<p>Medicare could save billions if they made it one big HMO or PPO type of program instead of fee for each service–with better coverage.</p>
<p>If any of your kids are pre-med, having a national health insurance program would lead to training more doctors. That’s what happened in Canada, though admittedly there was an annoying lag.</p>
<p>First of all, the Values plans have much lower benefits than mine. They have highly restrictive networks, with many fewer providers, and (worst of all), the doctors are salaried, and do not compete with each except in the bonuses they receive to delay or deny referrals to specialist care. Drug costs are higher - my generic Zocor, which costs $10 per month in Group Health, costs me 28 cents. </p>
<p>Secondly, you should know that FOR EMPLOYEES, (not for those on Cobra) rates I pay are (by law) 12% of the total paid by a combination of employee and state. Multiply $87 by 8 1/2 and you have the monthly premium; do it by 12 and you have the annual premium. Now do the same with the plans, and then multiply by the number of employees, and you’ll see the big “k-ching, k-ching” sound. Do the math. (COBRAs for state employeeshave different deductibles - from 2 1/2 to 5 times my current one, and different maximum out-of-pockets - the best part of my current insurance is the very low out-of-pocket expense.)</p>
<p>But the other plans are having a hard time making it, as more and more employees choose the single payor option. As I noted, there were 9 plans when I started with the state. Three or four would drop out every two or three years, once they could no longer get around the care they had delayed or denied. They used to come back later under other names. No more. They are voting with their feet. They can’t compete - on price, or on quality - and their marketing/advertising efforts just can’t make up the difference. So they are taking their marbles elsewhere.</p>
<p>I don’t think this is all that surprising. If you eliminate underwriting, marketing, advertising, and profit, if you manage patients for the long-term rather than assuming you are going to lose them every three years, if you eliminate the middle man in the health care transaction, things are cheaper. It’s not a magic formula, no sleight of hand. It just moves the incentives. If physicians want to attract more customers and make more money, they have to provide superior service. It moves innovation away from insurance companies (whose major “innovations” are in underwriting) and to those who provide the service. It’s just the impact of competition, and empowering consumers to make decisions rather than employers.</p>
<p>(I should note that the 12% is not exact, but is a weighted average.) Still, at 26.9% of the Aetna rate, I get a very, very good deal! But that’s not the point - the question is WHY I can get such a good deal, and why my average increase in premium 2004-2006 was 40% lower than the average of other plans (now gone in their entirety), and why the number of folks in my plan continues to grow, while the others are static or shrivel.</p>
<p>I expect of course that the same thing would happen under Hillary or Obama’s plans, but it will take 20 years, and trillions of dollars in “health care expenditures” for which no health care is delivered. And that’s absurd. But if you want to test the hypothesis at a cost of several trillion, we can go right ahead, and adopt Hillary or ObamaCare - except that since employers are still the ones making the decisions, we still don’t get consumer-driven decision-making. I’ll do okay in any case - I have single-payor, and if I get the Congresspeople’s options, I know which to choose.</p>
<p>“(I should note that the 12% is not exact, but is a weighted average.) Still, at 26.9% of the Aetna rate, I get a very, very good deal! But that’s not the point - the question is WHY I can get such a good deal, and why my average increase in premium 2004-2006 was 40% lower than the average of other plans (now gone in their entirety), and why the number of folks in my plan continues to grow, while the others are static or shrivel.”</p>
<p>Mini, you are throwing so many percentages out there I am having trouble following this.</p>
<p>What do the self employed people, with the private plans, pay for insurance in your state? 8 1/2 times what you pay? 4 Times? 2 1/2 times?</p>
<p>I don’t have a clue as to what self-employed people pay generally speaking. It seems that COBRA full-pay on my current plan, for folks who are no longer employed by the state, is around $13.5k. But I have no idea what folks pay in the private marketplace.</p>
<p>My premium is 26.9% of what I would pay if I had the same package of benefits through Aetna. In no way do I presume that this would universally hold in the private marketplace - there isn’t a single payor option in the private marketplace, and nothing for the private insurers to compete with. It would be lower - how much lower I don’t know, especially as consumers are, for the most part, not the purchasers, and hence have little power to drive down rates.</p>
<p>Last year, my wife and I together accumulated roughly $600,000 in medical expenses. Our out-of-pocket expenses were so low that, even with a mortgage and educational expenses for both kids, we couldn’t beneficially itemize deductions on our tax form. As noted elsewhere, my wife was able to access treatments that would have been difficult to obtain with other carriers, including those proven to result in lower mortality rates and lower reoccurrence. Our meds - and we have way too many - usually cost between 28 and 72 cents for a three-month supply/ I can’t be dropped from coverage. You have no idea how grateful we are.</p>
