Monday, August 17. 2009
Quoting (somewhat) out of context from President Obama's inaugural address:
"What is required of us now is a new era of responsibility -- a recognition on the part of every American that we have duties to ourselves...."
The duties to ourselves include taking responsibility for our health. That includes our eating, personal habits, exercise -- and personally paying for our medical needs. Rather than the medical community and the health insurance industry deciding on individual health care, the individual takes responsibility for those decisions.
When the health insurance premiums are paid by the employer or subsidized through Medicare, there is no relationship to the service received from the medical community. Doesn't matter what tests are done. It doesn't cost the individual anything. No questions asked – run the tests. Prescribe the drugs.
The vast majority of people (including those over 65) are very healthy and have little need for medical care. For the healthy, a visit to the doctor every other year would be a small amount of money that could be readily handled by most any budget. What is really needed is coverage for those accidents and medical events that escalate into the thousands of dollars. Purchase of a major medical policy with deductibles based upon personal capability would be the correct solution.
Liken this to your home owners insurance. The home owner does the house maintenance and upkeep to the home. The owners insurance is for the major loss of the actual home.
That is the same approach that should be used for health care. Insure for the major medical items. Be self responsible for the small medical issues.
Positives and negatives of the approach:
Positive.... Considerably less cost the government. If the government wants to hand out money there are plenty of poor and elderly who can't afford the medical -- let alone the major medical policy. That would be a whole lot less expensive than the plans currently under discussion.
Positive or negative depending on view.... The insurance lobbyists would be all over this proposal spinning how bad it would be. Why is it bad for insurance companies. The premiums for major medical would be much less than all the "laundered" money that goes through their hands from purchaser (employers or single purchaser) to medical provider. With reduced income the insurance company execs will get smaller bonuses and the share holder profits would be less.
Positive....Employers give all their employees a small raise once they no longer have to pay the insurance companies for employee health plans. The employee is now responsible for his health and purchase of a major medical policy.
Positive....Once there are no employer health insurance plans, everyone will pay the same rate for a medical service. Today there are contracts between insurers (including Medicare) and the medical provider about the cost of each medical service. A recipient of care without medical insurance pays the highest rate to the medical provider. There is no discount for that joker who isn't employed with a company providing health insurance.
Positive.... My approach would go from cradle to grave. The end of Medicare. The amount that is currently taken out of my social security could be used to purchase a major medical policy.
Positive.... The employer would no longer shop for the cheapest provider of health insurance. Instead of the benefit of health insurance, they could pay for a major medical policy. It would be a lot easier and less costly to administer.
Negative.... There may be no way to ensure that people will buy a major medical policy. However, that is no different than the requirement for auto insurance. There are some who do not have the auto insurance, but yet they drive.
Granted, my personal health is excellent and have had few reasons to visit the medical providers. Perhaps that affects my approach and my proposal, but I DO believe in personal responsibility. Watching what I eat and moderate amounts of exercise are my approach to avoiding visits to the medical providers.
The current health reform proposals being considered are receiving lots of media (print and air wave) attention. Most of it negative. How about a real alternative to that public (government) plan and give health responsibility back to the people.
There doesn't seem to be any support for my proposal, but in the meantime check out Consumer Reports Health Reform Guide.
With all the spin that comes from all sides on the debate, Fact Check does a great job in sorting through all those negative one liners.
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You've been above 9000 ft for too long. While I completely agree that there are many conditions that diet and exercise can ameliorate, there are many that those measures will not faze. Have a baby born with a genetic defect or a cancer, or a child with a mental health issue. (most insurers won't touch that with a ten foot pole). Add to that an aging post-stroke parent with just enough money to scrape by on. Believe me, I've paid plenty out of pocket for health care.
Health care is never an issue til you need it.
Sorry but you hit my sore spot.
Still love your journal and so enjoyed your visit with Bobbie and Mark.
With empathy, I understand the human side of the medical issues and loved ones with health issues. But insurance companies are not about people; they are about numbers.
You noted the major problem with the current system. Insurance companies don't take any risk if there is any possible chance that they will have to ever pay a claim. My belief is (probably naive) that with a major medical policy with tens of millions in the insurance pool, there may be a lifetime limit of one million for a single individual. That may be the place to get government involved. They can be the re-insurer after that max.
"Insure for the major medical items. Be self responsible for the small medical issues."
Well, that's what I do. But this approach would require a different consumer culture than what America has had for a generation or two. The average cubicle-thrall in America lives paycheck-to-paycheck. They simply can't afford a small, unexpected medical expense; not even an office visit to a general practitioner for a routine complaint.
And why should they save money? So they can earn 0.2% interest?
"Cubicle -thrall" That is either a Viking Slave or Warchief (World of Warcraft) I would rather think of myself as a retired warchief of the cubicle:) We moved from insurance to pre-paid medical care because of the tax system. I looked at my 1980 tax return. In 1980, I was a cubicle warchief, married(still am), three kids and a mortage. My incremental tax rate was 43%! With that tax rate I was more than happy to take prepaid anything.
I doubt that the decision to have prepaid medical rather than insurance was for the employees benefit. My bet it was for the company bottom line. Those company expenses are reported differently and taxed differently.
With that, you've hit another of my "soap box" issues. Taxation business: A totally unfair system created with loopholes by legislators for their big business friends and bank rollers of their reelection campaigns.
However, that tax system (and its annual changes) keeps my daughter employed at Intuit as she and her staff interpret tax law into TurboTax. (That plug for TurboTax should get me a free copy of Turbo Tax next year. )
Urgencies like medical care, or droughts, or hurricanes, forest fires, require a socialistic solution, not capitalism. Capitalism has sufficient areas to operate in ---comforts and luxuries----not urgencies.
