It has been many years since we have paid for health insurance, so I have been out of the loop on what my friends and family have to pay for their health care. I am not even sure what percentage an employer pays for their employees' insurance premiums. If you feel comfortable sharing how health care factors into your benefits package, that would be great.
I have wondered how much people spend on insurance as compared to what they would spend just paying the doctor fee for service. With a quick online application, I discovered that, without any help from an employer, we would pay at a minimum $21K/year for comprehensive coverage. This price does not include maternity and the breakdown leaves out the 20% of any hospitalizations after the $15,000 family deductible, unexpected ER visits, antibiotics for when we are sick. The $20K annual out of pocket expense limit includes the deductible, but not the premiums. Here's the breakdown:
$436 monthly premium X 12: $5232 (I'm assuming the premium covers all 6 of us and is not per person)
$7500 deductible X 2 People (for the family rate): $15,000
$30 office visit X 2 visits per person each year: $360 (This includes 1 physical and 1 sick appt)
$15 Rx Co-Pay X 7 meds we get each month X 12: $1260
This is where the employer benefits come in. How much do they pay of this cost? Is this really what people pay?
I also looked at buying only the insurance plan that covers hospital stays, surgery, etc. It allows you to have a Health Savings plan, and I thought it would be much less expensive than the regular route. Here's the breakdown:
$10,000 deductible
$430 premium X 12: $5160
Once you hit your $10,000 deductible for the family, you pay nothing out of pocket. It turns out to be less expensive, but only if you would actually spend that much money on health care costs and spend it early in the year. Since you are paying cash to the dr until you hit your deductible, would they give you a price break? Neil says no because they would still have to turn that claim in to your insurance company to verify that you are paying your way up to your deductible and that the dr could get sued by the insurance company for charging you a rate lower than they charge the insurance company. Could you still use the $4 generics price at Wal-Mart with this insurance?
Just a thought. I recently read an idea for controlling costs: avoiding building new hospitals where there is no need. Apparently in New York or Texas (the paper did not specify), a hospital administrator wanted a transplant service and wing at his hospital, but the local and state governments turned him down because there were three other transplant services in the vicinity. So the administrator appealed to a state congressman with whom he had political ties, and the new hospital service and wing were on their way. If the gov't pays for health care costs, or if the costs are run through the gov't, there won't be any new shiny hospital wings operating at less than capacity.
Tuesday, March 23, 2010
Tuesday, March 16, 2010
Health Care, Part IV: Doctors and access to care
How about this: Obama and subsequent Presidents can forgo all but $100K of their $400K salary each year, reduce their travel budget to $10K from $19K each year, and their entertainment fund can be taken from part of the salary that they are forgoing instead of needing it's own budget. That would buy a lot of health insurance for people with pre-existing conditions. If you want cheap healthcare, and you don't mind doctors getting up to -41% pay raise from CMS/HHS over the next decade, then the president and congress can do the same with their salaries. BTW, did you know that Congressmen's 401 Ks are matched by the federal gov't, but military members are not? I wonder why people are fine with doctor's salaries going down? Is it because they believe that it's not fair for someone else to make money? Should we be fine with everyones' salaries going down? That's the slippery slope we are on.
Who willingly goes into a career where they can expect negative pay increases? I get that some people have experienced unemployment or underemployment in the last two years. It stinks on ice. So people look at that field and say, "Wow, that field is shrinking. I better go into something else so that I can find a job to feed my family."
That will happen to doctors. There will not be enough people going in to medicine, willing to put themselves through what we have done-a total, after Neil finishes at Harvard, of 17 years of school/training after high school- if they know that their income will shrink every year for the foreseeable future. Your best and brightest will figure out that if they are making $40K, they will not work past 4:30. They are not going to want to work until 7 every night or work on weekends missing out on life. They will not even be able to live comfortably and still pay back their medical school loans and credit card bills that they racked up while their peers were out working at a well-paying job. Less people will go into medicine with a single payer system, so with less doctors, you will have access issues. Or you might, instead, have hospitalists that work for the hospital, not the patient, and then you lose continuity of care, or seeing the same provider that you always go to. It won't matter because your records are on the computer, but there is something to be said for having a dr know their patients, especially in peds and geriatrics. Also, if the patient is not the customer, and the govt or an insurance company is, then the patient loses in customer service, at least.
