As I was traveling up a short hill on my bicycle at about eighteen miles an hour, a mechanical failure sent me hurling head first over the handlebars until the crown of my head met the pavement, cracking my helmet in four places. The good EMTs and local police were there in minutes after fellow riders called it in. As I started to take inventory of my physical condition and wondered about the now broken bicycle, another thought came to mind. This is going to cost me at least $1,100 at the hospital emergency room, if I choose to take that route.
I have insurance. My family policy costs me in the neighborhood of $15,000 a year, plus co-pays and deductibles. But even at that price, the first $1,000 is not covered, and even after that, an ER visit will cost me $100. Since I had no prior claims on my $15,000 policy, this accident was, at minimum, a $1,100 cost.
We were saving for a new roof on the house and we had two boys in college with expenses that we are trying to budget for, so $1,100 was a figure that I had to struggle with. I was 57 years old and have had several concussions. I’ve been lucky so far that none has advanced to a more serious condition. For some reason, I thought about Natasha Richardson and at that moment I told the EMT who was waiting for my decision, “Yeah, looks like I should take the ambulance ride to the hospital for a full examination.”
Actress Natasha Richardson died from bleeding in her skull caused by the fall she took on a ski slope in Canada. Initially, Natasha refused treatment, assuming that a bump on the head was nothing to worry about. The medical examiner ruled her death an accident, and doctors said she might have survived had she received immediate treatment. However, nearly four hours elapsed between her lethal fall and her admission to a hospital. Richardson suffered from an epidural hematoma, which causes bleeding between the skull and the brain’s covering. A CT scan can detect bleeding, bruising or the beginning of swelling in the brain. The challenge is for patients to know whether to seek one. By the time Richardson’s condition had deteriorated to a point where the depth of her injury was apparent, it was too late. The nearest Canadian facility to treat her was too far away and there were no emergency helicopters to transport her in time to save her life.
After this tragic accident, the Canadian health care system was much maligned because of the lack of helicopter transport to one of the few hospitals that had the necessary technology to treat this injury once it was established that Natasha needed immediate care. It proved, to some, that the US system with an over abundance of medical technology and a surplus of hospitals eager to use it, would have made the difference. It proved to some that Universal Health Care, enjoyed by the rest of the developed world, was substandard when compared to the American system.
I beg to differ. Not everyone in the USA has $15,000 to spend on a family policy and many of those who can afford those premiums don’t have the extra $1,100 to spend on what might be unnecessary treatment. My CT scan proved negative, I was fine. I had a few bumps & bruises but other than that I was okay. Did I waste $1,100 on this wild goose chase? Should I have just called my wife to pick me up, sit on the sofa at home, see what might happen and save the $1,100 for the new roof? What if I did not have $1,100? Should medical care decisions be treated in the same way that one decides to buy a 36” or a 58” flat screen TV?
Some Americans, even some on the Supreme Court, see medical care as some sort of free market function, as if one sought medical care in the same way that one shopped for a dining room rug at an open air bazaar in Kathmandu. I was lying in the ditch, with my head pounding from the sudden impact on the tarmac. Was I really expected to enter into a barter session with a merchant?
“Gee, let me see, how about I offer you $125 for the ambulance ride and $500 for the CT scan. I’m talking cash deal here, no trade. Take this to your manager and see if he will okay the deal.”
Was that how I was supposed to talk to the EMT when he asked if I wanted to go to the hospital? The EMT strongly recommended I go to the hospital, but I’ve been in markets before. I’ve met the car salesman who told me I needed a new car when I did not. Was this EMT just trying to build sales? Did he have a quota to fill? No, of course not. The EMT was a professional who was concerned for my welfare. Money did not enter into his recommendation and it should not have entered into my decision, but it did, and that’s what’s wrong with the American system.
No system is perfect and we’ve heard the anecdotes of the problems in Canada and the rest of the developed world nations with Universal Health Care. In spite of those problems and despite the fact that all these nations are free democracies, not one of these nations has a significantly sized movement of its citizens opposed to Universal Health Care and supporting a market based approach similar to the one employed by the USA, not one. Why do you suppose that is? Think of that the next time someone tells you that we have the best health care in the world.
We do have some of the best care in the world, especially right here in Boston. Doesn’t do much good if you cannot access it, however.
