The Real Death Panels: Insurers Deny 22% of Claims
It's time to stop talking about make believe death panels, and talk about the real ones.
Six of California's biggest insurance companies have rejected more than one in five claims the past seven years -- according to data the insurance giants, Blue Cross, PacifiCare, Kaiser Permanente, Health Net, Cigna, and Aetna report to the state Department of Managed Care.
Researchers from the California Nurses Association/National Nurses Organizing Committee analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six insurers rejected 45.7 million claims -- 22 percent of all claims.
For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.
Claims denial rates by leading California insurers, first six months of 2009:• PacifiCare -- 39.6 percent
• Cigna -- 32.7 percent
• HealthNet -- 30 percent
• Kaiser Permanente -- 28.3 percent
• Blue Cross -- 27.9 percent
• Aetna -- 6.4 percent
As the news got out to the media, the insurance bean counters fell all over themselves digging up explanations, denials, and justifications for their unjustifiable behavior.
From the Los Angeles Times, the Sacramento Bee, and other reports, you can see them scrambling to shift the blame to the doctors, to the hospitals, to the nurses for daring to criticize them.
Left hanging in the air is a bigger question. If the private insurers are not paying for care, why do we have private insurers?
While not every denial results in patient death or injury, far too many do. As CNA/NNOC co-president Deborah Burger put it, "Care denials have a human face, a real patient enduring unnecessary pain and suffering."
Cigna, for example, gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself after protests organized by her family, her friends and community, CNA/NNOC, and netroots activists. Tragically the reversal came too late to save her life.
PacifiCare denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick's family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. "This was his last effort and the procedure had worked before with people in Nick's situation," said his older brother Ricky.
In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as "investigational" even though the lumbar artificial disc she was to receive had FDA approval.At the time of denial, which she calls "insurance hell," Kutcher notes she had "already gone through pre-op testing, donated a unit of blood, had appointments with four physicians." Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.
Why do they companies deny claims? Because it pays.
Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.
It's also a reason why private insurers divert up to 30 cents of every healthcare dollar to overhead -- much of it spent to support warehouses full of claims adjustors needed to deny care, to keep down their "medical loss ratio" or profits lost on approving claims.
So why aren't these obscene, all too routine denials of claims -- and ultimately care -- more widely discussed in the national debate over proposed healthcare reform?
The sad truth is there is little in the main proposals emanating from Congress and the White House to change these deadly practices.
Our nation remains the only one in among industrial nations to link access to healthcare to private profit.
That's one reason for data like this:
Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.
One way to end this disgrace is to unhinge care delivery to profiteering by expanding Medicare to cover everyone. Isn't that the best way to finally end this disgrace once and for all?
Get these people's families on video - and I do not mean YouTube, and tell these stories. Make them tight, personal, and as tear-jerking as humanly possible. And get them to the people who are sponsoring ads meant to pressure elected Reps and Senators into voting for a public option.
It will make a much better campaign than the typical Democratic policy-speak that serves to induce sleep in the public at large.
September 3, 2009 5:09 PM | Reply | Permalink
It should only happen. From your mouth to God's ears.
September 3, 2009 7:43 PM | Reply | Permalink
A lot of people see youtube videos. Just sayin'. I agree with your point though.
September 3, 2009 8:46 PM | Reply | Permalink
Put them up everywhere and anywhere.
YouTube, also.
September 4, 2009 11:17 AM | Reply | Permalink
The private corporate jets with gold plated restroom accoutrements, the 7 and 8 figure salaries of the top executives, the investment returns to hedge fund owners of stock, the campaign contributions to politicians, and the deceptive ads to prevent Democrats from creating any single payer competition for this for profit health care ATM machine are all expensive, any money spent on actual claims is like money down the drain.
September 3, 2009 5:49 PM | Reply | Permalink
The math no one is doing is doing is what could be paid by the unnecessary expenses the insurance companies are making.
How many mammograms can be done for the million+ dollars the insurers are a spending every day to fight health care reform?
