$8400 Annual Insurance with $200,000 Deductible
This Des Moines Register editorial spells out our problems so cleanly that I’d link to it anyway, but they also mention this bute:
Just a few weeks ago, this editorial page told the story of Jan and Gary Clausen, who didn’t have the option of buying health insurance through an employer. They went out on their own and bought AARP-endorsed plans for about $700 a month. They were left with more than $200,000 in medical bills after Gary was diagnosed with cancer.
Some insurance.
If you support the current system, you support a system that does this to people.
Or this, Shadowfax’s incredibly sad CT scan and story about a 54 year-old uninsured woman with metastatic cancer who will soon be leaving her 4 children behind.
Bravo, bravo, encore, encore!
hey graham – i thought you’d enjoy reading this article on slate.
funny you bring up the aarp plan – i was helping an unemployed friend look for insurance and came across this option. they take $150/month and then give you $700/day per hospital admission (oversimplified). unreal.
Here’s a story of a boy with government insurance coverage who died because that coverage was inadequate. Maybe the solution is to force doctors and dentists to accept the pittance paid by government (taxpayer-funded) insurance plans.
Or not. This isn’t Cuba.
Good link, scalpel. I guess I’d argue that the link supports providing basic dental and primary care, as it clearly would have saved the boy’s life, and cost a couple hundred dollars, versus $250,000.
I think it makes more sense to fix the reimbursements (Medicaid is notorious in this aspect, it’s a well-known problem) than live with our current system.
In a nationalized insurance system, we all will be on Medicaid. You can’t increase the reimbursements on a massive national scale without making the costs prohibitively high. You’ve got to decrease costs.
I like the Wal-Mart model.
That’s not true, Scalpel–there’s an incredible amount of waste in our system–a lot of it adminstrative–as well as a lot of money that could be saved if we were able to provide preventive, primary care services for everyone.
In fact, Canada’s physicians’ incomes increased when they enacted their single-payer system in the 1960s, and I believe Taiwan, which enacted single-payer in the 1995, had similar increases.
Do you have any evidence that moving to a single payer system will save money on administrative costs? Or that providing preventive primary care services for everyone will save money? I think both of those theories are suspect.
As an ER doc, I don’t really have a dog in this fight. My income would probably increase with a single payer system even if they paid at Medicare rates (which would honestly probably be the MAXIMUM the govt. would pay), simply because the 30-50% of “nopays” would at least pay something.
Other physicians who are already refusing to see Medicare and Medicaid patients should hate the idea of single payer more than me, at least with regards to their own incomes.
My beef against government single payer is as a patient, not as a physician. Overall quality would decrease, and my cost to receive care would probably increase.
Sorry graham, I’m with scalpel… To see how well our government does with single payor look no farther than the VA system and Walter Reed. Great if you need long-term HTN meds, not so great if you need more intensive care.
As for my ortho practice, we did an audit and found that we LOSE $5 for every Medicaid patient we see. The reimbursement doesn’t cover our overhead, and yes, decreased malpractice insurance with the tort reform that would have to accompany this would help, but you still got to turn on the lights. Medicare hasn’t raised their payments to physicians in 2 years and were up just 1.1% the year before that, and funny, my employees (110) expect pay raises anyway.
Utilization is another point. Medicaid patients notoriously overutilize medical care (its just $2/visit and that can be lowered) and yet have, as a group, still among the poorest health of any group in the country.
Scalpel–indeed I do. There’s a lot of analyses done by multiple different economist groups showing that single-payer is one of the few alternatives that would provide universal coverage without increasing costs.
See the end of my post here: http://www.grahamazon.com/2007/01/if-not-health-reform-x-then-what/
Fabella–single-payer has nothing to do with Walter Reed (an army hospital) or the VA (a government-run health care system). Neither is anything like what a single-payer system would be like.
An Army hospital and the VA are excellent examples of what totally government-funded health COULD look like. In fact, it is the only example in our country that is totally government controlled/funded. And in theses institutions, the bureaucracy is larger than any privately run system.
Reading my first post, I actually snickered at the thought of universal health care, by and large a Democratic ideal, being paired with “tort reform,” which is a Democratic anathema.
I know, I know… off thread, but still perhaps on target.
Ooh, US medical politics! *whizzing sound as it all flies over my stupid foreign head*
Still, it sounds heckuva lot better than what we have over here in the UK. Medical treatment is “free at the point of entry” in principle. The difficulty is actually getting IN.
Hope the new Bush plans for national healthcare help with the situation at your end though.
The primary operating principle of our current system is that of enriching insurance companies, pharmaceutical benefit management companies, and various other middlemen who provide no health care at all but consume an increasing proportion of the money ostensibly spent on health care. What you describe is just Good Business; from the middlemen’s perspective sick people are nothing more than parasites that steal money from executives and shareholders.
For some reason that fact is difficult for people to grasp. They’re quite eager to parrot the propaganda that the middlemen spend our money to promote that universal health care would be “socialized medicine” that would let the “big bad government bureaucracy” deny us health care. Unless someone can provide the funding to disseminate the truth about the intrusive, expensive, duplicative private bureaucracies that are sucking up our health care dollars, much of the public will have a reflexive aversion to needed changes.
I love the blog that you have. I was wondering if you would link my blog to yours and in return I would do the same for your blog. If you want to, my site name is American Legends and the URL is:
http://www.americanlegends.info
If you want to do this just go to my blog and in one of the comments just write your blog name and the URL and I will add it to my site.
Thanks,
David
Someone else besides me agrees with Fabella.
http://www.foxnews.com/story/0,2933,257443,00.html
BNow if I could only get CNN on my side, THAT would be an accomplishment!
