<p>The single payer – not single provider – model basically allows for what the health care system, IMO ought to shoot for: everybody should be in the same insurance pool. People like me who never have had to use the system for any major intervention (knock on wood) are pooled together with other folks who aren’t so fortunate. Insurance is there for all. One feature of the system now is that folks like me pay into the system thinking it’ll be there when we need it, and then when we really do need it, we are exceptioned out or otherwise denied care.</p>
<p>BedHead: One reality of health care is that we will all eventually need it.</p>
<p>Please do consider Medicare - a single payor model. Doctors are increasingly refusing to take on new Medicare patients. Why? Because the single payor - the government - fixes prices for services. And there’s lots of paperwork. I think it’s important to be careful with semantics here. If by “single payor” you mean a single provider of funds to a health care account in your name that you can use as you wish for health care costs, then fine. But if part of that model entails price fixing, then I think we indeed have Medicare for all and it is hardly a perfect solution.</p>
<p>By definition, it does include “price fixing”, if by that you mean health care practitioners get to compete with each other on the basis of quality rather than price. The “single payor” is not the government in my case, but a board of consumers and practitioners. We have (with a few rare exceptions that I know of) had no problem with doctors taking on Uniform patients - quite the contrary. It pays much faster than any traditional insurance, the docs don’t end up fighting for their payments, treatments are approved more quickly. But, yes, your concern is well taken, though I would note that there are docs all over my area who will not accept insurance from a whole range of private insurers. And every insurer that I know of engages in price fixing - that is, lists “allowable charges” (and percentages paid) for specific diagnostics and treatments, and forces doctors to accept them if they want to be included in their provider panels. And, in the case of the HMOs, the docs are on salary - entirely fixed by the “insurer”, with bonuses paid for delaying or denying care.</p>
<p>I should have added on to our visit to the endocrinologist. Once the single payor was established as the “insurer”, we received not only referrals for blood tests and scan, but specific instructions and referrals to NAMED pathologists for interpreting the results - the endocrinologist has broad experience with the pathologists in town, and was able to actually specify by name - on the basis of his perceived quality - who was to conduct the tests and interpret the results.</p>
<p>^ Excellent point that private insurers also price fix.</p>
<p>It costs the state of Washington a ton of money to provide the benefits to Mini and otheres. The portion of the state budget spent on health insurance has gone from about 20% to nearly 30% over the last few years. There is not magic in the system. </p>
<p>[Governor</a> Chris Gregoire | News Releases](<a href=“http://www.governor.wa.gov/news/news-view.asp?pressRelease=617&newsType=1]Governor”>http://www.governor.wa.gov/news/news-view.asp?pressRelease=617&newsType=1)</p>
<p>“Because the state provides health care
to approximately 1.3 million Washingtonians and, in doing
so, spends $4.5 billion per year, it can use its presence in the
market to influence how health care is delivered. This will
result in higher-quality, more cost-effective care for patients,
both within and outside of state programs.”</p>
<p>Again, the question is really not how prices are “fixed”, but how costs are controlled. Private insurers currently control costs (and profit margins) by fixing “allowable costs”, and by delaying and denying care, and by discontinuing coverage for high cost enrollees. Those last three options are not available under single payor, so there is (as you suggest) more pressure to control costs through the price-fixing mechanism. If that really bothers you, then you should like HillaryCare, where the single-payor price fixing has to compete with those of the private insurers, though the long-term effect would be drive down allowable charges among the private insurers rather than drive up reimbursements in the single-payor plan. (Hence, as I suggested, we end up with universal single payor anyway, just 20 years later, and having spend an extra 3-4 TRILLION dollars in the process.)</p>
<p>And, yes, a universal single-payor plan (I don’t have "universal single payor’, only single payor) is subject to political will in setting overall budgets. We saw that in the Canadian waiting lists of the mid-90s. BUT, with the political will, it doesn’t have to stay that way either, which is why, now, waiting lists in Canada for elective surgery are shorter than that for cancer surgery in the U.S., for people WITH insurance. The question really comes down to who gets to decide. I happen to side with democracy against the corporate socialists. Others might feel differently. But if you think the latter, then HillaryCare is the way to go, and the private insurers will make a killing off of it.</p>
<p>Barrons - off point again, as usual. First of all, most of the health care provided in Washington State is MEDICAID, and has nothing to do with my single payor plan. Secondly, yes, health care costs have risen, but by 3%, MUCH lower than what has gone on in the private sector. And third, and directly to the point: my premiums have actually declined slighly, and as they are fixed proportion of costs paid, total costs have declined as well. What has gone up substantially are the private insurance options.</p>
<p>But you are a shrewd businessperson, and know the value of a buck, and if I got to offer you the deal I get, I am sure you’d grab it and never look back.</p>
<p>The prior years were at 11%. The 3% was cited as the smallest increase in YEARS.<br>
Your deal is not comparable to mine. You pay nothing and I pay nothing for the plan I selected. We too have more expensive plans. Obviously the state has an interest in getting as many people into their plan as possible so we don’t know how hard they bargained for the other plans etc. If you could provide the cost to the state of the employee plan only I’d look at it–I could not find that info–just the total spending. Anyway the all in cost to my company of my plan is around $3500/yr. That seems pretty reasonable and Washington is not doing it for 33% of that or $1155/yr. No way. My guess is they are in the same ballpark.</p>
