“$2,229.11 For Three Stitches?”: We Don’t Have To Wonder What The Unfettered Market In Health Care Produces, We’ve Been Living It
Twenty years ago I had my first knee surgery, after tearing some cartilage while skying for a thunderous dunk on the basketball court (or it might have been just falling backward while getting faked out on defense—who remembers the details?). Although I had insurance, I was responsible for a substantial copay, and I vividly recall the one item that stood out among the dozens on the bill. For the two steri-strips that covered an incision—tiny pieces of tape that even today cost about 20 cents retail, and which hospitals buy in bulk so surely cost them just a couple of pennies—I and my insurance company were charged $11, or $5.50 per strip. A miniscule amount in a five-figure bill, but it struck me as the most absurd, since it represented a markup of approximately 10,000 percent, if not more. More recently, I was getting some physical therapy for the same knee, and in what turned out to be a session that wasn’t covered by my insurance, a therapist put a piece of kinesio tape around my kneecap. The retail price for that length of tape is around 40 cents (though again, they buy it in bulk so it’s probably a quarter of that); and there was the therapist’s time to retrieve, cut, and apply the tape, which took about 60 seconds all told. Total tape charge: $75.
My experience is not at all uncommon, as an excellent piece in today’s New York Times explains. The article discusses things like people getting charged thousands of dollars to have a couple of stitches put on a finger, or my personal favorite, the $137 charge for an IV bag that costs the hospital one dollar. There are a number of reasons why they can get away with this, including the fact that nobody tells you what the charges are going to be before you’re treated, and the fact that information is diluted through the insurance system.
But since we’re now talking about what government is and isn’t capable of handling when it comes to health care, allow me to repeat something I’ve argued elsewhere: The government didn’t give us this kind of price-gouging, just like the government didn’t give us 50 million uninsured Americans. Nor did the government give us lifetime and yearly caps on coverage. Nor did the government give us now-outlawed “rescission,” in which your insurer cancels your coverage because you got sick. Nor did the government gave us denials for pre-existing conditions. You know what gave us all that? The free market. Government can certainly cause problems, but just about all the major reasons our health-care system is so expensive and serves so many people so poorly (or not at all) are the result of the free market.
Or more specifically, the health-care market, which is so different from other kinds of markets. The unique features of health care are what makes a far higher level of government involvement than exists in the markets for wristwatches or shoes necessary. If we don’t want to have a system that costs so much more than every other one in the world while giving us crappy results, then we’re just going to have to accept that. In other industrialized countries, the government says, “We can’t sustain a system in which an MRI costs $1,200. So an MRI is going to cost $300.” And guess what? The MRI manufacturers and the hospitals accommodate themselves to that reality, and not only do they manage to survive, but people still get MRIs when they need them.
If maintaining the ability of certain people to suck as much profits from the health-care system as possible is your highest value, you find that unacceptable. But if having a system that serves everyone, maximizes health, and is affordable rank higher for you than making sure there are hospital systems with 28 different executives pulling down salaries of over $1 million a year, you have to make a different choice.
And let’s be clear about this: what conservatives are arguing for is the maintenance of the status quo that gives us the $2,229.11 hospital charge for putting in three stitches. It was their devotion to the primacy of market freedom in health care that put us where we are now. When the government doesn’t work properly, by, say, making a terrible website that took months to fix, the answer is to make it work better. Because we don’t have to wonder whether the alternative is worse. We’ve been living it.
By: Paul Waldman, Contributing Editor, The American Prospect, December 3, 2013
“Kicked To The Curb”: Republicans’ Self-Hatred Swells To The GOP Vs. Its Own Base
Does any modern political party besides the GOP hold a huge segment of its base in contempt? I’ve written a lot about how Republicans have failed to make inroads with Latinos, young voters or women since their 2012 defeat, but what’s really interesting is the way they continue to deride many of their older, white, working-class voters, too.
When Mitt Romney insulted “the 47 percent” of Americans who pay no federal income taxes, he failed to notice that the vast majority of them are white, most of them white seniors, the most reliably Republican voters in the country. A large portion of the people Paul Ryan describes as “takers” – vs. productive “makers” – are likewise older whites. And although Ryan and his party want to turn Medicare into a voucher program – run by exchanges, much like the Affordable Care Act – they tried to hide that fact during the 2012 race because it was hugely unpopular with their base.
