The difficulties of designing health care insurance, redux
Now that we’re considering how to replace or dramatically reform Obamacare, I went back to look at one of the very first posts I ever wrote on this blog. I decided it’s still pretty apropos, so here it is again, almost twelve years later.
The company I own just got our health insurance renewal quotes for 2017. Since we are under 50 staff, we buy through the local business association group. Next year we will have two not four carriers to choose from and a 15% premium increase! I’m not sure what is driving this since these are businesses with relatively healthy workers who are signed up as the become employed.
But if you want an example of a real, flexible and effective medical system you have no further to look than the US private veterinary system. Don’t get hung up on the difference between dogs and people just look at how it works. Over the years if I needed to take one of our dogs to the vet we got an appointment that day without fail. They (and us) were seen by our regular vets and we got plenty of time to discuss the problems with them. If there were treatments or surgery it was the actual Vet who called up to check on the dog’s progress. Over the years our various dogs have had surgeries (both simple and complex), visits to specialists, and cutting edge drugs. No months long waits, no rushed out visits, just personal attention and service.
This is largely due to the lack of a government role except to license and perform basic regulation. They can do the job with fewer helpers and less paperwork, alter their practice to deliver what the customer needs and wants, and tailor treatments to the client.
This was the model that used to represent US human medical care. The high end complex treatments like cancer or heart surgery are very good and pretty efficient, but the regular day to day practice has been totally destroyed by Medicare/Medicaid. Time to go back to major medical plus an HSA.
I noticed a link at the bottom of the linked article to the next one “The tsunami and the forgetting”. Ironically I actually recall reading that. I knew that I’ve been visiting you daily pretty much since the beginning but seeing the dates on those posts was quite frightening; where have the years gone.
Thanks for your analysis on so many topics over the years.
London Trader:
Just imagine how frightening those dates are to ME!
But I seem to recall that I re-posted that tsunami/forgetting post a few years later, so perhaps you first encountered it then.
DirtyJobsGuy:
I understand your point, but I think the analogy is flawed.
People love their pets, but pets are not people and there is a lot of discretion in treating them at all, as well as how far to go in treating them. I know people who don’t have the money to treat their pets and decide not to treat them. It’s not unusual, and the calculus is very different than with a human being.
In addition, pet ownership is discretionary in the first place.
DirtyJobsGuy: Also pet insurance is pretty strict about preexisting conditions, even quite simple ones like an upset stomach. My dog insurance lapsed and when I restarted it they excluded care for an upset stomach because my dog had once seen the vet for it.
The ever-feculent Jonathan Gruber was interviewed this morning by Maria Bartiromo. What a disgusting human being, He kept telling Maria that she didn’t get it and kept spewing the administration’s lies (via the disgustingly arrogant and condescending Ezekiel Emanuel) about how the ACA is working out “according to plan”. These jerks always point to the “150 million people” who get their healthcare insurance through large entity employers and are allegedly happy with their coverage and the cost of that coverage. They and the rest of the ACA cheerleaders have always utterly ignored the rest of the working population, including professionals and truly small business owners who are being crushed by ever-increasing premiums and ridiculous deductibles.
I’ve recently reached the ‘promised land’ of Medicare eligibility but my wife still has a few years to go. Humana has announced that as of 1/1/2017 it is cancelling all PPO plans in Georgia (the coverage we’ve had since 2009) and the new HMO-type coverage it’s now offering has higher copays and deductibles; the monthly cost for one person will increase from around and egregious $700/month to almost $1200/ month. Plus a $3500 deductible. For one person. Plus the GYN my wife’s had for over 30 years is not available under any of the available plans.
One thing I’ve noticed ever since the ACA was imposed on America is that many — probably most- – people aren’t really affected by it very much because they work for a large company or governmental entity that still provides what appears to be old fashion insurance. For those of us who are affected by it, it’s hard to express just how burdensome and oppressive it is. It’s not only ruinously expensive; I consider it to be a badge of tyranny and I know I’m not alone in feeling that way.
I’ve literally been praying that something can be done to ease the burden on us in the forgotten pool of the self-employed, which may be ‘small’ relative to the “still-lucky 150 million” but surely larger than the j in DC are willing to admit. [In 2015, 15.0 million people, or 10.1 percent of total U.S. employment, were self-employed, including those who had incorporated their businesses and those who had not]
– Rant over
carl in Atlanta, you are singing the same song we hear from our daughter, who is self employed.
She works hard, seldom takes a vacation, has no sick leave, and because she is in the healthcare field, Obamacare has affected her practice. She used to be turning patients away, now she has barely enough to cover overhead and pay her living expenses. It has been heart breaking to watch what has happened to her in the last eight years.
I have delineated my ideas of what needs to be done on this blog many times in the past, so will not belabor it. Three big things that I think could get done.
1. Allow buying of insurance across state lines and allow policies to be tailored to the needs of the patients.
2. Allow people to put money into HSAs that can build up over the years.
3. Allow private insurance purchasers to deduct their premiums from their gross income for tax purposes to put them on a level playing field with employers.
There are many more things that could be done, but I believe those three things could be done relatively easy.
1. Allow buying of insurance across state lines and allow policies to be tailored to the needs of the patients.
Plenty of people talked about this during and before the bill got debated.
The problem is who in power is going to actually do it? Might require some strong arming or blackmail.
I consider it to be a badge of tyranny and I know I’m not alone in feeling that way.
O care was Hussein’s big F U to the Americans that refused to vote for him. People should have figured that out by now. To the Left, their religion is personal, and heretics need to be Burned. Some literally like Jean of Arc, sometimes figuratively.
Atlanta Carl: Perfectly described.
Everything outside the original box the founders’ established with the Constitution that DC touches turns into costly crap. That is what is wrong with the medical system today. DC is the real sucking sound.