMALINK

I have been reading about universal health care since I was a kid. I have read all the arguments. I watched Hillarycare fail because nobody in the White House wanted to expend the political capital necessary to push the plan down the throats of Gingrich and the "Contract on America" gang. I am completely convinced that a single payer government plan is the best possible choice. All of that said, and maybe it is because I am getting older, I doubt anything will ever happen with health care if we don't find a way to involve the health insurance industry.

We can't let the perfect be the enemy of the good. We have 50 million uninsured. I was just looking at some data from an Federal Reserve Bank of San Francisco Economic Letter dated September 29, 2006, showing the ugly interrelated trend lines of the rising number of uninsured, the falling coverage of ESI (employer sponsored insurnace) programs, and rising premium costs. It is obvious that if America doesn't get a handle on health care pretty darn soon, out of control health care costs are going to sink our economy.

I know that making sure everybody is covered under some plan is just the first step. While that first step will help a lot, the real solutions won't be found until and unless some institution or institutions really clamp down on increase costs charged by providers. In my experience the insurance industry is not very good at cost containment. Generally they are paid based on a percentage of premiums. If premiums go up they make more money. They just don't have as much of an incentive to force providers to keep costs down as the other obvious player--the government. Governments are loath to raise taxes (increase premiums.) As such they will move heaven and earth to squeeze the providers into accepting less.

All of that said, I have read about some insurance careers doing a better than average job forcing providers to hold the line on costs. Maybe we should explore the topic with greater care and less snark.

I agree the President's plan is completely inadequate.

Posted by: Ron Byers on January 24, 2007 at 4:56 PM | PERMALINK

Yes, the Bush administration put itself on record as supporting a tax increase --

So what would he need to get in return for him to sign a Democratic bill that would most likely be opposed by almost all Republicans in Congress?

I don't know, but I think it's a worthwhile question.

I have some friends who live in Berlin, who qualify for coverage in the German system, but who get almost all of their health care in the U.S. I am trying to imagine a system in the US like the German system, where people like my friends would have good basic coverage, and an option to choose what they think to be better coverage.

Efficiency isn't the only goal. I think that Bush would sign a bill if it didn't reduce very much the freedom of choice that people who have freedom of choice have now; and if it did not legislatively or bureaucratically cap all the costs of treatment.

Unholy Moses: If I get my car fixed, I don’t get a bill from the mechanic, another from the guy who took the car around the block for testing, another from the store they got the parts from

To start with, mechanics do not require as much training as doctors, and do not have to pay as much in malpractice premiums. The parts and materials are not regulated by the FDA. And you can if you want buy your parts at a different place from where you have the mechanics work on your car. I appreciate your point, but you might want to compare the kind of bills you get from Drs to the kind of itemized bills you get when buying/selling homes or that you get for extensive legal services.

Posted by: calibantwo on January 24, 2007 at 5:33 PM | PERMALINK

calibantwo

I am a lawyer. I sign a contract with every client before I provide services. We go over exactly how much the services are going to cost. If work is being done on an hourly basis we agree as to the hourly fee we are going to charge.

I have never had a doctor tell me what his charges might be ahead of time. Like most people I think Doctors are only interested in finding out if I have insurance. They are either too arrogant to care or too ashamed to tell anybody what they charge.

Posted by: Ron Byers on January 24, 2007 at 5:59 PM | PERMALINK

Ron Byers: If work is being done on an hourly basis we agree as to the hourly fee we are going to charge.
...
I have never had a doctor tell me what his charges might be ahead of time.

You never have any contingencies, like "if it takes longer to review the files the cost may be higher"? A team of surgeons operating on my hand said "It will probably take an hour or two, depending on what we find when we open you up", and "You'll probably be in the hospital 2 or 3 days, more if it takes longer to make sure you are not infected."

My legal contracts had contingencies in them like that: depending how long it takes to travel, depending how long it takes to read the documents you receive, and how long I have to research the cases.

