Private health insurance is a product and private health insurance companies must make a profit for shareholders.
That’s a problem because there is no way to control costs. I champion Governor Patrick’s efforts to control rising private health insurance costs. As he said, “It is a complicated issue,” but I am confident we can solve this serious issue if voters are willing to critically evaluate rather than swallow private health insurance company advertisements claiming we need private health insurance products and that there are no other rational choices.
Please, let us not believe those media messages. Let’s examine all of the facts, not just how we need to work with private health insurance companies.
We need to bring all the options to the attention of the public including a single payer health care option. I won’t just sponsor single payer health care legislation. I will work hard to bring a collective coalition together inside and outside the state house to pass this vitally needed, long overdue health care policy. Below is a brief description of single payer care. For more info check out masscare.org to read more about how a single payer plan works and why we should lobby our legislators to pass single payer care legislation.
I propose exploring a public option that citizens can purchase. Those citizens who prefer to purchase private heath insurance can do so. I am interested in listening to your ideas and health care proposals.
Health care costs and coverage is the topic this week. What are your plans to fix it? Let’s begin talking about how we can solve problems now. Why wait? We are hosting an informal forum to discuss this health care issue. We will keep you posted on the date and time.
But in the meantime, let’s connect here and now. Feel free to call. Looking forward to hearing from you regarding this serious issue.
Thank you for your support and consideration!
Pamela and Team Julian
Pamela S. Julian
State Representative Candidate 10th Suffolk District
West Roxbury, Brookline, Roslindale
pamelajulian.com
Principal author of pending student voter registration bills
in Massachusetts, New York and Washington D.C.
“The way we currently organize health insurance:
Is Expensive: The United States spends more per person than any other country in the world on health care.
Has No Capacity to Control Costs: Our costs are not only high, but also rising faster than those of other developed countries.
Is Financially Ruinous for Many Households, Businesses, and Government Budgets: low-income people and small businesses pay these catastrophic costs disproportionately.
Leads to Very Poor Health Outcomes: Under this system we actually live shorter lives, and receive much less of the care we need.
Is Highly Discriminatory: Health Care disparities along lines of race, ethnicity, class, gender, and age are unmatched in the developed world.” Masscare.org
pamelajulian.com
Eliminating the middleman (insurance companies) will only allow more abuse and waste.
provide no added value to the consumer. That and the inflated compensation of insurance execs would go straight to the single-payer bottom line.
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p>Paperwork would be simpler and therefore less costly.
fixes healthcare? Also, how will you manage the abuses by both customers and providers which insurance companies filter out?
Every study that has looked at Medicare and the VA versus “Insurance” says that the overhead is less than 5% of total medical costs while private medical insurance add between 20% – 40% depending on the style and size of the plans.
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p>Let’s see – add a nickel to every dollar…
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p>or…
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p>add $.30 to every dollar of medical cost.
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p>That math shure iz hard.
Let’s take a state (something representative) and put your system in place. Follow if for a few years and if it works we could implement it nationally without the risk of a total meltdown.
Single-payer in a single state won’t work because people can move too easily from one state to another. Single-payer will cost healthy people more and sick people less. The result will be that healthy people will move from the state and sick people will move to the state.
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p>Now, of course, if you want to fund a state with federal dollars, that gets around the problem to a certain extent, though sick people will still move to the state to take advantage of the universal health care.
and you cannot be denied coverage for preexisting conditions. Are we having a problem of sick people moving here? Healthy people leaving?
and if that doctor is taking new patients.
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p>Big IF.
with NoPolitician who said
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p>Are people coming here OR leaving due to our healthcare system.
…in the form of Medicare and VA, plus other countries such as Canada (Medicare) and the UK (VA) have this or something similar in place. Contrary to your implication we are not reinventing the wheel here.
… lower ages can only make the program cheaper per capita than what it’s costing now because the risk pool can only get better.
…in terms of lawmaking, implementation, AND political argument. Why can’t we just have “Medicare for All” and be done with it?
I’ve made this suggestion a few times, without the aid of any sort of actuarial information…
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p>if you’re going to expand the pool of ages for Medicare, don’t go from 60-whatever downward. Go from 0 upward. Huh?
