The obstacles against single-payer

It is more than the insurance industry that reformers will have to overcome:

So, to do as Moore wants in the United States, you would need to do more than just overcome the insurance industry. You would need to cut the salaries of doctors, reform the legal system, enrage our allies by causing their prescription drug costs to escalate, and accustom patients to a central decision-maker authorized to determine what procedures they are and are not allowed to get. Unless every one of these changes comes together, Moore’s new system would end up costing an enormous amount of money.

File under Hell, frozen over.

Comments

doctork@equalhealthcareforall.com
You couldn’t be more incorrect. Yes, it is true that the entire system needs a thorough overhaul but you, as well as Mr. Goolsbee in his article posted on Slate-July 1, 2007, have glossed over the most important issues, namely the definition of what health care really is and the overt greed of our hospitals’-insurance companies’ interaction called the Cost-Shift.
To begin with the definition of health care: it is the doctor—patient relationship. When people get sick they go to the doctor and therefore the doctor—patient relationship with zero financial conflict of interest on the doctor’s part has to be the driver of all health care expenditure. That’s where the control lies and not with the single payer.The single payer completely funded by the people in America administers payment, provides strict ongoing assessment of quality and availability, and controls the prices paid for services through honest, transparent, tough negotiation with the health care businesses and providers, but notably does NOT interfere with the doctor—patient relationship as do the insurance companies in our current
system, by choosing which procedures and medicines etc. are covered. If health care economists and politicians knew what it meant to practice medicine, they would have been able to arrive at this conclusion, I think. However their pandering to the health care lobbies obstructs their view. Could there be some rationing? Sure, for example, on completely unnecessary plastic surgeries and the like but there can be no rationing on taking care of sick people.
Regarding the interaction between hospitals and insurance companies and how it allows the outrageous charges of hospitals to continue via a mechanism called cost shifting, I can only say that health care expenditure will never come under control if this is allowed to continue. Cost shifting is a financial manipulation that individual hospitals and their insurance payers actively engage in. When Medicare and Medicaid and the completely uninsured fail to pay 100% of the hospital charges, the hospital shifts the charges to the patients who have private insurance. ( Allen Dobson et al. Health Affairs. Chevy Chase: Jan/Feb 2006. Vol.25.Iss.1, p.22-33. “The Cost-Shift Payment ‘Hydraulic’: Foundation, History, And Implications.”) The insurance companies are willing to negotiate because in the long run it benefits them. To account for paying more than 100% of hospital charges, they simply increase premium payments and deductible payments so that their profit remains untouched. And of course if a patient has co-insurance as part of his/her policy then that amount of payment increases. In all of this it also should be known that what hospitals charge can be far above the true cost of services.(Uwe E. Reinhardt. Health Affairs. Chevy Chase: Jan/Feb2006. Vol.25, Iss.1, p.57-69. “The Pricing of U.S. Hospital Services: Chaos behind A Veil Of Secrecy.”)& (http://wherethemoneygoes.com- June 22, 2007) Even if Medicare and Medicaid do not pay 100% of hospital charges, they may still be paying the true cost or even more for those services. Oh yes! Capitalism at its best. Gouge the individuals seeking the service. The hospitals in this country are a major part of health care expenditure and this will never be brought under control until the pressure relief valve called cost-shifting is removed. To do this we need to eliminate the insurance companies.
There is a worry for some health care economists that if the cost-shifting process were to stop, health care financing could become unstable.(Dobson et al.- noted above) My comment is SO WHAT!
The hospital buildings; their electrical and plumbing systems; their physical plant staff; their cafeteria workers; their technicians, nurses, doctors, and patients would all remain and do their jobs, the ultimate goal of which is to support the doctor—patient relationship for the delivery of good medical care. Well, who would feel the squeeze? The hospital business people who operate their little fiefdoms to achieve maximum profits would feel the squeeze. They and their profit seeking ventures operated under the guise of being health care providers would have to disappear. Of course, this would require extreme constant vigilance from our single payer/ administrator to make sure that these business people didn’t cut hospital services, for example, by increasing the patient to nurse ratios in an effort to maintain their own position and profit game.