Posted by: calibantwo on January 24, 2007 at 6:11 PM | PERMALINK

Again, I ask, regarding the proposal to tax health-insurance-payment imputed income: If a person's income is X per year, and your employer is paying out Y for health insurance that a person with X + Y income would normally have to shell out of their "income" (whether or not the same exact amount of Y, just consider the principle of thing), isn't it only fair that the first person pay taxes on the total effective income X + Y that they are getting? Why should some workers pay less taxes than others by the subterfuge that their employer pays for some services directly instead of paying them more to begin with, for them to pay out of "their" pockets? Don't most of us complain about not taxing options and exectutive perks as income, etc? Fair play? Forgive me if I'm missing something.

Posted by: Neil B. on January 24, 2007 at 6:26 PM | PERMALINK
Again, I ask, regarding the proposal to tax health-insurance-payment imputed income: If a person's income is X per year, and your employer is paying out Y for health insurance that a person with X + Y income would normally have to shell out of their "income" (whether or not the same exact amount of Y, just consider the principle of thing), isn't it only fair that the first person pay taxes on the total effective income X + Y that they are getting?

No.

Why should some workers pay less taxes than others by the subterfuge that their employer pays for some services directly instead of paying them more to begin with, for them to pay out of "their" pockets?

It's not "subterfuge". There is public value (compared to the alternatives in the absence of a public universal service) to people being insured through risk pooling group programs that are (through COBRA, etc.) of at least limited portable compared to purchasing insurance individually; therefore, it is appropriate that public resources be expended to encourage that public interest. The tax exclusion of employer/union-provided health coverage of this type is the expenditure of public resources to provide an incentive.

Now, admittedly, that is a far from perfect public healthcare policy. But reducing that incentive, discouraging high-quality group insurance, and incentivizing purchase of insurance through the private individual market where those who most need healthcare are likely to be entirely excluded, would make the existing poor healthcare policy in the US downright dismal.

Posted by: cmdicely on January 24, 2007 at 7:00 PM | PERMALINK

I know the perfect test audience to try out the idea on. A limited amount of people who can be easiliy monitored to see if the idea really works. The President, Congress and its many former legislators. Who has a more gold plated health care then those dudes. Lets see how much they like the private market and rationed care.

Posted by: aline on January 24, 2007 at 7:24 PM | PERMALINK
I have never had a doctor tell me what his charges might be ahead of time. Like most people I think Doctors are only interested in finding out if I have insurance. They are either too arrogant to care or too ashamed to tell anybody what they charge.
Ron, it occurs to me that what you describe above is a purposeful, strategic avoidance on the parts of some professionals. Many doctors do not want to be involved in the financial matters between their patients and their practice as it tends to muddy the waters, as it were. They hire an office manager to deal with that. On the whole, I believe that they think it frees them to practice the best medicine possible unencumbered by other concerns.

Most of the medical care I get is not optional, and certain procedures need to occur regardless of their financial impact. I did have a dr work to get me on an FDA effectiveness study where all visits, tests and drugs were free, but my doc was more focused on the info that the new drug was really good.

She was right. The results were so good that they ended the study early (with FDA approval) so they could get it out to more HIV patients and save lives (at least temporarily).

Posted by: Keith G on January 24, 2007 at 8:29 PM | PERMALINK

My legal contracts had contingencies in them like that: depending how long it takes to travel, depending how long it takes to read the documents you receive, and how long I have to research the cases.

Posted by: calibantwo on January 24, 2007 at 6:11 PM

Actually we include what we will charge for contingencies. The hourly rate is disclosed. I make it a practice to send my clients a detailed bill monthly. I tell them that if they want to talk about any part of it they should call.

Most doctors give no thought to cost, eventhough they give no thought to hounding poor people to the grave if every penny isn't paid.

What I find most offensive in your first post is this:

To start with, mechanics do not require as much training as doctors, and do not have to pay as much in malpractice premiums. The parts and materials are not regulated by the FDA. And you can if you want buy your parts at a different place from where you have the mechanics work on your car.

How long it took you to train, how much you pay for malpractice insurance, how much you pay for "parts" in comparison to an auto mechanic might justify charging more for your services than a mechanic, but it is totally irrelevant to your duty to communicate your charges ahead of time. Let's face it, doctors don't tell how much things are going to cost because they don't want the patients who can to shop price.