The latest insult came from former senator and 2012 presidential runner-up Rick Santorum. On CNN’s “State of the Union” Sunday Santorum complained that the Affordable Care Act has meant that “sicker, older” people are getting health insurance (h/t Crooks and Liars.) Santorum told Candy Crowley and former Gov. Howard Dean:
Well, let me just add that one of the solutions that President Obama tried to accomplish was to let people keep their own insurance. It turns out that a lot of insurance companies are actually allowing that to happen, and that could cause even more problems for Obamacare, because that means fewer and fewer people getting into the exchanges. And the ones who, at least to date, it’s just facts Gov. Dean, the ones in the system are much older.
I talked to one insurance company today, a third of their enrollees are over sixty years of age. That is not how an insurance system would work, but those are the people signing up and the folks who can keep their plans because they’re more customized and lower cost, will now. And the folks who are going to get into these exchanges are going to be probably sicker, older, and as a result, premiums are even going to go higher.
First of all, it’s not clear Santorum is right about this. Some states are seeing unexpectedly high proportions of younger people sign up for coverage. In Kentucky, 41 percent have been under 35; in California, it’s 22 percent, which is proportionate to their share of the population. Still, the enrollment rate in California is highest for people over 55. That’s not surprising, or permanent: Based on the experience of Massachusetts, older people tend to sign up for coverage first; younger enrollees do it closer to the deadline.
But assuming that Santorum isn’t wrong (admittedly a leap), what is he saying? That people over 60 who don’t have coverage shouldn’t be able to get it? We know these people are white, and presumably – since they’re not eligible for Medicaid, which covers many of the poor and unemployed — they’re working people. But Santorum says “that’s not how an insurance system should work.”
Luckily Howard Dean was there to disagree. “I think it’s great that we’re insuring people who can’t get insurance that are over 55 and 60,” he told Santorum and Crowley. “That’s what this is supposed to do.”
Of course, if insurers are unhappy with their older customers, Rep. Alan Grayson has an answer: his “Medicare for All” bill, which would allow anyone who wanted to to sign up for Medicare instead of a private insurance plan. Back during the ACA debate many liberals wanted to see that option, but it was vetoed by insurance interests. Opening up Medicare to people 55 and older would help stabilize the program – although they’re the older edge of the ACA pool, they’d be younger and healthier subscribers in the Medicare pool – and provide an alternative for those priced out of or under-served by the private market.
Still, the big news this weekend was that the federal website that lets most people access insurance exchanges, Healthcare.gov, is mostly fixed. That’s why Santorum was reduced to railing against those takers in the GOP base. On Fox News Sunday, Chris Wallace attacked the ACA as “income redistribution.”
And, of course, Santorum insisted that the ACA’s troubles raised questions about “the president’s competence.” Dean wasn’t having that either.
“That’s right-wing talking points against this president,” Dean replied. “From day one, they’ve tried to undermine him as a human being … I lose my patience with this nonsense. I do believe that the facts are going to be determined by what happens on the ground. Three months from now, a lot more people are going to have health insurance, and a lot more people are going to be happy with all this.”
By: Joan Walsh, Editor at Large, Salon, December 2, 2013
“Like It Or Not, Obamacare Is Moving Forward”: For Certain People, This Isn’t As Good A Story As The Website’s Implosion Was
HealthCare.gov just tweeted that more than 375,000 had visited the refurbished federal website as of noon today. White House press secretary Jay Carney confirmed the figure shortly after.
So demand still appears to be there, despite weeks of deservedly awful press about the website and the law, and weeks of Republican claims that the law is so disastrously flawed that it cannot be rescued.
Along those lines, Kevin Drum captures what matters most about the news of the moment in one half a sentence:
if you need to buy health coverage via healthcare.gov, you can do it
This really is the rub. Sure, there will be continued problems. Charles Ornstein personally had a terrible experience. Sarah Kliff found the site is still not working for everybody. And the snafus at the back end may persist, too.
But the big picture is that far more people who need health insurance — whether they were bumped from plans or whether they were previously uninsured — will now be mostly able to go online, do some shopping, and buy health insurance. Before, they couldn’t.
This isn’t as good a story as the website’s implosion was, and if the site continues to function as expected, it will mostly stop getting media coverage. The press will move on to the next Obamacare disaster story, should it materialize: The “keep your doctor” saga, coming soon via Republican press release directly to reporters’ inboxes.
