An estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.
Many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.
“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
Too many other people already have coverage so meager that a medical crisis means financial calamity.
One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.
He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.
At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.
He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.
In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there.
Classic! They collect the premiums, and then deny care! Yay!
Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”
“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.
And that's why, if we give the insurance companies any role at all in universal health insurance, we could very well end up paying more and getting less -- as insurance companies dump all the people who need care onto the taxpayer, and then game the system to screw their customers just as hard as they are today. Which, as profit-making entities, it is their fiduciary duty to do.
You can't buff the turd of for-profit health care to make it about health instead of profit. It's dead, Jim -- not matter that wistful "progressives" are trying to give the corpse the kiss of life with so-called "public option."
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Great comment from WNYC segment discussing end of life care
costs:
people competing with insurance companies for resources
that's probably the best framing i've ever seen
Elizabeth Warren for President, I say
Though she probably is too smart to want the job.
He who will not reason is a bigot; he who cannot is a fool; and he who dares not is a slave.
- Sir William Drummond
The simple argument I make for single payer
is that this is the only country in which an accident or illness can ruin you financially for life.
Quality of health care is a separate issue. Single payer addresses the financial part. (A third part, which I find compelling, is no paperwork.)
single payer,
in freeing up physicians and their staff from all that paperwork and haggling with recalcitrant insurance companies, will allow them to spend more of their time practicing medicine. that alone will raise the quality of care, but hr 676 has some other provisions that should improve quality too. real ones, not any of this pay-for-performance wishful thinking that we keep hearing about.
Wow, the A-list makes that shit-sausage sound so appetizing! n/t
.
Well, to be fair....
... one may be able to sniff or lick the shit, and not actually eat it. There's that.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
That's reassuring, indeed
This all recalls this classic comment (warning, it includes the "C" word -- not that one, the one that Obama fans actually found offensive):
http://www.correntewire.com/gallows_scha...
My parasite is very healthy!
Just look:
Yay!
It's why they do what they do.
(By the way, the Barron's article, now behind a firewall, clarified that "better pricing" means raising premiums.)
---------------
We can't afford not to have single-payer!
Obama had his first health care town hall today,
and I listened to the first question: why are we trying to maintain the private insurance company model with its high administrative costs, instead of a single payer plan with low administrative costs that would save hundreds of billions of dollars and cover everyone in the country?
And part of one answer: Yes, we know that other countries are doing single-payer, and doing it well, but this is America, where employer-based insurance plans are how we've been doing it for like forever, and even though we have Medicare, which is a single payer plan for older Americans, it would be just too disruptive to disturb the employer model. We need something "uniquely American." Something that could preserve the private model but also have a form of public plan.
And then I changed the station, understanding that it was going to be nothing new, just the usual, stale talking points that have little basis in fact. For all I know, someone asked why, when the private insurance companies have never had anything standing in their way that would have prevented them from actually designing such a uniquely American system, we should have any confidence that whatever we impose on these companies stands any chance of success. Yeah, right. I suspect the answer to that question would be just more of the same old crap.
I have no doubt that the AHIP-sponsored townhalls will be reinforcing these same old blah-blah-blah memes, and clips from them will be used by the media to speed the death of real reform.
What a colossal waste of time and energy. And what a huge lost opportunity to be really creative and innovative and fiscally responsible.
What a total coward.
Yes, we are the only industrialized nation to have an employer based health coverage system. That's the God damned problem!
Medicare for All is Civil Rights
Question for the single payer bloggers
(and anyone else)
I'm writing up an article on risk pooling, and I just wondered if anyone has heard of any attempt in the proposed reforms (or deforms) to limit the kind of regulations the individual states could have on health insurers (such as NYS guaranteed issue and community rating).
Anyone know? This would be a big, huge fracking deal in a plan that is not single-payer and it could be easily slipping under the radar.
---------------
We can't afford not to have single-payer!
the leading proposed deforms
are all including guaranteed issue and community rating. what they've been less forthcoming on is that we're going to get modified community rating, with the chief modifier being age [older people will pay more for the same coverage than will younger people]. the only actual numbers i've seen have 7.5x from the senate finance committee [yay max!] and 2x from the help committee [kennedy/dodd] and these were only in their drafts.
if baucus gets his way, the expected-to-be-most-expensive people would be paying 7.5 times what the expected-to-be-least-expensive people will pay for the same coverage. i think [from reading one of baucus' drafts/white papers/wev] that the 1x payers would be 20-something single non-smokers living in low-cost communities and the 7.5x payers would be 60-something smokers, with multiple dependents, living in high-cost areas, but i've seen one or two analyses that say no, this 7.5x range applies across each family size [older single smokers in high-cost areas will pay 7.5x what the youngest single nonsmokers in low-cost areas will pay, and so forth for increasing family size]. this strikes me as unlikely, but they could be right and i could be wrong.
i've seen less commentary on the help committee's plan, the 2x version, but it does look like this is across family size and maybe across geography, and with no additional provisions for smokers [good] -- ie older single persons will pay twice what the youngest single person will pay for a given amount of coverage, but i could be wrong on this too.
additionally, they're all pretty much proposing reinsurance or risk adjustment, where those insurers who have 'too many' healthy [cheap] people will be taxed [or will pay into some kind of kitty] some of the money they got from premiums and those insurers who get stuck with 'too many' unhealthy [expensive] people will get that money. it's an added layer of bureaucracy to basically pool the risk pools, but other countries do this -- with varying amounts of success, it appears [some of them use complicated formulas, some use simple formulas for the redistribution]. germany does this, and i think switzerland and the netherlands do too.
