Last week I was travelling, and not able to respond to all of your comments. Though I did begin writing replies in the car, while driving down to D.C.
This is not as dangerous as it sounds—my husband was doing the driving. And we drove from our home in Manhattan to the hotel in D.C. in just four hours!
Is this as dangerous as it sounds? Hard to say. In all of his years of driving my husband has never had an accident. And we’re certainly safer than if I were driving. (I tend to start thinking . . . about healthcare, the problems, possible solutions . . .)
But all you really need to know is that you’re not likely to encounter me on a highway near you, and if you commented on a recent post, you’ll probably find my reply.
Secondly, readers have e-mailed me to ask whether individuals can buy the DVD of Money-Driven Medicine, the documentary based on my book, produced by Alex Gibney (“Enron: The Smartest Guys In the Room” and “Taxi to the Dark Side,” which won an Academy Award for best documentary in 2007.
Originally, the information on the website where you can buy the DVD (www.moneydrivenmedicine.org) was unclear. But the fact is that individuals can buy the DVD from the film’s distributor for $49.95. The distributor is hoping that you might then host a home screening—invite five or six friends over to watch the film, much the way you might invite them for dinner. (Or “pass the hat” and everyone can chip in for the film.) Full disclosure: I have nothing to do with pricing, and will not profit from sales of DVDs. The distributor owns the rights.
The Book : Money-Driven Medicine: The Real Reason That Healthcare Cost so Much is now once again available, one-day shipping When Bill Moyers showed an abridged version of the film on his PBS show, Bill Moyers Journal, demand for the book soared, and the publisher, Harper/Collins, ran out of copies. They immediately went into a second printing, and books are now available on www.barnesandnoble.com to be shipped the next day. Amazon.com also now hax copies, though their website hasn’t yet updated to say how quickly they can ship them.
Correction: I’m afraid I created some confusion on the “Truth Squad: The House Bill Would Prevent Medical Bankruptcies” post below ( https://healthbeatblog.com/2009/09/truth-squad-the-house-bill-would-prevent-medical-bankruptcies.html)
I was writing about Harold Pollack’s post on TNR where he argued that a well-known single-payer advocate was simply wrong last week when he told the New York Times that none of the healthcare reform plans now under consideration would protect families against medical bankruptcies. The single-payer advocate claimed that only a single-payer plan would do that.
Pollack pointed out that in fact, the House bill would eliminate medical bankruptcies. And Pollack was right.
But I created confusion. While summarizing Pollack’s argument in two lines, I typed too fast, and said that under the House Bill, a family of four earning $55,000 would find their out-of-pocket expenses capped at $368 a year. That should have been $368 a month—or roughly $4,400 a year. (I did link to Pollack’s post on TNR, so if you went there you saw the right numbers.) Nevertheless, I apologize because my error just spiraled into further confusion on the comment thread.
That’s why I want to clarify here: If you correct my mistake, Pollack’s argument still stands. If a family of four earning $55,000 was in a car accident and family members racked up medical bills totalling $300,000, under the House bill , their insurance would pick up everything after $4,400. The $4,400 includes co-pays and deductibles.
That’s not small change, but it’s not enough to drive a family earning $55,000 into bankruptcy. In the case of a bill that small, the hospital and doctors would almost certainly let them pay it off over time, as long as they made a good faith down-payment of , say, $500 to $1,000 on the bills , and worked out a schedule of re-payments. Some doctors and hospitals would offer a discount if they were able to pay sooner.
By contrast, today, without the healthcare reform, in a case like this, even an insured family could easily face a bill of $200,000 (assuming there was a $100,000 cap on how much their insurer would pay in a given year. The House bill doesn’t allow insurers to cap either annual or life-time benefits). If you earn $55,000 and owe $200, 000, it’s much more difficult to persuade a hospital and doctors that you will be able to pay them over time. These are the bills that drive families into bankruptcies.
Unfortunately, my initial error led to confusion on the comment thread. First, Don McCanne weighed in to point out my error. This was helpful– thank you, Don.
But McCAnne also confused things a bit when he pointed out that in addition to a deductible and co-pays that would be capped at $4,400, under the House bill, the family of four earning $55,000 would be paying insurance premiums of $322 a month. Thus, he suggested, their total liability could be over $7,000 a year.
McCanne is quite right that, under the House bill, the family earning $55,000 a year would be paying $322 a month in premiums But the $322 a month would not be a sudden, unexpected expense. It would be part of the family’s budget. And for a family earning $55,000 a year, $322 a month is not unaffordable. As Kaiser Health News points out, http://www.kaiserhealthnews.org/Stories/2009/September/04/health-insurance-affordability-rau.aspx today a similar family who had access to employer-based insurance could easily be asked to pay $600 a month toward premiums.
For a middle-class family earning $55,000 a year, $322 a month is a real expense, no question. But the basic benefit package in the House bill is extremely comprehensive: $322 a month to provide good coverage for a family of four is an excellent value. Many of us pay nearly that much every month for cable television.
Bottom line: the House bill offers families far more protection and security than they have under the status quo.
Nationwide, prescription pills have become a societal force. Adults and children rely on them for a growing list of afflictions, including anxiety, depression, even shyness, for which few alternatives were available a generation ago. Nearly half of all Americans take at least one prescription drug, it indicates findrxonline in his article about this topic. Meanwhile, direct-to-consumer drug marketing that touts new and expanded uses has become widespread. Adults and children alike are exposed to print, television and radio ads promising happier, more fulfilled lives. For young people, experts say, all these factors appear to have blurred the line between the benefits and dangers of the medications.
