Health Insurance Like Car Insurance
Milt Romney finally does what I've been insisting America should do -- insist that everybody have health insurance of one kind or another -- but health insurance of their choosing. And that means everybody, including those people who are gambling that they won't get sick -- and don't see putting monthly money toward health care as a necessity. Here it is from The Economist:
To make the plan work, Massachusetts will offer a mix of penalties and subsidies. Individuals will be allowed to buy health insurance with pre-tax dollars, just as firms currently can. Those who don't will be penalised through the tax code, and then fined. At the same time, private insurers will receive subsidies to offer bare-bones insurance to those who cannot afford fancier packages.Of the 6.2m people in Massachusetts, about 500,000 lack insurance. They fall into three overlapping groups. Some are poor enough to qualify for Medicaid, but have not enrolled. Some are not quite poor enough for Medicaid, but get no insurance from their employers and cannot afford to buy it themselves. Others could afford it, but just don't buy it, perhaps because they are young and healthy.
Massachusetts has already done a good job of reducing the size of the first group. A new computer system uses the Social Security numbers of those who show up at hospital to see if they qualify for Medicaid, and automatically enrolls them if they do. The other two groups will be shrunk by imposing a levy on firms with more than ten employees that do not offer health insurance, and by forcing everyone who still lacks insurance after that to get some.
With more healthy people in the pool, average premiums should fall, or at least rise less quickly. The burden on emergency rooms should be reduced, because insured people are more likely to go to a doctor before a problem becomes critical. Overall, the plan will cost no more than the state currently spends on the uninsured—about $1 billion a year, says an optimistic Mr Romney.
Here's more from Wired. What I'm opposed to is employers being forced to provide health care. I pay for my own health care via Kaiser, which isn't the Cadillac of health care by any means, but it's there for the basics and in case of catastrophe or just plain serious illness...which can end up costing you bigtime. I've always had health insurance, even at my churchmouse-poorest, because I didn't want to put my parents in the position of paying for me if something went dreadfully wrong (or, worse yet, be stuck in with "My doctor is the state government!").
Health insurance like car insurance?
Are you really happy with your car insurance? Hey, it's no coincidence that the biggest buildings in lots of cities are banks and insurance companies.
What's the difference between forcing employers and forcing individuals? Are we the busybody here, or what? I can't see the involvement of a state government lowering the cost of anything, or improving the quality. I can't see Massachusetts in particular either lowering their taxes OR staying within the billion-$ mark regulating this nonsense.
The concept of "fines and punishment" was the major emetic in Hillary Clinton's public health proposals. It has no place in medicine, "voluntary" or otherwise. The State has no place in this for a simple reason: it will simply outlaw anything it can see as a risk to improve the budget. "Mountain climbing is prohibited, sir. It costs the Plan too much to care for the serious injuries which inevitably result."
It would cost my healthy, gorgeous 24yo daughter about $250 a month for the equivalent of the basic plan I have from my employer. Where do you think that figure will go if it's mandatory, and who do you think will really pay for it?
Radwaste at April 9, 2006 7:57 AM
It costs me $235 for Kaiser. I don't have the equivalent of the plan you have from your employer, I'd bet, but I have something, and I'm not breaking businesses (see GM) to pay for it.
I'm thrilled people are forced to have car insurance, because, again, it means I don't have to pick up the cost if some asshole on a cell phone hits me and they spent all their savings on a wide-screen TV. Usually, they're insured and you call up their insurance company and make a claim.
I'm not for government health care for everyone, a la Hillary Clinton. I'm for everyone being insured, and ending the ridiculousness that insurance is a huge cost to business.
Amy Alkon at April 9, 2006 8:01 AM
If you want to have "health care for everyone, a la Hillary Clinton," come to Sweden.
http://egoist.blogspot.com/2003/06/socialized-medicine.html
All the Best,
Martin Lindeskog - American in spirit.
Gothenburg, Sweden.
Martin Lindeskog at April 9, 2006 8:54 AM
None of you are reading very closely. I don't want the government to provide health care, except for the very poor...which, by the way, even if you hate the poor, is a cost-savings. Preventive care vs. dialysis, for example.
What I want is for it to be mandatory to have health care of some kind. You can go for the Cadillac or the Kaiser. And you should pay for it yourself, as I do. It should not be an employer cost.
Amy Alkon at April 9, 2006 9:08 AM
I got this visceral theory that as long as anything called "insurance" is involved, this crisis of costs isn't going to go away. The Massachusetts system will no doubt benefit the insurers in the long run. Consumers will still be in a habit of passing their bills on to a third party without thinking carefully about whether the charges are necessary... Or even correct for the treatment received.
A lot of things that smell like compassion are actually irresponsible.
Crid at April 9, 2006 9:25 AM
What if you call it "paying to cover your ass in case it gets run over"? Or just paying for "health care." To me, it's a basic need, like food, transportation, and housing. And people who aren't paying to be covered, despite being able to afford it, who then get sick, are too often paid for by the rest of us.
Amy Alkon at April 9, 2006 9:40 AM
Last year I made about $26,000, out of which I paid my rent, my car payment, my car insurance. I paid for my food and my cable internet and my electricity and my heat and my phone. I buy a pair of pants occasionally, and sometimes a shirt. I'm self-employed and paid my social security taxes (15%+) and for my office expenses. I didn't take a vacation and I didn't really go anywhere special besides home and I go out to eat about twice a month, if that.
So where am I supposed to get $300+ for a health insurance plan? I'd still have to pay for doctor's visits and medicines (I spent about $1200 last year on such mundane medical expenses).
