Thursday, March 27, 2008

I hear an "Amen"...

Great opinion piece in the Chicago Tribune regarding health care costs.
First, Americans need to forget about the myth of a free lunch. Workers are not getting something from employers while paying nothing. They are paying for their health insurance, including the premiums supposedly contributed by their employers.

Second, to help the struggling middle class, we need to get health-care costs under control. There is no way to have a sustained rise in middle-class incomes without restraining the growth in health-care expenditures. Similarly, if we want government to invest in better primary education and more affordable colleges we need to find a way to hold down the cost of health care. We are robbing our children to pay for medicine.

We need to rewrite the social contract in America. We need to get employers out of providing health insurance. It is one of the most inefficient ways to get people covered, and it impedes efforts to keep costs down.

Instead, we need to provide all Americans with a standard benefits package regardless of their income, employment status, health status or age. This will provide Americans invaluable peace of mind, defuse labor-management conflict and get people to focus on value and determining whether more health care is worth the added costs. [More]
OK, these guys have some horsepower going for them like advanced degrees and actual expertise. But remember I reached the same conclusions with little more than an engineering education and some pliers.

4 comments:

Ol James said...

I like what Mr.'s Emanuel and Fuchs said in the later paragraph-
"Finally, we need to change how we pay doctors and hospitals. Most doctors are paid fee-for-services, that is they get money for doing more tests and procedures and not for coordinating care and ensuring high quality medical care. Doctors need to be paid on the basis of performance and patient outcomes."
And I will give my AMEN now! An alternative to Health Care Cost could possibly be worked out by the way you pay a speeding ticket in most of Europe. The German and other governments determine the amount of the fine based on your income, but there is a minimum.
The last time I can remember going to the doctor and NOT having them run a battery of test....well.....I was still in High school. My Doctor was the one who brought me into this world also, says a lot for "Ol Country Docs".
Just in case I would stock up on the kerosene, sulphur, whiskey and such.

Kirk Kreikemeier said...

I agree having employers play less of a role in health care is needed but I disagree with the proposed solution.

The solution I strongly favor is Health Savings Accounts (HSA). We simply need to put the 'consumer spirit' in health care. By having the consumer spend out of their own pocket (or keep what they don't spend) the first $2000 or $5000 or more deductible would be a tremendous force in cutting back on unnecessary tests and emergency hospital visits. When it's your own money on the line you are likely to say "what will that test cost and what will it tell us?"; "is there an alternative?" "what if if wait a couple days and see what happens?"

Some argue that people can't afford the high deductible. I ask if they can afford the high premiums that come with the cadillac versions of policies that don't have any personal responsibility. "Don't worry, insurance will cover it" is often the response.

I recently started my own business and chose an HSA. Yes the first $10000 is out of my own pocket, but I only expect to incur about $5000 in medical expenses. That plus the $3600 in lower insurance premiums was lower than the low deductible option. God forbid if my family incurs medical costs in excess due to an unexpected event, that is where the true value of insurance comes in to cover the unexpected catastrophic. In the meantime I'll not go to the emergency room on the weekend, waiting until Monday to see my doctor if still bothering me. And if my doctor wants to run a battery of tests, by all means I may do them, but only after I know what my hard earned dollars are buying.

John Phipps said...

Kirk:

Your ideas are good, but do not address the growing issue of "grouplessness". Try getting underwritten as an individual today. Because of superb diagnostic tools, genetic research, and improving computational power, self-employed people face growing hurdles to even obtaining insurance of an kind. Simply put, our medical prediction capabilities are revealing more of us to carry risks that would have gone unnoticed before.

By age 50, even relatively minor health issues like migraines or treatment for anxiety can trigger rejection. It is this lack of access save through employer group plans that I think should be changed.

Nor do I blame the companies - why should they insure a probable loser?

What do we do with that growing "uninsurable" population? What happens when you or a member of your family becomes one?

Stipulating what kinds of insurance people should buy is one thing. Access to buying insurance is another.

Kirk Kreikemeier said...

I have been fortunate in having the access, though not after intense underwriting as you refer.

I believe a starting point for any broad coverage program has to be catastrophic coverage only and not the daily or routine needs. The first step in starting to solve the crisis has to be over utilization of services and the basic cost/benefit thinking that we all do in everything else we consume.