An anecdote:
One of the big sticking points in the new health care plans offered through the Connector was the inclusion of certain preventative care. But I went to the site to test something out.
Let’s look at Tufts Health Plan Bronze “HMO Select 2000”, for instance. (Find it at the Connector — you’ll have to enter some info.) It’s one of the cheaper plans out there. And let’s say you’re a woman of child-bearing age, and you go for a PAP test. That’s just about the most standard preventative measures out there, right?
So Tufts arranges for a co-pay of $35 for the visit. Not cheap, but definitely discounted.
But what about the lab work? That counts to the $2000 deductible. So you get a bill for maybe $300 for lab work! [However, see update below. -David]
How is that including preventative care?
I’m still concerned that we’re going to send people to the poor house so that they can buy coverage meant to keep them out of the poor house, that because of huge gaps in coverage, will not keep them out of the poor house.
UPDATE (by David): Upon further review, it appears that the Tufts HMO Select 2000 plan may fully cover pap smears and other preventative screenings after all. According to this document, “preventative screenings, pap smears and mammograms” are “covered in full,” whereas certain other services, such as “diagnostic x-rays and lab tests,” are “covered in full after deductible.” I’d say it’s not entirely clear where the lab work associated with a pap smear falls in that universe, but it seems likely to me that it would be covered and not subject to the deductible. If anyone has the time to check in with the good people at Tufts, go for it.
FURTHER UPDATE (by David): In this regard, it’s worth noting that there’s a hearing TODAY at 1 pm at the State House, Room B-1, on Senate Bill 703, which would establish the Massachusetts Health Care Trust. That’s true single-payer. If you’re interested, show up and let ’em hear you.
or include it in the high deductibles, then these policies aren’t worth the paper they’re printed on.
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So I will take this opportunity to bang the drum I’ve been banging for months: the government never should have gotten into the game of forcing people to buy expensive products in the private marketplace, just for the privilege of living in this state. This isn’t going to work. If the state wants everyone insured, it should damn well insure everyone. It’s really pretty simple.
The government shouldn’t be forcing anybody to buy anything. I think you know what part I disagree with.
Common decency prevents us from kicking people out of the ER when they show up wounded or gravely ill, which they will, eventually. So we already pay for their healthcare, such as it is, and will continue to do so. I am therefore content to compel people to show a little responsiblity for their own well being.
I don’t have a beef with forcing people to buy health care. It’s worth noting that Canada and France and Spain and the UK and …. all do just that.
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You see where I’m going. Even if there isn’t a national care plan, if you’re going to force people to buy health care, make medicare an option for everyone. Even if it isn’t free — even if it’s linked to ability to pay or some other metric — let’s let the gov’t run a health care plan too. I don’t have an ethical problem with public or with private health care: I have an ethical problem with my government forcing me to enter a contract with a private company. There’s simply no precedent for that. The only way to avoid this contract is to move out of state or to die, and suicide is illegal too!
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If the government wants to require people to have health care, it should provide that health care — maybe not free [nothing is!], but for a socially equitable price.
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We’ve visited this topic before. Vaccinations were required of all citizens by law as early as 1805. There’s the precedence: that is, citizens were required–in the face of a significant health crisis–to contract with a physician.
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So, is your ethical objection that you must contract with a company as opposed to an individual? Quite the narrow distinction, if true.
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Or, would you have also objected to the mandatory Mass vaccination statute?
Why is being forced to buy from the government different from being forced to buy in the marketplace?
Because right now the government has made me part-owner of a war in Iraq whose only victor thus far has been al-Qaeda.
Great, it’s not going to work. So, you either wait for it to fail, and frankly there’s some chance it will succeed, or you bail out now. And, what’s the politically feasible alternative once you’ve bailed.
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Same’s true whether it’s Dem policy on healthcare or Dem policy on Iraq–same solution, lament the past; punt on the future.