September 4, 2009 11:54 AM | Reply | Permalink
We have criminals in the business sector running everything. These very same businesses are dumping millions into PACs and political campaign funds in order to keep stealing from Americans.
And congress is perfectly fine with this arrangement. Criminals every one.
September 3, 2009 7:50 PM | Reply | Permalink
As OG says above we need video now. And we need ads about this. In NM, I keep seeing on TV only one healthcare ad, one that compares reform to a balloon blowing up and getting ready to pop. Nice image that resounds with people, right? I bet an ad with a family member who was lost to a denial of coverage would be a far more resounding image.
September 3, 2009 8:48 PM | Reply | Permalink
Wonder why for-profit Aetna's rejection rate was so low and why Kaiser, a nonprofit, turns out to be a median-rejector.
We probably should keep in mind that the vast majority of these rejections (99.9%?) are not rejections of treatment but rather, rejections of post-treatment claims submitted by providers (that is, claims submitted by doctors, hospitals, pharmacies, medical equipment sellers, medical transporters, home health aides, etc.) -- and we don't know why the claims were initially rejected or what number of initial rejections were ultimately paid or at what percentage of the initial claim payment was made.
September 4, 2009 12:23 AM | Reply | Permalink
We probably should keep in mind that the vast majority of these rejections (99.9%?) are not rejections of treatment but rather, rejections of post-treatment claims submitted by providers...
And you know this how?
You go on to say:
and we don't know why the claims were initially rejected...
Must be your coffee pot is on the fritz.
September 4, 2009 3:29 AM | Reply | Permalink
The point of hyperbole -- my (99.9%?) -- is to balance the hyperbolic assertions of the opposite side of the argument -- in this case the Nurses' claims that "many" rejections -- how many? -- result in "deaths."
Note: If we don't know why the claims were rejected -- and the Nurses don't say -- we're free to suggest any old reason that appeals -- and especially, in the case where the proponent is reduced to screeching, generally an indicator of a weak, unsupported position.
September 4, 2009 11:09 AM | Reply | Permalink
So if somebody spouts off with unsubstantiated figures we are are entitled to do the same? Ellen, you're much smarter than that. Why bother when the assured result of the dialog is an endless argument where everyone is lying. We may as well hang it up if that is the standard to be used.
September 4, 2009 12:34 PM | Reply | Permalink
I had my first of 4 heart surgeries in Hawaii at Kaisers Hospital. The care was great, the doctors first class Those doctors came from Kaiser's Hospital staff (the surgeon and internist), private practice doctors from the community and a doctor from Tripler Medical Center (the military hospital in Hawaii). I was the first full blown heart surgery to clean out my mitral valve. I had excellent care and it cost me $34.00 for 34 days of care. Since then I had three more surgeries and do fairly well now. All this medical expense because my mom, a single mom who worked all the time during the depression, could not afford to take me to the doc who would have given me a regimen of drugs that would have precluded me from having damaged valves. On my 4th heart surgery, the surgeon place two mechanical valves so I would not have to have any more surgery. All this because my mom could not afford to get the medicine I needed the first time I had rheumatic fever. All this surgery due to no medicine that would have cost $2.10, Except for those times I needed drugs early in my life, I have been working as an RN and had great insurance. But I can only imagine the heartache of my mom when I needed medicine during the depression and she was unable to get it for me, She was forced to chose to either feed 5 kids or get me medication. So get this health care bill passed Dems, even if my party stalls you and refuses to cooperate. We all even switched parties this last vote so we could depend on you to get health care passed!
September 4, 2009 3:30 AM | Reply | Permalink
Great comment. I wish more republicans and former republicans would make common sense statements that calms the rhetoric emanating from the right. I heard some republican representatives on the radio last talking about the bill as if they hadn't even read. Talking about "Brew-crats getting 'tween them and the doc!"
My next blog will address this deadly downward spiral in the GOP and how real conservatives must address it, but while their insanity is clear, it easily refuted. I could sell health care reform that was substantive and sustainable and built largely out of existing proposals just by changing the messaging for different groups of voters.