I wonder why Mr. Goolsbee, economic advisor to a presidential candidate doesn’t bring this up in his article. He must know that it exists. Well, who contributes to the financial campaigns of the presidential candidates. The answer is lobby groups for the insurance companies and hospitals. I also wonder why Mr. Goolsbee doesn’t discuss Professor Thorpe’s (a well known and respected health care economist) analysis of a universal publicly financed program designed to insure all Americans that he performed for the National Coalition on Health Care in 2005. (http://www.nchc.org/materials/studies/Thorpe%20booklet.pdf). He predicted substantial savings with such a system.
So my message to the people who are afraid of a single payer system which they like to label as “Socialized Medicine” is this: Pay attention to the doctor—patient relationship as it is the definition of health care. And there is no such thing as “Socialized doctor—patient relationships.” And create a system that administers our money properly so that these relationships can become a reality for every patient in America. I develop these concepts more fully in my book, EQUAL HEALTH CARE FOR ALL,(ISBN13: 978-0-9796994-0-5) avaiable through my web site, http://www.equalhealthcareforall.com.
Doctor K.
Anonymous
One phrase in the above socialistic crap is valid: “it is the doctor patient relationship”
From there it is all flawed. He who pays the piper calls the tune. If the state pays, the doctor works for the state. When the insurance company pays, he works for the insurance company. When the patient pays, and only when the patient pays, he works for the patient.
Anonymous
Did someone repeal the laws of human nature?
Unless they have, doctork is living in utopia.
And he is wrong. There is definitely such a thing as “socialized doctor-patient relationships”. It is the doctor patient relationship that exists in socialist utopias in which the physician is paid by and therefore the agent of the state or the “community” and puts the health of the state or “common good” above the interest of his patient.
Anonymous
So this retard thinks hospitals will go right on providing services when the finances collapse? What a moron! He thinks the employees are going to show up when the paychecks are late? He thinks they aren’t going to look for more secure jobs? He thinks the physical plant is going to keep chugging along within money there to put into maintenance and upgrades?
doctork@equalhealthcareforall.com
Thanks to anonymous, anonymous, and anonymous for your hard-headed comments which are woefully uninformed. The health care system that I describe in my book, EQUAL HEALTH CARE FOR ALL, is based upon the doctor—patient relationship, with zero financial conflict of interest on the doctor’s part, being the absolute driver of health care expenditure, without interference from the single payer. The single payer will set the prices through a mechanism of tough, honest negotiation with health care businesses based upon their true cost coupled with good, acceptable profit margins, but notably not based on greed. (Chapter 4 of my book) Payment for physician services will be generous and standardized. (Chapter 7)
Understanding that hospital prices far exceed true cost, it becomes reasonable to ask, “Where does the money go?” The answer to that question will become readily apparent during the negotiation with the single payer. Once true cost (as opposed to prices charged) is determined, a reasonable profit margin can be applied by the single payer which will include monies necessary for correct operation of the business.
The work of the business will not change, and it will be generously compensated. What will disappear is the greed manifested by the “business” people who direct the operations of the business unless of course they decide to sabotage proper operation to maintain their profit games.
It is true that he who pays the piper calls the tune. Had the person who wrote that comment read my book, he/she would have known that the system I describe is absolutely and completely paid for by everyone living in America and ONLY administered by the single payer. Interference with the doctor—patient relationship by the single payer is just not allowed. Everyone in America has to pay into a health care fund that I create in the system which I describe. Therefore, everyone has a stake. Once everyone has a stake in it, the system can not only succeed but perform beautifully.
The system that I describe in my book has as its primary agenda the development of a sound, ongoing doctor—patient relationship for every patient in America and the focus on the dollar bill, profit, and other agendas are at best secondary.
I expect the words idealistic and utopian and even naive to be applied to what I write. I did not expect the words moron, retard, and socialistic crap. Had the people who wrote those comments taken the time to read my book thoroughly and understand the concepts as I have tried to develop them, they would have been able to see that none of those words really apply to what I write. Indeed, given the increased volume of health care work that will occur in my system, it may well be possible for health care businesses to do very well financially, maybe even better than they do now. Hardly a socialist point of view. There will be no more bad debt. Only the insurance companies really lose with my proposals.
