The facts are 33% of all health care costs go into bogus administration overhead that can easily be cut by a one-payer system. That is enough saivng to INSURE EVERY SINGLE AMERICAN.

Just like the huge companies, self-insure, the US government would simply self-insure and have the power to push down costs and drive an efficient market.

What we have today is NOT A FREE HEALTH MARKET but a market control by big-pharma and big -insurance. A FREE MARKET would be great, but it is not going to happen so a “socialist” health care plan is actually a step in the right direction and better then what we have today.

To me, it comes down to what kind of society do you want to live in? Say you go a government job with cheap health and your neighbor is dying because she cannot afford some treatment, happening all over America, is the what you call “capitalism” does it matter? is that the society you want to live in?

On a message board a woman told us she went to a school board meeting and they told the crowd that two teachers have cancer and because of these two teachers taxes will be going up. I’m not sure how legal that is, at least they didn’t name them, but what a horrible thing to do!

I have the Kaiser permante federal health plan,

Interferon went from 30$ a month to 300$ a month.

sat april 19 I got a fed ex from Kaiser saying (OOPS! we messed up!)

they are sending back the 900$.

The insurers need to be put on notice… first do no harm.

Ren

I’m self employed. Medical and dental insurance for my family of four comes to about $1,100/month. It’s really going off the charts.

What is unspeakably frustrating to me is that in spite of spending $870 on health insurance (a company plan) for a family of three, every time we have a hospitalization or health crisis, we can’t seem to avoid digging into our own pocket and bank account for some costs you can’t anticipate.

This last time we actually had to work out a plan to pay it off.

We also pay $40 a month for cancer insurance, but if it’s got as many holes as the regular policy, I wonder how much help it will be in case I need it.

JS: Thanks. I knew you’d come to rescue of this economic illiterate.

Jeff: I know you feel this keenly in light of recent events. Cancer is the second-leading cause of the death in the US — more than half a million people. Many more than that are diagnosed with cancer in a given year.

Yet it cost your family $150,000. It continues to amaze me that cancer, despite its high standing on this list, remains a financially devastating disease for those who suffer from it and their families. Yes, research is costly. Yes, the drugs are costly.

But why has that situation remained so for so long?

Annie, Orangutan: Thanks, too, for your comments. I know little about this arena, and I’m glad to have your help in understanding it.

Yep, your employer knows everything about your health care usage. I have been in meetings where we went over printouts of what drugs were being used most and who was using them. I can’t say that I ever heard of anyone being terminated because of health care use. HR generally doesn’t have that much power and there’s usually confidentiality within HR, so that the health care administrators don’t share info with anyone else in HR, other than the bosses.

I’m not saying it doesn’t happen, but I’ve never seen it happen.

Some time, I should do a piece on how I’ve seen all this change since the 80s, and how discussions at the highest level in some of the US’s largest companies changed around it.

Really good explanation. I was surprised at the costs of medicine when my lovely wife was sick. There were little bottles of chemo medicine that cost thousands of dollars for 100 ml of medicine. All in all, her illness cost $150,000+. Being insured, somebody still had to pay. That being said the medical business, medical insurance business, and pharma business is one big clusterF#*k.

Jeff

Jeff

Thanks for laying that out so well. Most hospitals are self-insured, and so employee health information is most definitely shared with their employers – so much for HIPAA. the self insured employers get very detailed information about diagnoses via coding and submitted claims and reimbursed claims data. The smaller the employer, the easier it is to pinpoint just who is a large user of resources for self or dependents. And don’t think for a moment that these people aren’t targeted for termination.

The WSJ had an op-ed today speaking to the insurance industry as parasitic, a term I’ve been using for awhile. I blogged about it (link at my name). Frontline tomorrow is examining several other countries’ health care systems, and we should be paying close attention to viable models since we have catastrophically failed in the health care arena.

Dr. Denny, you asked about the priorities of the Big Insurance and Big Pharma industries: both exist to maximize profits to investors (shareholders). They are entirely untethered from having any aim to improve the health of consumers of their products.

First off, it probably is employers who are demanding this change. My years working with experts in this field and attending meetings at large companies gives me some insights:

1. Most really large organizations don’t insure their health care costs with an insurance company. I know you’ll find that hard to believe, but it’s true. Instead, they self-insure, paying for health care costs as they go, because it’s generally (but not always) cheaper than using an insurance company. You probably think your university insures with an insurance company because you have a card with the insurance company’s name on it, but that’s window dressing. What that means is that the insurance company has an ASO contract (adminstrative services only) with the university. The university puts money in an account and the insurance company administers paying claims out of that account for, say, 3% of anticipated health care costs for the year.

2. Both the NY Times and the insurance companies are correct when the Times refers to “cost shifting” and the insurance companies say that what they do reduces premiums for everyone. Every health plan design conversation I’ve ever seen has centered around the question “who pays”? Premiums are what everyone pays in common to create a funding pool to help those who are ill or injured. You’ve got that right. But then the issue becomes, where does the other money come from? There are copays, coinsurance, and deductibles, for instance, which shift costs to those who actually use the services. Generally, this cost-shifting is limited by a “stop loss” provisions that says, essentially, “once you’ve paid x much money out of your pocket, we pay the rest.” Some stop losses are limited by lifetime maximums ranging from $500,000 to $2 million and, oddly enough, often reset each year.

3. The funny thing is, I know you must remember the day when there were no copays. Instead, you’d have something called an “indemnity plan” from someone like Blue Cross/Blue Shield that required you to pay a deductible before the plan paid anything, then somewhere between 20% to 0% of all other costs until you hit an “out-of-pocket-maxium,” at which point the plan would pay 100%. Those plans went away, for the most part, when managed care emerged.

It sounds like they’re coming back, but they’re not nearly as rich as they were.

Oh, almost forgot. I’m sure your number on Big Pharma research dollars are correct, but the structure has changes. Once upon a time, Big Pharma did it’s onw R&D from the beginning. They don’t do that anymore. Now, small companies begin the research and, if a drug looks promising, Big Pharma buys the company and takes the drug through development and the FDA process. The R&D costs are still there. They’re just hidden in the purchase prices of the small companies they buy.

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