Or on a positive side, drs would feel no need to rush through seeing patients because they get paid regardless of how much time they spend with a patient. The patient is happy because they feel they have been listened to, thoroughly worked over for their illness, but you cannot see as many patients in one day at that rate.
Thanks for reading through my thoughts. If there are errors, please comment. If there are grammatical errors, please overlook them. Audrey has been helping my type for the last two days, and I am out of time for editing and revising.
Who willingly goes into a career where they can expect negative pay increases? I get that some people have experienced unemployment or underemployment in the last two years. It stinks on ice. So people look at that field and say, "Wow, that field is shrinking. I better go into something else so that I can find a job to feed my family."
That will happen to doctors. There will not be enough people going in to medicine, willing to put themselves through what we have done-a total, after Neil finishes at Harvard, of 17 years of school/training after high school- if they know that their income will shrink every year for the foreseeable future. Your best and brightest will figure out that if they are making $40K, they will not work past 4:30. They are not going to want to work until 7 every night or work on weekends missing out on life. They will not even be able to live comfortably and still pay back their medical school loans and credit card bills that they racked up while their peers were out working at a well-paying job. Less people will go into medicine with a single payer system, so with less doctors, you will have access issues. Or you might, instead, have hospitalists that work for the hospital, not the patient, and then you lose continuity of care, or seeing the same provider that you always go to. It won't matter because your records are on the computer, but there is something to be said for having a dr know their patients, especially in peds and geriatrics. Also, if the patient is not the customer, and the govt or an insurance company is, then the patient loses in customer service, at least.
Or on a positive side, drs would feel no need to rush through seeing patients because they get paid regardless of how much time they spend with a patient. The patient is happy because they feel they have been listened to, thoroughly worked over for their illness, but you cannot see as many patients in one day at that rate.
Thanks for reading through my thoughts. If there are errors, please comment. If there are grammatical errors, please overlook them. Audrey has been helping my type for the last two days, and I am out of time for editing and revising.
Health Care, Part III: The public option
Eventually the scenario will occur where most everyone is paying for the public option. Would the govt be able to sustain the low rates, go without the overhead and profit, with an entire country to cover? It sounds like a great plan and something that should work, but is it wise to change the entire system when it might not work. How can they undo this if the financials don't work out as planned, if it costs more for the govt to run the healthcare system than they thought it would.
Or what if some other govt agency takes the money earmarked for health care? It has been known to happen before. Roads in San Antonio received funding, but the money was taken to pay for other things; Children Health Insurance Plan was given funding in Texas from Tobacco lawsuits, but the money went elsewhere. Education funding was supposed to come from the new state Lottery... See a pattern? Is it possible that this happens in other states as well? Ask the people in Oklahoma and Illinois who are fixing to be asked by their state gov'ts to pay $9K and $32K respectively.
This entire issue all comes down to a person's fundamental belief in either competition among insurance companies and less federal regulation leading to better practices or the gov't taking over and coming up with their own best practices. My money is not on the federal gov't. Sorry.
There are many things wrong with this huge industry, and I think people would be glad to support some of these reform measures right now. This would give Washington more political capital to work out the larger problems without the rush we have experienced in the last six months.
One concern that so many people have with this particular version of reform is the fact that someone has gone on the record as saying they are going to pole vault over the People to get this done. Wow, that doesn't sound right! I think it makes people defensive and wonder why they would need to do that if it was the right action.
I'm still offended by Obama's comments at the State of the Union where he said that people against his health care reform are wondering what's in it for them. He needs to get a clue. Even if congress and the president are being 100% up front about everything, the people are pushing back hard because their ability to choose is being taken away from them.
If I thought that our gov't could do something efficiently and streamlined, I might agree with you. Our family has been on a govt insurance plan three times: SChips for my kids, medicaid for myself, and tricare. I love free or reduced cost health care and I think many people love the idea of not paying very much for health care. But if this became the norm, you would get what you paid for, in terms of updated equipment and meds and caliber of dr.
