The only good insurance customer is the healthy and irresponsible consumer—the prototypical healthy 30 year old who refuses to get a flu shot or annual checkup. Everyone else gets turfed.
Ah, turfed. Allow me to introduce you to one of the cherished terms of medical care in the United States. You turf difficult, or undesirable, patients to someone else. The insurance industry has succeeded, more than anything else, at transmitting this hatred and fear of sick people down to the lowliest depths of the health care system—from the mightiest administrator to the lowliest medical student.
People with easily treated maladies—high blood pressure, high cholesterol, high blood sugar and so on—go untreated (despite the huge potential long-term benefits from cheap therapy) because the entire health care system hates the ill with a deep and embittered passion.
Let’s think for a moment what the product of health insurance entails. For a fee, a company will pay your medical costs for a fixed period of time. These contracts are never lifetime—often they are annual. The multitude of insurance companies offering these contracts operate in a genuine market. Being efficient—successful—in such a market means figuring out any way to avoid providing healthcare costs, avoiding providing care. If you know you’ll only be writing a short-term contract, caring about long-term cost savings is a totally losing move.
The market has worked well: Insurance companies (for profit or non-profit) have proliferated a multitude of caps, fees, co-pays, deductibles and ‘preferred provider’ lists all oriented on reducing short term costs, regardless of consequence. The very concept of a “pre-existing condition” was generated to prevent sick people from becoming customers, and whole mechanisms have developed to kick people out of their contracts if they become ill. The better the market for health insurance works, the more these mechanisms become inevitable.
A big part of the proposed reforms floating around congress are attempts to subvert these market forces without fundamentally changing the nature of the market. Laws preventing exclusion based on pre-existing conditions or dropping people from plans due to illness seem like obvious ways to improve the situation. But the dynamic will remain, and the clever people at insurance companies will come up with new ways to turf those who need care that tip-toe right up to the new lines being drawn.
The great turf in the sky, right now, is Medicare. All of us, when we hit that magical age, become eligible. A public option, as proposed and under fire as a part of this reform, would probably end up serving a similar role: a government-chartered floor beneath which no American could fall. Stuck with these patients for the rest of their lives, suddenly the dynamic would change. Any clever administrator of a public option health plan would be tremendously motivated to provide preventative care; success of such a plan would be contingent on reducing long-term, not short-term, costs.
A model for such a plan already exists—the Veterans Affairs system. Patients in that socialized American health care system are demonstrably and objectively healthier than their privately insured compatriots in every measurable way.
Barring requiring private insurers to cover people for the rest of their lifetimes, there is no other way to achieve a similar focus on long-term health and cost-reduction than a public plan.
(Cross posted.)
Very well said. Fix the “plural apostrophe” in this sentence:
“Patient’s in that socialized American health care system are demonstrably… “
and it’s perfect.
I don’t understand why insurance companies insist on not paying small preventitive claims because the insured might not be with them very long. All these people cycle around the insurance system and each company gets anothers “turf” eventually. It would make longterm sense to encourage preventitive care because in aggregate then insurers would make more money.
Fixed. Thank you.
@stevema14420: I think the problem is the market is too functional. There are too many insurers spread over too many states to allow any sort of cooperative action (i.e. anticompetitive collusion) to occur. Non-profits like Group Health try, but still slather on the copays for most policies.
The companies are also pretty good at turfing these patients permanently–to uninsurable outside of group policies. Hence, pre-existing conditions. And remember, your insurer is typically allowed access to your full medical record.
It is an interesting article but the shrillness of this ruins it for me: “because the entire health care system hates the ill with a deep and embittered passion.”
I’ve had to deal with some frIghtening dianoses relatively early in life (cancer, that won’t stop coming bac) and my amazing doctors and surgeons — very much part of the system — showed me exactly the opposite. They were caring, called in the evening to see how I was, etc.
No doubt there are despicable dynamics afoot, but take a moment to temper these swipes so they more closely resemble the truth.
I just don’t understand how anyone can be satisfied with the status quo. I have premium (ha!) insurance, yet I have to pay out the ass for simple preventative measures. For instance, sealants are considered cosmetic under my dental plan, and thus are not covered when the whole purpose of sealants is to prevent cavities. Bullshit!
Sealants – cosmetic? Aren’t they see-through?
“People with easily treated maladies—high blood pressure, high cholesterol, high blood sugar and so on—go untreated “
Yes, all easily treated by getting off your ass, cooking your own food, and eating balanced, fresh meals. Just ask Dan Savage.