Frankly, this $300 is not money I have, and something has to give. There really isn't any room to cut back on my ordinary living expenses--I'm living hand-to-mouth as it is--and there's just no way I'll be able to afford health insurance, even if the state gives me a little subsidy. Health insurance is a luxury I can't afford.
Rufus at April 9, 2006 11:03 AM
The part of it that worries me is the notion of a state government deciding who can afford health insurance (and should be penalized for not buying it) and who cannot afford it (and should have it subsidized). I've heard the ivory-tower folks in government talking about the cost of things and how much people make, and it's clear to me that they have no idea what life is like (and what things cost) for what I would consider a normal working family. There were quite a few years that my family went without health insurance when I was a kid - but a government would probably have looked at our home equity and my parent's combined gross income (never mind that my father was self-employeed and a lot of what came in went right back out for supplies, etc.) and they would think we could afford health insurance.
jenl1625 at April 9, 2006 11:28 AM
So, your health care should be free? (ie, if you get sick the rest of us should pay?) I'd imagine if you're making $26,000 a year, you're pretty young. I'm 42. I paid a lot less when I was younger. And I paid for my health insurance when I couldn't afford a bed.
Amy Alkon at April 9, 2006 11:29 AM
There should simply be some bare minimum thing - so the rest of us don't end up paying for the people who decide to go for the wide-screen TV over the HMO, then fall their motorcycles and go on longterm life support on the public dime.
Amy Alkon at April 9, 2006 11:36 AM
The first thing to do is have the insurance payment go to the premium payer. Then the individual would select the best care for the money. The insurance companies and the health care providers are playing the system instead of providing the best care for the dollar.
I have worked as a controller and it really ticked me off that I could not pick a plan independent of the hospital or even the list of limited partnership associations of doctors.
We even had a local hospital add additional floors to keep another hospital from moving into our area. By state law, a new hospital could not come into the area unless there was a shortage of beds.
Too much price fixing and shenanigans – excess profit in one area used to offset losses in another. Just not enough competition - IMHO.
JG at April 9, 2006 2:25 PM
No, I'm not young (I'm 47). I'm not expecting my health insurance to be free -- I pay for doctor's visits and medication that I use. But it comes to about $100/month, which is something I can afford -- $300+/month for full insurance is not something I can afford. I'm prepared to do without and do not want the state forcing me to pay for something I cannot afford.
Rufus at April 9, 2006 3:47 PM
> To me, it's a basic need,
> like food, transportation,
> and housing.
You keep saying that... It's fundamental, it's basic, it's infrastructural, it's all these very important things. You plainly see that it costs too much and delivers too little. So where's the MISSING VALUE?
Ever see a hospital bill? 700 items, 250 of 'em overpriced. $7 dollar dressings for $38.44, and $1 water pitchers for $4.75, etc. But why would the consumer complain about that item and not the three next three items? Insurance, no matter who pays it, is all about removing the consumer from these decisions because it feels more humane, especially when people are dying.
The problem's not going away until individual consumer judgment is brought back to individual purchases. It's not just employer-provided insurance that's warped the market... In the last century we've acquired thousands of new medical goods and services, but nobody knows what they worth, because we don't ask the people who buy them.
Crid at April 9, 2006 6:55 PM
Put it another way... You KNOW what your individual plane trips and bus rides and eco-cars are worth, because you carefully pay for each one, including incidentals (meals at layovers, gas for the car etc.)
Crid at April 9, 2006 7:04 PM
I see a time in the future when hospitals have priced themselves right out of business. They are already growing resistant bugs that we might not be able to kill. (MRSA, VRE) There's already a terrible nursing shortage only getting worse. Overpriced doctors, overpriced drugs, overpriced hospitals and insurance, health and malpractice, all feed each other getting outrageously expensive. I view them as a mafia behemoth. I see a time when home health and home doctor visits will return with small local surgerys. Something's gonna give. The burgeoning baby boomers are already straining the healthcare industry, and how about when the estimated 13 million illegal aliens start aging and needing health care. The original theory behind insurance is now lost; everyone pays a little so that the few that need operations can get them. Now it's only the few, who can afford it through their companies, that obtain it.
chicknlady at April 9, 2006 10:34 PM
If you'd like a small sample of pricing shenanigans, here's an example. I have coverage through BCBS. Of course, there is a list of doctors, etc., who are members of their plan; here's a bill from one of them:
"Total charge for your claim: 181.09
Total amount we paid: 116.00
What you owe provider: 20.00"
Below is a notation stating that the maximum allowed amount was exceeded for one of the three services provided for this single visit to a cardiovascular specialist. If you aren't covered by this plan or one like it, it appears - provided you can even get in the door - that you will pay $45.09 more for the same service.
How is that encouragement for the uninsured to engage in preventive medicine?
Radwaste at April 10, 2006 2:07 AM
Yes, please use police, courts, tax agents, informers (we won't call them that). Then, I and my investor friends will buy up, consolidate all the carriers, use our vast size to influence every day with my lobbyist and have one or two entrenched companies and make sure that we salt the business fields of health care for as far into the future as we can so that no start up can challenge us. Oh, and Doctors, nurses, healthcare workers...you'll work for me and do as I tell you. Patients? You are a cost center, to be reduced. Look towards legislation freeing us from self inflected damage, i.e. smoking, fattyness, sunburn…
Thank you
The Management.
Have a Nice Day.
Paul at April 10, 2006 6:00 AM
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