Tag: medical

Why I Support the “Individual Mandate”

Posted onAuthorcahwyguy1 Comment

Way back in 1984, columnist Art Buchwald wrote a piece on the insurance industry that has always struck with me. It began as follows (you can read the whole piece here):

I’m not a betting man by nature, but I have this bookmaker. He works for the Reluctant Insurance Company of America. This is how we bet. Every month I give him a certain amount of money, and he takes a gamble that my house won’t burn down or be broken into or damaged by a falling tree. Another bet I place with him is that my car won’t hit someone in an accident, or I won’t be hit by somebody else. Still a third one is that my family will not be stricken with an illness that will require hospitalization.

Funny enough, I was never anxious to win one of those bets. I didn’t want to collect from the bookie on any of them. He seemed to feel the same way I did. So much so that if, for some reason, I forgot to send him a check for one of our bets, he would mail me a nasty letter wanting to know where the money was. He was not, he told me, in the bookmaking business for his health.

Recently, due to an illness in my family, my bookie lost one of my bets. Since this was the first time I had won, I thought he would be happy to pay off. After all, even in Las Vegas the house expects to lose once in a while.

You can guess where the piece goes from there, with the bookie refusing to pay out, and even threatening to break his legs.

Thinking about insurance as legalized gambling is very instructive. Currently, we’re in a situation where a lot of people have employer-subsidized casinos where they can gamble. These casinos pay very well, but they are open only to the employees. They are like credit unions: they know their community, and they pay very well.

Those who aren’t so lucky to have employer-subsidized casinos have a problem. Playing at the other casinos are very expensive, and some of them are quite shady. Some of them have really bad odds: they collect in lots of money, and pay out an extremely small percentage, with the rest going to the mob bosses that control the casino. Others only allow you to gamble if they know you will lose; if you have ever won before, they do not permit you to play the game because their oddsmakers tell them that if you have won once, you’re going to win again. Further, there are a group of players that only want to go into the casino when they know they will have a winning streak. When their luck is cold, they avoid the casinos. Casinos could not stay in business very long if the house regularly lost; it depends on the balance of winners to losers.

Let’s now translate the above into the affordable care act, often called “Obamacare”. One thing Obamacare does is mandate that the house pay a certain percentage to the winner, and not to the mob bosses — in other words, that a significant portion of premiums (I think 80%) must go to medial payments, not administrative costs. Obamacare also mandates that individuals who have ever “won” can continue playing — in other words, that individuals with preexisting conditions must be able to get coverage. It also mandates that the casinos must pay out when people win — in other words, that when you get sick, the insurance companies cannot retroactively drop your insurance. It also mandates that players just learning the game can come in the casino with their parents — in other words, that children who are unlikely to get sick must be covered under their parent’s policies. All off these have the potential to cost the casino money. To counter this and balance the system, Obamacare mandates that people cannot play only when they know they will win — in other words, that people must get health insurance when they are young and healthy. This is the basis of the “individual mandate”: to provide incentives for people who do not carry insurance to carry insurance, and those premiums offset the additional coverage costs.

Now, Obamacare recognizes that not all players have the same ability to gamble. For those that have the ability, they have the choice: they can regularly gamble and lose, or they can pay a fee (lower than their gambling costs) for not playing (this is the tax that the Supreme Court just ruled as legal). For those that can’t afford to play at all, the government will provide the casino and pay for them to play — this corresponds to Medicare and similar programs. For those that can barely afford to play, the government will provide subsidies to help them play — in other words, low income people can get financial support on buying insurance. Lastly, the government will maintain a list of available casinos (the “registries”) that tell people the best places for them to play; it is the states that have the option of setting up state-run casinos for those that can’t find anyway to play.

Continuing the analogy: Does the government dictate when people can win and when they lose: in other words, are there “death squads”. In the government run casinos, yes — but this is what we have today with Medicare dictating what they will cover (in other words, this isn’t new). For private-run casinos, only partially. The government does dictate some cases where the people can win — that is, coverage that must be provided. The government, with some exceptions, does not dictate when people lose (i.e., when things aren’t covered). That’s up to the private insurers  (oops, casinos). The exception: abortion, and this restriction came not from Obama but from the Conservatives in government.