My book takes human nature into full account, most notably American human nature. When everyone pays into a health care fund, everyone has the standing to pound their fist on the table and demand that what they paid for happens in an accurate and timely manner. Our current system has disenfranchised large segments of our population.
Regarding the statement that there is such a thing as “socialized” doctor—patient relationships, the person who wrote those words demonstrates zero understanding of what the doctor—patient relationship really is. He/ she however can inform themselves by reading chapter 2 of my book.
My system is credible, doable, and based on commonsense, altruistic management of our health care system. Part of the reason our health care system is so flawed is because people like our hard-headed anonymous contributors will not take the time to think. If our health care system is to change for the better, everyone in America has to change. Try reading my book and learning how.
DOCTOR K.
Anonymous
What do all you constant “healthcare sucks” people think is going to happen? You’ve been whining to the public about malpractice, about the health insurers, about your patients, and on and on and on for years.
The public thinks you want something else. What other choices do they have? You’re certainly not offering anything. The single payer crowd is simply building off your incessant bitching, and they’re far ahead of any free marketers in terms of organization.
Anonymous
Stop whoring your book. How annoying can you get?
Anonymous
Worried about someone taking your title?
Anonymous
HSA growth:
438,000 individuals were covered in November 2004.
3.2 million covered in 2005.
4.5 million by end of 2006.
And that’s without a government forcing them on us.
Jack Lohman
Doctor K is absolutely correct. I’ve been in a single payer system for four years and it works beautifully. It’s called Medicare, where all of the doctors work for the patient but get reimbursed by the taxpayers. Medicare pays the bills but my doctor calls the shots.
And though I do not know him personally I give him credit for speaking out about our failed health care system (as opposed to Anonymous, who is likely an insurance industry rep but doesn’t have the balls to admit it).
It never ceases to amaze me, the amount of energy that can go into a project just to avoid doing the right thing. The best, simplest, least costly, most effective thing we could do is expand what has been working well for 50+ years, Medicare. You get sick, you get care, and the caregiver gets paid. Nothing could be simpler.
But that’s probably its problem. Politicians don’t like “simple” when it affects a major source of campaign cash. Which should tell us that we are getting screwed over in many ways by our corrupt political system. Get the political money out of the system and we’ll fix the health care system overnight.
To paraphrase a famous quote, “America will always do the right thing, but only after failing at everything else.”
And Doctor K is correct on another issue: There is absolutely no legitimate reason we should have an insurance bureaucracy that consumes 31% of health care dollars without ever laying a hand on the patient. This is an absolute waste that must be eliminated, and a single payer will do that. Let’s retrain the displaced people for meaningful healthcare jobs, like in our shortage of nurses.
Jack Lohman
And “Anonymous,” give me a break.
“And that’s without a government forcing them on us.” ???
No, it’s with employers forcing HSAs down the throats of employees.
HSAs will go down in flames just as HMOs have. Yes they are good investment vehicles but they are terrible plans for reliable health care. People will deter care until diseases are more costly to treat or will be untreatable. People will die, but as long as we don’t find that out for 10 years the insurance industry will be pleased with the profits generated.
Anonymous
What you tout is not medicare for all. It’s medicaid for all.
Jack Lohman
That’s BS, Anonymous. You simply don’t know what you are talking about. Get youself up to date.
Anonymous
Wow, Lohman is one bitter old man.
I have a group HSA for my practice. Myself and my employees.
I fund the employee’s HSA to a deductible that would be the same as a traditional plan.
The high-deductible insurance (HDHP) has a network in the area, so services are repriced same as the insurance traditional PPO product. You’re not going to see the “rack” rate where the hospital charges $500 for a service that’s $200 for a BC/BS patient.
I got a HSA for myself and employees as soon as the ink dried on the bill. Notice it’s myself AND my employees. What I really had to wait for, was the state to get out of the way. It took work to get state law to allow group insurance to offer the HDHP. We’ve had major surgery done under this insurance. We’re motivated to price-shop a few things, which most people say is a good thing. Bigger things, the insurance price-shops, with the same repricing they use for traditional products.