Sounds like living in hurricane prone Florida, there is no reason for home owners insurance. Odds of hurricane damage are greater than fire.
With no comfort and luxury requirements, just wait for the Government to send the check.
What about urgencies like food and water and shelter? Homo sapiens evolved and lived without any real medical care (that did any good) until two or three generations ago. But it can only live without food for two weeks or so; water for three days; and shelter, well, for one night in the winter. So these three things are drastically more urgent than medical care.
Randy should be in favor of socializing them, too, in order to be logically consistent. Stalinist collective farms, anyone?
My son is in his last year of medical school and is currently doing a rotation in the Emergency Room at a local hospital.
He told me that only about one in ten patients coming to ER had a true medical emergency. With no history on the patients, they have to run several expensive tests to rule out certain conditions. The hospital must provide treatment and if the patient can not pay then the cost is pasted to those who can pay. That is why insurance coverage is so expensive, because of overhead rates that include the uninsured.
We have, in fact, socialized hunger and water and shelter and ( rudimentary) medical service IN THAT we will not allow anyone to starve, or die of thirst, freeze in the cold or die of untreated medical emergencies who ask for help. (Indeed we are often proactive in reaching out to them.) Does Boonie oppose this bit of Socialism? How about our Socialized Military, VA medical services, Interstate Highway system, weights and standards enforcement etc. I FAVOR A NATIONAL SAFETY NET ---NOT GOVERNMENT CONTROLL OF PRODUCTION. Here's why: Without a safety net--like Social Security---insecurity and greed and eventually public order run riot. Unmoderated capitalism is a prescription for descent into fudalism.
In all this debate about health reform, we hear from the general public, the 535 elected legislators, the TV talking heads, the insurance company reps. However, I wonder who is speaking for the hospitals or medical providers and their financial interest. What is their recommendation for reform -- if any.
This thread is not about form of government, but the country in which we live today. This thread is about health reform.
Worms! Grab your fishing pole and lets head to the river. If we catch something, it will be a great day. If we don't, it will still be a great day.
Hey Lloyd...I do support much of what you said. As a teacher, I do have great health insurance...in fact, I would say it's too cheap...so I know it's already highly subsidized...I would like to see a careful, unbiased look at the major medical option...with more personal responsibility for the routine care, maybe people would begin to choose that over
300 channels of cable TV. So many people are addicted to $10 and $20 co-pays, I can't imagine how we could cut them loose!
When I stepped on the soap box with this proposal, it was done to get some discussion going on this approach. It is not an approach that beneficiaries of medical services want. They don't want to have to make any decisions.
Not only are today's shoppers addicted to low co-pays, they are also addicted to low price as the major determinant of any purchase. Grocery store carts piled high with more calories per dollar is the example that comes to mind.
From the cynic regarding health reform legislation...For me it goes back to "following the money." Where does the bulk of the money come from that bankrolls the re-election of politicians -- also known as legislators. Who are these guys actually trying to please. It isn't the voting public. The premiums for health insurance represent a lot of dollars which in turn affects the large corporations balance sheets, executive salary, share holders -- and in the end -- reelection campaign dollars.
As long as the relationship between big government and big business is what it is, nothing will change on health care. (My pessimistic conclusion.)
Second reason is that the legislators do not have to worry about their jobs since the number of those who do not have health coverage is far less than those that do. There aren't enough votes to be concerned about.
Follow that with the scare emails that go after votes. Where are the most votes of those that vote. That would be the over 65 crowd. Those scare emails frequently address that older demographic.
Hey Lloyd: I'm not confused about the subject. The underlying question resolves itself into this dichotomy: Are we all in this together (SOCIALISTIC APPROACH) or is it every person for themselves: (CAPITALISTIC APPROACH)
Franklin's admonition to the colonist (on another subject) is relevant here: WE MUST ALL HANG TOGETHER OR WE WILL HANG SEPARATELY.
Here's one line of an email I got from Congresswoman DeGette of Denver.
"Today, 22 percent of Denver residents and an incredible 47 million people across the country do not have health insurance, including many who were denied coverage on the basis of a pre-existing condition."
So, 78% of Denver residents are covered and for 22% we're to turn the current system upside down? That's crazy. We need to have a safety net for those that really need help but I fear that the road our elected officials seem intent on taking (regardless of what their constituents want) will lead us to fiscal disaster.
Now that I understand your use of the "socialist" term, you corroborate my cynical conclusion; there will be no change in health reform. The self interest of the capitalist will make sure there is no change from the current system.
Agreed fully. We are addressing a problem of a minority of the uninsured or those denied insurance with a legislation that will affect all. Perhaps it might be better (and cheaper) for the US govt to pay for the health care of that very small minority.
Lloyd : I doubt passage also--but regret it. Here's a thought experiment for all idealogical capitalist: What if all the water rights in the US were privately owned. Do you not see the vast evil and chaos that would be spawned by the corporations that owned the water. I ask that all hardcore capitalist learn from England's Corn laws controversy (people starved) and more recently the Scotia Lumber co Fiasco (California) where Corporate raiders siezed controll of that vulnerable co and the vast trees it owned and WRECKED IT. Uncontrolled corporate greed will wreck our country. SOME ESSENTIALS--like AIR, WATER, MEDICAL CARE must be considered as a commons.
My intent was to determine and get reaction to the viability of an approach of major medical along with personal responsibility for health. Didn't happen.
With that result, There will be no more comments to this thread.
Any future thoughts or comments can be sent in an email.