This was on video is the Stossel series which now has been posted in a thread and has its own thread. I suggest you watch it.
I don't see how having a high-deductible solves anything. It just creates a situation where people are less likely to deal with health issues, creating more serious issues down the line. Here's some reader comments about HSA's on the Sullivan blog: http://andrewsullivan.theatlantic.com/the_daily_dish/2009/08/the-view-from-your-sick-bed-1.html#more This sickbed story received a number of responses. I've rounded up some of the best ones. A reader writes: I'd be interested to know if your reader has ever actually had to rely on an HSA--I've noticed that those who rave about them are usually doing so from a theoretical perspective, not from personal experience as a consumer. As a freelancer, I've had an HSA for several years, and I hate it. The policy has a $3500 deductible, so, short of a catastrophic claim, I pay for everything out-of-pocket. It's true that I only pay $113/mth in premiums for my insurance policy, but I never actually use my insurance policy (other than receiving the insurer's negotiated rates for medical services), and it really comes out to $405/mth if you include the deductible that I must pay before getting coverage ($3500/12=$292, although I'm only allowed to deposit $2,900 in the HSA annually). Yes, the deductible is paid with "pre-tax" dollars (I still pay state and self-employment taxes on any deposits to my HSA), but that doesn't make it any less painful when I'm paying the bills. And it definitely deters me from seeking care on a timely basis. In the past year, I've had two different doctors suggest an MRI (which they seem to do as a matter of form these days--and usually at an affiliated MRI center that shares profits with the doctors). I still haven't gotten an MRI because, with business down significantly, I can't afford at least $1,000 for a test that may well prove inconclusive. I've found no medical providers willing to negotiate with me for their services. In fact, many of them seem almost totally unfamiliar with HSAs and how they work. And what patient really wants to try to negotiate lower prices with a provider? Talk about uneven bargaining positions. That's just another conservative "let-the-marketplace-decide" pipedream that is totally removed from reality. I'm also deterred from seeking timely care because I don't want to make myself uninsurable in the future. Last year, I applied for a group policy through my alumni association. After I completed the detailed application and provided additional information over the phone, I received a letter telling me Blue Cross California was "declining" my coverage. Days later, I received another letter listing three reasons: * Knee tendonitis and low arches treated with physical therapy (in 2002) * Shin splints treated with physical therapy within the past year (which cost me $3,000 out of pocket) * History of treatment for sciatica (once-in 2004) My blood pressure, heart rate, and cholesterol are all low, and I weigh less now than I did 20 years ago in college. I take no prescription drugs, have never been seriously ill, and have never received ominous test results. But I couldn't get group coverage because I'd previously sought medical care while insured under COBRA or grad school policies. And a traditional individual policy would be prohibitively expensive. This is how we encourage people to become entrepreneurs? Our system is clearly in need of reform. Another reader: I have been self employed with an HSA for my family for about 4 years. My experience with finding out even approximately what a procedure would cost was a nightmare. My son was having one of the most simple procedures done, ear tubes. Yet no single person could even give a ball park figure for what the procedure would cost. Individual calls needed to be made to the doctor performing the procedure, the hospital, the anesthesiologist, etc. Also, the costs for everyone varied on where the procedure was done. When it was all said and done, the cost was $6,000 for a 10 minute routine procedure with no complications. This was up from $2,500 just two years earlier. The most touching part of the whole experience was realizing that the people doing the actual procedure, the doctor and the anesthesiologist, were less than 20% of the total cost. Of course the ear-tubes were not covered because my son had one ear infection prior to getting our HSA coverage, so it was considered a preexisting condition. On a related note, my wife's entire back is not covered, not because she had some sort of prior procedure or injury, but because she has been to see a chiropractor. Also, her lungs are not covered because she has asthma. Brilliant. Another reader Yes, I successfully negotiate a firm price for eye glasses, teeth cleaning, and even a tooth inlay, paid from my HSA. I suspect the average person's ability to do that drops pretty quickly when they are taken to the ER suffering a heart attack, or when they face cancer surgery. Their choice of secondary providers (hospital, supply vendors, labs) gets determined by their choice of primary provider (surgeon), which reasonably is focused on finding the best treatment to their life threatening problem. I want to meet the mythical patient who, before all the other things they must do prior to their cancer surgery, calls up the lab that will do the biopsy and asks how much that will cost, and what discounts have been negotiated with their particular insurance. And if the patient doesn't like the answer, then decides... what? That they will ask the hospital to use a different lab? Or their surgeon to use a different hospital? Or restart their search for the right surgeon for their medical condition? Some medical expenses are very much like other consumer purchases. But the ones that cost the most are the most complex and urgent transactions consumers will make, in the face of the greatest information asymmetries. One more: This latest poster shows quite a bit of ignorance as well. The poster repeatedly explains to us that he/she once "worked in medicine," and therefore understands billing codes and the procedures for negotiating prices. That's great for the poster. I have a J.D. and a Ph.D. in the humanities; I also have a tenured position as a university professor and good medical insurance (provided, I might point out, by the state government that employs me). But despite all my years of education, I completely missed the memo explaining to me--as a relatively well-informed patient and consumer--how to negotiate my way through the maze of the medical insurance industry (who to call, what to ask, what to demand, what to offer, etc., etc., etc.). As your other posters have illustrated so vividly, our current system for medical pricing and billing is utterly impenetrable to anyone on the outside of the medical fraternity, and that's surely the situation the vast majority of American citizens find themselves in. And as your posters have also pointed out, even if I get that elusive memo, how can I be expected to begin the process of information gathering and negotiation at the very moment I suddenly find myself in unexpected and dire physical distress? This is a capitalist market that will never work efficiently, because it's a market that thrives on keeping the flow of information a one-way street.