You make it seem like the pre-existing condition rules have no viable and understandable business purpose. Without that restriction, why would anyone buy (and pay premiums for) insurance until they were sick? Try allowing that and see how long an insurer can stay in business. The pre-existing condition screen is no different than having to have insurance BEFORE you wreck your car or BEFORE your house burns down.
That doesn’t mean it hasn’t had unintended consequences like making the chronically ill uninsurable in the current system. But your issue is really with an employer based system that easily allows people to have gaps in coverage not with a rule intended to keep a business from being bankrupted by people who won’t pay their fair share.
I am all for single payer and a nice, wide public option. But why must all insurance programs be evil and necessarily fail? Don’t universal, mandatory, highly regulated social insurance programs work in some other countries, e.g., Germany and Switzerland?
The Veterans Admin is the poster child of a successfully run health delivery system? That is complete and utter bullshit. The VA has more selective criteria for enrollment in their program than many private insurance companies. Only a small percentage of former active duty and reserve personal are eligable to utilize the VA health system.
Another question, how can a system require insurers to accept sick patients without at the same time requiring everyone (everyone) to buy health insurance (and face fines if they don’t, just like auto insurance.)
I’ve heard this statement made about the VA from several quarters, and I find it hard to square with what I hear about the VA from medical professionals who have worked there. What I hear is that the VA has lousy facilities, old equipment, poor continuity of patient care, and is under-staffed relative to private hospitals.
I don’t pretend to know how to reconcile these competing assertions, but several possiblilties come to mind:
1. What I have heard is wrong. (Someone who has seen the inside of, say, the Seattle VA and Overlake or Swedish want to chime in?)
2. These things just aren’t very important to quality outcomes. (Perhaps having patients who obey orders is?)
3. Comparisons are fraught, and the superiority of the VA is much more questionable than is being asserted. (One
news article appears support this explanation.)
As a diabetic, this all this “shrill” talk rings 100% true.
Back when I was “covered” by Regence, they would interrogate me every time I called — and I called often, as they were always reluctant to dispense payment for my necessary supplies of insulin & test strips — with a series of annoying questions, always the same, obviously hoping to disqualify me from their program if I gave the wrong answer.
“No, as I told you the last ten times I called, I am not married to a spouse who is eligible for another health plan,” I would say.
“No, I am not a student living at home with my parents,” I would say.
And still they’d ask, every time I called, all the while short-changing my prescription amounts. Sometimes I was tempted to tell them that if they persisted in annoying me with their obvious reluctance to provide customer service, I would commit myself to being their customer for life.
Fortunately for Regence, I made a career change and thereby self-turfed my way to UnitedHealth, which at least spares me the obvious hostility for the low, low price of about $1,350.00 a month plus doctor’s office copays.
So, fuck these guys. If a diabetic was elected president, we’d be talking single-payer.
I don’t understand how a public option will be “tremendously motivated” to do anything – it will be a government agency. It would be nice to think that efficiency would play a role, but you know what govt agencies are like.
Instead of creating a floor, I’d prefer to see a competitor. Create a non-profit corporation with an appointed board of directors. Run it as an HMO, only its role will be more like the Fed – cooling prices by undercutting the market, yet maintaining a competitive environment on elective care. Provide an incentive based corporate pay structure based on RVU pricing targets. Hire a CEO and let the market do the rest.
@14: I’m sorry that’s been your experience. That sucks…no ifs ands or buts.
My point is that the health care providers with whom i’ve dealt have been wonderful and I hate to see them tarred with the same brush as the back office bean counters who cause problems such as those you experienced.
“Hire a CEO and let the market do the rest.”
Yes, that would make complete sense if disease, accident or injury by various means was an intentional, expected, and consequently, a marketable event. The fact is, almost nobody wants to be ill or injured, and for that simple reason, there is absolutely no compelling reason and/or logic to having the market involved in curing individuals of their illness or injury. To put it simply, there is no comparison between the notion of calling various repair shops to have the brushes changed on the dying alternator on one’s 1998 Toyota Tercel and deciding what is the the best course of treatment when one is faced with liver cancer. One marketable event will cause a minor inconvenience, the other has the potential to render oneself dead. And frankly, the Tercel doesn’t care if it is running or not. I think as a society, we can do a fuck of a lot better than that.
” if disease, accident or injury by various means was an intentional, expected, and consequently, a marketable event.”
75% of health care costs in the US are from CHRONIC diseases, entirely preventable with better life style choices. It’s the fat fuckers with diabetes, heart disease and hypertension (and a cigarette stuffed in their mouths) who are bankrupting us. Blame them, not health insurance companies.