<p>Mini, I understand you have great coverage. I am just trying to get an idea what private health insurance would cost for somebody who is self-employed with a family in Washington state. </p>
<p>I am guessing that somewhere between what you pay and what I pay is what it would cost a self employed person under single payor.</p>
<p>Your drug costs are cheaper than candy. :)</p>
<p>“I can’t be dropped from coverage. You have no idea how grateful we are.”</p>
<p>That’s huge.</p>
<p>Did anyone notice the mention in this morning’s paper that Bush is proposing raising Mediare premiums for upper income recipients, eventually tripling them?</p>
<p>So it begins. I think this is where we’re headed with SS, too. Diminishing benefits at increased income levels.</p>
<p>Is it just me or does this seem a tad unfair - higher income folks pay the most in Mediare and SS taxes, but receive less in benefits.</p>
<p><a href=“http://www.nytimes.com/2008/02/16/washington/16health.html[/url]”>http://www.nytimes.com/2008/02/16/washington/16health.html</a></p>
<p>"The bill would require the secretary to provide price and cost information to Medicare beneficiaries to help them select treatment options and choose among doctors, hospitals and health plans.</p>
<p>Under the proposal, the federal government would have to “release to the public physician-specific measurements of the quality or efficiency” of doctors. </p>
<p>Doctors have been working with the government to develop such measures, but many doctors fear that the government will use the data simply to reward the lowest-cost providers.</p>
<p>As for the prescription drug proposal, it would create an income-linked system of premiums similar to the one already in effect in Medicare Part B, which covers doctor visits and outpatient services. Prescription drug premiums would increase for any individual with income over $82,000 and any couple with income exceeding $164,000. Premiums would more than triple for many individuals with incomes over $205,000 and for many couples with incomes over $410,000.</p>
<p>While premiums vary by plan, the monthly premium for standard drug coverage, as defined by law, is about $28 this year.</p>
<p>Initially, fewer than 5 percent of people with Medicare drug coverage would have to pay the higher premiums. But this proportion would grow because the income thresholds would remain the same, with no allowance for inflation.</p>
<p>The president’s package does not include proposals to cut payments to hospitals or other health care providers, which could have touched off a furor in this election year."</p>
<p>Upper income folks (like myself) have to start paying more if we want OUR TEAM (that is, our fellow American citizens) to be healthy and well-educated in this competitive world. Tax me more, I say.</p>
<p>SuNa - nice sentiment. Here’s the problem. Smart citizens will see that staying healthy and becoming well educated will lead to well paid employment . . . and really high taxes to support those who do not maintain their health, pursue an education or work.</p>
<p>Not sure your exact meaning, mammal, but I think I know. I respect your views.</p>
<p>I know there are lazy people, and folks with bad health habits. I don’t care. They have deserving kids. I want everyone in this country to be as healthy and well-educated as possible. These are OUR people, our team. </p>
<p>We can afford a good health care system; those of us who make a lot of money can afford to pay more taxes; and my faith calls me to support generous giving.</p>
<p>Well, I think we want the same thing - a healthy educated population engaged in productive work. I think entitlements don’t produce that. In fact I think they discourage it. We can agree to disagree. I’ve changed my mind every few years on this issue. May again.</p>
<p>I change my mind every few days on this issue! </p>
<p>In theory each of the two contrasting approaches makes a lot of sense: 1) government provided benefits, or 2) private enterprise provided services. In practice, each of the approaches has its flaws and can fail miserably. </p>
<p>We need to get away from ideological extremes and find common-sense solutions. We should not complain about taxes, instead we should insist that government money is well spent.</p>
<p>“We can afford a good health care system; those of us who make a lot of money can afford to pay more taxes; and my faith calls me to support generous giving.”
I can’t tell you how much I respect and admire that point of view.</p>
<p>“those of us who make a lot of money can afford to pay more taxes; and my faith calls me to support generous giving”</p>
<p>Why don’t you buy an uninsured family health insurance? Change the world one person at a time. :)</p>
<p>how much $$, But to make things more exciting I will give everyone until noon PST, Sunday to give you the answer. Write down your estimate for a 55-59 year old for single male, 20% copay, $2500 annual out of pocket, $2mil max coverage, no prescription coverage.</p>
<p>No fair googling.</p>
<p>^ ^</p>
<p>Probably ~ 4,000…But the more important question is how do we as a society care for the individuals with preexisting conditions-a significant portion of the population-that can’t usually qualify for insurance. Or if they do the rates are prohibitive. . In MA car insurance rates are dictated by the state. The good drivers, or those living in rural, low accident prone areas, subsidize the poor drivers and those living in the higher accident/theft probably of cities. Or how do we treat those with self-inflicted–smoking, drinking, et cetera, preexisting conditions?</p>
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<p>Hear, hear! :)</p>
<p>What is $309 for single; $$618 for couple; $477 for 1 adult + kids; $712 for family. Oregon and Western Washington, Jan 1-Mar 31, 2008. In network, 80%, $2500 maximum. No dental, vision, or prescriptions.</p>