16 years ago, I was told by several excellent lung docs that I would likely need a lung transplant in the very near future costing $1,000,000 plus requiring 2 dozen anti-rejection meds daily for the rest of my life and lots of medical care for the rest of my short life after transplant. Because I have had excellent care, my lungs are still too good to require a transplant and I’ve never even needed to be hospitalized saving me and society well over $1,000,000 in medical costs plus all the money I earned and benefits I did not have to collect for being disabled over the past 16 years. The math is pretty clear to me on how society saved money.
HImom, that’s wonderful, for you and for us as a society. 
Consider also that if you had ended up needing a transplant, before ACA you likely would have bumped up against the annual/lifetime cap.
People who are so eager to repeal ACA should think about that. The prohibition on caps helps all of us, including those with group/employer insurance. Insurers are no longer allowed to kick us to the curb once we cost them $1,000,001. Sounds like a lot of money, but it only takes one catastrophic illness – or an ongoing crisis like a special-needs child – to hit that limit. That protection is now in jeopardy.
I regret to say that preventative care doesn’t pay for itself, on average, if we only account for health care costs and put no monetary value on the better health. This has been studied numerous times.
When I do the accounting, though, I don’t just look at the money. I don’t say, hmm, let me count up the cost of controlling diabetes, versus the cost of a foot amputation, wow, amputation is cheaper in dollars so let’s not bother treating diabetes for poor people.
I can’t bring myself to value money alone, and ignore a person’s health. I care if someone spends the rest of their life with no foot.
Better health and better quality of life has great value, I believe, even when in terms of dollars and cents preventative care may cost more. @Cardinal Fang illustrates this well. As a society it’s sad we don’t have consensus on this.
Even in purely economic terms, wouldn’t better health often help the person be more economically productive and therefore contribute to the economy as a whole (and pay taxes on additional income and spending)? For example, being able to do productive work instead of being out sick or otherwise unable to work is likely to be helpful to others in the economy.
Being prematurely disabled due to health issues is a short term immediate issue for workers as well as a long term issue in that if they can’t return to work, they are doomed because they didn’t work long enough to have a comfortable retirement and will be at the mercy of patchwork low income social programs that are frequently cut and highly variable.
^Exactly! There are hidden costs and benefits to many things that don’t get factored in. (like dependency on cheap oil, which doesn’t factor in the huge costs of the environmental impact and supporting a huge military) I agree with you, @ucbalumnus.
The other thing about some very costly treatments, including lung transplants is that the patients often don’t live all that long–many rarely survive five years post-transplant. As one of my new doctors noted, I’d likely be long dead if I had received a lung transplant years ago.
I am fortunate–since H worked for the fed govt and our insurance is from that, there has been no cap on our lifetime max for some years now, tho there was a $1,000,000 cap in 2006 when we had to fax proof to son’s U to opt out of university coverage.
I have to say, I do agree with LasMa on this… if we can figure out a way to keep pre-existing conditions and eliminate lifetime caps, I’d be happy, even if that meant my insurance rate going up.
I know I tend to be slightly right of center fiscally, but I am also aware of the fact that we are all vulnerable to serious illnesses. The reason I am weary of 100% government controlled healthcare is two-fold: 1) If you don’t like your plan for whatever reason, you have no other options. This problem could be compounded by… 2) The absence of any competition would increase the likelihood of corruption (waste, fraud, and abuse) and cost creep.
(1) Even “Medicare for all” proposals would presumably include the Medicare Advantage private option, and allow use of private providers, just like Medicare now. Voucher type proposals would also use private insurance companies. Of course, the political problem with any such proposal is how to pay for it (i.e. whose taxes get increased?).
(2) The existing environment has rapidly rising costs from various directions, each of which is small, but add up to a substantially higher cost than in other rich countries. Unfortunately, each of the small extra costs is defended by a powerful or vocal special interest. This would be a multi-front political battle.
There are other issues that are problematic.
- What is the best way to pay for medical care for the indigent?
- What is the best way to induce people to lead healthier lives and lower the rate of preventable conditions?
- What is the best way to lower the cost of health treatment overall?
fractal, we do NOT have “government-controlled healthcare.” Words matter, and one of the reasons this whole issue is so contentious is that ACA opponents have successfully conflated health insurance with health care. They are not the same thing.
If what you meant was government-administered health insurance, then to your first objection: show me a senior who’d like to give up their Medicare in favor of scrambling around on the free market like the rest of us have to. To your second objection: The administration cost of Medicare is 3%. Three percent. As opposed to the private insurers who were forced by ACA to keep their administration cost to TWENTY percent. Before ACA, that number went as high as 30+ percent. And if you have an hour, we can talk about wastefraudandabuse in the private-insurance industry. But if cost is what you care about, then private insurance is indefensible.
We do know that 69% of seniors use traditional Medicare (although some or many buy supplemental private insurance), while 31% choose the somewhat privatized Medicare Advantage. However, even in the latter case, it is heavily subsidized (unlike non-seniors’ individual insurance for those with income too high for ACA subsidies), has guaranteed issue (so no worries about pre-existing conditions, unlike the pre-ACA individual insurance situation), and the public option of traditional Medicare is available if none of the Medicare Advantage options are suitable.