Departing employees have been able to continue their HDHP same as with traditional insurance. Difference is, traditional insurance was unaffordable to an employee leaving. HDHP insurance, the employee can pay premium with HSA savings.
Oh, and when I add up the numbers, the insurance premium, AND my deductible contributions to employees, the total cost is a little less than what I would have paid for traditional insurance.
I wish I’d been able to get a HSA when I was in my 20′s.
Lohman, are you worried that HSA’s will not work? I think your worry is they WILL work.
Jack Lohman
Yes, Lohman is bitter. Bitter that Corporate America has co-opted both our democracy and our healthcare system. But good for you, I’m sure everybody else with HSAs has a physician boss that funds their plans to traditional co-pay levels. How much free care do you give them on the side?
Most certainly being a provider you can easily price-shop other providers. How does the average Joe do that? And I also suppose that you always go with the lowest bidder, which you imply we all should do.
Come back to me in 10 years and let’s talk about how the rest of the world likes HSAs. Already the horror stories are emerging.
Anonymous
Well, since you bring it up, let’s hear the horror stories.
I provide no free care to my employees. “Price-shopping” is done by…..get this…..we ask. There are many complicated products and services you price-shop for every day. That price was not easily knowable was the fault of our hospitals. Actually, I could go to England and price-shop a package price of a total hip arthroplasty, far easier than I could in the USA.
But yes, price transparency is the problem that is being addressed now, because there is finally a motivation to do so. It’s called HSA’s.
Kinda strange, that there in more price transparency in a country with “socialized” medicine, than in a country with “free-market” medicine.
And the old “how do you price-shop your emergency heart surgery” line……the answer is, you don’t. The insurance price-shops. My insurance is a Blues plan now, previously a big regional player. Same idea. They reprice the service. If I’m contracted with a Blues PPO plan, my fee is the same whether the patient’s deductible is $500 or $5,000.
The “lowest bidder” thing is beneath contempt. What do you think the insurers were doing all along? Now the individual shopper has the option to go to a higher bidder.
Jack Lohman
>>> “Kinda strange, that there [ia]more price transparency in a country with “socialized” medicine, than in a country with “free-market” medicine.”
Oh really? The fees are zero in Canada and the UK. Why would they need price transparency?
And when someone does find the price difference between a 16 slice CT scanner and a 64 slice unit, how do they assess this?
Oh, so they all go to the highest bidder, now, and we have an arms race. I like it. My money is going into GE stock.
I see. Let’s leave it to the HSA insurance companies.
Anonymous
There is a significant amount of privately-delivered healthcare in the UK.
Just one example: http://www.nuffieldhospitals.org.uk/
They have a link for those who will self-fund healthcare services, you can inquire about pricing for services like arthroplasty.
The Canadians have private healthcare, far less than, say, UK or USA, but it exists.
And, of course, the press has been talking about US medical tourists going to India, Thailand, Singapore (Singapore has HSA’s). You get package prices from their agents.
Canada has their own brokers for those trying to find timely private healthcare. One example: http://www.timelymedical.ca/
Strange that such businesses should exist if there is never a problem with waiting time for medical services there.
Jack Lohman
Canada is just beginning to allow private healthcare to compete with public, mainly to offset the wait times that the politicians have created by underfunding their system. If they’d just fund it to 11% of GDP, a 10% increase, they could eliminate the wait times and still cover 100% of their people. But the moneyed interests, through the right-wing Fraser Institute and others, have lobbied to cut back funding. Strange how the moneyed interests have gotten to even the think tanks, isn’t it?
Perhaps there is also a private insurance market cropping up in Canada, but they have always had a special market of “travel policies” for Canadians coming to the US and not wanting to go “naked.” Quite a reputation we have. Some have travelled here specifically to obtain non-urgent procedures and pay cash because they could (a) afford it, and (b) didn’t want to wait in line. In one survey of 18,000 Canadians, only 20 fell into that category. Over 80% of Canadians prefer their system to ours (but of course, they don’t have HSAs).
