Monday, March 22, 2010

Healthcare "reform" passed...so I guess I can start smoking now?

First, let me state for the record that I am a recovering news junkie.  I used to watch C-SPAN, Fox, MSNBC, and listen to talk radio to get my news. Then I realized that I hate pretty much every politician on the planet, from my Mayor who assessed a levy on my property to pay for sewers that have been installed since before I was born all the way to Bush and Obama.  They're like many doctors - great at noting the problem, expert at "managing symptoms" but not so good at fixing things, and the ones they do fix end up having unintended consequences.

So, I stopped reading and started hoping for something like "A Boy And His Dog", "Fallout", or "28 Days Later" to occur so I could raid all the pharmacies for antibiotics, raid the libraries for books on medicine, and then raid the gun stores for more weapons and ammo to keep back the hordes of mutants, zombies, or slavers with my family.  A bit like lawn bowling, but messier, I suppose.

Anyhow, I was sucked back into the news fold via the pervasive reports on the Health Care Reform stuff. I dug in a little and it sounds like the usual: Instead of fixing the problem, just treat the symptoms and hope for the best. I find it disturbing that of all the morons that we've elected are trying to write legislation when 99.999% of them are lawyers, and of those, rarely have any ever run a small business, owned a corporation, or been living as a "normal middle class American".  Further, few are practicing doctors.  So, what makes them so bloody smart that they're going to change things for the better this time, when everything else they have ever done, with an infinitesimal amount of exception, has turned out like shit and been a costly and unsuccessful joyride to bankruptcy? The answer is nothing - this too shall probably end up failing, like everything else the government does, and they'll eventually end up blaming the last Administration, whatever group that turns out to be when we realize it's been a heinous error in judgement. It reminds me of a line from the movie 300 - "This will not be over quickly, and you will not enjoy it."

I keep reading all these horror stories about insurance companies and how evil they are, but then I think to myself that without them, or something like them, everyone who gets cancer, diabetes, or other really bad illnesses would be SOL and end up on the street, dying in front of God and country. Seems to me that if they're only making a margin of 2.2%, per some news reports I've read, they're on the verge of being broke anyhow.

What people don't realize, I think, is that insurance companies are like casinos.  They take money from some people who lose to pay people who win, and as long as more people are losing than winning, the company can pay its employees and set money aside for those big Jackpot winners.  If the casinos are always losing, they go out of business.  That's just the same with insurance - if the risk pool has a higher payable than receivables can cover, the money has to come from somewhere, and that's how higher premiums become the topic of the day - people keep getting sick...imagine that.

Then I keep thinking about how my experience has been so much different, and I'm not rich, I'm not influential (even at home) and I'm just about as average as they come. I have chronic illnesses (allergies to the 10th power) and I have 2 young kids, one of which goes to the Germ Warfare Center known as Public School, so they're sick all the time.  The thing is, I'm not going broke.  My premiums used to go up a lot, but now I'm on a new deal, an HSA.

I've been on an HSA (Health Savings Account) plan for about a year now, and let me tell you: This is how it should be. I pay a little over $200 bucks a month and of that $200, $75 goes into a tax-free account.  I never, ever pay tax on this except maybe sales tax.  I can use it however I want, be it paying for office visits, vasectomies, Sudafed, prescriptions, whatever I want that's medical related.  The best part is that I have a $2500 out-of-pocket maximum per year, and so once I hit that number, everything at all, from prescriptions to chemotherapy is 100% covered.  It's bad ass, in short. The best thing is that every eligible purchase I make from doctors visits to prescriptions go towards that $2500 nugget, and so if my wife buys her $80 birth control every month, by the end of the year we're $960 towards that deductible, and if we had some other expenses during the year to get us to that $2500, everything afterwards is paid 100% by the insurance provider.

The other aspect of this is that I get to go to whomever I want, since I'm paying. If I want to go get accupuncture, it's covered.  Chiropractic? Covered. How about a specialty allergist? Covered.  No cursory referral required!  Bush did a whole lot of completely stupid shit, as has every president I can remember, but this was the one thing those Texans got right.  I even negotiate with the billing chickies at the office and before I get service I ask them if they can give me a non-insurance discount rate which lowers my out-of-pocket costs at that visit by a good amount.  I just had some cancerous chunks removed from my back, and it cost me $400, where if I was on a normal insurance plan they'd have billed the company $780.  That's a hell of a deal, especially for an old horse trader like me who shops EVERYTHING out.

Now let me be clear here, when we were offered this we were scared shitless.  Worries of us going broke by going to the doctor, having to pay for everything out of pocket...all that.  Turns out that our fears were unfounded and we're actually SAVING money! I even had my employer take some extra money out of my paycheck every month to deposit it into the HSA account, and we're building savings for "rainy day expenses" like seasonal flu, allergy medicine, and a vasectomy if I decide that babies suck!

