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Man, can I kill a thread on health care reform or what?
The problem is when you ration preventive care by price, too little of this good/service is "consumed", especially if you are looking at the wider economy.
Think about the consequences of missing cancers or other problems.
1) Shorter working lives of people = less contribution to the economy
2) Increased curative costs = more unproductive costs to the economy
3) More absenteeism on the part of the sick= more costs for business
4) More absenteeism on the part of those who have to care for sick loved ones = more costs for business.
5) More sick uninsured = more bankrupcies from medical bills
Balanced against all of this is the ONE argument:
"But the government will waste all that money".
(shrugs)
Ok, for the sake of argument, let's assume that the government will waste a good chunk of money doing this. The costs of doing nothing are increasing at a rather alarming and measurable rate. How long before those costs are greater than the costs of this government waste?
the economic arguments for single payor systems far outweigh those stacked against it, from what I have seen.
Man, can I kill a thread on health care reform or what?
#4 is the kicker.
If I get sick, wife must stop working and care for me, and vice versa, and the same goes for either of our children.
We lose two incomes with no reserves if my wife or I get sick, and at least one income if it is one of our children.
I have insurance to mitigate these risks, but that insurance must be ultimately paid for, and is still probably inadequate.
Imagine the consequences for those who have no such insurance...
Where is anybody, except the truly wealthy, gonna find the $$$ to pay for for-profit medical care?
================
April 14, 2008
Co-Payments Soar for Drugs With High Prices
By GINA KOLATA
Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.
With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.
The system means that the burden of expensive health care can now affect insured people, too.
No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepa is C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.
Insurers say the new system keeps everyone’s premiums down at a time when some of the most innovative and promising new treatments for conditions like cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year.
But the result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.
The system, often called Tier 4, began in earnest with Medicare drug plans and spread rapidly. It is now incorporated into 86 percent of those plans. Some have even higher co-payments for certain drugs, a Tier 5.
Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson of Avalere Health, a research organization in Washington. It is the fastest-growing segment in private insurance, Mr. Mendelson said. Five years ago it was virtually nonexistent in private plans, he said. Now 10 percent of them have Tier 4 drug categories.
Private insurers began offering Tier 4 plans in response to employers who were looking for ways to keep costs down, said Karen Ignagni, president of America’s Health Insurance Plans, which represents most of the nation’s health insurers. When people who need Tier 4 drugs pay more for them, other subscribers in the plan pay less for their coverage.
But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”
Traditionally, the idea of insurance was to spread the costs of paying for the sick.
“This is an erosion of the traditional concept of insurance,” Mr. Mendelson said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”
And often, patients say, they had no idea that they would be faced with such a situation.
It happened to Robin Steinwand, 53, who has multiple sclerosis.
In January, shortly after Ms. Steinwand renewed her insurance policy with Kaiser Permanente, she went to refill her prescription for Copaxone. She had been insured with Kaiser for 17 years through her husband, a federal employee, and had had no complaints about the coverage.
She had been taking Copaxone since multiple sclerosis was diagnosed in 2000, buying a 30 days’ supply at a time. And even though the drug costs $1,900 a month, Kaiser required only a $20 co-payment.
Not this time. When Ms. Steinwand went to pick up her prescription at a pharmacy near her home in Silver Spring, Md., the pharmacist handed her a bill for $325.
There must be a mistake, Ms. Steinwand said. So the pharmacist checked with her supervisor. The new price was correct. Kaiser’s policy had changed. Now Kaiser was charging 25 percent of the cost of the drug up to a maximum of $325 per prescription. Her annual cost would be $3,900 and unless her insurance changed or the drug dropped in price, it would go on for the rest of her life.
“I charged it, then got into my car and burst into tears,” Ms. Steinwand said.
She needed the drug, she said, because it can slow the course of her disease. And she knew she would just have to pay for it, but it would not be easy.
“It’s a tough economic time for everyone,” she said. “My son will start college in a year and a half. We are asking ourselves, can we afford a vacation? Can we continue to save for retirement and college?”
