There is one obvious advantage to our system of employer-provided health care. Working people are our healthiest people. They have the strongest immune systems, for one thing. It isn’t until people reach near-retirement age that any significant percentage of working people are in need of expensive health care. And, obviously, this means that tens of millions of working people would probably gamble on their continued good health throughout their twenties, thirties, and even forties before deciding that insurance was a good investment if they didn’t receive health insurance as part of their basic compensation package.
By pulling tens of millions of healthy people into the pool of the insured, it makes it possible to offer somewhat reasonable rates to people who are entering the high-risk categories in older age. Millions of people benefit when they get sick because they have insurance they would not have bought on the free market with their own disposable income.
That’s the good part. The bad part is that you are probably insured by a corporation whose first reaction to you making a claim is to seek any and all rationales to deny you coverage. Maybe you made an error when you filled out your paperwork. If you did, your premium payments may turn out to have been completely in vain. Wouldn’t be nice to have a law that says that any insurance company that has accepted your monthly premium payments must refund that money if they ultimately rule that you were never eligible for insurance in the first place?
The truth is that you pay money for health insurance but your insurer doesn’t want to pay for your health care if you actually require it. They want your premium payment, but they don’t want to give you anything in return for it. They have armies of bureaucrats whose entire reason for being is to deny you coverage. They stand between you and your doctor, seeking to kill you rather than prolong your life at their expense.
Is that something you want to pay for? Why would you want to pay for that? I have no health insurance because I cannot afford it. And I sure as hell don’t want to take what little money I have and give it to someone who would rather see my die quickly than present a drain on their coffers. I think everyone feels similarly.
I do not see any reason for health care to be something that is insured. I should pay for my health care while I am working so that I don’t have to worry about it when I retire. I should have health care coverage, not insurance. Other than those few that die suddenly, all of us get ill and decline and require expensive care. Why insure against a near certainty? It doesn’t even make sense. I might as well buy insurance against the Sun rising in the East tomorrow. I know it will happen eventually, why would anyone bet against it?
It simply doesn’t make any sense to have a system of for-profit employer-based heath insurance. Employers shouldn’t be responsible for the health care of their employees, and we shouldn’t be forced to buy insurance against the inevitable from people that want us to die much more than they want to pay our claims.
Yeah, give me a public option. If you try to force me to buy insurance from people that want me dead, I’m not going to do it even if you subsidize it. But why are we forced to even discuss this? No other industrialized nation fetishizes corporatism to the degree we do. It’s ludicrously expensive and it’s plainly immoral. A single-payer plan is so obvious that Congress is forced to disallow all debate about single-payer to even have a chance of passing a stupid health care plan that will cover 97% of the people. If they pass it, which I hope they do, it will be needlessly expensive and it will still deny coverage to millions. And it will still involve corporations insuring people who they wish would just die.
You mean like cancer patient Robin Beaton?
This is pretty hyperbolic, BooMan.
Actually it isn’t if you have had experience with the US healthcare insurance system.
I HEVE had experience with the US healthcare insurance system, and based on my experience and that of most people I know, BooMan’s post is hyperbolic. I’m not defending the system as it is, but hyperbole is not helpful in making the case against it.
no it’s not: go read some of the horror stories at fdl or great orange.
it looks like the ideals to mandate purchase without mandating coverage.
the reason we’re having this discussion to begin with is because the democrats, led by president obama, took single payer off the table before the table was even set.
and that’s because the democrats have never meant one word of what they campaigned on for the past 30 years.
i am so deeply disappointed in this administration. I’ve pretty much lost all faith that they’re going to anything good for the country.
The Democrats’ performance is another issue, and one on which I cannot disagree with you.
I think it is completely accurate.
Based on my experience and that of most people I know it is not accurate, the numerous horror stories notwithstanding. It’s a very poor system, and it’s a terrible idea to have non-medical people who are motivated by profit making Americans’ health decisions, but overstating your case is not the way to convince most people.
It is not overstating the case in even the smallest detail.
Testimony of Wendell Potter, Philadelphia, PA Before the U.S. Senate Committee on Commerce, Science and Transportation
June 24, 2009
Anecdotal.
That’s odd, because I thought citing detailed scientific studies was the opposite of making an anecdotal argument.
The truth is that health insurance companies routinely cancel policies rather than honor them.
You are right. That was a knee-jerk reaction, and did not really make sense.
Look, BooMan, my experience and that of most people I know does not support your contention that insurance companies want their customers dead. In fact, the two main insurance companies I have used have actually had decent preventive health programs, and the one I have now has emphasized preventive care in the last few years. Of course, a smart insurance company would realize that such a thing actually saves them money in the long run.
So, while I do not support the current system, I do not find it helpful to overstate the case.
What they want is to make money. They do not want to honor claims and look to any excuse they can find to deny coverage to those who need it.
