Dear President Obama, Per Your Request ...

"China has embraced capitalism to keep the socialist elites entrenched while, more lately in the west, we've embraced socialism to keep the capitalist elites entrenched." -- Jim Chanos

To Chanos, we say, well ... at least the Chinese have some modest talent at capitalism. We, on the other hand, are really bad at socialism.

With this insight in mind, we offer a response to President Obama's call for health-care system reform alternatives in his State of the Union address last month: 

[I]f anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. (Applause.) Let me know. Let me know. (Applause.) I'm eager to see it.

We believe that the fundamental weakness of our current health-care system lies in the irrational incentives it has created, which conspire to reduce the responsibility of individuals for their own care, and encourage providers to focus on cures rather than prevention.

How we got here
These incentives (and disincentives) exist because under the current system, people other than the consumers and providers with a direct interest in the outcome -- namely, insurance-company bureaucrats -- are making resource-allocation decisions, or at least setting parameters for those directly involved to make those decisions. While this is theoretically well-intended, in practice this convoluted system encourages suboptimal choices by both consumers and providers, by driving costs up while simultaneously degrading the quality of care.

The very concept of employer-provided "insurance" that covers standard health-care expenses -- as if it is just bad luck that folks need to see their doctors every now and then -- is fundamentally dysfunctional. People covered by health insurance typically get only indirect feedback on the cost of medical treatment, because they are charged only a token fraction of the fee.

Consequently, patients have no financial disincentive to pursue the greatest amount of treatment available -- even past the point of diminishing returns, medically speaking -- since it doesn't make any difference to them, cost-wise. And health-care providers often have incentives to overprovide care too, either to maximize billing, justify underutilized equipment, or reduce the risk of a potential lawsuit. Worse still, if you find a new treatment that is more effective, less painful, and/or cheaper, unless your insurance company approves it, you can't use it (unless you can pay the entire cost out of pocket).

How things got even worse
And, of course, there's the problem of how to extend coverage to people who are not employed. With no employer to foot half or more of the insurance bill, such folks often find it hard to afford the cost of health insurance. (By the way, while it is beyond the scope of this article, for anyone wondering whom to blame for designing our weird health-care insurance system -- unlike anything anywhere else -- the answer is serendipity, as is well-explained in an excellent edition of This American Life.)

Even more insidious is the current cultural focus on fixing problems once they arise, as opposed to preventing them in the first place. It is much more cost-effective and better for overall health, for example, to teach children optimal diet and exercise regimens, than to wait for them to grow up and develop serious medical problems. 

But instead of focusing our efforts on ounces of prevention with health education and preventive medicine, we allow ourselves to become unhealthy or sick, and then scramble around to find pounds of cures: emergency-room treatments, a variety of heroic and expensive responses to conditions such as heart disease that could often have been prevented much more cost-effectively, and expensive drugs for (preventable) chronic conditions. No wonder the United States spends more per capita than any other nation upon health care, while getting only mediocre results!

What should we do?
We believe that a genuinely "better approach" must address both the cultural and financial issues.

The key component on the cultural side would be comprehensive education to combat and eventually eradicate health-care illiteracy. The focus -- for both consumers and providers -- would be on the efficacy of preventive care and the imperative to attend to results in making medical care choices.

The role of government here would be to:

  • Work with content experts to develop and distribute standards for health education curricula.
  • Oversee the creation of electronic medical records to facilitate coordinated holistic care between providers for each individual.
  • Serve as an honest broker to collect and distribute outcomes data, so that consumers can make informed choices with respect to health-care providers.
  • Conduct needs assessments to identify and address inefficiencies (e.g., if a rural county does not have adequate preventive health-care providers, providing incentives to redress that situation).

On the financial side, we propose universal health savings accounts (HSAs) combined with mandated catastrophic medical insurance coverage. Each individual would contribute at least a minimum number of pre-tax dollars -- which may vary depending on demographic data and medical history -- into his or her HSA each year, as well as contributing the requisite funds to the HSA of any minor dependent. For individuals who cannot afford the minimum contribution, the government will cover the difference.

Individuals have total control of the funds in their own HSAs, with the exception that they can only use those funds for their own health care, and that they are required to use some of that money to maintain catastrophic medical insurance coverage. And teaching financial literacy -- so that folks can responsibly manage or delegate the management of their HSA funds -- must be part of the comprehensive education initiative discussed above.

Unlike the Flexible Spending Accounts that exist under present law, at the end of the year any funds remaining in the HSA are not forfeited, but instead roll over to the next year. Over the course of your career, you would be encouraged to build up a growing surplus in your HSA, to ensure the availability of funds for retirement medical expenses. If you succeed in gaining enough of an excess surplus, you can -- after paying back government contributions to your HSA from prior years, if any -- withdraw the excess funds and use them for any purpose. (Of course, you would have to pay income tax on any such withdrawal used for non-medical purposes.) If your HSA is still funded when you die, the proceeds become part of your estate (again, after paying back government contributions, if any).

How does this approach stack up with respect to President Obama's five criteria?
Well with respect to (1) bring down premiums, (3) cover the uninsured, and (5) stop insurance company abuses, we get full marks. Under our plan, anyone who prefers having some bureaucrat dictate which doctor he or she can see and which treatment is "covered" is welcome to spend their HSA funds to buy traditional "health insurance" -- but we would bet that not many people will prefer that option.

To retain any such business at all, insurance companies would have to compete hard. But for most folks, paying health-insurance premiums and pleading to get coverage for a visit to the chiropractor, or for an herbal or homeopathic remedy, will be merely a not-so-fond memory. And by definition, everyone is required to have an HSA, so everyone is covered.

As for (4) strengthening Medicare and (2) reducing the deficit -- which, on the face of it, would appear to be contradictory objectives -- under our proposal Medicare would be redundant, and can be eventually phased out. During a transitional period, many retired and low-income seniors will need government assistance funding their HSAs each year, because they will not have had the opportunity to build up a surplus during their working years. But as the years go by, more and more newly retiring folks will be self-sufficient with respect to health-care expenses (not to mention healthier). 

Eliminating one of the entitlement black holes most definitely qualifies as deficit reduction. It would also bring systemic efficiencies, by reallocating the energies of all those folks currently dedicated to inventing clever ways to deny medical insurance claims toward more productive work.

So ... how do we get there from here?
Clearly, the politics will be tough. With the opportunity to service and manage HSA funds, some of the large financial services companies such as Bank of America (NYSE: BAC  ) and JPMorgan Chase (NYSE: JPM  ) would probably support our plan. But insurance companies such as UnitedHealth Group (NYSE: UNH  ) , Aetna (NYSE: AET  ) , or WellPoint (NYSE: WLP  ) , faced with the potential loss of a lot of business, would be far less enthusiastic. 

Big Pharma companies such as Merck (NYSE: MRK  ) and Pfizer (NYSE: PFE  ) may find the emphasis on preventive medicine a hard pill to swallow, since it could potentially zap the market for expensive new drug cures. We believe the best strategy would be to appeal to Americans' sense of fair play and concern about pocketbook issues. On that basis, this proposal is miles ahead of the current system.

Implementing the proposed approach will put cost back in the decision-making equation for both consumers and providers. And it will result in the creation of government-capitalized data systems to enable patient record information sharing by different providers, facilitating coordination and making available provider results data, to help consumers get the biggest bang for their health-care bucks.

Consequently, the percentage of GDP spent on health care will decline, while quality will improve.

But the best things about this approach are that it plays to our strengths in exercising liberty and independence in the pursuit of happiness; it utilizes market forces to promote quality and cost-effectiveness; and it provides incentives for us to take more responsibility for the welfare of ourselves and our families, and educate ourselves about health (and perforce science) issues.

To the extent that it succeeds, we will end up with not only healthier and wealthier, but more responsible and well-informed citizens.

What are your thoughts on health-care reform, Fools? Are Brad and Madge onto something? Join the debate in the comments section.

Motley Fool guest contributors Brad Hessel and Madge Cohen don't agree on everything, but they are married and living (together) in North Carolina. Brad manages an investment advising service, has previously worked in investment banking, and has founded or co-founded a computer game design company, a CASE tool software company, and a knowledge-management consulting practice. Madge works for the North Carolina Division of Public Health as operations manager of the Oral Health Section. Neither currently has any position in any of the equities mentioned; however, Brad's clients may have such positions. The Fool's disclosure policy includes certain trading restrictions that apply to Brad and Madge. However, his clients are not subject to our disclosure policy, and thus are free to trade any such equities. 

Pfizer, UnitedHealth Group, and WellPoint are Motley Fool Inside Value selections. UnitedHealth Group is a Motley Fool Stock Advisor pick. The Fool owns shares of UnitedHealth Group.The Motley Fool's disclosure policy firmly believes that an ounce of prevention is worth more than a pound of cure.


Read/Post Comments (158) | Recommend This Article (212)

Comments from our Foolish Readers

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  • Report this Comment On February 24, 2010, at 3:41 PM, zhuubaajie wrote:

    To lower the cost of health care, it is necessary to cut the cost of the "production factors." One of the biggest such is the income of physicians. Lift the Cuban embargo, and import 100,000 Cuban doctors (even with the must reduced access to drugs, Cuba has one of the higher life expectancies in the world (78.3 76.2 80.4), placing it JUST ABOVE the 18th ranked United States (78.2 75.6 80.8), even as the Cuban men smoke cigars. The availability of Spanish speaking doctors would greatly improve health care for Hispanics in America.

    Allowing the government bodies to negotiate prices (other than paying "list") would also bring drug prices down by at least 20%. But with the Supremes ruling that corporations have free speech rights, the chance of that happening is slim.

    There are alternatives, and life is about choices, but most Americans still choose not to choose, thus allowing the corrupt and hugely expensive system to continue enriching the few.

  • Report this Comment On February 24, 2010, at 4:05 PM, zhuubaajie wrote:

    Sorry it is 38th ranked for the United States, and 37th ranked for Cuba.

  • Report this Comment On February 24, 2010, at 4:48 PM, npeebles wrote:

    And, your plan works how for the unemployed and underemployed.

    There are people out here, unbeknownst, apparently, to you, who can barely put food on their table.

    How do they put money away for health insurance?

    What we have is a system in place that arbitrarily and caprciously awards theives. The greedy just keep getting greedier and richer.

    We have a system that is trillions of dollars in debt.

    We have a system about to implode.

    Karma, my dear friend, Karma.

    There is no solution. You cannot stop the inevitable. What goes around comes around. Always has. Always will.

    Like the old seaman said to the Captain of the Titanic

    "I thinks me smell ice."

    The old Captain cried "Full speed ahead."

  • Report this Comment On February 24, 2010, at 4:51 PM, jackpcwp wrote:

    I like the points provided in your article. I disagree on the issue of Medicare, and would like to add the following changes to enhance your ideas:

    *** ELIMINATE fraud, waste, greed, incompetence, mismanagement, and administrative inefficiencies in Social Security, Medicare, and Medicaid. Doing so you can increase the benefits provided by those three programs to the people who are desperately in need of the taxpayers help. And you do it without increasing costs to the taxpayers.

    *** DEPORT ALL illegal immigrants. Do not put them in US jails as it only increases the deficit. Keep track of deported illegal’s and if they are caught a second time, create an agreement with their home country to put them in jail in their country. See how long they will enjoy the free food and housing. If the host country is hesitant with such an agreement,

    try using sanctions or taxes or tariffs --- our government is good at doing that even though the U.S. continues to have trade deficits with a multitude of foreign countries.

    *** ELIMINATE all pre-existing conditions from every American insurance plan.

    *** ALLOW ALL Americans to purchase health care plans for their family across state lines. Watch the increased competition and reduced cost for the insured. CAPITALISM --- remember what that is? Forget Bailouts, try bankruptcy!

    *** DESIGN a single uniform health care claim form and mandate that it be used by all insurance companies. Again watch health costs decrease, and just maybe watch doctors and hospitals reduce their fees.

    *** TORT REFORM --- eliminate all punitive damages from medical malpractice suits. CAP all claims to ONLY allow a lifetime payment for medical care that is related specifically to the damage caused to the patient that the suit covers. Mandate that the loser pays all attorneys fees, and watch the amount of legal claims dramatically decrease. Then watch medical malpractice insurance rates decrease, and then watch medical costs to the insured or uninsured decrease.

  • Report this Comment On February 24, 2010, at 5:13 PM, cropconsultant wrote:

    You said it at the very beginning, we are very bad at socialism. Looks we we better start improving on that, since to date capitalism has not served us very well in regards to health care.

    I like the idea of HSAs for everyone. Who gets to fund the HSAs of the 17% unemployed workers though.

    I can't believe the government will do a worse job telling me what doctor I can visit, or what procedure will be funded than my health insurer, whose bottom line has to be more important to them than my health. Can you say "conflict of interest?"

  • Report this Comment On February 24, 2010, at 5:22 PM, footchester wrote:

    So, the USA is the only 1st or 2nd tier country that can't afford universal coverage? I thought all of the hyper-patriots would have too much pride to admit that we can not keep up with Finland, New Zealand, Austria or other mighty nations.... Or do Republicans believe America is really that pathetic that we are not as good as these other countries?

  • Report this Comment On February 24, 2010, at 5:34 PM, tobetterdays wrote:

    Appalling article. The "Let them eat cake" of health care reform. Too much crap to actually debate this, but the biggest missing item is exactly how does this provide healthcare to those who cannot afford it? Or those who have preexisting conditions? .....

  • Report this Comment On February 24, 2010, at 5:38 PM, Roth100 wrote:

    I think your ideas are very close to those expressed by Obama. The problem with the current congressional proposals is that they are getting too murky in an attempt to please special interests. Because the majority of our health care costs are related to incurable chronic diseases, it makes no sense to spend most of our health care dollars on treatment of chronic disease and a small (tiny) fraction on prevention. It makes even less sense to pay insurance companies to be the middlemen...they do nothing to improve the health of the country and they consume billions of "health care" dollars.

  • Report this Comment On February 24, 2010, at 5:46 PM, bhessel wrote:

    npeebles and cropconsultant,

    Sorry we were not more clear in the article, but we are proposing that "For individuals who cannot afford the minimum [annual] contribution, the government will cover the difference." This is likely to be relatively expensive as the system is phased in (especially with older citizens who have not built up savings) but as more and more folks become aware of the advantages -- financial and healthwise -- of preventive care and have time to build up savings, fewer and fewer will need any government help, and the overall costs of keeping us healthy will decline.

  • Report this Comment On February 24, 2010, at 5:56 PM, ejm23 wrote:

    when hmos were first made available to the public, one of , if not THE major reasons, for joining an hmo was that the medical coverage would be preventative in nature. you would visit the doctor more often for preventive medical exams. once you joined however, the number of visits allowed and the scope of the testing was drastically cut back and you were back in the same boat as before, only with less choice for your health care provider.

  • Report this Comment On February 24, 2010, at 5:58 PM, dotdashdot wrote:

    Very interesting approach. The HSA has one disincentive to me and that is to actually spend those dollars. Would we spend them on preventive care or would it be better to bank the bucks for a rainy day in the future? Would we get little things done or buy medicine to fight a sinus infection or get stitches for a small cut, when we could "get by" without the treatment. Maybe that is your intent, to have us make these kinds of choices.

    What ever is done, we have to lower the costs and to cover more people. Hospitals have a "list" price for services, but the price paid by the insured is much less. The very poor expect and get emergency service for free. The uninsured Middle class has a hard time because they don't get indigent care and they are expected to pay the bill.

    CNN did a piece this morning on the unbelievable hospital prices for simple items- $200 for one suture pack, $800 for a biopsy needle, and on and on. As pateints we don't check the itemized bill if we have insurance. HSA will have us looking more carefully. Still, Big pharma and other medical suppliers are making a big bundle. People looked to Canada to get perscriptions at lower prices. In the US we are set up to be gouged.

    Enuf ranting.

  • Report this Comment On February 24, 2010, at 5:59 PM, csandvig wrote:

    Excellent article. Any effective solution will require that consumers take more responsibility for their health care costs.

    An additional element that would help reduce cost is "standard of care guidelines" for physicians. For any given diagnosis it would specify an acceptable cost-effective standard of care. If the physician follows the standard of care she cannot be sued. This would eliminate countless MRIs, CAT scans and other defensive treatments. This is one way that other developed countries keep their health care costs under control.

  • Report this Comment On February 24, 2010, at 6:06 PM, dargus wrote:

    I currently use insurance as described in this article. Granted I am young, just hit 30 this month, but so far it has worked out well for me. I've maxed out my HSA contributions for the last two years, and I don't intend to spend out of it unless I absolutely have to. I'm even able to invest in stocks and mutual funds.

    Essentially, it becomes an IRA if I don't have any heath care costs, and it grows larger towards the end of my life when my medical costs will likely be high. So far, I've yet to make a single claim to my insurance company. The only thing that worries me is if I do make a claim, which would have to be a big ticket item, will my insurer find a way to get out of paying it. At any rate, with the government subsidizing the poorest in this plan, I think it is a viable solution. At the very least, it could be combined with some other ideas out there to produce something with less of a budget impact that the current bills floating around.

  • Report this Comment On February 24, 2010, at 6:14 PM, jsj3 wrote:

    I'm sick and tired of articles like this. It basically blames the end-user. I would argue that most people are too busy in their daily lives to know the ins-and-outs of their tome of a health insurance contract. Insurance companies make profit by making it confusing and then denying everything they can. I'd rather just pay x% of my salary in taxes and live worry-free about my health. That doesn't mean I won't stay healthy, but I won't die or go broke trying to get better should something unforseen happen. People like to blame the end user and say "He should have had better insurance"--that's ridiculous! How does one predict what diseases will come up next year? Because the ones you have are pre-existing conditions and you don't get coverage for those. I'll take socialism, thank you. If socialism is okay when we pay for our libraries, our roads, our military defense, our national parks, our fire departments, our post office, and our police, WHY isn't it good enough for our health? Most countries do it socialist-style. They do it better than us, they have better outcomes, and they do it CHEAPER. Quit heaping responsibility on the end user. We have enough to do already...

  • Report this Comment On February 24, 2010, at 6:14 PM, psalmsinger wrote:

    The problem with healthcare is not the lack of government intervention, it is the excess of it. The restrictions on out-of-state insurance, litigation, regulation, etc., all contribute to increasing the costs, reducing choice, and failing to punish inefficiency.

