Republican Sens. Linda Evans Parlette and Janea Holmquist have an op-ed in today's P-I: "State insurance laws keep costs too high for young adults"
What's preventing those young adults from buying health insurance? Simply put -- it's too expensive.Parlette proposed a bill to deregulate the marketplace and permit more insurance options for young adults. But the Democrats killed the bill in order to exacerbate the "affordabililty crisis" and justify their push for even more government intervention, or something. Posted by Stefan Sharkansky at March 27, 2007 04:58 PM | Email ThisAlthough they're a healthy population, young adults do understand the value of health insurance. The problem is, when weighed against the cost of buying health insurance in this state, they opt to take the risk of going without. The costs are a result of Washington's heavily regulated insurance laws.
A "supplemental" insurance paid next to nothing, meaning I was essentially uninsured. If you are not a charity case you are charged full price of about 40% over what insurance would pay for the same procedure.
Some health providers will permit a 20-30% discount for prompt cash payment. GOOD SAMARITAN in Puyallup overcharges and will not negotiate. If you need treatment, avoid Good Sam - they are not so good and very pricey.
Anyway some fairly simple things could be done to make health care more affordable and equitable, but our politicos would rather grandstand with free stuff to illegals or indigents. Those charges are simply added to the accounts of those who actually personally pay.
Sorry, enough whining.
Posted by: Dick on March 27, 2007 07:09 PMNo, under no circumstances do I support Canadian style government controlled health care. I believe unimpeded free market will ALWAYS be more efficient and more equitable than anything the power brokers will devise. The politicos always aim for a voting constituency. Fair, efficient, or effective are not part of their analysis.
It would be nice if there was a forum to compare the quality of health care providers and the cost of similar treatments. UW Medical has been great, Good Samaritan (now owned by Multicare) has not, and it would have been good to have had a heads up on that. A forum to share good and bad experiences would be helpful. Maybe one exists. If it does, I am unaware of it.
Or we can look to the fine people who dominate our political offices for solutions. Of course they have been there forever and nothing good has come from them.
Again, sorry -- I am cynical especially about the State of Washington politics, but I don't look to them for anything anyway.
Posted by: Dick on March 27, 2007 08:39 PMThere is only one true monopoly; the government. As soon as deregulation and competition arrive, there will be mid and lower tier health care options that open up the market to everyone. But Marxists like Gregoire are against deregulation, because that removes power from the state and concentrates in back in the hands of the people. And, it lessens the excuses for class warfare that allows for the vicious cycle of more government as an excuse to solve the current, already over-regulated, and government induced health care crisis.
As long as government remains in the business of healthcare, it will be expensive and of poor quality. Don't believe me, just ask someone you know who has moved here from Canada how they liked health care in their former country.
Government is like the urge to fall back when skiing. It feels safe and helpful, but in the end, removes control from the very part of the skis that need to remain in contact with the snow for you to navigate down the mountain safely. Gravity is your friend when skiing, and competition is your friend with government. Embrace them both.
Posted by: Jeff B. on March 27, 2007 09:24 PMFrom what I have heard, the most efficient health care program in the U.S. is the VA.
Socialized medicine, using scale to drive costs down. They still have their problems, but the treatment you receive is not based on their lawyer's ability to deny you expensive treatment in court to protect their bottom line.
Having unimpeded free market health care means the people that get really sick get no treatment, because it would not be profitable. You might as well stand in the freeway.
If you complain about the power of PHARMA, ya better not just point yer fingers at just Dems....
It wasn't the Dems that pushed plan B through the house, and threatened the comptroller to not disclose the true cost a couple years back.
Posted by: Facts on March 27, 2007 09:39 PMI still think your ideas are nutty. But I do appreciate that you're keeping your comments on topic.
Posted by: Stefan Sharkansky on March 27, 2007 09:43 PMI'm a 39 year old male, overweight (6 feet tall, 290 pounds), in decent health. No major illnesses, but not Jack Lalane, either.
Both parents died of cancer in their 50s, all grandparents died of heart attacks or strokes, in their 70s.
I'm self-employed, have been so for 10 years.
I currently have a $2500 deductible policy, $20 copay on visits beyond my two free covered visits a year. It's a PPO policy with Premera, I have a large selection of doctors.
