Massachusetts makes health insurance mandatory

[Accidental_Yuppie]

Many people do not have an employer to buy health insurance for them and this makes affordable insurance difficult to find if they make any money at all. There are subsidized programs but they cut off at a fairly low income threshold, about $50,000.00 for a family of 4, less for individuals and couples.

The MONTHLY local rates for individual Blue Cross in my region are
Individual crappy HMO plan $625.00
Individual good POS plan $1100.00

Family of 4 crappy HMO plan $1850.00 a month
Family of 4 good POS plan $3300.00

See the problem here? People who get insurance through their employers don’t know how good they have it, even if they have to pay the whole cost.

Unfortunately, one of the reasons insurance is so expensive is that health care is expensive. The drugs used to keep a typical advanced cancer patient alive for one more month can easily top $20,000.00 and medical advances have made cancer and AIDS long term chronic illnesses in many cases.

While the price of some of the drugs is justified, most of them are outrageously expensive. This is in large part due to a well-meaning but misguided piece of legislation requiring insurance companies to provide neccessary drugs regardless of cost.

http://www.iht.com/articles/2006/03/12/business/web.0312berenson.php

is the story of how the makers of a decades old anticancer drug just increased the price from about $75 a tube to about $500, just because they could. They probably felt the insurance companies weren’t paying enough for a drug that treats CANCER, but it was a real problem for the uninsured that needed the drug.

Still, I am against socialized medicine, the system is broke in large part because of stuff like this which legislates against the free markets. I have spoken with seriously ill people in Canada and the UK, and I am amazed at the way these governments ration health care…waits of 6 to 8 weeks for a CAT scan, which you can usually get if needed in a few days in the US system. The patients in these countries seem to accept the reasoning that there aren’t enough machines and doctors, but the reason that there aren’t enough is that the government won’t buy more.

Barbara

[kanicbird]

A personal level unfunded mandate, gov’t is not God, it just can’t say ‘You shall do this’ and expect it to happen, it appears even God has trouble enforcing these.

@phall0106

Hmmm…so if a couple who have two children are both working, making minimum wage, and paying daycare, rent, buying food, trying to keep their POS junker car running (and buying the state minimimum required car insurance) so they can get back and forth to work, and living sometimes not from paycheck to paycheck, and can’t afford to buy new shoes for the kids, then they’ll be penalized for not buying health insurance through their employer?

I’d like to know the number of couples who both make minimum wage, If taken over a few months I’d bet this number drops to zero. Also how can a coulbe making min wage afford daycare, it would be cheaper for one parent to stay home.

[Barbarian]

@crazyjoe

Really? And you base this on what set of statistics? I might not be able to cite mine (proprietary company info that I no longer have access to) but I did work in the industry and I did see this sort of thing happening. I know that in countries with universal healthcare, lines and waiting a long time are not uncommon things. Here, depending on your doc, you can usually get in the same day if you need to see one for a cold.

I find it odd that you might think that American health care consumers have no need to change their ways of thinking, that they will magically change if they switch to universal health care.

Malcolm Gladwell has a good article about what he calls moral hazard and its effect on health care.

Canada only implemented universal health care in the 60s. Sorry that you think Americans are more likely to abuse the system. But I think you’re wrong. One great demonstration is to look at uber-rich people who think nothing of a co-pay. How often do they abuse seeing a doctor? Probably not that often.

Having used the Canadian health care system, and knowing plenty of doctors, I can tell you that any Canadian shortages in care aren’t due to abuse/overuse by patients. Health care in Canada is a provincial matter, and the provinces have historically been less willing to spend money on equipment than health care practitioners in the U.S. As a result Canada does have longer wait times for hip replacements, MRIs, etc… because the facilities are overbooked. Canada has 151 MRI machines. The U.S., with 10 times the population, has about 5500 MRI scanners. cite

Any queues aren’t because people who think they have hip problems are clogging up the queue. They can’t. The first step for any procedure in Canada is to see your GP, if you have one. The GP then refers you to a specialist, and so on and so forth. (And right now, many provinces are working on universally accessible wait time lists so patients and doctors can figure out how to minimize wait times.)

About 1/3 of Canucks don’t have a primary care physician, because fewer doctors are setting themselves up in family practices. There have been times I’ve had a family doctor, and times (because of moving and whatnot) that I haven’t. Every time I’ve been sick enough to see a doctor I have always been able to see a doctor that day – and if I’ve gone to a clinic, I don’t even have to make an appointment. I have never even heard of someone who has had to wait to see a doctor for a basic emergency (as a journalist, it’s my job to know*). Nurses do triage when you come in the door, and if it’s serious, you’ll be moved to the front of the line. The only restriction is facilities, operating rooms, and doctors. Canada doesn’t have enough – but that’s a problem that can easily be fixed.

This is only partly true. I have stupid moron friends who were taking their newborn to the ER every couple of weeks for things like “she’s constipated” or “she bumped her head.” Her copays for ER visits obviously were not high enough.