Another thought is that the health care providers in the military are great, but the military medicine system is so large that it is hard to change course, to update, to somehow make decisions based on a short-term and long-term basis. There tend to be access issues due to the sheer volume of patients.
On the other hand, China is a great country to look at as they try to combine socialism with capitalism. Because the Chinese govt does not worry about political games, they are free to consider the long term. China obviously has socialized medicine, but they are attempting to update that system and offer other options. Is it possible for the private system to run side by side with a public option? Watch China, but don't write anything bad about them on the internet.
My overarching concern with this bill is financial: most people who oppose this bill worry about the cost. Will it really be as inexpensive as they say it will, where will the money really come from? Would it be possible to set aside tax revenue and premium payments without other gov't agencies taking it? Also, people look at the Social Security program and even state pensions and wonder how we will fund healthcare if we can't fund these other programs.
The gov't just does not have a great track record as far as keeping costs low. Ask Hillary Clinton who recently authorized $5.4 million dollars in lead-free cyrstal for freaking entertaining at American embassies around the world. Really? My left-leaning friends wonder why I worry about health care costs staying affordable and this legislation staying under budget.
BTW, look for the picture of Obama on the Great Wall of China shaking hands with some diplomat. Read Obama's body language and tell me what you think he's saying. That's the next bump on the horizon.
Or what if some other govt agency takes the money earmarked for health care? It has been known to happen before. Roads in San Antonio received funding, but the money was taken to pay for other things; Children Health Insurance Plan was given funding in Texas from Tobacco lawsuits, but the money went elsewhere. Education funding was supposed to come from the new state Lottery... See a pattern? Is it possible that this happens in other states as well? Ask the people in Oklahoma and Illinois who are fixing to be asked by their state gov'ts to pay $9K and $32K respectively.
This entire issue all comes down to a person's fundamental belief in either competition among insurance companies and less federal regulation leading to better practices or the gov't taking over and coming up with their own best practices. My money is not on the federal gov't. Sorry.
There are many things wrong with this huge industry, and I think people would be glad to support some of these reform measures right now. This would give Washington more political capital to work out the larger problems without the rush we have experienced in the last six months.
One concern that so many people have with this particular version of reform is the fact that someone has gone on the record as saying they are going to pole vault over the People to get this done. Wow, that doesn't sound right! I think it makes people defensive and wonder why they would need to do that if it was the right action.
I'm still offended by Obama's comments at the State of the Union where he said that people against his health care reform are wondering what's in it for them. He needs to get a clue. Even if congress and the president are being 100% up front about everything, the people are pushing back hard because their ability to choose is being taken away from them.
If I thought that our gov't could do something efficiently and streamlined, I might agree with you. Our family has been on a govt insurance plan three times: SChips for my kids, medicaid for myself, and tricare. I love free or reduced cost health care and I think many people love the idea of not paying very much for health care. But if this became the norm, you would get what you paid for, in terms of updated equipment and meds and caliber of dr.
Another thought is that the health care providers in the military are great, but the military medicine system is so large that it is hard to change course, to update, to somehow make decisions based on a short-term and long-term basis. There tend to be access issues due to the sheer volume of patients.
On the other hand, China is a great country to look at as they try to combine socialism with capitalism. Because the Chinese govt does not worry about political games, they are free to consider the long term. China obviously has socialized medicine, but they are attempting to update that system and offer other options. Is it possible for the private system to run side by side with a public option? Watch China, but don't write anything bad about them on the internet.
My overarching concern with this bill is financial: most people who oppose this bill worry about the cost. Will it really be as inexpensive as they say it will, where will the money really come from? Would it be possible to set aside tax revenue and premium payments without other gov't agencies taking it? Also, people look at the Social Security program and even state pensions and wonder how we will fund healthcare if we can't fund these other programs.
The gov't just does not have a great track record as far as keeping costs low. Ask Hillary Clinton who recently authorized $5.4 million dollars in lead-free cyrstal for freaking entertaining at American embassies around the world. Really? My left-leaning friends wonder why I worry about health care costs staying affordable and this legislation staying under budget.