It includes a $15 copay on prescriptions.
This policy costs me $109 per month. Is that expensive? I don't think so... It's actually rather affordable. If you're young your policy would be under $90 per month. Meaning around $0.55 per hour if you work full time. Or under 5% of your income if you make $11 per hour or more.
Or less than you'd pay for car insurance...
Now, if I could drop the mandatory chiropractic and psychiatric coverage that this State requires, I'm sure I'd cut another $15/month off my bill.
The issue here is that the State mandates certain add-ons which drive up the cost, and of course everyone immediately goes for the Cadillac policies. Insurance is just that - insurance. For the rare cases when you have more than a flu or cold.
Folks running to the doctor for every little sprain or tweak or rumble in the stomach is the problem, and why they choose the expensive policies. Then complain about it.
High-deductible policies are available, and affordable. And should be used by all. It's insurance after all!
Posted by: Edmonds Dan on March 27, 2007 09:51 PMYou hit it right on the head. Get insurance to cover you not take care of you and get the damn government out of regulating what I have to have.
Our government here in WA is mostly to blame for high prices, but like with most feel good lib policies they do more damage than good and their "followers" just lap up the fecal matter they get fed.
Posted by: Dengle on March 27, 2007 10:32 PMAs a modest proposal, how about this: have a rule where insurance companies must use a standard line-item accounting of the cost breakdown in your policy, similar to the standard feature / optional feature breakdown on a car price sticker. Let me know how much of my $200/mo policy covers medical, chiro, drug, snake handling, cryogenic brain freezing, etc. Put this in company-paid benefit disclosures as well. Then, when I get my bill, I can clearly see that I pay 40% for things I need, and 60% for things I don't. Maybe people would realize how much marginal treatments and benefits are driving up their insurance costs, and will realize that these required insurance features are like taking an optional extra and making it a (paid) standard feature.
Posted by: Andy on March 27, 2007 11:01 PM1) The insurance refuses to cover a treatment. The insurance company will gladly pay for any treatment that your employer chooses to cover. Your employer gets to pick and choose what they will cover and that is how the premiums are calculated. The employer then decides how much of that he will pay and how much the employee will pay. That is called a benefit and some have a better benefit than others.
2). The Office of the Insurance Commissioner (under Deborah Senn) mandated that any employer that offers a health plan must include coverage for mental health and chemical dependency. Furthermore, the insurance company must be willing to pay for "any willing provider", which basically means that if a person believes that a witch doctor can heal them of arthitis, then they must pay for a witch doctor. The kicker is that they don't have to negotiate rates with these people and so they can be considered "out of network" and they don't pay as high a coverage.
This approach was meant to give people choices, but the law of unintended circumstances made it so small niche insurance providers couldn't make any profits, so they left the state. This left only the huge insurance companies that have no incentive to negotiate better deals with physician groups as most of them are owned by the hospital groups in association with doctors.
3). There are certain insurance groups that make their entire living of Medicare and Medicaid coverage. Two of them are in Seattle (Molina and CHP). They have huge departments that do nothing but lobby the state for more coverage in basic healthcare and welfare because that is how they make their money. These lobbyists just celebrated the last legislature session because they will now have access to approximately 40,000 new patients (children). The nice thing for these groups is that the pay is guarenteed by the state, so they never have to worry about whether the patient will skip out on the bill or go to collections.
I would urge everyone to really learn what goes on in the healthcare industry before making rash decisions about a single-payer system. Find out what got us to where we are and where we are headed. A single-payer system is headed for disaster.
Posted by: Ken on March 28, 2007 09:09 AMYep, prescriptions are covered right now, but I don't use them. And I have been shopping for a plan that does not include them, because I have the $20/month plan from 1020RX.com - good coverage, significant discounts at a low cost.
In fact, I just got around to looking at yesterday's mail and I got information on a new, lower cost plan that covers everything I want, for $84 per month. Yes, it's $25/month less, and I'm jumping...:)
The company is LifeWise Health Plan of Washington. I'm looking at the WiseEssentials plan, $3500 deductible.
It appears they also have a plan with prescription coverage and a $1500 deductible for $183 per month. To me, that extra $100 would be better spent on a separate prescription drug plan and the difference placed in an HSA or other targeted plan for savings. Build up to cover your deductible, and you're set.
