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Many of the candidates are proposing that health insurance be mandated or required. In other words, the public would have to buy it like they now buy auto insurance. I recently read a letter sent into the WSJ which calls a health insurance mandate “unenforceable and disingenuous”. The author, John Powers, makes this claim on the basis that our laws are based on English common law that refuses to impose upon individuals any positive duty whose breach would constitute a crime. An example would be getting people to wear motorcycle helmets.
I don’t fully agree with him on this but I do understand where he is coming from. Unless we would be able to stop “bailing” out those who refuse to pay into health insurance, it wouldn’t work. And that was his real point. If you have a mandated health insurance policy intertwined with socialized medicine then once you become weak on the mandate all you have left is socialized medicine. And a whole more taxes.
What is your opinion about this? I would love to hear it.
I don’t fully agree with him on this but I do understand where he is coming from. Unless we would be able to stop “bailing” out those who refuse to pay into health insurance, it wouldn’t work. And that was his real point. If you have a mandated health insurance policy intertwined with socialized medicine then once you become weak on the mandate all you have left is socialized medicine. And a whole more taxes.
What is your opinion about this? I would love to hear it.
20 comments:
Unfortunately, the auto insurance analogy is not completely accurate because if you do not want or own a car, you are not required to purchase auto insurance (walk, ride a bike, etc.)
Insurance of any kind is a shell game. They pool funds so that the healthy pay to cover the sick. And the insurance company always makes more money than they provide to the service provider (doctors in the case of healthcare). My company and I pay over $14000/year in healthcare insurance premiums (family of 4), yet my family has used less than $3000/year for vision, dental, and healthcare each of the last 4 years. The only reason I do this is that I am fortunate enough that my company pays 90% of the premiums. Otherwise, I would have purchased real healthcare insurance policy (catastrophic insurance) and funded a Health Savings Account that I control.
What people purchase today is prepaid healthcare, not insurance. Try going to your auto insurance company and ask them to pay for all your oil changes, car washes, brake jobs, new tires, and tune ups on your car. True insurance doesn't pay for regular upkeep and maintenance.
If we socialize medicine or go to a 'one-payer' system as the Democratic Presidential candidates like to call it, we are making the decision as a society that access to healthcare is a 'right', not a priviledge. The healthcare providers will be the big losers if healthcare becomes a 'right'. Each individual needs to take responsibility for his or her health. My doctor is not responsible for my healthcare. She is a consultant that provides options and recommendations. The ultimate decision to exercise, eat right, and take the medicine she prescribes is up to me, not her.
If I cannot mandate that you get health insurance, then I should not have to pay a dime of your medical bills by my taxes. Walk into a restaurant and tell them you're hungry but forgot your wallet. They will show you the door.
Health insurance is like a health club membership right now. Check-ups are covered just like towels at the gym. ALL insurance should be catastrophic....simply prevent the patient from being wiped out by unforseeable illness. And insert riders like not covering smokers for lung cancer, alcoholics for liver failure, etc.
A good example of what I'm talking about was in the WSJ last week. Some guy had a bad staph infection (he was really fat too, maybe he was DM2) which went systemic and wiped out his valves, and maybe seeded his spine. His bill was over $2.5M, and insurance maxxed out at $1.5M. He was being billed for the other million. This is a perfect example of requiring insurance to have no cap, but not kick in until a high $$ number is reached. Not $1000, but maybe $10,000 per year or $50,000 over any 5-year stretch. If the $50K number is reached one year, the numbers don't reset the next year, so people with chronic problems don't get wiped out every year.
Well, I have a different take... Dennis Kucinich is a bit crazed, but when he says that health insurance companies need to be omitted from the mix and driven off the edge of the earth, I'm afraid I agree with him. Health insurers have caused ALL of the problems in the health care professions. Not some. All. To include them in any plan, to allow them to continue to profit, well, that is patently unconsciousable.
Honestly, I don't have a solution yet in my own head, but I do know that to allow their monopoly of the nation's health care is foolish and irresponsible.
For better or worse, this debate has been shaped by societal judgments. Without expressing any opinions, they are:
1) Everyone should be able to get high-end treatment without balancing such issues as age or underlying condition. (For a contrary view, go back and study the plan Oregon proposed a while back to triage healthcare based on those factors, among others.)
2) Emergency care should be available for everyone when they need it, regardless of ability to pay. Think EMTALA.
No. 2 eliminates the ability of providers to just not treat non-payers, and No. 1 drives the high level of cost for health care, however it is covered. None of the current proposals does away with these two factors, yet without putting them on the table for discussion the debate is seriously limited.