Although Kaiser advised patients of the new plan in its brochure that it sent out in the open enrollment period late last year, Ms. Steinwand did not notice it. And private insurers, Mr. Mendelson said, can legally change their coverage to one in which some drugs are Tier 4 with no advance notice.
Medicare drug plans have to notify patients but, Mr. Mendelson said, “that doesn’t mean the person will hear about it.” He added, “You don’t read all your mail.”
Some patients said they had no idea whether their plan changed or whether it always had a Tier 4. The new system came as a surprise when they found out that they needed an expensive drug.
That’s what happened to Robert W. Banning of Arlington, Va., when his doctor prescribed Sprycel for his chronic myelogenous leukemia. The drug can block the growth of cancer cells, extending lives. It is a tablet to be taken twice a day — no need for chemotherapy infusions.
Mr. Banning, 81, a retired owner of car dealerships, thought he had good insurance through AARP. But Sprycel, which he will have to take for the rest of his life, costs more than $13,500 for a 90-day supply, and Mr. Banning soon discovered that the AARP plan required him to pay more than $4,000.
Mr. Banning and his son, Robert Banning Jr., have accepted the situation. “We’re not trying to make anybody the heavy,” the father said.
So far, they have not purchased the drug. But if they do, they know that the expense would go on and on, his son said. “Somehow or other, myself and my family will do whatever it takes. You don’t put your parent on a scale.”
But Ms. Steinwand was not so sanguine. She immediately asked Kaiser why it had changed its plan.
The answer came in a letter from the federal Office of Personnel Management, which negotiates with health insurers in the plan her husband has as a federal employee. Kaiser classifies drugs like Copaxone as specialty drugs. They, the letter said, “are high-cost drugs used to treat relatively few people suffering from complex conditions like anemia, cancer, hemophilia, multiple sclerosis, rheumatoid arthritis and human growth hormone deficiency.”
And Kaiser, the agency added, had made a convincing argument that charging a percentage of the cost of these drugs “helped lower the rates for federal employees.”
Ms. Steinwand can change plans at the end of the year, choosing one that allows her to pay $20 for the Copaxone, but she worries about whether that will help. “I am a little nervous,” she said. “Will the next company follow suit next year?”
But it turns out that she won’t have to worry, at least for the rest of this year.
A Kaiser spokeswoman, Sandra R. Gregg, said on Friday that Kaiser had decided to suspend the change for the program involving federal employees in the mid-Atlantic region while it reviewed the new policy. The suspension will last for the rest of the year, she said. Ms. Steinwand and others who paid the new price for their drugs will be repaid the difference between the new price and the old co-payment.
Ms. Gregg explained that Kaiser had been discussing the new pricing plan with the Office of Personnel Management over the previous few days because patients had been raising questions about it. That led to the decision to suspend the changed pricing system.
“Letters will go out next week,” Ms. Gregg said.
But some with the new plans say they have no way out.
Julie Bass, who lives near Orlando, Fla., has metastatic breast cancer, lives on Social Security disability payments, and because she is disabled, is covered by insurance through a Medicare H.M.O. Ms. Bass, 52, said she had no alternatives to her H.M.O. She said she could not afford a regular Medicare plan, which has co-payments of 20 percent for such things as emergency care, outpatient surgery and scans. That left her with a choice of two Medicare H.M.O’s that operate in her region. But of the two H.M.O’s, her doctors accept only Wellcare.
Now, she said, one drug her doctor may prescribe to control her cancer is Tykerb. But her insurer, Wellcare, classifies it as Tier 4, and she knows she cannot afford it.
Wellcare declined to say what Tykerb might cost, but its list price according to a standard source, Red Book, is $3,480 for 150 tablets, which may last a patient 21 days. Wellcare requires patients to pay a third of the cost of its Tier 4 drugs.