I guess I view insurance more AS insurance - and not a monthly maintenance fee - than a lot of people. Or the way that most on Congress want to view it.
The fact that you can go to an emergency room - without any "insurance" and still be treated shows that we have - in terms of basic definitions - universal insurance. You won't be refused treatment if you're in a serious condition. Just like my house will get repaired if a tree falls on it. Or my car gets smashed by someone else.
But I don't buy car or home insurance to allow me to do tuneups, paint the trim, etc. Those come out of my pocket...
Always hearing the stories of people saying they can't afford the $400/month premium for their health insurance makes me wonder if they've ever actually LOOKED for a different plan! All I did was call an insurance broker 10 years ago, told them what I wanted and how much I wanted to spend, and it's been that way ever since. Every 6-8 months or so I get information about new plans that expand coverage for the same price, or drop the price and I change.
Affordable insurance is out there, if people want to look for it. Factor it in as compared to other expenses, and I think most of those uninsured who complain about it - typically mid 20s people on TV - really aren't shopping properly, and don't put it in terms of actual expenses. They'll think nothing of spending $300/month to insure their car, but $100/month for health insurance is too high?
Posted by: Edmonds Dan on March 28, 2007 09:47 AMYep, prescriptions are covered right now, but I don't use them. And I have been shopping for a plan that does not include them, because I have the $20/month plan from 1020RX.com - good coverage, significant discounts at a low cost.
In fact, I just got around to looking at yesterday's mail and I got information on a new, lower cost plan that covers everything I want, for $84 per month. Yes, it's $25/month less, and I'm jumping...:)
The company is LifeWise Health Plan of Washington. I'm looking at the WiseEssentials plan, $3500 deductible.
It appears they also have a plan with prescription coverage and a $1500 deductible for $183 per month. To me, that extra $100 would be better spent on a separate prescription drug plan and the difference placed in an HSA or other targeted plan for savings. Build up to cover your deductible, and you're set.
I guess I view insurance more AS insurance - and not a monthly maintenance fee - than a lot of people. Or the way that most on Congress want to view it.
The fact that you can go to an emergency room - without any "insurance" and still be treated shows that we have - in terms of basic definitions - universal insurance. You won't be refused treatment if you're in a serious condition. Just like my house will get repaired if a tree falls on it. Or my car gets smashed by someone else.
But I don't buy car or home insurance to allow me to do tuneups, paint the trim, etc. Those come out of my pocket...
Always hearing the stories of people saying they can't afford the $400/month premium for their health insurance makes me wonder if they've ever actually LOOKED for a different plan! All I did was call an insurance broker 10 years ago, told them what I wanted and how much I wanted to spend, and it's been that way ever since. Every 6-8 months or so I get information about new plans that expand coverage for the same price, or drop the price and I change.
Affordable insurance is out there, if people want to look for it. Factor it in as compared to other expenses, and I think most of those uninsured who complain about it - typically mid 20s people on TV - really aren't shopping properly, and don't put it in terms of actual expenses. They'll think nothing of spending $300/month to insure their car, but $100/month for health insurance is too high?
Bottom line for me: the "health insurance crisis" in America is completely manufactured by the media. There are plenty of options out there, if people are willing to ask someone to look for them...:) Call an insurance broker and the problems really become rather small.
For the latest "60 million without insurance!" screed, I think it shows there are about 57 million people who either choose not to have insurance or are too lazy to go and look for affordable insurance.
The other 3 million may have a legitimate reason, and would be the ones I'd consider for state assistance. But 1 out of 5? I don't buy it.
Posted by: Edmonds Dan on March 28, 2007 09:50 AMWhy should the state provide any benefits at all to the loser class? Why should hospitals treat anyone who can't pay? It's immoral to reward the slothful and a drain on society to keep them alive at the expense of the hardworking.
Posted by: calling all honest men on March 28, 2007 10:10 AMWhen I was doing hospital billing, I saw many times where obese people on public services have gone to the emergency room to have their toenails clipped because they couldn't reach them and they became infected from neglect. A cough became an emergency room visit because they didn't want to wait to see the doctor the next day.
True emergencies from the welfare class were few and far between, but the emergency room was the only place they would want to be seen and many were high utilizers of healthcare whether they needed to be seen or not.