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p>Add a new class: pregnant women, their unborn child, and their newborn. Every woman deserves a shot at a healthy pregnancy and delivery, and even more compelling methinks, every child deserves to be born healthy. Even the mean ol’ Republicans will be forced to agree with this or be cast as ogre-ific. Once you’ve got folks who both (a) had Medicare treatment during a time in their life when they may not have had a steady job, steady insurance, or steady finances… and saw how straightforward Medicare was… and then no longer had it for mother or child… they’ll demand expanded Medicare coverage. Then, you simply, over time, ratchet up the age-out of Medicare from 1 to 3 to 5 to 8 to 12 to 18, etc.
When you do an experiment, I think you try to limit the variables to understand which component contributed to the result. Medicare and the VA do not look like a state. They do not share the demographics, the diseases and care models are vastly different… What is the big problem you have trying a new healthcare paradigm on a state such as PA? My issue is there are many things we believe can be cut/pasted into a scenario but when we in fact do it, we are “surprised” by things which we never thought of or under/over estimated. The Federal Government and politicians are infamous for “not thinking about that”.
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p>Robert Samuelson wrote an article “As Massachusetts health ‘reform’ goes, so could go Obamacare”
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p>While Samuelson was critical of how the Obamacare plan will be onerous when implimented across the country, I think he missed a big point. MA had roughly only 6% of the population uncovered in 2006 before the mandate was required. The question is, how will the costs excalate for states which have many uncovered residents?
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… Medicare and the VA don’t look like a state. (I’d note that the VA is an inapt comparison here – it’s not a single payer system… it’s more akin to the British National Health Service.)
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p>”They do not share the demographics, the diseases and care models are vastly different.”
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p>Yes,… they are much much worse and the pool is much more expensive to insure. If medicare were a state it’d be the worst risk pool in the country.
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p>Nevertheless, the medicare system, drawn from a combined population greater than many states with the worst characteristics for an insurance program to save money still manages to outperform the private sector.
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p>So to be clear, while we don’t have a specific state to work with here, you can imagine the worst state you can conceive of and run it under medicare cheaper than the private sector runs the rest of the country. Medicare’s own risk pool would to nothing but improve were to just replace it with the population of a similarly sized state.
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p>Nuff said… no state experiment needed to draw conclusions.
… that your concerns about the new national legislation are a distinctly different question than the efficacy of a single payer system (which it doesn’t implement at all).
Besides Medicare applies to a subset of the population most in need of care, so to expand it to include everyone can only be better than the current system.
I’m pretty sure single-payer systems consistently are shown to cost everyone less, plus our own single-payer system, Medicare, tends to get better results for those who are eligible.
… consume supplemental coverage doesn’t mean that they ‘need’ it or that there is a deficiency. There are private supplemental products in places with full single payer (or other state systems) too. If you let there be a market, people will innovate for themselves, so if you allow supplements to medicare, people will find a way to sell them whether they are needed or not.
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p>Also note that wile it is true that Medicare is our most analogous system to single-payer, it should be noted that it is a single-payer system with the worst kind of risk pool… the kind of risk pool that private insurers would dump and a new york minute if they’re allowed to (and would lobby to be able to if they weren’t). That is to say that, not only is medicare price-competitive, it is so with an enormous handicap. So even if there is a deficiency, that isn’t an argument that it isn’t actually more efficient.
Are you suggesting a two-tier health system, where those who buy supplemental get decent care, and the government-only buyers get crappy care? Isn’t that inequality?
… the rich can supplement whatever they want. Even in France. The trick is that ‘standard’ care should be adequate.
for anyone, anywhere, on the left. There is already a two tiered system: enough, and not enough. Why should moving that to “more than enough” and “enough” raise objections raise objections on inequality grounds, except in right-wing caricature?
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p>The real issue, noted above, is the assertion that providing all of this extra insurance will not cost vastly more.
Which now has 5M in administrative salaries?
I’m no fan of insurers, but the cost explosion has not been to insurers, it’s been to providers.
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p>The way to make single payer cut costs is this: nationalize all healthcare provision in the USA and make it a crime for doctors to operate outside the network. Then set salaries from the top down, lower than they currently are.
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p>Facing these cuts in compensation, doctors will leave or retire, and the supply of students will dry up. This will lead to rationing of care, and hopefully the very sick will die off while waiting for treatment.
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p>I have tried to interest our elected officials in another explanation for our rising costs, which if they understood it would lead to a more realistic projection of municipal budgets and so forth, to no avail.
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p>One could almost believe that they are more interested in executing a power grab over our health care decisions rather than saving money and the economy.