    Even consider that requiring that your employer provide healthcare adds to the costs. First, it puts small businesses into a poor competitive position. Secondly, it promotes corruption and collusion between healthcare insurers and large corporations at the expense of value to the consumer. Third, it eliminates a free market where the consumer votes with his pocketbook, which in turn stifles innovation that would allow for better care at lower costs. Why not simply have the employers pay you and you shop for healthcare that makes sense to you? Why not have a Consumers Digest for healthcare to help consumers pick healthcare with more care than choosing their next car? Professional organizations, unions, social clubs, churches, the bar on the corner, the health club, or any other group could band together and negotiate a group rate, if desired. Creating a law to require businesses to entangle with healthcare provides no benefit, but has contributed to the healthcare system we have now. The consumer must have the power to vote with his money, or it will always fail.

    Consider how many hospitals are named "Mercy" or "Providence" or "St. xxxx" or "Memorial". Why these names? Hospitals used to be run by churches. Hospitals used to exist for charity. Now, hospitals are for profit. So, we go from charity, to business, to government. This is not improvement; this is demise.

    And, by the way to counter another comment, if you consider Finland, New Zealand, or Austria to be a mighty nation and that the USA is not as good as any of them, then why do you live here? You can choose to live anywhere you want, and you live here because it is better. Not choosing the better is clear insanity. In fact, you live here because it is better; not in one area better, but the whole system as a whole is better. Today, everyone deserves healthcare. Tomorrow everyone deserves a job, then a college education, and a car, and a house, and anything else that is their neighbors'. The USA is better because people generally get what they work for here, and those who get a bum steer find charity from their family, friends, and neighbors. The taking from one man, by the muzzle of a gun (and how else does a government collect taxes?), to give to another, is what we rejected in 1776. It is called "armed robbery" when a person does it, but a "program" when the government does it. Many of our children died in wars to prevent this nation from becoming like those other "mighty" nations. I am no hyper-patriot. I do not consider myself in the same league as the real patriots whose names are only fond memories. However, I take great offence at any pathetic attempt to besmirch this nation by vain comparison.

  • Report this Comment On February 24, 2010, at 6:14 PM, Sunshyne43 wrote:

    Your elegant solution to our healthcare crisis is to be applauded! But getting our Legislators to work with us on this type of solution would be impossible. HSA's are a great vehicle for helping people take control of their healthcare costs. And, prevention is always better than fixing something that is broken. Wouldn't it be wonderful if our grandchildren did not have to participate in Medicare! And, a healthier society is a more productive society. It sure would be nice to not have to fight with insurance companies to get reimbursed for legitimate healthcare expenses.

  • Report this Comment On February 24, 2010, at 6:15 PM, gunnboy wrote:

    I think your plan has a lot of merit. You need a marketing plan to get it before the dummies in Congress.

  • Report this Comment On February 24, 2010, at 6:16 PM, jsj3 wrote:

    Furthermore, why invest in an HSA when most trips to the hospital can knock out a lifetime of savings? My father was recently hospitalized for FOUR days...$17,000. How many years of HSA do you think that would knock out? Better start saving young--like when your grandparents are born...

  • Report this Comment On February 24, 2010, at 6:19 PM, Hoping2Retire wrote:

    In my opinion, the most important thing to start with and thereby ultimately realize real reform to the health care system lies in development of a robust and dynamic outcomes measurement system. (Not unlike the suggestion above that government be an "honest broker" for such information). Current outcomes measures are extraordinarily crude and emphasis on them could cause providers to avoid difficult to treat patients. To make the system sufficently robust and responsive to changes in technology, the system of measures needs to take into account patients' presenting conditions as well as patients' choices. Did the patient not seek care in a timely manner and/or follow physician instructions, etc.?

    I believe the government should sponsor the development of such a system, taking input from medical experts regarding how the various cohorts should be distinguished so that, to the extent possible, apples are compared to apples. Government should also mandate reporting on a timely and audited basis of data needed from all providers. That is government should develop an SEC for healthcare outcomes.

    Once a robust and dynamic system for outcomes measurement is developed, we can start reimbursing provider groups (insurance company organzied or organized by doctors and hospitals themselves) based on outcomes for patients based on the cohorts they fall into. I do not see this as an individual's personal choice as I believe the costs of uncontrollable situations, like a bad accident or genetic condition should not be paid for by the individual but rather spread over the population as a whole and therefore an honest broker is needed to accomplish this. And logically the central conduit would be the federal government who would contract with providers meeting minimum outcomes standards on a competitve basis and allow individuals to choose amoung the available alternatives. This will change dramatically the perverse incentives to over utilize health resources where unnecessary and increase the speed of integrating promising new innovations where they are of demonstrable benefit and otherwise result in increased efficiencies in service delivery. I also believe that such a set of incentives would cause all health providers to maintain electronic medical records so they could both support the outcomes reporting requirements as well as identify the most cost-effective strategies for achieving ever improving outcomes.

    The final key leg of the stool needs to be incentives for individuals to pay the cost of their own choices. If I choose to smoke, I should pay the present value of the expected furutre cost of that decision. If I choose not to follow my physician's instructions and continue to eat cake and candy despite my diabetes, I should pay a price in my monthly insurance premium. That is we should accelerate and quantify the costs of these decisions. This area would also be one which would involve difficult decisions regarding what is a matter of choice, that should be paid for by the individual, and what is a matter the cost of which should be borne by the population as a whole. But the debate about which should be which is a necessary one. For example, should the costs of maintaining a persons bodily functions on life support be borne by the individual or by society as a whole as it is today. I do not know where we as a society would come down on such a question if it were asked in such a direct way and the cost to each of us for the choice was known.

    Well just a few thoughts for the debate....

  • Report this Comment On February 24, 2010, at 6:23 PM, ynotc wrote:

    Cropconsultant wrote; "Looks we we better start improving on that, since to date capitalism has not served us very well in regards to health care."

    We haven't had a capitalistic health care system in the United States since the day that insurance companies entered the picture. A pooling of resources, which is what insurance is, is socialism.

    If the consumer was paying directly for their healthcare I can assure you that they would be more concerned about the cost and the results!

  • Report this Comment On February 24, 2010, at 6:33 PM, richie54 wrote:

    Look at the Miracle Gro Company of Columbus, OH. They're a great example of how many large companies can be self-insuring and get and keep their employees living healthy life styles.

  • Report this Comment On February 24, 2010, at 6:39 PM, mtracy9 wrote:

    REAGANOMICS IN ACTION

    -------------------------------------------

    How long did it take Reagan to reduce the unemployment rate to below 8%?

    01/1981 - Unemployment rate 7.5% …. Reagan sworn in.

    02/1981 - 7.4%

    03/1981 - 7.4%

    04/1981 - 7.2%

    05/1981 - 7.5%

    06/1981 - 7.5%

    07/1981 - 7.2%

    08/1981 - 7.4% * Reagan CUTS taxes for top 1% and says unemployment will DROP to 6.9%.

    09/1981 - 7.6%

    10/1981 - 7.9%

    11/1981 - 8.3%

    12/1981 - 8.5%

    01/1982 - 8.6%

    02/1982 - 8.9%

    03/1982 - 9.0%

    04/1982 - 9.3%

    05/1982 - 9.4%

    06/1982 - 9.6%

    07/1982 - 9.8%

    08/1982 - 9.8%

    09/1982 - 10.1%

    10/1982 - 10.4%

    11/1982 - 10.8% * Unemployment HITS a post WW2 RECORD of 10.8%.

    12/1982 - 10.8%

    01/1983 - 10.4%

    02/1983 - 10.4%

    03/1983 - 10.3%

    04/1983 - 10.3%

    05/1983 - 10.1%

    06/1983 - 10.1%

    07/1983 - 9.4%

    06/1983 - 9.5%

    07/1983 - 9.4%

    08/1983 - 9.5%

    09/1983 - 9.2%

    10/1983 - 8.8%

    11/1983 - 8.5%

    12/1983 - 8.3%

    01/1984 - 8.0%

    02/1984 - 7.8%

    It took Reagan 28 MONTHS to get unemployment rate back down below 8%.

  • Report this Comment On February 24, 2010, at 6:42 PM, MKArch wrote:

    Brad and Madge I have an even better idea than MSA's. It's a pay as you go hybrid insurance loan plan. For a modest premium the insurance company pays your medical expenses but you then pay the insurance company back over time up to a certain agreed upon maximum. If you agree to interest on your expenses you get a lower premium.

    Since you will ultimately be paying the medical bills you have to decide how much care you can afford although with the guaranteed maximum you are covered for a disaster. Not only will this plan cut back on unnecessary treatments it will encourage preventative behavior. It's the greatest plan that nobody knows about.

  • Report this Comment On February 24, 2010, at 6:46 PM, KJTemplin wrote:

    I very much like your ideas which revolve around putting the health burden where it should be, on each of us.

    Unfortunately, our society is too far down the path of "someone else" making the health decision for us and the detecting (as opposed to preventative) aspect that goes along with it.

    Regardless, I hope you passed your thoughts on to our elected officials as they need more ideas like yours.

    Thanks.

  • Report this Comment On February 24, 2010, at 7:00 PM, PositiveMojo wrote:

    With all due respect part of your plan is crap - part of it is ok. Let's say I want to buy a loaf of bread. So, we create a big govt agency to determine where bakers need to be sent to make the bread, what bread is going to be made, who can sell it and the price. So that every time you want to buy a loaf of bread you go to the government. Wouldn't it be easier to go directly to the baker and buy the bread? Why should govt get in the middle of the transaction? That is Medicare, Medicaid and all current forms of socialized healthcare. The problem is TOO MUCH REGULATION AND MIDDLE MEN!! I agree - get rid of the middle men.

    Educate the people? You've got to be kidding me. Tell them - hey dude, eating the hamburger makes you fat. Veggies are good for you. Don't you think people already know that! They are not stupid. It just that they make bad choices. So unless you are talking about brainwashing or a gulag - forget it. People will be people - no joke - just check history. People usually don't change unless there are consequences for their decisions (proven by research). Oh yeah - almost forgot - you'll have to counteract all the commericials pushing drugs instead of alternative medicine.

    And then there's one comment knocking evil capitalism. If you have two teams playing a football game with no rules - somebody is gonna get hurt sooner rather than later. A football game has to have rules to protect the players and make the game fair. Same with capitalism - it's an ugly game without rules. But with rules it's fun to play and watch.

    Ok - I didn't want to do this... but I'll admit I'm an old guy. A very old guy. I remember going to a doctor when I was a kid and his office was in his home. I can't remember if the visit was $10 but I know it wasn't more than twenty because he was paid in cash with a single bill. We didn't have an emergency room, hospital administrators and an army of nurses and whoever else holding out their hands. Here's the question. Why don't we have doctors working out of their homes any more? Bingo - give the kid a lollipop! Regulations - state and local. The snooty medical schools (I went to one) and interference in some poor sap trying to directly help someone on every level. THEY ARE KILLING HEALTHCARE ENTREPRENEURS.

    When Social Security was passed did you know it was 64 pages long - that's it! And it was brilliantly written to help the destitute. Yep - those who didn't have the means to pay for themselves. What happened to that idea? I'd tell you but you wouldn't like the answer.

  • Report this Comment On February 24, 2010, at 7:02 PM, RobertC314 wrote:

    "I'm sick and tired of articles like this. It basically blames the end-user."

    I pretty much stopped reading here. Thoughts like these are why we are in the mess we are; after all, why should the "end user" [us] be responsible [for their own health]. Lack is preventative care is SOLELY the responsibility of the "end user". It makes me sick to think that people would want to blame anyone except the "end user" of medical care for the fact that they didn't take care of themselves.

  • Report this Comment On February 24, 2010, at 7:16 PM, BurntTiger wrote:

    Kinda off topic but I'm wondering if health care passes smoking and other unhealthy activities would increase? If 1 in 10 smokers increase by a pack a day because they now have health care....hmmm

    I'm pulling numbers outta my ass but I'm trying to think outside the box to see this as an opportunity. Any other fools wanna add to my line of thinking?

  • Report this Comment On February 24, 2010, at 7:17 PM, stan8331 wrote:

    Some good ideas are presented here, but I see some serious flaws. Requiring catastrophic coverage sounds sensible, but what will happen to those unfortunate folks who actually do have a debilitating incident? No insurance company will be willing to renew their contract at a price anyone who's not VERY wealthy would be able to pay.

    Similarly, for anyone who happens to live beyond an average life-span, catastrophic coverage will quickly become impossible to afford. Catastrophic coverage for a 90 year-old person would have to run into the hundreds of thousands of dollars per year. None of us are getting out of here alive, and the medical bills that can be incurred prior to death are truly astronomical.

    The unemployed and under-employed would also continue going to emergency rooms under this plan. That is clearly not a path to the dramatic savings we need to find if the country is going to avoid healthcare-spawned bankruptcy.

    The thing that concerns me most about the healthcare debate is that I see no will on either the left or the right to make the terribly difficult decisions that will be required to bring our healthcare spending down to a sustainable percentage of GDP. Republicans and Democrats engage in lusty fistfights over rearrangment of the Titanic's deck chairs while the baby boomer iceberg looms ever closer.

  • Report this Comment On February 24, 2010, at 7:20 PM, PositiveMojo wrote:

    @mtracy9. Wow - you must have had a spreadsheet on unemployment during Reagan and just itching to use it.

    However, for those of us who lived during the Reagan years, things were TOTALLY out of control when he took office - not just unemployment. Gas prices weren't just high - gas wasn't available (folks today probably can imagine filling stations with no gas). I bought a big victorian house at the end of the Carter admin - guess the interest rate - 17.5%. I got it dirt cheap but loans did not exist. Not even close to today's environment.

    What did Reagan do? He stabilized the economy during those years that you are quick to jab at. Then in 1985 he promoted people buying American made products. You may not remember Sam Walton and the "Made in America" signs in WalMart. THAT - my friend, is what put Americans back to work.

  • Report this Comment On February 24, 2010, at 7:28 PM, 4profit101 wrote:

    I concur, excellent article, and a very good additional idea proposed by csandvig.

    I would add that we should use these "standard of care guidelines" to reduce the cost of end-of-life treatment. Medicare spent approximately $50 billion (with a "B") covering expenses for the last two months of life, and this cannot continue. We treat animals with more end-of-life respect than human beings, so even though I know this will rankle many people, we cannot continue to prolong life needlessly, and especially in opposition to an individual's wishes.

    Unfortunately, I am highly skeptical that we will implement these needed reforms anytime soon because our political system is handicapped by some egregious structural problems. As long as we allow individuals to make a career of serving in Congress, the primary incentive will always be to get re-elected instead of genuinely trying to solve problems. No true health care reform will take place until we reform our government system to place limits on the time that a person is allowed to serve, and at the same time, increase the minimum span of time between elections to four years. Otherwise, we will continue to see what we have today where no meaningful problem solving happens in an election year, which is every other year, and each political party becomes more and more dominated by the extremes of society.

    And the reason why that won't happen anytime soon is because of another major systemic error......the very people that this would affect are the ones who would have to vote to change the system.

  • Report this Comment On February 24, 2010, at 7:52 PM, gjf100 wrote:

    The whole push in the Health Care industry is to increase preventive care and encourage responsibility on the part of the consumer. The impediments are not necessarily the 'big bad insurance company' or 'big pharma'. Government mandates certainly play a big part. Legislators mandate coverage in order to garner votes, medical science be damned. "Thou Shalt cover this or else" say the bureaucrats even though it is not supported in the literature as providing better outcomes, Then out the other side of their mouth they say, "How dare you increase premiums" The health care industry is one of the most regulated industries with very low margins. Over 80% of premiums go to paying for health care. The majority of the balance is used to set up the infrastructure to access care.

    And as far as teaching the public to be fiscally responsible and make wise decisions with their HSA goes. We can look to retirement accounts for a clue as to how well that works. The majority of individuals who have access to 401K don't invest in them and those who do typically make poor decisions about where and when to invest.

    I don't think setting up additional government bureacracy is going to cost us less money. Quite the contrary...

  • Report this Comment On February 24, 2010, at 8:01 PM, kuendigb wrote:

    I encourage all of you to read "Comeback America" by David Walker. It covers the healthcare issue as well as the many other issues that are bringing this country down. Our healthcare system is broken as both parties have agreed. But the proposals do very little to fix the system. Essentially all they do is put more people on a sinking ship and that only forces the ship down quicker.

  • Report this Comment On February 24, 2010, at 8:06 PM, fxrfxr wrote:

    You get what you pay for in this world. Cuban doctors? Be my guest. Never mind physician pay is only 12% of the overall cost. Blame the docs anyway. Easy to do with the politics of resentment that so many people embrace and get elected with these days.

    The government can't even run a lemonade stand. Having them in charge of so many points in the system is horrifying to me. Ask anyone who has had to use the VA or military medicine. But is makes for a great jobs program. Lots of new people to run the checklists.

  • Report this Comment On February 24, 2010, at 8:07 PM, Posaune641 wrote:

    Until "for-profit" health care companies are removed from the equation there is little chance anything will get better. They care only about one bottom line; and that is not the sick patient. How about a not-for-profit, patient owned, cooperative model? An education heavy, transparent operation where the patient/owner has personal motivation to keep costs down and duty to take personal ownership of their own health. The problem is, again, we live in this lopsided/backwards economic model (capitalism): designed for aristocracy, to benefit aristocracy. The issue issue is much, much larger than health care alone.

  • Report this Comment On February 24, 2010, at 8:25 PM, ynotc wrote:

    I agree with Posaune641. Private coops owned by the people receiving the care what a concept. If healthcare is taken over by the government you can bet this is what the rich elites will do. Just like the Canadian government official who recently had surgery in the U.S. Governement "free" healthcare sounds great until you need it.

  • Report this Comment On February 24, 2010, at 8:32 PM, janethepane wrote:

    The thing that is going to make it the hardest to pass any good health bill is the hugh money and power of the drug companies and the FDA who act in a crooked and dishonest way to suppress dietary supplements and alternative therapists, always ruling in favor of drug companies..

    I call your attention to Bill S.3002 introduced by Senator John Mcain.. If passed Americans would no longer be able to get supplements. They would be much more expensive if sold at all.

    This would keep a person with excellent health habits from further improving or protecting himself from toxins and other things even at his own expense. Also the Government couldn't save money by using supplements!

    I beg you to ask your legislators vote against this evil and unjust bill.

    Jane the pane

  • Report this Comment On February 24, 2010, at 8:44 PM, TomBooker wrote:

    I'm curious.. I'm an average Tom with an average IQ, how do I know if I "pursue the greatest amount of treatment available -- even past the point of diminishing returns, medically speaking". I wish I was a doctor, but I'm not.

    An HSA and catastrophic insurance, ...good idea. Of course if i actually get really sick, my ability to contribute to the HSA goes south, and my catastrophic premiums go through the roof "based on demographics and medical history".