But the current fix has mostly tamped down concerns among Democratic lawmakers, and barring some truly catastrophic change, they just aren’t going to abandon the law in any meaningful sense. Meanwhile, demand looks likely to continue, even as insurance companies redouble their efforts to entice people on to the exchanges, which means enrollment will continue piling up, too.
Will it be enough? It’s too soon to say. Republican lawmakers and their voters have been 100 percent certain for some time now that Obamacare has already collapsed, but for everyone else, the law’s long term prospects will turn mostly on what that enrollment looks like over time. And for that, we’ll just have to wait.
By: Greg Sargent, The Washington Post, December 2, 2013
“Exploiting Consumers”: Republican Obamacare “Fix” Is Junk, Just Like The Junk Insurance Plans It Protects
In an effort to cynically score political points, the Republicans have taken up the cause of people who have received health insurance “cancellation” notices. The problem is that the Republicans aren’t helping these people, they are exploiting them. They’re peddling a “fix” that will stick consumers with lousy insurance policies, put the insurance companies back in charge of our health care and deceive people who deserve a straight answer about what’s going on with their health coverage.
If you’re one of the people who received a notice, it’s unsettling and confusing to say the least — and you don’t need a political party to play politics with your life. You need to know the truth and learn the available options.
People are receiving cancellation notices because they were sold health insurance policies that provide bare-bones coverage and expose them to financial ruin if they get sick or injured. Insurance companies sold these plans knowing full well that consumers could not keep them after the Affordable Care Act (ACA) standards are fully implemented on Jan. 1. The insurance companies didn’t tell their clients that they couldn’t keep the plans they sold them, and they certainly didn’t tell them that the plans were junk. Now the Republicans want to allow the industry to continue to sell these policies for another year in the name of letting people keep the plans “they like.” This is hypocrisy and politics at its worst, not to mention terrible policy.
There are roughly 15 million Americans who buy health plans in the individual market, and they represent 5 percent of people with private insurance. About half of them got cancellation notices, which naturally leaves people anxious to find out what they’ll do next year.
Instead of passing a law allowing insurers to keep selling bad policies that provide little for their premium money, we should tell people what their coverage options are and how much better they’ll do under the ACA. Because the enrollment web site HealthCare.gov has yet to work properly, most folks don’t realize they will save money and get better insurance if they shop in the new insurance marketplaces and take advantage of generous instant tax credits that will drastically cut their premiums.
People can save a lot of money when they buy their insurance through the online marketplaces: Seventeen million people will qualify for tax credits to reduce the cost of their insurance. As many as 7 million people may have no premium costs at all. Six of 10 uninsured Americans will pay $100 or less in monthly premiums. While it sucks to get canceled, the vast majority of those folks will see that getting coverage through the ACA marketplaces is a better deal.
The GOP-led legislation is bad public policy. It will disrupt the insurance market and make things worse now and in the future. You can’t mend our broken health insurance system if millions of people can opt out of participating in it. That’s how we got into this mess in the first place.
Allowing inferior insurance plans to exist alongside quality ACA policies will destroy the economic foundation of the law — the idea that financial risk must be spread and shared — and give our health care back to the insurance companies. Nothing could be worse for the health and the pocketbooks of everyday Americans.
For example, the Republican proposal would prompt younger, healthier people to opt out of enrolling in the marketplace plans, meaning the ACA policies will cover mostly older and sicker people who are more costly to insure. As a result, marketplace premiums would spike and millions of Americans would lose out on health coverage they can afford. People would be denied insurance or charged sharply higher premiums because of their medical history. Consumers would be at the mercy of the health insurance companies. That’s not why we enacted health reform. America reformed our health insurance system so everyone could have insurance with real benefits — not benefits that are only revealed to be phony in the middle of a medical crisis. We did it based on the simple principle that we all do better when we all do better.
The Republican bill would be a disaster for consumers. As we learned during the drive to pass the ACA, junk policies cause nothing but trouble. There are millions of stories of bankruptcy filings, homes and jobs lost, college educations abandoned and dreams deferred because someone with fake insurance got sick and was overwhelmed by medical bills. We can’t go back to those days.