Though my roots are somewhat libertarian, I must say that the insurance companies have convinced me that a for-profit model is just not going to be effective in providing coverage for the sick. Their greed issues are exacerbated by selective participation, another problem that undercuts the financial viability of a private-pay free market system. Which means that you either have to require 100% participation or make it a government program. Or both. And the costs will still continue to rise because we all want gold-plated care.
If we mandate that everyone must have health insurance, will all physicians be mandated to accept health insurance? The physician community must think carefully about that one before supporting universal health insurance. Health insurance is destroying primary care. Universal primary care at health insurance mandate reimbursement rates will be the ultimate coup de grace. The only hope for primary care physicians to practice good medicine and make a decent income is to free themselves from the current health insurance reimbursement system.
Realistic says:
Whatever your position on the issue is, one thing is already known.
At the present rate,estimates report that the health care budget by 2025 will be equal to the National budget. So forget about National Defense, roads, schools and what else your taxes pay for.
So lets get real, we need a National Health Care system with Universal access that at the same time places limit on futile treatments (the hell with trial lawyers), and also promotes real prevention at the primary care level. We need to stop coorporations from promoting unhealthy life stiles, having us to pay exuberant amount of money for our medications and continue to depreciate the status of physicians in this country.
Social Darwinism is a stong way to put it but as a married, 40 year old male that has never smoked, done drugs, exercises regularly, eats right, and has a glass of red wine 2 to 3 times a week, I really don't feel the need or have much sympathy for the 10% of the population that consume 90% of the healthcare "product". I DO own an HSA and have been funding it for the last 3 years. I hate paying insurance at all, but since I don't have $5 million disposable, I have to be prepared for the chance bout with cancer or on-coming car (aka - catastrophic event). I have lived my life the way I save for my retirement - to prepare as maximally as I can so that I do NOT have to rely on others.
The idea that the government can start and effectively run ANOTHER government program is laughable. I pray this never sees the light of day, but since I represent a demographic of about <1% of the population, I am sure I will be outvoted at the polls by folks who are on less friendly terms with Charles.
This is funny...we keep hearing about the "GREED!" of the insurance companies, and we wring our limbs over their quest for evil profits. I'm no lover of Big Insurance, but why solely blame a market response to unreasonable consumers? The insurance companies are merely following their nature, and we are horrified that they do what we should expect. The dumb American patient is the real cause of low deductible, high premium foolishness that has allowed Big Insurance to scour the economic oceans for a dwindling catch.
And while we are on the topic, why aren't those so upset over the insurance companies equally frothy over the biggest of them all: Uncle Sam??! Talk about a foolish risk pool that throws an undue burden on the paying customers. But!, I hear you say, there is no profit, and there is no greed. Silly, silly people. There is greed in every voter who thinks that someone ELSE should pay for their expensive elderly relative, or the batch of unplanned pregnancies living down the street. The emotional greed with which voters steal their neighbors' tax dollars is avarice that would make Aetna blush, and the hundereds of billions so confiscated dwarf the gains of the Blues. No profits?? Politicians gain the profits of arrogant self-satisfaction and electoral returns by sops to granny and the poor. Voters gain the profit of negligence, by simply voting for someone else to care. And all of it inflates medical costs far beyond what Big Insurance could accomplish while depressing our economic vitality. Those of you who think that giving all this over to the government will eliminate profit and greed should really stay out of the eggnog.
Uh, do y'all have any reliable statistics to prove fat/lazy people are responsible for the high cost of health care or is that just a convenient assumption?
And what makes you so special that you should have health care insurance while someone else shouldn't?
Do you know that the bulk of Medicaid funds go to the elderly (your granny in a nursing home) and the disabled, and not crack whores spitting out illegitimate kids?
Do you know that 59% of employers are offering health care benefits down from 69% five years ago?
Do you know that half of the bankruptcies are related to catastrophic medical bills and, in many cases, those people had insurance?
Do you also realize you with employer provided health care insurance are responsible for a $340 billion dollar tax shortfall because those benefits aren't taxed?
Your tax dollars are used to provide health care coverage for some of the laziest, most useless people in our country...Congress. Those dollars also subsidize insurance for millions of federal employees.
The Feds now pay for about 60% of the total health care tab, and that is MORE than the total health care expenditures (private AND public) of the UK, Sweden, Japan, Italy, Austalia, France, Germany and Canada.
So what do you propose doing about the 16 year old in our parish who was hospitalized for a liver tumor, has been hospitalized 21 times since last February for complications and has a hospital bill in the millions? Let her eat cake? This didn't happen because she "didn't take care of herself."