“For everybody in my position with metastatic breast cancer, there are times when you are stable and can go off treatment,” Ms. Bass said. “But if we are progressing, we have to be on treatment, or we will die.”
“People’s eyes need to be opened,” she said. “They need to understand that these drugs are very costly, and there are a lot of people out there who are struggling with these costs.”
==============
Get sick, or injured, in USA and you, even with expensive insurance, very often are
ed out of every last penny.
"studies have shown" that people with a serious sickness, even cured, never recover financially.
There is no correlation to a preventive care benefit and decreased claims.
There is no correlation (state by state) to number of doctors per capita (access to care) and life expectancy or health.
The only correlation is the more doctors, the more claims, the more cost - no subsequent increase in health.
I pay less than one third per capita to insure my over 65 employees than the govenment spends on Medicaire - and they opt for my plan because it has better benefits.
As soon as the United States Government gets involved you can toss out any type of "economic" benefit. There will be none. As expensive and out of control it is now; it WILL be worse. You know it, I know it, you just won't admit it.
There are other arguments for single payor, most of them on a equity based moral ideology (everybody ought to have the same healthcare) - but economics is one that only works in theory.
Also, since it is MY money you are spending - my personal and business taxes are going to pay for this panacea you are espousing. I guarantee you that I can insure my employees (probably with better coverage), and deal with all of that absenteeism (they all get Short AND Long Term Disability Insurance) you are concerned about for FAR less than the government is going to coersively take from me to pay for YOUR system.
OK, show me the evidence that it just isn't coincidence. Each has it's own cause and effect. Tort reform is not going to increase the numbers of the uninsured. What else did the government do? What else changed?Gee the numer of uninsured in Texas has risen since tort reform was passed be the state legislature 4 or 5 yrs ago..capped those damage claims so the evil trial lawyers can't gouge those poor innocent insurance companies..
you guys are ridiculous.
I was talking about those who already had 401K's to show the fear of loss wasn't right.
Different argument. Please keep up.
My God man.No knock on the upper income levels but just the facts..so now the income gap can continue to grow.. great plan ! now you and boner di-nasty can go nut hug each other..
Yes, you are knocking upper income people by insisting their tax dollars are fairly given to programs that help your desires.
Get off your jealousy rant. It's not healthy, it's divisive, it's unethical.
This is the land of opportunity. You have to make it happen for yourself. Nobody's going to hold your hand. Stop looking for hand-outs, and be your own man.
Doctors are the root of all problems in America and this survey just cements my belief that doctors support the terrorists.
croutons sits here and es about the insurance companies making big profits, screams for universal health care as a 'solution', and seems oblivious to the idea that if we have universal health care the insurance companies will make even more bank - they'll be getting everything they get now for 'premium' care for those who can afford it, and will take the money the government is passing on so as to not have to deal with the paperwork of dealing with hospitals and docs.
Like in other countries, the would be a national insurance plan, and expanded Medicare, that is receives mandated national health payments from everybody. If you're on welfare, part of your welfare check is taken for health coverage.
There would a national health care provider, an expanded Veterans' Administration. The staff would work for the govt, be salaried, no pay-for-piece work like now. Their priority is to provide health care, NOT make money. They may money from their salary, not from lab tests, prescriptions, etc like now.
If people wanted to afford private insurer, they buy additional insurance privately. They would still have to participate in the national plan.
All of this stuff exists in other countries and works a of a lot better than the US system and costs a of a lot less. It ain't pioneering rocket science.
Drug research/discovery/testing would be separate from mfring and mkting. New drugs would be bid upon by mfrs, sorta like the frequency spectrum auctions.
When I'm elected, I will do all of the above (but I can't because of dubya's deficits and debt service)
I suggest they survey doctors in countries where they already have a single-payer system; Britain or Canada, for instance.
For all of you who want UHC I would like you to see this video.
It will no affect me but for your younger people you have a long
row to hoe. You better get someone elected who has a little fiscal
responsibility. Now you know why Bush and his domestic programs
are not one of my favorite things.We are going broke
Link?