All of this drives costs upwards. HMO's tried to contain costs by basically acting as a socialized medicine and we saw what happened. They were crucified as not caring for the patients. What people didn't do with HMO's was the middle word in the acronym... MAINTENANCE... which means you need to adapt a healthy lifestyle too.
The only way it works is if people are generally healthy. I doubt that is going to happen any time soon.
Posted by: Ken on March 28, 2007 10:47 AMTrue, but once they get the bill they likely will end up in the poorhouse if their uninsured.
but I heard about some girl that needed $11,000 worth per month of prescription drugs and that's the kind of thing one buys insurance for--catastrophic events.
That would likely be my wife who underwent a kidney transplant seven years ago. She takes about 5k worth of pills a month just to stay alive. Luckily she has an excellent insurance plan through work and has around $100/mo payment. Now should she ever loose her job she would have to scramble for new insurance. Due to her 'pre-existing condition' I find it hard to believe that any insurance company would want to insure her since they would be loosing money like crazy.
As I recall, the jist of it was that any resident of any state would be allowed to purchase any policy sold (somewhere) in the US, thus bypassing the state insurance offices.
Several commentors have mentioned that the state is still piling on, so the federal bill must have gotten sidetracked, which is unfortunate.
Posted by: ewaggin on March 28, 2007 12:32 PMAh yes, Deborah Senn....who, while State Insurance Commissioner, single-handedly ruined the Washington State Basic Health Plan by mandating that insurers cover pre-existing conditions after 30 days.
The result (foreseen by everybody...except complete boneheads....like Deborah) was that people no longer needed to maintain coverage. When they got sick, they would just sign-up and wait 30 days before getting treatment.
I used to have BHP (and paid the unsubsidized rate), but during Deborah's term the premiums more than doubled, and then full-rate subscribers were kicked out.
Thanks for running BHP into the ground, Deborah.
Posted by: ewaggin on March 28, 2007 12:47 PMNow your wife can't afford to be lazy and stop working. If anything, now she has a rational economic incentive to work harder for her employer. Where's the problem?
More importantly, why aren't you insuring your family yourself, either through your employer or as an entrepreneur with your own business's group health plan?
Posted by: calling all honest men on March 28, 2007 01:20 PM2) What happens when we retire and can't afford the $5k/mo drain on our combined finances? I find it ironic that you're fine with saving unborn children, but you're not ok with helping save honest hard working Americans who happen to have a serious medical issue that's no fault of their own.
Check out http://www.lifewisewa.com/pdfs/016892.pdf - that plan - at its highest cost, if you're 65+ years old - is $438 with a $1500 deductible. And provides drug coverage.
You're not going to spend $5K/month unless you really want to... You could both be covered for under $900 per month, and you could probably find a lower cost plan if you shop around.
Seriously, contact an insurance broker and ask. The whole "thousands per month for insurance!" mantra is demonstrably false.
Posted by: Edmonds Dan on March 28, 2007 03:49 PM1. I implied no such thing. I only mean to say that if she was not financially prepared for this unfortunate turn, then that was her fault. No one is owed a living. (And while this may not be the case with your wife, bad lifestyle choices are the most frequent causes of illness and death.)
2. Why should you think that someone else should provide for your retirement? Gather your own nuts for the winter. If you can't afford to retire, keep working. Those who provide real value to society find people willing to pay them for their goods and services. Those who provide enough value to society will earn enough to survive. Those who fail to sufficiently justify their existence will perish.
Stealing from the survivors to prop up the insufficiently valuable eliminates the incentive to work and ultimately holds back society from all progress. The outcome of the Cold War amply demonstrated this general principle.
Posted by: calling all honest men on March 28, 2007 03:52 PMi say give people lots of (deregulated) private carrier choices and let them decide. most people are smart enough--proof? just look at 401k plans and other self-directed retirement plans--people are quite capable & figure it out. if not, hire a consultant or advisor like some do for personal financial planning.
Posted by: jimmie-howya-doin on March 28, 2007 04:41 PMEnding up in the poorhouse because of inability to pay is another myth. By law, public hospitals must write off a certain amount every year for people who cannot pay.