I happen to have a son who is a world class mechanic. His time is worth more than a lot of doctors and most lawyers I have encountered.

Posted by: Ron Byers on January 24, 2007 at 9:41 PM | PERMALINK
…I have some friends who live in Berlin, who qualify for coverage in the German system, but who get almost all of their health care in the U.S….calibantwo at 5:33 PM
We are Canada's Mexicans 250,000,000, INSURED BUT STILL IN TROUBLE Tue Jan 16, 8:04 PM ET The Healthcare Crisis for the Rest of Us NEW YORK--Some people are just cheap. Others are playing the odds, reasoning that paying for doctors and prescription medications on an ad hoc basis will prove cheaper than the $500-plus per month they'd have to shell out for health insurance. But most of America's 47 million uninsured live and die without coverage because they can't afford it. Worse than a national scandal, our failing healthcare system is an international disgrace. Hundreds of thousands of Americans are so desperate that they travel overseas in order to leech off socialized medical care systems, which are prevalent in other industrialized nations. "We are overwhelmed by you (expletive deleted) Americans," an exasperated emergency-room physician at a Canadian hospital across the border from upstate New York told one of my friends, whose girlfriend had driven him the eight hours from Manhattan to Quebec after he'd fallen down some stairs and broken his arm. We are Canada's Mexicans….

People willing to travel to the US from Germany for medical care must be wealthy or a job that makes it easy.

Posted by: Mike on January 24, 2007 at 11:21 PM | PERMALINK

I just want to pull Dick Cheney's and Bush's insuance and see if they can get private insurance coverage. I will guarantee you Cheney wouldn't be able to get any coverage(and no I am not talking about medicare.) and I would be willing to bet Bush with all his substance abuse problems wouldn't be able to get any either. I would like to see these two apply for insurance with their names crossed out and see if they get coverage.

Posted by: azggl on January 24, 2007 at 11:59 PM | PERMALINK

cmdicely: Now, admittedly, that is a far from perfect public healthcare policy. But reducing that incentive, discouraging high-quality group insurance, and incentivizing purchase of insurance through the private individual market where those who most need healthcare are likely to be entirely excluded, would make the existing poor healthcare policy in the US downright dismal.

Dismal for individuals anyway. But I can see a great niche market for those who can't afford to pay for decent coverage, but could benefit from the deduction... $1/year plans with a $100000 deductible that covers the cost of tissues in case of a cold (doctor certification and receipts required, of course).

Voila! $14999/7499 tax deduction. Moreover, the plan could offer a rebate at the end of the year if you don't sumit any claims. I bet getting the deduction will require itemization, but that's a small price to pay. (But is that in addition to the standard deduction? Hmmm...)

Posted by: has407 on January 25, 2007 at 12:58 AM | PERMALINK

I hardly ever read Kevin Drum, but he sabotages himself. I'm all prepared to think he's a smart guy. But then he claims Paul Krugman is smarter than him. That's sort of like proclaiming that, I don't know, Jimmy Carter is smarter than him on the subject of Israel. Who you look up to says a lot about you. Paul Krugman is thoroughly and utterly discredited as a commentator even by most of the left these days - it's well known he twists statistics, and flat out lies.

Please Kevin, read up - and save your career.

Posted by: daveinaustin on January 25, 2007 at 4:10 AM | PERMALINK

Unholy Moses: "In what other industry do you get eleventy hundred bills for one service?"
"I have never had a doctor tell me what his charges might be ahead of time. "

These are very good points: The pricing/billing model used in the medical field could be improved. And if those inefficiencies were addressed, some real money would be saved. According to this (pdf) report, just googled, administrative costs account for ~ 20-24% of health care costs.

Ron Byers: " I am completely convinced that a single payer government plan is the best possible choice. All of that said, and maybe it is because I am getting older, I doubt anything will ever happen with health care if we don't find a way to involve the health insurance industry."

The other Special Interest that has made health care reform such a problem is the medial profession, the AMA. They are tremendously powerful, but seem preoccupied, like the music industry, with maintaining the status quo, the system that got us into this mess in the first place. Their energies are going into fending off the consequences of their poor model of service delivery (malpractice suits, insurance industry paperwork, government control of pricing.)

