I know I write mostly about books, but the name of the blog is This That and the Other Thing, so I can write about anything I want.
Yesterday I ran across an article that was discussing some very high-priced treatments (some over 100,000) which while they showed some benefit for some people, on the whole extended life by only a few months. Not long ago I ran across an article that said the average per-capita healthcare cost in the US was over $7,000 per year. I also read somewhere that the average family health insurance plan costs around $12,000 per year (with employer contributions paying part of the cost for many). Healthcare reform was a big issue in the last election and is the issue that will either sink or save Obama's presidency, depending on who votes in the next election.
I've heard it said that our system is inefficient, that other countries pay less and get more. The insurance companies are made out to be the villians but are they? The new law says insurance companies have to pay out 85% of their premiums in claims--a figure most large group plans are already meeting. "Go to a single-payer plan" say some, but even if we do that, someone is going to have to process the paper, decide what is covered and what is not, and run checks for fraud (and as someone who has worked Medicaid fraud cases, let me tell you that when the person getting the service pays nothing for it, the ability of the provider to perpetrate fraud goes up). In short, while some marketing money might be saved by a single-payer system, I doubt much of that 15% is going to be transferred from claims processing to claims payment.
Given the information I have given you, and given what you already know about healthcare, I want to know the answer to these questions:
1. Whether in taxes, premiums or co-pays/deductibles/non-insured expenses, what percent of a family's income do you think it is reasonable for them to spend on healthcare?
2. What would you rather have: 1) An insurance plan that has a high but predictable premiums and low to no co-pays, deductibles etc or 2) An insurance plan with lower premiums but very high deductibles (let's say $10,000) such that most years you end up making no claims at all, but which has a stop-loss on it such that your out-of-pocket for covered expenses won't be more than a set amount--let's say $20,000. When deciding between 1 & 2, assume that your total cost (premiums and medical costs) for 2 on a year where you pay your maxium out-of-pocket is the same as your cost for 1 would be in such a year.
3. Given two plans that are identical in terms of coverages, doctors "in the plan" etc. how much more would you be willing to pay each month for a plan that did not require you to get referrals specialists from a PCP?
4. Should we put a price on human life? If I can keep your disease in remission indefinitely for a cost of $100/month do we as a society "owe" it to you to do so? What about $1,000/month? $10,000/month? , $100,000/month?
5. What if those treatments in #4 don't keep you alive indefinitely, but simply allow you an average of three months of life as an invalid?
6. How do you feel about impoverishing old people before helping with nursing home care? Should the elderly be required to spend down all of their assets before the state will pay for longterm nursing home care?
7. How about setting a limit on how much Medicare will pay per year per person and requiring an additional costs be borne by the patient, until the patient's assets are depleted?
8. Should patients ever be in a position where they have to financially consider whether a recommended treatment is worth the cost?