Health Care in the USA

**thebigspendur** · 07-28-2009, 12:43 AM

Originally Posted by jnich67

This model exists to some extent already. You can have a Health Savings Account (HSA) combined with a high deductible health plan. This is what my wife and I have. We pay something like $50 a month in premiums for a plan with something like a $4,000 deductible. Our routine preventive services are covered in full. We then make tax free contributions (the employer kicks in a little too) to a health savings account via payroll deductions (you can make your own directly too). We can use those funds to cover any medical/health care costs without paying taxes. If something really bad happens, the health plan kicks in after we've covered the deductible. This works if you're fairly healthy, but for someone using frequent services it could be tough.

I'm guessing, but I would estimate coverage (a typical benefit plan) for the average American is in the area of $6,000-$7,000 a year - give or take.

Very few Americans have the means to be able to save enough money to cover the costs of even a moderate illness and hospitalization - or maybe they could pay for it just once. A few doctors visits or a broken leg is one thing, but a week in the hospital plus physician fees and meds - you're talking tens of thousands of dollars. It also helps a lot to have access to the negotiated rates health plans have. They're usually 40%-60% off of what you would pay "retail".

Jordan

I don't like health saving accounts and the reason I don't is because they are good for the insurance companies because they are collecting premiums and admin costs from basically younger people who rarely have serious problems. Insurance is based on collective risk. You pay for insurance and maybe for the next 15 years you will never need it but when you reach a certain age believe me you will. So when you reach age 50 and decide you need a real plan you find it is unaffordable because the insurance companies don't make money off of sick people so you can't afford the premiums and the younger people are off on their own plans which don't help to ameliorate the higher costs for older folks but go tell that to someone in their 20s or 30s. Its the old story of by the time you wise up its too late.

As far as people who don't want a govt plan and keep talking about the govt telling them how they will receive medical benefits I just don't understand these people. Its like someone who has this intractable position and keeps spouting the same ridiculous excuse to justify their position even when its been shown to be rediculous.

As has been said for most folks its some guy in a suit with a calculator concerned about next year's bonus who will decide whether you get that operation or test. I used to know someone who worked for a large medical insurer and during lunch the people used to brag about how much money they saved the company by denying things for their claimants. Thats who's deciding now.

As to medical costs, until something bad happens you guys don't have a clue. Up until I was age 50 I was the healthiest guy in the world. I didn't even see a doctor but maybe 1x a year for a bad cold and then I found myself one day in a cardiologist's office being told I needed open heart surgery. That was over 10 years ago and the total bill was well over 100 grand. Luckily I have very good insurance. If not I would have been living out on the street or be dead now because I couldn't afford the surgery.

**honedright** · 07-28-2009, 12:47 AM

Originally Posted by gugi

so you then must agree that it is not a viable practical model. the small percentage of people who i know and who have this level of discipline end up in a fairly high position on the socio-economic ladder.
quite significant portion of the americans completely lack such discipline. as a proof you can take a look at the current recession. people and businesses continually take way more risk than they can afford and sooner or later the proverbial SHTF scenario takes place and then everybody, their children and grandchildren have to pay for it.

for those who have read the non-usa version of this thread you may notice that the hypotherical 'scary scenarios' either don't happen or they don't bother the non-us members as much as they seem to bother americans.

of course, if things don't happen this year they are likely to not happen for another decade. next year is election year so the level of politicizing and demagoguery will likely increase to the point where nothing useful can be done, then it's time for the next presidential campaigning and so on.... as most people the members of congress are more concerned with having a job than doing something good for their community or country.

the market forces are fairly strong and they can eventually settle things into a market driven state just like everything else. and with all the positive feedbacks of the market the process will largely suck for most and be highly beneficial for the few very smart ones who can take advantage of it.

So if I get what you're saying, discipline is not practical? And because, according to you, "quite significant portion of the americans completely lack such discipline." And the current recession is evidence of this??

Do you know the story of Ben Franklin, when asked in 1787 following the close of the Constitutional Convention in Philadelphia? It is reported that he was asked, "Well Doctor, what have you given us, a republic or a monarchy?" Franklin replied, "A republic, if you can keep it."

I wonder if he was a little pessimistic, as your comment suggests that you are, about the discipline of Americans. I think we all know that Franklin was a big believer in the virtue of discipline as evidenced through his writings such as "Poor Richards Almanac" and "The Way to Wealth."

I think Franklin's "a republic if you can keep it" statement was either eerily prophetic, or just demonstrated his extreme knowledge of history, the history of republics, and human nature in general, or maybe all of the above.