Did you fail to mention that you once had prescription acne medication? Then we’re not covering your double mastectomy. Go find the $40,000 to pay for that on your own.
Now, what do you call that? Preventive medicine is beside the point. You get cancer and your insurance company wants to do on of two things. Cancel your policy outright, or delay you procedures so that you die faster.
It’s not even controversial if you’re willing to read the congressional testimony.
My experience and that of the majority of people I know has not been consistent with that. I’m not saying it doesn’t happen – obviously it does – but I have colleagues and friends who have had cancer or other catastrophic illnesses or injuries, or severe chronic problems that needed ongoing treatment, and no one I know has been denied treatment. As for me, the only problems I have had with any insurance company have been minor annoyances that were resolvable. I don’t think my experiences and those of virtually everyone I know are atypical.
Again, I am not defending the current system, which is obviously badly broken. It is scary to think that some accountant somewhere is in a position to decide for me what medical treatment I should or should not have. On the other hand, I am, as I said in a earlier thread, appalled, angry, and a bit frightened to hear from Obama himself that under the system he envisions one day I might be denied treatment that will improve my quality of life, or extend my life a few years simply because I am considered too old to be worth the expense. That is especially of concern as I come from a very long-lived family, and I don’t want to be cheated of a minute of the one life I have.
link
Now THAT is anecdotal. But for what it’s worth, a couple of years ago I turned down an excellent job offer primarily because the only medical insurance they offered was Blue Cross.
I have a plan now that offers good preventive health care, a lot of flexibility, and does not require me to have a primary care doctor, which allows me to make my own decisions about whether I need to see a specialist. The only thing they have not covered was very minor, and due to a misunderstanding which we are in the process of correcting.
Clearly my good experience is not universal, nor is it unique.
What state do you live in? From what I have heard, California actually has a few consumer protections in place. The rest of the country doesn’t even have that.
You sound very lucky. You had a choice of jobs, and you had a choice of health insurers. With double digit unemployment, most people will take any job offered.
According to a recent study, http://tpmmuckraker.talkingpointsmemo.com/2009/06/healthcare_market_characterized_by_consolidation_n
.php, health insurance is a monopoly in most of the US. We already have single payer here in Alabama. It’s called Blue Cross/Blue Shield of Alabama.
A point of interest on the recision issue. The insurance companies almost certainly use data mining techniques (neural networks, genetic algorithms, decision trees, etc.) to build their fraud detection models. The results are essentially black boxes that say “yes” or “no” (with a certain confidence level of course). So, when the executives say don’t know what triggers a recision investigation then they’re not necessarily lying (except through omission perhaps). The data sets used have thousands of inputs and are thus beyond what a single human brain can deal with.
I worked on some of the data mining software that is used to build these models. The models are statistically accurate and do work as advertised. However, GIGO (garbage in, garbage out) applies and you can make the models say whatever you want; if you train them with skewed or false data (e.g. every cancer case in the training set is marked as a fraud) or ask them to detect the wrong thing (e.g. optimize profit rather than optimize fraud detection), then the results are worthless for their claimed purpose.
I’m not defending the insurance companies here, I’m just trying to inject a bit of background information.
No, they don’t want you dead. They want you barely alive so you can just keep paying.
Actually, BooMan, they don’t care whether you live or die so long as your premium is part of their cash flow.
Any collection of savings is a great temptation for fraud or embezzlement by the person(s) having fiduciary responsibility. That’s why insurances companies and banks have been regulated in most states, and banks regulated at the federal level. Without regulation, failures of fiduciary responsibility can destroy the industry by driving away folks seeking to save or insure against risk. So you have lots of legal ways of sucking cash out of the same cash cows; essentially these days by nickel-and-diming savers through service charges, co-pays, overdraft charges, deductibles, access rules (transaction are not posted until the next business day), precertifications, exclusions of certain conditions, and so on. I conflate banks and insurance companies here because the regulatory problems arise for similar reasons and the strategies for non-payment have parallels.
So knowing that regulation ensures the market, both banks and insurance companies would rather be regulated by states, where lobbying costs are cheaper and public outrage is more diluted.
But saving for healthcare risks is not the only model for providing healthcare. It looks sensible to our individualistic, personal responsibility flogging culture. Risks could be pooled over the entire society and services financed out of general taxation and provided by government employees (UK) or paid to providers by the government (Canada). The government could use general revenues or special taxes to pay for services to certain classes of individuals – old, disabled, poor, veterans, public employees – and in some cases acting as the payer of last resort (US). And these classes of people too often pay for healthcare by lost time waiting for hours in a clinic. Or through indignity.
Fact is, markets are a way of rationing scarce goods and services on the basis of ability to pay. They never can cover everyone. If you want everybody to receive some service (vaccination, say, or education, or fire protection), markets are not the best way to deliver those services.