This is what is says is covered in the high deductible (which is good)
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Office visit: Adult routine physical
Office visit: Routine gynecological (GYN) exam
Office visit: Well-child care
Office visit: All other visits to PCP
Office visit: Specialist
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But as Charlie noted:
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Laboratory + Imaging: Outpatient
Subject to deductible Yes
Diagnostic lab $0 after deductible
Subject to deductible Yes
Diagnostic X-ray $0 after deductible
Subject to deductible Yes
Diagnostic CT/ MRI/ MRA/ PET scan $0 after deductible
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Many just assumed that a GYN exam being covered would in fact cover everything, not just an office visit. No good.
lab tests is that if you’re not sick, it’s not “diagnostic.” If you’re getting a routine screening, with nothing to diagnose, then it wouldn’t be diagnostic. What that means is, if you wait until you’re sick, you’re gonna have to pay up to the deductible. Generally people have to be educated, enticed, prodded, etc. to get routine screenings–it’s a lot cheaper for the insurer for people to get screened than to wait until they have symptoms.
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It also means you better f***ing well get that flu shot, because if you don’t and you get sick and need treatment, you’re gonna pay–big time.
Charley, you point out a huge problem with private insurance companies. This Senate bill cosponsored by Stan Rosenberg and others looks promising. I’m going to keep up with this bill’s progress. As a Somerville resident, I surely hope my senator Pat Jehlen will support this effort.
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It’s also great to see new Senator Ben Downing supporting progressive causes such as this.
I don’t think there’s any doubt that the new law needs work. But the legislature is motivated to tinker with it, and I think it could be a good law, with some good adjustments along the way, and the attention and push from the governor’s office.
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Those who want Single Payer and nothing else are going to be disappointed I’m sure. But we may be another 10 or 20 years away from getting there (no matter how much I like Jamie, that’s just the reality as I see it — the last time a state voted on Single Payer in a public referendum, it lost 75-25 in California from what I recall). So how many more people are we going to let slip through the cracks without insurance just to prove that that’s the only way to go? This is the best thing we got going on right now in the country, it seems worth taking it out for a spin before asking for our money back.
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Charley, while I don’t deny that you have some reasonable points here, I also think it’s worth noting that you took one example of one catastrophic care plan and used it as your example. Why not lay out what the other options were? How much did that plan cost, maybe $160 or $170? What was available at $200? $225? $250?
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The plans as they stand now are about 30-40% cheaper than they had been, and in 2009 there are additional mandates on drug coverage. And a lot of people qualify for subsidies, reduced cost plans, and can apply for waivers if they simply can’t afford what’s offered.
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I think it’s worth giving this a shot.
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For one thing, if you’re currently paying for your own health insurance, maybe see if The Connector is offering your same plan for significantly less money. You might be surprised.
A few years ago, I used to run a nationwide ERISA multi-employer welfare group and these are prices lower than you can find most places in America. I saw HC pricing for everything in 11 states; Indiana was the cheapest, NY the most expensive (MA close behind.)
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Complaints about $35 co-pay as “not cheap” are a red herring. The engine, I think, behind the bitching and moaning is the insatiable progressive desire for a single-payer system.
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Keep “tinkering” indeed.
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I was in the ER at BU Medical (the former Boston City Hospital) and 75% of the folks there had no serious medical issue … they could have been better served at a walk-in clinic or community health center. (Memo to slacker ER customers: try eating less and lose some weight. You might have fewer health problems.) But it costs them nothing so they show up for hang nails and out of boredom.
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I suppose this is why our health care costs so much: when no one has to pay anything for it, demand for services is limitless. Of course, I had a real medical problem and so went to the front of the line immediately.
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Health care services, like every other scarce economic resource, is allocated on the basis of price. If there’s no price, utilization zooms and you end up with huge demand, and ultimately rationing.
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How is single payer going to fix any of this? It’ll only make it worse.
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Okay, so the people at the ER could have been better served elsewhere. Did they know about the community clinics in their area? Did they know the hours those clinics were open, whether they accepted walk-ins, and whether they’d have to pay?
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No, most of them probably only knew that the ER was open 24 hours and that they’d be helped.
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Yes, it’s sad that many probably didn’t know about the options available to them and therefore were unable to make the best choice. I’m betting that most of them didn’t have the luxury of opening up google and seeing what was in the area. So educating the public on how to best get healthcare is a step that needs to be taken, and it’s information that those of us who were regularly taken to the family doctor take for granted.
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And yes, it would truly be horrible if everyone who wanted healthcare was able to get it. That would be the end of modern society as we know it. Oy.