Bill Moyers talks to Wendell Potter

[John Smith]

Reading this discussion is tedious but here are my only comments on the issues. 1) MSA’s or any similar accounts are not designed to help employees save for health care costs in a tax deferred manner. They are sold that way, but it is painfully obvious from reading about them and the philosophy behind them that they are a cost shifting mechanism. It is why you hear of them talked about at the same time as they talk about ending corporate deductions for health insurance. Besides these accounts are not even close to being large enough to cover health insurance let alone all the additional costs involved with health care.

 

2) the notion that health insurance is to cover only catastrophic or large health events is pure and utter bullshit. Whoever thought that one up has no clue whatsoever and has a perversely skewed view of the topic. If the insurance companies only wanted those events covered and not routine care, then they would specifically write that into the policy and charge HIGHER PREMIUMS, they seem to have no trouble whatsoever writing other issues into policies. More and more the insurance industry is seeing that preventative care saves costs down the line. It is much cheaper for them to cover regular checkups today than it is for them to cover a catastrophic illness down the line, it is why more and more companies offer wellness programs which lead to lower premiums and lower long run costs. It is why at my company if I go in for annual physicals and get annual blood work done, I pay a lower monthly premium. Using the logic that has gone through this thread that should not be the case. When my kids were born, not that long ago, well baby care and annual medical expenses were not covered by my insurance, they are now, not because people are stupid and using insurance for the worn reasons, but because the insurance companies (or as I see them…the medical care rationers) see cost savings in paying for these routine things.

 

3)As to the financial mess, the government no more coerced private industry to do what they did than I did. The protections that were in place to prevent or minimize the catastrophic financial meltdown of our markets were removed because the private sector had and still is lobbying to remove virtually all oversight. Once the lines between regular banks., investment banks, financial products deals, insurance companies etc… were broken down, what happened was inevitable. Sadly it is going to happen again someday as the financial industry has too much sway over our legislators on both sides of the aisle. Sure you can look to the Bush administration pushing “ownership society” and pressuring the financial industry to loan loan loan, but the industry is not going to do it if they don’t see a profit in it, they are not altruistic at all, and nor should they be. They are here to make a profit for the benefit of their shareholders. Beyond that anyone who thinks this is just about poor people getting mortgages they were neither qualified for nor had the ability to pay, well you just have not been paying attention. The meltdown was all about financial products, derivatives and such…

 

 

4) Somalia is the place to go if you want to live in a society where government does not provide any of the services that people think government should not supply. Heck, they are not even in my world wide tax guide, they don’t even have any official taxing authority. Sounds like heaven.

 

 

 

I’m done.

[caliber66]

They go up, as they should. Just like your car insurance premiums go up if you get multiple speeding tickets. If your behavior increases your risk, it's going to cause more to insure against an adverse event.

Does your auto insurance go up if you fail to get your oil changed?

[John Smith]

Does your auto insurance go up if you fail to get your oil changed?

 

No because it does not cover mechanicals/wear and tear. It is nto covered if you put the wrong oil or other fluids in either.

[ikol]

Reading this discussion is tedious but here are my only comments on the issues. 1) MSA’s or any similar accounts are not designed to help employees save for health care costs in a tax deferred manner. They are sold that way, but it is painfully obvious from reading about them and the philosophy behind them that they are a cost shifting mechanism. It is why you hear of them talked about at the same time as they talk about ending corporate deductions for health insurance. Besides these accounts are not even close to being large enough to cover health insurance let alone all the additional costs involved with health care.

 

I'm not suggesting that they should be used to cover health insurance, but they could be used to cover the amount that high-deductible plans do not. The average amount spent on healthcare is $6-7000 per American. A $5000 tax-free HSA that rolls over sounds pretty good to me. And I am not advocating ending corporate deductions for health insurance; in fact I would be in favor of adding individual deductions for those that buy their own.

 

2) the notion that health insurance is to cover only catastrophic or large health events is pure and utter bullshit. Whoever thought that one up has no clue whatsoever and has a perversely skewed view of the topic. If the insurance companies only wanted those events covered and not routine care, then they would specifically write that into the policy and charge HIGHER PREMIUMS, they seem to have no trouble whatsoever writing other issues into policies. More and more the insurance industry is seeing that preventative care saves costs down the line. It is much cheaper for them to cover regular checkups today than it is for them to cover a catastrophic illness down the line, it is why more and more companies offer wellness programs which lead to lower premiums and lower long run costs. It is why at my company if I go in for annual physicals and get annual blood work done, I pay a lower monthly premium. Using the logic that has gone through this thread that should not be the case. When my kids were born, not that long ago, well baby care and annual medical expenses were not covered by my insurance, they are now, not because people are stupid and using insurance for the worn reasons, but because the insurance companies (or as I see them…the medical care rationers) see cost savings in paying for these routine things.