BTW, look for the picture of Obama on the Great Wall of China shaking hands with some diplomat. Read Obama's body language and tell me what you think he's saying. That's the next bump on the horizon.
Healthcare, Part II: Pre-existing conditions and the Self-Employed
Obama has politicized and dramatized the coverage extended for pre-existing conditions. His Organizing for America website asked people to submit videos of showing pictures of loved ones who suffered when their pre-existing conditions were not covered. I heard that it was quite the emotional outpouring.
My guess is that people do not usually have their pre-existing conditions covered for the first year at a new insurance company. Or else they are not covered at all. Either way, families are left to pay for COBRA. My dad, who has a job with the City of Houston, pays $600/month plus deductible and copay. I can only imagine what that would cost for a family. It is an unfortunate problem.
The risk of a person with pre-existing conditions needing money from the insurance pool is 100% , so their cost to the insurance company are going to be higher than the average Joe. Insurance companies' main concern is minimizing risk, and if the risk of a patient/consumer is 100%, they are at an impasse. If that person is indigent or over 65, they already have access Medicaid/Medicare. Otherwise, the cost to treat their illness is spread to the rest of the insurance pool, and rates go up for everyone.
My Facebook friend suggested this: when everyone who has a pre-existing condition gets into the gov't insurance pool, they will pay their premiums to the gov't, and the cost will spread and be equally carried by the patients themselves. They will leverage the size of their group and more people will be paying less. If that works, great.
Insurers will not cover people with pre-existing conditions because they cut into the company's profit margin by filing more claims and because the insurance company needs to consider their shareholders. This is the rationale for taking health care out of the for-profit sector. The assumption is that the govt would not be out to make a profit, so they can take all of these pre-existing condition patients, cover their health care needs because they would not have to jack up the rates to cover a profit margin. BlueCross/BlueShield of NC reportedly posted a 2% profit margin last year. I am not sure what their overhead was, but windfall profits these are not.
Could the govt plan keep their costs low enough to make it affordable or would they have to add those people to the dole?
Would it be possible to take a group of people who are not joined geographically or by a common business, and increase their leverage to that of a large company? There is a saying that goes something like this, "Where does the 700 pound Gorilla sit? Where ever it wants." This is how you work with insurance companies: a large group of people and large groups of doctors have more to leverage against the insurance company. But the need for this approach might become obsolete with this new bill.
I just do not understand why the gov't is the only solution that people can come up with for this problem? This is another opportunity for someone to earn a living, feed their family: come up with this kind of plan. Surely someone has already thought of this...
My guess is that people do not usually have their pre-existing conditions covered for the first year at a new insurance company. Or else they are not covered at all. Either way, families are left to pay for COBRA. My dad, who has a job with the City of Houston, pays $600/month plus deductible and copay. I can only imagine what that would cost for a family. It is an unfortunate problem.
The risk of a person with pre-existing conditions needing money from the insurance pool is 100% , so their cost to the insurance company are going to be higher than the average Joe. Insurance companies' main concern is minimizing risk, and if the risk of a patient/consumer is 100%, they are at an impasse. If that person is indigent or over 65, they already have access Medicaid/Medicare. Otherwise, the cost to treat their illness is spread to the rest of the insurance pool, and rates go up for everyone.
My Facebook friend suggested this: when everyone who has a pre-existing condition gets into the gov't insurance pool, they will pay their premiums to the gov't, and the cost will spread and be equally carried by the patients themselves. They will leverage the size of their group and more people will be paying less. If that works, great.
Insurers will not cover people with pre-existing conditions because they cut into the company's profit margin by filing more claims and because the insurance company needs to consider their shareholders. This is the rationale for taking health care out of the for-profit sector. The assumption is that the govt would not be out to make a profit, so they can take all of these pre-existing condition patients, cover their health care needs because they would not have to jack up the rates to cover a profit margin. BlueCross/BlueShield of NC reportedly posted a 2% profit margin last year. I am not sure what their overhead was, but windfall profits these are not.
Could the govt plan keep their costs low enough to make it affordable or would they have to add those people to the dole?