Prior to the accident, I was dealing with chronic sinus infections. I had been to my GP several times and we went the usual routes of antibiotics, Prednisone, and so forth. Nothing worked and the infection would return periodically. My GP mentioned that there was a more successful antibiotic but my insurance company would not approve (pay for) it. It was very expensive. Additionally, he seemed concerned that this infection could spread beyond the sinuses to the bones of the face and other structures within the skull, including the brain. A CAT scan would rule that out but again, the insurance company would not approve.
After the bike crash, the physician at the hospital ordered a CAT scan to check for fractures in my neck and skull. When she came back with the results, she reported, “No fractures, no serious injury, but we have located a large area of sinus infection that is getting rather dangerous”.
A week later I went in for sinus surgery, received the better antibiotics, and the infections have never returned.
So when opponents of Universal Single Payer argue that “you don’t want the government between you and your doctor…..” I ask them, “Is it really better to have my insurance company’s accountant between me and my doctor?”
…that all the talk of rationing and long waits was bogus. In Belgium a classmate came down with a minor bug and was treated the next day, costing her the equivalent of 20 USD each for appointment and prescription.
One lived in the USA, the other in Denmark. Sadly, both died within five years of diagnosis. The only difference was that my friend in the USA had to worry about finances and leaving his family in massive debt. My friend in Denmark only had to focus on his health and his family, enjoying what time he had left. Also, Denmark lacked a specialist in his particular cancer, so the Danish government flew him and his wife to Germany for treatment.
I had a similar situation with a family member who (as to was determined later just fainted) who collapsed for no reason. Called 911, everyone arrived. The family member was still disorientated and dizzy. Was I going to drive them to the ER or let an ambulance and EMT’s take them?
Of course the only thing on my mind was well being of my family and of course I had the ambulance and the professionals transport them for the 6 mile ride to the ER…for a cost at $3,500.00!!!!!!!!!
Their milage rate was like $35 PER MILE, they gave them oxygen for $250 and gave them an IV to rehydrate them, at at cost of $350, plus (get this) $200 in supplies, which when I inquired later, they told me it was for things like tape to hold the iv to the arm.
At the time I had among the best health insurance available, but I was still stuck with $900 for that 6 mile ride. Now that I’m paying my own freight at a similar cost that John pays, I would have had to pay most of that bill, just to meet my debatable.
…about going for a “preventative” colonoscopy, that is supposed to be free for those over 50…and how it cost me $600!!!
colonoscopy in October. At my pre-operative appointment, they warned me to check with my insurance. I’m 99% sure I’m all set, but my experience supports your experience.
Your colonoscopy is probably covered 100%, as are most exam procedures, however, if the doctor discovers any polyps, the doctor will want to remove them during the procedure and that is not covered until your deductible it reached. You could say that you do not want the polyps removed until later, when you’ve saved cash to pay, but that would mean another trip. Of course, you do not know how many there may be, so it’s difficult to pay in advance.
Yeah, the “best health care in the world”…
As a teacher, I have a PPO and pay $7000-8000 a year plus copays for a family plan.
For 2012,annual premiums for employer-sponsored family health coverage reached $15,745
in 2015, Annual premiums for employer-sponsored family health coverage in Massachusetts reached $16,351
My wife’s employer subsidizes most of the premiums. That company also provides a lower out-of-pocket maximum (family and individual) than the plan purchased through the insurer (BCBS/MA in our case).
Presumably Mark’s employer does something similar.
What you have seen over time is, in an effort to keep the premiums down, an increase in the co-pays and deductibles. Co-pays over the last eight years have gone from $15 to $35. ER from $100 to $250. Not complaining, just noting that the advantage some of us have in health care coverage costs diminishes year by year. Then the next step is lose your job, and end up with a new employer who has a crappy plan. Then you’re all about changing the system.
covers about 50% of my premium.
Expanding Medicare and Medicaid has been offered as part of the solution, with little consideration.
NPR offered a great program [as always] about health care.
One caller explained that her partner had cancer, was on Medicare which has deductibles and co-pays [Medicare only pays 80%].
When her partner died, she was forced to sell their jointly-owned home to pay medical bills, starting over late in life.
The deductibles and co-pays are remedied by a Medex plan which can be costly – running + $100 per month per person.