Maybe you are correct that Americans in general lack discipline. Does that mean that we are to continue down that lazy, slothful, non-virtuous road? Is it easier to just give in to the lowest common denominator and settle for so-so? Especially when we were handed a priceless jewel by our founders, a Garden of Eden even? That garden requires constant tending. But it's a lot of work for us to keep watering, weeding, feeding. Aww to hell with it, a few weeds here and there, who cares? after all some of us don't want to pick weeds ...then, we're tired of gardening altogether, let's just forget about the garden, let someone else do the weeding, the tending. But then it's not our garden anymore.

As to the recession - I wholly blame the recession on government intervention (beginning with FDR's policies to Johnson's "Great Society" the Community Reinvestment Act under Carter and Clinton's involvement in the 90's. Let's not forget about Barack Obama's involvement with ACORN either) We allowed them too much control and it turns out they are lousey gardeners.

"of people who i know and who have this level of discipline end up in a fairly high position on the socio-economic ladder."
- Isn't this the idea? Wouldn't it be a better goal to get everyone to achieve this?

**Leighton** · 07-28-2009, 12:58 AM

I am only half kidding, because I think what I am going to say is true. But I say it in jest.

Without government and the sacrifice of liberties, as you call them, this is the world you would live in.

http://www.youtube.com/watch?v=gSWjkYAjAzA

**honedright** · 07-28-2009, 01:03 AM

Originally Posted by Leighton

I am only half kidding, because I think what I am going to say is true. But I say it in jest.

Without government and the sacrifice of liberties, as you call them, this is the world you would live in.

If you are referring to my post, I never said that no government is preferable. Most of the founders, not all, felt that limited government was best. That's why they left us with a constitution that gave the government enumerated, limited powers. Otherwise they would have created a monarchy if that's what they thought was best.

**Leighton** · 07-28-2009, 01:06 AM

Originally Posted by honedright

If you are referring to my post, I never said that no government is preferable. Most of the founders, not all, felt that limited government was best. That's why they left us with a constitution that gave the government enumerated, limited powers. Otherwise they would have created a monarchy if that's what they thought was best.

No, I'm not referring to anyone in particular. Just pointing out what would happen without government. And by extension the flaws in thinking life is better with complete freedom.

But I say it in jest, please take no offense, as none is intended.

**JimmyHAD** · 07-28-2009, 01:33 AM

Originally Posted by honedright

If you are referring to my post, I never said that no government is preferable. Most of the founders, not all, felt that limited government was best. That's why they left us with a constitution that gave the government enumerated, limited powers. Otherwise they would have created a monarchy if that's what they thought was best.

thebigspendur said it better than I can. He is right on target.

As for the founders, they were aristocrats who believed aristocrats should run the government. If you didn't own land you had no vote or if you were a women. If you weren't white you were cattle.

FDR was IMO the greatest president we ever had and I think highly of LBJ outside of his Vietnam policies. They were for the poor and the working class. If RFK hadn't of been killed we would be living in a different country today and a better one for the average person IMO. YMMV.

**jnich67** · 07-28-2009, 02:50 AM

Originally Posted by thebigspendur

I don't like health saving accounts and the reason I don't is because they are good for the insurance companies because they are collecting premiums and admin costs from basically younger people who rarely have serious problems. Insurance is based on collective risk. You pay for insurance and maybe for the next 15 years you will never need it but when you reach a certain age believe me you will. So when you reach age 50 and decide you need a real plan you find it is unaffordable because the insurance companies don't make money off of sick people so you can't afford the premiums and the younger people are off on their own plans which don't help to ameliorate the higher costs for older folks but go tell that to someone in their 20s or 30s. Its the old story of by the time you wise up its too late.

As far as people who don't want a govt plan and keep talking about the govt telling them how they will receive medical benefits I just don't understand these people. Its like someone who has this intractable position and keeps spouting the same ridiculous excuse to justify their position even when its been shown to be rediculous.

As has been said for most folks its some guy in a suit with a calculator concerned about next year's bonus who will decide whether you get that operation or test. I used to know someone who worked for a large medical insurer and during lunch the people used to brag about how much money they saved the company by denying things for their claimants. Thats who's deciding now.

As to medical costs, until something bad happens you guys don't have a clue. Up until I was age 50 I was the healthiest guy in the world. I didn't even see a doctor but maybe 1x a year for a bad cold and then I found myself one day in a cardiologist's office being told I needed open heart surgery. That was over 10 years ago and the total bill was well over 100 grand. Luckily I have very good insurance. If not I would have been living out on the street or be dead now because I couldn't afford the surgery.

I agree, the HSAs are not a real long term solution. It takes too much "healthy" money out of the pool.

For most of us, we don't have much choice or freedom in choosing our health care plan. Our employers choose one or maybe a few plans for us. That's who decides.

I hope your friend was describing the claim reviewers/payers. Some doctors and many hospitals try to get over on insurers including Medicare/Medicaid. They up-code in their billing, among other things, so for example, they may use a code that indicates a similar, but slightly more severe condition - calling for a higher payment. The insurance company has an obligation to catch and correct that kind of thing. So, yes, they brag about denying an inappropriate claim just like the hospital people brag when they find a way to play the system for more of our money. I've seen both...