    If ya get MS, Hotchkins, Parkinson's etc, you are a deadman walking. But after all, you are a lazy mooching bum who didn't fund your HSA enough, and you are a financial flunky because you didn't plan ahead for your $3000/mo premium on your catastrophic insurance renewal. (Correct? The object here is to price and pay for your own illnesses, and fund as little as possible of somebody else's.)

    Why be whimpy... let's just push capitalism and rational self-interest to its logical conclusion for something like healthcare. Let's Darwin the gene pool.

    If somebody gets really ill and runs out their HSA, why blow anybody else's money on them? They are a bad bet, and they are hogging treatment dollars. Just off the top of my head, people with non-specific lymphomas often take expensive chemo treatments "past the point of diminishing returns" and probabilities of recovery.

    What we can do instead, is build government run work camps all across the nation. The people who run out their HSA and are ill, usually have a little left in them. We can ship 'em to the work camps. Treat 'em at full cost. During the day they can be minimum wage labor for infrastructure projects etc.

    When they finally drop over, you bill their estate (minus their earnings) directly for the final treatments, which will be a huge number. The government can take the money from their assets and put the excess towards the deficit, and the medical suppliers get their cut, too.

    People who are unemployed go on HSA watch. If they go longer than a year and burn their HSA, they get yanked, too. They obviously don't want to work, so let's get them out of the gene pool, before they start costing us anything.

    With whatever shreds of seriousness remaining....

    The gestalt of the problem is easy. There is not enough money to cover healthcare for everyone. Either everybody takes a haircut, or you just cut out part of the population. There are no other choices, unless you wage war directly on costs.

    In Japan, physician groups, diagnostics, and hospitals are all privatized. The "socialist" catch is that there is a phone book sized price list for any diagnosis or treatments.

    A simple MRI in the US costs $600. In Japan, only $65 is allowed to be charged. Not reasonable. Until Hitachi manufactured an MRI machine at a cost which made a $65 MRI profitable. See Frontline.

    Before we started on the Heathcare food fight, we refused to answer the tough question...

    Is the right to "the pursuit of life, liberty, and happiness" for any and every citizen maintained, if it can be destroyed in bankruptcy or unnecessary death, by one Act of God?

    We have proven beyond a shadow of a doubt, that laying profit layer, upon profit layer, upon profit layer cannot possibly do it for everybody, when it comes to people's lives.

    BTW, that work camp idea will guarantee roads filled with joggers and gyms filled with people working out. Peoples' health won't get significantly better, until the fitness industry out-earns the medical industry.

  • Report this Comment On February 24, 2010, at 8:47 PM, deforge17 wrote:

    "We believe that the fundamental weakness of our current health-care system lies in the irrational incentives it has created, which conspire to reduce the responsibility of individuals for their own care, and encourage providers to focus on cures rather than prevention." -

    are you high? the whole health care system in US is capitalist to the core, rewarding return visit for 'trial and error treatments' versus serious pursuit of a cure. the only time something is cured is if some organization milks the public for donations. cure is not where the profit is, its renewable treatment subscriptions with never ending income. as long as people suffer they'll pay for a temporary relief if no perm solution is available.

  • Report this Comment On February 24, 2010, at 9:12 PM, madbrain wrote:

    These are no solutions to any problems at all.

    HSA and catastrophic insurance plans are completely inappropriate for people with chronic conditions that are expensive to treat.

    Chronic conditions account for 70% of deaths in the USA . http://www.medicalnewstoday.com/articles/13255.php

    Also, 133 million americans already have a chronic conditions, for whom catastrophic insurance is inappropriate.

    See http://www.restministries.org/invisibleillness/statistics.ht...

    Take for example HIV treatment - you need about $15 - $20k of prescriptions per year for life, and $4k per year, minimum for lab tests. Most individuals with the disease can't afford to pay it, and many of them can't even work.

    Only traditional insurance that spreads risk between the healthy and unhealthy people can help. Same for cancer treatment, though it may not be lifelong.

    Your education goals are laudable and they may well reduce costs in future generations, but they won't cure everyone who has chronic conditions today, and who still need expensive treatments. And a lot of chronic conditions have genetic causes and others still unknown, which education can't do anything about.

    You should be ashamed of yourself for writing such a poorly thought out article.

  • Report this Comment On February 24, 2010, at 9:22 PM, gilligan2 wrote:

    Some of what you present is interesting. I have a problem with the establishment of fund or account that the POLITICIANS can get their hands on. They are paid saleries, have their own medical support, a pension plan, and other benifits at the expense of the taxpayer. They have all this and can not balance a budget. They only seem to know how to spend money to get elected, and then they expect the govenment to work the same way as their campains. I beleive that the funds deposited will have a limitted return because the only income will be from funding the deficit. Any money depositted should have access to a better return than prime lending rate.

  • Report this Comment On February 24, 2010, at 9:25 PM, baudjamesbaud wrote:

    What about the outrageously inflated costs for equipment and procedures?

  • Report this Comment On February 24, 2010, at 9:42 PM, KeitaiOtaku wrote:

    Dear Brad and Madge. You are really out to lunch if you think an HSA and disaster coverage solve the problem.

    What about the difference in cost between the minimum HSA amount, and the max-out of pocket cost reached before the "disastrous coverage" kicks in? As a right-winger, 10K might be no big deal for you. But for a $6/hr restaurant worker, that is more than half a year's rent payment (maybe even a fuil year). This is a very, very big deal.

    As for purchasing private insurance... with the minimum supported contribution, perhaps donated by the government... what you really end up doing is having the government pay for private health insurance for the individual (if it even covers the amount paid... which it would have to for the system to work) I'm sure you didn't intend for that mix up!

    So basically, you're back to what you probably really don't want. Your tax dollars going right into the hands of private insurers.

    Despite my criticism, I really do like your idea... as long as there is a public health insurance option, an option that cannot raise rates past what an individual who is being supported by the government, can afford through payments by the government. Then, costs are fully controlled, fully contained.

    This of course needs to be paired with a strong law that an individual is not required to come up with the difference that the government won't pay, thereby capping distributions to health-care providers (and not simply bankrupting our poor little $6 restaurant worker).

    That can work.

    Paired with mandatory health insurance for everyone above a certain wage limit, and mandatory HSA contributions? And mandatory disaster coverage. Yea. I think this could work.

    Of course, the money going into the $6 restaurant worker's HSA has to come from somewhere, and we do want to balance our budget right?

    So... we better charge a little bit more of every other person in the system so we can cover the 20% that are living below the poverty level.

    Of course, that's starting to look like a tax, but we only tax the rich, right? So we better hike up those taxes on the > 200K/year workers.

    And suddenly we're back to begin Canda, which is a great country, but taxes the heck out of people.

    Here's my point: don't be so smug. You definitely don't have all the answers.

  • Report this Comment On February 24, 2010, at 9:50 PM, Theotherleadingm wrote:

    You collectively don't "get it" as you all appear to accept the premise that some form of universal health care insurance coverage is required.

    1) Health insurance is not required (people got along for how many millenia without "insurance"?)

    2) It is just a transfer of wealth "lottery" where the large collective number of healthy persons pay to cover the unlucky winners of some pretty nasty health problems.

    3) With the private sectors (HMOs) and now the government sticking their hands into the process to take a little out the middle of this huge cash stream. Neither health care "managers" nor the goverment bureaucrats are working for free.

    Reject the premise of universal coverage or (I shudder) a 'right to healthcare'. No such thing.

    If I choose to live my life and spend my money on "health care" that is the business of me and the companies and doctors I do business with. Other people have made other decisions as to what is a priority in their lives and I see no reason why I should pay more money, or accept degraded services, because of someone else's sense of charity that involves my money.

  • Report this Comment On February 24, 2010, at 10:07 PM, metinm wrote:

    What makes you think that we have the ability to manage our HSA account? Look at how well (!) we are managing our retirement accounts. If you run out of money in HSA account but need to see the doctor, how will you do it?

    It may be easy for you and me who have enough money, but a lot of people, including the middle class is STRUGGLING.

  • Report this Comment On February 24, 2010, at 10:09 PM, hegibson wrote:

    There are some good ideas in this article that assume the best about people. Like people if educated will make wise choices. Getting people to do the smart or right thing is good in theory but I doubt that it will be the panacea as suggested. HSA's with catastrophic insurance coverage is not a bad formula, however the devil is in the details. There are so many vested interest groups and political ideologies that have a stake in this mess that it is not likely to ever sort this thing out to everyone's satisfaction. I'm a US citizen who lives in Canada. A lot of what has been said about the Canadian system is inaccurate and fear mongering. Is the Canadian system perfect? No. Is it adequate? For the most part. Is it more equitable? Yes in the fact that everyone has access to it. Is it less costly? Yes, significantly lower percent of the gdp.

  • Report this Comment On February 24, 2010, at 10:12 PM, hegibson wrote:

    There are some good ideas in this article that assume the best about people. Like people if educated will make wise choices. Getting people to do the smart or right thing is good in theory but I doubt that it will be the panacea as suggested. HSA's with catastrophic insurance coverage is not a bad formula, however the devil is in the details. There are so many vested interest groups and political ideologies that have a stake in this mess that it is not likely to ever sort this thing out to everyone's satisfaction. I'm a US citizen who lives in Canada. A lot of what has been said about the Canadian system is inaccurate and fear mongering. Is the Canadian system perfect? No. Is it adequate? For the most part. Is it more equitable? Yes in the fact that everyone has access to it. Is it less costly? Yes, significantly lower percent of the gdp.

  • Report this Comment On February 24, 2010, at 10:15 PM, ilovebatz wrote:

    I somewhat agree with the idea of having usbe responsible for our medical care. However, pricing medicine is difficult. I don't have the time to do comparison shopping between which labs have the best prices for the tests I need, nor do I know going into a doctor's office what may be wrong with me and how much it will cost. If I need shoulder surgery how do I shop for the orthopedist, anesthesiologist, the nurse, the pharmacist, etc. This is not an easy answer. Medical care has become so complicated. If we are going to be responsible, we need a way to simplify things so that we can quickly and easily make decisions about who to use for our care and how much to pay.

  • Report this Comment On February 24, 2010, at 10:23 PM, HangLighter wrote:

    The most infuriating part of this entire debate to me is this: Everyone is looking at this from a purely financial point of view, and not from a moral or humanity position.

    Look, the reason countries have Universal Health Care is because they care about their fellow countrymen. This comes from a sense of national identity that developed from being very close to other countries that were constantly waging war with each other throughout the centuries, or settling a new country and bringing that identity with them.

    The opening ceremonies of this year's Olympics featured a poet who hit the nail on the head when he was describing Canada: "And some say what defines us, is something as simple as please and thank you." These other countries are full of nice people, who care about the well-being of the humans they share their land and lives with. None of the countries implemented universal healthcare because it was cheaper, or more effective, or kept the bills for the the poor down, they did it because they believe that everyone deserves the opportunity to be healthy.

    Meanwhile, guess which country in the whole world has the least coherent national identity? Our United States covers a huge landmass, is one of the newest countries, comprised almost entirely of immigrants, and has the largest melting pot of nationalities as a result.

    Ultimately, our desire needs to be that our countrymen are healthy. If we, as a nation, cannot prioritize that over the cost of doing so, this reform will never happen.

    President Obama invoked Ted Kennedy in his September State of the Union Address. To quote:

    He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that "it concerns more than material things.” “What we face,” he wrote, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

  • Report this Comment On February 24, 2010, at 10:25 PM, sevenofseven wrote:

    jsj3 is a whiner.

    It's called INSURANCE. It's not supposed to pay EVERYTHING. 133 million people have chronic conditions?? Get rid of the cell phones, the flat screens, the leased car payments, the vacations, the eating out, etc. etc. Then maybe you could fund your HSA.

    Give everyone else up to a certain income a tax credit for purchasing a health care policy. Everyone else, you're on your own.

  • Report this Comment On February 24, 2010, at 10:41 PM, bbwyo wrote:

    Shouldn't we decided on exactly what needs to be fixed before we start overhauling the entire system. Right now we have a big shell game going on with Big Pharma, Big Insurance and the medical community.

    Greed is a big part of the problem. The more confusion the easier it is for errors or abuses to become profitable.

    Two examples of what is wrong with the system:

    Medical coding that allows a Podiatrist to charge $440 every three months to provide foot care to my 91 yr.old diabetic mother. Basically the same service I get with a $45 pedicure.

    Another family member shopped around for a hip replacement procedure and saved over $20,000 by getting it done at an Orthopedic center rather than a hospital. Even though she had been preauthorized for the procedure she had to hire an attorney to get the insurance company to pay.

    We live in a small community I can't imagine how much of this goes on in larger metropolitan areas.

    The current system is broken. The incentives are wrong. Fix the system before we start adding to the confusion. Someone has to be strong enough to tell all the special interests to back off. The special deals, wheeling and dealing going on isn't addressing the real problems.

  • Report this Comment On February 24, 2010, at 10:54 PM, zepone wrote:

    Maybe Obama has the wrong criteria.

  • Report this Comment On February 24, 2010, at 10:58 PM, jm7700229 wrote:

    I have a sister who became totally and permanently disabled in December, 2006. It took until April, 2009 to get a Social Security disability award and then it was for a lump sum. Because she took a part time job against her doctor's advice (keep in mind, she'd been unable to work for over 2 years), Big Brother determined that she was only eligible for a year of disability allowance.

    In order to get even this much, she had to hire an attorney, who got 25% of her award. And ten months later, we still haven't seen the money.

    And you want to turn your health care over to these people? Are you flippin' nuts?

  • Report this Comment On February 24, 2010, at 11:02 PM, jm7700229 wrote:

    I have a sister who became totally and permanently disabled in December, 2006. It took until April of 2009 to get an award from Social Security -- not a disability income but a lump sum covering one year, because after two years without an income, and against her doctor's advice, she took a minimum wage part time job.

    In order to get this award, she had to hire a lawyer, who will get 25% of her award. If it is ever paid to her; we have yet to see any money ten months after the award.

    And you want to turn your health care over to these people? Are you freakin' nuts?

  • Report this Comment On February 24, 2010, at 11:08 PM, Lonestarmd wrote:

    Well, as a practicing physician I will give you guys my 2 cents.

    We do not want to go to the european/Canadian model of socialized medicine....where the majority of the public gets crappy care while the priviledged few pay for their "good" care in the U.S.A. I see it everyday in my hospital....lots of canadians coming for hip surgeries (just an example). This country will simply not accept substandard care on any of its citizens.

    The republicans have some good ideas. HSAs are the way to go for medicine with them rolling over every year. Loser pay system should work well in the states (but it will not happen with the concentration of lawyers in our beloved congress).

    Most important of all: COSTS WILL GO UP REGARDLESS OF WHAT WE DO.

    Why? Because we hold our hospitals hostage to taking care of anyone that walks in...thanks to our beloved democrats. Since they sabotaged the system with socialism, their solution now is more socialism to take care of the other uinsured.

    Either one of two things will happen: we take care of everyone and the quality of care goes down the crapper (nobody gets timely treatment), or we insure most of the public and receive very good care. Take your pick. Oh and slash medicare before it destroys us all financially. Slash the proverbial socialist goat before it consumes us all.

  • Report this Comment On February 24, 2010, at 11:29 PM, TMFBiologyFool wrote:

    I completely agree with the premise of the article; if everyone were more conscious of the true cost of health care we'd all be better off. But...

    HSAs plus catastrophic insurance are a great solution for the relatively healthy, but I'm not sure the plan will work for people that develop chronic diseases. What happens after the HSA is wiped out after a year or two?

    Also HSAs tend to discourage preventative care in less long-term thinkers (that would be most people) since it's out of pocket expenses today that won't reap rewards for years down the line.

  • Report this Comment On February 24, 2010, at 11:49 PM, jgrass11 wrote:

    Although I have not read all the posts to this article, the one thing everybody seems to miss about the high cost of health care in this country is the legal system. That's right, doctors are forced to pay such ridiculous medical malpractice insurance premiums that they have no choice but to pass those costs onto the consumer. Millions, maybe billions of dollars are awarded annually by jurors (we the people) for claims made by the consumer for "errors or mistakes" made by doctors. Yes, gross negligence deserves some compensation to the victim, but outrageous sums of money are awarded to people for everyday mishaps, some so minor that the case should never make the courtroom. Doctors make mistakes, they are human. So do accountants, analysts, manufacturers, etc. For example, the elderly woman who burned herself with the hot coffee she placed in her lap when drove away from McDonalds was awarded millions of dollars by a jury. I seriously doubt this is the first cup of coffee she ever ordered, and she didn't know the coffee was hot??? Come on people, stupidity does not warrant a multi-million dollar settlement. America has become greedy, plain and simple. The lawyers encourage it, the legal system permits it, and the people (the consumers) are the same ones who end up footing the bill. Reign in the frivolous lawsuits that are filed everyday throughout this country, and the cost of everything we consume will go down. I guarantee it!

  • Report this Comment On February 24, 2010, at 11:53 PM, velstra wrote:

    I like the proposal. Certainly has a basis for improved medical care. Some areas (unemployed as noted by others) that need work. But it beats the current politician proposals which are simply another welfare program. I also would propose more govt money to focus on education - the only real way out of our welfare state of mind. Will take many years to improve so we should get started quickly. I read quite a lot on health and nutrition but also have many years of habits establised and it is hard to change even when we know better. So we need to start the education at an early age - Sesame St level?

  • Report this Comment On February 25, 2010, at 12:01 AM, Ter2ry wrote:

    I can only look at my own family. We're well-educated in healthcare, no shortage of knowledge on how to stay healthy. Our youngest, a boy, comes down with shingles for some reason. He's rarely sick except for a time he was limping during basketball season at age 9. The doctor sends him to a specialist on childhood arthritis because his blood work shows something odd. By the time the specialist sees him, he's not limping. At 16, after shingles begins, he's limping again. The doctor says he needs an MRI, but tries antibiotics first--probably because insurance would question his spending so much before trying meds. Limping gets to the point of using crutches, finally does MRI---PANIC, glob behind the knee, maybe cancer, maybe infection. $50,000 later staph infection, surgery, wearing portable antibiotic pump for 6 wks. Infection had probably been walled off by the body 5 years earlier and re-emerged when his immune system crashed and he got shingles. We had great insurance, think everyone should. I don't think the HSA idea as described would have covered it. Don't know what level is considered catastrophic--probably not the $50,000 level, but to me that would have negated all my years of being careful with saving for college for both my children.

  • Report this Comment On February 25, 2010, at 12:08 AM, Ter2ry wrote:

    Okay, the McDonalds award was reversed, so quit using that. Texas has had tort reform, but it hasn't kept Texas from having a lousy system with one of, if not, the highest uninsured population.