Another thing we can do to aid health care without adding to the deficit is pass the health care reform bill since it will pay for itself and won't add to the deficit. It's one thing to disagree with the bill, but folks should at least disagree with stuff that's actually in the bill, not made up garbage.
The CEO of a company that almost exclusively services a wealthy clientèle doesn't support an effort to make health care more accessible to the less well-to-do? Color me shocked. Mr. Mackey doesn't seem to realize that "healthy lifestyle choices" are expensive. But even eating an ideal diet and exercising daily won't prevent all disease. Apparently this guy has never heard of germ theory. Somebody with a high deductible plan might not be able to afford regular tuberculosis screenings, for example, and no amount of organic, free-range, omega-3 reinforced eggs are going to prevent him from becoming infected.
Running deficits for federal programs is not made up garbage. Give me one program that is actually growing instead of shrinking into bankruptcy? IMO, if we have a federal deficit, then all programs that require tax dollars are running in a deficit.
Ehh some of what he outlines WOULD be beneficial, but I do not believe that the concepts he articulates are practical or thoughtful in relation to human nature. Also, it is NOT a good idea for people to not go to the doctor, a check up periodically saves a HUGE amount of money in the long term. I am sure that the public option health care being discussed would eventually run a deficit, it is a government program and would be at the mercy of politicians and unqualified people put into positions based on quotas or seniority, but it has to be better than what there currently is in place... as it is, the government is over paying for uninsured people to go to the emergency room. As for you space ghost, what you spout is the equivalent to us all having no public schools, no roads, no sport stadiums, no public transportation, no police force, no FDA.... a scary world, even more scary than the one we live in with democrats wanting to give everything away free, no absolute right or wrong, no personal accountability.....
• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care. Right....that's why it worked so well in Texas, which still manages to feature some of the highest health care costs on the country despite having malpractice caps for 6 years.
Come on Sam, lighten up man.... doctors are supposed to make $400,000 a year and not pay high insurance costs, the consumers can pay more... they are doctors, special people in our society. BTW you give a doctor enough money and they will w**** themselves in malpractice suits or other lawsuits.. they are just like everyone else, in it for the money.
Sure. Every doctor is in it for the money. Show what little you know about the industry. If everyone is out for money, then why bother taking care of anyone?
If it doesn't add to the debt then it isn't running in deficit. It is running a new program without adding to the deficit or debt. So to pretend that the program is adding to the debt is made up garbage.
Tort reform in MO. also resulted in insurance rate increases, not decreases. Tort reform has been shown to not positively affect the rates of health insurance.
Honestly, the best thing we could do to combat the growing health care costs would be to shrink our collective waists until obesity falls to its pre 1990s levels.
Clearly none of these ideas are enough to solve the problem individually, but what about 6, 7, or all 8 of them together?
In my experience there is a significantly above average percentage of raging narcissists in the medical profession, and I know a couple of doctors who agree. There is a significant subset of doctors who are in it either for the money or the ego boost that is ancillary to being "the man" and making the money and having the power.
Some of them are actually counter productive to health care. The one that says we should repeal govt. mandates of what insurance has to cover is insane. Then insurance companies could not cover whatever they wanted, and people would have less access to health care. Some of the other ones are OK, but some are not, and tort reform doesn't help at all.
The great thing is that, every doctor who isn't in it for the money will love that the public options enables them to help more people. Right?