There is a good chance you will find yourselves among the uninsured in the future. So don't come crying to me when it happens.
And yes, I have citations for everything I've quoted.
Well, Mr. Grump, that is great that you have statistics. I guess when I don't have enough money to buy a new car I can just show the government my bank statement "showing" that I don't have any money and that will some how qualify me to get a free hand-out.
This is not a question of statistics. It is a moral debate. I don't think ANYONE here would feel bad about providing healthcare/insurance for the 16 year old with cancer. That was not a lifestyle choice. I think what we are mostly concerned with is the idea that a 57 year old, 285 lb male that has smoked 2 and 1/2 packs a day who presents with his second MI, has diabetes and declining renal function should somehow be on equal footing with the 16 year old. The kid did not necessarily make poor choices. He was dealt a bad genetic hand. Where does society cross the line? What dollar amount is too much for 1 life? I don't think government can or should make that decision. Insurance is just a tool to try to fill any void that might exist. If you cannot afford to pay you probably should not play. Can't afford a baby, better not have unprotected sex. Can't afford to treat asthma, better not smoke. Unfortunately we are just not that smart.
Well, Mr. Grump, that is great that you have statistics. I guess when I don't have enough money to buy a new car I can just show the government my bank statement "showing" that I don't have any money and that will some how qualify me to get a free hand-out.
This is not a question of statistics. It is a moral debate. I don't think ANYONE here would feel bad about providing healthcare/insurance for the 16 year old with cancer. That was not a lifestyle choice. I think what we are mostly concerned with is the idea that a 57 year old, 285 lb male that has smoked 2 and 1/2 packs a day who presents with his second MI, has diabetes and declining renal function should somehow be on equal footing with the 16 year old. The kid did not necessarily make poor choices. He was dealt a bad genetic hand. Where does society cross the line? What dollar amount is too much for 1 life? I don't think government can or should make that decision. Insurance is just a tool to try to fill any void that might exist. If you cannot afford to pay you probably should not play. Can't afford a baby, better not have unprotected sex. Can't afford to treat asthma, better not smoke. Unfortunately we are just not that smart.
Wow. I have to agree with "grumpy" that blaming people for their illness is not the way to go, though it may make one feel self-righteous, a la "graymatter" missives. It's not just the 16 year old with liver tumors, but people with multiple sclerosis, lymphoma, West Nile, trauma from car accidents or work injuries etc. etc. who end up suffering regardless of how they may have tried to stay young, healthy, financially secure, and privileged.
I support the idea that a society exists to benefit its members, and that education, health care, police and fire protection, and infrastructure are benefits we should all enjoy and contribute to through taxes.
The insurance schemes in the U.S. make their profits by excluding the most costly and medically needy patients. We don't need the insurers taking their cut--we would pay less and get better use of health resources if everyone were in a common pool (yes, single payer DOES make the most sense).
Mandating that people buy insurance is not the answer, because it can't address the fact that insurers won't make money on sick patients and will therefore always dump them or charge unaffordable fees. The public still picks up the cost of those the insurers can't or won't cover. Worse, the patients often don't get care until they have gotten much sicker (if they haven't just died...)
Also, instead of just blaming individuals, it would help to have more robust public health measures and regulation, such as getting rid of direct-to-consumer drug and tobacco advertising, limiting junk food in schools, and providing health education including realistic sex education.
I have worked in the U.S. and in Canada, and have to say that the latter does better at basic access to health care, it costs less, and the health measures are overall superior. While there is no perfect health system anywhere, I believe the difference is because the Canada Health Act requires a universal, portable, publically supported, more equitable system. The U.S. proposals for insurance mandates, HSAs, "catastrophic" coverage, or just callous disregard of the poor or ill do not lead the way to better health care.
As I attempted to say but was sort or misrepresented, almost no one (including myself) would feel bad about folks dealt a bad genetic code, or unlucky enough to be involved in an accident. But if you think I believe all people should receive equal financial support, I don't. If one driver was a 23 year old mother of 3 on her way home from soccer practice and the other is a 30 year old driving home after 4 drinks at happy hour (one made a choice, the other didn't). If people are not held accountable and continue to depend on our ever-so-efficient government they will never learn from their mistakes and the mistakes of others. Why did "3 strikes" reduce major crime in California? I guess I am off topic here. You cannot tell me that by moving the cost of insurance away from the private sector to the government, that it will reduce costs. That has, historically never been the case. And, additionally, by having the government "mandate" control of junk food or tobacco we as Americans just lose a little more liberty for the "good of the nation". If the government was really into protecting our health why haven't tobacco products been banned? PROFIT. No profit to the share holders, but profit in the way of taxes and lobbying. This thread is depressing me.
