Survey: 59% of American physicians now support UHC

[Weirddave]

@DSeid

I will illustrate with my personal circumstance. Our company offers an HSA, a PPO, and an HMO option for different amounts of employee contribution. My wife has ongoing medical issues. Nothing life-threatening but chronic stuff. Two of my children and myself are on daily medications of different sorts. Between those we probably have 10 -15K of real costs … maybe more. I’d spend the whole 10K and then insurance would kick in. With the PPO option my out of pocket is less than that per year. OTOH, if none of us had any known issues then the money could build in the HSA and my only expense would be the monthly premium. In that case the HSA choice would be great.

I’ve been thinking about this, and I have a couple of questions. First of all, forget the “savings” aspect of an HSA. It’s a red herring. You’d be a damn fool to look at the 1 or 2 % that an HSA is going to give you when there are CDs, mutual funds and other investments returning many times that amount on you money. You need to think of the actual savings account itself as simply the mechanism you use to pay your medical bills for tax purposes. IOW, you get a bill from the doc for $100, you put $100 in your health savings account and then write a check drawn on the hsa to your doc. I’ll come back to this in a bit, because we can’t ignore the tax savings aspect of this, something I did earlier.

Second, I don’t know where you are getting your figures from. In order to qualify as HSA eligible, a HDHP(high deductible health plan) has to meet several federal guidelines, one of which is that the maximum yearly deductible for a family is $5k. When you talk about an HSA with a 10K deductible it does not compute. your company may offer a HDHP with some type of flex spending account, but that’s not the same thing (and I don’t know what kind of limits there might be on those types of plans). Can you clarify this?

Third, having your employer pay for your coverage really skews the sample. If I didn’t have to pay anything in premiums (or very little because my employer was footing the rest of the bill), I’d probably take the HMO. Little or no out of pocket cost at the point of service? Hell yes baby. I’ve been talking about people who are paying their own premiums too. When that “little or no out of pocket cost at the point of service” comes at a cost of $1500/month the picture changes. A lot.

Fourth, in that vein, I went looking for HSAs in Chicago on ehealthinsurance, and I found out that what I said in point 2 is apparently wrong, according to the site HSAs can have out of pocket expenses of up to 11K per family, which is not correct according to the training I had to take to get my insurance license, but I’ll go with it for now. Still, using the same parameters as I did in MD earlier, 40yo father, 37 yo mother, 2 kids in Zip Code 60601, I found a Humana HSA with a $5000 family deductible, $0 coinsurance after deductible is met, for $361/month. That changes my earlier calculations, but still puts the family’s total possible annual medical liability at $9300, all of which is tax deductible. Figuring a rough 30% tax bracket they would get $2800 back on taxes, leaving them with total net medical expenses of $6500/year, worst case scenario. Compare that with a “standard” PPO. Here’s one offered by BCBS of Illinois, $1000 deductible per person(max 3), Out of pocket maximum of $3000 per family (not including deductible). Here are that family’s total possible costs, worse case:

Premiums-$729/month or $8750 annually
Deductibles- $3000
Out of Pocket max- $3000

Total cost- $14050
Tax savings (premiums only)-$2625
Next cost- $11425

That’s almost double what an HSA would cost. Now, suppose take this a step further and look at a good year, one where nobody goes top the doctor more than once or twice, say for a total cost of $1000. In either case that’s going to be out of pocket because deductibles have not been met, so all that’s left is premium costs. HSA: $4332 (minus $300 tax savings because the $1000 was deducted)
PPO: $8750

Are you starting to get the picture? Now, I’m not saying that HSAs are a cure all for our health insurance woes in this country, but that are a good option, and in many cases they are the best overall financial protection out there ($10K deductibles change that a bit, I’m going to have to look into that). Unfortunately, since many people no longer view health insurance as insurance but as an entitlement (THE biggest problem out there IMO), there are a lot of people who never get beyond the “WHAT???YOU WANT ME TO SPEND $2500/$5000 OF MY OWN MONEY ON MY MEDICAL CARE BEFORE INSURANCE KICKS IN???THAT’S CRAZY” reaction. That’s not crazy, that’s INSURANCE. Most people in America could benefit from cracking a dictionary and finding out what the word means.