I've never seen medical management people - those medical professionals who pre-authorize services as appropriate and covered behave in so callous a fashion when reviewing cases. If that was happening, that's pretty sick, but there are bad apples in every profession.

I have no reason to think these same things won't happen under a single payer system. Even non-profit hospitals and health plans try to reduce costs...The other side might be the government plan not caring how much they spend and becoming very inefficient.

Where's the balance? I don't really know.

Jordan

**honedright** · 07-28-2009, 02:55 AM

Originally Posted by JimmyHAD

As for the founders, they were aristocrats who believed aristocrats should run the government. If you didn't own land you had no vote or if you were a women. If you weren't white you were cattle

"As for the founders, they were aristocrats who believed aristocrats should run the government"

Everything I've read leads me to the opposite.

"If you didn't own land you had no vote"

This is based in English common law and had to do with representative taxation . Basically "only those with a property stake in the nation had the responsibility and permanence necessary for it's councils." (Novus Ordo Seclorum, McDonald, p.26)

"If you weren't white you were cattle"

To the best of my knowledge, not a single one of the founders had this attitude. Jefferson, Franklin, and Adams all opposed slavery and had some part in it's eventual end. (Yes Jefferson had slaves, but do a Google search and read up on his situation).

**JimR** · 07-28-2009, 03:41 AM

Originally Posted by honedright

"As for the founders, they were aristocrats who believed aristocrats should run the government"

Everything I've read leads me to the opposite.

"If you didn't own land you had no vote"

This is based in English common law and had to do with representative taxation . Basically "only those with a property stake in the nation had the responsibility and permanence necessary for it's councils." (Novus Ordo Seclorum, McDonald, p.26)

"If you weren't white you were cattle"

To the best of my knowledge, not a single one of the founders had this attitude. Jefferson, Franklin, and Adams all opposed slavery and had some part in it's eventual end. (Yes Jefferson had slaves, but do a Google search and read up on his situation).

Sure, sure, Jefferson was a "good" slave owner, which is a lot like saying "he was a good rapist". Sorry, but the idea that the founding fathers were lily white working class heroes is delusional. Did they do a great thing? Absolutely. Were they utterly selfless heroes who are immune to all criticism?

Of course not.

Slavery ended in 1865, as far as I'm aware, long after the founders were dead (the last to die, Madison, died in 1836), and although Ben Franklin DID openly oppose slavery, and free his slaves, Jefferson kept his in life, as did Madison and Washington. If a man opposes slavery, but keeps slaves, what does that make him?

Furthermore, by any meaningful definition of the word, a great many of the founders were most certainly aristocratic. Many held power, money and position from early ages. They didn't hold titles like "duke" or "count", but they certainly weren't born to poor, unknown families. Alexander Hamilton actually felt that the senate was just the place for the American aristocrats. Granted, Adams opposed this, as did Jefferson...a man descended from the English gentry, and born into an important colonial family. But not aristocratic, of course.

Funny, you know, now that I think of it...there are certain names that DO pop up a lot in American politics...Names like Adams, funnily enough...

My opinion is, honor great people for who they are, and recognize their failures as honestly as you recognize their successes. Deify no one, as people are human, and not gods.

**gugi** · 07-28-2009, 04:11 AM

Originally Posted by honedright

- Isn't this the idea? Wouldn't it be a better goal to get everyone to achieve this?

it's a good idealistic goal, but it doesn't work in practice. communism is a nice idea too but when put to a practical experiment it failed.

as you well know the current american society is quite different from what franklin et. al. wrote in. whether i'm pessimistic or optimistic depends largely on your point of view, i guess. for example if you think the current politicians are more corrupt than the ones from the times of the founding fathers i think you've been reading propaganda instead of history.

so back to my point, people lack discipline therefore the system that you propose does not work in practice even if it looks good on paper. the disciplined ones get well off enough that they don't worry about health insurance. it's a positive feedback, those who wold benefit from such system are 'disadvantaged' enough to not be able to take advantage of it and those who has the advantage to benefit don't really need it.

you can blame any administration or policy you like, but at the end of the day if americans had the culture of not living beyond their means there would not have been a crisis. it's a free country and everybody makes their own decisions. it's not the government who forces people to make bad decisions, at best they may have mislead them into those, but that's about it. not so smart people thought that they are actually making good decisions, smart people thought that they would be able to jump off the train before the wreckage (some financial institutions actually pulled it off and had negligble amount of bad assets when SHTF).

i already posted earlier that this is not an academic problem, there is plenty of experimental evidence what various systems cost and what results they produce.
of course, there will be always the ideologues who insist that the current system is better, even though other systems have demonstrated better results and efficiency.

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