Would it be possible to take a group of people who are not joined geographically or by a common business, and increase their leverage to that of a large company? There is a saying that goes something like this, "Where does the 700 pound Gorilla sit? Where ever it wants." This is how you work with insurance companies: a large group of people and large groups of doctors have more to leverage against the insurance company. But the need for this approach might become obsolete with this new bill.
I just do not understand why the gov't is the only solution that people can come up with for this problem? This is another opportunity for someone to earn a living, feed their family: come up with this kind of plan. Surely someone has already thought of this...
Monday, March 15, 2010
Yard Fairies and a novel about Health Care
It has taken two guys, a sitting lawn mower, two blowers, a tarp and the bed of a pick up truck, working since 10AM. As of 4:30 Pm, they still were not done. This is probably the best money I have ever spent because it's now obvious to me that I could never have done this on my own. Money can't buy happiness, but I sure feel better knowing that my yard is not harboring snakes under all those leaves. Did I mention that I paid the guys at noon, and they continued to work hard all afternoon? That is integrity.
Here are my current thoughts on health care. I posted some of this on a friend's Facebook page.
Here are my current thoughts on health care. I posted some of this on a friend's Facebook page.
Thursday, March 11, 2010
Reading List
I have read some amazing books in the last month. Everyone should read these books!
1) Megatrends China: Written by a guy with the last name Nesbitt. He wrote the original Megatrends in the early 1980's. I read this book in 6th grade, and developed a city of the future as an enrichment project. I picked up Megatrends China at the library just because I recognized the title from back in the day. Megatrends China was written by an American and his European wife, but most of the research was done by Chinese business students. The facts were taken from a database that they compiled and translated into English. The database was taken from all mediums of news reports, print, television, and the internet. The data is a compilation of the way the Chinese view themselves. After reading this book, China is my new 2nd favorite country. My favorite idea was "Borrowing Arrows." I will come back to its relevance in modern business policies. "Borrowing Arrows" comes from a story about some Chinese dynasty's army that was stuck on one side of the river without any arrows left to fight the bad guys. So they tied a rope to a canoe, filled it with straw and it sent it out into the river. The morning was foggy, and, due to the low visibility, the bad guys assumed the canoe was filled with warriors. They shot arrows into the canoe. Once enough arrows filled the straw, the good guys pulled the canoe back to their side with enough arrows to finish off the bad guys. If you know anything about China's current events, you will see the application to their business sector.
2) The Aid Trap, written by Hubbard et al. This is my dream job described in a book. I even emailed one of the authors, and he thought I had good questions about the book. It has a concise history of economic systems as well as the international charitable giving paradigm. The essence of this book is that all of the money poured into developing countries since the 1970s has not served to raise the world's poor out of poverty. Even the UN's Millenium Plan to bring the world out of poverty by 2015 is not going to happen on time. Instead, the authors say that we should pattern aid after the Marshall Plan. I had heard of the plan, but had to Google it. Charitable organizations should stick with emergency aid, food, refugees, etc, but not development. The Marshall Plan lent money to businesses in Europe after WWII. Their plan calls for the same format. The businesses, in turn, would repay the loans to their respective governments. The federal governments have to agree to the rules in order to qualify for this investment. The money has to be spent on infrastructure or other programs that lead to stability and business development in their country. If we believe in Capitalism and pro-business measures in America, why do we thwart the business sector of the countries we want to help? Or if you are Bono, and do not believe in Capitalism, but still move your business to another country entirely when your hometown decides to start taxing you, this still applies to you. If a foreign charity comes into a poor country and builds a well, that's great. But then the well breaks, and they have to wait for another charity to come along and build a well. What if, instead, we give a loan for a well-building business, facilitate education and training through grants and American professional societies and universities, and allow the local guy to build the well and earn the money? Then he can feed his family, employ others, and pay taxes to his government. What a concept. The authors use China and India as examples in this book, and the references made more sense to me after reading Megatrends China.