While I agree with you that we don't want to let perfect be the enemy of the good, I also think that --changing metaphors--letting the foxes dictate the design of the hen coop may result in some nasty surprises for the hens.

Posted by: PTate in FR on January 25, 2007 at 5:07 AM | PERMALINK

daveinaustin:"Paul Krugman is thoroughly and utterly discredited as a commentator even by most of the left these days - it's well known he twists statistics, and flat out lies."

"well known?" Maybe in Austin and Fox news, Dude. Maybe in the right blogosphere. Krugman is still good as gold elsewhere. More so, since time is proving him right.

But perhaps you are projecting or displacing your fears onto Krugman? Surely, the following IS true: "George Bush is thoroughly and utterly discredited even by most of the right these days- it's well known he twists statistics and flat out lies."

Posted by: PTate in FR on January 25, 2007 at 5:23 AM | PERMALINK

No money to get health care working in our own country.

But there are all this money to fund a war in a foreign country.

Let's start a Healthcare for Oil Program. It might get the attention of the greedy bas'tids in WA.

Posted by: Zit on January 25, 2007 at 9:48 AM | PERMALINK

'Paul Krugman is thoroughly and utterly discredited as a commentator even by most of the left these days - it's well known he twists statistics, and flat out lies.
--daveinaustin

Discredited by who, Dave? Rush Limbaugh? Bill O'Reilly? Sean Hannity? Give one example where Krugman has lied or twisted the facts. Just one.

Saying something over and over again, doesn't make it the truth, asshole.

Posted by: The Conservative Deflator on January 25, 2007 at 10:50 AM | PERMALINK

I think this would effect(help) me. My salary has health benefits built in. This was negotiated by the union. My salary is higher on paper, but then they take a chunk of the $500.00 (per person) a month for what I would consider a "silver-plated" plan. (For a family, the "gold-plated" plan can run up to $32,000 a year).

So my question is:
According to Bush's plan, would my wife and I get to write off the $12,000 a year in health care payments?

Posted by: Questionman on January 25, 2007 at 11:34 AM | PERMALINK
... and do not have to pay as much in malpractice premiums --calibantwo

I discussed this with my mother, who happens to be a surgical nurse (for 40 years) and now exclusively does eyes, and the claim of high insurance is both true and false.

It depends on what the specialty is -- an eye doctor pays near 6-figures a year for insurance in KC, but can do 12 cataract surgeries a day, at $1,000 a pop. He more than pays for the premiums in a very, very short time.

Plastic surgeons also pay through the nose -- upwards of $250K a year -- but they charge insane amounts, and it's all elective.

But the claim that malpractice insurance drives out health care costs for, say, a family practicioner is blatantly false. Their premiums aren't that much because they don't have a lot of liability issues. And since that's what most Americans need, the costs should not be as great as they are.

Also, your point doesn't really address my issue: Why don't doctors tell you what they charge up front?

And wouldn't admin costs be greatly reduced if the billing process was streamlined?

Posted by: Unholy Moses on January 25, 2007 at 11:51 AM | PERMALINK

For the people who, like me and Unholy Moses, don't like to be billed for every little piece of medical services, besides the obvious inefficiency......the HMO!! My experience with Kaiser (nonprofit) and Aetna (unfortunately, for profit) have both been good. No bills. Physicians on SALARY (at Kaiser, more of a classic HMO) so no incentive to do unnecessary procedures or tests. OK, when I started Kaiser in 1976 the copayment was $1.00 per visit (equals $3.50 today!). Aetna HMO copayment today is $25 or $30 (about what the whole visit corrected for inflation would have cost in the 1950's....what happened?.) But anyway no paperwork, no per centages I have to pay, no deductables etc. I do wonder what would happen in a single payer system, as there seems to be inherent effiencies in the HMO system as well as user convenience in services being more in one place. Could the good features of HMOs be somehow incorporated in a single payer system? Anyhow, as some old Demo politician on Charlie Rose a couple of months ago said in response to a question about what kind of universal health care he thought was best - any kind that passes.

