Still fixing the fixed, fixed healthcare system
by Daniel Becker
I posted in 7/2009 on the issue of fixing our healthcare system based on the Massachusetts model. The first was Massachusetts is fixing the fixed healthcare system. The second was a followup to the first: Fixing the fixing. Healthcare Deja vu.
The issue was that we are dancing around. All the proposals to date have been nothing more than a relabeling of already tried organizational structuring within the private insurance model. I ended the first article with a quote from a NEJM report and a my question:
Despite these imprecisions, the difference in the costs of health care administration between the United States and Canada is clearly large and growing. Is $294.3 billion annually for U.S. health care administration money well spent?
Well, is it? Did they even ask?
I ended the second article with:
We’re talking the same old approach to what really is a problem with the product. At least in the bad socialist health care programs they recognize that a for profit third party only adds cost and thus do not have to account for that part of our problem (it’s called savings). They just need to resolve the product quality issue. It is the only common issue to all nations.
I’m taking bets on the date of the new fix of the newly fixed, fixed system.
Ok folks. The betting is closed. Time to lay the cards on the table.
US News and World Report: Mass. Health Reform Hasn’t Halted Medical Bankruptcies
“Health costs in the state have risen sharply since reform was enacted. Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance. High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs. None of that changed. For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services,” the researchers wrote.
The results from the actual published article in The American Journal of Medicine:
In 2009, illness or medical bills contributed to 52.9% of bankruptcies in Massachusetts. In contrast, in early 2007, medical bankruptcies accounted for 59.3% of personal bankruptcies in the state (P#.44 for comparison with 2009 proportion) and 62.1% nationally (P#.02). Because the total number of personal bankruptcy filings in Massachusetts increased by 51% between fiscal years 2007 and 2009(6) the absolute number of medical bankruptcies in the state actually increased by more than one third during that period, from 7504 to 10,093.
The profile of the bankruptcies:
Most of the recent Massachusetts debtors were female (Table 1). Their average age was 48.2 years, two thirds of them had attended college, and 70.5% owned a home or had owned one within the past 5 years. The average debtor household included 2.94 persons; in three quarters of them, at least 1 adult was employed at the time of bankruptcy filing.
In 2009, 45.6% of the entire sample (86.2% of the medically bankrupt) had high medical bills or specifically cited illness as a cause of their bankruptcy, proportions that did not vary by insurance
status. The remaining 13.8% of the medically bankrupt (7.3% of the entire sample) were classified as medically bankrupt because they had lost significant work-related income because of illness or had mortgaged a home to pay medical bills.
As would be expected in a state where medical insurance is mandatory, the overwhelming majority (89.0%) of debtors had health insurance for themselves and all of their dependents at the time of bankruptcy filing…
The 2009 coverage rates in Massachusetts were higher than those for Massachusetts debtors in 2007 (before the coverage mandate was enforced), when 84.1% had insurance at the time of filing and approximately one third (34.1%) had experienced a coverage gap. In both 2007 and 2009, Massachusetts debtors’ had higher coverage rates than in our 2007 national sample, in which only 69.7% of bankrupt families were insured at the time of filing and 37.4% had experienced a gap.
Here we go folks, the table is open. Taking new bets.
Ah well, my last post indicated global payment reform was the only major answer nationwide and here in MA. Not very promising if that is mostly true. Halasy will give us a run down on the Prometheus plan for FYI since that is the buzz.
Does anyone believe the insurance/investment brokers will pull their fingers out of the pie so long as they live and own the politicians. Next law passed will say “you will pay us or you face our death panel”.
Still hold the same position that a national plan with:
– Progressive HSAs (e.g. rich do not get em – Bill Gates does not get one, or need one), use tax credits to fill these.
– Progressive Catastrophic plan (e.g. progressive deductibles $0, $5K, $10K, $20K) then national – insurance covers the rest.
– Private insurance can fill in any gaps for those that want to buy it like Dental.
That is a “national” plan even republicans might go for.
Of course Medicare and Medicaid account for large portions of our health spending, and our governmnet cannot seem to make it more cost effective – they already control that huge bucket. We have the most expesive system for people 65+ among the developed countries.