 

If what you say is true, then "health insurance" is a misnomer. The whole idea of insurance is that you pay a small amount to a company so that they insure against an expensive but unlikely event. And you are equating insurance not covering routine care to someone not getting routine care. That's not at all what I am advocating. And one thing that keeps getting lost in this debate is that guaranteed funding for healthcare does not mean people actually receive the care. People on average do not comply with preventative care, and there is no better example of this than the VA. Having the government fund more of our healthcare means funding the adverse results of not practicing preventative care more so than it means funding preventative care.

 

Does your auto insurance go up if you fail to get your oil changed?

 

No, but it may result in me having more out-of-pocket repair expenses down the line.

[MattZ]

No, but it may result in me having more out-of-pocket repair expenses down the line.

 

Yes, and in the health insurance scenario, it's the insurance company that would have more out of pocket expenses down the line. Which is why they want to incentivize you to get your checkups. Which is why they cover them. And you know this, I think. Which is why you are confusing me.

 

Bottom line: even if insurance companies are paid to insure against catastrophes down the road (as you say), it is very much in their interest to keep those catastrophic expenses down. And they do this by incentivizing you to get your own personal oil changed as often as possible. So they cover your checkups.

[ikol]

OK, but say for example that you have two routine clinic visits per year and they cost $100 each. If your insurance covers those visits, do you think they only increase your premiums by $200 per year? I would bet not. Why not cover them with your own money and the insurance companies can charge you lower premiums on the condition that you make regular appointments?

[ih8music]

OK, but say for example that you have two routine clinic visits per year and they cost $100 each. If your insurance covers those visits, do you think they only increase your premiums by $200 per year? I would bet not. Why not cover them with your own money and the insurance companies can charge you lower premiums on the condition that you make regular appointments?

Honestly, and I know I'm probably just being overly cynical about the health insurance industry, but the very first thing that came to mind when I read this was how this would be a convenient way for them to deny future claims. "in 2002-2003, your annual dr visits were 12.4 months apart. Since you did not fullfill the agreement to have annual appointments (annaul defined as no more than 12 months apart) your 2009 claim has been denied."

[John Smith]

The average amount spent on healthcare is $6-7000 per American. A $5000 tax-free HSA that rolls over sounds pretty good to me. And I am not advocating ending corporate deductions for health insurance

 

 

The arithmetic is simple $2.5trillion, that's 2,500,000,000,000, spent annually on health care in the US. Divide that by 300million people and you get $8,333 per person. For me my family of 4 that comes out to $33,332. That $5,000 credit looks like what it is.

[ikol]

Or it could be $5000 per person, making it $20,000 in your case. And does your family actually spend $33,000 per year on healthcare? I highly doubt it. Those numbers are skewed by the enormous amounts spent on end of life care.

[John Smith]

Gee, you're right on every topic, as always. You should be made emporer for life. And yes one of us has chronic kidney stones and we are getting major treatment a couple times a year. Last year the gallbladder surgury (misdiagnosis by the doc who knows full weel the kidneystone history.) followed by the lipotripsy was way up there when you add in all the tests and such. BEsides the HSA's are per family.

[ikol]

Gee, you're right on every topic, as always.

 

I find it more comforting to believe I am right than to operate on the opposite assumption. But I guess most people think they're wrong. I don't understand why you always resort to that sort thing when we have these discussions. All I do is state my opinion. I'm not insulting you or anyone else that disagrees with me. If anything, you are the one that comes off as the know-it-all. Scroll up the page to your long-winded, numbered reply in which you dismiss all my opinions as either "utter bullshit" or favoring anarchy if you don't think so.

 

And my point was that whatever current current regulations on HSAs are ($5,950 per family for 2009 according to wikipedia), there is nothing preventing them from changing the law and making it $20,000 per family.

[Good Old Neon]

I say it depends on who the individual on the scale is. If it's someone I know and love, they're going to count more than some anonymous individual. But that's probably why I'm not a utilitarian like Singer.