Oops, just re-read my comment: Clarification: "... would feel bad about folks dealt a bad genetic code, or unlucky enough to be involved in an accident RECEIVING HELP."
A few minor things to think about when it comes to the government "fixing" health care:
1. Medicaid
2. Medicare
Are the above are well thought out efficient programs that are policed well to keep out abuse of the system? If not then why do we think any other plan they come out with will be. Food for thought. We as physicians need to have the ability to formulate the system with input from the logical public not some career congressman sitting in a multimillion dollar office complex with a degree in buisiness or law.
Graymatter:
You won’t die if you don’t have a car; and no one expects their car insurance to buy them a car. You might die without access to health care. So are you saying if someone can’t afford insurance, they should just take two aspirin and hope for the best? Or commit suicide and not put so much pressure on the system.
The average cost of a family policy is equal to the annual salary of someone working for minimum wage (about $12,000). Can you afford $12,000 a year for health insurance in addition to your other expenses? What if no one will insure you (for whatever bogus reason insurers use to deny coverage)?
I’ve had asthma since I was 6 and I’ve never smoked. Should I be denied health care because I will be consuming resources?
Rural doc: So what is wrong with Medicare and Medicaid? No insurance company would ever insure old people. My friend’s mother (68) had surgery for a thymic tumor a few months ago and spent about 3 weeks in ICU for complications. The hospital billed Medicare $460,000. So you figure she should have been on the hook for the tab?
Tell me people don’t scam insurance companies…oh yeah, how about physicians and other health care entities indicted for Medicare fraud?
Grumpy is right! There is nothing wrong with medicare and medicaide at all. It is the system we will all be using in the future when it becomes the standard for universal health coverage. You are right. I hope medical school becomes free as well because no one will go into primary care when it becomes the standard. Heck why even have physicians in rural areas the cities are really all that matter anyway.
60% of the US population is covered by Medicare, Medicaid and government funded private insurance. So why not include everyone? I'm assuming your objections are:
1. Medicaid people are scum
2. Medicare and Medicaid don't pay for shit.
1. I see more nice middle-class working people on Medicaid than I did 10 years ago. And I hate taking care of Yuppie scum anyway.
2. My late father-in-law's internist did pretty good coding all his 5 minute follow up visits as Level IV and getting $100 a pop. Judging from the high-end luxury cars I see in the doctors' parking lot, I don't think you guys are hurting.
There are some who think medical school should be free because graduating with $200K or more in debt doesn't make one want to go practice in the hinterlands. I'd be in favor of that if the tradeoff would be enforeced. We pay for your medical school; you practice in an underserved area without trying to weasel out of your commitment.
Grumpy: No medicaide people are not scum but alot of people that are hard working cannot get it. Also alot that have it do not work so they can keep it and other government welfare because if they did get a job they get kicked off and fall through the cracks. Problems with the system? Also if you pay for your insurance you think twice about using the emergency room for convenience instead of a clinic and use it for emergencies like it is intended. When it's free it becomes a 24 hour clinic for some. Alot of doctors do not take medicare and medicaide because the regulations and hassle is not worth it. We have yet to see the solution to our health care payment system crisis from the government or private insurance companies.
By the way I work in a rural area some would say "frontier" or you would say "hinterlands". I am the only physician in the county and I drive a chevy pickup if you consider that high-end luxury car. Auditors have told us we are not a free clinic but close due to no real profit margin what so ever.
First of all, the most people "pay" for insurance is about 35% if they are getting it from their employer. Joel smugly admits his company pays 90%. Insurers are prohibited from weeding out group participants, so going to the ER is more a matter of "do I want to wait 4 hours or not?" It has nothing to do with being more careful because you are insured.
If you pay out of pocket for insurance, you think twice because the company can dump your ass for no good reason and you don't have the financial resources to fight their army of lawyers. Problem is, most of the people who need to buy individual policies can't because (a) they can't afford them or (b) they have some "preexisting condition" and get rejected.
If you read Dougie's Placebo Journal, you'll note he doesn't think much of Medicaid patients, although he stops short of calling them scum. Most physicians I've known (a fairly large number), think Medicaid patients are parasites.
I drive a Nissan Altima and I've known a few docs who've driven some really big-ass Chevy pickups, way out of my price range. And as I've said before, I much prefer rural areas.
You said: "We have yet to see the solution to our health care payment system crisis from the government or private insurance companies." Interesting choice of words. Physicians are most concerned with getting paid. I'm most concerned with everyone getting affordable coverage.
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