Guess what that’s basically John Kerry’s plan in 2004. A national cat policy in his case it was 75k.
Single payer.
Cost controls.
And tax heavily: tobacco, alcohol and marijauna.
Add corn syrups, refined sugar beets etc to the tax heavily list.
Daniel:
You cite MA issues in having a state healthcare policy and then equate it to the national healthcare proposal. What is the difference? You imply there is no difference. Perhaps, this plan is an improvement, better, and different.
Ilsm; Today’s healthcare plan is the result of Dems-with-no-balls, flip-flopping by I-Am-A-God Lieberman, blue dogs who walk both sides of the street, and the party of “No.”
McWop: Repubs want “no change” other than private sector plans which foster the dropping of people to remain profitable by keeping costs low.
Run,
Best I can read, the MA plan is more complete as to mandatory insurance and exchanges. The national plan is based on the MA model. The MA model is not new. The National plan suffers the same problem the MA plan suffers: plan affordabliity.
People can not suddenly take $8000 to $13000 out of their budgets for health insurance. You can go to the Mass Connector, put in your numbers, pick a zip and see just how expensive it is. And, “affordability” is just as the report said, high deductables and percentage ratios.
Even MA published data before the plan went into effect showing that the middle claas ($68 to $92K) would be the sector actually to receive on real benefit in cost and most struggle to forfill the mandate.
Both National and MA are based on the market and thus choice being in insurer. That is they both are based on the product of health and healing being insurance. It’s like basing the product of personal transportation on the choice of bank which determins the package of the transportation you buy. It is wrong. Completely and totally wrong.
I am writing about the hardshoips of private school loan. Please check out my link http://churaumanieb.blogspot.com
Besty wishes.
Churaum Bissun
Disagree, repubs have tried many times with various HSA proposals and Democrats oppose. There was middle ground but nobody want to compromise, and the result is we have a mish-mashed system of single payer and private. Both parties are to blame. And like I said we gave the worst 65+ system in the developed world, the one run by government.
And note I am not opposed to a national health plan.
Very well said. And the question becomes where do you shift those premium costs? Even if an $8k or 13K premium were 20% lower, then we are still talking $6400 to $10K+, which is a big hit at many income levels.
We use two accepted tools within economic and thus business: Risk pooling and economy of scale.
Single payer that includes all health care. That is, no more workers comp health care portion. No more personal injury, health care portion. All of it. Everyone in.
Now you have the largest pool for risk sharing possible and the largest number of “agents” (people, companies) for the greatest economy of scale.
Then you make sure the market is the proper one: health and healing. That is you make sure all schools and systems of medicine are allowed to compete in the market.
With all in, you solve one aspect of the “tort reform” that the conservative mind states they want to solve. Malpractice, liability becomes issues outside of solving the victims health whether short or long term.
If we are smart, we’ld do like RI and add a national disability issurance to the program too. Now you cut tort even more if one is so concerned.
DOLB:
“People can not suddenly take $8000 to $13000 out of their budgets for health insurance.”
What people? People who make >$90,000 or people who make median income?
The national health plan has a MLR of 80 and 85% which I am going to assume you know something about dolb. Working within those MLR are ratios based upon the cheapest insured or the youngest. It is possible to receive a rebate if 80% of your premiums are not applied to payouts. Futhermore, there are subsidies for insurance which limit the total pay out at 8% (if I remember correctly) of salary up to 89,4000 (2011) for a family of 4 and I would bet this is the same as the SCHIP qualifications also. Even companies are subject to this control of premiums. Poverty level people (133%) pay no more than 3-4% from $14000 for individuals and $29,725 (2011) for families of 4. Together, these two factors should have a control on premiums paid out by individuals and families. I can detail the national plan; but, I find it difficult to argue against the subjective. I am not sure you cn draw a comparison between the two plans dolb unless you get into the details.
We all know what we would like. Each time it has been over turned by the blue dogs or the Repubs or in combination. Working with private healthcare insurance companies is not the best alternative; but, it is the only one that could pass Congress because of the opposition in the Senate. And yes McWop, the Repubs did their damnest to blocck one payer and medicare alternatives which were in themselves the better options. To my knoledge, no Repub measure excluded the insurance companies.
dolb, what is the alternative? Wait another 4 years for another swipe at it and several $trillion later? Healthcare costs since Clinton’s swipe at it grew by 400%. 4 million people were dropped from the private insurance rols in 2010. 2010 was the year of deceased payout costs (those costs associated with payouts – 71%) in a deacde. Do you think the two are related? I do.