  • Report this Comment On February 25, 2010, at 12:20 AM, stan812 wrote:

    None of these ideas will be acceptable to the Democrats pushing socialized medicine, because socialized medicine is not intended to make health care affordable or better or any of those things. The REAL agenda is government control for its own sake. That's why Obama, Pelosi and Reed get so violent over the matter - they crave the power and the control. If they cared even the slightest about cost and quality, they'd go for the low-hanging fruit - eliminating punitive damages. This would lower the cost of malpractice insurance so that doctors and hospitals could actually charge appropriate fees.

  • Report this Comment On February 25, 2010, at 1:21 AM, TMFSelzhanik wrote:

    Bravo, Madge and Brad. Bravo. Can I somehow vote you into an office?

  • Report this Comment On February 25, 2010, at 2:25 AM, buntyp wrote:

    Well here it is, all these many thoughtful comments. What then leaps out at me, is the Health Care debate is only now just starting.

    If this is recognized by all who read & contribute to this forum, this almost un-holy rush by the Admin. to pass something, anything, should be seen now by ALL as really more about Poitics than it is about actual Health Care.

    Those people who like to talk about Universal Health Care in other Developed Countries, however omit the comparative 'Cost Structure History' of Health Care in those Countries as against what has occurred in the U.S.

    If there is still a fundamental premise of 'First things first', then it is COSTS that must be tackled first. Does it not strike anyone that widening the Net to cover all those who are un-insured, at the the present costs, & trends of those Costs, would simply soon become not just be impractical, but downright Impossible.

    The thing that most people seem to forget, it is not the Insurance Companies who are charging-up these Costs, IT IS TO THEM THAT THE BILLS ARE BEING SENT.

    So if y'all wanna reely, reely, get SERIOUS, start with the Fundamentals, COSTS.

    This debate as far as I am concerned is in it;s infancy. The best way to jump-start any sort of;Reform', is to look at those 'States & or Institutions where things are working pretty well, & see how some of their 'Programs' can be applied elsewhere.

    And, that alone would be about a 2 year study. Then the Un-insured could be tackled separerately, but simultaneously & perhaps take another 2 years.

    What y'all looking at here is a proper 5 year Review of all these 'Factors', & at least another 5 years for Implementation.

    Whats going on with the Admin. & Congress at the moment, should hopefully just peter-out, because who in 'God's Name is going to administer what nobody yet understands what is in all that 'Paper', that could or may become 'Legislation'.

    That factor, I submit, is what is really 'Weirding-up' the debate so far.

  • Report this Comment On February 25, 2010, at 2:30 AM, PALH wrote:

    Oh, please, why even bother writing an article when all you need to do is run a few excerpts of Republican talking points? The health care ``system'' so many here so slavishly adore for starters leaves 40 million people uninsured. Some ``system.'' Health care companies make staggeringly huge profits collecting money for basically doing nothing but get in the way as often as possible when someone actually needs help and disappearing altogether when someone changes jobs and carries their ``precondition'' -- the word itself a creation of actuarials and bean-counters -- to the next job. A friend of mine recently was rejected for insurance because of a minor congenital heart problem he had diagnosed AND FIXED on his last job. He had a demonstrable NON-precondition but because he USED to have it the jackals can still claim it's a precondition -- where are the onerous, nanny-state regulations preventing THIS kind of criminal behavior? -- and toss him out of the ``system'' altogether.

    What a joke, and a sick one at that.

  • Report this Comment On February 25, 2010, at 2:33 AM, milleniumfalcon wrote:

    Please, just raise my taxes and give me full coverage.

    Every other option is straight up Bullsh*t.

  • Report this Comment On February 25, 2010, at 2:34 AM, claudewilbur wrote:

    I doubt the government's capacity to act as an honest broker about health and insurance issues. Lawmakers and regulators are, in general, too beholden to the regulated industries. See to what extent the current Senate and House bills have very feeble cost containment measures. See to what extent recommended foods (for example, the "food pyramid") differ from medical and scientific research.

  • Report this Comment On February 25, 2010, at 3:00 AM, PoundMutt wrote:

    dotdashdot wrote: "...Hospitals have a "list" price for services, but the price paid by the insured is much less."

    Not ALWAYS: my wife 's last mammogram cost us $180. She was uninsured. Hospital told her that IF SHE WERE INSURED, the LIST PRICE would be $600!!!

  • Report this Comment On February 25, 2010, at 3:01 AM, happybeachbum wrote:

    Interesting article. Part I agree with and part I don't. The interesting thing to me was the violent argument/discussion that it provoked. No one can honestly say there are not a lot of different opinions on the health care subject and a lot of both good and bad ideas.I think this is a major reason we have not seen a solution to the problem; congress and the president refuse to have an open and honest debate on this as well as other subjects and actually solve a problem in an intelligent manner. They don't even understand what the problems are.

    This is not a republican problem nor a democrat problem. The whole damned bunch is more concerned with their own image than they are with the American people.

    One of your ideas that concerns me is having the government educate us. We spend more per student by far than essentially every country in the world educating our kids with one of, if not the, worst outcomes in the world.

    I guess the beauty of all this is it really doesn't mean anything. The last three chairmen of the Federal Reserve have said the United States will never be able to repay it's debt starting with Paul Volcker in 1985, and we just keep piling it on higher and deeper. The US is now included among the PIGS countries, and if I remember correctly our debt is either second or third worst. It is time for us to get to work and take responsibility for our country and our personal lives. No I am not a tea partier; I am just one of the silent majority who writes his congressman and senators weekly and attend their town halls that none of them have showed up at for over a year. No, I don't vote for them.

    Thanks for the thought provoking article.

  • Report this Comment On February 25, 2010, at 3:27 AM, aptosjoe wrote:

    Good ideas abound. The problem is getting Congress to forego theirs infavor of yours. Or in the alternative to stop arguing about what's wrong with everybody else's ideas. The current system is so broken that anything would be an improvement.

  • Report this Comment On February 25, 2010, at 3:37 AM, PoundMutt wrote:

    I don't understand the Democrats bills. WHERE are the provisions that will increase the numbers of doctors, nurses and other medical personnel that will be necessary to treat the uninsured 41?million? There is already a shortage of nurses and GPs!

    dotdashdot wrote: ...Hospitals have a "list" price for services, but the price paid by the insured is much less."

    Not ALWAYS: my wife, who was UNINSURED, was charged $180 by the hospital for her last mammogram for which we paid cash. They told her the price to an insurance company would have been $600!!!

  • Report this Comment On February 25, 2010, at 7:54 AM, 4mythreegirls wrote:

    HMO's negotiate prices that make it hard for providers to make a living which makes them charge for BS. IE I took 4 year old daughter for a well visit and was charged $80 for a procedure I could not pronounce. Watching the whole visit I tried to figure out what this charge was for. Well is was to remove earwax from my daughters ear so the provider could get a better look. The device used to "remove" the wax cost less than $2.00 and took him less than 5 seconds... So what is really wrong with healthcare?!?!?!? that says it all...

    As for pharmaceuticals.... prescription drugs account for 10% of healtchare and "branded" products acount for 4% of that.

    How many of those supposed 41 million uninsured are illegals? How many of those are born into welfare? We need quality control from the government and tighten the borders.

  • Report this Comment On February 25, 2010, at 7:59 AM, jbcarithers wrote:

    I think the first post made a good poignant statement - "Cut the production costs." I can't specifically comment on how good or bad the market is doing with that part other than the fact that it is definitely at capacity (Economists know what that does to prices), but what I do know is that I have yet to see the ROOT CAUSE in simplistic form - "Cut Demand."

    Wake up, socialists and capitalists. There is no such thing as "the communist paradise of Cuba" and Capitalism has brought us to the economy we have today. You all should read some real books about it. I suggest John Kenneth Galbraith for starters. Everything is a tradeoff.

    We need to change the rules to give stronger boundaries to the free market. No gray lines, same game for everybody. Very strong penalties for coloring outside the lines. That is a compromise that wins objectives on both sides, as well as reining in our production capacity to the point we can harness it for good and begin to talk about a beneficial socialist revolution.

    That being said..

    Here's my beginning of an attack on THE root cause: Demand Reduction and Elasticity. Make consumers and producers more responsible for the Nation's health with across-the-board black and white rules that effectively accomplish the true objectives of our civilization, using the free market to reach towards social progress.

    Results desired: More capacity, more elasticity in demand, price shift in supply/demand intersection. Do this by:

    1. A "doctor's bill of rights." Keep the chronics and nasties from winning excessive litigation in the cases where "diseases" like CVD are easily avoidable for most of the population and have too many causes/factors to even begin to prescribe a drug that "fixes" things. Doctors won't need to run 5 million tests for the common cold because their asses won't be as on the line every day for the amazing things they have sacrificed so much of their lives to give us. They should be respected in the true Ayn Rand sense. These rules will have to be thought out very carefully and deeply, however, with as few gray lines and holes for excessive regulation as possible. Otherwise they will be disastrous like the patient's bill of rights.

    2. Make preventative care the focus of health insurance with strict rules on what must be offered. Why do you need to spend $10k on surgeries (requires numerous honed skills and very individual attention and thus a high price) all year, when you can spend $100/pop on a chiropractor, nutritionist, herbalist, physical therapist, etc.. You would have to see these specialists 100 times in a year to equal the same cost. Capitalists can all agree on this, and socialists easily recognize this as the root of the problem.

    3. Place a tax on "Big Food." Places a disincentive for people to buy overly processed food that is void of nutritional synergy and filled with lab-creations. This one could be very tricky to make it fair and straightforward. Hrm... Perhaps based on levels of added sugar or fat content? Or towards specific ingredients or processing methods?

    4. Place new boundaries on the "supplement" market. Those guys will sell you snake oil, and you'll buy it. Calcium pills without Magnesium? really?? There is such a difference in absorption rates and usefulness of these isolated vitamins that is never labeled. I think we should disavow Americans of their blind addiction to these. It simply forces us to be a little more in tune, which, again, is half of the problem.

    5. Make the drug companies public like in the socialized countries or force them to be nonprofit. Advertisements for drugs? Seriously??!!! What could be MORE detrimental to our nation's mentality. I think it constitutes a breach of the hippocratic oath. It is well documented that our system creates its own demand. Let's remove that upward spiral altogether. The patent system and business structure of the drug market needs a fundamental retooling. Their profits and capital resources can be shifted by the market to something more useful in the long run like energy conservation or pollution control. Even publicly owned drugs will still need research and production, thus I can't see that it will kill millions of jobs. I'm willing to sacrifice the overall structure, and if displaced workers need help, give them that help in the short run as compensation. Plus side is that, once the rest of the structure starts weening us off our crutches, those drugs won't be nearly so important anymore. It should work itself out fairly well.

    6. Make healthcare "universal" in the fact that it is federally voted on. Decades ago, moving from state to state was difficult. Different rules easily applied. That's not the case anymore. State-to-State rules I think hinders Interstate commerce by this point in our transportation abilities.

    ------

    The great effect is a climate of responsibility, a reduction in demand for healthcare which is at capacity, (producers have more price control abilities), less actual and perceived need for drugs, more quality face time with doctors who are not pressured by big pharma or lawsuits to give bandaids, and freeing them for the people who are both actually ill and diagnosable.

    Prices lower automatically through supply/demand. Once the effect of these measures is in place, we can begin to talk about the uninsured and whether the problem of Medicare costs still exists.

    Anything I left out?

  • Report this Comment On February 25, 2010, at 8:04 AM, rwmjr wrote:

    I have to say, this is one of the best thought out, best written pieces I've seen lately. It is spot on. I hope this treatment gets wide distribution and moves people to think about how to better manage their heath, health dollars, and to morph this non-functional system into one all Americans can benefit from and be proud of.

  • Report this Comment On February 25, 2010, at 8:35 AM, ewent0 wrote:

    It is a glib commentary on conservatism to lob all the blame on those who don't make all the decisions on their own healthcare. It's an even worst commentary on conservatism when that blame is insidious and ignorant of the real problem with US healthcare...It costs too much.

    When people are supposed to manage their own healthcare, they are also supposed to be able to afford it. US HMOs do not allow choice of physicians or hospitals. US HMOs cut costs by forcing employers to up the ante on the cost of copays employees pay, thereby reducing salaries.

    What is it about reductions in salaries and unaffordable health care the uppercrust doesn't get?

    With 200 millions Americans living in this country, the wish list of all HMOs is not to have to provide the services people pay for.

    No HMO CEO needs to earn the kind of salary that forces the sick and dying to do without affordable healthcare. I'm fed up with the greedheads at the top of the food chain stuffing their pockets with money while others make enormous sacrifices and do without decent healthcare.

  • Report this Comment On February 25, 2010, at 8:36 AM, bigbadone wrote:

    Many good ideas, thank you. These solutions are definitely moving in the right direction. I would like only to comment that the four points you make where government should be involved are possibly contrary to your argument, though. To implement your ideas would require significant deregulation within all areas of health care. This is good. This would level the playing field in the insurance and provider markets and drive costs down through market pressures. But to turn around and expect that government would, conversely, be effective regulators of the four areas you mention (education, medical records, needs assessments, market failure) I believe is flawed, and would ultimately beget even more costly regulations that produce fodder for special interests. All in all, though, these are the types of vehicles that we need to look at, which empower individual responsiblity and highlight the clear fact that we still need to address the most needy in our country. People have very good moral intentions. The solutions must be economically viable, though. Thanks again for the article. I'm sure you have, but read the Atlantic Monthly article "How American Health Care Killed My Father."

  • Report this Comment On February 25, 2010, at 8:39 AM, ewent0 wrote:

    Health Savings Accounts? From people who are already living on the salaries they earned in 1971? What possible good is any health savings account when the cost of a single emergency room treatment will deplete the entire account? DUH?

    The conservatives who all love the HSA know exactly what they are doing: demanding people make a choice between a huge deduction from their already paltry salaries into an HSA or pay the rent and keep their kids feed.

    Conservatism in this country is nothing more than Greedism.

  • Report this Comment On February 25, 2010, at 8:39 AM, cummiw wrote:

    Prevention of illness is a great idea, and should be encouraged, but all of us need insurance for the terrible, expensive illnesses any of us may get any day. If you haven't yet experienced an urgent hospitalization with intensive care, you will not believe the bills that will be due, $30,000 - $40,000 for a day or two for an obstructed coronary artery. Careful eating, daily exercise, no smoking, etc. may make such events less likely but they still happen to thousands of us every day. Everyone needs affordable, available, effective health insurance. Then we can tackle the even bigger question of alternative ways to remunerate providers. Those who think the staus quo is OK have just not dealt with serious illness.

  • Report this Comment On February 25, 2010, at 8:42 AM, ewent0 wrote:

    If you really want to even the playing field, end Civil Service for all but those in the military. And, since the Supreme Court deigned to grant extraordinary election influence by banning McCain-Feingold, cut all corporate loopholes, tax umbrellas etc. that are subsidized by individual taxpayers. Corporations will only use their ability to infuse campaigns with billions in influence money that individual taxpayers paid for in the first place.

  • Report this Comment On February 25, 2010, at 8:49 AM, ewent0 wrote:

    Does anyone want to admit that stress is the No. 1 cause of most people's illnesses? There is no way to reverse what's in a congenital gene pool. If your family history is one of diabetes, you will have diabetes. The same is true of the ripple illnesses related to diabetes.

    Then, there are the illnesses no one can control: Lyme Disease and other insect borne diseases that can cause life-threatening and debilitating illness.

    Let's stop the nonsense that there's a way to wave a magic wand and make generations of congential illnesses disappear.

  • Report this Comment On February 25, 2010, at 9:14 AM, bstog59 wrote:

    Hey Hessel and Cohen, how about sticking to writing articles about how I can make more money in the market as opposed to writing about politics. Let's face it, this is purely about politics and not about cultural inefficiencies. Get the lobbyists out of DC and then our servants will start thinking with their heads and not with their wallets. Oh I am a true believer in capitalism, but what we have happening in this country now is capitalism run amuck as evidenced by the tip jars on every counter top at your local coffee shop and sandwich shop. We have to wait in line to get a sandwich and then are expected to tip someone for simply doing the job they're already getting paid to do. We tip for excellent table side service, not for waiting in line!

    How does your plan take care of the 22 year old college student that has rheumatoid arthritis (like my son's girlfriend)? Have you seen the cost of treatment for this disease that has nothing to do with taking care of yourself. It's not her fault she has this extremely debilitating disease.

    As far as HSAs go, I think it's an idea that has merit. The only issue I have with it is that I can't even afford to save for retirement, college tuition, etc. because I was laid off from my $87K job that apparently is now only worth $45K. With unemployment at the absurdly under reported 10% level, many employers can pay whatever they want to people like me who are desperate just to work. I live in a "Right to Work" state. "Right to Work" doesn't mean that I have the right to a decent paying job, it means that employers can fire you for no apparent reason and replace you with someone for half the price. Where is the money for an HSA going to come from in a situation like mine?

  • Report this Comment On February 25, 2010, at 9:18 AM, dauril wrote:

    The problem is not the game. The problem is the rules.

    When applied to health care this translates into "Who decides?" And if one were to read all of the responses the answer is obvious. "NOT YOU !".

    This may not sound like a suitable solution, but it is a good definition to a starting point. I don't trust and will never willingly submit to majority rule. Equally, I cannot abide absolute authority. That leaves only one alternative -- the collective wisdom of men of good will.

    This certainly does not describe Congresses at any level of government. Nor does it describe any special interest group, whether it be drug companies, insurance companies, associations of lawyers or of physicians.

    The closest we have been able to come to the "collective wisdom of men of good will" is the Supreme court. Sometimes wrong, sometimes right, but most often well intentioned.

    So this is my contribution. The creation of a Medical Supreme Court with the absolute authority to void any decision made which is not (or no longer is) in the best interest of providing medical service to the citizens of the US. (Sorry non-citizens you don't get to vote.)

  • Report this Comment On February 25, 2010, at 9:31 AM, lional288 wrote:

    I recently purchased my first individual health insurance policy and the experience of finding one that was even mildly affordable was almost impossible for this 63.5 year old. But the experience of using it for the first time to pay for a visit to the emergency room for my first Gall Bladder attack was even more of an eye opener. In order to have a monthly premium that was south of 1400 dollars per month required a deductable of 15 grand. And thanks to the 2.5 hour visit to the emergency room for the above mentioned Gall Bladder attack I took care of most of that amount immediately. The 8500 dollar charge for a CAT Scan helped (this was less the 1500 dollars charged by the doctor reading this test and a few xrays, which were invoiced by the hospital for another 2 grand. I could not believe the charges made by the hospital or the doctors but now I know that there are lots of reasons to have a better system and to start lets take a look at the poor folks like myself that pay almost 500 bucks a month for medical insurance that covers only conditions and diseases that you have never had before and then only with large deductables to compensate for the large fees charged by the medical community. As my late mother used to say, there are a lot of thieves that don't wear masks!