… side often get’s left out of cost growth discussions. Standardizing payment schemes via a single payer system would help with this side of the problem in that the ‘labor market’ would adjust to the new ‘market’ prices. Aside from that, the other real problem on the service side is that the ‘market’ of patients doesn’t really perform like a market because patients are so much less informed about their condition than the doctors. We generally trust what the doctor says is ‘needed’. Comparative effectiveness data gathered by Medicare should make some inroads in the private system also eventually because private insurers don’t want to overpay either.
If you want to attack providers, attack the families and patients who demand that grandma be put on every drug that MIGHT help give her an extra week. Or the attending physician who takes the 3rd CT scan of a deteriorating heart in a week just of confirm the obvious.
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p>You are right and you are wrong. The real change needs to come societally with the acceptance that death is natural in most cases. Our culture of grasping at the last medical straw costs hundreds of billions a year.
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p>Every physician should be required to spend six months in a good hospice facility. I think a lot of things would change very quickly. All the numbers would go down dramatically, except life expectancy. That might change by a week.
Link, please – I think you’re way off. I found this study of expenditures between 1993 and 1998:
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p>Emphasis mine
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p>Source: http://content.healthaffairs.o…
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p>I doubt they’ve changed much since then – if you have a more recent study showing your numbers to be correct, please link away…
From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages. Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.
I was quoting from memory something I had heard in the car a few hours prior and got it wrong.
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p>From Marketplace:
I had a relative who was close to the end of life for at least a decade and she recovered and was doing fine for a few years, got ill almost died came back and was well again?
The situations where they tend to happen are not what I am referring to.
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p>See my hospice comment. It is extraordinarily rare that someone receiving palliative care recovers.
My own experience is the elderly can get very sick and then recover 100%. This happens every 2 or 3 years and they get well until they have a final bout. But how do you know it’s the final bout? That’s why I question the statistics and the thesis.
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You’re confused about how we know any stats about end of life care, because to your mind we can’t possibly know when someone’s life will end? You can’t be this obtuse – of course we know when someone’s life ends, we keep track of that, on death certificates. Millions of old people on Medicare die every year – that’s where these statistics come from.
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p>Once you have a date of death, and you have a database full of medical expenditures on behalf of the deceased, you simply count backwards 365 days, tallying the expenses as you go. That tells you how much was spent on care in the last year of life. Continue counting backwards until you get to the first claim Medicare ever paid, still tallying the expenses as you go, and now you know how much was spent in total. Simple math tells you what percent was spent in the last year of life.
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p>Programming this would be a cinch – you have no reason to doubt the methodology because no one knows it’s the final bout…
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I understand how the statistics are collected, what I’m worried about is a fair set of moderately sick people may look like they are dieing but they are not. So we cut off care because some master database that the feds keep says they are statistically not likely to recover.
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p> As I mentioned before this was the situation with a family member who lived a very healthy decade with 3 or 4 very ill bouts. Any of episodes could have resulted in death. This was not hospice care, but ER and hospital care.
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There are no death panels in the Democrats health insurance reform plan – stop listening to Sarah Palin, ok?
At first I thought you were advocating for a UK-style system, which surprised me, then you lurched into a most extreme form of social darwinism – no thanks!
The problem is the emphasis on costs in the original post. Here are a few ways to cut costs:
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p>Don’t pay doctors/providers what they are worth
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p>Don’t treat sick people
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p>– I don’t think the explosion in health care costs is truly an explosion, I simply think the dollar is worth a lot less than it was in 2002, and health care has risen in price before much of the rest of the economy, because people are afraid they will die without it, and so are willing to pay up at the new level of the dollar.
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p>In time, the rest of the economy will catch up, and the proportion of health care spending will go down. This will depend on a competitive market for the rest of our labor. However even then, if the dollar remains at its present value, costs will not go down unless they are forced down by not paying doctors or not treating the sick.
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p>Through the 1970s, the dollar fell to 10% of its original value. It took 30 years for everything else to finally catch up in the 90s and real wages to grow etc. Since 2002, the dollar has probably fallen to 25% of its value, so maybe it won’t take so long to catch up, unless we keep making it worse.
…”A Modest Proposal”:)
As someone who has strong family connections to world of cancer research and activism, I do not agree with the culture of desperation care at the end of life. I believe in fighting, but I also believe in accepting.
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p>I never want to take away a patient’s hope, but I have come to believe that 99% of the final-stage terminally ill are not best served by aggressive over-treatment. I tend to think they are actually harmed.