Those employers who don’t want to give up providing healthcare benefits do so because it is a nonfinancial way of handcuffing workers to below average salaries. The story is that healthcare leverages the services that additional salary could buy because of the difference between group and individual premiums. As employers cherry-pick workers based on healthcare records (employer self-insurance should rightly be seen as an invasion of privacy), these distinctions matter less. The fact that Congress is not facing is that given the volatility in the labor market and the number of temporary and contract jobs, employer-based health insurance no longer works for anyone. And COBRA has proven to be just a big snakebite.
I think you’ve hit the nail on the head, Booman, in that “insurance” is a wildly inappropriate model for providing health care because *everyone* needs health care eventually & to some degree.
Therefore, the only way to make a profit is to deny someone a needed & deserved payout.
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It was encouraging that the recently passed $787 billion stimulus package included $1.1 billion for funding comparative research into the relative efficiency of different drugs, medical devices, or surgical procedures for treating the same specific condition. The aim is to steer healthcare expenditures toward the most cost-effective treatment methods. This type of comparative analysis is often revealing.
However, given the scale of the cost challenges facing the healthcare system, the scope of the comparative cost analysis program in the stimulus package was strikingly timid. A far more informative comparative analysis would focus on contrasting the costs of different healthcare systems rather than just treatment options; in other words between the levels of total healthcare spending versus outcomes in different countries.
This is done in two charts, which compare the total per capita healthcare spending in the United States and Europe with two intuitive quality indicators of national healthcare outcomes, “healthy life expectancy” and infant mortality rates.
OECD Health Data
"But I will not let myself be reduced to silence."Right on, brother. Insurance is a scam, what they really want is your money.
Live or die – just don’t generate any bad publicity to stop the cash flow.
may be the one dying.
timothy noah had an interesting piece in slate last week regarding employer-based health insurance, wherein he posits that “Employer-based health insurance is dying….”The Paradox of Health Reform*
one interesting factoid in it is this:
as one of the comments said, one could look at the 52 – 48% number and just as reasonable interpret it as nearly have the people with employer health ins. are dissatisfied with it, not a particularly positive sign either way, imo.
additionally, he quotes economist uwe reinhardts’ article from the nyt’s economix blog:
l would also point out the pay to play option, as l currently understand it, exempts small businesses who employ fewer than 25 people…which is by and large, one of the groups hardest hit by the rising costs of health insurance/care.
it’s a worthwhile read.
And Charlie Rangel has decided to build the House plan around a tax surcharge on people making over $280,000 a year and couple making over $350,000, which will go over like a lead balloon with Evan Bayh and his band of merry centrists in the Senate. The whole fucking thing looks doomed.
what l really cannot fathom is why the major manufacturers, what’s left of them, aren’t behind a strong public option. they’ve historically complained long and loud about how medical insurance is a financial drain on them, and that foreign mfg.’s have an unfair advantage…especially the auto makers, notably gm and chrysler
who owe their continued existence to the largesse of the government…aka: the taxpayer.
and who knows why the national chamber of commerce, the presumed the “voice” of small business, is opposed to it when it’s as obvious as the nose on their face that it would be of enormous benefit to them and their employees.
there’re approximately 46m people in this country without health insurance, but are you aware that… “With more than 28 million uninsured Americans working for small businesses, according to the National Federation of Independent Business (NFIB), access to affordable health care is now a top priority for small business owners. The organization stated that health care premiums for small businesses are on average 18 percent higher than those of large businesses and this disparity is restricting small businesses’ ability to invest and grow.”…61% of those uninsured are working.
failure to provide a strong public option in the plan, while still far short of the single-payer plan that’s really required, is not an option.
It’s a crazy system, booman and it’s long past time for a change. I think ultimately, after we do get a public option, the options will be weeded down to a basic (public) plan, a platinum plan (which also covers things like plastic surgery and invitro fertilization) and a fundie plan (which covers everything in the basic plan except for family planning).
I’m all for the public option, single payer or whatever else it is being called now but I must say that not all insurance companies are fucked up.
My husband was in the hospital for three weeks before he died.
I just got the bill the other day….$141,444.97.
Paid in full by the insurance company. Thank God.
I bet your insurance company is fucked up. They just spared you. Someone else, on the same day, got reamed by the company.
You don’t know that.
Actually, I do.
Very sorry for your loss, Cee, and I wish you strength.
Exactly right that not all insurance companies are alike. As I said earlier, I turned down an excellent job offer a couple of years ago because the only insurance they offered was Blue Cross. On the other hand, I have heard no significant complaints about the two health plans I have used in the last fifteen years or so, and the only problems I have had have been minor ones.
Out of curiosity, what insurance company was it?
Thanks for your kind words.
The company is United Healthcare.
I’m not at all surprised.