it would be much simpler, and cheaper, to put us all into one pool -- everybody in, nobody out! -- but nooooo, can't do that, we have parasites to support!
the plan seems to be that this reinsurance will be done through the health insurance exchanges, but there seems to be some debate on whether all insurance will have to be sold through these exchanges, or if insurers can opt out of participating in the exchanges, or sell some of their plans through the exchanges and other plans outside the exchanges, and whether this reinsurance will apply to just those plans in the exchanges or to all insurance sold.
the exchanges themselves are still nebulous [last i checked] with much debate over whether we need one national exchange, or maybe regional exchanges, or one exchange per state, or even multiple exchanges in some states. it looks like individual states will maybe be allowed to have more strict consumer protections than what the exchanges offer, but then again, it does look like some of the proposed across-state-lines regional exchanges might be attempts to circumvent requirements in the stricter states. hard to say, since if anybody's talking about this much [out loud, in public], i haven't yet stumbled across it.
ezra klein, bless his progressive little heart [/snark], has at least been posting on exchanges a little -- some good explanations of how they would work, but little analysis of what could go wrong.
apologies for the paucity of links, i've been doing a lot of speedreading on this without bothering to bookmark most of it, and i haven't the foggiest remembrance of which sites i've stumbled across. ezra's blog has been a good source of information and links [links that lead to other links...], and he's good at explaining the stuff that our deformers are coming up with, even if his explanations tend to be way too sunnyside-up. i can recommend rooting around in his archives if you've got the time, energy, and inclination.
all of which is way too many words on my part to say i dunno. right now, it looks like they're still hashing out just how much power the individual states will be allowed to have in regulating the insurance companies that operate inside their borders.
yes, it's a very big deal, and it looks very much like they all want to keep most of it a secret and spring it on us at the end. but hey! stand with dr dean! support that public option! just don't have the audacity to ask what it is that you're actually going to get.
The Senate makes a mess
Thanks, Hipp. More artificial complexity when the answer is simple. Anyhow, this from Bloomberg sums up the state of play at the recess:
Punt!
So, with our per capita spending of $5711 double the next highest in the world, this works how, exactly?
Need to pick this apart, I think. The Bloomberg article is thin, and the public option advocates are too busy advocating for it to say what it means.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Thanks a bunch, Dodd! Way to eviscerate the public option
Srsly, d00d:
---------------
We can't afford not to have single-payer!
your $5711 is out of date
[we paid about $7500 per capita last year and are expecting to top $8000 per capita for 2009] but yes, we're still paying roughly twice what anybody else is paying per capita.
definitely need to pick that one [bloomberg] apart.
the public option advocates are too busy advocating for it to say what it means.
ackshully [ooooooh! catliek typing appears, i've had to completely retype this comment because of all the help i'm getting from one of my cobloggers] the public option has yet to be defined. its advocates are busy trying to whip us little single payer advocates into line, when they should be whipping all their senators and representatives to define a public plan.
I got the list from Somerby
Do you have a comparative current list?
As for the public option, I was over at Digby's today saying the same thing in longer words, and she responded by citing yet another advocate... [pounds head on desk]
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
2003 is probably the latest year that the oecd
has made a definitive list available for [ack grammar]. there are shorter lists with somewhat later data scattered around the web. i'll look for one.
eesh [pounds head on desk in solidarity with lambert]
need to stop all this head pounding, btw.
where the 2003 numbers come from
just in case you want them all
ooooh! jackpot!
a chart of 2007 numbers! from a site i didn't know existed. cool.
also, there's this --
i had somewhere a comprehensive list of countries and what their life expectancy was in, iirc, 1960-ish and 2000-ish [about 40 years apart anyway]. lost it. i keep searching the intarwebz for it though...
2007
the numbers on that chart are hard to read, so i copied the ones for the countries on somerby's list:
United States: $7290
France: $3601
Germany: $3588
Denmark: $3362
Italy: $2688
United Kingdom: $2992
Japan: $2581 [2006 data]
he left off canada, an important one, since we little single payer advocates are talking about adopting a system that is arguably closer to canada's than to any other country's.
canada: $3895
Thanks!
I do wonder just how much inequity this country (I was about to write "our society", but it made me weep) is willing to tolerate. A lot, I'm afraid, especially if it's invisible.
This is from a World Bank Health, Nutrition and Population (HNP) Discussion Paper: [pdf]
Oh yeah, hmm, those socialists and their communal structures...
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We can't afford not to have single-payer!
invisible inequity
i think that's a huge part of our
society's[agree with you on that one] country's problem, lots of this inequity is invisible.private insurers are not required to disclose any of their data or business doings beyond the standard sec filings for all corporations. medicare, otoh, discloses all, warts and smiley faces alike. canada's system too, which is why the fraser institute can make such a big todo about the waiting times there -- it's all public data. nobody forces the insurance companies here to tell how long they're making people wait for care.
lots of other inequities in our country too, that are kept out of the public eye. this dude, for instance, is solidly against single payer and cites the indian health service as proof that single payer would be bad bad bad. it doesn't seem to matter how many commenters show up to tell him that this country always has and is continuing to treat native americans badly and that, among many other ills we've visited on them, we've also put them off into their own [damn near unfunded] health care silo.