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My Thoughts on Health Care Reform
I've been cobbling this post together for a few weeks now and it is here to share, if you are so inclined.
Political disclaimer: I consider myself most closely aligned with the libertarian philosophy. However, I've not been terribly impressed with the typical libertarian solutions for health care. I think everyone should have a way to get needed medical help. I readily concede that health care right now is BROKEN and that solutions presented by both sides of the aisle scare me. Health care isn't an issue I think needs to be tweaked; I think the entire system will require an overhaul. And whenever you overhaul an industry (no matter how good things will be after the transition), there is pain and anger and second-guessing.
Quick History of Health Care:
Other than basic first aid, the health care that the typical person could expect until just over a century ago was just to have someone try to keep them comfortable until they die. The clergy did this for "free" so everyone who could get to the hospital would get free health care. It wasn't until just before the 20th Century that surgeons spread outside the academic circles and became a common element to health care for the average person. Strangely enough, as health care moved from the free clergy to paid professionals, the cost of health care started rising. Hospitals started offering services/policies where patients could pay a monthly premium and have all medical care covered. This system grew and eventually evolved into the Blue Cross family of insurers. As this "health insurance" expanded from policies issued by non-profits to insurance industries, don't you know that those companies altered the flow of money to help mitigate the "risk" of folks that used the service more than others.
Personal Medical Overview:
I grew up an Army Brat. I've always found it ironic that some of the most politically conservative folks fighting for the freedom of Americans live the most socialist life in America. A trip to Canada isn't necessary, I've already lived in a US-govt run health care system. My parents were thrilled when they were able to get BCBS and take us to doctors of their chosing and not just whoever was available on post.
I currently pay just under $500/month for health insurance for everyone but Harper. With that monthly premium, there is a $1k individual deductible and something like $3k for the family. In the 3 or so years I've had this insurance policy, there was a 3 week period in one year where I met my individual deductible and the single chiro appt I had was covered 80/20. I've paid about $6000/year the past couple of years in premiums and deductibles. What has BCBS paid for? My rates for many tests/vaccines/evaluations get a 10-20% discount. My vascectomy was paid out-of-pocket with some sort of discount (I would hope) because of my insurance. I don't think I get my money's worth from insurance. My health insurance policy is basically worthwhile as an emergency tool that provides some discounts.
This situation does do one thing I think is important - it makes me pay enough attention to what the medical costs are. While it would be nice for all my chiro appts to get 80/20 coverage, the fact that I'm paying much of that cost for the visits I have with the chiro makes me evaluate how necessary these appointments are. Yes, sometimes I really need them...but other trips are just for the sake of keeping a prescheduled appt for "maintenance."
Anecdote illustrating a philosophical and practical problem I have:
I waited too long after Harper was born to have her added to the family's health insurance. I finally got around to applying for the state-offered ALLKids. When I completed the application, it said for me to include all my kids, so I did. Harper was approved and the state said that if the other two kids weren't already covered, they could also use ALLKids. Let's see...ALLKids covers each kid for $50/year. You bet I'm making an effort to reapply for the boys and then dump BCBS upon approval.
Want to know the kicker? ALLKids is administered by BCBS. Harper couldn't get added to my BCBS policy and when I investigated getting her an individual policy, I was quoted about $300/month. BUT, for some reason, they will accept her thru this state-offered program for an exceptionally lower rate. Are my direct premiums to BCBS paying for the ALLKids program? Why the difference, folks? I think this illustrates the concern conservatives have about a public option removing the competitive aspect of the insurance companies and everyone ditching the private options for the subsidized public ones. Hey, and BCBS, I do expect answers from you on how you'll cover my daughter for either $3600 or $50 a year. There is a lot of buck passing: companies pass the buck to the customers, the public passes the buck to the govt, and the govt passes the buck back to everyone...but in a way that spreads the burden amongst the taxpayers.
What features I want to see in health care reform:
1. I would love to see a shift closer to Medical Savings Accounts (MSAs). I have a problem in general with insurance and the uncanny ability for insurance companies to bump up premiums when you actually use the policy. It's like the bank increasing your fees or lowering your interest rates each time to withdraw money. There should be a correlation between the amount of money you pay/save and the amount of money you can obtain without penalty. No, MSAs aren't the answer for everyone, but I think there are far more people who would be better off using MSAs than their current health insurance.
2. Remove the employer/heath care dynamic. Since businesses weren't able to raise pay during WWII, businesses started to add health insurance as an incentive to lure employees. There isn't a reason for something as essential as health insurance to be dependent on who employs you or if you are employed. Unfortunately, severing the employer tie to insurance would cut the employer's paying for part/half the insurance and Uncle Sam providing a tax deduction for making those payments. Individuals would likely pay more and Uncle Sam would end up playing the shell game some more and offer essentially the same tax relief for individuals as it currently does to businesses. Thus continuing the govt subsidy of the insurance business.
3. Increased use of nurses and small medical centers to address preventive care or minor injuries. If we could train folks to go to a financially efficient medical center instead of going to the ER (and provide medical centers in rural areas that lack hospitals), that would certainly cut some of the expense that is generated by the patient's own actions, let alone decreasing the strain on ERs across the nation.
4. Finding a secure way to digitize medical records. This one can be a technical doozy with all sorts of horror stories possible from lack of security or abuse. However, the payoff of a medical professional knowing they have access to all your medical records can save lives.
Political disclaimer: I consider myself most closely aligned with the libertarian philosophy. However, I've not been terribly impressed with the typical libertarian solutions for health care. I think everyone should have a way to get needed medical help. I readily concede that health care right now is BROKEN and that solutions presented by both sides of the aisle scare me. Health care isn't an issue I think needs to be tweaked; I think the entire system will require an overhaul. And whenever you overhaul an industry (no matter how good things will be after the transition), there is pain and anger and second-guessing.