Hi Maggie. What about families who don’t make the subsidies cut? They still benefit from the caps, right? But they have no protection against sky-high premiums. Am I right on that?
I think I found my answer in the Kaiser link. It looks like the House bill doesn’t help everyone:
The overhaul plan would offer little benefit for some of those families who say they are struggling right now to afford insurance.
To cover her husband, herself and their three children, Liz Stevens, a business manager at a small design firm who lives in Waterbury, Vt., says she currently pays $8,687 in premiums for insurance, and her employer chips in $2,213. In addition, she contributes $2,600 to a health savings account while her employer pays $1,500; the money goes toward her plan’s $4,000 annual deductible. All told, the family’s share adds up to about 12 percent of the Stevens’ income of roughly $91,000 a year.
Those costs are so high, Stevens says, that she and her husband stopped saving for college or retirement, and are discussing dropping out of her employer’s plan and enrolling their three children in the state insurance Vermont offers to minors. Stevens and her husband would then go without coverage, as they did during the family’s leaner financial years. As it is, she says she already shuns regular check-ups for herself to save money.
“It’s the equivalent of what happens with people without health insurance: you avoid going to the doctor,” she says. “It definitely changes your mental approach.”
Under the House bill, Stevens would have to pay more than $10,000 a year on premiums before the government subsidized the remainder. Even then she would still be on the hook for deductibles and face as much as another $10,000 in out-of-pocket costs should family members fall very ill. “The least expensive option for her would be to keep her current employer coverage,” says Ken Jacobs, chairman of the University of California, Berkeley’s Center for Labor Research and Education, who reviewed the case for KHN.
e-robin–
The subsidies cover middle-class and low-income families.
The subsidies don’t cover families who are upper-middle class (families that earn more than 50% of all U.S. famlies.)
A family of four earning $88,000 or more actually earns more than about 60% of all families. They really can’t expect people in the bottom 60% help support those in the top 40%–though I realize that upper-middle class families often feel strapped for cash because they would like to buy all of the things that upper-class families have, and they can’t afford them.
This is one of the downsides of living in a society with such large gaps between the rich, the upper-middle class, the middle class, the lower-middle class and the poor.
People who are 2/3 of the way up the ladder feel very frustrated, and are never likely to get close to the top of the income ladder (unless they win the lottery.
Regarding “sky-high premiums”–
Premiums are so high because we undergo so many unncessary tests, procecdures, hopsitalizations, and surgeries while over-paying for too many cutting edge drugs and devices that are no better than older less expensive drugs adn devices.
More than two decades of reserach done at Dartmouth shows that 1/3 of our health care dollars are squandered on unncessary, ineffective treatments.
This is hazardous waste because when a patient is exposed to an unncessary treatment, by definition he or she is exposed to risk without benefit.
The amount that private sector insurers have been paying out in reimbursements to doctors, hospitals and patients has risen 8% a year, each year, for the past 10 years.
That’s why premiums have skyrocketed. As they pay out more, they raise your premiums.
Premiums for hte public sector plan could be significantly lower,if the public sector plan refuses to overpay inefficient hospitals (as private insurance does now), refuses to pay for unncessary tests and treatments, and uses comparative effectiveness reaserach.
Under the House Bill, both Medicare and the public sector plan would be able to steer physicians and patients to the most effective treatments, while reducing costs, by lowering fees and raising co-pays for less effective treatments—while raising fees and lowering co-pays for more effective treatment.
Finally, in most countries in Europe where everyone is ccvered, families are expected to spend 10% of their income on healthcare before getting help from the government.
Today, in the U.S. upper-middle class families who work for a large company and have employer-based healthcare often pay only 25% of the premiums, while the company pays 75%.
They are defnitely better off stickig with their employer-based insurance.
Tax-payers are not going to pick up 75% of their bill.
The woman you describe works for a small coompany, and like many small companies, it can only afford to pick up 25% of her bill.
What is not clear is why she has a high-deductible plan and a heath savings accoutn–sounds like she’s trying to get the tax shelter of an HSA>
But she would be better off with a lower deductible and no HSA.
She and her employer are now payign $4,100 for that health savings account.
She should be able to get a plan with a $1,000 deductible and a higher premium which woudl probably be a better plan.
The HSA is essentially a tax shelter for the very rich; she’s ot wealthy enough to take advantage of it. (She would need to be wealthy enough to pay he deudtibe, co-pays and any out of pocket expenses out of other savings, leave the HSA untouched, roll it over each year, as it generates untaxed capital gains and dividends, builiding an estate that she can leave to her heirs.
That’s the real purpose of the HSA–to help the very rich get richer.
But at her income level she’s not in a position to do that, so she should forget the HSA (which someone “sold” to her or her employer) and look for a good plan with a lower deductible.
Reserach shows that high-deductibles cause people to put off needed preventive care.
One of the many good things about the House bill is that there are No co-pays for primary care.
That means there is nothing to make someone hesitate about going for primary care.
The goal of health care reform is not just to make care affordable for low-income and middle-class famlies, but to improve the quality of care for all families.
The House bill, by stressing primary care and chronic disease management does that.
Either Obama is right and he can truly cut $500 billion of waste, fraud and abuse out the Medicare budget or Medicare dependent seniors must suffer when $500 billion is cut from muscle and bone because there really wasn’t that much fat.