The issues we face today are often muddled by a plethora of media outlets. Whom to believe? Often, the points of the issues can get distorted or exaggerated. And all too often, we don’t discuss the issues, and when we do, we don’t always listen with an open mind. We hang on to our opinions like a spider to its web. Most of the issues are not black and white; they’re gray.This column is not about one particular person’s opinion. This column is about “why and how.” The sources are reputable organizations. If we don’t include statistics in some areas, it’s because we don’t trust where they came from. Stats can be skewed to anyone’s agenda, too.Any national issue is up for discussion. We’ll take it on – with respect to all sides.The United States spends more on health care than any other nation. Yet, according to the World Fact Book (published by the Central Intelligence Agency), it ranks 49th in life expectancy.From January through March 2010, 46.7 million Americans were uninsured. Costs of health care services continue to spawn increases in insurance rates. The Colorado interim commissioner of insurance, John Postolowski, has said that in 2011 consumers “should plan accordingly or be prepared to shop around for other options.”The health care issue in this country is a house of horrors, with the access debate at the front door. However, access to health care has somehow been reduced to an ideology that is naive: Is health care a right or privilege? It’s just not that black and white.Before getting into the ideology, it’s important to look at what has imperiled the health care system in this country. And it is in peril.The costsIn 2008, the last year for the study comparisons, health care expenditures were more than $2.8 trillion – more than eight times the $253 billion spent in 1980. Health care spending was about $7,681 per citizen, accounting for 16.2 percent of the GPD (gross domestic product).According to the Kaiser Family Foundation, four factors are driving health care costs.
- Technology and prescription drugs:The development costs, including marketing, of new and advanced products have to be recouped by the industries providing them. Consumer demand for high-tech health care diagnosis and treatment, even if it’s not cost effective, fuels the fire.I recently had a torn tendon in my rotator cuff. I finally gave in and went to a doctor. He took an X-ray, gave me a steroid injection and a set of exercises to complete each day. He told me if it wasn’t better in a couple of weeks, he might have to order an MRI. I have $5,000 deductible insurance – my arm was going to get better, believe me. I wasn’t about to pay for an MRI. Too many patients expect an MRI immediately. Too many doctors oblige.According to an article by Dr. Ezekiel J. Emanuel and Victor Fuchs, Ph.D., published in the Journal of American Medicine Association in 2008, “Paying for doing more adds a strong financial motivation to what is often a slim clinical rationale for an intervention … paying significantly more for procedures rather than for evaluation and management reduces physicians’ inclination to watch, wait and communicate, and increases their propensity to order a test.”
- The second driver of costs is chronic illness.The Kaiser Foundation reported that longer life spans have equaled a greater prevalence of chronic illnesses. Treatment costs for chronic diseases are estimated at 75 percent of the national health care expenditures.Five percent of the population with higher health care expenses was responsible for 49.5 percent of total health care spending, while the 50 percent of the population with the lowest expenses accounted for only 3 percent of total spending.Obesity in the U.S. amounts to $147 billion per year in direct medical costs – more than 9 percent of all medical spending. Obese people spend almost $1,500 more each year on health care – 41 percent more than an average-weight person. During a press conference in July, Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, said, “Obesity, and with it diabetes, are the only major health problems that are getting worse in this country, and they are getting worse rapidly. The average American is now 23 pounds overweight.”
- Third, an aging population:As the first wave of baby boomers qualifies for Medicare in 2011, more costs will be shifted to the public sector. We’re also providing questionable care. Quoted in a September article for DailyFinance.com, David Feinberg, chief executive officer of the UCLA Hospital System, said, “We have 90-year-olds getting heart-valve replacements. We do surgeries on people who really weren’t living before.”
- Fourth, administrative costs:Including marketing, billing, general office costs – about 7 percent of health care spending.
To insure or not to insureIn 2010, the average annual family premium for employers is $13,770 – 114 percent higher than 2000. The amount paid by the worker has increased by 128 percent: $5,049 for single coverage.In 2009, the average annual cost for single (private) coverage was $2,985; for family, $6,328. The average yearly premium for single coverage ranged from $1,350 for under 18 to $5,755 for persons 60 to 64.The average cost of a premium for families with children under 18 was $2,573 and $9,952 for heads of families age 60 to 64. The average annual premium for a $5,000 deductible plan is $2,696 for single coverage; for families, $6,251.I have friends who don’t have health insurance. They pay for their health care with cash. One of them was in the hospital recently for an emergency heart problem. The ER doctor was $1,321 alone for what my friend said was a “30-second” exam. My friend’s total bill for a five-day stay was $52,500. Because he paid cash upfront he received a huge discount and paid only $13,148.On that note, just show me the money. I’ll manage my own care. Perhaps insurance companies could be more like brokers. Put money into an account, earn interest. The “brokers” can provide us with cost comparisons and manage our accounts, but we deal directly with the doctors and hospitals. We purchase our health care treatment options based on need, knowing the money will come back to us at the end of the year, if we don’t use it. It’s kind of like health insurance savings plans. The difference is that we direct our care, the billing and choose our procedures based on cost effectiveness.How’s that for health reform?
Speaking of reformIn March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act. Many of the provisions of the act will not take place until 2014 or later. The following provisions were among those that went into effect in September.
- Insurance companies cannot limit or deny benefits or coverage for a child younger than age 19 because of pre-existing conditions.
- Health plans can no longer put a lifetime dollar limit on the benefits of people with high-cost medical conditions like cancer.