The GOP is using overhyped cancellation stories as a pretext to destroy the ACA, a law they have attacked with a single-minded fervor never before seen in American politics. When the Republicans’ bill, H.R. 3350, reaches the floor, it will be the House GOP’s 46th vote to repeal Obamacare.
Any fixes to the Affordable Care Act should be judged by whether they help people and improve the law. The Republican-led proposal does neither.
By: Ethan Rome, HCAN Blog, November 14, 2013
“Obamacare, A Question Of Morality”: Indifference To The Needs Of Others Is, Indeed, Immoral
There was a lot of bloviating about the Affordable Care Act on the talk shows last weekend. The Obamacare critics’ chief focus was the open-enrollment fiasco, the un-kept presidential promise and the millions of cancellation notices. Overlaying the palaver was the unrestrained glee of health-reform opponents.
The same weekend, in a section of our nation’s capital where pompous politicians and self-important opinion-makers seldom venture, the Affordable Care Act was the subject of thanks and praise at the First Baptist Church at Randolph Street and New Hampshire Avenue NW.
The talk-show criticism and the pulpit defense crystallized the Obamacare debate. Drawn into sharp relief is the struggle taking place in this country between doing what is right and good and an unashamed indulgence in the immorality of indifference.
The issue couldn’t be put more simply.
Forty-nine million Americans do not have health insurance. For many of them, the ability to deal with their illnesses and injuries depends on their ability to pay. Lacking the money, some of them just go without the care they need. Better to put food on the table for the kids than to check out that awful pain in the gut. Can’t afford to do both.
Which helps explain why the Affordable Care Act is viewed more kindly by the congregation at First Baptist Church, located a few miles from the shadow of the Capitol, than by those within the governmental structure.
First Baptist celebrates its 150th anniversary this year, having been founded in Southwest Washington by freed slaves in 1863 .
The church’s broad ministry includes parts of the city where good health care is an unaffordable luxury.
The Rev. Frank D. Tucker, who has been First Baptist’s pastor for nearly 38 years, used Sunday morning’s service to address Obamacare in terms its critics do not.
He announced that First Baptist, working with the city’s health-care exchange, DC Health Link, would host a health insurance enrollment fair on Saturday. He issued an emotional call to his congregation, young and old, to enroll in the program, resorting to language associated with the battle to win the right to vote.
Tucker noted the decades of unsuccessful efforts by several presidents to extend medical care to all Americans, including those living in dire circumstances beyond their control. Not sugar-coating the problems that President Obama has encountered in bringing about health-care reform, Tucker hammered at the obligation of the uninsured to enroll in the insurance program that Obama and other health-reform advocates have worked so hard to create. The Obama administration and its congressional supporters, Tucker observed, have been opposed every step of the way, taking a beating from people in Congress and around the country. Don’t let their sacrifices be in vain by sitting on your hands, he contended. Get enrolled, he declared.
And Tucker wasn’t even Sunday morning’s featured speaker. That honor fell to William P. DeVeaux, the presiding bishop of the African Methodist Episcopal Church’s second district, which covers the nation’s capital. DeVeaux’s presence, however, made Tucker’s appeal more compelling because DeVeaux’s message drew heavily on the scriptural command to serve others. It reinforced Tucker’s appeal to give all Americans the health security they deserve.
Tucker, DeVeaux and other members of the cloth are those whom the opponents of health-care reform are up against.
Gaining access to no-cost preventive services to stay healthy, which Obamacare provides, is not a sign of indifference. Neither is giving senior citizens discounts on their prescription drugs, or allowing young adults to get health insurance on their parents’ plan, or ending insurance company abuses. Those steps represent the caring actions of government.
In his apostolic exhortation this week, Pope Francis said he begged “the Lord to grant us more politicians who are genuinely disturbed by the state of society, the people, the lives of the poor!” Referring to the “excluded and marginalized,” the pontiff said that “it is vital that government leaders . . . take heed and broaden their horizons, working to ensure that all citizens have dignified work, education and healthcare.”
That, too, is where the health-reform resisters come up short. Their horizons are too narrow to notice or care about people who lead lives stunted by lack of opportunity. Stunted lives leave the critics unmoved.
And that’s why, when the bloviators take to the airways, preachers like the Rev. Tucker, Bishop DeVeaux and Pope Francis take to the pulpit.
They know that indifference to the needs of others is, indeed, immoral.
By: Colbert I. King, Opinion Writer, The Washington Post, November 29, 2013
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 