You have to read the fine print.  Let's take a look at that Celtic Insurance Company $50 plan.

Additional $250 deductible for the Emergency Room visit

20% coinsurance for X-Rays

Additional $250 deductible for surgery, 20% coinsurance after that deductible

Additional $500 deductible for admission, 20% coinsurance after the deductible

And that's with a $5,000 deductible to start with.

From the article, we know she also needed dental work.  That's not covered.

Now the plan does have one really nice feature -- it's a $7,000 out-of-pocket cap including the deductible, which is actually pretty rare.

So with this fine, fine plan from eHealthInsurance.com, she would have only had to pay $7,000 out of pocket with no job.

Color me unimpressed.

I am unimpressed too. This is another reason we must see the Health Care reform pass into law. When victims of crimes are getting denied benefits or forced to pay high out of pocket/co-pays, this becomes a microscope for all the injustice in the current system.

Still, not exactly a "disaster" to have to come up with $7,000 max if you are traumatically injured.  And the point remains she could have afforded that but did not know about it or pursue it.

Still takes a little wind out of that blogger's sails I would say.

Unimpressed! I wish I could find a better word!

Suggesting that a recent grad who is unemployed spend money on a gamble that she might get seriously injured is offensive. The whole insurance game is offensive. We cannot predict the future and shouldn't have to. There's no way to know how much to spend for what depth of coverage.

Lending insult and irony to this tragic episode is the fact that she was taking responsibility for her own health by exercising at the gym. Maybe she should have been a couch potato waiting until she had insurance before risking her neck trying to stay healthy. You know, push her health care costs into the future.

I like Zuska's comments on charity. Too many conservatives think that charity not only begins at home but it ends there, too. Only one nation on nthis planet would not be embarassed by this situation and we're in it!

"The test of our progress is not whether we add more to the abundance of those who have much it is whether we provide enough for those who have little." Franklin Roosevelt

She should also check out the Victims Fund in her state.  I found this online.  America ain't so bad.

Does the Fund Help Victims of All Types of Crime?

The Fund pays for services to victims of every type of crime. Each year, 4,400 local service providers throughout the U.S. rely on the Fund to offer support and assistance to close to
4.1 million victims and their families.

In Pennsylvania, 124 agencies provided services to 141,410 victims of crime. Providers include rape crisis centers, domestic violence programs and shelters, prosecutor- and law-enforcement-based programs, child advocacy centers,
drunk driving victim and homicide survivor support groups, etc.

How Much Money Is in the Fund?

The current balance totals approximately $1.9 billion dollars and the federal government expects to collect an additional $710 million in 2009.

Every person at birth should be issued a big plastic jug.  When people become ill, they should tape their most endearing photos and a brief description of their illnesses to their plastic jugs.  Then all they have to do is display the official containers at a local pizza shop - or something similar - and problem solved.  More seriously ill people can apply to receive more big plastic jugs.  I'm pretty sure that Sen. Coburn (R-OK) is planning to introduce this plan in response to "Obamacare" when the Senate returns from the district work period.  I for one look forward to codifying our status as a nation of desperate beggers. 

James Dunham:  Don't you get tired of using the same old rhetoric on the Health Care subject?  If you don't want Health Care, then don't get it.  You have no right to stop others from having Health Care.  This victim needs Health Care and needs it now.  Shame on your heartless comments.

Again with your nonsense?  Your willful denial of facts and casting of aspersions is what is shameful in such a serious time as this. 

SHE CAN HAVE IT NOW.  I have given her an option that she can pursue right now.  What have you offered her NOW?  Is all your blindly partisan diatribe getting her healthcare NOW?

"Stop others from getting healthcare"?  You are exceptionally dense.  For the last time:  I am FOR reform, and specifically The HAA over the awful House Bill.  I look forward to seeing what the Senate produces.

Knee-jerk emotional responses do not serve your cause well.

C-span: Max Baucus introduces T.R. Reid.

http://tinyurl.com/mkca2p

T.R. Reid talked about health care systems in foreign countries, how governments and business have worked to deliver health care, and potential lessons for the future of U.S. public health care policy. He showed clips from his "Frontline" documentary "Sick Around the World."

Thanks, Tim, for the prompt reply.  Good, spirited discussion, folks.