Further, my post was about health outcomes in general, not claims in particular.
If you are trying to make the argument that preventive care is somehow not cheaper than curative care, you will have to provide a LOT of substantiating evidence to support that.
I have already provided arguments that point out that you are currently paying for the uninsured anyways even without government taxing you to do so.
Do you understand how? (honest question, no sarcasm intended)
Is it ethical to benefit from something but not pay back into it, i.e. to take but not give?
Underwriters set it as such, that's how I know.
If I take a standard medical plan:
$500 Deductible/80% Co-Insurance/$1,500 Out of Pocket Maximum/$20 Doctor's Visit Co-Pay, etc.
and send that plan, along with census data on the group I want covered, and include any "serious" conditions in my report (diabetes, active cancer, heart disease and if it is at least 200 people), they will send me back an estimation as to what that group is going to cost for that benefit package for the next year. Their software and methodoligy is amazingly accurate, and is usually going to hit the target within 1 - 2 % points.
If I add a $500 - $1,000, or even unlimited, "wellness" benefit (which is the standard, and the norm, btw - almost all plans have them), the cost goes UP not down.
Not sure I can provide do entation to you, but it's what I do. I know it's counterintuitive, but those are the facts.
Now, if the government took control; it could do something the insurance companies are not allowed to do: Mandate well care (people HAVE to go get physicals, etc. by force of law). That MIGHT help; but usually, if you go into a physical, and tell the doctor you feel fine, he isn't going to find anything, even if it's there. My dad went to the doctor in October of '03 for a physical, and was given a clean bill of health. In April '04 he died of cancer (ran up $750,000 in bills in the interim).
Hey, maybe I should stand corrected. Maybe there is more to
this Universal Health Care than I was aware of. Seems that
they take care of everything. Nawh, it wouldn't work here,
someone would complain.
Call Girls at Nursing Home Fuel Debate in Denmark (Update1)
By Christian Wienberg
April 16 (Bloomberg) -- When a male resident at Kildegaarden nursing home in Denmark made an indecent sexual proposal to a member of the staff, the home's director, Inger Marie Kristensen, told a nurse to telephone for a pros ute.
``There was a considerable change in his demeanor after the escort girl had paid him a visit,'' Kristensen said in an interview. ``We do this for our clients just as we offer them other services that they need as human beings.''
Kildegaarden, located 100 miles (160 kilometers) west of Copenhagen in Skanderborg, has about 100 residents, including victims of Alzheimer's disease and strokes. Nurses arranged visits by call girls three times in the past three years.
While Welfare Minister Karen Jespersen says Denmark's 98 municipalities are free to let nurses call pros utes, some lawmakers are stepping up efforts to pull women out of the profession, which has been legal in the country since 1999.
``I don't want to contribute to keeping this industry in business,'' said Mie Bergmann, an elected official with the Social-Liberal Party in Skanderborg, who led a failed vote to end pros ution at Kildegaarden.
Denmark is doubling spending to 80 million kroner ($17 million) over the next three years to get women out of the sex trade. The government estimates that 6,000 women work in the profession in the Scandinavian country of 5.5 million.
`Discriminating'
Copenhagen forbids contact with call girls in nursing homes. Other towns don't publicize their policies.
In a poll posted last week on the Web site of national broadcaster DR, 46 percent of 1,982 readers said nursing home staff should be able to organize visits by pros utes, 45 percent were against the practice and 8 percent were undecided. A margin of error wasn't given.
Denmark's Society for Women started a campaign in March called ``Take a Position, Man'' urging men to sign up at a Web site to protest against pros ution. So far, 1,887 women and men, including the editor-in-chief of newspaper Politiken Thoeger Seidenfaden, have signed.
The Copenhagen-based Danish Sex-worker Association was established last month in a bid to protect the industry. The leader, who gives her name only as Susanne on the association's Web site, said pros utes ``often'' visit Danish elderly homes.