Spoken like an insurance agent who wants to minimize costs. But I’d rather have a medical professional determine if your friends were wasting time, since the U.S. ranks [url=http://www.cdc.gov/omh/AMH/factsheets/infant.htm]fairly high* on the infant mortality scale. A kid who hasn’t pooped in a week may or may not be sick; that bump on the noggin could be normal, or could be something more serious. But the reality is that laypeople don’t know how serious any medical complaint is-- that’s why they see doctors.

[sub]*If you fall a break a hip between Christmas and New Year’s, you will have to wait for surgery, because odds are only one or two doctors are doing surgery that week. But you’re not waiting because of any patient abuse problem with universal health care. You’re waiting because there aren’t enough trained doctors working. Different problem, but you end up waiting three days in the hospital. [/sub]

[Sal_Ammoniac]

@WillMagic

Say you are a 25-year-old healthy, single male, looking for cheap health insurance. You don’t drink…period. Now, when looking at various plans, it would make sense to purchase a plan that didn’t cover alcoholism, right? Alcoholism coverage costs some nonzero amount of money. So, in a free market, you could look for a plan specifically tailored to your needs, and that plan would save you money.

This assumes that people know, to a nicety, exactly what healthcare they will need in the near future. They don’t – that’s just the problem. Even to take your example, it’s not unheard of for a non-drinking 25-year-old to start drinking, and suddenly find himself unable to stop. What then, in your example? Is he to pay for his alcoholism treatment out of pocket? Or maybe he tries to change plans, but finds he has a “preexisting condition” for which he’s unable to get insurance.

The other problem is that there is not, currently, an IT infrastructure that well supports this profusion of tailored plans. The inevitable result would be people showing up at the hospital to get care, and not knowing what care they’re entitled to. The hospital has no way of knowing either, so they either have to chance it, or call the insurer to find out. This, by the way, is real-world problem today, one that I have encountered personally. Your proposal would make it more severe, and probably result in more uncollected bills for the hospital. And by the way, hospitals in Massachusetts at least are not operating on fat margins. With any significant increase in bad debt, they’re at risk of having to shut their doors.

The problem with free-market approaches generally is that they push a lot of the risk onto individuals. You go with a low-cost plan, or a low-cost drug, or a low-cost provider, and you’re taking a big gamble. It may work out for you, but boy, the penalties when it doesn’t are severe.

[WillMagic]

@Sal Ammoniac

This assumes that people know, to a nicety, exactly what healthcare they will need in the near future. They don’t – that’s just the problem. Even to take your example, it’s not unheard of for a non-drinking 25-year-old to start drinking, and suddenly find himself unable to stop. What then, in your example? Is he to pay for his alcoholism treatment out of pocket? Or maybe he tries to change plans, but finds he has a “preexisting condition” for which he’s unable to get insurance.

Wow. So because of this hypothetical, people shouldn’t even have the OPTION to forgo alcoholism coverage? Even though it is an entirely voluntary choice to drink?

Obviously people don’t know exactly what health care they will need in the future…that’s why there is insurance in the first place. However, when it comes to ailments that are in a real sense voluntary (alcoholism, drug addiction, marriage counseling et al.) there are going to be people who know they are highly unlikely to need coverage. ** So why should they be forced to pay for it? How is that not a gross violation of liberty? **

The other problem is that there is not, currently, an IT infrastructure that well supports this profusion of tailored plans. The inevitable result would be people showing up at the hospital to get care, and not knowing what care they’re entitled to. The hospital has no way of knowing either, so they either have to chance it, or call the insurer to find out. This, by the way, is real-world problem today, one that I have encountered personally. Your proposal would make it more severe, and probably result in more uncollected bills for the hospital. And by the way, hospitals in Massachusetts at least are not operating on fat margins. With any significant increase in bad debt, they’re at risk of having to shut their doors.

Well then the hospital needs to start running its business better. This seems like an extremely minor quibble. If a hospital is really going to go out of business because they can’t get their administration together, then let it go…it’s a poorly ran hospital anyway and will probably be replaced by a hospital that can get its shit together.

I mean, this is a nonzero cost, certainly, but are you really going to argue that everyone should be forced, BY GOVERNMENT, to pay for coverage they don’t want and have no use for just so hospitals can save?

The problem with free-market approaches generally is that they push a lot of the risk onto individuals. You go with a low-cost plan, or a low-cost drug, or a low-cost provider, and you’re taking a big gamble. It may work out for you, but boy, the penalties when it doesn’t are severe.

Sure, but people willingly assume that risk when they get to make their own choices. Every person has a different needs, different wants, different values. Free-market approaches allow people to, GOD FORBID, make their own decisions and spend their money in the manner of their pleasing. And arguing that they shouldn’t be allowed to do so is arguing for totalitarianism.

