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What is happening to healthcare?
Posted at: Jun/16/2009 : Posted by: mel
Related Category: Healthcare,
In my youth, and that was a long time ago, my father taught me that there were three sins of polite conversation. Polite conversation is that conversation you might have with someone at a social gathering that you don’t know really well. In this unique setting the three subjects that my father taught me to avoid were religion, politics, and sex. The concern is that venturing into any of these subjects you might run the risk of turning a good discussion into either and argument or an embarrassing moment. The issues of healthcare have rapidly grown to now create nearly as much divisiveness. Despite all the issues, healthcare is growing into a gorilla that we can’t keep avoiding. I will begin with a few summary items. I am sure that my details are not entirely accurate. The nature of statistics is that each author spins them slightly differently. Despite all the available data, the consistently only exists at the highest level, and not with the details. For this reason my summary details may vary from yours, but should still emphasize a significant problem. Fact 1: Approximately 1 in 8 Americans do not have any available healthcare. This means that these people do not get vaccinations or regular medical exams. Yes, I know that these items cost money, but just like with a car, health maintenance nearly always cost significantly less than waiting for the catastrophic failure and showing up in the emergency room. Fact 2: Medical care costs as an industry are out of control. During each of the last 12 years the cost of living or inflation rate in America annually has been right around 3.0% plus or minus ½ %. During this same period of time Medical care costs have never grown by less than 12% - 14.5% annually. I can understand a single year of cost spikes, but this is an industry that is out of control. If the doctors, lawyers and insurance executives are not getting rich at this 10% over inflation annualized growth, who is? If you are a math geek you could do a little research and compounding over time to determine that by 2025 we will be spending 50 cents of every dollar on health care if this is not reigned in. Should I blame the insurance industry, it sure would be easy? We have patients; we have doctors, so having an expensive middle man that just does not seem like a good use of money. What about lawyers? We have a litigious society. Malpractice insurance is expensive and with all the ambulance chasers on the other side of the same table, maybe only the lawyers are actually winning. Yet some doctors do make significant errors in judgment and need to be held accountable. I really don’t want to blame the doctors. I know a couple and none of them are getting outrageously rich, but after 10-12 years of post high school education I am happy to entrust my health for a reasonable fee to them. In those 10-12 years it is reasonable to assume they have acquired some special knowledge warranting some special level compensation. Now that I have raised a flag, I should propose a solution…I just don’t know enough about medical costs to be useful. I know that some folks propose nationalizing medical care. On the plus side, everyone gets medical care. On the down side, the cost in taxes would be substantial. Obviously, for those who can afford a more significant level of care, they would still be able to purchase whatever is available in a free market. Insurance is by it's very nature participation oriented. Right now healthy people are backing away from buying health insurance which reduces their cost, but hurts everyone else. Confused, for an insurance plan, home, health, auto to be successful you need to have lots of healthy people paying in without drawing out to offset the cost of the major medical being spent on a few who do need care. Government run insurance, whether at the state or federal has been shown to deliver care, but not control rising costs. Did you notice that I keep coming back to the rising cost issue. I still see this as the crux of the issue. The notion that medical care can and does grow at an +12% rate is just too scary to me to understand why it is not being investigated. Medical care seems kind of like an astronomical event called a “black hole”; it is consuming everything in sight and yet all we can do is watch with our jaws hanging low. Are we as a country healthier due to the system we currently have? More importantly, as individuals most of us will avoid buying things we cannot afford, will our public institutions operate with the same thoughtfulness? I hate to whine without proposing a solution but I just don't think any real national healthcare debate is really accomplishing anything without delving into the question of rampant cost growth. I could sure use some intelligent insight here.
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Mel, I'm a little older than you, and I remember how health care used to work for my parents. They had what was known as major medical. You paid for a plan with a large deductible. Basically you paid for your health care. If you ended up in the hospital or having a debilitating expense, the insurance company paid for your care. Anything less, and you were on your own. We currently have a system where our employer pays for and chooses our health care for us, and even ordinary doctor's visits are mostly paid for. That's because employers can cost your health insurance as an expense--not subject to tax because it's not income. A number of years ago the GOP created a health plan like the old days. You can purchase a medical insurance plan with a high deductible (originally $5,000 but currently I think $2,500), and you can create a medical savings account that you contribute to up to $5,000. Unlike a typical flexible spending account, the money rolls over if you don't spend it in a year. Basically it puts you on the same playing field as your company, but there's a catch. You have to either be self-employed or not be offered a company medical insurance plan to qualify. I've had the same doctor for 20 years, sometimes he was on my health plan, other times not. Did he get less qualified from year to year? If somebody else pays for my health care, it's unlikely their priorities are going to exactly coincide with mine.
Posted at: Jun/16/2009 : Posted by: Frank Hood
Frank, I remember the days of major medical. My father referred to them as 80/20 plans. My concern is the large precentage of people not getting medical care at a maintenance level. Once they are sick enough to go to the emergency room, we all pay at the highest rate. I also have the concern at medical cost growing annually at four to five times the rate of inflation year after year. The system is broken. I don't know the fix, but I know this is a ticking time-bomb.
Posted at: Jun/17/2009 : Posted by: mel