Problem remains that the democratic party are the ones that drafted legislation that would lead to such confusion and Obama let them. Much like the original blogger when she/he says:The sad truth is there is little in the main proposals emanating from Congress and the White House to change these deadly practices.This simply isn't the case. The vast majority of the current proposals have specific foundational measures to ensure this practice stops.
Things like medical best practice boards and the National Health Insurance Exchange will dictate broad policy guidelines that ALL insurers - public and private - must follow to provide that health insurance services in the United States. The same way we regulate energy and food production and and banking and every other industry central to human life.
This effort was a reflection of the president's learning curve and nothing more. I suspect he is actually forcing Congress to step-up and do their job again. I still find his actions remarkably consistent with what he campaigned on and what I read in his books. I certainly never thought cleaning up the federal swamp would be pretty.
September 4, 2009 9:17 AM | Reply | Permalink
Hey Jason,
It's well worth looking into.
I strongly recommend that you include sentiments like those of my grandparents(grandfather graduated Anapolis just in time to help occupy Japan). Staunch Republicans from day 1.
Asked on Labor Day of 2000 about Bush:
"I'm no fan, but he's the party candidate, so I'll vote for him."
On a note that is at best tangentially related, have you seen this?
http://www.nytimes.com/2009/09/03/opinion/03blumenthal.html?em
September 4, 2009 10:18 AM | Reply | Permalink
Awesome link. Thanks. The link to original letter from Blumenthal's piece was especially enlightening.
September 4, 2009 11:34 AM | Reply | Permalink
why Kaiser, a nonprofit, turns out to be a median-rejector.
My guess: The Kaiser figures derive from an outlier cohort of claims--out of area or non-Kaiser emergency room treatment.
Kaiser is a full service HMO--once you pay to enter, its pretty much Britain (with copays...)
There is no opportunity to hondle with the patient over a recommended treatment, because the origin of the recommendation was a Kaiser employed GP.
September 4, 2009 1:25 PM | Reply | Permalink
"Cigna's Chris Curran said that, nationwide, the company approves "more than 99% of eligible claims for care that the doctor recommends."
On the first try?
And why isn't it 100%, if the claims are eligible and a physician has recommended the care?
Ellen is correct that there could be many reasons why claims are rejected and that they do not necessarily represent denial of care--but no matter how you slice it, 22% is a lot of rejected claims and bears investigation and improvement.
I can't wait for the State Managed Health Dept's follow-up report, breaking down the rejected claims and making recommendations! Which conclusively demonstrates that I need to get out more.
I also wondered why Aetna's rejection rate is so low. Do they have better paperwork? More efficient process? Or are they just nicer? If whoever posted this article could shed light on that it would be very interesting.
September 4, 2009 12:52 AM | Reply | Permalink
there could be many reasons why claims are rejected and that they do not necessarily represent denial of care
Sure, that's all well and good for the first incident in which a doctor is not paid for a treatment, as the initial patient was cared for.
I certainly hope that neither you or Ellen is trying to suggest that the doctor will continue to provide the same procedures to the same demographic that she was forced to pay for out of her pocket.
Given that insurance compensation is not instantaneous, there will be a lag between submission of a claim for treatment and response from the insurer. That response may be a check for the full bill, a check covering part of the cost, or an outright denial. So it may be months and hundreds of patients before the physician discovers that she's losing money to the insurer.
We know(not suspect, KNOW) that an economically rational actor will cease providing that treatment to that cohort when it is evident that there is no benefit to doing so.
Absent regulation requiring that treatment be provided by her,
care
WILL
BE
DENIED.
September 4, 2009 8:26 AM | Reply | Permalink
On ewonders what treatments were denied by the doctor once his nose was smacked by the insurer. What other treatment would have followed? For instance, and this is NOT a true example, but only an example easily undertood, if a break my ankle and they deny the cast, woud my doctor then submit claims to remove the cast and for physical therapy(PT)? If the doctor recommended PT 12 times and the insurer denied #7, what they are effectively doing is denying 7, 8, 9, 10, 11, and 12. Where is that represented in the statistics?
