In Switzerland, insurance companies are forbidden to make a profit on their health insurance coverage. They made the switch to this system in the 1990s because in the Swiss view too many citizens were without coverage. They became alarmed when 5% were without health insurance. We are closer to 18%.
The insurance companies make money on the other products they sell and use health insurance to show what good companies they are.
In this country, we spend 30 cents of every premium for nothing. The insurance companies skim 30% for profit and handling costs. Medicare's handling costs are about 5.5%.
The logic of managed care would be to eliminate the insurance companies. It's an easy 25% to pick up in savings, but would be only one step in the process of reigning in runaway healthcare costs. We get nothing for that 25%. I bet Marc wouldn't pay someone 25% more for work on his house. For that 25%, the person would simply cash your checks, deny you work on your home, then cheat the workmen and companies doing the work out of their money by denying their bills. This system makes no sense it is also producing bad results. We pay more and get less than other countries. We are not healthier for the extra money we pay.
The premiums for my company rose 29% last year. Who can afford jumps in costs like that for long? We dealt with the jump by finding a better price from another company. The quality of the insurance dropped and people's deductible jumped out of sight. The deductible for my family went from little to $4,000. In my view, the insurance company became a tax collector. What would George Washington think of that--taxation without rerpresentation.
I laugh when I hear politicians ask, "do you want government between you and your doctor?" Certainly would be better than what we have now, which is profit-driven insurance companies between my doctors and me. I can call my congressman, my senator. I can't call the insurance company. They are not elected, they don't have to answer to the public.
And I must admit, I fear more that I will lose my insurance or be dropped to a pre-existing condition and end up losing everything when I get sick than I worry about a terrorist attack. My insurance company is more likely to kill me than any terrorist.
Doug On Mar 21, 2010, at 10:02 AM, Eric Goldstein wrote:
Marc - I agree that this is a thoughtful reply.I will take issue with your implication that MDs in this country earn 50-75 thousand dollar salaries; the average PCP salary in the US is twice that. Also, to suggest that the average salary of specialists such as Cardiologists, around 450 thousand annually, is justified is crazy; no where else in the world do you see this kind of compensation.Basically you are accurate in saying that it is insurance companies who have escalated health care costs far above the rate of inflation over the decades, and that cost containment is the key to bringing affordability back into the US health care system. They have done it because of the failure of the so-called "free market," they have done it via a fee-for-survices reimbursement structure, and they have done it by adding an additional 10-13+% to the cost of health care via their administration and profit.Where your argument goes astray is the suggestion that tort reform is the answer. At most, successful tort reform, if it could be meaningfully achieved, would result in about a 2% reduction in health care costs, which won't cut it no matter what your goal for the future of health care. We need to find about 13% to get us to a place where we can move forward by insuring most every citizen, if that is the goal, and about 8-10% to get us to future solvency under existing programs.Real life has shown us that successful cost containment within a private insurance model has only been achieved, and can only be achieved, via comprehensive and strict government insurance guidelines in health care systems. There are numerous examples of successful health care systems with outcomes better, and costs lower, than those in the US which substantial this and none which refute it.To keep the discussion simple and focused, I won't address in detail your constitutional argument as it relates to health care. The fact is the vast majority of US citizens support Social Security, Medicare and other federal programs which are not referenced in the Constitution. In our democracy, it is the will of the majority exercised within our framework of laws and government which prevails; and for that I am thankful.Eric Goldstein --On Sun, Mar 21, 2010 at 4:35 AM, Marc James Small <marcsmall@xxxxxxxxxxx> wrote:Thank you, Eric. Allow me a reasoned response. I do occasionally post outrageous remarks to get active discussions going, such as my recent one on vegeterarians, but I am being a lot more serious in this note.First, we in the US have suffered for sixty years due to the growth of medical insurance. From the early 1950's into the 1980's, there was just no cost containment on this. In 1950, the US medical field was almost all self-paid, and so MD's ran the gamut from Dr Tubes the Back-Alley Abortionist to some real silk-stocking types taking care of the wealthy. (Richard Knoppow will appreciate my noting Raymond Chandler's inclusion of some of these silk-stocking doctors as bit of nasty work, indeed.) So, from 1955 or so (when Blue Cross/Blue Shield finally sold their package to the US labor unions) until, roughly 1985, the medical insurance companies did not quibble over charges. And so, ALL doctors began to anticipate getting paid the sort of salaries previously restricted to specialists and society