So, this reform bill is proabably like everything else that government does - wasteful, and a bad idea even if the intentions are good.  I really hope that it works out because I'll never bet against my own country, but I'm here to tell you that if they REALLY wanted to fix things, they'd take all this money they're laying out and simply do 3 things:
  • Fund people's HSA accounts and migrate the system toward that with subsidies and grants
  • Make insurance companies accept people with pre-existing conditions
  • Have a national pool of sick people and spread them across the nations risk pools so that there's an even distribution of sick people with healthy people to alleviate the burden on smaller companies and private citizens.
That's my answer, and I'm no expert, but from my experience this is one thing that I am positive will work.

6 comments:

Red Bull said...

Jeez, man. Not sure where you live, but this sounds nothing like anyone else's experience I know. $400 for a surgical procedure? Seriously? You must be one hell of a horse trader.

A doctor's visit is $100 for walking in the door. Lab tests are $250 apiece easy. Add in medicines and you're talking multiple hundreds of dollars for anything beyond a sniffle.

And I don't know where you pulled that 2.2% profit margin figure from, but the CEOs of the top 5 insurance companies made a combined $140 million in 2008. That's 5 individuals at the top of those companies you seem to think are "on the verge of bankruptcy". Yep. Sounds like they're barely scraping by. (http://www.aflcio.org/corporatewatch/paywatch/ceou/industry.cfm)

I'm glad your HSA is working for you. But you seem to think paying $200 a month for something the entire Western world gets for free is a great deal.

Do the math - those "exorbitant" extra taxes that Europeans pay for government-run health care adds up to about the same you're paying for your "fantastic deal" on health care. And they get it whether they have a job or not. (http://www.worldwide-tax.com/)

Greyweather said...

"And I don't know where you pulled that 2.2% profit margin figure from, but the CEOs of the top 5 insurance companies made a combined $140 million in 2008."

Those statistics are compatible. US health care is a $2.5 trillion dollar industry. 2.2% profit from that is $55 billion. A combined $140 million in CEO pay, even for just five companies, is a minuscule percentage.

"But you seem to think paying $200 a month for something the entire Western world gets for free is a great deal."

Since when is an 8% difference in tax rate (difference between USA and OCED average) considered "free"?

"Do the math - those "exorbitant" extra taxes that Europeans pay for government-run health care adds up to about the same you're paying for your "fantastic deal" on health care. And they get it whether they have a job or not."

You don't need a job to get health care in America. I refer you to the Emergency Medical Treatment and Active Labor Act. You seem to be confusing health care with health insurance.

Red Bull said...

"Since when is an 8% difference in tax rate (difference between USA and OCED average) considered "free"?"

You've missed my point: that 8% is roughly equivalent to what the original payer is paying, and he's healthy. And he is talking about what a great deal he gets on health care. Under a different system, everyone gets that deal, regardless of whether or not the insurance company feels like paying up for your particular type of cancer.

Not to mention that 8% also pays for (depending on the country you're talking about) government-sponsored day care, long-term unemployment benefits, public transportation, etc.

And that's the most important point here: the profit motive has no place in medicine. I think that doctors and hospitals should be focused on helping people and not on making money.

"You don't need a job to get health care in America. I refer you to the Emergency Medical Treatment and Active Labor Act. You seem to be confusing health care with health insurance."

"Emergency Medical Treatment" is not health care. It's a last resort. You seem to be confusing survival with health.

=+=SuperflyTNT=+= said...

I am a hell of a horse trader, but that's beside the point, Redbull. The point I was trying to make (and apparently failed) is that it's bullshit that a provider has 2 price lists; one for people with insurance and one without. That's tantamount to fraud, IMO, if some doctor can think that doubling a bill simply for going through the AUTOMATED PAPERWORK SYSTEM on their computer and filing a claim.

I'm happy with what I have, and I'm glad I live in America. I have many european and canadian friends, and they bitch as much, if not more, than we do about healthcare.

The whole system is fucked, and that's the only thing everyone can agree on.

=+=SuperflyTNT=+= said...

Holy shit! I just realized people actually READ this blog!

Thanks guys!

Greyweather said...

"You've missed my point: that 8% is roughly equivalent to what the original payer is paying, and he's healthy. And he is talking about what a great deal he gets on health care. Under a different system, everyone gets that deal, regardless of whether or not the insurance company feels like paying up for your particular type of cancer."

Instead they have to worry about whether the government feels like paying for their particular type of cancer. Rationing is the norm in public health care systems.

"And that's the most important point here: the profit motive has no place in medicine. I think that doctors and hospitals should be focused on helping people and not on making money."

If you take out the profit motive you reduce the incentive for people to enter, or even stay in, that industry, leading to shortages in doctors and hospital staff. Look at the public education debate. We are constantly being told we need more money for public education and need to offer higher teacher salaries to attract more, and higher quality, people to the profession.

""Emergency Medical Treatment" is not health care. It's a last resort. You seem to be confusing survival with health."

The US Congress has a different definition of "Emergency Medical Treatment" then you do, but their version is the law.