Oh, and how is Aetna evuating what a denial constitutes. It seems much mor eprobable they found a legalese way to circumvent admitting their recission numbers. It may be kind of like asking what the definitiion of "is" is. It's a dramatic difference and hardly comports with the experiences of people I know who have Aetna.
September 4, 2009 12:09 PM | Reply | Permalink
No argument from me on this point--a physician who's had patients denied for a treatment is less likely to recommend it again. (Or at least will try to code it a little differently the next time in order to get it covered.) Eventually, this discourages certain treatments.
My quibble was that the article didn't make a strong effort to explain that denial of claim doesn't necessarily mean total denial of service & thus goes a bit more toward polarization than explanation, which bugs me a bit. But hey, when you start to explain this stuff completely, people tune out.
September 4, 2009 1:35 PM | Reply | Permalink
private insurers divert up to 30 cents of every healthcare dollar to overhead
Using that "up to" qualifier with that high number is going to backfire on you guys some day. Because the truth is, though it would be nice to see them disappear, there's no magic pony in getting rid of those profits, savings would probably only be 3.5% of our total health care bill, a drop in the bucket right now because that's smaller than the annual inflation in our health care costs:
http://tpmcafe.talkingpointsmemo.com/talk/blogs/howard711/2009/08/health-care-financing-reform.php#comment-3573388
Not to mention one of the goals of reform is to have more managed care in some way shape or form, and less fee-for-service, in order to slow down the escalation of costs.
And some of those denial figures are due to managed care. Managed care can be a nightmare with a stingy insurance co. run by beancounters, but it is also exactly the same thing that works at places like the Mayo Clinic and Kaiser. Example: right now, it's called a denial when the doctor with an investment in the MRI lab wants to give you an MRI, but the insurance co. says you don't need one. The idea is in the future, it won't be called a denial, because you won't even know that kind of "denial" even happened, because you just won't be told you need one when you don't need one by a doctor who makes money every time he does an M.R.I.
September 4, 2009 1:21 AM | Reply | Permalink
From your quote, "advertising, underwriting, executive bonuses and lobbying" are not - by far - the totality of "overhead". That list is, among the less obvious, missing profit itself altogether.
September 4, 2009 5:12 AM | Reply | Permalink
Profit is not part of overhead.
September 4, 2009 7:46 AM | Reply | Permalink
If it is pre-determined, meaning a target was selcted before the books were opened(as opposed to being closed), I think we can safely call it that.
September 4, 2009 8:40 AM | Reply | Permalink
It is not overhead for the insurance company, but it is overhead for the national health policy.
Although, yes, I am liberally applying the term since overhead is in theory - though not in practice - comprised of necessary costs.
September 4, 2009 8:53 AM | Reply | Permalink
I simply don't have the context to know whether 22% is a high number or not. No matter what kind of health insurance system we have, aren't many people going to try to make claims for treatments that are not covered by their plans? Wouldn't that be the case even if we had a single payer national health insurance program?
September 4, 2009 7:56 AM | Reply | Permalink
No, Dan. Under single-payer as practised here, a patient doesn't submit ANY claims. You swipe your card and the medical institution, clinic or specialist bills the government accordingly. You don't get a bill or even know what the procedure costs.
For things that Canadian medicare doesn't cover (purely cosmetic surgery, vaccinations for travel, dental care, medication, etc.) you pay out of pocket but you can deduct the expenses at tax time.
Employers usually offer coverage for whatever's ineligible. That's the only time you need to submit a claim.
Because the law clearly spells out what is and what is not covered, the global bill your doctor submits is not a "claim" that's accepted or rejected. It's either valid or fraudulent.
Occasionally, some doctors do get caught inflating their bills with bogus patients and procedures, but that's rare.
What I'm saying in my long-winded way is that there's no rejection rate in Canada. If you and your doctor agree on a covered treatment, it's paid for. No hassles.
Trust me, it works. And for some reason, it's way cheaper than what you've got. Or even what a public option will cost.
September 4, 2009 4:10 PM | Reply | Permalink
Great movie on this point based on John Grisham novel, the Rainmaker. Joe Bob says check it out.