[BrainGlutton]

@DrCube

We don’t want to make hard societal changes that could keep health-care free (as in freedom) and high quality.

@BrainGlutton

Eh? What societal changes would do that?

I’d still like an answer on that point, because I’m drawing a blank.

[Spoons]

@Weirddave

Unfortunately, since many people no longer view health insurance as insurance but as an entitlement (THE biggest problem out there IMO), there are a lot of people who never get beyond the “WHAT???YOU WANT ME TO SPEND $2500/$5000 OF MY OWN MONEY ON MY MEDICAL CARE BEFORE INSURANCE KICKS IN???THAT’S CRAZY” reaction. That’s not crazy, that’s INSURANCE.

It seems to me that you’re talking about two things here: insurance and deductibles. Insurance is simply the principle of indemnification; of making one whole after a loss. A deductible is what an insurance policyholder pays before the insurance kicks in. The two do not necessarily go hand-in-hand: an insurance policy may well have a deductible, but it doesn’t have to. For example, my provincial health insurance has no deductible. My car and home insurance does.

No matter what kind of insurance is being sold, if an insured opts for a high deductible in exchange for lower premiums, then I agree that they really have little to no right to complain about paying that high deductible if/when they incur a loss. But if all an insurer offers are policies with deductibles in the four-digits, then it would seem to me that the broker, agent, insurer, company benefits department, and/or whoever else is responsible for selling/signing people up for the plan must explain the plan fully, must explain how much will be owed by the insured in case of loss, and must explain that there is no way they can get around that deductible. Even then, the insurer should prepare for complaining. Withstanding complaints, while unpleasant, would have to be another part of the job.

But insurance and deductibles, which they do work together, are different things, certainly. To paraphrase Lewis Carroll, “I have seen a policy without a deductible, but I’ve never seen a deductible without a policy.”

[Weirddave]

@Spoons

No matter what kind of insurance is being sold, if an insured opts for a high deductible in exchange for lower premiums, then I agree that they really have little to no right to complain about paying that high deductible if/when they incur a loss. But if all an insurer offers are policies with deductibles in the four-digits, then it would seem to me that the broker, agent, insurer, company benefits department, and/or whoever else is responsible for selling/signing people up for the plan must explain the plan fully, must explain how much will be owed by the insured in case of loss, and must explain that there is no way they can get around that deductible. Even then, the insurer should prepare for complaining. Withstanding complaints, while unpleasant, would have to be another part of the job.

I agree with you 100% on this paragraph.

To clarify what I meant by INSURANCE. You are correct in stating that the job of insurance is to “make one whole again”, but I was using the term in a little bit broader sense: to protect against major loss. This concept is intact in all other types of insurance, you don’t buy (nor expect) car insurance to pay for your oil changes and tires, your homeowners doesn’t cover the cost of the plumber when the toilet clogs or the new TV when the old one goes on the fritz. WRT health insurance, however, lots of people expect to pay little or nothing out of pocket for anything, and when insurance companies respond by offering policies that offer this type of coverage*(policies that are, in a word, bloody expensive), then the cry goes out “WAH! That costs too much!” and talking heads start nattering about the crisis of sky high insurance rates. I am suggesting that we as a country would be much better served if we thought of health insurance the way we think of every other kind of insurance: something in place to protect us from major loss. I don’t think it’s at all unreasonable to expect individuals to cover the cost of Dr. visits, strep tests and penicillin with affordable, comprehensive insurance in place to pay for surgery, MRIs and chemotherapy.

*Just as an aside, these types of plans have also given free reign to the two giants currently raping the system in the ass: Big pharma and excessive, unnecessary testing.
Aside part 2:Calgary and Edmonton?? Do you hate yourself?