<p>mini:</p>
<p>since the state reports comingle the employee benefit plans, we have no way of knowing which plan is actually less expensive from an actuarial standpoint. </p>
<p>But, more importantly, the Uniform Medical Plan design is significantly different than the Classic plans offered to Wash ee’s bcos of UMP’s reliance on copays (which I don’t necessarily disagree with). For example, Classic Plan has a $10 copay for an office visit, including lab work, whereas UMP has a 10% copay. Similarly, Classic Rx = $10/$25/$40 per retail scrip, in comparison to UMP which has 10%/30%/50% per script, with a max of $225 for a 90 day supply of Tier 2 drugs. Does Tier 3 even have a max?</p>
<p>Given its higher out-of-pocket costs, the UMP should be less expensive. But, the other plans would be less expensive, too, if they had higher copays.</p>
<p>“Aetna - $104/$296
Kaiser Permanente - $101/$288
Group Health - $74/$214
Uniform Medical Plan (the single-payor option) - $28/$87”</p>
<p>These latter numbers are family rates, correct?</p>
<p>Why am I paying over $600 a month for a family with an incredibly high deductible? </p>
<p>Is Wash state that much cheaper than Cal?</p>
<p>Auto insurance was also insanely high when we lived in Cal . . .</p>
<p>Probably. Fewer lawsuits and weirdos.</p>
<p>^^and, of course, the obvious, tens of thousands uninsured, forcing the insureds to carry an extra rider.</p>
<p>Aetna - $104/$296
Kaiser Permanente - $101/$288
Group Health - $74/$214
Uniform Medical Plan (the single-payor option) - $28/$87"</p>
<p>These latter numbers are family rates, correct?</p>
<p>Why am I paying over $600 a month for a family with an incredibly high deductible? </p>
<p>If this is mini’s stuff again realize that is the EE portion of the cost, not the true cost. Find the COBRA rates for an idea. </p>
<p>I have just glanced at the tail end of this post and it’s the same old thing. If we do it this way “it will all be free” NO it won’t, Unless you reduce the drivers of cost and restrict payment to providers significantly tain’t gonna fly…The magic cure is not just insurance cost, far far too many other factors in the game that government is going to have to address to truly reduce cost. </p>
<p>I didn’t realize this post was going on I may go back and reread it but I doubt there’s any New revelation that is going to make me forget that insurance pays my bills. UNLESS you reduce the cost of MY BILLs, my premium is always going to be up there single or multiple player. </p>
<p>Mini’s advantage over private business is the tax payers pay the way, not customers. </p>
<p>These are the same people that run medicare, medicade and the VA… and everything I read about them tells me I have nothing to worry about…really??? Does any body who believes this want to buy some property in eastern washington that grows magic beans?</p>
<p>Opie:</p>
<p>Looking at COBRA rates is a brilliant idea, since the ee premiums are comingled. </p>
<p>Mini’s current UMP plan at $1,126.15/mo. for family coverage is higher than the Group Health Value plan, which has richer benefits, but only costs $1,102.11/mo. Rates for Aetna are higher at $1,338/mo., but Aetna’s out-of-pocket costs are significantly lower, for inpatient, outpatient and Rx. And, of course, those out-of-pocket costs are after-tax costs for employees, whereas premiums are before-tax.</p>
<p>Okay then, now that we’re all depressed over the rat’s nest of health care costs, where were we regarding Obama and Krugman?</p>
<p>In 1979 I paid $12 a month for an (individual) HMO plan from Kaiser. Those were the days…</p>
<p>"Looking at COBRA rates is a brilliant idea, since the ee premiums are comingled. "</p>
<p>thanks, I respect mini’s opinion and statistic on several things (teen drinking and risks) as that where he spends his time. I respect his views in that arena. Health care however, is another story. He does not approach it with the same honest clarity that I see him do in other matters. </p>
<p>Common sense has to prevail at some point. Yes, Aenta’s CEO makes an ungodly amount of money as many CEOs across this country do. But his massive income (and the few others like him) are honestly a “fly’s f art” in the amounts of money moving through healthcare in america. So you remove those guys and you’ve dipped a bucket in the ocean… how much have you really done except made yourself feel better, till your tax bill arrives and it’s 15% higher to cover the cost of your HC. </p>
<p>Nobody here REALLY wants to hear the cost or commitment that real cost reduction in health care will cost. We aren’t willing to do it as a culture. I know some will automatically respond with “I do a,b, c and D”. yes, you do, but do you represent the norm? our culture? </p>
<p>I gave up mcdonalds long before fast food nation, you don’t see them shutting down too many places yet? </p>
<p>I spent a decade trying to bring ball fields to my community for kids to exercise. After 15 years, 3 fields were built. At that rate, we should have the orignal 16 soccer fields built by the time my son turns 85. </p>
<p>Our culture does not want to get healthy, We want to eat and drink to excess and watch sport rather than exercise. And then we want our care to be “free” for the treatment of our aliments that we’ve in around half the cases have brought upon ourselves. </p>
<p>No politican has the you know what to introduce sweeping healthcare reform that this country needs. We are one of the few places on earth where a cause of death and disease is over consumption. All they ever want to do handle the money needed to treat our society, they don’t want to make it better. It’s about controlling the dollars not improving our health.</p>
<p>mammall:</p>
<p>I think Krugman is spot-on regarding health care mandates, at least from an theorectal economic perspective. However, as RomneyCare is finding out, mandates are practically impossible politically, and economic practicality – too many poor folks to make it work. The (liberal) Calif Legislature came to the same conclusion, even with support of the Governator.</p>
<p>I am going to voice my opinion in 5-10 years when a larger portion of us Boomers hit Medicare age. Until then, everyone is just passing wind,… Solids will encourage healthcare reform simply because the system as it exits will be very noticeable and smelly.</p>