September 4, 2009 8:33 AM | Reply | Permalink
From the Los Angeles Times, the Sacramento Bee, and other reports, you can see them scrambling to shift the blame to the doctors, to the hospitals, to the nurses for daring to criticize them.
I detect some especial pleading here.
Unfortunately, medical care providers, i.e. doctors and hospitals, as well as the pharmaceutical companies and medical suppliers, have gotten a largely free ride in this debate, mainly as a result of a strategic decision by the administration to advance health care reform by working with pharma and the providers to gang up on the insurance companies.
I can't say I disagree with this strategy. But it is regrettable, because the explosion of medical costs is not just the fault of insurance companies.
There has been an interesting series on NPR's Morning Edition this week that looks at medical costs at the treatment level.
http://www.npr.org/templates/story/story.php?storyId=112522353
September 4, 2009 9:58 AM | Reply | Permalink
The White House and Big Pharma make strange bedfellows, indeed.
When are we going to see Medicare negotiating costs of prescriptions using the leverage they have in the form of hundreds of thousands of participants? Refusing to allow this consideration when Medicare seeks medications was an abrogation of responsibility by individuals who are charged with representing the people. It is time to remove that self-induced barrier to better prices.
September 4, 2009 12:15 PM | Reply | Permalink
the White House and Big Pharma
That too is more complicated than most blogosphere rhetoric both right and left suggests.
While the political blogs are going "public option" and "death panels" 24/7, turns out just the other day Obama administration was trying to trumpet the big $2.3 billion win against Pfizer for fraud:
but apparently no one in the political blogosphere wants to take the administration up on their attempt at P.R. on this. It's easier to paint them as in the pocket of big pharma rather than try to understand the complicated approaches involved in what's currently going on, And then go back to demanding a public option like it's a magic pony, when most of them don't even have an idea of what that public option would consist of, how it would work, nor how helpful it would be in creating competition, or whether they themselves would even like its conditions for themselves.
I will say one thing, it does sound kind of crazy to me to make the argument that our government would be incapable and incompetent at decently regulating insurance companies, while at the same time arguing that it would supremely capable of running a competitive public option.
This case has very much to do with what is broken about our system: money driven medicine, consumer-driven medicine much more to do with it than insurance co. profits or denials. From the article:
I did find a post on it on the Healthcare Economist blog, kudos to him on that:
Pfizer to pay $2.3 billion in Medicare/Medicaid Fraud.
But I'm getting real tired of reading the spin and agitprop from all sides in the political blogosphere on health care reform, and that's mostly what I am seeing. It's mostly worthless reading.
Money-driven medicine is our real problem, and it includes practioniers not just big pharma, and that is more egregious in fee-for-service, like Medicare is, than it is in even for-profit insurance companies. Getting the insurance profits down or gone is a drop-in-the-bucket problem, it's just a first step. It will help move us along to what we need, but it's not a solution. Currently they at least do managed care, even though the profits from that management go to their shareholders, their system is at least set up the way we have to go.
And I certainly don't appreciate seeing the counter-agitprop against right wing agitprop coming from nurse's unions, who I would hope would be trying to educate the public truthfully on the whole entire situation. Are they professionals who care about practicing their profession and having the public understand the real problems, or are they more interested in political agitation, just hoping that gambling on results of the agitprop wars will be good for them?
What I am starting to see about the health care debate is that it has been hijacked by the same old same old players: the right makes up some inflammatory bullshit that resounds (socialist "death panels") and the left once again for the umpteenth time buys into their framing and plays the game, precisely because they are invested in getting offended about people saying socialism is bad and because they like trashing corporations, especially insurance companies (and it's so easy, because everyone has knee-jerk hate for insurance companies of all kinds, me included.) It's the same ways right wing trolls work on the internet, the know what gets a knee-jerk from liberals, and they hijack the whole conversation away from reality, ends up both sides talking about things that have nothing to do with the real situation, both spinning and spinning and spinning.