DOLB:
“People can not suddenly take $8000 to $13000 out of their budgets for health insurance.”
What people? People who make >$90,000 or people who make median income?
The national health plan has a MLR of 80 and 85% which I am going to assume you know something about dolb. Working within those MLR are ratios based upon the cheapest insured or the youngest. It is possible to receive a rebate if 80% of your premiums are not applied to payouts. Futhermore, there are subsidies for insurance which limit the total pay out at 8% (if I remember correctly) of salary up to 89,4000 (2011) for a family of 4 and I would bet this is the same as the SCHIP qualifications also. Even companies are subject to this control of premiums. Poverty level people (133%) pay no more than 3-4% from $14000 for individuals and $29,725 (2011) for families of 4. Together, these two factors should have a control on premiums paid out by individuals and families. I can detail the national plan; but, I find it difficult to argue against the subjective. I am not sure you cn draw a comparison between the two plans dolb unless you get into the details.
We all know what we would like. Each time it has been over turned by the blue dogs or the Repubs or in combination. Working with private healthcare insurance companies is not the best alternative; but, it is the only one that could pass Congress because of the opposition in the Senate. And yes McWop, the Repubs did their damnest to blocck one payer and medicare alternatives which were in themselves the better options. To my knoledge, no Repub measure excluded the insurance companies.
dolb, what is the alternative? Wait another 4 years for another swipe at it and several $trillion later? Healthcare costs since Clinton’s swipe at it grew by 400%. 4 million people were dropped from the private insurance rols in 2010. 2010 was the year of deceased payout costs (those costs associated with payouts – 71%) in a deacde. Do you think the two are related? I do.
McWop:
Like dolb, you are speaking out of hat. Neither of you have drawn a true comparison. Facts please on the MA plan.
Daniel:
Which does absolutely nothing for doctors who are negligent and poor hospital care which cause a a large percenatge of deaths yearly.
“In 1999, a landmark study by the Institute of Medicine found that an estimated 44,000 to 98,000 patient deaths occur each year as a result of preventable medical errors in hospitals. A new report by the Institute of Medicine, published in July of 2006, found that ‘medication errors are surprisingly common and costly to the nation.’ This is the true health care crisis. Attention focused on the false claims of the business lobby diverts much-needed resources for work to save lives by reducing preventable errors.”
“Several of the most common types of errors producing malpractice payments significantly increased over time as a proportion of all errors. Meanwhile progress has stalled in reducing the errors that are easiest to avoid. ‘Failure to diagnose” cases, for example, grew from 16 percent of payments in 1991 to 19 percent in 2005. ‘Improper Performance’ cases grew from 10 percent to 15 percent of payments.”
“33.26 percent of doctors who made 10 or more malpractice payments were disciplined by their state board – meaning two-thirds of doctors in this group of egregious repeat offenders were not disciplined at all.” http://www.citizen.org/publications/publicationredirect.cfm?ID=7497#15
By saying we will install universal coverage for all, you are treating the symptoms of negligence by doctors and hospitals without attaching the root cause. It appears the direction of the stats are different than what you suggest and would lead us in a different direction. People do not sue without reason and lawyers do not take cases without a firm basis in which to sue. Tort reform is a red herring.
If I may say, in my past postings and even here I have always been consistant that the problem with heatlh care is two fold. The first is how we get the money from the patient to the doctor and cut cost. Simple solution: cut out the middle man. Medicare for all.
The second is the real problem: the product…health and healing, how to make it happen. It is the doctors. Nothing, and I mean nothing happens without the doctors signature.
My post above and the main post are only dealing with the first issue.
Never said tort reform was an issue. Just said for those who want to make it an issue, the simple answer that totally cuts the bottom out of their argument is to put all health care payment under the single payer system. I believe New Zealand does this. The deal with the liability separately as it should be.