[Sal_Ammoniac]

@WillMagic

Well then the hospital needs to start running its business better. This seems like an extremely minor quibble. If a hospital is really going to go out of business because they can’t get their administration together, then let it go…it’s a poorly ran hospital anyway and will probably be replaced by a hospital that can get its shit together.

No question that hospitals need to run their business better. But to do so, they need to make huge IT investments, and they usually don’t have the money because their margins are so low. And I can assure you this is not a minor quibble. It is an important fact of life for the hospital industry. It’s fine to say, “Oh, just let them fail,” but tell that to a community that’s looking at losing the only emergency room for miles around.

But I’m curious how far you are willing to take the fair-market gospel when it comes to healthcare. Are you willing to let anybody practice medicine, regardless of training or licensure? Because that would certain bring the cost down, and be respectful of patient choice, and the willingness of individuals to assume risk.

And you didn’t answer my question about what happens when people forego a certain kind of coverage, only to find they need it after all.

[WillMagic]

@Sal Ammoniac

No question that hospitals need to run their business better. But to do so, they need to make huge IT investments, and they usually don’t have the money because their margins are so low. And I can assure you this is not a minor quibble. It is an important fact of life for the hospital industry. It’s fine to say, “Oh, just let them fail,” but tell that to a community that’s looking at losing the only emergency room for miles around.

Huge investments? Isn’t this kind of a one time thing? You make an IT investment and you don’t have to make another one?

But anyway, my main point is this: if people demand choice in their health care, and a hospital is unable to supply that choice and consequently people stop patronizing that hospital, then I think it’s for the best, and I don’t think the government should step in to stop it.

But I’m curious how far you are willing to take the fair-market gospel when it comes to healthcare. Are you willing to let anybody practice medicine, regardless of training or licensure?

I bet you aren’t expecting this answer. Yes. I am. That’s not to say I would end liability, or that a doctor that performs malpractice or other fraud shouldn’t be sued.

Because that would certain bring the cost down, and be respectful of patient choice, and the willingness of individuals to assume risk.

You’re right! It’s a great idea. Also it means that the small community hospital that couldn’t compete because of some IT expenses will be replaced quickly by one that can.

And you didn’t answer my question about what happens when people forego a certain kind of coverage, only to find they need it after all.

Obviously they have to pay for it out of pocket. Or, they can look for charity, if their situations warrant it.

I noticed you snipped the other parts of my argument. Any comment on those, or are you just going to concede those points? You know, that mandating insurance coverage of alcoholism etc. is vastly inefficient as well as being a gross violation of liberty?

[Sal_Ammoniac]

@WillMagic

Huge investments? Isn’t this kind of a one time thing? You make an IT investment and you don’t have to make another one?

People outside the industry are staggered by the cost of the IT investments required in healthcare. If you’re going to build an IT system to verify in real-time the insurance coverage of every one of 300 million Americans who might want to walk through your doors on any given moment, you need to connect it to your billing system, which you need to connect to your medical coding system, which you need to connect to… etc., etc. You’re often dealing with legacy systems, many of them proprietary, and most of which need to be up 24/7. Believe me, it’s very expensive, which is why community hospitals – and even big academic hospitals – haven’t done it.

@WillMagic

I noticed you snipped the other parts of my argument. Any comment on those, or are you just going to concede those points? You know, that mandating insurance coverage of alcoholism etc. is vastly inefficient as well as being a gross violation of liberty?

I’ll concede that mandatory alcoholism coverage is a teensy-weensy violation of liberty. What I don’t see is where it’s “vastly inefficient” or makes our insurance system “sooo expensive,” particularly compared with all the other factors that *do *make our insurance system expensive and inefficient.

As for the rest the argument, you get points for consistency, but allow me to say that I have no interest – and I doubt many other people do, either – in living in the libertarian dystopia you propose.

[bizzwire]

@Sal Ammoniac

Actually, one other thing I should mention. This is very much an “art of the possible” sort of deal. The activists weren’t wild about it, but their line of thinking goes like this: once we establish universal care as the basic proposition, and introduce the notion that businesses will need to assume at least some responsibility for healthcare, then it becomes easier to talk later about a more rationalized and more efficient system.

The Governor of Massachusetts was on NPR today, talking about it, and as far as he is concerned, you couldn’t be farther from the truth. To condense his argument, if an uninsured person shows up at the hospital and is treated, their medical care is not free: somebody pays. That somebody are those people who pay insurance premiums. The goal of this plan is that everybody pays.

[clairobscur]

@crazyjoe

I know that in countries with universal healthcare, lines and waiting a long time are not uncommon things. Here, depending on your doc, you can usually get in the same day if you need to see one for a cold.
.

Here too. As I say times and again, waiting lists exist in some countries with a public healthcare system (and it happens to be the countries american people are the most familiar with : Canada and the UK). It’s not a unavoidable consequence of a public healthcare system.
Besides, as usual, without such a system, you can indeed see a doctor on the same day providing that you have enough money to pay him this day.