  • Report this Comment On February 25, 2010, at 9:35 AM, 1122graydon wrote:

    i have to add my comments. there is a lot of waste in the system. As a practicing physician, I treat a lot of illegal immigrants who were refused care in their countries and were coached what to say in our ERs. As to big pharma, the US pays for the worlds medical research. The prices we pay are much higher here than anywhere but it allows for increased R and D of new drugs. supplements are considered food by the FDA.The standard of truth in advertising is much different than drugs who have to prove they claim what they do and are safe. There are very few good studies with supplements. I agree we spend way too much money on people in their last year of life but it difficult to determine when that last year of life is. Americans will talk with their feet. If I refuse to give someone antibiotics for a virus they will go to a competitor who will unfortunately

  • Report this Comment On February 25, 2010, at 10:24 AM, Idahosehead wrote:

    Thank you Brad and Madge for the article. It is pure and simple genius! You have my vote!

  • Report this Comment On February 25, 2010, at 10:31 AM, bbwyo wrote:

    1122graydon.

    All of your points are right on except for the last.

    Now that I have an HSA and pay most of my own costs I have become a much better consumer. As long as someone else is picking up the tab I can keep Doc - drug shopping.

    This is a cultural problem. There is no longer a personal relationship between Doctors and Patients. I

  • Report this Comment On February 25, 2010, at 10:42 AM, clydejazz wrote:

    We don't have to re-invent the wheel. Government-run insurance programs in Europe and Canada keep their citizens healthier than ours at much lower cost. There are plenty of anecdotes circulating about foreigners who come here for "better" medical care; there are just as many anecdotes about Europeans and Canadians moving back home as soon as they develop serious health problems.

    Let's move beyond anecdotes and deal with facts: the World Health Organization keeps comprehensive and detailed lists of health statistics, and our system consistently ranks well below Europe and Canada in quality, but we have much higher costs.

  • Report this Comment On February 25, 2010, at 10:46 AM, clydejazz wrote:

    We don't have to re-invent the wheel. Government-run insurance programs in Europe and Canada keep their citizens healthier than ours at much lower cost. There are plenty of anecdotes circulating about foreigners who come here for "better" medical care; there are just as many anecdotes about Europeans and Canadians moving back home as soon as they develop serious health problems.

    Let's move beyond anecdotes and deal with facts: the World Health Organization keeps comprehensive and detailed lists of health statistics, and our system consistently ranks well below Europe and Canada in quality, but we have much higher costs.

  • Report this Comment On February 25, 2010, at 10:53 AM, leenapaivikki wrote:

    I LOVE it! HSA - what a great idea! Pretty much like the 401ks, the IRAs and the like for our retirements. Perfect! Puts responsibility - and control - on the customers' hands. Wonderful!

    Investment within the HSA to grow it would be good as it is with the retirement funds presently. I do believe this approach would be the route to reduced health care costs, but it does require the individual to well educated about health care, illness prevention, and medication. This is how it should be. We need to be our own advocates - there is ton of good information on the web + that with the proposed education one will be in a good position to make decisions concerning their life/health/well being.

    Now to the complex part: how does one get this to the President and to the deciding entities in the government? What do we fools have to do to get a hearing for this proposal? Sign me up!

  • Report this Comment On February 25, 2010, at 11:12 AM, Research1st wrote:

    I don't need the government negotiating how much should be paid for my medical care. My insurance provider already does the negotiating which has saved me thousands. I have heard people say they were turned down due to a pre-existing condition. So was I, but, I didn't quit because I was turned down, I kept looking and now have better insurance than the companies that turned me down. There are insurance companies out there with reasonable rates. If you can't afford it, there is medicaid (all you have to do to get it is prove you can't afford insurance.) The only problem with it is that it has been grossly mismanaged. How about the Government following up on Federal and State run institutions?

    I already have an HSA, it's called my deductible. If need be, most institutions are willing to accept payments for this. Forcing people to save for this or RAMMING it through (one of your parties favorite terms - not mine) is wrong. What will you be doing, investigating my bank funds to make sure I have it covered or will I be sending it directly to you to let you manage it? I don't think so.

    It is not healthcare that has created this massive debt that is hurting America's credibility and reputation. It is the out of control government spending. Take responsibility for your own actions and clean your own house before you start trying to clean ours. We American's take pride in our credibility and reputations and we are held accountable for it. Government institutions and politicians (Federal and State) have misdirected funds for Social security, Medicare, and Medicaid by means of waste, mismanagement, greed and bailout to companies that should have been held accountable for their own actions.

    Another thing that is hurting the AMERICAN CITIZEN and would greatly reduce the massive debt, is efficiently controlling our borders. But instead, the message was sent out to come on in and we will put anyone who tries to stop you in jail. Remember that one? Now, the people that work for the Border Patrol just take pictures of illegals coming in. And don't try to convince me the illegals are not taking American jobs. Ride by the chicken manufacturing plants, ride by your "small business" landscaping, house framing and roofing jobs and your grocery stores that do there shelf stocking at night (Walmart.) You need to come to South Carolina, get out in the real world and see who is being hired here and not being taxed. What message have you sent out to those who legally studied and took oaths to become citizens.

    I took my grandchildren to the clinic (my daughter has 5 children) for shots. The ratio of hispanics vs black or white was 25 to 3 ( my 2 grandchildren and I were the 3.) And, I was the only one that didn't have a medicaid card and had to pay cash. Again, I had the privilege of seeing the hard working American Citizens tax dollars at work. It took me years to build up my credit. I have to prove my assets for every thing I need, and yet illegals can open bank accounts, get free phones, and finance a car with no ID, can you tell me what's wrong with this picture? What message have you as politicians sent out to the hardworking blue collar American that can't get anything without a clear credit report or a social security number? And now, you want to give illegals the American Citizen's hard earned Social Security benefits. You want to take and misdirect more of their hard earned tax dollars that you took from their paychecks for their future security. SHAME ON YOU. If we ran our household the way Politicians in Washington have run up the Government debt, would you trust us to choose your healthcare? I don't think so. NO NO NO to your healthcare plan.

  • Report this Comment On February 25, 2010, at 11:43 AM, caltex1nomad wrote:

    I love my HSA but, it is a use it or lose it. I have to try and guess how much I am going to spend from 1 year to the next. I'm screwed if I have too much taken out and don't use it by the end of the year or I'm screwed if I don't take enough out and I have something major happen. I'd love to be able to Roll over what I don't use from 1 year to the next. I like the idea of using it as an investment account to pay for medical when I get older. I like that better than LT insurance.

  • Report this Comment On February 25, 2010, at 11:59 AM, BYREMP wrote:

    I am delighted to read your solutions. They are good. I have something to add. Educated citizens are the best contributers to the society. I think each school from primary to college must make physical training as their daily part and during school provide preventive health and healthy food courses compulsory. This will make future generation aware of health. Also provide free check ups to each child till high school so their foundation willbe strong. provide nutricious food as lunch and breakfast. Invested money and taxes paid by homeowners for schooldistrict, state govt and federal govt. should share the cost. For preventing fraud govt. and public appointed commissions shoud keep track and watch school managements for proper use of funds.

    Since childrens are covered in school, that cost indirectly saved from parents will be used for out of school time coverage.

    For unemployed or who cannot afford HSA, should be covered under social entitlement program by govt. state and federal.

    This will still be way less than what we are trying to do to day. We should create a culture that people go to doctor only as a last resort.

    All pharma lobies and insurance lobies should be stopped from making their noise. all the constituents should force their congressmen and senators to try for this reforms.

  • Report this Comment On February 25, 2010, at 12:08 PM, fu1pr0NY wrote:

    Lots of comments already on why your proposal glosses over some significant drawbacks. Suffice to say your plan is a bit utopian and suitable for those who have the capability and foresight to fund their own long term care. Sorry - overall your plan is a big loser.

    Stick to stock analysis.

    Actually, I'm starting to think your stock analysis may be similarly tainted.

  • Report this Comment On February 25, 2010, at 12:20 PM, fu1pr0NY wrote:

    The actual number of people who do not have health insurance is 10 million according to the US Census Bureau, if you take out non-citizens, double counting by Medicare/Medicaid, and thos who can buy insurance but choose not to. This means that 97% of Americans ahve health insurance already covered publically or privately.

    Most people want health insurance "reform" to improve that which they already have - better service at a lower cost. No rational person would look toward the US Government for that solution. They can't even run the Post Office effectively and people actually want to turn health care over to them? That's insanity.

    We take for granted that Medicare is run as we would run a business. It is not. There is no annual spending budget - none. Ther eis no limit on supply - shoudl we pay for 50,000 pacemakers annually or 100,000. If we only pay for 50,000 does the 50 year old with a family to support get the pacemaker or the 85 year old with diabetes? Medicare needs reform, not simple expansion.

  • Report this Comment On February 25, 2010, at 12:45 PM, langco1 wrote:

    with the US now in its second year of a depression and close to a major collapse does obama resign or simply get thrown out of office?

  • Report this Comment On February 25, 2010, at 12:50 PM, lutece7 wrote:

    I think Hessel and Cohens proposal is excellent. This needs to be sent to someone on Capitol Hill, or to the White House.

  • Report this Comment On February 25, 2010, at 1:03 PM, MikeLCT wrote:

    It's an absurd crime to let insurance companies profit off our critical need for medical care and then give them cart-blanch to do so... in an un-capitalistic bubble of abuse. Not long ago health care was paid for out of pocket and was affordable. The current set up is primarily one for Insurance profit and patients are an after-thought. Ever had to deal with an insurance company and you know that what I am saying is the truth.

    The purposed solution brings us out of this artificial insurance profit-making bubble and optimizes efficiencies as only a free capital system can.

  • Report this Comment On February 25, 2010, at 1:21 PM, Beckielt wrote:

    As a health care worker, I can tell you that there needs to be full and complete transparency from insurance companies and health care facilities. The percentage of money actually spent for health care compared "administrative" cost in insurance is truly obscene. The cost to cover indigent care passed on to patient's with insurance is astonishing. The burgening population of undocumented workers (formerly known as illegal aliens) and their anchor babies should all be given green cards instead of amnesty so they can pay in like everybody else. They can stay and work while they work on becoming legal citizens.

  • Report this Comment On February 25, 2010, at 1:31 PM, jfstinson wrote:

    Our problem is we as a society can no longer afford the medical care that is avaialble. Our technology and inovation has long surpassed our ability to pay for it. Look at automotive technology for instance. We have everything from High tech luxury vehicles to low tech economy vehicles. In a car, we will chose to pick something that is (usually) within our means, however with medical care, every one wants a Mercedes and not a Pinto (sorry, showing my age)

    Well we can't afford a Mercedes for everyone, and no one is willing to settle for less, so we wind up rationing based on who has a job, and who does not.

  • Report this Comment On February 25, 2010, at 2:18 PM, PALH wrote:

    ``I don't understand the Democrats bills. WHERE are the provisions that will increase the numbers of doctors, nurses and other medical personnel that will be necessary to treat the uninsured 41?million? There is already a shortage of nurses and GPs!''

    Good point. The shortages are the result of a ``system'' that devalues doctors and nurses at the expense of keeping corporate profits high. Obama has proposed major buttressing But when Republicans are in control, government student loan programs -- which certainly spur attendance at medical schools -- are suppressed, cut and villified as socialistic. Just look at any number of thoughtless comments on this thread for proof.

  • Report this Comment On February 25, 2010, at 2:21 PM, PALH wrote:

    ``Investment within the HSA to grow it would be good as it is with the retirement funds presently.''

    So, if say it's 2008 and your HSA has taken a 35% knee-capping you just don't go to the doctor until you've got the money back?Brilliant.

  • Report this Comment On February 25, 2010, at 2:46 PM, bhessel wrote:

    jsj3 wrote:

    > I'm sick and tired of articles like this. It basically

    > blames the end-user. I would argue that most

    > people are too busy in their daily lives to know the

    > ins-and-outs of their tome of a health insurance

    > contract. Insurance companies make profit by

    > making it confusing and then denying everything

    > they can. I'd rather just pay x% of my salary in

    > taxes and live worry-free about my health…. Most

    > countries do it socialist-style. They do it better

    > than us, they have better outcomes, and they do

    > it CHEAPER.

    jsj3,

    We don’t see it as “blaming” the end-user, we see it as empowering him/her. And we think most Americans would prefer to be empowered.

    We do agree with you that a truly socialist approach—which the current system is not because health care providers, insurance companies, and drug companies are generally for-profit—would be somewhat cheaper and would achieve universal coverage. However, we do not share your optimism that substituting government bureaucrats for insurance company bureaucrats would improve quality. And we believe that our solution—empowering individuals with the information and resources they need to make good decisions—would not only improve quality but be way more cost-effective than a pure socialist solution. Not to mention that our solution—which does not require ending the for-profit status of all these groups—is more politically achievable.

    But the main advantage of our approach is that it plays to our strengths. Most Americans actively chose to uproot themselves and come to a strange place to gain more control over their lives (or are descended from folks who made that decision). Not to be glib, but we gained independence from Europe in order to escape the stultifying illiberty exemplified by their health care system.

    However, under our plan, if you genuinely prefer to allocate your HSA dollars to a traditional health insurance provider so some bureaucrat can make all your decisions for you, you're welcome to it. So we are willing to accommodate your predilections…are you willing to let the majority of Americans make our own health care choices?

    Brad Hessel

  • Report this Comment On February 25, 2010, at 3:29 PM, bhessel wrote:

    madbrain wrote:

    > These are no solutions to any problems at all.

    > HSA and catastrophic insurance plans are

    > completely inappropriate for people with chronic

    > conditions that are expensive to treat….

    >

    > Take for example HIV treatment - you need about

    > $15 - $20k of prescriptions per year for life, and

    > $4k per year, minimum for lab tests. Most

    > individuals with the disease can't afford to pay it,

    > and many of them can't even work.

    >

    > Only traditional insurance that spreads risk

    > between the healthy and unhealthy people can

    > help.

    madbrain,

    Thanks for raising the question of how to handle chronic disease. We should have liked to deal with this topic (among others) in our essay; however it was already considerably longer than it was supposed to be. :-)

    We agree with you that catastrophic insurance is not the right mechanism to deal with chronic illness. In fact, we foresee providing guarantees to catastrophic coverage providers that they will *not* be on the hook for pre-existing chronic conditions so that it would be feasible for them to insure someone with HIV against, say, serious rock climbing accident-related injuries…which is near-impossible now. Obviously if we are going to require folks to carry catastrophic coverage, we need to ensure it is available.

    As for chronic conditions, “Each individual would contribute at least a minimum number of pre-tax dollars -- which may vary depending on demographic data and medical history -- into his or her HSA each year.” The required minimum for someone with a chronic condition would be more than for someone more healthy, all other things being equal. While medical care is not “free” under our proposed system, if you cannot adequately fund your HSA (up to the annual minimum) the government will make up the difference. There are strings attached to that funding as we outlined, and the minimum contribution is not going to buy you access to cadillac-level health care, but the bottom line is we do provide a risk-spreading mechanism/safety net without recourse to traditional so-called “health insurance.”

    Brad Hessel

  • Report this Comment On February 25, 2010, at 5:35 PM, bhessel wrote:

    madbrain wrote:

    > These are no solutions to any problems at all.

    > HSA and catastrophic insurance plans are

    > completely inappropriate for people with chronic

    > conditions that are expensive to treat….

    >

    > Take for example HIV treatment - you need about

    > $15 - $20k of prescriptions per year for life, and

    > $4k per year, minimum for lab tests. Most

    > individuals with the disease can't afford to pay it,

    > and many of them can't even work.

    >

    > Only traditional insurance that spreads risk

    > between the healthy and unhealthy people can

    > help.

    madbrain,

    Thanks for raising the issue of how to handle chronic diseases. We should have preferred to discuss this—as well as several other topics—explicitly in our essay, but it was already too long. :-)

    We agree with you that catastrophic insurance is not an appropriate answer for the cost of treating chronic disease. In fact, we foresee providing catastrophic insurance providers with guarantees that they will *not* be responsible for expenses associated with pre-existing chronic conditions so that it will be feasible to offer, say, folks with HIV coverage for serious rock-climbing accident injuries—coverage which currently is virtually unobtainable. Indeed, to make catastrophic coverage mandatory for everyone, you have to ensure that providers are not on the hook for pre-existing chronic conditions (or prepare to deploy lots of TARP bailout money that would never come back).

    Our expectation is that the cost of treating chronic disease would be borne by the patient out of his or her HSA. As we stated, “Each individual would contribute at least a minimum number of pre-tax dollars—which may vary depending on demographic data and medical history—into his or her HSA each year.” Thus, the minimum annual contribution for an individual with a chronic condition would be higher than that of a chronic-condition-free individual, all other things being equal. But keep in mind that for people who cannot afford to fund their HSA up to the annual minimum, the government would make up the difference. Now there are strings attached to that funding, and the minimum funding will not afford you cadillac-level treatment, but this does constitute a mechanism for spreading risk between healthy and not-so-healthy people that does not recourse to traditional health “insurance.”

    Brad Hessel

  • Report this Comment On February 25, 2010, at 6:04 PM, langco1 wrote:

    dear obama just resign and quietly disappear!!

  • Report this Comment On February 25, 2010, at 6:08 PM, Anishinabe wrote:

    Brad and Madge are proposing some great ideas for health reform.

  • Report this Comment On February 25, 2010, at 6:22 PM, harrymax wrote:

    The constant refrain about socialism is a scare tactic. One could also call the coziness between the Senate and big business as facism and oligarchy.

    These labels are used to get off the real topic and create a side show. I can think of no better market driven idea than the single payer health care. This would be market driven competition, and it would create better heathcare at better healthcare costs.

    This, of course, is being killed by the corporate lobbiests who stick together and pass rewards back and forth to each other and to the Congress members. They turn their backs on real market driven competion in favor of the the kind of competition they can crush and kill. They like to keep their thumbs on the scale.

    The nation needs health care. There are those who want to make the middle class and poor expendable. There are those who want to build opulence on the backs of "lesser" Americans. It used too be if you built a better mousetrap, the world would beat a path to your door. Now it is about the grabbing of the gold that belongs to others, also known as piracy. What kind of America are we? These are quality of life issues. This is about who America is.