A friend with metastic cancer couldn’t afford the co-pays, so has gone without care.
Recently, a highly specialized specialist asked about medical coverage because the appropriately indicated care was costly. Doctors are now accountants?
$15,000 per year for health insurance? NUTS!
ACA and MassHealth solved a few of the problems, provided coverage for many, but we need something better that includes an economic solution.
That’s how it’s done in Washington. One needs patience and appreciation of small gains, one after the other, slowly. That way, people are far less likely to complain, or even notice…..which is a bad thing as well.
At least their overhead costs are a fraction of those claimed by private insurers.
Like the prescription drug plan that genuflects to Big Pharma and is simply shameful?
‘For Profit’ Health Care orders unnecessary [sometimes dangerous] tests, under-staffs, employs part-timers and we will all live to regret it.
If TPP is approved, forget about Medicare!
But here’s mine:
Got married, took wife’s insurance (worked at software company), had baby, c-section. Every bill had a co-pay, plus deductible, etc etc. $1500.
Changed to my company’s (manufacturing) insurance, same scenario two years later, now only $150 co-pay.
My point is that if two well educated people didn’t realize what was in the policy, how is “competition” supposed to be good? No way anyone could get to apples and apples given the current situation. You have to rely on your company’s view of this stuff (necessary evil, providing for our employees).
This is also my concern about the ACA. Tons of people will find out what “high deductible” means.
Just a question.
It also seems like all payer rate setting would be the next and most logical fix to ACA, it would basically find the lowest possible rate one could charge for a medical product and have that be the price across the board.
It maintains the private market infrastructure reformed by ACA while reforming it a step further with one of the key elements of a public option or single payer plan-government price setting. It’s worth noting that Switzerland and Germany which have private or partially private health plans already do this, without either having a true single payer system.
Here’s the direction I come at in from:
1. Companies spend too much time trying to manage health costs when they should be doing business.
2. By freeing people from jobs they have only because they “need benefits” we will unleash a huge number of entrepreneurs.
3. We waste too much in claims processing and other inefficiencies.
4. I believe in rationing. In the current environment no one can say no.
This being said there’s going to be some downside, but I think the end result would be positive.
We’re paying twice as much as the Europeans for health care as a share of GDP and getting a mediocre system for the vast majority of the population. It’s absurdly inefficient and is dragging down the nation’s standard of living (which is already lower than many countries, even though it shouldn’t be).
I completely agree.
First, who doesn’t believe in the basic concept of “personal responsibility”, but when I hear a conservative political spout that, I hold onto my wallet because someone is trying to rip me off.
The reality of “letting consumers decide” on things like health care, retirement and scores of other complex issues is we really don’t have time to become experts on these issues, leaving many people prey for plans that sound good, but have tons of hidden costs that enrich the small group of companies selling the plans.
I offer a slight edit to the final phrase of your comment.
Perhaps you meant:
“but have tons of hidden costs the enrich the executives and directors of the small group of companies selling the plans”.
Most of the obscene industry profits are going into the portfolios of the very wealthy. The workers in those companies are being plundered just like everyone else. I suspect that even the shareholders (for the publicly-traded companies) are at the very back of the line.
The money plundered by these 21st century Robber Barons goes to the Robber Barons themselves. Only a pittance actually remains in their companies.
If you can’t decide on your own, who decides for you (the govt)? When we are forced to buy auto insurance you have to decide how much of a deductible to carry. If you don’t feel comfortable making your own decisions there are resources available.
Retirement, hire a financial planner but realize he won’t do things for free. It’s in your own best interest to make decisions on your own, and certainly worth it for the very important decisions to become informed, you don’t have to be an expert. If not hire a life coach.
You have to pay for quality. If it sounds too good to be true… etc. These ideas should be part of a mandatory high school class, “Life skills” because apparently many people aren’t willing or able to study these things on their own. Yes these things are complex but the only thing I want the govt to do is to make a law that contracts etc must be written in language that can be understood by a high school graduate.
… so, ah, res ipsa loquitur, I guess…
In the interstices of personal values, physical need, a doctors acumen, insurance fiat, actuarial jiggery-pokery and governmental regulations I make very few decisions completely on my own. You’re in that same boat. What you want is the illusion of choice in the context of options that were last relevant when George III was the king.