[DSeid]

Weirddave we do digress. I’ll concede that some people may indeed be best served by an HSA depending on the exact products being offered in a particular locale. But the original point being questioned was that “the cost of employee sponsored health insurance which is generally much more expensive than paying for coverage yourself” …

More and more employers are offering HSAs but the fact is that for the same plan, same benefits, be it HSA, HMO, or a PPO, an individual purchasing it on their own will pay more than an individual getting through the workplace. They’ll pay more for the product (no volume discount) and they’ll not get the tax subsidy of having it paid with pre-tax dollars.

Finally while a comparison with Canada is interesting, it is an intellectual exercise only. Single payor will not happen here, for better or worse. It threatens too many vested interests too much (including but not limited to doctors and the insurance industry). UHC does not require single payor. Many other models can also provide for UHC. And to bring this back to the op, I believe it is the awareness of these other (less threatening) models that have gotten a majority of MDs to support UHC. And would probably get it past the insurance industry as well.

[Weirddave]

@DSeid

More and more employers are offering HSAs but the fact is that for the same plan, same benefits, be it HSA, HMO, or a PPO, an individual purchasing it on their own will pay more than an individual getting through the workplace. They’ll pay more for the product (no volume discount) and they’ll not get the tax subsidy of having it paid with pre-tax dollars.

Not to set my self up for accusations of offering an Appeal to Authority fallacy, but will you accept my word, as someone who has for the last 10 years worked with small businesses and individuals to help them get health insurance, that this is not accurate? As a general rule, small business plans are more expensive than individual plans (to be fair they are often but not always more comprehensive too). This is my career, this is exactly what I do, I really do know what I’m talking about here.

Oh, and FYI health insurance premiums are tax deductible for individuals as well. That makes them “pre-tax dollars”.

[Spoons]

@Weirddave

Aside part 2:Calgary and Edmonton?? Do you hate yourself?

It sure isn’t easy when the Oilers play the Flames, or the Eskimos play the Stampeders. Sometimes, I just cheer for the referees.

[chorpler]

@Renob

Exactly, it is a single-payer system for poor (and not-so-poor) people. And it pays for crappy service.

I’m actually not opposed to Medicaid for the poorest of the poor. I think it’s a pretty horrible system, though, and I wouldn’t wish it on anyone.

Just to add my data point from the end user’s point of view: I don’t know how it works in other places, but in Nevada, at least, it’s actually pretty good. We (family of four) have had five different kinds of health insurance in the last 15 years, and Medicaid was by far the best of them, with the exception of its nonexistent dental benefits for adults. Medicaid run through an HMO, that is.

[DSeid]

@Weirddave

Not to set my self up for accusations of offering an Appeal to Authority fallacy, but will you accept my word, as someone who has for the last 10 years worked with small businesses and individuals to help them get health insurance, that this is not accurate? As a general rule, small business plans are more expensive than individual plans (to be fair they are often but not always more comprehensive too). This is my career, this is exactly what I do, I really do know what I’m talking about here.

Oh, and FYI health insurance premiums are tax deductible for individuals as well. That makes them “pre-tax dollars”.

Really?

Under current tax law, health insurance premiums are largely tax-exempt if the insurance is provided through an employer but generally are not deductible when a person purchases insurance directly. The share of the premium paid by the employer is not counted as income to workers and retirees under the federal income and Social Security payroll taxes. The employee’s share of the premium also can be tax-exempt in firms with flexible spending plans (such as Section 125 cafeteria plans). Out-of-pocket health spending in excess of 7.5 percent of adjusted gross income is tax-deductible for all individuals.
<snip>
Because 43.6 million Americans, most of whom are in relatively low income groups, are uninsured, it is important to ask whether it is appropriate that 26.7 percent of federal health benefits tax expenditures goes to the 14 percent of the population with the highest incomes. Moreover, these tax expenditures should be reevaluated in terms of their tendency to encourage overuse of the health care system.

Proposals have emerged that would replace the current health benefit tax expenditure with a refundable tax credit. Workers would be required to count the value of employer-sponsored health benefits as income when computing their taxes, which would increase their incentives to enroll in less costly health plans. A refundable tax credit of perhaps $1,500 for individuals and $3,500 for families would be provided to all Americans and would be phased out as income rises. This would refocus the health benefit tax expenditure on lower-income people to help the uninsured obtain coverage. The tax credit also would be available for all health insurance including nongroup coverage (excluding Medigap), which does not now qualify for tax preferences.