docs. The, around 1985, the health insurance companies began to cramp down their payment rates, and this has led to a lot of the problems.We now have a system where most "Family Practitioners" are making decent, but not outstanding, salaries ($50,000 to $75,000) but the working conditions are intolerable. I know a few husband-wife doctor teams who make it work by splitting the duties so each works half-time (half-time being 40 hours a week) to earn one salary. I get my health care at the Veterans Administration, and the doctors I know there all describe themselves as "refugees from private practice". Specialists make a lot more and, to be blunt, almost all earn their keep. But then look at the salaries paid to medical administrators! Oh, my! $500,000 a year to be a CEO of a regional hospital system? Back in the day, that system would have been run by the docs and the administrator would have been paid a journeyman's wage. This all changed when the insurance companies, at the gunpoint of the Labor Relations guys in Washington, just paid the bills without question.If you want to bring health care costs down, you have to do some really severe cost containment. Hillarycare involved direct wage and price controls, and that was its main drawback. That will not work. Tort reform would help -- and I mean comprehensive tort reform, reform of the system, reform of the process. Until the late 1970's, health insurance companies would settle small claims out of court. Then the Great Mass Media started screeching about "killer docs getting away with murder" and insisted that the malpractice results for each doctor be made publicly available. This was dumb. The docs then insisted on having the right to approve settlements and, as each settlement becomes public record, they resist agreeing to ANY reasonable settlement. The first Tort Reform ought to be to set out that the insurance claims professionals handle the settlements, and the docs have no voice in yea or nay.Eric has raised the issue of obesity and the like, and these are good points. But, in the end, we are ruled by our genes and we are ruled in two regards. First, some folks come from long-lived families and never need any serious medical attention until the Medical Examiner signs off on the Death Certificate -- "body wore out at 91". And some folks have genes that allow them to eat outrageous foods but their defective "digestyum track", as Frank Zappa called it in THE THINGFISH, just passes it through, so they can eat a half-gallon of ice cream and never gain an ounce.I come from long-lived stock, my parents having died in their 80's and my grandparents in their 90's. That does not mean that I am not going to have a fatal stroke later today, but, then, as a Christian, I am happy to go when the summons comes. However, as my mother used to note, our family is living proof that only the good die young, so I expect I will be around for quite a while longer -- I am only 60, after all!And this raises all sorts of other issues -- should insurance companies be allowed to demand DNA samples from their insurees to look for possible future health problems? Now, whole life insurance purveyors want to know your family history back four or five generations -- I am surprised ANY Roosevelt, Hyde Park or Oyster Bay, could ever get a life insurance policy! Should health insurance carriers be permitted to do the same? I don't have answers, just questions.Almost any US citizen had the chance to get a great lifetime health insurance system by spending two years in the military. I have been treated by the VA since 1981, and I have no argument at all about the care I have received. My father was treated by them from his retirement in 1944 (on medical grounds) until his death in 2000. Primo care, all the way. I recently turned 60, so I switched from being a "gray area" Reserve retiree (base privileges only, and not all of those) to a full retiree, so I know receive the Widow's Pension every month, and I am now entitled to sign up for the military version of Medicare, aka Tricare. I have signed up. It goes into effect on April Fool's Day, and appropriate that is, as the doofuses in Congress are probably going to vote later today to eliminate this plan. I hope I get a refund of my premium!Finally, as I have noted here before, I seem to have a defective copy of the US Constitution. Nothing in my copy says anything about a requirement for the Federal Government to provide health insurance to anyone. The wonderful part of all this is that when Pelosi manages to force her way through, she has just lost her own job as Speaker and has cost at least 50 of her folks their seats come November. And, bless the Chief Justice of the US: this scheme will never pass Constitutional muster.Those of you who WANT to have a Federal government entitled to do such things ought to be working to convene a new Constitutional Convention. Whatever came out of such a circus would probably be a vile mess, but at least it would be an honest mess, unlike the "interpretations" we now use to protect government intrusions far beyond what the Founidng Fathers intended.George Washington and National Health Care? Think about it, folks! Back to your regularly scheduled programming. Marc
--- Rollei List - Post to rollei_list@xxxxxxxxxxxxx - Subscribe at rollei_list-request@xxxxxxxxxxxxx with 'subscribe' in the subject field OR by logging into www.freelists.org - Unsubscribe at rollei_list-request@xxxxxxxxxxxxx with 'unsubscribe' in the subject field OR by logging into www.freelists.org - Online, searchable archives are available at //www.freelists.org/archives/rollei_list