The PI ran a story last month (I think) about Harborview doing credit checks to make sure only the needy are the ones that get this kind of benefit. By needy, they mean that they make within 400% of the poverty level. The PI felt this was an invasion of privacy to actually check them out so that people with means couldn't just get away with saying they are destitute when they have ample money.
I knew a person that tried that scam with Harborview a couple years ago. They were very happy to tell everyone how they got the hospital to write off tens of thousands of dollars so that they wouldn't have to cash out some of their stocks that are worth millions.
By the way... they are about as liberal as you could get...
Posted by: Ken on March 28, 2007 04:52 PMposters above that did their homework benefitted by it. i venture to say many people are lazy & put more research into buying a car, refrig. or the latest video game toy/plasma tv than their "boring" healthcare or other insurance info.
this at a time with excellent internet info at one's fingertips not previously available.
understandably, it's not fun reading, but it beats charging everyone for every conceivable coverage & emulating the failed, high-taxed single payer systems of other governments.
Insurance is designed to spread the risk of unpredictable and rare events (house fires, hurricanes, auto accidents, heart attacks). No one buys an auto insurance policy which covers oil changes and fuel fill-ups, because these are predictable common periodic events. Yet we all buy medical insurance which covers routine doctor visits, annual mammogram screening, immunization, etc.
Imagine the cost of an auto policy which covered car washes, gasoline fill-ups and new wiper blades!
Posted by: Steve on March 29, 2007 11:42 AMSo. Back to the original question. Why is health care so expensive?
1. Malpractice lawsuits. In this country lawyers don't have to prove that anything wrong was done by the doc they just have to convince 12 people that person x deserves compensation. So docs in order to keep practicing basically build a (perceived) water tight battleship for every case, even when the case doesn't require it. That's far and above the #1 cost driver.
2. Expectations. For some reason, lots of people in this country think it's their right to be kept or grandma to be kept in the ICU for 2 months at age 94. There's lots of data showing a significant cost towards end of life / hopeless situation care. We need to start setting reasonable expectations. But, this also goes back to #1. Docs feel like they need to "do everything," cuz if they don't, its court-time.
3. Middle man...i.e. insurance companies. Currently only about 11% of all health care dollars goes to provider services. Well over 50% goes to your broker. While the docs offices are absorbing the costs of the billing and collecting. You've heard that for every 1 doc in an office, they need 3 office personnel to deal with the insurance companies. (Can you imagine that every penny you make is based on an insurance claim? Have you ever tried to get an insurance claim? Multiply that by 4000 visits / doc / year.
4. Reimbursement schemes. Docs currently get paid based on a very archaic system (made by the feds, imagine that). They are reimbursed based on the number of things they do to the patient, i.e. tests, X-rays etc, not based on the number of problems they solve. The system encourages "doing something / ordering something" for the least number of problems. This increases costs, and increases number of visits.
These are just a few of the many many cost killers.
Solution:
1. Tort reform. Huge tort reform. Get the lawyers off the system. At least even the playing field. They are an enormous leech bleeding the system dead. I could write a book on this point. I bet some of you construction guys know what Imp talking about.
2. Malpractice reforms:
Create a new type of settlement called a "bad outcome." ie, the doc did everything right, but the patient still had a bad outcome. For example: Dr X did a knee replacement, but patient got an infection. Not malpractice, but a bad outcome. A separate insurance should deal with this. This would greatly reduce the number of malpractice claims.
3. Create a separate court to sue docs for malpractice. How does a jury of citizens know if the doc didn't provide standard of care? I maintain they can't. A malpractice jury or a board should be one of docs. They're more capable of determining malpractice. And if you think they'd just be protecting their own, no way, docs would want to rid themselves of the bad providers.
4. Get the docs out of the business of billing and collecting the insurance. Bill the patient. The patient pays the docs. The patient settles with the insurance co's.
5. Develop better standards of deciding when its time to let grandma go.
These few steps would make medical care infinitely more accessible.
But in order to make this happen, it would require malpractice attorneys to step aside, and insurance co to step aside.
But, what's more important to this country?
Keeping the huge business of malpractice and health insurance thriving, or providing care to its citizens?
I dunno, ask John Edwards. From his gadzillion dollar medical malpractice mansion.
But, like all things done in today's modern liberal approach...
Do the right thing.....nationalize. It'll be great, trust me.