The big sweep of new health care laws is set for 2014. I found the best summary of the bill’s provisions at http://kff.org/healthreform/upload/8061.pdf. One aspect of the law is the creation of state-based American Health Benefit Exchanges, where individuals can purchase coverage, with premium or cost-sharing credits available for individuals and families living on incomes between 133 and 400 percent of the federal poverty level.Whether you are for or against it, the new law is not about a government takeover of the health care system. The approach to expanded health care coverage uses private health insurance companies. Employers will continue to provide coverage to the majority of Americans through private insurance companies. Medicaid will be expanded, but the act is a far cry from socialized medicine.
The mandateWhat is really raising the ire of the minimal-government supporters is seemingly the most controversial provision of the bill: the requirement that all U.S. citizens purchase health care insurance.As soon as President Obama signed the bill, the naysayers of the bill were talking lawsuits to challenge the power of Congress to institute mandatory health coverage. At this time, 20 states have filed lawsuits against the measure.Three judges have already ruled. Two judges have said the Affordable Care Act is constitutional, and one has ruled it’s unconstitutional. Other rulings are pending.One of the arguments for the mandates is the pre-existing condition clause. Many people cannot get health care coverage because of pre-existing conditions unless they’re attached to an employer plan. That changes under the new bill, but if the mandates were deleted, some people might wait until they were sick to purchase coverage. It happened in Massachusetts. Without the mandate, the cost of insurance in the individual market increased and reversed itself with the mandate.However, a mandate doesn’t necessarily mean that everyone will have insurance. Like auto insurance, there will be those who refuse to purchase coverage and risk the consequences. People covered by employers definitely have the advantage.
The crème de la crèmeIn August 2009, Sen. Jim DeMint, (R-S.C.) in an interview with the Charleston Post and Courier said this: “I do think in our country and in any civil society there should be a safety net for basic health, food and shelter, but that doesn’t mean that the whole system should be designed around the belief that people can’t make their own decisions … (we need to) make sure everybody has access to policies they can afford, own and keep. We’re not doing that. What we’ve done is set up the whole system to reward employers for offering health insurance, but we don’t support people who don’t get their insurance at work, and that’s not fair.”The health care system today doesn’t support housekeepers, pet sitters, hair stylists, freelance writers and artists. Service people are the bedrock of our society. We can’t expect everyone to be covered by employers. But I’d sure like to be part of the diced-up federal employee health plan.Federal employees can choose from an assortment of plans, with options for spouses and dependents. There is no waiting period for benefits to start – no precondition clauses or denials. The government – or taxpayers – pays up to 75 percent of the premium.Taxpayers also foot part of the bill for extra perks for members of Congress. They have their own pharmacy housed within the Capitol, along with a team of doctors, technicians and nurses. They pay extra for the services, but taxpayers subsidize their in-house mini-hospital by $2 million a year.Of note: Since 2005, health insurers and pharmaceutical companies combined gave $6.1 million to the top 10 recipients of each house of Congress.
Black or white – noSome in Congress and elsewhere believe that health care is a right or privilege. I don’t buy that.It’s not about “rights,” it’s about need. Do we have a right to food?Health care is not a privilege. Is it a privilege to eat? It might be a privilege to eat dinner with the Queen of Sheba, but how is it a privilege to have that colonoscopy?”Health care is a need.If we disarm the ideology that health care is a right or privilege, perhaps we can find an innovative answer to the health care dilemma.We should be able to come up with a system to reward people for taking care of their bodies and utilizing health care options cost-effectively. We can come up with technology to save the tiniest newborn, but we can’t figure out a reasonable health care system?What if we hike sales tax on cigarettes, liquor and fast food? A bottle of wine costs $16 – tax is $1.60 at 10 percent. I’d pay the tax to help insure America.Drug companies would realize substantial savings if they were banned from advertising on television. Drugs are dispensed by doctors, not T.V. commercials. Who else is tired of that bathtub-on-the-beach scene?
In the grayHealth care is part of a bigger problem in this country: Our priorities are way out of whack. Actor Leonardo DiCaprio made $50 million for one movie; my teacher friend makes $41,000 a year.Making money as a business owner is one thing, but paying chief executive officers millions in salaries and bonuses is another. CBS reported in September that when CEO Fred Hassan of the pharmaceutical company Schering-Plough lost his job, he received a $33 million “golden parachute” when his company merged with Merck. While 16,000 employees lost their jobs.And remember this? As the government rescued his company, American Express CEO Kenneth Chenault took home $16.8 million, including a $5 million cash bonus, while his company laid off 4,000 employees and received $3.39 billion in Troubled Asset Relief Program funding – from us.That aside, we will never make any headway until we satisfy the need for jobs in this country.People won’t embrace health care reform unless it’s affordable. How can they afford it if there aren’t jobs?In this country, 15.1 million people are unemployed. Meanwhile, Forrester Research Inc. predicted that U.S. employers will move 3.4 million white-collar jobs and $136 billion in wages overseas by 2015. Congress is battling about tax breaks for companies that ship jobs overseas. That answer seems black and white to me.Constant bantering among politicians isn’t doing the country any good as well.The people who are on the edge in this country – people who can’t afford health care or even food – are workers, they’re you and me. They’ve been caught in a whirlwind of greed and incompetence.People who frequent a food bank in Cleveland wrote messages on paper plates to state legislators in Ohio. The messages were published in a Connie Schultz column.”I’ve been working for over 25 years and never needed any kind of help. I lost my job two months ago, and if this food pantry wasn’t available we’d be hungry at least one week at the end of the month.””I got laid off in Florida, came here to Ohio – got laid off. I have a bachelor’s degree and still can’t get a job. My son is diabetic, and I take care of my disabled mother. The food bank has been my savior. Without them, I don’t know what I’d do.”I wonder what he’s doing about health care.
This column does not necessarily represent the views of The New Falcon Herald.