In the instance where my personal values, physical need and my doctors acumen are opposed to insurance fiat and actuarial jiggery-pokery I’d like to trust my government to regulate both the insurance and actuaries such that their opposition isn’t based upon the profit motive. Why? because my doctor, the insurance companies and the actuaries all speak and write in languages incomprehensible to an ordinary high school student. My doctor can tell me I have ‘acute post prandial distention of the upper abdomen’ to which the actuary might reply with ‘statistical anomalies attend habituation thus mitigating risk” to which the insurer, in denying my claim, says that ‘lifestyle choices are pooled separately incurring out of pocket expenses.” Which is all just a way of saying the insurance isn’t going to cover the stomach ache I get from eating too much. However, change “post prandial distention’ to ‘environmentally induced bronchial infection’… and the insurers can come back with the same thing (‘don’t work in a coal mine’) Absent the government making sure the actuaries are honest and the insurance companies are too, the range of mischief available to them increases markedly.
So, I don’t particularly care to have the government making choices for me, but I do care that they scope and police the the range of choices the insurers and actuaries can make.
Maybe I’m the consumer from hell, but if I’m paying (and when you buy insurance you are) for something it gets explained to me (over and over) until I understand. Whether it’s my mechanic, doctor, insurance agent or funeral director I get answers.
Your funeral director or car salesman or whatever, does that job over and over day by day. You can spend time “over and over” but you will never gain the informational advantage. This matters most when one is buying something once, like a retirement plan.
Footnote: When I was in my early 20’s and working at a car dealership, I remember this one customer who bragged how he was going to get the better of me and this car deal was all in his control. He went on to tell me that “I’ve been doing this for quite some time son, and last count, I’ve purchased twenty cars.” I smiled and did not tell him that I sold twenty five cars last month I’d been on the job for a year. Yeah, he thinks he got the better of me. Oh well.
It goes back to pogo’s unease about making decisions, maybe the same for the rest of you. I never purported to be an “expert” and I know companies will make money off me, my point was I get as much info as I can and I am happy making decisions for myself. If I need to hire someone for their technical knowledge I’m fine with that, but the corruption and incompetence of our government is on constant display so I would rather choose for myself when I can. Didn’t supporters of ACA tout the ability to choose, if people are frozen with fear from choice they just want the nanny state to guide them.
How many of you choose the deductible on your car insurance, or do you just go with what your agent tells you?
Making health care decisions is qualitatively different from buying a car.
I’m under the impression that the basic mathematics of micro-economics (supply/demand and such) haven’t changed since my undergraduate course forty years ago. Those mathematics presume that the value of whatever is being bought or sold is finite. I don’t know about anyone else, but the value of someone I love is infinite. In my view, that knocks the foundation out from under the entire “free market” approach to health care delivery. When my child is sick or threatened, I want them treated in whatever way is most likely to maximize the likelihood of a positive outcome. The cost of that treatment is not a factor.
The most prominent feature I notice about our current health-care delivery system has been with us FAR longer than the ACA. It’s what I call the “Wallet Biopsy”. I come to a provider presenting a set of symptoms. The first step my provider does is confirm my insurance coverage. The provider has a rich suite of effective tools that match my symptoms to what the insurance company reimburses. A long and highly-profitable list of tests, procedures, “follow up” appointments, and referrals to other providers in the same conglomerate (how many sole practitioners are there today?) follows.
Our health care providers have optimized their businesses to profit from our health insurers. Outcomes for the patient are an early “check-off” from the cash-generating process — most of these tests, procedures, and follow-up are low-risk, provide minimal new information, play a minimal role in treatment strategy, and result in generous amounts of cash. The “product” of a health-care provider is NOT a medical outcome, it is instead a list of reimbursable diagnostic codes for each patient visit.
Government policy provides only the loosest constraints on all this. If anything, the ACA provided a predictable FLOOR (not ceiling) on the value of these transactions. Government corruption and incompetence is, frankly, irrelevant — the corruption and incompetence of the insurance companies that drive and profit from the current system dwarfs the contribution of government.
I suggest that a tiny handful of consumers are able to make an informed choice about many or most health-care decisions, especially long-term decisions. Suppose the question on the table is “is a PSA appropriate for this 42 year old male” or “is a daily 81 mg dose of aspirin suitable for this 67 year old male with other heart risk factors”. For nearly everyone except the physician, the answer obtained from flipping a coin is likely to be as valid as an “individual choice”.