>>> “…. the press has been talking about US medical tourists going to India, Thailand, Singapore (Singapore has HSA’s). You get package prices from their agents.”
Ah yes. And usually the patients belong to a managed care system and the employers split the savings with them.
If I were a physician I’d be damned concerned about where healthcare is heading. He who has the gold, rules. And that’s the corporations and they are already establishing their own co-op managed care companies. Get ready for corporate medicine, Anonymous, you won’t have another choice in five years.
Anonymous
>>Perhaps there is also a private insurance market cropping up in Canada
Chaoulli and his patient had to sue for the right to get that in Quebec. Went all the way to their provincial Supreme Court. Why waste all that effort if everything is so wonderful?
Timely medical alternatives (the Web site I pointed out) is not “travel insurance” and you know it. It is for Canadians in their country, who find waiting for certain procedures unacceptable and want to be able to get the healthcare privately. There would be no need for the business if healthcare were delivered in a timely manner. Surely, it usually is timely. All too often it appears, it is not timely, often enough to justify the business model.
And so what if the Canadians or anyone else get private insurance to cover health care while out of their country, visiting the USA. I do the same when I go to theirs.
The “underfunding” line is the same old tired line you always hear. And blame someone else. It’s John Cleese at the Ministry of Silly Walks. “I’m sure if I had funding I could make it more silly”.
There’s always some evil business or rich person who could fix everything, would they just be willing to be taxed more.
Jack Lohman
If your last comment was in response to my last comment, I don’t understand. But then again, I don’t have to. The handwriting is on the wall.
And were I a physician I would not be promoting HSAs that will encourage patients to reduce their own care until it becomes more costly to treat. Dollar signs or not, it does not seem like the doctor-thing to do.
Anonymous
No, I don’t suppose you do understand.
Were you a physician……frankly I don’t care. You’re not. I have a HSA. I have HSA’s for my employees as a benefit. A benefit they LIKE, by the way. It helps me attract good employees.
I encourage my patients to get them. So often I see patients who are independent businesspeople. They have their own high-deductible insurance already. All they need to do is set up the HSA and they’d be better off.
Also very often, they tell me they hadn’t heard of HSA’s. Funny that. You’d think the insurers would be pushing these plans if they were so lucrative.
In Lohman’s world, the insurance companies make so much money off them. Where more than half the money that used to go to the insurance company, now goes to the employee directly in a HSA plan.
Yeah, that’s a good way for the insurance companies to make money.
I know what you’re afraid of. Not that HSA’s won’t work. You’re afraid they WILL work.
Jack Lohman
.
That’s absolutely rediculous. I’m on Medicare, I don’t care whether they work or not. And the only reason your employees like them is because the doctor business allows you to subsidize them down to the traditional co-pay level. 99% of employers do not do that. You are a hero!
.
Jack Lohman
.
And I would say, too, yours sounds like the typical “I’ve got mine, so you get your own” situation I see on a regular basis. But in this case it’s coming from a physician that is obviously benefitting well from the very system that’s screwing the public over. I now understand why you would remain anonymous.
.
Anonymous
Wow, I’m both a hero, and benefitting from the system that’s “screwing people over”.
A typical Lohman quote: “That’s BS, Anonymous. You simply don’t know what you are talking about.”
I remain anonymous because there are a lot of ignorant, nasty, bitter old men with time on their hands, who like to harass people if given the opportunity.
Jack Lohman
What an ignoramous. The “hero” comment was aimed at an arrogant doctor whose obviously high patient charges are being passed on to his employees in the form of subsidizing their HSA.
Get over yourself.
Anonymous
My HSA was a no-brainer. I have employees, and I offered healthcare with a PPO from a certain insurance company that’s a big regional player. I found I could offer the employees the same insurance, with a HDHP plan, fund their HSA to where they see the same deductible, and save money. I get the same insurance as my employees.
Subsequently, we changed to another insurance plan. Think of a color. Since this is not like, say, Kaiser or similar player, the insurance allows fairly unlimited choice of docs. I get patients all the time who say they had to change docs because of insurance. We don’t have that problem. Most docs sign with these insurances if they sign with anything at all.