  • Report this Comment On February 25, 2010, at 6:55 PM, cmb34 wrote:

    You are absolutely correct that we need to focus on preventive care. Could you please show me a system in another country (or anywhere for that matter) that actually works or has ever worked in the way you suggested? cmb34 M.D.

  • Report this Comment On February 25, 2010, at 8:53 PM, njdolfan65 wrote:

    there are some comments that make no sense such as the one that the in the past people paid out of pocket and medical care was affordable. So how did insurance companies cause the cost of medical care to rise to the point it is unaffordable now. Insurance companies are not saints, but to just focus on them as the cause is wrong. They are the symptom and the cause is the 70 dollar doctor visit for 10 mins. The cost of all the testing to diagnose your sickness. Why aren't we discussing these causes for the high cost of insurance.

    as for those comments about all the other countries which have health care coverage for all, how are their economies doing and how do they compare with the US economy. last i saw the US economy drives the rest of the world. It takes money to fund socialism, the funds come from those with discretionary income, because the poor and unemployed do not pay for anything. So to pay for universal health care you are taking out discretionary income from the economy and thus making the US economy smaller. Go ahead and have the government take over health care and get rid of all the insurance companies and their jobs and tax dollars. The government can hire all those unemployed workers to run the government health care and raise taxes and take even more money out of the economy. The US is a consumer driven economy and it's why the rest pf the world wants us to get healthier do that we buy their goods and expand their economies.

  • Report this Comment On February 25, 2010, at 11:05 PM, bhessel wrote:

    njdolfan65 wrote:

    > there are some comments that make no sense such

    > as the one that the in the past people paid out of

    > pocket and medical care was affordable. So how did

    > insurance companies cause the cost of medical care

    > to rise to the point it is unaffordable now.

    That is an excellent question and to get a good idea of the answer, we reiterate our suggestion that you invest the time to listen to the most excellent “Someone Else’s Money” episode of This American Life:

    http://www.thisamericanlife.org/Radio_Episode.aspx?sched=132...

    Brad Hessel

  • Report this Comment On February 25, 2010, at 11:23 PM, madgecohen wrote:

    We are very pleased that so many of you posted comments on this article. While we definitely have some ideas and opinions about the way we'd like things to go, we're especially interested in getting people involved in this vital topic and moved to action. In addition, our few suggestions are not intended to be all encompassing; they're just a starting point for a much larger discussion.

    We're learning from each of your comments and are thrilled to be gaining more insights and knowledge into different options that might be considered in this critical and contentious debate around health care reform. Our views are just that, the way things look to us, and were all to happy to be provided with other views that can further help us formulate realistic/well-informed/constructive approaches to making much needed changes in our health care system.

    Thanks for the feedback. Keep it up!

  • Report this Comment On February 25, 2010, at 11:45 PM, alimaamoser wrote:

    Obama budget: Record spending, record deficit. Is he mad, why won't he wake up?

    http://www.articlesbase.com/health-articles/ultimate-max-bur...

  • Report this Comment On February 26, 2010, at 12:14 AM, Keal7 wrote:

    Great thoughts! But how do you get square the fact that the care you can buy (your life and health) is directly proportional to your income. In many ways are the poor disadvantaged - nutrition, comfort, housing, neighborhood, (unfortunately education). By your proposal, health becomes enshrined in our system as another social inequality.

    It means the moment you are born your potential, aspirations, and possibly life span is already decreed by the accident of your birth parents. Does not seem to align with that hidden quality that is American to which all aspire. If the poor could also be as educated as you and I would this be solution their thoughts would lead them? We seems to be fashioning solutions without realizing its based on our self advantaged point of view.

    (What we need to do is take out health and education as one of the variables amongst Americans of all stripes - as privileges. Then see if we can fashion a solution with that paradigm in mind. Hmmm, where would that lead? We already conceded some socialism in securith, defense, justice, and civil infrastructure. Adding health would not convert the coutnry into one giant socialist nation if we stop there.)

  • Report this Comment On February 26, 2010, at 12:31 AM, Keal7 wrote:

    A comment for fellow citizens. The health care problem (developed via serendipity as the author suggested) has been a problem for decades and will culminate in financial disaster if not addressed. While we may have wise and better suggestions to fix it or not, credit should go to the new President for trying (and consuming much of his political capital in the process) instead of comments requesting he resign or trashing his motives. No President takes on a task that ruined many of his predecessors just for fun.

  • Report this Comment On February 26, 2010, at 9:17 AM, mpendragon wrote:

    Some of the big cost drivers in US medicine include too much defensive medicine and administrative overhead from activities related to billing.

    A guaranteed issue plan from the government should help reduce the amount of defensive medicine and reduce medical liability costs for providers because patients harmed by malpractice aren't permanetly uninsurable so the cost of their care after injury is dramatically reduced.

    As for administrative overhead issues, the hospital needs a small army of billing staff to essentially fight their counterparts at the insurance companies they work with. There really isn't an effective way to manage that without at least a government option open to the public like a Medicare buy-in.

    While adjusting incentives is a good idea in general they don't seem to go over very well when implemented in the private system. We have private entities adjusting incentives and they are called HMOs. These are like death panels Republicans invented to scare elderly voters but they exist in the for-profit health insurance world.

  • Report this Comment On February 26, 2010, at 11:24 AM, metame wrote:

    I strongly considered an HSA and and it was actually a CATO institute study that talked me out of it. Basically they like the idea (being staunchly libertarian) but said it does not work in practice because health care is not something you can effectively comparison shop for. Yes, the government could take steps to improve consumer information, but those would need to be proven effective FIRST before putting everyone in HSAs. It's hard to imagine any health care decision being as easy (or even as difficult) as buying a car or a house. Until then, HSAs are a very poor solution.

  • Report this Comment On February 26, 2010, at 12:53 PM, PositiveMojo wrote:

    @metame. There is a lot of talk about buying health insurance across state lines to make it more competitive, but what about published rates for medical care?

    I like your point about about not being able to effectively comparison shop for healthcare. I think that is a big part of the problem. If you need to select an emergency room and there are 5 hospitals close by - how do you know what they charge before you make a decision? Published rates would be a huge help - for both doctors and hospitals.

  • Report this Comment On February 26, 2010, at 1:00 PM, FredBrown wrote:

    Number one: People w/o insurance of 30 to 40 million is incorrect. If illegal's were eliminated the number would be reduced by 50% at the minimum.

    Number two: the biggest problems with health care are self inflicted. Lack of competition; too much adminsitrative costs rather than medical treatments caused by requirements demanded by insurance companies, legal industry standards, and of course the governments at all levels. One can not compare costs of medical procedures, treatments, or benefits.Number Three: A lot of people do not think it is their responsibility for their health. This indoctrination comes from the idea they are not responsible for their homes, food, and healthcare. All primary needs. That has to change. The education bit is very inportant in regards to personal health, but also attitudes. I am a Pharmacist and if I see someone below 45 years, they will have tatoo's, body piercings, and a attitude that I owe them something. Most do not even attempt to keep tract of their welfare info. We are to provide that service along with the medication. I give them free medication so they can go buy more illegal drugs or a lottery scratchoff ticket.

  • Report this Comment On February 26, 2010, at 1:42 PM, brjmj wrote:

    I think education is the key to reducing the cost of anything. We do need to take more responsibility for our own health care. I like the use of HSA's but unfortunately if you are over 60 you can't have one, at least where I work. What we have to do is stop paying for those that choose not to work, illegals, etc. It is okay to assist the elderly and widows but the massive giveaways our government proposes is lunacy. I think you are on the right track, keep up the good work.

  • Report this Comment On February 26, 2010, at 1:43 PM, theHedgehog wrote:

    <i>Each individual would contribute at least a minimum number of pre-tax dollars -- which may vary depending on demographic data and medical history</i>

    Same old story - punish those with health problems. IOW, same as we have now, but with a different name. :(

  • Report this Comment On February 26, 2010, at 1:43 PM, theHedgehog wrote:

    <i>Each individual would contribute at least a minimum number of pre-tax dollars -- which may vary depending on demographic data and medical history</i>

    Same old story - punish those with health problems. IOW, same as we have now, but with a different name. :(

  • Report this Comment On February 26, 2010, at 1:59 PM, bucksmaster7 wrote:

    I agree with most of your article. Quite a number of comments were around the idea that each person should be guaranteed health care because they exist. The entitled recipient doesn't care who pays for it, they just want it. They deserve it ! That is a gap in philosophy that is difficult to bridge. The idea that every person "deserves" healthcare is a socialist idea that has great appeal for some and that is understandable. Who wouldn't want something for free? "My neighbor has a nice house. Why doesn't the government seize it from him and give it to me? I deserve it." But, it's just not a right in this country - as of yet - and I hope it never becomes a right.

  • Report this Comment On February 26, 2010, at 2:15 PM, ecloud wrote:

    Obviously everyone's pulling in a different direction, which is why nothing is getting done. Let's hope we all can live with the status quo because we're still stuck with it, until some sort of consensus emerges. Maybe eventually something unique and wonderful will emerge, rather than unique and fubar. Who knows if it will be within our lifetimes though.

  • Report this Comment On February 26, 2010, at 2:38 PM, kmacattack wrote:

    Let me start by summarizing a few established FACTS:

    1. The US has some of the best medical technology in the world.

    2. The US pays the highest costs for healthcare in the Industrialized world, in spite of having 45 million citizens un-insured and an additional 80 million people under-insured

    3. The US has the sickest population in the industrialized world. Juvenile and adult diabeties are now at epidemic proportions. The US has one of the highest infant mortality rates in the western world.

    4. The statement made by universal health care opponents that other countries' citizens have to wait to see a specialist or have a surgery while implying that Americans have no waiting line is a CRUEL and DELIBERATE LIE. 45 million uninsured have the distinct possibility of waiting until they DIE without seeing a specialist or having a needed surgery. 80 million more could face financial ruin if they were stricken with cancer, a heart attack, or an extended stay in intensive care.

    5. Canadians outlive Americans on average by almost 3 years, as do almost all of the other countres which have universal coverage, including poor nations such as Cuba. 88 PERCENT OF Canadians recently polled said they would NEVER exchange their health care system with the US system. The Canadian CONSERVATIVE party leader who opposed universal health care APOLOGIZED to the Canadian people for opposing universal care saying "It was the greatest piece of legislation ever enacted for the Canadian people."

    6. Health savings accounts are first and foremost another way to shift the tax burden from the wealthy to the middle classs and poor. Most middle class people can not afford to purchase health insurance with the "disposable income" they place into the HSA. Many families' "disposable income" vanished when gasoline prices were $5.50 per gallon and Oil related inflation drove the costs up of almost everything they purchased. Given an either food and home heating or health insurance option, I believe people would drop their insurance (unlikely that they could afford coverage anyway) or HSA contribution. If they were able to save, for example, $200 per month (about 25% of what health insurance would cost for an average family of 4 people), and 5 years later one of the 4 family members suffered a heart attack, and were presented with a $200,000 bill, they would only be about $190,000 short of being able to pay the bill with their HSA. Your idea that the government would subsidize the premiums to buy health insurance sounds socialistic.

    Thirty years ago, I sublet an apartment from an inhalation therapist who lived a lavish lifestyle. He bragged to me that he worked with only one doctor, administered a test that cost him $3, plus about $2 labor cost and billed the patient $150. The free market is one thing. Robbery is another. Insurance companies, Pharmas, Doctors and Hospitals should should be treated much the same as public utilities. They should be able to make a reasonable profit for their investors. They should not be able to rape the patients, nor the taxpayers by charging ridiculous amonts to Medicare. Hospitals often write off huge amounts, sometimes over a million dollars, that uninsured patients are unable to pay, By doing so, the huge "losses" insures that they can be considered "non profit." If my company tried to write off a ridiculous charge as "bad debt" I would go to jail for tax fraud. A simple MRI is often billed to the patient at $2,000, but if an insurance company is paying the bill, the cost is reduced to $300, THEN the patient pays their deductable, plus 20% out of pocket, so the insurance company's cost may be ZERO.

    The current system is more than broken, it's more like organized crime. It creates an increasingly unhealthy population, impoverishes millions, leads to premature death for millions. The "benefits" of the system seem to be that the insuarance and pharma companies have hundreds of millions of dollars to spend on lobbying against reform and to buy congressional votes.

    A lot of our nation's problems could be solved if we adopted public financing of all federal elections. The radio and TV broadcast airwaves are PUBLIC PROPERTY, licensed with the sole purpose "To serve the public interest." Both parties are guilty of being manipulated by contributors and lobbyists, but the republican party seems to be owned outright by Insurance companies, Pharmas, Big Oil, The US Chamber of Commerce, the National Association of Manufacturers, etc.

    I watched some of C-pan's coverage of the National Governors Conference this week, and it was refreshing to see the governors of all the states discussing, in a civil, and even cordial manner, ideas for providing health care which were working in their own states, and even admitting things that had been tried and had not worked. Maybe we should immediately fire the congress, and let these governors write a health reform bill.

  • Report this Comment On February 26, 2010, at 3:04 PM, RaiddinnRZ wrote:

    I don't know why more people aren't talking about Professor Wheelan's idea, you can find it on Yahoo Finance. It is miles better than anything I have seen so far.

  • Report this Comment On February 26, 2010, at 3:04 PM, gnorton100 wrote:

    The "old" people that lived through WW I and WW II must be completely disgusted.

    Our politicians are reshaping this country into the very entity that they fought to protect the world from ... Socialism, complete with the "elitists" and "the rest".

    The authors are abviously NOT part of the working poor or lower middle class,or they'd know that rent and food and utility payments are mandatory; and that overpriced health insurance is not.

    Obama's goal of insurance for everyone is great but not terribly realistic unless the US becomes a Socialist state, like Canada or Germany and provides all healthcare in limited, rationed form.

    And it's not cheap.

    A friend in Canada loses over 40% of his paycheck to taxes; much of it to pay for healthcare.

    A friend in Germany lose over 50% of his paycheck to taxes. Again, much of the taxes are to cover healthcare.

    The problem with Socialism: sooner or later, you run out of OTHER people's money.

    Do you really think that Obama and all other politicians will open their bank accounts to redistribute THEIR wealth ?

    They've got the best retirement plan in the world.

    Survive a term and get a retirement check for life,

  • Report this Comment On February 26, 2010, at 3:14 PM, kmacattack wrote:

    Buckmaster,

    I'll bet you will drive somewhere on a road today and I would bet a lot of money that you didn't pay for the road out of your pocket. You probably passed a police officer, and maybe a fire truck somewhere along the way that I would bet are not your private employees. If, along the way, someone runs a red light and wrecks your car and possibly injurs you, I'll bet you will be thankful that some "socialists" in your state legislature required the guy that hit you to carry insurance.

    If your kids attended public schools, I'll bet that you didn't pay the thousands of dollars per year for their education. In fact the system is so socialistic that people who don't even have kids pay school taxes. Maybe you don't have kids. Maybe you are wealthy enough that your kids attended private school and you resent property taxes. Maybe you think all taxes are socialistic.

    Last summer, one of my renters, a 50 year old Navy Seal veteran who received 3 Purple Hearts, became suddenly ill and was denied admission to the VA hospital because he was "ony 20 percent disabled." He was forced to drive to a public hospital, was diagnosed with tick fever which had gone unteated because he had no health insurance. he spent about 10 days in ICU, was released and was devestated by the prospect of a hospital bill in the hundreds of thousands of dollars which he could never repay and would ruin his credit. A week later, he blew his brains out with a 45 automatic.

    Last month, a business associate of mine died of cancer, 3 weeks after being diagnosed. He had felt bad for months, but didn't go to the doctor because he could not afford it, his wife had a pre-existing condition, so health insurance was out of reach.

    Last Sunday morning, one of my daughter's best friends called from Florida. My daughter had been in her wedding last summer. Her new husband had been feeling ill fo about a week, but didn't have health insurance, and, like a lot of young families, they didn't have $2,000 for an emergency room visit, or $150 for a doctor visit. The young husband, a 22 year old with a baby, died in his sleep early Sunday morning.

    What we have now certainly isn't socialized medicine, it is SOCIOPATHIC. I've got health care, scre. the rest of you, right?

    Since you didn't pay for the road you drive on, but the money was "confiscated" from someone else, on principle do you plan to stop driving, or refuse to call the police when your house is being robbed, or the fire department when it is on fire? According to your logic, these are socialistic institutions, and therefore, are bad.

    Do you plan on refusing your "socialist" social security check when you retire? I doubt it. Those 3 friends of mine who died UNNECCESSARILY in the last few months might have helped contribute to the system to insure that you get those cheks.

  • Report this Comment On February 26, 2010, at 3:14 PM, RaiddinnRZ wrote:

    Note also, many people who could buy insurance don't and because a family of 4's medical bills often only amount to about $100 a month whereas coverage for such a family would realistically be closer to $800 - $1000 a month.

    A huge part of the reason that certain people aren't ensured is because they can't justify $700 more a month with no visible gain. This problem is much worse the lower your income level goes.

    For these people, the choice is often (realistically) having a whole year of complete coverage and ending up with 10k more credit card debt at year end guaranteed OR rolling the dice and praying.

    For these poverty line type individuals, and lets not kid ourselves here a large percentage of people are like this at the current time, they can't justify skipping putting food on the table to get health coverage.

  • Report this Comment On February 26, 2010, at 3:48 PM, 1122graydon wrote:

    The first thing I would do is make it mandatory whatever our legislators pass It is their health plan -no better no worse. Our representatives have country club health plans and have no personal experience with current health care. It is unfair to overlegislate medicine when the legal system is not similarly controlled. There is greed in medicine but you need to allow physicians to earn a good living to compensate for the years of training, long hours and high stress. If you have chest pain at 2AM try calling your lawyer or accountant or representative!

  • Report this Comment On February 26, 2010, at 4:13 PM, kmacattack wrote:

    Graybear,

    You were talking about how Reagan fixed things, and ignored the "spreadsheet." You talked aout buying a house when Carter was president and paid 17.5% interest. I bought a house in '85 (FOUR YEARS AFTER REAGAN took office and fixed rates were 18.5%, worse than under Carter after four years. In addition, after the Reagan record tax cut, the deficits exploded so much that Reagan had to have the largest TAX INCREASE IN HISTORY. Inflation worsened under Reagan, and there were TWO RECESSIONS while Reagan was in office.

    Your belief that Sam Walton's "Made in USA" campaign created American jobs is proof that "you can fool some of the people some (or all) of the time."