I’m gonna get a t-shirt: Put down the donut you fat fuck, you’re bankrupting the nation.
@14, 16 – don’t confuse health care providers (doctors/nurses/etc.), who want to help you, with insurance companies, who want to make money off you. Ask any health care professional how they feel about insurance companies.
“75% of health care costs in the US are from CHRONIC diseases, entirely preventable with better life style choices”
Ahhh,.provided what you wrote is valid. Frankly I don’t
know if it or not, however let me ponder it while I ingest this Larsen’s Bakery…no financial interest implied or intended…sweet, doughy and fat Maple Bar. Preventable diseases associated with poor choices (Yes, I imagined she had an STD but we fuck like rabbits and I’m going to do it again with her) would and should be an expected events.
The child who ingests a foreign object should be an expected event too. It is what children do, however where does one draw the line on expected events? I am not trying to be argumentative. I’m only rather curious.
I’m a good insura-! hey wait a minute
@19: I think we’re saying the same thing. Providers definitely bemoan the sysem, to be sure, but I’m also sure they see themselves as *part of that system.* So when language is deployed that besmirches all in said system, my hackles go up.
Perhaps not. Cuba is only two spots behind the U.S. in health care outcomes and their per capita income is $200/year.
@18,
Entirely preventable? Go fuck yourself. My mother died of cancer despite living a healthy lifestyle. Thanks to our shitty, expensive, and inefficient health care system, she also died bankrupt.
Actually, I take it back. Don’t go fuck yourself. Get cancer and die.
Can someone answer me this…
Why hasn’t the following solution been thought of yet?
To lower insurance rates for individuals we need competition. The answer to more competition isn’t bigger Insurance companies. They just buy out the competition when its necessary. To get insurance costs under control is to “Prohibit” employer paid health insurance. You will see competition like never before when the insurance companies are trying to sign up individuals instead of taking the easy money from the large companies.
You would get an increase in your pay and you could take the responsibility of providing health care insurance and shop for the coverage and price you want.
Give the individuals the tax break on their 1040 as a deduction similar to their home interest deduction.
You keep your insurance if you are laid off or change jobs.
Create a Health Insurance Savings account similar to the Health Care Savings account to let individuals to fund a cushion if they lose their job to pay for their insurance premiums.
Keeping the same insurance company reduces the problem with pre-existing conditions.
Create a “risk insurance pool” similar to car insurance, requiring all insurance companies to cover high risk individuals, those with pre- existing conditions in a lottery type selection..
Keep the 11 million who don’t have insurance and need it on Medicaid, instead of cutting the program. Medicare is deducted from each senior’s social security check, deduct Medicaid from the individuals public assistance check each month. Medicaid only cost 226 billion in 2008. Offer a Medicaid “part B” as a gap for coverage above what Medicaid covers. Similar to part B offered to cover the gap in coverage with Medicare. A part D drug program could work the same way.
I almost forgot, prohibit paid health insurance for federal, state, county, city and municipal employees too. Increase their pay and let them shop for the best deal Congress and the President too. That should help increase competition.
Mandatory open state borders for all insurance companies to do business. In instead of one “public option” we would get 60 major insurance companies and all of the other small insurance companies looking for our $$$.
As a last resort break up the large insurance companies into regional competing insurance companies. Similar to the break up of North Western Bell years ago.
Mandatory 10 years cleaning bed pans for health care fraud!!
Seriously health care and insurance can be reformed or tweaked with out a public option if only the people we send to DC would take care of business instead of trying to hang the other party from the tallest tree.
To lower healthcare costs by lowering insurance rates to doctors, hospitals, clinics, Tort reform is necessary and congress doesn’t want to touch it.
Offer a “Patients comp” insurance policy to doctors, hospitals, etc. similar to Worker’s Comp. to eliminate frivolous and mega lawsuits by trial attorneys.
Man was that simple, I should have thought of this months ago!
C’mon, stop being such hypocrites. Does anyone here care about 300 pound sixty-six year olds riding on U-Scoots who have horse farms in Bellingham and hate gay people?
Your commissars would turn them away at the Death Panel meeting on the 4th Tuesday of the month.
Has anyone thought of a 20-cent fee for I.V. and colostomy bags? That would solve all of the world’s problems.
“People with easily PREVENTED maladies—high blood pressure, high cholesterol, high blood sugar and so on—”
@2: because, despite all the right wing rhetoric to the contrary, the free market is fucking stupid.
18
Canadians have just as crappy a diet as us, drink about as much, smoke about as much etc. The only thing that is different is a lower violence rate. Yet they cover everyone cradle to grave for 10% of GDP. We cover way less for 16% of GDP. Furthermore we are a wealthier nation. Your self rightous bullshit doesn’t fit the facts.