Setting aside the scurrilous remark about how I charge patients, saving money is saving money. It’s cheaper. I put the money in their hands and not the insurance company’s hands.
If they leave employment, any money saved is theirs to keep. Even at our age, with kids, we find we do not always spend the entire deductible every year. So there is usually savings over time. If they choose, they can pay premium with savings via COBRA provisions, so they can retain insurance between jobs.
Will HSA’s disappear in the future? Who knows? The alternative? People who start them in their 20′s could well find they have enough saved by their 50′s, that they could fund the annual deductible off of interest from savings. So instead of insurance companies holding onto your money and investing it, the individual gets to hold onto the money and invest it.
I don’t feel sorry for the insurance companies. They will make money off HDHP’s that are used less often, as they don’t have to pay for an office visit for someone who rarely needs a doctor. Plus they are realizing that someone has to play bank and investment firm for the HSA funds saved, check processing, extra funds put into mutuals, etc.
How do you know my patient charges are “obviously high”? Have you seen my fee schedule? My “obviously high” patient charges are set by Medicare, Medicaid, and the insurance companies.
I’m sorry you think that’s arrogant, but that’s how it is.
Oh, and still waiting to hear about the “horror stories” associated with HSA’s.
Jack Lohman
Here’s just one that canme in today….
————-
My personal story is disturbing, though not necessarily for its impact on our family.
Because of our high claims, my employer was forced into a HDHP/HSA plan for 2005. Had we stayed with the PPO plan, it would have seriously hurt my employer financially.
I remember the option well. It was November 2004. We were offered a choice between two options:
1) Stay with our PPO. Total premiums would increase 36% and employee contribution would jump from $2200 to $4810/year.
2) Switch to HDDP. Total premium + max HSA contribution would still be 34% increase over previous year’s premiums, but at least $4,000 of that would be going pretax into an HSA.
Since we had to deal with massive cost shifting in either case, everyone chose what seemed like the lesser of two evils at the time and went with the HSA.
Personally, it has served our family fairly well. We’ve been able to find 3rd-party financial assistance in covering part of our deductibles and other out-of-pocket expenses when we hit our maximum every January, which lets us keep some money in our HSA. Then we can actually use some of that money for other things that are never covered by insurance — such as travel to/from medical conferences.
It has pretty much screwed everyone else, though. There are some that couldn’t afford the extra $4,000 of cost-shifting that first year (almost $6,00/year now), and have decided to roll the dice. Here are a few anecdotes picked up in water cooler conversation since the switch to the HDHP:
– coworker injured his ankle, but decided not to seek medical attention because it would cost a minimum of $500 for the doc, xrays, etc. and he didn’t want to spend that much for “just a sprain”
– coworker cut the back of his head open in a bicycle accident and had a friend stitch it up to avoid the ER expense
– coworker, recently hired, has a pregnant wife and not enough time to fund the HSA before his wife delivers. The annual deductible is now higher than the IRS will allow in annual HSA contributions and the max out-of-pocket is over $4000 higher than can be contributed. His first child was premature and spent time in the NICU, so they are at higher risk anyway. He is planning on paying several thousands of dollars on a credit card to cover the birth of this next child.
HDHP/HSAs are simply a nasty form of cost shifting that hits the people in the middle the hardest, resulting in delayed or substandard treatment and more financial problems for consumers. I worry that more businesses will be attracted to them simply because of the significant reduction in their outlay for premiums.
Anonymous
yawn.
Is that the best you can do?
- coworker injured his ankle, but decided not to seek medical attention because it would cost a minimum of $500 for the doc, xrays, etc. and he didn’t want to spend that much for “just a sprain”
That person showed up at my office, or the urgent care where I work part-time, the total cost, with X-rays, would be about two hundred. That’s assuming I even ordered X-rays based on clinical findings. Otherwise, it’s an office visit charge and a splint.
Of course, that part of the idea behind HSA’s. To encourage people to be more prudent with medical services.