    Even then, 80% of the merchandise sold on Wal Mart's shelves was foreign made. I was a Wal Mart stockholder off and on for about 25 years (just exchanged it for Berkshire two weeks ago and I will never regret getting rid of it). I know, 1% of Bekshire's holdings is Wal Mart, but I had nearly 20% of my porfolio in it. Wal Mart has done for America what General Sherman did for the south during the Civil War- pillage, rape and burn.

    And, of course, Wal Mart caused millions of Americans to lose health care by dirving competitors out of business, replacing decent paying jobs with benefits with minimum wage part time jobs with no benefits. Lee Scott, former chairman of Wal Mart commented on the alligation that Wal Mart was driving American Manufacturers out of business said in a CNBC documentary "If we hadn't one it, somebody elso would have." Unbelievable.

    What Wal Mart is "bringin Home to the USA" is cheap foreign merchandise, American job losses, and Billions of dollars in trade deficits.

  • Report this Comment On February 26, 2010, at 4:22 PM, kmacattack wrote:

    Raidden.....

    You are exactly right. A lot of people apparantly are sufficiently wealthy that they have no concept of how "the other half lives." The really sad thing is that there are a significant number of people who post to this and other sites who could care less whether their neighbor down the street is going to die because he couldn't afford health insurance. I hope I never become so callous as to be so defensive about "someone coming to take my house" that I have no compasion for my neighbors, or fellow countrymen because some insurance company's bagman on the radio or TV, or in congress, scared me by yelling "sociaist,"

  • Report this Comment On February 26, 2010, at 6:07 PM, INoFoolin wrote:

    This is a great idea for the top 10% of the country, but that is not where the problem lies. Philosophically, is basic health care a right or a responsibility? I feel it must be a right in 21st Century America. We need a baseline safety net of health care for all citizens and legal residents. It is simplistic (foolish?) to think that the 30 million without health care can or should manage this. The average American has negative net worth and lives hand to mouth.

    It is similar to the ignorant idea that we eliminate Social Security and everyone should self-manage their retirement accounts.

    The health industry (insurance, providers, pharma) do not operate in a capitalist system. There is no free market, and anti-trust rules do not apply. Five percent of patients consume 50% of the resources. Most of these people are in terminal situations, and the 'health' system has no mechanism to rationally allocate resources in those situations. ( Pull the plug on grandma!) If we don't put strong 'regulation' on insurance, pharma, and providers they will bankrupt the nation. They have a our credit card, and we can't continue to pay the bill.

  • Report this Comment On February 26, 2010, at 6:16 PM, INoFoolin wrote:

    This is a great idea for the top 10% of the country, but that is not where the problem lies. Philosophically, is basic health care a right or a responsibility? I feel it must be a right in 21st Century America. We need a baseline safety net of health care for all citizens and legal residents. It is simplistic (foolish?) to think that the 30 million without health care can or should manage this. The average American has negative net worth and lives hand to mouth.

    It is similar to the ignorant idea that we eliminate Social Security and everyone should self-manage their retirement accounts.

    The health industry (insurance, providers, pharma) do not operate in a capitalist system. There is no free market, and anti-trust rules do not apply. Five percent of patients consume 50% of the resources. Most of these people are in terminal situations, and the 'health' system has no mechanism to rationally allocate resources in those situations. ( Pull the plug on grandma!) If we don't put strong 'regulation' on insurance, pharma, and providers they will bankrupt the nation. They have a our credit card, and we can't continue to pay the bill.

  • Report this Comment On February 26, 2010, at 6:20 PM, shbeavers wrote:

    You make a good point about addressing the cultural issues as well as the financial ones. A couple of thoughts:

    - A step in the right direction would be to make HSAs available individually (like IRAs) and not just through employer sponsorship.

    - the poor, un- and under-employed would have to be brought into the fold in some fashion much as you suggest the elderly should be.

    - health is only a truly insurable risk for insurance companies if the entire population is insured. Then pre-existing condition become moot. In this, the Obama administration has the right idea.

  • Report this Comment On February 26, 2010, at 9:32 PM, peters46 wrote:

    I like the idea of HSA, and many of the other comments/opinions expressed. But you started out the article with an incorrect opinion that current "providers ... focus on cures rather than prevention." They focus on neither - their focus is solely (for most) on treating symptoms, don't waste time on diagnosis. E.g..if you have pneumonia, rather than finding the cause (bacteria, virus, mold, etc) they will pump you full of steroids to treat the bodie's immune response - then six months down the line you will die of conjestive heart failure (because enlarged heart is an almost certain side effect). Another example, my sister went thru almost eight years of missed/ misdiagnosis of Graves, with it almost killing her because her physician prescribed TSH. Everything appears to be for appearance sake. To the insurance company, the diagnosis appeared good, so don't bother with further testing. And education to get people to change their ways? Ha! Exercise and healthy eating - how long has that been broadcast by health professionals? And the obeisity rate is now? And resultant diabetes and cardiac conditions?

    It is only when actual costs (diagnoses, treatment, drugs, malpractice insurance) come down that insurance costs will come down to the point universal coverage will be feasible.

  • Report this Comment On February 26, 2010, at 10:45 PM, Tomohawk52 wrote:

    It seems to me, with a population that is aging (here in Canada and in the US), getting fatter, lazier and generally unhealthier we have two choices:

    1) Force citizens to stop eating crap and eat measured amounts from the food pyramid, get their government mandated and regulated amount of sleep and exercise, and for the government to prohibit/restrict substances that are known to be unhealthy like cocaine, tobacco and alcohol. Then cover everyone. In other words, you get great health coverage but anyone who wants to smoke, eat at McD's every day and drive instead of walk to the corner store is out of luck. Perhaps you have to go to the doctor every few months for urinalysis, body-fat measuring, etc. to make sure you are "behaving". End result: government micromanagement of its citizen's day-to-day living in exchange for a more informed, healthier citizenry.

    or

    2) Allow anyone to do whatever they want. If they smoke, for example, get lung cancer and can't get insurance and can't pay for an operation ... well, too bad, they're dead. End result: a libertarian system where people are either going to learn to live healthier or they are not going to be sticking around long.

    The way things are now, you have an enormous imbalance between rights and responsibilities which is what is causing the problem.. Irresponsible people can behave in any way that harms the collective (by increasingly requiring more medical care for self-imposed problems), while they have to bear a small percentage of the actual costs. This is obviously not sustainable. I should imagine that either you are going to see elderly people getting euthanised "for the good of the country" (i.e because the costs are too onerous for society in general to bear), or people who have problems like a failing liver caused by a lifetime of drinking are just going to have to be denied medical care.

  • Report this Comment On February 26, 2010, at 10:46 PM, Tomohawk52 wrote:

    It seems to me, with a population that is aging (here in Canada and in the US), getting fatter, lazier and generally unhealthier we have two choices:

    1) Force citizens to stop eating crap and eat measured amounts from the food pyramid, get their government mandated and regulated amount of sleep and exercise, and for the government to prohibit/restrict substances that are known to be unhealthy like cocaine, tobacco and alcohol. Then cover everyone. In other words, you get great health coverage but anyone who wants to smoke, eat at McD's every day and drive instead of walk to the corner store is out of luck. Perhaps you have to go to the doctor every few months for urinalysis, body-fat measuring, etc. to make sure you are "behaving". End result: government micromanagement of its citizen's day-to-day living in exchange for a more informed, healthier citizenry.

    or

    2) Allow anyone to do whatever they want. If they smoke, for example, get lung cancer and can't get insurance and can't pay for an operation ... well, too bad, they're dead. End result: a libertarian system where people are either going to learn to live healthier or they are not going to be sticking around long.

    The way things are now, you have an enormous imbalance between rights and responsibilities which is what is causing the problem.. Irresponsible people can behave in any way that harms the collective (by increasingly requiring more medical care for self-imposed problems), while they have to bear a small percentage of the actual costs. This is obviously not sustainable. I should imagine that either you are going to see elderly people getting euthanised "for the good of the country" (i.e because the costs are too onerous for society in general to bear), or people who have problems like a failing liver caused by a lifetime of drinking are just going to have to be denied medical care.

  • Report this Comment On February 27, 2010, at 8:11 AM, mabjco wrote:

    Anybody remember Ted Kennedy? He created HMO's. It was congress that created this mess by legislating just how the medical system was to work. By limiting natural competition with the excuse that "Too many people were not getting access to health care!"

    The result was higher costs, government intrusion (see also limited coverage) and inefficient care. And how much money is in the Social Security trust fund? Our fine representatives have control of that. Medicare is broke.

    We rely on these idiots who know nothing about how the greatest country on earth got to be the greatest country on earth. Capitalism, free capitalism!

    Any new legislation should be legislation that frees up competition, reverses restrictions and slowly removes the government from people's lives.

    We have the best health care on earth despite all the

    regulation and government intrusion. Thats why people from other countries come here for complicated procedures

  • Report this Comment On February 27, 2010, at 8:58 AM, igotitmade wrote:

    Most of the repliers appear to have either not read the article, not understood it, or have no knowledge of human nature or economics. Our current system is terrible because the incentives to patients, providers, insurers, and governments are all wrong. The proposed Federal takeover would get the incentives even more goofed up. The article is a start at lining things up properly; it at least approaches the problem rationally.

  • Report this Comment On February 27, 2010, at 10:56 AM, jlclayton wrote:

    One thing this article did not explain well is that with an HSA there is a cap on the amount of medical expenses you have to pay every year. I have an HSA and can contribute up to $3050 each year. My medical expenses are capped at a $3000 deductible ($6000 under the family plan) and are covered at 100% after that.

    So those who are worried that 1 surgery would wipe out their whole HSA in a year, can rest assured that this would not happen. During the years that you have few expenses, you will be able to build up your account to your deductible amount. You can also pay for over-the-counter medications from your HSA, and they count towards your deductible. It is definitely something that everyone should look into to get the whole picture and see how it may work for their personal situation.

  • Report this Comment On February 27, 2010, at 12:41 PM, masterN17 wrote:

    Too bad these incredible ideas are appearing in investing circles and not Congress. I like reading good ideas but it just depresses me that it will not pass due to the bitter political divisions created by vocal minorities that prefer idealism to pragmatism.

    As a young person (theoretically charged with returning the nation to its greatness while simultaneously paying off the debt load incurred by my predecessors) I am depressed about how terribly useless Congress is to my generation. Worst case, the brightest of us will move away due to government's lack of concern for our generation, leaving the country to be governed by the mediocre.

    Our generation increasingly tends to view themselves as global citizens of humanity instead of American citizens, and many will not see a reason to stay once their parents pass away. I know I don't...

  • Report this Comment On February 27, 2010, at 1:28 PM, jfrankh57 wrote:

    Everybody forgets one thing...the federal government has had a hand in running a medical system for generations. It is called the VA Hospital system. It has also been often called the worst and rarely one of the best medical care systems in the country. The quality of care used to be a shameful point of contention between the US government and Veterans/Vet groups. Based on my own father's care in this system, I'd qualify the federal government's efforts at a D-. I think the quality has improved somewhat since the exposes that showed its short comings after OEF and OIF early in the decade, but it still shows the ineffectiveness and inefficiency of the federal government in providing medical care for the masses.

  • Report this Comment On February 27, 2010, at 9:07 PM, altonoch wrote:

    As a physician, we share many agreements. The health care situation is vital to economic security. Medicaid foots the bill for many women and children and, before scoffing , I must mention the benefits of user independent, easily reversible contraception, vaccinations, and the prevention of hearing loss by treating ear infections in children. Preventing pre term birth and the issues around NICU care are a big goal. Its hard to make people stop having sex.

    You are correct about education. Focusing on development of the brain as our greatest natural recourse would help improve many health care issues.

    At the risk of sounding paternalistic, there are some among us who do not do well with money. Despite a reasonable salary, little is saved for retirement. Under your plan, if a person fails in personal responsibility, cashes out, then what..death with illness for lack of coverage?

    Success is a learned behavior, we do not default into it. Between birth and 2 years the brain grows from 400 to 1000 grams. This time sets much of the thermastat of temperment and establishes social interraction timing. If this period is lost because mom is depressed, a child will be a different adult. Not for the healthier.

    In 1900 the lifespan for a male was 40. Maternal mortality was approximately 6 per 1000 births. Throughout history our issues have revolved around starvation. Appendicitis, dental abscesses, childbirth, severe anemia, kidney stones, gallstones, perforated ulcers, infected lacerations...sufferring then dead. Watching your family members die, more depression, worse quality of life.

    Technology has outpaced our ability to pay. Capitalism and profits have driven much of the success. Our free market system has not adapted well in helping an ever increasing number of people gain access. Our society is complex and stressful. Pleasurable inexpensive food is prevalent and marketed. We use millions of automobiles to travel extensive distances increasing life threatening trauma. Gunshot wounds in inner cities utilize recourses in correlation to the level of poverty and the number of guns.

    The capacity to save the young, old and injured is available, expensive and carried out by highly trained professionals. You are not going to have the people with the drive to do well in college, go to medical school, then residency training from 3-7 years without adequate compensation. Compensation must be commensurate and anywhere from 150 to 600k, depending on the specialty.

    Using cuban statistics may be difficult. Do they factor in infant mortality? What about other society based injuries as mentioned?

    Our situation evolved. The doctors are not villains. The hospitals are not villains. Insurance companies, not villains (mostly). Pharmaceutical companies, not villains. I must say in my patient population I have very few surgeries or hospitalizations refused. Politicians, at least most, are not villains.

    Integration of medicine to reduce suffering when so much is available and so many cannot afford it is tough in capitalism. Hopefully the Democrats will come out with the bill. It is moderate and market based. Few that have insurance will see premiums increase and about a 1% increase in taxes above 200k will go to medicare. It will take 30 million more on the roles to increase coverage and benefits.

    Your article sounded in parts like a bit of a conspiracy theory. The reality we have is a failure of planning, not a conspiratorial plan. We all have to work to reduce costs, from doctors to hospitals to insurance companies.

    One tip is to get medications in tablet form at twice the dose and take 1/2 as directed (get the doctor to write 1/2 to 1 per day so you get the full amount).

    Thanks,

  • Report this Comment On February 28, 2010, at 6:29 AM, WileyCyote wrote:

    While ther are some outstanding ideas here, we have one terrible problem.

    The hubris of most of this current government. It would appear that this "president" thinks that we need a collection of "czars" to guide us.

    Unless we can correct this, the special interests, lobbyists etc will continue to block any meaningful actions.

    Isn't it interesting that ANY health care "legislatioin" will EXCLUDE the "govmint" employees. (I haven't seen any ranting and raving by the mainstream press relative to this issue)

  • Report this Comment On February 28, 2010, at 9:34 AM, spairscript wrote:

    I thought it was amusing that someone actually posted that "people aren't stupid".

    Actually, stupidity is what created this mess. Unfortunately we don't have a cure for stupidity.

    The trick is, how can we lead people in the direction of making better choices? The bottom line comes down to economic incentives.

    Prevention (what we know actually works) comes down to eating right, exercising, and not smoking. We can keep premiums lower for people who adhere to this. This can documented with measured activity (accelerometers) and bloodwork to confirm absence of carbon monoxide in regard to smoking. The others who choose to make unhealthy choices (as is their right) can simply pay much higher premiums for coverage until they figure it out that they need to change their lifestyle.

    We should not provide coverage for all the things that aren't proven to work (specialized nutritional supplements have no hard data that they are better than simple multivitamins, just unsubstantiated testimonials. Chiropractic nonsense is also unsubstantiated and should not be covered. These bozos advertise that they can treat infections, heart disease, etc by doing "manipulations".)

    If you want these unproven remedies, pay for them out of your own pocket.

    For those that still need to get legitimate treatment, to keep unnecessary costs out of the picture, implement real tort reform. Adjudicating what should happen if someone is injured, is what should be the function of government. Let CMS have an arm that will investigate injury claims, and provide medical cost coverage for legitimate claims, and then let the licensing boards decide what should happen to the provider. We don't need to have attorneys becoming multimillionaires, and sucking dollars out of the healthcare system that could have gone for treatment. If they really want to claim that they are doing this to "protect people", they can do this as a salaried government employee.

  • Report this Comment On February 28, 2010, at 2:47 PM, stockju wrote:

    Finding opportunities in healthcare -

    In the analysis of last 90 day activity of Institutions, a positve net buy was seen in Financial, Healthcare, Utilities, Basic Materials, and Services.

    Healthcare stock purchase by Institutional buyers - is it a Healthy signal?

    Total Purchases by Institutions - $ 9,118,990,692

    Total Sale by Institutions - $ 8,645,084,781

    Net Activity - $ 473,905,911

    Interestingly, healthcare appears in the Top Insider purchases for week ending 02/19

    Total Buy - . $5,025,325

    Healthcare sector was written off by a few analysts as one of the worst sectors for 2010. With hot debate around President Obama's healthcare reform still active, it may be too early to predict the exact outcome. Per the latest, President Barack Obama and Democratic congressional leaders are trying to revive the administration’s top domestic priority after a year-long battle to pass a bill. House Speaker Nancy Pelosi said “time is up” for Congress to pass health-care legislation and that lawmakers in her chamber need to figure out the right policy.

    See complete table on Institutional transactions here- http://www.stockjupiter.com/Step1/Sector%20Insider%20and%20I...

    sincerely,

    www.stockjupiter.com team

  • Report this Comment On February 28, 2010, at 4:56 PM, petrus7136 wrote:

    I want to begin by saying how ridiculous it is that you repeat the tired and unhelpful notion at the beginning of your article that universal health care is "socialism". It is not, Not any more than many things our society does for ourselves as a group, such as a justice system, a transportation system, a military, etc. The fact that the US alone among industrialized countries has zoned off health care for its citizens into a category labelled "socialist", is absurd and reduces the quality of life for all of us.

    Now, about your plan, obviously you have thought seriously and make some intelligent proposals -- unlike the Republican members of Congress and the tea-partiers who seem to think the current lack of a health care system (because that's what it is) is acceptable.

    My question is this: let's say I find out I have cancer tomorrow, but my HSA is not sufficiently funded to cover the costs, which will of course be huge. Is that just tough luck the way it is now unless I work for a large employer with good insurance? Do I have to sell off my home, assets, everything to pay for the expensive treatments and care? Who pays for the catastrophic illnesses?

    Maybe you are right that people are not encouraged to use preventive care. But let's face it, not everything is preventable. So now what?

    Personally, I think we owe a huge debt of gratitude to President Obama for engaging us in this conversation. He's being bombarded from all sides, but we need to figure this out, and NOW.

  • Report this Comment On February 28, 2010, at 5:57 PM, TopAustrianFool wrote:

    What capitalist elites? These people in government who act like it is the responsibility of government to solve every problem, regulate every industry and save every citizen from their own decisions? You need to understand what the Free-Market is and what capitalim means before you classify anyone.