Doctor Golob, you haven’t had the title for very long to already be feeling a hatred and fear of sick people.
“Any clever administrator of a public option health plan would be tremendously motivated to provide preventative care; success of such a plan would be contingent on reducing long-term, not short-term, costs.”
Why don’t the “clever administrators” of Medicare and Medicaid already do this?
“A model for such a plan already exists—the Veterans Affairs system”
The VA is a small selective subset of the overall system.
It is totally funded by taxpayers at no cost to recepients of the care.
It is not a model for anything.
The VA is not a sustainable “system”, it is a taxpayer funded “benefit”.
@23
“My mother died of cancer despite living a healthy lifestyle. Thanks to our shitty, expensive, and inefficient health care system, she also died bankrupt.”
Blame the fat fuckers who waste precious health care $ by demanding $50K stomach surgery because they can’t stop themselves from stuffing a Big Mac down their gobs.
A heavily taxpayer subsidized “public option” into which all the crummy patients are dumped is not a good solution.
It will be full of unmotivated irresponsible people making terrible lifestyle choices that lead to most of their health problems who have no motivation to improve their health thru better living. A bunch of fat slobs who expect the government to be responsible for their care.
A better system will shift responsibility where it belongs- to the patient.
If patients financially benefit from healthy choices and suffer from poor choices they will start making needed changes in their lifestyle.
The system Golob describes will get bigger and bigger over time, and cost more and more over time, literally bankrupting the economy in short order.
It is exactly why knowledgeable citizens oppose the public option so adamantly.
“Stuck with these patients for the rest of their lives, suddenly the dynamic would change.”
The dynamic would change, but not how Golob imagines.
These patients will realize they have a front row seat at the government gravy trough with no lifetime caps on benefits they can recieve and a limit to out of pocket expense and will loose any motivation to improve their health.
They will become professional patients eating up a greater and greater amount of resources.
And more and more eager piglets will crowd into the system, pushed along by insurance plans and employers that know a “too good to be true” deal when they see it.
No Thanks.
23
75% of health care dollars go to treat an irresponsible minority whose chronic health problems are DIRECTLY the result of their lifestyle choices.
They soak up all the available resources so that when someone like your Sainted Mother actually get ill through no fault of their own there is not suffecient dollars to cover them.
Blame the fat slobs.
Damn Evil Insurance Companies.
Damn them and their PreExisting Conditions to Hell.
When Obama makers them ignore PreExisting Conditions it will be the greatest advance of Social Justice of the Millenia.
But don’t stop there.
The auto insurers need to be smacked into line as well.
So I can wait until after I have an accident before I get coverage.
Sweet.
And the greedy fire insurance companies.
I don’t want to pay for coverage unless I see that my house has caught on fire.
Why pay for something I won’t use?
Don’t get me going on the life insurers.
Why should a measley PreExisting Condition like Death keep my wife from taking out a policy on me after I croak?
I mean Really.
Justice for All!
@23
So if we understand you your ma smoked three packs a day and died broke and left you squat.
And you’re chapped about it.
That’s Brutal, man.
@18, @34,
Type 1 diabetes – which I have – is not a lifestyle disease, it’s an auto-immune disorder in which your body’s immune system rejects the part of your own pancreas that produces insulin, and kills it.
I’d love to sit around blaming all the “fat fucks and alcoholics” for the high cost of my health care, but it’s not them to whom I write that $1,350.00 check every month, only to have to argue with their customer service droids about why they never seem to reimburse me for the full amount of test strips I require, or why my quarterly checkups at Virgian Mason’s endocrinology department aren’t covered.
Jonathan can you look at my post @24, and tell me what these ideas haven’t been floated by Congress?
Is there a flaw in my logic?
“People with easily treated maladies—high blood pressure, high cholesterol, high blood sugar and so on—go untreated (despite the huge potential long-term benefits from cheap therapy) because the entire health care system hates the ill with a deep and embittered passion.”
Right, I am slogging through my fourth year of medical school because I hate sick people. That makes sense. And I’ve never sat down with a patient before and discussed their anti-hypertensive regimen, or devoted a whole fucking hour to explaining the importance of and how to use insulin and oral gylcemic agents. Nor have I ever seen a physician do so. And before you say I’m in it for the money, try again. I don’t have to work a day in my life thanks to my grandparents.
I agree that lots of people in this profession do seem to genuinely dislike the sick and the debilitated, but extending this to “the entire healthcare system” is disingenuous and obnoxious.