- coworker cut the back of his head open in a bicycle accident and had a friend stitch it up to avoid the ER expense
About a hundred fifty bucks at my urgent care. Less in my office. Bet he spent more on beer or cigarettes or restaurants that month.
- coworker, recently hired, has a pregnant wife and not enough time to fund the HSA before his wife delivers. The annual deductible is now higher than the IRS will allow in annual HSA contributions and the max out-of-pocket is over $4000 higher than can be contributed. His first child was premature and spent time in the NICU, so they are at higher risk anyway. He is planning on paying several thousands of dollars on a credit card to cover the birth of this next child.
If deductible is higher than annual allowable contribution it does not sound like a qualified high-deductible plan and your story already sounds suspect. Legislation is in place to allow acceleration of contributions to HSA’s for the reason you allude to. We’ll see if the current Democratic Congress lets it through. So, what you get is medical costs that will be higher than deductible.
So, what do we see in regards to payment for services. Insurance pays some. Doc lets patient pay deductible at rate currently allowed. I can’t think of any doc I have met who would have a problem with a payment plan. Certainly I get patients with payment plans all the time.
If you choose the socialized system, you can find the government taking away your money in taxes AND denying you care. Here’s just one example. I could cite dozens.
http://nhsblogdoc.blogspot.com/2007/03/tale-of-two-cancers.html
Let’s see. Not getting X-ray for a sprain when indication is questionable in the first place (see Ottawa ankle rules), not willing to spend a hundred bucks for boo-boo on head, having to make a payment plan for high-risk pregnancy…….versus denied treatment for cancer.
Oh, yeah, you’ve convinced me.
Your profile says you’re retired. You got a lot of coworkers for a retired guy.
Anonymous
Four thousand dollar deductible going into HSA, divided monthly. Rough estimate, $333 a month.
The docs here in the group. You have a patient where they face a big procedure and there’s a cash flow problem. The patient says he’s getting HSA contributions of three hundred dollars a month that he’ll sign over. Would you say no?
I get patients making twenty dollar payments, I don’t think many docs would turn away a payment plan of hundreds of dollars a month.
Jack Lohman
I AM retired; my note said “this came in today.” read that, by email, from someone with the horror story you sought. Sorry it wasn’t a tearjerker. Let’s talk in a year after you’ve experienced your own problems.
Anonymous
I’ve had the HSA for several years now. Enough to get through major surgery. Chronic medical problems with kids, now better fortunately. It worked like it was supposed to. Deductible paid for with HSA funds, insurance kicked in when deductible met.
Since I now have savings that exceed deductible, I would not even have the cash flow problem of Example Three.
The medical issues aside, the financial issues were non-problems.
I see, though. The “horror story” was not yours, but you had to go out and solicit “horror stories”, if I understand you now. “Already the horror stories are emerging” you said, but you didn’t really have any. Sorta like the “99%” statistic of employers not funding HSA’s. You just make things up as you go along.
So you go out and look for some examples of problems, and the best you can find is people who put off inexpensive health care because they would not pay anything out of pocket. Your worst example is a high-risk pregnancy, where the person will go on a payment plan so the HSA can get funded.
Looks like I’ll be waiting a long time for you to come up with some facts to go with your mouth.
Jack Lohman
Yeah, Anonymous, I’m all wrong and you’re all right. We’ll see. But several things you should know:
1) My example was just the one I received yesterday, not the only one. I was not going to scour my inbox for this discussion.
2) You seem to believe that medical debt is going to take care of itself, as long as you can self finance your receivables. Good for you, but the bankruptcy attorneys likely disagree with you.
3) I said earlier “He who has the gold, rules. And that’s the corporations and they are already establishing their own co-op managed care companies. Get ready for corporate medicine, Anonymous, you won’t have another choice in five years.”
You seem unconcerned about where the system is heading. Good for you.
And in response to your earlier comment, I know that Medicare and Medicaid have caps, but the privates often reimburse up to quadruple those fees. So I’m guessing that you do alright, and if not, you can simply over-order to drive up income.
That said, however, most physicians are pretty fair with their billing, and according to one Minnesota survey 64% prefer a single-payer system.

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