So there you have it. Insurance is legalized gambling. The individual mandate is simply a way to get more people into the casino so that the casino operators can afford to let more people play and have better payouts.

 

Share

A Positive Experience

Posted onAuthorcahwyguy

For the last few days, I’ve had an odd sore throat. Negligible hoarseness, but a little pain when swallowing, especially after a sneeze or yawn. However, getting to the doctor is a problem: I’m the only driver on the vanpool next week (meaning if I’m not on, the van doesn’t run and all the regular riders are inconvenienced, plus it raises the costs for all). So I decided to try a local Minute Clinic at the CVS in Reseda. I must say, I came away impressed.

When you need to check something medically on the weekend, it is usually a pain. ERs weren’t designed for that purpose–they take forever and cost lots and lots. The few times I’ve tried the local urgent care, I wasn’t impressed. The Minute Clinic was clean, there was no line, and they had a nice automated check in. From the time we arrived to the time we left was under an hour. They did a strep test — no strep, so it is likely a virus. It should go away in a week; if not, I’ll work in a visit to the doctor on Friday when I was going to be off the van anyway.

I also must comment on this CVS. When Walgreens stopped accepting ExpressScript, we had to switch to the CVS across the street (this is the Northridge CVS at Reseda and Devonshire). The store is old and crowded, and their pharmacy is backed up. Prescriptions are not ready when promised, and it takes forever for them to call the doctor. The CVS we were at today (Tampa and Victory), in contrast, was clean. The pharmacy was prompt. I left with a positive impression. It really showed the difference that different stores–even in the same chain–can give.

Music: Elton John (Elton John): Your Song

Share

Cleaning out the Links

Posted onAuthorcahwyguy

It’s Friday at lunch, and you know what that means–it is time to clear out the accumulated news chum links from the week that haven’t fit into any theme. There’s a bunch of interesting stuff in here, so read on, McDuff:

Music: Cheapo-Cheapo Productions Present John Sebastian Live (John Sebastian): Waiting for a Train

Share

Piled Higher and Deeper

Posted onAuthorcahwyguy

The New York Times has an interesting article on a debate in the medical world: Should nurses who have doctorates in nursing practice be called doctors? Should pharmacists who have doctorates in pharmacology be called doctors? The medical profession, that is, doctors, are against it. They say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point? Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power. Of course, there’s also the worry that patients will be confused.

Now, what goes unmentioned in this article is the fact that pretty much anyone who has earned a PhD has the right to call themselves “Doctor”. This is true for someone with a doctorate in English as well as Engineering. Yet we don’t confuse them with medical doctors (well, unless they try to take advantage of it 😉 ). I can’t see why we should deny that naming privileges to nurses or pharmacologists. What makes a medical doctor is the letters behind the name (i.e., M.D.), not “Doctor”. In fact, some of the people that emphasize the title (and might have even had the magic M.D. letters at one time) just seem to use it to bilk people.

Share

I’m Sick of It

Posted onAuthorcahwyguy

There are two interesting articles about healthcare in today’s LA Times (which I’m reading as I eat lunch). The first discusses the rise in the cost of employer provided health insurance and health insurance premiums: the net effect of this is that any raise you might see will probably be offset by the increase in your share of your insurance premiums. The second is that fact that primary care doctors admit that they are part of the problem, ordering unnecessary or defensive tests for a variety of reasons.