  • Report this Comment On February 28, 2010, at 7:30 PM, BobFurr wrote:

    To state the obvious: Free Markets (so free that the health care industry is exempt from antitrust laws) created the current mess. How can anyone believe more of the same will lead to a different outcome?

  • Report this Comment On February 28, 2010, at 10:08 PM, futuretrade wrote:

    mtracy9,

    I was a young adult during the Carter and Reagan years and I remember what things were like very well.

    During President Carter's administration (I'm not saying it was his fault, just the way things were):

    Gas prices out of sight

    Gas shortages

    Inflation rates that topped 13%

    Top personal income tax rate of 70%

    Interest rates that topped 20%

    No loans available anyway due to the tactic that Volker was using to keep inflation low by keeping unemployment high and the money supply extremely low.

    Unemployment of :

    1977 7.1

    1978 6.1

    1979 5.8

    1980 7.1

    (from Bureau of Labor Statistics http://www.bls.gov/cps/prev_yrs.htm)

    Yes, unemployment was higher during the early Reagan years but the last two years of Carter's administration gave us interest rates over 20% and no loans available anyway. By the time Carter left office, the real estate and construction industries were dead. As were the automobile and mortgage industries.

    Yes, President Reagan cut the ruinous tax rates from 70% to 28% over 8 years and you are dead wrong about this tax cut applying to the "top 1%", the 28% tax rate applied to anyone making over $29,750.00. The tax cuts were across the board.

    (http://www.truthandpolitics.org/top-rates.php#fn-8)

    Yes, the income brackets over $200,000 got a bigger tax break, but the majority of taxpayers at this income level are small businesses. The 70% tax rate was killing us.

    President Reagan's fiscal policies saved us. The loosening of the money supply meant that interest rates could fall and money was actually available to loan.

    "President Ronald Reagan's record includes sweeping economic reforms and deep across-the-board tax cuts, market deregulation, and sound monetary policies to contain inflation. His policies resulted in the largest peacetime economic boom in American history and nearly 35 million more jobs. As the Joint Economic Committee reported in April 2000:

    In 1981, newly elected President Ronald Reagan refocused fiscal policy on the long run. He proposed, and Congress passed, sharp cuts in marginal tax rates. The cuts increased incentives to work and stimulated growth. These were funda-mental policy changes that provided the foundation for the Great Expansion that began in December 1982.

    As Exhibit 1 shows, the economic record of the last 17 years is remarkable, particularly when viewed against the backdrop of the 1970s. The United States has experienced two of the longest and strongest expansions in our history back to back. They have been interrupted only by a shallow eight-month downturn in 1990-91."

    (http://www.heritage.org/research/taxes/bg1414.cfm)

  • Report this Comment On March 01, 2010, at 11:47 AM, MAURIZIO400 wrote:

    thou speeketh soot !

    great article!

    bu-ya!

  • Report this Comment On March 01, 2010, at 5:06 PM, ijoyce wrote:

    Firstly, thanks for the article. Obviously there is great contention across the board as to what is the best route to take with Health Care. I think the only way we can come to any solution is to do this; work together and not only hear each other but actually listen.

    I agree with the main premise of this article, which is that we must address the real issue: cost. Simply transferring the burden of coverage to U.S. government by instituting universal health care does nothing. We the people still have to pay for it. With insurance companies nickel and diming us at every turn and the government mismanaging our money (is that really so hard to believe?), the only result of universal health care will be our entire economy in "critical condition".

    Reform needs to happen now in many aspects of the Health Care spectrum. Protect our doctors from excessive and retalitory litigation. They're human, just like us. Allow public competition between insurance groups. Let the market determine the best price. Allow for customized insurance policies, just like car insurance plans. Relax the laws on end-of-life litigation, and let people die with dignity (inexpensively). Get rid of employer-based insurance. Relax the standards when it comes to the medical profession. Why can't a nurse just give me a physical? Get rid of the FDA. It kills more people than it protects with its excrutiatingly drawn out approval process. We don't need the FDA anymore; if a drug company screws up they're getting class-action out the wazoo anyway. May be the only upside of our ridiculous legal culture. Then maybe the HSA and catastrophic program could work...

    Yet, HSA's make me nervous. I like the idea of encouraging fiscal responsibility, but I think I may be confused as to how the HSA will be accruing interest. Will the government be pooling our monies together and then reinvesting them? Or will private companies be looking to manage our funds. I don't want this program to turn into an even larger scale social security fiasco.

    Finally, people on this blog are voicing opinions about the impoverished in our country and how this does not set them up for much of a change at all. I think that if this program were set into motion (along with many other things such as insurance, medical, litigation, and pharm reform), the government should focus more on education in our society. We need to make a change in people's minds, not just pocket-books. We need re-learn fiscal responsibility and money management so that people save and can pay for the newly affordable health care. Only in this way will we be able to assist the poor in getting them what they need in life. Solve the problem, not the symptom..

    If you really care about people and their lives, care about the whole person, start to finish.

  • Report this Comment On March 02, 2010, at 9:12 AM, THEMATHISNEAR wrote:

    Brad and Madge,

    I'm sad to say that your proposal has no hope. It makes too much sense to be passed by Congress. :-)

    By the way, I have been advocating just this approach for the past several years. Driving the decisions down to the beneficiary, and making them understand the cost-benefit trade-off with their own money at stake, is the ONLY, that is, ONLY, way to fix this problem.

  • Report this Comment On March 04, 2010, at 9:28 AM, ChiRaven wrote:

    Those commenting on the unemployed and underemployed must not have been reading the same article I read, which CLEARLY mentioned government assistance for those who were unable to fund their HSA's to the necessary level. And the requirement for catastrophic insurance coverage covers the case of "what if I suddenly get cancer" that someone mentioned earlier.

    My concern is with the people who ARE able to fund an HSA, but just DON'T. How do we deal with people who fail to purchase the necessary catastrophic coverage that is a requirement of the HSA? Certainly allowing them to go without medical care is not something we are likely to do. But what kind of penalty should there be for failing to have an HSA (and catastrophic coverage) if you have the financial means to do so? And how would it be enforced?

  • Report this Comment On March 20, 2010, at 9:28 PM, mfscheer wrote:

    As a physician I am appalled at some of the suggestions here. Bring in 100,000 doctors from Cuba? I would be surprised if there were 100,000 doctors in Cuba. Charging patients $800 for a biopsy needle is unreasonable? I perform biopsies in my office. The needles cost 250$ each and the vacuum device is $10,000 just for your reference.

    As physicians we would be happy to eliminate the insurance company from the equation and charge each patient our full fare. I am sure you would all be surprised to learn what we as physicians are actually paid for the services that we provide. The Medicare fee for removal of a part of the colon for cancer is $1322 and we receive 80% of that fee and the patient is responsible for the other 20% or their supplemental insurance may pay after they further discount the amount. That Medicare fee is $65 less than it was in 2005. So while everyone else's fees are increasing we are receiving less year after year.

    I, as the majority of Americans and physicians, agree that the current proposed health care reform is a disaster and fatally flawed. The two major reasons for reform in general are to lower health care costs and to cover 45 million uninsured. Unfortunately the proposed legislation fails miserably in both instances. Health care costs will rise for everyone and although 30 million uninsured "Americans" will be covered with insurance they will become underinsured Americans and small and large businesses will quickly find that they will save money if they no longer provide health insurance for their employees or they will cover them at a level that is "underinsured" and I can tell you that very few doctors want to see "underinsured" patients because they cannot afford to. I anticipate that the number of underinsured patients will rise to 115 million and who will see those patients. You guessed it, the emergency room! Where we are compelled by law to care for the sick. Currently, Medicaid patients are severely limited in their ability to see any physician and the same is happening with Medicare so I hate to see what will happen when there are even more of these patients who will be getting their care through ERs.

    The bottom line is that there is not an easy fix but the current proposed legislation will not make matters better. Only worse.

  • Report this Comment On March 21, 2010, at 1:34 AM, madbrain wrote:

    bhessel,

    re: your feb 25 response which I just read, I continue to be appalled.

    The last thing someone need is to have several insurance companies involved and more red tape fighting over who caused what. This certainly is not in the best interest of the patient and only contributes to delayed or denied care. For example, as HIV-positive, my bf and I are more likely to develop all kinds of cancers, heart problems, pneumonia, skin problems, and really just about anything else, than the general population, heck, even a rock-climbing accident since those life-saving HIV drugs can make one dizzy at times.

    It makes no sense to involve multiple insurers, one for chronic diseases, and another for the rest. Ask a doctor if you think the answer is always 100% clear cut as to the cause of one disease. Medicine unfortunately is not an exact science, and what you propose is simply impractical.

    What you are proposing - providing guarantees to "catastrophic coverage providers", ie. the insurer of choice for everybody according to your article, that they won't be on the hook for pre-existing conditions, makes little difference from what we have today. Who will be on the hook for them, then ?

    You go on to say say that people with chronic conditions (as I mentioned, 133 millions of them) have to save their own additional pre-tax dollars, in a variable amount depending on demographic data and medical history, to an HSA. Who is going to determine that extra amount they need to be ? What's reasonable and unreasonable ? When the annual cost of treatment for one's single medical condition is $25k+ for life, how much of that is one expected to pay additionally in their HSA, which would presumably be depleted each year to cover it ? What if they have a few other chronic conditions, too ? And who exactly provides services for those chronic conditions, if it's a different insurer as you propose ? If one saves less than the total amount of the needed care every year, who else is paying for the difference ? Inquiring minds want to know.

    And did you not read the part where I stated a significant share of people with HIV/AIDS are disabled and unable to work, and thus hardly have dollars to spare, pre or after tax, not that they can afford to pay any tax. Stating that they are going to pay for it is not realistic, you know very well that most people cannot afford to pay for expensive care out of pocket, much less expensive care for life with disabling conditions. You say the government will make up the difference if they can't afford it. If we do that, why not go all the way to socialized medicine ? It would be much more efficient. Forget about all those insurance company middlemen.

    Disability is not a problem unique to that disease - many other conditions can be disabling. Many people who get very sick stop working and as a result can't afford to pay their insurance and let it lapse. Even if they can afford COBRA, it has a limited duration, and their insurance lapses eventually. This is the case for many of the 45 million uninsured.

    Frankly, I don't see any answer to those problems that somehow doesn't involve government, at least, not in your proposal, and it certainly fails. Certainly, no one in the private sector has proposed to pick up all those uninsured at rates they could afford.

  • Report this Comment On March 21, 2010, at 1:34 AM, madbrain wrote:

    bhessel,

    re: your feb 25 response which I just read, I continue to be appalled.

    The last thing someone need is to have several insurance companies involved and more red tape fighting over who caused what. This certainly is not in the best interest of the patient and only contributes to delayed or denied care. For example, as HIV-positive, my bf and I are more likely to develop all kinds of cancers, heart problems, pneumonia, skin problems, and really just about anything else, than the general population, heck, even a rock-climbing accident since those life-saving HIV drugs can make one dizzy at times.

    It makes no sense to involve multiple insurers, one for chronic diseases, and another for the rest. Ask a doctor if you think the answer is always 100% clear cut as to the cause of one disease. Medicine unfortunately is not an exact science, and what you propose is simply impractical.

    What you are proposing - providing guarantees to "catastrophic coverage providers", ie. the insurer of choice for everybody according to your article, that they won't be on the hook for pre-existing conditions, makes little difference from what we have today. Who will be on the hook for them, then ?

    You go on to say say that people with chronic conditions (as I mentioned, 133 millions of them) have to save their own additional pre-tax dollars, in a variable amount depending on demographic data and medical history, to an HSA. Who is going to determine that extra amount they need to be ? What's reasonable and unreasonable ? When the annual cost of treatment for one's single medical condition is $25k+ for life, how much of that is one expected to pay additionally in their HSA, which would presumably be depleted each year to cover it ? What if they have a few other chronic conditions, too ? And who exactly provides services for those chronic conditions, if it's a different insurer as you propose ? If one saves less than the total amount of the needed care every year, who else is paying for the difference ? Inquiring minds want to know.

    And did you not read the part where I stated a significant share of people with HIV/AIDS are disabled and unable to work, and thus hardly have dollars to spare, pre or after tax, not that they can afford to pay any tax. Stating that they are going to pay for it is not realistic, you know very well that most people cannot afford to pay for expensive care out of pocket, much less expensive care for life with disabling conditions. You say the government will make up the difference if they can't afford it. If we do that, why not go all the way to socialized medicine ? It would be much more efficient. Forget about all those insurance company middlemen.

    Disability is not a problem unique to that disease - many other conditions can be disabling. Many people who get very sick stop working and as a result can't afford to pay their insurance and let it lapse. Even if they can afford COBRA, it has a limited duration, and their insurance lapses eventually. This is the case for many of the 45 million uninsured.

    Frankly, I don't see any answer to those problems that somehow doesn't involve government, at least, not in your proposal, and it certainly fails. Certainly, no one in the private sector has proposed to pick up all those uninsured at rates they could afford.

  • Report this Comment On April 24, 2010, at 4:49 AM, wright4ulg wrote:

    How about Bank of America reform!

    WHERE IS MY LOAN MODIFICATION BANK OF AMERICA?

    If it walks like a piggy, talks like a piggy, by golly it’s a PIGGY!

    BofA and it’s CEO Brian Moynihan reminds me of that song by John Lennon and George Harrison titled "Piggies" I invite you to listen to this song on youtube and see if it appropriately fits.

    http://www.youtube.com/watch?v=NTmeHM-Hojg&feature=relat...

    Have you seen the little piggies

    Crawling in the dirt

    And for all the little piggies

    Life is getting worse

    Always having dirt to play around in.

    Have you seen the bigger piggies

    In their starched white shirts

    You will find the bigger piggies

    Stirring up the dirt

    Always have clean shirts to play around in.

    In their ties with all their backing

    They don't care what goes on around

    In their eyes there's something lacking

    What they need's a damn good whacking.

    Everywhere there's lots of piggies

    Living piggy lives

    You can see them out for dinner

    With their piggy wives

    Clutching forks and knives to eat their bacon.

    John Wright vs. Bank of America Lawsuit at www.unitedlawgroup.com or at:

    http://www.prweb.com/releases/2010/03/prweb3766544.htm

    When I filed my lawsuit against Bank of America, myself and United Law Group thought of the many others out there in the same situation. It was then that we decided to educate the public on what these piggy banks are doing, as well as unite us all together as one voice. Please help me turn this David vs. Goliath modification process, into a Goliath vs. Goliath.

    Please stand with me and United Law Group and send an email to Bank of America that states that we will no longer tolerate their potentially illegal, fraudulent, irregular and abusive business methods.

    One blogger named Terri sent me an email stating: “You won't believe it but while I was at work today I had a voicemail from an advocate from BofA. What do you think about that? No calls all this time, I respond to your email and I get a cal!. How do you like that one?

    So please send your email directly to Bank of America and include the following:

    1. Your name

    2. Your complaint concerning your experience with Bank of America.

    3. Please end your email “I support John Wright vs. BofA Lawsuit!”

    4. Please send a copy of your email to johns-wright@hotmail.com

    5. Please send your email to both BofA link below and the CEO email

    CEO Brian Moynihan:

    brian.t.moynihan@bankofamerica.com

    BofA Linked Email:

    https://www3.bankofamerica.com/contact/?lob=general&cont...

    Patricia Barbosa - 818-713-2886

    Assistant Vice President Office of President at Bank of America:

    Call Patricia Barbosa if you want to complain about your modification taking so long.

    It is my understanding that she is a CEO and has authority. She would not work with because

    I am in litigation with BofA. But she might work with you.

    Divided we might have fell America, but united we must stand!

    Sincerely,

    Johns-wright@hotmail.com

  • Report this Comment On May 08, 2010, at 1:36 PM, PositiveMojo wrote:

    @kmacattack

    With all due respect, you claim paying an 18.5% interest rate in 1985 for a mortgage - well you are either stupid or a liar. Interest rates in 1985 ran between 9-10%. Check it out dude! http://mortgage-x.com/general/indexes/prime.asp

    Also - sounds like all of your other claims are bogus too. Especially the Walmart stuff. When you begin to throw around statistics please make sure they are factual.

  • Report this Comment On September 15, 2011, at 6:28 PM, bhessel wrote:

    madbrain,

    Sorry for the tardiness of this reply. The lack of a mechanism to subscribe to discussions here is somewhat of a disincentive to discourse.

    I guess we are not explaining our proposal very well. First of all, while we do mandate catastrophic health insurance coverage, in most cases there would be no second insurance company or policy because the patient would be responsible for any portion of costs not covered by their catastrophic policy—which generally means most patients are paying 100% of their own medical costs most of the time. The only time there might be a second insurance company would be those cases where someone decides to allocate their HSA funds for buying “traditional” health “insurance” (presumably because he or she deemed himself incompetent to make his or her own medical care decisions, for whatever reason). We don’t expect that to happen often.

    Secondly, as everyone is required to obtain catastrophic coverage, the problem of pre-existing conditions is largely a transitory one. Once older patients who had pre-existing conditions before our plan took effect died off, there would be no such thing anymore (except for the small number of folks who enter the system later in life for whatever reason, such as immigrants), and catastrophic coverage would evolve to cover anything significantly beyond ordinary and reasonable expenses for everyone. In the meantime, however, yes for patients with preexisting conditions, they would have to put aside more to cover their costs…but keep in mind that beyond some reasonable limit determined by their medical situation, their HSA funding level, and their income, the government would fund the HSA with enough money to provide reasonable and necessary care.

    And that would always be true for patients with chronic conditions that do not rise to the level of “catastrophic.”

    And yes, the government—most likely, a government sponsored medical panel—would have to determine what care is necessary and reasonable, and set the minimum HSA contribution levels for folks with and without chronic conditions (and, for folks with preexisting conditions not covered by their catastrophic insurance, which number should shrink very low).

    But generally, the involvement of insurance companies would be minimal; with the exception of folks who elected to pay for “traditional” health insurance, only those small number of unfortunate folks who experienced catastrophic health problems would ever have to deal with insurance issues (beyond selecting and paying for a catastrophic policy, that is).

    Of course, the best feature is that each individual would have the freedom—and responsibility—to determine how to spend their own HSA funds…and, of course, an incentive to spend those funds cost-effectively. And health providers would have an incentive to offer cost-effective care, because that is what health care consumers would be seeking. And please keep in mind that we also envisage significant resources being devoted to health education—e.g., teaching about the benefits of preventive medicine—to ensure that health care consumers are well-prepared to make optimal decisions.

    Brad Hessel

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