If you read my blog on a regular basis, you already know what a dork I am. So it should come as no surprise to you that this idea practically brings me to tears. Working for the Auxiliary last year taught me that if I am going to spend all day going to meetings, answering emails, and putting out fires, it had better be for something worthwhile. Could rebuilding a country and lifting millions of people out of poverty be any more amazing? I am going back to school in Boston so that I can be ready when someone takes the concepts from this book and actually starts a business. Or, I would like to run a Food Bank. Yes, I aim high. I know.
3) Socialnomics. Author unknown at the moment. I'll have to get back to you, or you could Google it as I am currently sitting in on a conference call from San Antonio where my friends are planning the 10th Annual BAMC Auxiliary Charity Golf Tournament. (It was all great until I heard that the newest Marriot Golf Course and Convention Center is hosting a tournament and Gala at the end of March. The tickets are $800, including golf, the gala and a hotel room. This is all benefitting the CFI and the Ft Sam Hoston Fisher House. Why are my friends going through the trouble now? Maybe the Fisher House manager should have mentioned this other charity golf tournament back in September when my friends started meeting for our tournament.) Moving on, this book describes the effect of social media on economics. There is a paradigm shift in marketing, production, and revenue streams due to internet sites like Facebook, Twitter, Youtube. A key point of the book is that Barak Obama would not be the President if not for the masterful work of leveraging social media. The author cites the number of times Obama was mentioned on social networking sites the last month before the election. He dwarfed McCain on those sites. By a huge margin. Another point was that you either life your life more fully because it sounds cooler to post that you went snowboarding on Facebook instead of sitting around watching reality tv re-runs. Or you tamed your life down because you did not want your bad choices going viral on Youtube. People get fired over things like that.
Coincidentally, I just read a report by NY Times publisher that says their opinion is that we, the public, should not expect to view things online for free. (Did they forget that I already pay for the internet in my cable bill and on my phone? If they wanted to make money off the internet, then they are in the wrong industry. They deliver news, not the internet.) Nonetheless, they are going back to charging us to read news on their websites. How about this: NY Times charges you for the news while I study up real hard, find the news, write it on my blog where you can read it for free. And then I have so much traffic on my blog that I get someone who will pay to advertise on my blog. Which sounds more likely?
1) Megatrends China: Written by a guy with the last name Nesbitt. He wrote the original Megatrends in the early 1980's. I read this book in 6th grade, and developed a city of the future as an enrichment project. I picked up Megatrends China at the library just because I recognized the title from back in the day. Megatrends China was written by an American and his European wife, but most of the research was done by Chinese business students. The facts were taken from a database that they compiled and translated into English. The database was taken from all mediums of news reports, print, television, and the internet. The data is a compilation of the way the Chinese view themselves. After reading this book, China is my new 2nd favorite country. My favorite idea was "Borrowing Arrows." I will come back to its relevance in modern business policies. "Borrowing Arrows" comes from a story about some Chinese dynasty's army that was stuck on one side of the river without any arrows left to fight the bad guys. So they tied a rope to a canoe, filled it with straw and it sent it out into the river. The morning was foggy, and, due to the low visibility, the bad guys assumed the canoe was filled with warriors. They shot arrows into the canoe. Once enough arrows filled the straw, the good guys pulled the canoe back to their side with enough arrows to finish off the bad guys. If you know anything about China's current events, you will see the application to their business sector.
2) The Aid Trap, written by Hubbard et al. This is my dream job described in a book. I even emailed one of the authors, and he thought I had good questions about the book. It has a concise history of economic systems as well as the international charitable giving paradigm. The essence of this book is that all of the money poured into developing countries since the 1970s has not served to raise the world's poor out of poverty. Even the UN's Millenium Plan to bring the world out of poverty by 2015 is not going to happen on time. Instead, the authors say that we should pattern aid after the Marshall Plan. I had heard of the plan, but had to Google it. Charitable organizations should stick with emergency aid, food, refugees, etc, but not development. The Marshall Plan lent money to businesses in Europe after WWII. Their plan calls for the same format. The businesses, in turn, would repay the loans to their respective governments. The federal governments have to agree to the rules in order to qualify for this investment. The money has to be spent on infrastructure or other programs that lead to stability and business development in their country. If we believe in Capitalism and pro-business measures in America, why do we thwart the business sector of the countries we want to help? Or if you are Bono, and do not believe in Capitalism, but still move your business to another country entirely when your hometown decides to start taxing you, this still applies to you. If a foreign charity comes into a poor country and builds a well, that's great. But then the well breaks, and they have to wait for another charity to come along and build a well. What if, instead, we give a loan for a well-building business, facilitate education and training through grants and American professional societies and universities, and allow the local guy to build the well and earn the money? Then he can feed his family, employ others, and pay taxes to his government. What a concept. The authors use China and India as examples in this book, and the references made more sense to me after reading Megatrends China.