Quick History of Health Care:
Other than basic first aid, the health care that the typical person could expect until just over a century ago was just to have someone try to keep them comfortable until they die. The clergy did this for "free" so everyone who could get to the hospital would get free health care. It wasn't until just before the 20th Century that surgeons spread outside the academic circles and became a common element to health care for the average person. Strangely enough, as health care moved from the free clergy to paid professionals, the cost of health care started rising. Hospitals started offering services/policies where patients could pay a monthly premium and have all medical care covered. This system grew and eventually evolved into the Blue Cross family of insurers. As this "health insurance" expanded from policies issued by non-profits to insurance industries, don't you know that those companies altered the flow of money to help mitigate the "risk" of folks that used the service more than others.
Personal Medical Overview:
I grew up an Army Brat. I've always found it ironic that some of the most politically conservative folks fighting for the freedom of Americans live the most socialist life in America. A trip to Canada isn't necessary, I've already lived in a US-govt run health care system. My parents were thrilled when they were able to get BCBS and take us to doctors of their chosing and not just whoever was available on post.
I currently pay just under $500/month for health insurance for everyone but Harper. With that monthly premium, there is a $1k individual deductible and something like $3k for the family. In the 3 or so years I've had this insurance policy, there was a 3 week period in one year where I met my individual deductible and the single chiro appt I had was covered 80/20. I've paid about $6000/year the past couple of years in premiums and deductibles. What has BCBS paid for? My rates for many tests/vaccines/evaluations get a 10-20% discount. My vascectomy was paid out-of-pocket with some sort of discount (I would hope) because of my insurance. I don't think I get my money's worth from insurance. My health insurance policy is basically worthwhile as an emergency tool that provides some discounts.
This situation does do one thing I think is important - it makes me pay enough attention to what the medical costs are. While it would be nice for all my chiro appts to get 80/20 coverage, the fact that I'm paying much of that cost for the visits I have with the chiro makes me evaluate how necessary these appointments are. Yes, sometimes I really need them...but other trips are just for the sake of keeping a prescheduled appt for "maintenance."
Anecdote illustrating a philosophical and practical problem I have:
I waited too long after Harper was born to have her added to the family's health insurance. I finally got around to applying for the state-offered ALLKids. When I completed the application, it said for me to include all my kids, so I did. Harper was approved and the state said that if the other two kids weren't already covered, they could also use ALLKids. Let's see...ALLKids covers each kid for $50/year. You bet I'm making an effort to reapply for the boys and then dump BCBS upon approval.
Want to know the kicker? ALLKids is administered by BCBS. Harper couldn't get added to my BCBS policy and when I investigated getting her an individual policy, I was quoted about $300/month. BUT, for some reason, they will accept her thru this state-offered program for an exceptionally lower rate. Are my direct premiums to BCBS paying for the ALLKids program? Why the difference, folks? I think this illustrates the concern conservatives have about a public option removing the competitive aspect of the insurance companies and everyone ditching the private options for the subsidized public ones. Hey, and BCBS, I do expect answers from you on how you'll cover my daughter for either $3600 or $50 a year. There is a lot of buck passing: companies pass the buck to the customers, the public passes the buck to the govt, and the govt passes the buck back to everyone...but in a way that spreads the burden amongst the taxpayers.
What features I want to see in health care reform:
1. I would love to see a shift closer to Medical Savings Accounts (MSAs). I have a problem in general with insurance and the uncanny ability for insurance companies to bump up premiums when you actually use the policy. It's like the bank increasing your fees or lowering your interest rates each time to withdraw money. There should be a correlation between the amount of money you pay/save and the amount of money you can obtain without penalty. No, MSAs aren't the answer for everyone, but I think there are far more people who would be better off using MSAs than their current health insurance.
2. Remove the employer/heath care dynamic. Since businesses weren't able to raise pay during WWII, businesses started to add health insurance as an incentive to lure employees. There isn't a reason for something as essential as health insurance to be dependent on who employs you or if you are employed. Unfortunately, severing the employer tie to insurance would cut the employer's paying for part/half the insurance and Uncle Sam providing a tax deduction for making those payments. Individuals would likely pay more and Uncle Sam would end up playing the shell game some more and offer essentially the same tax relief for individuals as it currently does to businesses. Thus continuing the govt subsidy of the insurance business.
3. Increased use of nurses and small medical centers to address preventive care or minor injuries. If we could train folks to go to a financially efficient medical center instead of going to the ER (and provide medical centers in rural areas that lack hospitals), that would certainly cut some of the expense that is generated by the patient's own actions, let alone decreasing the strain on ERs across the nation.
4. Finding a secure way to digitize medical records. This one can be a technical doozy with all sorts of horror stories possible from lack of security or abuse. However, the payoff of a medical professional knowing they have access to all your medical records can save lives.
no subject
no subject
What about malpractice insurance and the impact that has on many doctors raising their rates? I know my family doc back home was actually quite nice to our family, charging us discounted rates and giving us samples of meds instead of having to pay for full scripts because he knew we couldn't afford it. However, he was quite candid in saying that he didn't think he could open his practice to more patients because his malpractice insurance was dragging him under. That's a damn shame, because he's a good doctor.
no subject
Not familiar with this issue and couldn't properly address it.
Don't you think that a centralized medical record should be for both patient and doctor?
I think a centralized medical record is for both the doctor and patient. A medical record is owned by the patient and used by the doctor(s).
What about malpractice insurance and the impact that has on many doctors raising their rates?
See my post on my opinion of insurance in general. Otherwise, I honestly don't have a good idea on the tort reform needed to vanquish the need for malpractice.
no subject