That is sort of the key point of McCain’s approach to health care reform.

Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit remainder in expanded health savings accounts.

I actually like that aspect of his plan and would love to see that merged with Hillary’s proposals as a good step. (Maybe they can both work together in the Senate to present such for Obama to sign as President. :))

And despite your expertise I’d need some evidence for the claim that the same insurance product would be cheaper to buy as an individual than to buy as part of MegaCorp’s group purchase. The only argument by which that makes any sense is that when the insurer sells to individuals they can cherry pick effectively whereas selling to MegaCorp they need to account for those who have high health care expenses.

[Weirddave]

@DSeid

Really?

Ahh. I see the problem here. I am talking about an individual needing insurance and going out and buying it himself(form 1040, line 29). You are talking about an individual getting it from his employer but still being charged for part or all of the cost. Two different things.

And despite your expertise I’d need some evidence for the claim that the same insurance product would be cheaper to buy as an individual than to buy as part of MegaCorp’s group purchase. The only argument by which that makes any sense is that when the insurer sells to individuals they can cherry pick effectively whereas selling to MegaCorp they need to account for those who have high health care expenses.

2 things: #1 You put your finger on a large part of it. The difference between underwritten and non-underwritten insurance is that non-underwritten insurance is always more expensive.

#2 I don’t know what to tell you. There isn’t (to my knowledge) any type of website where you can get rates for small business plans like there are for individual plans, I have nothing to link to to prove my point. The best I can suggest is this: If you know anyone currently on COBRA, which is generally a pretty accurate representation of the real cost of the insurance, ask them what it costs them each month, then go to a website like ehealthinsurance and compare what’s available to them individually. 9 times out of 10 you’ll find that individual plans are cheaper.

[DSeid]

Uh no Weirddave. Not what I am talking about. An individual purchasing health insurance on his or her own can only claim tax deductibility for the amount over 7.5% of their income. You may be thinking about someone who is self-employed buying health insurance for themselves.

If you have self-employment income, then you can take a deduction for health insurance expenses.

Before claiming this tax deduction, you must calculate your allowable health insurance deduction. Take your self-employment income, and subtract the 50% deduction for self-employment taxes, and subtract any retirement contributions you make to SEP-IRA, SIMPLE-IRA, or Keogh plan. The remainder is your allowable deduction for health insurance expenses.

So I see how you’ve gotten your faulty impression. Your business must be helping self-employed small business owners decide whether or not to offer insurance as a business to their handful of employees and themselves, or just buy insurance on their own and offer a slightly higher pay scale to employees instead. In that case the owner (providing those calculations play out okay) gets the same tax break whether they buy it through the business or on their own. The employees however do not. And policy for a small business that has to cover everyone no matter what health condition they may have is more than individual policies that are only available to those with no past medical history of any potential note.

This self-employed tax deduction option however has little to do with the circumstance for most Americans, who work for other people in jobs that have stopped offering health insurance coverage.

[Mr.Duality]

@BrainGlutton

I recall a cite presented in some GD health-care debate or other to the effect that physicians in Canada have a significantly lower average income than physicians in the U.S. Yet Canada has no shortage of doctors.

Do Canadian doctors have the same heavy burden of student loans which is carried by U.S. doctors? I suspect not. Paying back student loans eats up a large portion of the income of U.S. doctors.

[brazil84]

@brazil84

Lol. Why are we debating single payer systems? The most recent survey by the same folks who did the survey from the OP asked doctors about this issue. The doctors were against a single payer system by a wide margin. That’s highly persuasive isn’t it? Isn’t it?

[crickets chirping]

[Liberal]

Regarding a part of the discussion on page 1, how does UHC help with a pandemic? My understanding is that the problem with bird flu vaccine and the like is that pharm companies simply aren’t producing enough vaccine because of the costs. Would UHC pay pharm companies to produce drugs as well?