Couldn’t agree more LasMa. Also need to add in the pharmaceutical costs and that we can’t continue to pay whatever the pharmaceutical company feels they can get away with. It seems to me that they are often a monopoly, and the free market system doesn’t work so well with monopolies. We seem to accept regulation for utilities, and it is crazy that there isn’t a similar system in place for drugs as exists in other countries.
quote Even “Medicare for all” proposals would presumably include the Medicare Advantage private option, and allow use of private providers, just like Medicare now. Voucher type proposals would also use private insurance companies. Of course, the political problem with any such proposal is how to pay for it (i.e. whose taxes get increased?).
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No I am aware of that, but some people earlier in this thread were suggesting a single payer, public-run system, suggesting that everyone be required to join one pool. I could be misinterpreting their comments, but that’s what I gathered.
quote The existing environment has rapidly rising costs from various directions, each of which is small, but add up to a substantially higher cost than in other rich countries. Unfortunately, each of the small extra costs is defended by a powerful or vocal special interest. This would be a multi-front political battle.
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You are referring to cost increases as a whole. I agree that the increases come from a number of different directions, but I was referring to cost increases specifically from waste fraud and mismanagement of a hypothetical government run insurance system. These increases would be in addition to other increases from within the healthcare industry that drive insurance costs up (e.g. malpractice lawsuits/insurance, administrative bloat, excessive drug research profits, etc.). Private insurance providers are, to some degree, less prone to waste fraud and abuse issues because of competition – operational inefficiencies are passed onto the customer in the form of increased premiums and/or reduced benefits.
http://www.nejm.org/doi/full/10.1056/NEJMp0708558#t=article Here’s a relevant survey article, concluding “Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.” The article surveys 599 studies of about 1500 interventions. It concludes that around 19% of interventions save money without even including quality of life. Another 50% of the interventions cost less than $50K (2006 dollars, 2006 costs) per quality adjusted year of life. Check the first graph, which is wonderfully explanatory.
The survey doesn’t count productivity, but think about it. Extra years of life come at the end of life-- you don’t get any extra years of being 45 years old, unfortunately. Most of those extra quality-adjusted years are extra years of life in retirement, when the person is not economically productive. Increased productivity isn’t going to rescue this argument. We want the person not to lose her foot when she’s 70, but she’s not going to be in the workforce then.
ucb, true that seniors have the option to go with private insurance. The ones who do are mostly younger and healthier. Once they start getting into significant health problems, they tend to go back to traditional Medicare.
But let’s take that model for the whole population. I’d be perfectly happy with what we have now, lock stock and barrel – IF I also had the option to go to Medicare. That’s how ACA was originally written, but the insurance industry quickly killed it off. Sounds to me like they know very well that a large number of people would rather not have to deal with them ever again.
I know people like to point to Medicare as an example of how healthcare “should” be done. I might even be persuaded of that. But there’s a tremendous amount of dishonesty in that talking point.
Medicare might seem like a successful program, but part of the reason why is that the costs are being pushed off on future generations. The financial model is completely unsustainable. Each and every current retiree probably owes the US Treasury about $50,000 - $100,000 because their contributions to Medicare were way too low … even if they paid the full 2.9% payroll tax their whole working careers. My back of the envelope is that we’d have to raise the 2.9% to about 9.5% to make Medicare (all parts, not just part A) long-run sustainable.
So, everybody would need to pay an extra 6.6% payroll tax. That isn’t to provide healthcare to everybody; that’s just to put the current program for retirees on a truly fiscally sound basis.
I’m not even saying that I’m opposed to this. I’m just saying that it’s fundamentally dishonest to say that Medicare is an example of a great program when it’s clear that it’s going to collapse in 30 years unless its funding model is revamped. It’s easy to provide cheap healthcare for people if you’re immoral enough to only pay 40% of the cost and then hand off a ticking debt timebomb to your children and grandchildren.
In other forums I’ve had to smack down the idea that Medicare pays for itself, so I’m sympathetic to this line of attack. However, there are other ways to raise money than payroll taxes.
Instead of doing back of the envelope calculations, I opened up my envelope to see how to make Medicare long-run sustainable. Inside it said, “Increase capital gains tax, get rid of carried interest loophole, increase estate taxes, find some way to force people to have to increase the basis of their investments every year or every five years or something.” If you want to find money, go where it is.
Also inside the envelope it said, in very small print, “At some point we have to ration treatments that work but cost too much.”
Lot’s of ways to raise taxes. I think it’s immoral for the current generation of retirees to stick future generations with their bills. I would like to do things to redress this - like severely cutting social security benefits for retirees who can afford it, starting yesterday. (Snowball’s chance in hell of that happening, I know).
You might want to do things like raise capital gains rates. Sure. But I have a more fundamental problem. Money is fungible. If those dollars are spent on Medicare then they’re not available for something else. Fundamentally, I think our first priority should be spending money on investing in our young people and on building our country. Health care for old people should take a back seat to that. I would rather take the money raised from higher capital gains taxes and spend it on things like effective education for young people. I say that as a somewhat old person myself. We owe the next generation a brighter future, not a darker one because we were selfish.