``To forbid vulnerable customers from obtaining the services of a legal business is discriminating, both against the sex workers and the people who need help to get the services,'' Susanne said in an e-mailed response to questions.
Ban Proposal
An increasing number of Danes oppose pros ution, a December 2006 opinion poll by newspaper Politiken showed. Forty- two percent of 1,180 said pros ution was unacceptable compared with 25 percent four years earlier. A majority of 54 percent approved of pros ution, compared with 66 percent in 2002.
``I don't want a society where some people are used as a vehicle for others to live out their desires,'' Ozlem Sara Cekic, a Danish Turkish member of parliament for the Socialist People's Party, said in comments posted on her Web site.
The Danish People's Party, which backs the minority Liberal- Conservative government in parliament, said earlier this year it may join opposition lawmakers to form a majority in favor of a ban on the sex trade.
The parliamentary committee for social affairs announced this year that it's planning a trip to neighboring Sweden to investigate how that country has handled legislation it passed in 1999 that criminalized paying for sex.
For Kristensen, residents at the Kildegaarden home have rights under the current laws, no matter how old they are. And Danes are getting older. According to the Danish government Web site, on Jan. 1, 2007, 715 people were 100 years of age or more.
``Basically this is a matter of respecting the elderly and their needs,'' she said.
To contact the reporter on this story: Christian Wienberg in Copenhagen at [email protected]
Last Updated: April 15, 2008 20:44 EDT
O.K. Ray, I'm SOLD!
Let's get us some universal coverage (then maybe 93 year olds in Cali. wouldn't be picked up for solicitation)
So all of those commercials run by the GOP during the election cycle that brought us tort reform were incorrect? I don't seem to remember any caveats to the advertisements rather I distinctly remember the reform was to lower malpractice insurance and punish evil trial lawyers. So now you are telling me that those adds were bull ..we were lied to?
Your second question related to what the govt did? Uh skippy Texas has been blood red for a while so I guess if the republican dominated legislature and governorship were out to get those insurance companies they did. Of course it was the same govt who passed the legislation.... The free market has slowly shrunken the pool of insured AS IT IS and you want to give the market free rein?
You speak of the land of opportunity.. well mechanics are hard working productie citizens but on avg they may not make enough to afford insurance? So I guess your response is that they chose to ne mechanics and if they can't afford coverage then they should hit the emergency room..
bump. cause it's relevant again.
"it's relevant again."
... was never irrelevant, will be relevant forever, because the people whose _INCOME_ is the $3T/year national health will never permit cost (their revenue) reductions, will only continue to organize the health care industry to generate more profits from delivering less care to fewer people.
So the media talks about the highly relevant ... fist bumping.
Beats the out of listening about Britney Spears 24/7
I am a news junkie but I have a 2 second rule when it comes to listening to someone blather about their opinions on this or that in politics and the news.
That's why I try to get all of my news direclty from AP/Reuters and the source.
All cable news does is just read those and maybe send their own reporters to look into stuff that someone else reported on anyways.
Is it ethical to benefit from something, but never give back into the system that you benefitted from?
yeah sure, AP/Reuters are really unbiased. Not that there is anything wrong with bias. Everyone is. And I like my news biased, you get a clearerBeats the out of listening about Britney Spears 24/7
I am a news junkie but I have a 2 second rule when it comes to listening to someone blather about their opinions on this or that in politics and the news.
That's why I try to get all of my news direclty from AP/Reuters and the source.
All cable news does is just read those and maybe send their own reporters to look into stuff that someone else reported on anyways.
picture of what is really going on. From both sides. Although I like Drudge, not his reporting, but his website and links.
For years, I was a contract analyst and a gatekeeper for DOD, TMOP and VA pharmaceutical contracts. The Feds are absolutely ruthless in their pricing and contract demands. There isn't a GPO on the planet that can touch their contract pricing and woe be unto the company that screws their pricing up. , they'd give WalMart a run for their money when it comes to negotiating pricing. The government can be damned effective when they want to be.
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