That's actually how they win time after time, by hijacking the conversation on something complicated to spin vs. spin, because the public in middle senses there's more to the story than the bullshit both sides are pushing, but they don't know what it is. Since the right wings' goals are to prevent change, that's all they need to do. When people don't understand the situation but know that both sides are bullshitting them, they will vote for status quo, no change, every time.
There is no magic pony solution. The truth is that if we went to single payer, we do not have a government managed care program in situ right now, and that would actually cause an explosion in all kinds of dubious treatments. The stock market would go wild on bio-tech and pharmaceuticals and anything they think the government might pay for if someone could get consumers to request it, i.e., if it was marketed well to both consumers and doctors, or specialist doctors found it intriguing or prestigious to invest time in.
In the end I am starting to think there is no bigger priority than getting more quality primary care doctors trained, trained in managed care and not in feeding money-driven medicine. A whole new paradigm has to get going discouraging the latter. The government paying with a fee-for-service solution, without managed care, is not going to get us there. That being the case, unless you want to steal a couple of big county's entire population of primay care doctors, baby steps with the right carrots and sticks are probably the only real solution.
September 4, 2009 2:28 PM | Reply | Permalink
I sympathize with your frustration, and yet ---
The "public option" -- Medicare fee-for-service rates plus 5% together with the new President's Medicare Council -- is all that's on the table.
If not now, when?
September 4, 2009 3:40 PM | Reply | Permalink
the new President's Medicare Council
I'm starting to think this part is much more important than whether or not we have a public option for the under 65.
Medicare is already the two ton elephant in the room. Its the big money in the country's health care budget. Its recommendations are already used by most insurance companies as the standard to fall back on when they do have an argument about coverage.
Mho, the years of influence that Medicare's secretive RVS Update Committee (or RUC) is a big part of the reason we have the current culture of medical specialization over wholistic primary care. Just by virtue of specialists being paid better by Medicare, it became part of medical culture that specialization was the thing to do if you wanted respect as a doctor.
Which is why I wondered about the politics of not having a current Medicare director, not starting your health care reform fight with that. The only reason I can think of, besides a belief in "grass roots" deciding what it is to be, is that Medicare is a third rail and to challenge it with change from the start of health care reform would, to continue the metaphor, derail any other health care reform. You have to come at it from the back end, is what Obama is thinking? (If that's the case, the irony is, those quotes from seniors worried he's eventually going after changing Medicare are valid--even if dumb in not wanting change.)
I don't have any coverage and would be happy to have Medicare just as it is, as something is better than nothing. Heck, I'd be happy with just high-deductible castastrophic coverage. But I do wonder whether those who have other plans who are begging for "Medicare for all" on blogs really realize what it is about, how it works, what it covers, and I suspect many might not be happy with it at all and would prefer a plan with more preventive coverage.
(I will admit to one prejudice: both I and many family members and friends have experienced disastrous results from being sent around to specialists willy-nilly. And I do mean serious disastrous results. I could give hundreds of personal anecdotes, and then I could give you thousands and thousands from every health-care-related forum on the net. People are being hurt daily by going to specialists without a wholistic attitude towards their care, as in breaking the "first do no harm" oath. There's nothing like having a really good generalist directing your care, nothing, I strongly believe that. But they are very rare birds, even those that could be great are ovewhelmed by too-large practices and things like capitation payment. To me, the whole discussion of "death panels" is a joke for a different reason--the rejection of a claim for a transplant or for a controversial or expensive cancer treatment is quite rare compared to people going around getting treatments from specialists that are treating single symptoms and doing them a lot of long-term harm as to their general health, probably cutting years off their life.
September 4, 2009 9:30 PM | Reply | Permalink
Nice summation. I might not agree with every point but really well done.
September 4, 2009 3:46 PM | Reply | Permalink
In NYTimes David Brooks article, Let’s Get Fundamental, he talks about David Goldhill’s essay, “How American Health Care Killed My Father,” in the current issue of The Atlantic.