The physician generally knows the answer and knows the risks. I’d like my physician to share those answers based on my health rather than on the balance sheet of her employer.
So hold your elected officials feet to the fire and make them pledge free national health care plans. In the interim buy the Blue Cross/ Blue Shield premium plan.
…if I have to choose between private insurers intervening and the government intervening, I’ll take the government in a heartbeat.
Okay. Here’s the problem. When I buy a house, or a car, or a hamburger at a restaurant, it’s something that I’ve done often after a while. Sure, I’ve made a mistake buying a house, but I learned and made changes the next time. It was the same with the burger and the cars.
I only retire once. Whatever I learn from this is good or bad, it’s of no use to me again.
As for hiring a planner, I have one simple question. I am an average guy with an average income and and average family. I have average hopes for my retirement future. Car manufacturers are able to provide average cars for average folks. The same is true for most all things.
So why, as an average guy with average numbers have to pay some “planner” a few grand (I’ve asked) to provide me with information on what average retirement plan I need to buy?
Sure, there is a difference between a Camry and a Altima, a Jetta, and Malibu, but they are all pretty similar and I don’t have to hire a “Auto Planner” to make a choice, and no matter what choice I make of he aforementioned, the outcome is going to be fairly similar.
To me, it’s all a con game.
…I don’t want to have to wonder if it’s safe to eat. I expect government intervention to regulate that from the getgo. In the most extreme circumstance if I make a mistake or lack the appropriate information, it could be fatal.
In some things, yes.
In many things, no (you can’t see the bacteria in your burger), hence government regulation.
I think that financial anything has outrun the average person’s ability to comprehend it. We just have to face the facts that most people are inept at understanding financial anything. Regulation is called for, but how far?
There are some gray areas though. Do you need title insurance? In most cases no. Do you need earthquake insurance? Flood? Mortgage insurance is not as cost effective as term life- but it’s a big seller. What about “credit card insurance” (borders on scam)? These are all questions that some might say regulate, others point to the market.
I’m blue collar but was always interested in investing. I do individual stocks as a hobby but don’t use that for retirement. There is a reason people drive their camrys to wal mart, reliable.
Don’t know your situation but if you have a company 401k use it, at least 5% of your pay. If you’re on your own, go to Fidelity, they’re reliable. They have low costs and plenty of info. 70%stocks / 30% bonds for a start.
I went to a planner once for a free evaluation. He looked at my portfolio, liked my choices, and for $500 a year he said he would help me with a yearly review. Never went back. Unless you have a million (IMO) these advisors are not worth going to.
I would stay away from annuities, unless you want to help a specific charity. IMO in another 3-4 years there will be another recession, great opportunity to buy so switch to %100 stocks when things look bleakest.
Watch the business channel one afternoon a week, it will be gibberish to start with but anyone can pick up on it after a while. Good luck. Check out FEQTX, DODFX, FLPSX.
A patient entering a physican’s office is analogous to a consumer entering the office of a financial planner. Con game? Probably. I think the technical term is “pipeline”.
The patient presents with a set of symptoms and presumably has a history with the provider. The result is a predictable sequence of interactions between the patient and the provider — each one an opportunity for profit. A profitable health care delivery company is profitable because it is good at making that pipeline rich, robust, and safe (dead patients are generally bad for business).
My interaction with financial planners has been similar. They review my current situation, and then — if I allow them — insert me into a pipeline of insurance products, investment products, tax products, and so on.
The underlying premise of our “free market” economy is that these processes provide better outcomes for consumers than other alternatives (such as government regulation). In my view, the reality is that they result in better outcomes for the providers (health care, financial, whatever).
I think the jury is very much still out on the question of impact for the consumer. Let me pose a question for our financial experts, and then see how the answer maps to health care:
I’m a 40-something working-class male with an annual income of $50 K/year. I have and opportunity to invest $1,000 of pre-tax income in an employer-sponsored 401k. I also have an existing Fidelity money market fund and equity fund that I keep balanced at about a 50-50 split. I have two choices:
1. Invest the $1,000 in the 401k
2. Split the after-tax amount (figure $750) between my two existing funds.
In terms of my personal gain, which is the better choice?