If you read my blog on a regular basis, you already know what a dork I am. So it should come as no surprise to you that this idea practically brings me to tears. Working for the Auxiliary last year taught me that if I am going to spend all day going to meetings, answering emails, and putting out fires, it had better be for something worthwhile. Could rebuilding a country and lifting millions of people out of poverty be any more amazing? I am going back to school in Boston so that I can be ready when someone takes the concepts from this book and actually starts a business. Or, I would like to run a Food Bank. Yes, I aim high. I know.
3) Socialnomics. Author unknown at the moment. I'll have to get back to you, or you could Google it as I am currently sitting in on a conference call from San Antonio where my friends are planning the 10th Annual BAMC Auxiliary Charity Golf Tournament. (It was all great until I heard that the newest Marriot Golf Course and Convention Center is hosting a tournament and Gala at the end of March. The tickets are $800, including golf, the gala and a hotel room. This is all benefitting the CFI and the Ft Sam Hoston Fisher House. Why are my friends going through the trouble now? Maybe the Fisher House manager should have mentioned this other charity golf tournament back in September when my friends started meeting for our tournament.) Moving on, this book describes the effect of social media on economics. There is a paradigm shift in marketing, production, and revenue streams due to internet sites like Facebook, Twitter, Youtube. A key point of the book is that Barak Obama would not be the President if not for the masterful work of leveraging social media. The author cites the number of times Obama was mentioned on social networking sites the last month before the election. He dwarfed McCain on those sites. By a huge margin. Another point was that you either life your life more fully because it sounds cooler to post that you went snowboarding on Facebook instead of sitting around watching reality tv re-runs. Or you tamed your life down because you did not want your bad choices going viral on Youtube. People get fired over things like that.
Coincidentally, I just read a report by NY Times publisher that says their opinion is that we, the public, should not expect to view things online for free. (Did they forget that I already pay for the internet in my cable bill and on my phone? If they wanted to make money off the internet, then they are in the wrong industry. They deliver news, not the internet.) Nonetheless, they are going back to charging us to read news on their websites. How about this: NY Times charges you for the news while I study up real hard, find the news, write it on my blog where you can read it for free. And then I have so much traffic on my blog that I get someone who will pay to advertise on my blog. Which sounds more likely?
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Obama's "Organizing for America" is a great website. You can find it at www.barakobama.com. I might not be in agreement with the content, but I am amazed at the how the website forwards his plans. Obama does new media very well. You should check it out, even if it is to see what you are up against. Many people could learn from how he allocates resources to interact with people via new media, for example, blogs and interactive websites, Youtube, Facebook and Twitter. Apparently he is the first President to keep his Blackberry and maintain his own email communication. From what I have read, his blackberry is James Bond-esque in it's security apps and his email address is known only to a select few.
I agree that there is a need for health care reform, but this version is not the best alternative. Health care reform is a huge problem with complicated solutions. I agree with Obama that the Reps had 8 yrs to do something, but they didn't. My guess is that they knew it was a complicated issue in ways that are technical, financial, and emotional. While I have not researched this, it is possible that political donations, lobbyists, and the overwhelming representation of lawyers in Congress have prevented them from tackling this issue before now. The more I research, the more I find that there is still to learn.
I read last night, and need to do more research to verify this, but the federal govt decided at some point in the past that if a doctor accepted cash, or what is called now "fee for service", they had to pay higher taxes on that amount than if an insurer paid a claim to them. It is my opinion that there are huge ramifications if that is the accurate; however, this story will probably never see the light of day again. For better or worse, doctor's needs are low on the priority list of health care reform.