The part that intrigued me most was where Goldhill discusses health savings accounts to pay for routine medical services instead of relying solely on health insurance - which he refers to as a moral hazard. These are accounts which people fund with their own money and draw out when needed to pay for medical services received. If you overdraw, there are mechanisms to pay the overdraws in following years - definitely eliminates heath insurance policies.
And the only role health insurance plays is for the catastrophic illnesses associated with old age of traumatic injury beyond what a health savings account would cover.
It's worth the effort to read it. I can see where single payer/public option could easily be the health savings account which leaves the doctors and hospitals on their own to market themselves for business from the public. It's worth the effort to read it. At the very least, it's a conservative idea that has some substance to it and I give it respect based on its merits trying solve some of the issues on health care that make sense using free market concepts as they were meant to be used - for the good of all.
September 4, 2009 10:11 AM | Reply | Permalink
What's wrong with a single health-care savings account for everybody? Ah, I see that you have that on your mind also. I'll check that out.
It would save quite a bit on administrative costs vs. 300 million individual accounts - that's how economy of scale works. Even if statements are only available via internet to eliminate printing and mailing related costs, the hardware and software must be purchased to run individual reports, and to serve and store them.
(Let's ignore the personnel and energy costs of maintaining those systems, just to low-ball the potential costs.)
I have to take issue with this:
free market concepts as they were meant to be used - for the good of all.
I wasn't aware of any user manual or mission statement for free market concepts.
Could you point me to a citation to support that?
I am truly beset by doubts that that is the case.
;-)
September 4, 2009 10:41 AM | Reply | Permalink
My point on the free market concepts is it is a free market when everyone on both sides benefit from the exchange. Currently, the repuglican concept free markets only allow business unfettered access in the marketplace without the constraint of providing a benefit to the consumer. I can see Goldhill trying to create a niche for the free market in his overall concept. It's an acceptable approach, but it's only an approach - not a done deal. I can see where health saving accounts could be an alternative to taxes - everyone putting in a percentage of their own hard earned cash that they deem necessary instead of a flat rate for all. But, if you suffer a traumatic injury, you're still on the hook to pay off the medical debt incurred. Whereas, a true single payer/public option foots the entire bill at no extra cost. There's many pros and cons, but at least, in my opinion, this approach by Goldhill merits serious consideration. At the very least, it's a plan that a reasonable person can understand and argue its good and bad points.
September 4, 2009 11:38 AM | Reply | Permalink
Well, if the free market crowd and anti-free market crowd would both stop quoting Adam Smith as it suits their needs, there is indeed a user manual for capitalism called Wealth of Nations.
People who are cynical about the free market don't trust that such a thing will ever work, though all of their policy ideas require that it must. People who are overly optimistic tend to forget that strong and strictly enforced regulations were a requirement for a strong and sustainable free market.
What got lost along the way was any notion of corporate responsibility being enforced by way of broad and sweeping public regulation of those profit-focused efforts in support of a common good.
September 4, 2009 11:44 AM | Reply | Permalink
AMEN!
That's what I was seeing in Goldhill's essay ... an attempt to use the free markets as they were intended - provide a needed market service that was profitable, cost efficient and a benefit to the public. At the very least, I give him credit in moving towards the center of the debate instead of yelling from the outer fringes.
September 4, 2009 12:12 PM | Reply | Permalink
Prezactly!
There is nothing wrong with bridled capitalism!
September 4, 2009 12:19 PM | Reply | Permalink
"Prezactly!" I like that one. :O)
September 4, 2009 3:17 PM | Reply | Permalink
I like Kaiser, but I had to form a bogus company in order to get in.
They wouldn't accept me as an individual based on some really ordinary past medical issues. (Plus I made the mistake of telling the truth. I checked the box that, Yes, I had EVER used illegal drugs and/or EVER taken medication without a prescription. I was born in 1960; I thought stating "No" would be so obviously a lie.)
When I formed a vague partnership with my sister-in-law (also rejected by Kaiser as an individual), we got in as a "group," no questions asked.
I actually prefer to go through life not telling lies, but our health care system pretty much demands it.
September 4, 2009 2:23 PM | Reply | Permalink