 

Though I don’t disagree with you, I thought of your reply while reading the following article on end of life care. It’s really pretty excellent.

 

Money quote - Own the way you die. And die as you lived, surrounded by family and friends.

 

We could save billions in healthcare if we could accept death and say goodbye outside the hospital

 

http://www.salon.com/mwt/feature/2009/08/04/dying/

[ikol]

Good article. I'm all about hospice. Part of my geriatrics rotation included hospice, and I saw a patient who actually got better on hospice!

[Good Old Neon]

My dad died in a nursing home, and hospice was not involved until the very end, but in all my contacts with them, they were wonderful.

 

I think Peter Singer was expressing a similar view of end of life care in his article, just a bit more business like. I completely and thoroughly understand the desire to extend the lives of loved ones, but in those cases where death is inevitable, despite the use of monstrously expensive measures that will, ultimately, grant a few more days, weeks or months at best, time often spent in pain and misery, or, in some cases, alive only in the sense that one has a pulse, well, given that money is in finite supply, I think it would be more wisely invested in those who have a future – up to and including rationing, albeit carefully monitored and implemented rationing.

[WilcoFan]

It seems like much of this debate is centered around the cost of health care which is really only one aspect of the issue. Cost is obviously tied to quality or at least should be a factor... Why is health care so expensive in America? Probably because of the amount of research that is done here.

 

Does anyone have any opinions or visions of what might happen to research/innovation in worldwide health if America, the world's largest contributor to health care informatics, R&D, etc. decides to make health care a government responsibility? Without true free enterprise, and the government's insistence on going with the lowest bidder, will the incentive for innovation fade? Just wondering what people think...

 

Also, getting back to cost and quality, it seems like everyone has a Utopian view of health care. Is affordable and quality health care just another rendition of the 1950's fairy tales like GM and paid pensions for life? Are we kidding ourselves? Don't people in countries with National Health care like Australia also go out an buy additional insurance anyway? Maybe we should face the reality that seems pretty evident to me after 911... That there are no guarantees in life.

 

Maybe I'm just feeling a little cynical today.

[Tweedling]

When health care is handed over to the government will they take on the responsibility of malpractice insurance?

[bjorn_skurj]

Ha! No one will be allowed to sue for malpractice. That's the beauty of it.

[Good Old Neon]

Just when you thought the right couldn't possibly get just plain fucking dumber, they somehow manage to dumb it down further still, by like, the power of 10.

 

http://news.smh.com.au/breaking-news-world/obamas-health-care-plan-is-evil-palin-20090808-edfh.html

 

Excerpt:

 

Former Alaska Governor Sarah Palin called President Barack Obama's health plan "downright evil" on Friday in her first online comments since leaving office.

 

She said in a Facebook posting that he would create a "death panel" that would deny care to the neediest Americans.

 

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society', whether they are worthy of health care," the former Republican vice-presidential candidate wrote.

[Tweedling]

Ha! No one will be allowed to sue for malpractice. That's the beauty of it.

Sounds like there will be doctors and plantiffs attorneys looking for new professions. We'll create jobs one way or another.

[M. (hristine]

The evangelical right believes this is the beginning of the end. They are stockpiling food and ammo. I'm not making this up.

[bjorn_skurj]

Can I be on the "death panel"? Or at least get a T-shirt?

[Good Old Neon]

More from the world of dumb and crazy - from Salon (with video):

 

Gingrich backs Palin on "death panels"

 

http://www.salon.com/opinion/walsh/politics/2009/08/10/gingrich_backs_palin/

 

and even crazier:

 

Anti-Health Care Reform Protester Encourages Physical Violence, Use Of Firearms

 

http://tpmdc.talkingpointsmemo.com/2009/08/anti-health-care-reform-protester-encourages-physical-violence-use-of-firearms.php

 

The mind boggles.

[Guest Jules]

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society', whether they are worthy of health care," the former Republican vice-presidential candidate wrote.

From what I have read in the plan, this isn't that far off.

[ih8music]

From what I have read in the plan, this isn't that far off.

Please share with us - what sections of the proposed bill talk about "death panels" or measuring ones "level of productivity to society" or terminating kids with DS?

[Guest Jules]

Please share with us - what sections of the proposed bill talk about "death panels" or measuring ones "level of productivity to society" or terminating kids with DS?

How the hell would I know?