Yes there are subsidies to help pay the premium. As a tax credit, advancable to the insurer. It is only for the premiums. It is not for the out of pocket expenses
It is the out of pocket expenses (OPE) in the MA exchange plans that have put people into bankruptcy.
I do not believe 80 to 85% MLR will be enough to lower the OPE such that ones total cost potential for a family of 4, age 45, 70K/yr AGI will not result in a total expense of $12,876.
http://healthreform.kff.org/subsidycalculator.aspx
If they lose their job along the way, certainly they will pay less. However, I don’t think it would be retroactive/backdated.
Wait 4 years? No. Start making the changes now. I hear Oregon is looking to do a single payer, as is Vermont. There may even be potential for OR, WA and CA to form one pool. Like I said. If they are smart they will dump all healthcare into that pool, collect the premiums that were related to PI insurance and WC insurance along with primary insurance and now everyone save totally. Not to mention the loss of the duplication. After all, every health issue is treated the same regardless of where or the circumstances of it’s onset. That is a sprained ankle do to you playing, or moving at work or someone hitting you is still a sprained ankle.
Then we deal with the actual product. It is not the best in the world. Infact, health care knowledge is rather ubiquitous throughout the world. How it is applied is the issue. The corrupting factor is profit.
Daniel:
Yea right, instant healthcare insurance. Have you ever read your healthcare insurance policy coming from a company? Do you realize how many pages it is? Have you read the current bill? Mikie Rogers, a congressman claims he has; but, the lies he spews forth shows he has not. I have read it and documented parts of it and sent it to angry bears. Maggie Mahar and I conspired on it.
What you believe is adequate and what we have are two different things. You have a choice, do nothing or accept what we have and figh for change. As I said, 4 million people were dropped fom healthcare which will increase faster than the rate of inflations. And your for sure alternative is what?
The changes are happening s we speak. No limits on insurance. Keeping kids on healthcare until 26, no limit on insureabilty, etc. Read the bill and then come back and discuss this. You don’t know what is in the bill, do you?
Daniel:
The problem with healthcare is they are a business and they make money “selling services.” No money is made selling prevention because it avoids illness, pharma, procedures, a bed in the hospital, specialists, heart procedures, stints, etc. Knw the issues if you wish to solve them.
I’m sorry run7541, you are not reading what I’m saying or what I have written in the past. Yes, I read the bill. I even debated a section of it here at AB with Bruce and contacted my state rep to get clarification for both Bruce and I.
Yes, I know my policy very well having dished out $18K for the none covered aspects of 2 surgeries for my sweety.
Frankly, I don’t know what you are arguing with me about.
I’m a physician. I have passed legislation in my state regarding health care. I have look the number 3 person at BC in the face and asked if they see stupid written on my fore head after agreements were broken.
And, I have to deal with the health care professional who has convinced themself they are doing Gods work all the while counting their money. People who know the game play it instead of fighting to get what the patient needs, they run them through the matrix for the given problem for 8 to 12 weeks knowing it will all fail in order to get to the proceedure or test that is needed. Why, because it save them time which is money. Don’t get paid for arguing for the patient with the insurer.
I’ve done claims reviews. I’ve testified in court with it being declared “most probative”.
Yeah, it’s a freaking money machine. And I repeat: Nothing, absolutely nothing happens in health care until the doctor signs off.
However, the doctor issue is separate from the payor issue.
BTW, I told you what my alternative is. What’s yours?
dolb:
Not this plan; but like SS, you have to start somwhere. Ok doctor, tell me how much is imaging, an electrocardiogram, a blood test for pneumonia, urine test? With castrophic insurance, my fees were 50%. I waited for the costs and no one could tell me, not even my doctor. Finally a clerk at U of M told me to go to an offsite cline for imaging and urine tests. The other stuff cost me ~$1000 including two fees for the ekg.
The systems sucks and they they are in the business of selling services.
Yes, exactly. It sucks. And it sucks because we have one idea of the product controlling 90+% of the market.
X-ray varies $80 for an extremity to $160 low back. Chest $136. UA can be about $30. MRI $600 and up.
Paid for a plastic splint $236 from an ER. I even reported it to my insurer and they said that was normal.
None of this has anything to do with the way money gets from you to the care giver. 2 separate problems.