Tuesday, September 28, 2010

Healthcare Questions

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?


  1. I think I read the same article you did. I didn't read it all, but it does raise some interesting debate about how much we are willing to pay for good health. I think cost is absolutely and always a concern. We live in a world of handouts and for people to think they are "owed" every possible treatment no matter what the cost is another example of our society's selfish and irresponsible mindset. We should consider what our health care options would have been like 30, 50, 100 years ago. whatever happened to accepting our fate and letting God take us when he wills? Sometimes I think all the new expensive technology that has sprung up in the last several decades is a double edged sword for our society. I'm not into a "no medicine plan" but when it comes to more and more high tech, high cost treatments, there IS a point where we as patients have to accept God's will. I absolutely pay a high premium every month, yet when I go to the hospital, I still think how much out of pocket expense it will be. I would not be the type of person to blow 100,000 for a few months of life- knowing that someone else is footing the bill. That's irresponsible and selfish. Unfortunately in the world we live in, health care has a price-it's just the way things are. To ignore that fact and give everyone every treatment available is a recipe for disaster.

  2. These are huge questions, and the reason that this issue is so difficult to deal with is because there are so many complex facets. For instance, the speech therapy company that provided our ONE covered visit for our daughter with DS, billed the insurance company FIVE HUNDRED DOLLARS for that visit, even though the going rate is more like 75-100. What's up with that? It actually infuriated me. Of course, the insurance company only paid $50, and half of that was our copay.

    As for your questions, I can only answer some...
    2. For us, we'd like something in the middle. But we're really blessed; that's what we have now. My only complaint with current insurance is that it doesn't cover Julianna's therapies b/c of her Down syndrome.

    3. It depends on my primary provider. If he or she is willing to refer to specialists, then I don't feel a need for a referral-free plan.

    4-5. That is a hard question. I question the validity of those kinds of treatments, but OTOH, I wouldn't want the option taken away.

    6. Absolutely not.

    8. I don't know. I have a feeling that this is the reality of life, whether we like it or not.

    The big flaw to this is that the process is too much @ politics and not enough about getting something done.

  3. Kathleen, about #6, why do you believe this, and how much more are you willing to pay in taxes to achieve this? I know lots of people get all upset because that's the way Medicaid works (Medicare doesn't pay for nursing homes except for a couple of months to recover from something). Speaking generically, why should I (generic) pay more taxes so that you (generic heir of a nursing home patient) can get an inheritance?

  4. Something else Kathleen, I'm with you about the billing practices of providers. I had PT earlier this year. 3 sessions, less than an hour each, and the therapist had another patient at the same time. Bill was over $1000. Insurance paid less than half (and I paid a small co-pay). How many other business send you a bill and are very happy when less than half of it is paid?


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