My theory is that there are small parts of the puzzle that we could fix now. Here are a few:
1) Keeping costs low to the provider will translate to lower prices for the consumer:
Tort reform is a huge part of improving costs and access to health care. Look at the success Texas has had since they enacted Tort Reform laws. When you have a neurosurgeon who pays over $100K a year in medical malpractice, the money has to come from somewhere. And that "somewhere" is the patients.
Take the example of a surgeon who operates on an indigent patient. This could be someone who is not already covered by Medicaid, or an illegal immigrants, or it might be someone who has fallen through the cracks, homeless people, for example. The hospital receives money from the gov't, but the surgeon does not. Again, the money for the doctor has to come from somewhere. A certain percentage of pro bono cases is one thing, a large majority of a surgeon's work obviously cannot be done without compensation. This problem isn't likely to be fixed by the current reform. If people fall through the cracks, then mandating insurance for them won't help.
Another idea is to consider requiring that insurance companies, including Medicaid/Medicare, should be required to pay claims within 2 weeks, or a month at the latest. When a doctor has to wait a year to be paid, the money to pay for their overhead-the staff, rent, and equipment-has to come from somewhere (Read the patients).
Did you know that doctors do not have the right to collective bargaining? I thought that meant they do not have the right to unionize, but what Neil told me is that a medical practice negotiates for each of it's physicians a reimbursement deal from an insurance company. The doctor is not allowed to know what the other doctors in his practice get from the insurance company, nor are they allowed to know what a different practice is getting from the same insurance company. When you only have one or two large insurance companies to deal with, you have no option but to accept their insurance. I have heard that if the doctor finds out the rates for other physicians and act on that knowledge, the insurance company can sue that doctor. There are websites that allow users to compare salaries, so that potential employees can better negotiate and make better career choices. That option is not available to doctors.
2) Competition in the insurance industry. Is competing against the federal govt a good idea? Will it force the insurance companies to change or just put them out of business.
I am not a fan of insurance companies, but I am also not out to look for scapegoats. There are people that feel that a public option would force the insurance companies to compete, but I am not sure that competing against the govt is the best idea.
In every other communist/socialist country, where there is actual govt ownership of the means of production, the private sector always does better in comparison. When people are given the freedom to innovate and take ownership of their product, whether it is something tangible like a refrigerator or intangible like media, they come up with something better. They create a business or a system more efficient than the govt owned enterprise does. If you would like to open a private business in China, there are times that the govt forces the entrepreneur to take over two state-owned enterprises. One of them would be a company that already does what this new company wants to do. The second company would be a failing company, most likely in a different sector of the economy so that the new business owners will have to fix both companies. This is the only way to get access to the licensing rights and govt distribution channels that are necessary for business success in China.
If our country turns to the public option, would it be possible for these new govt employees to come up with ideas that increase efficiency? What if that means getting rid of a GS job (govt service job)? One thing is for certain, it is impossible to fire a bureacrat or GS employee. Neil tells stories all the time of how poorly performing employees are promoted to get them out of someone's hair. Surely a private insurance company can compete with that kind of inefficiency, but should they?
Apparently, there is an issue with insurance companies merging. As the options have disappeared, the competition in the insurance market decreased. As a result, the insurance companies can charge whatever they want and cover whatever they want, because who else is the patient, the consumer, going to turn to? For example, maternity benefits are not automatically covered.
US News and World Report says:
"The near total collapse of competitive and dynamic health insurance markets has not helped patients," AMA President Dr. J. James Rohack said in a new release. "As demonstrated by proposed rate hikes in California and other states, health insurers have not shown greater efficiency and lower health care costs. Instead, patient premiums, deductibles and co-payments have soared without an increase in benefits in these increasingly consolidated markets."
Rohack added that a lack of competition in the health insurance industry "is clearly not in the best economic interest of patients," and the AMA wants the U.S. Department of Justice and state agencies "to more aggressively enforce antitrust laws that prohibit harmful mergers."
End of part I.