[BobLibDem]

@brazil84

By the way, a few years ago, the same survey asked doctors if they favor a so-called “single payer” health care plan where health care is paid by the federal government.

26% favored such a plan; 60% opposed it. That’s a pretty wide margin – a bit wider than the margin trumpeted in the original post in this thread.

So anyway, I suppose if we are to put our faith in doctors, we should rule out a single-payer style plan from the get-go.

Sort of like polling weasels about options in henhouse security.

[brazil84]

@BobLibDem

Sort of like polling weasels about options in henhouse security.

I’m not sure I would go that far, but as I said earlier in this thread, I don’t see why doctors’ opinions on the issue should be seen as dispositive, or even terribly persuasive.

[BrainGlutton]

@brazil84

I’m not sure I would go that far, but as I said earlier in this thread, I don’t see why doctors’ opinions on the issue should be seen as dispositive, or even terribly persuasive.

Then the point of your citation of the (uncited) poll in post #77 was . . . ?

[brazil84]

@BrainGlutton

Then the point of your citation of the (uncited) poll in post #77 was . . . ?

The point was that certain people are seemingly inconsistent. They want us to trust and be persuaded by the doctors’ poll, but only when they like the results. At least that’s my impression. Duh.

[evangelinagirl]

@Renob

Perhaps, but their views should not necessarily receive some special weight. It’s like listening to teachers when trying to formulate education policy. Yes, they are an important part of the system, but they have their own interests and these interests may not be in line with the interests of those whom they are serving or those who are paying for that service. Sometimes, in fact, it’s better to listen to someone with a little more distance on these issues. Those who are involved in something as a profession may be too deeply involved in the intricacies of that profession to see the big picture or be able to break away from the groupthink which may characterize it.

In short, what doctors say about health care policy should be given consideration, but no more consideration than someone else who has an informed opinion on health care policy.

I think we should let everybody weigh in. It didn’t happen with a little piece of legislation which the powers that be created. Granted, those who drafted the new law had distance from the situation for the most part, however, I don’t think any of the lawmakers could see the big picture. What is the policy? A little law called “No Child Left Behind.”

This law says that a mentally retarded child functioning on a level of a twelve year old (even if the kid is seventeen), must pass the tests that all seventeen year olds (juniors) pass. Hmmm.

So, if we leave out doctors, nurses and other healthcare practitioners in this national debate, or God forbid don’t listen to them carefully, will we have legislation that exploits patients, dehumanizes them? Wait, our current medical system does that already. My bad.

[Zoe]

The Danish friends that knew were very happy with their medical care. I can remember that one of the expectant mothers was particularly happy about their maternity program. I don’t remember specifics. Not paying insurance was good too. They pay a hefty portion of their income to the government to begin with. But the price on many products is reasonable because they are not having to pay for the other fellow’s employer to pay the employee’s insurance.

If these government sponsored programs are undesirable, then why are the citizens complaining?

I had only one experience with socialized medicine. I fell in Paris and needed to be checked out. Someone called an ambulance and off I went. My granddaughter and I waited about five minutes in the ER before I saw a doctor. There was no one else waiting there. I was given an exam and a tetanus shot and released. Everyone was very pleasant and the hospital was certainly clean.

I was sent only one bill for all of it: ambulance, doctor, shot, ER fees: $30.

In response to the Wall Street Journal article, When 11,000 people died in France in August of 2003 because of the heat wave, it wasn’t the fault of the hospitals. Most of these people were elderly and died in their homes. The French were unprepared for such temperatures.

As for the value of the viewpoints of doctors and teachers: I think we have had just about enough of having our classrooms run by people who haven’t been in a school building since the Class of '68 graduated. Teaching is not as easy as it looks. A person is not an authority just because he sat through 12 or 16 years of classes. We don’t need the perspective of distance. We need the input of people who know what is going on in the classrooms and behind the scenes.
Face it: Teachers didn’t go into education for the money and glory to begin with. They are the last people that you should be suspicious of.

(I am retired.

I feel the same way about doctors. I want doctors making medical decisions. The informed bricklayer can make decisions about construction. I can respect the expertise of each person in her own field.