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p>Cost is very secondary to my thinking. However, there is a tendency in America to demand the most treatment you can get, even if it is not at all likely to help. That does cost money and the culture of aggressive end-of-life care should recognize that.
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p>Or did you have a problem with my hospice comment? I truly think that all physicians should spend time with the dying. It is a remarkable experience that gives those who do it a lot of perspective.
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p>Death is quite natural. It is often not easy, but then again, neither is childbirth.
Thank you for the post Ms. Julian. I look forward to reading more about your positions on how we, as a society, can improve health care outcomes for better value.
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p>I am not convinced that single payer is the answer, it may be, but I am not convinced yet.
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p>I am taken by your comment about how a family was paying over $18,000 for their insurance. That is a lot, I agree. It is also significantly less than the City of Boston and other municipalities pay for their employees, and not only while they are working, but while they are retired. Boston is even more extreme because they, unlike many other cities, do NOT require their employees to move from their private insurance (paid by the City) to Medicare when they turn 65. Would save the City significant money that could be used to help fund education, libraries, etc.
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p>So I think you and I would agree here, the City should be able to require City employees to move onto Medicare, the closest thing we have to single payer, when they reach 65 and the City gets to reallocate resources to boot. If we are to move to single payer, let’s get everyone who qualifies onto Medicare as a good first step and keep moving from there.
but our company was on BCBS up until 2010, when our 2009 $18k premium was slated to go to $22k. As ConsEph is trying to imply, your constituent actually has a pretty “good” rate right now for coverage, at least in the Commonwealth.
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p>Of course, when I talk to my brother out in MN who works for a major company, and his gross (employer and employee) family premium is around $12k in 2010, or when I talk to a client in NJ (who runs a company even smaller than ours) which isn’t exactly a low cost state, and she falls out of her chair when she hears how much our premium is in MA (she’s at $13k from a “for profit” insurance company), I do start to wonder if the problem may lie in how our state has handled health insurance costs over the last 10 years. In 2003 our BCBS gross family premium was $9k; in 2009 $18k with higher deductibles, and was going to $22k in 2010. Somehow I don’t think “single payer” or attacking insurance profits are the answers (last I checked, the major players in MA are all non profits themselves); may very well be how we decided to “reform” here that has caused the spike in prices.
for a family of 4.
That’s gamesmanship at it’s finest. The idea is to make single payer a good option, not to lump as many people downward to the thing in America which most closely resembles single payer.
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p>Work it out in a contract, then honor the contract. This “force them” nonsense from the right is no different from underpaying some employees or not paying them 1.5 for overtime or any other trick of promising compensation for work and then reneging.
between two parties negotiating with their eyes open is a valid contract, where a prudent assessment of costs involved of promises is known to both parties. Not quite sure that scenario plays out in negotiations between elected officials and public unions though.
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p>Do you have any idea however of the GASB-45 liability facing the City of Boston (i.e, the present value of projected costs for retiree health):
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p>http://www.cityofboston.gov/Im…
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p>Look at page 5 of file (page 146 of report) of this PDF for some illumination. As of June 30, 2009 estimated GASB-45 liability for Boston was $5.8 billion dollars. But fortunately the City is ahead of this impending liability; they’re setting aside $65 million in total against these costs. Looks like they’ve solved 1.12% of the problem so we should be good to go for sure.
But we don’t want to hear any of this union/city/state worker bashing on BMG.
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p>Besides, Paul Krugman would argue that this is a good thing.
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p>We need Gov Christie…
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p>Wow… 1.5% and they’ll probably bitch endlessly.
I have no problem with government negotiating hard with labor. That’s their job, and they should be tough. When both sides sign a deal, I expect both sides to honor the deal.
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p>So, Mr. Christie — you talked an awful lot of smack about public school teachers not too long ago, perhaps you weren’t aware that they too were “people who work in the public sector. They work hard, they’re find folks, …”. In any case, if you can get them to agree to those terms, good for you (and the budget).
She’s dynamic, interesting, a non-insider though she is experienced in politics, and genuinely interested in a rising tide to lift all boats. She’s particularly knowledgeable about voting issues and medical care issues, and has been actively seeking out and talking with environmental experts as well.
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p>I also know she’s looking for folks to help with her campaign, for a district which includes South Brookline and some of JP. Live near the area? Check her out online: PamelaJulian.com.