Posted by: emjayay on January 25, 2007 at 11:58 AM | PERMALINK

How long it took you to train, how much you pay for malpractice insurance, how much you pay for "parts" in comparison to an auto mechanic might justify charging more for your services than a mechanic, but it is totally irrelevant to your duty to communicate your charges ahead of time. Let's face it, doctors don't tell how much things are going to cost because they don't want the patients who can to shop price.

I was thinking more about this as I was driving in this morning. The doctors I know come down on all sides of the issue of discussing costs up front, but I haven't known anyone who actually advocates keeping them a secret. maybe if patients and patient advocates (not just the insurers) more actively required the cost estimates up front the practice would change. The insurance companies will pay what are called "usual, customary, and reasonable" charges, which provides an incentive for the health care providers to jack up their prices each year. My wife and I are covered by her insurance policy, and we are charged a lower premium for getting our care through the hospital system that employs her.

Most doctors give no thought to cost, eventhough they give no thought to hounding poor people to the grave if every penny isn't paid.

I don't know how you know what is true of "most" doctors, but neither of those assertions is true of the doctors I have worked with.

Posted by: calibantwo on January 25, 2007 at 1:52 PM | PERMALINK

As a long-time Kaiser patient, I've had my issues with them, but I agree with emjayay that the Kaiser model has a lot to offer as a model for universal coverage.

First of all, Kaiser is a non-profit. It is obscene to let insurance companies make huge profits, or any profit for that matter. That is a simple inducement for them to NOT provide health care. More health care = less profit. The health care system should have as it's number one goal to provide HEALTH CARE, not PROFIT.

Second, Kaiser does pay good salaries to its MDs, and I've had very good doctors tell me they came to Kaiser from "private practice" to avoid both paperwork and second-guessing from insurance companies as to which tests to order and which drugs to prescribe. True, Kaiser has a drug formulary (like every other health insurance plan), but doctors can prescribe outside the formulary if they think it is necessary. (The patient pays extra, of course.)

Finally, all my medical records are quickly available to any specialist I see. My adverse drug reactions, my prescribed medications, my other health issues, etc. My primary care doctor immediately sees what other things have been happening, etc.

One last comment: I totally agree that any individual in this country should be able to acquire the same coverage our Congress establishes for itself. They should simply open their pool to anyone, who would have to pay the total "employer" cost. Bet it would be cheaper than anything else you could find.

Posted by: Cal Gal on January 25, 2007 at 3:49 PM | PERMALINK

calibantwo--
The problem with asking doctors how much a service will cost is that it depends.

If you have insurance, doctors have the "agreed upon rate" with your insurance company.

If you don't, you don't get that agreed upon rate, so they can't tell you because the rate they charge is never the same.

My question is why? Why don't they have a flat fee and let everyone -- insured or not -- know what will be charged?

Don't get me wrong -- I don't expect you or anyone else here to know. It's just a general question that needs to be asked if this country is going to have a dialog on how to solve this complex problem.

As far as the attack dogs of collections --
I had to go the ER a few months ago, and I owe all of $276. We offered them $25 a month (we be broke), yet they say that's unacceptable. Of course, we've sent them $25 for the past two months -- and they've cashed the checks -- yet still send us letters and leave nasty (and I mean NASTY) messages saying that it's "unacceptable."

And all for $276!!!

They're also trying to charge me interest, even though I never received a TILA agreement. Last I checked, charging "interest" (their word, not mine) makes it a loan and, without conforming to TILA and Reg Z, they are violating federal law. I could be wrong and am looking to see if that's true.

Oh ... and the kicker?

IT'S THE SAME HOSPITAL BUSH VISITED TODAY IN LEE'S SUMMIT!

At some point, it'll be more expensive to collect the debt than the debt is worth. I find that kind of funny.

Posted by: Unholy Moses on January 25, 2007 at 5:09 PM | PERMALINK




 

 

Read Jonathan Rowe remembrance and articles
Email Newsletter icon, E-mail Newsletter icon, Email List icon, E-mail List icon Sign up for Free News & Updates

Advertise in WM



buy from Amazon and
support the Monthly