Graham,
You are always decrying our current system and are pushing for a single payer system, but you don’t describe what your “ideal” single payer system would look like. You disagree that the “VA or Walter Reed” are examples of a single payer system.
I have no idea how much you know about Medicare, but is a single payer system, the government is the source of all payments, that is administered by private insurance companies. You are too young to know about the origins of Medicare and how the Johnson Administration touted what a wonderful system it was. Reimbursement has steadily gone down as has the coverage, since Medicare’s inception. The reason, cost. The Medicare trust fund is destined to be bankrupt by about 2025 or 2030. I am embarrassed when I see how little Medicare pays my physicians compared to what I received when I was in active practice.
I admit that something has to be done about our current system but I don’t know just what the best approach should be. Would you inform us how your “single payer system” would function and what entity would be the “payer” if not the federal government? The “Angry Medic” describes the problem of access to care in the UK, and at least in Oregon, Medicare recipients are seeing some of the same problems, namely, finding a PCP who will take new Medicare patients. If everyone was covered by a Medicare like insurance program doctors couldn’t refuse to see these patients. If we eventually have a Medicare type universal coverage, I really don’t know how young physicians will be able to pay their student loans, because I doubt if they would earn enough under such a system to repay them.
Graham,
Excuse me. After I submitted my post, I read your dialogue with David Catron, in which you did describe what you mean by a “single payor system.” It sounds just like Medicare. You don’t need to restate your concept of the single payor system.
Dr. Thompson,
Not only would young physicians have difficulty paying off their student loans (between my ER wife and I >$250K and I had a scholarship), but I can guarantee that out of my 12 partners, at least 6 would retire rather than face reimbursement at completely Medicare rates, leaving us with 6 orthopods for a cachement of 450,000 people. Many of whom feel its too hard to get an appointment now….
Hi Graham,
Thanks for keeping up the good work. I’m surprised to see all the docs who read your stuff and yet don’t know that physician satisfaction is just fine in single-payer countries; ditto for patient satisfaction and outcomes.
How do they get through med school without knowing that U.S. costs are so much higher, and yet without a concurrent near doubling of outcome or quality? Is that just some kind of weird anomaly in the time-space continuum that affects U.S. healthcare?
I’m not at all surprised, by the way that Scalpel turns out to be a bigot. This kind of elitism comes in packages. You have to believe that some people are just more deserving than others in order to maintain many of the fictions we hold dear in America.
So much of it is systemic. I worked for the Catholic Church for a long time, and could finally see that the system — while well formulated for continuity — was not ever going to “get it” when it came to the whole picture, women’s issues in particular. How could it? They purposely exclude half the population from any position of influence.
Our healthcare system springs from the same place that the invasion of Iraq came from: a fearful populace easily exploited by politicians willing to abuse their positions and corporations who can buy the means to propagandize us.
My dad was a doctor in favor of single-payer back in the ’60s and ’70s. Possibly because he went into medicine in order to help people, and because also he was an environmentalist who understood the concept of sustainability long before the term was coined.
We do not have a sustainable system, nor do we have a system in which the primary goal is to keep people healthy and heal the sick.
The doctors who are comfortable with it either do not understand the damage it does or do not care. This system kills people — including the 12-year-old boy who died for want of a dentist.
And Fabella, for crying out loud. How on earth do physicians get by in Scandinavian countries, Canada, Scotland, Britain or elsewhere with single-payer? For that matter, how do you figure it works in France?
How do you tease out the fact that docs actually show higher rates of job satisfaction in those places? Do you think that Americans are simply so spectacularly incompetent that we couldn’t replicate the best of their systems, adjusting as needed as we went?
Take a look at the McKinsey Report on Health Care for a pro-business, pro-quality, objective look at the problem. It’s really a top-notch analysis with no single-payer ax to grind.
From Medscape General Medicine
Bioethics
Pay, Pride, and Public Purpose: Why America’s Doctors Should Support Universal Healthcare
Posted 02/28/2007
Laura K. Altom, BS, MSIII; Larry R. Churchill, PhD
Author Information
Abstract
“What’s in it for physicians?”
… Our aim here is to explore and discuss some of the reasons that should motivate active physician involvement in a more just and equitable system. We will discuss 3 reasons in particular. They are: (1) the need for paying patients; (2) the need to take pride in what one does — that is, the need to be nurtured by recognition of skillful professional performance in medical work, and not just rewarded monetarily; and (3) the importance of embracing a public purpose for medicine and thus engaging the trust and esteem of the population.
Kristen,
For crying out loud, try suing a doctor in Canada, Britain, or a Scandanavian country… can’t do it, or difficult at best. Have I ever ordered more tests than needed to CYA? Every single day (except the weekends when I don’t work). Would I accept a pay cut to reduce that… in a second. Would that incredibly increase my job satisfaction? Even more than DOUBLING my salary. (I got in this primarily because I like to help people… but don’t get me wrong, the money is also nice)
Do Britains expect an MRI for every knee pain? No, but many of my patients do, and when I don’t order one… they go to the next guy who will. How long does it take to see 2 or 3 orthopods in Canada? And then to get an MRI even if you need one?
Because I have a healthy lack of confidence in a single payor system, doesn’t mean that I believe the current system is good or even acceptable. I think insurance companies make WAY too much money while cutting payments to the people who provide care, but I am very wary of having the same government who got us into Iraq (Republicans AND DEMOCRATS were all on board) take over our healthcare system.
Also interesting that the article you cite was not written by real life American physicians… as I’ve said before to Graham and others… your life changes in the real world. Medical school (MSIII) is a beatiful wonderful place were decisions come across as very black and white. Reality is different.
To paraphrase my Dad, every one is in favor of higher taxes, until they get their first paycheck.