Were I to mention this to a “tea party conservative”, I’d likely get a rant about Obamacare. However, the Affordable Care Act (which is the real name of what was passed) is not behind the increase, other than some preventative care costs. The ACA does nothing to control healthcare insurance costs; indeed, if the mandate of the act to have every have insurance coverage comes into play, insurance costs (but not medical costs) will get lower simply because the pool of insured is lower. No, you can’t blame this problem on Obama directly*
[*: well, other than he wasn’t forceful enough to get Congress to do the right thing, but the right thing would have had the conservative right complaining more]

A series of recent Planet Moneys give some insight into this problem. First and foremost, our medical insurance system is broken, broken, broken. Trying to fix the problem within the existing system is difficult if not impossible. The Planet Money folks gave a good analogy: Supposed you had employer-provided food. You could go to specific stores, and for a $20 co-pay, get all the food you want. You would consume food without regard for the actual costs. You wouldn’t think twice before ordering the caviar or lobster. You would eat prime beef. As this happens, your employer’s food insurance costs will risk. The insulation from the actual costs of services leads to bad consuming decisions.

Secondly, how we pay doctors is broken. This is illustrated well by the doctors article. They are paid by how many people they see and how many tests they order, not for providing a good service with good outcomes. It is in the doctor’s financial interest to order more tests for a number of reasons: more income, better legal protection, and for enhanced diagnostics when they don’t have time to spend with you.

What’s the answer. One approach is cost containment. In this approach, you need an insurer large enough to dictate basic prices, and you need some gate keeping to have insurance cover only cost-effective and effective procedures. This is what has been termed “death squads” by those looking to kill it, but is really one of the hallmarks of a single payer or government run system. This doesn’t mean that other services are not available, mind you, only that insurance wouldn’t cover them or would only partially cover them. But such an approach goes against a lot of our well-financed special interests: drug companies, health insurance companies, and the medical establishment (who would have dictated rates).

Another approach might be tiered reimbursement. Known cost effective procedures would be reimbursed at one rate, and there would be increased cost sharing for more expensive procedures. This would at least let people know the cost of their services, although it would price some people out of the ability to get life-saving treatments.

Of course, underlying all of the health insurance debate is one question no one ever seems to bring up: What is the value of a human life, and are all human lives valued equally? This depends on who you ask. There are some folks who give the appearance of valuing the life of an unborn child much highter than the life of that same children when they are 25 and on welfare. There are others who value lives differently based on where you are in the social strata, or who your employer is, what you do, or how much you care about that specific individual. Ultimately, although we are loath to admit it, every life has a value. A hard cash value, which represents how much you are willing to spend to save that life.

Perhaps one reason that dealing with the whole health insurance muddle is such a mess is it forces us to face that question… and the answer exposes things we don’t want to admit publically. Your thoughts?

Share

Obamacare Misunderstood

Posted onAuthorcahwyguy

This morning, while I was up early, I was reading a USA Today article on how the rules on FSAs are changing. I was reading the comments, and I realized that most folks don’t seem to understand the health care reform. This is the fault of the Obama administration for not getting out a clear message about what benefits and changes the legislation brings. Here are some examples:

IAMFEDUP wrote: “Take congress’s healthcare away… make the politicians use the same healthcare that the pubic uses… and wall-la watch how fast the healthcare system gets fixed.”

One of the aspects of the law—pushed by the public that didn’t want a single payer system—was that you could keep your health care plan if you want to. Single-payer might fix the health care problems, but the public didn’t want that. You get what you want.

Mister Grumpy wrote: “If Obamacare is so good………. how come the program doesn’t apply to those in Congress and the Executive Branch?…………….. They get to keep their current benefits at little or no cost to themselves…………..”

See the above. The program does apply to those in Congress and the Executive Branch: they get to keep their employer-provided insurance if they want to. Sounds like you’re agitating for a single-payer plan, which “Obamacare” isn’t.

baboons wrote: “THanks for making it more difficult to use our health care Obama… you suck.”

Making it more difficult to use health care, you say. First, remember we’re dealing with not being able to easily pay for OTC medicine with pre-tax money. Instead, you have to let your doctor know what OTC medicine you are taking so they can inform you of any drug interactions that might reduce its effectiveness. That sounds like you’ll get better care. As for “using health care”, that’s not the question here. The question is whether you can pay for it with pre-tax money.

Share