Some follow up.

Tim, fair enough on the $50 plan analysis.

A couple things:

Fine, then, the $70 plan is capped at $4500.

Good economic lesson. Being that the potential burden in the event of a catastrophe is significantly less, I'd wager many people would wisely elect the $70 plan over the $50 one for this reason.  Thinking back, I actually did that exact thing a few years ago.  I had a choice between two plans, one about $150/month, the other about $200.  I chose the $200 one.  If I had a serious emergency, the peace of mind of knowing I'd be less on the hook for a sky high bill with the latter plan was a rational choice.  The odds were low that I wouldn't, and I did go the whole year without an incident, but that doesn't make it a bad decision.  In the case of these various plans, the market will likely dictate to the insurance companies that the entry level plan is not attractive enough.  They can then choose to a) leave it as is, or drop it and sacrifice the potential income from those that can't afford $75 or $100, but would be buyers at $50, or b) make the plan more enticing to cover the entire pool of potential buyers, i.e. lower the deductible, the co-insurancem, etc.  Mr. Bring, incredibly enough, my plan actually went DOWN in price after a year to $175, the other one dropped to $135.  Youth on my side, I guess, but I'll propose some help further down in the post.

Now, $4500, $7500, which ever --- anyone know what the "sticker price" is on her treatment?  The article didn't say.  A friend of mine broke her leg badly while uninsured a few years back and her bill was about $50,000.  Multiple gunshot wounds must be what, twice that? 50% higher?  So, say $4500 for a $100,000 life-saving procedure?  That's what insurance is meant to do.  And, long term payment plans could be arranged here.  The physical and emotional trauma on this innocent young woman and her family must be suffocating.  They definitely didn't need financial ruin thrown in the mix.  That said, I have all the faith in the world that she will not go through this alone.  I'd be devastatingly surprised if her family, friends, and her community did not rally around an effort to alleviate her from the unfortunate financial burden.  Honestly, if L.A. Fitness doesn't step up and pay the bills of every single victim, well then that's a terrible look for them.  Anyone know what the word has been from them?  

Again, awful, BUT, we'll all agree, this was a tragic and freak occurrence.  I said earlier, one can never plan for or base their life around such outrageous odds.  If we all calculated that every last catastrophic event might occur on any given day, we'd never leave our homes.  Any insurance policy --- private or public --- that weighed equally the odds of every major catastrophe along with that of the common cold would be unreasonable and prohibitively out of reach for every single one of us. In regards to this case, about 0.03% of the U.S. population suffers a gunshot wound each year...which means 99.9% do not.    

Food for thought: change the headline.

"22 year-old PA girl instigates, injured in gang-related gunfight." 

"22 year-old PA girl injured in freak hunting accident when her rifle backfires."

How sympathetic are you now? How much "injustice" is there if the hunter or the gangmember was uninsured?

Freak, sometimes tragically unfortunate accidents occur. Shit happens, as the saying goes.  No matter the circumstances that lead to either of these scenario's victims being admitted to a hospital, once inside, they all require and will receive the same treatment.  The treatment will cost the same.  The paramedics still need the same first responder training and equipment to stabilize the victim en route.  The trauma nurses still need the same training, vital monitoring instruments and drugs.  The ER doctor still needs the same training to repair the wounds.  The hospital still needs to have a full administration staff on duty.  These are fixed costs, and ones EXPECTED to be provided by and to us, the "consumers" of these services, but, they are costs, nonetheless. Single payer, two-party, third-party payer, which ever --- doesn't change this fact.

Now, forgetting these freak occurrences, what about the 22 year-old who has shingles, or dislocates their arm snowboarding.  Tragic? Offensive? Unfair? Shouldn't be responsible to take care of their own medical needs?  Shouldn't need to guess if and when they're going to need medical care?  No, they shouldn't.  That's what insurance is for.  Insurance, contrary to popular belief, is not meant to be a "get out of medical bills free" card.  I love when people say "I think health care should be free."  Nothing's free.  And most people can afford to pay $100 every couple of years for, say, a routine, non-emergency physical.  And a dental cleaning is a hundred bucks.  That's $8/month over the course of a year.  Hardly prohibitive.  Save insurance for catastrophic incidents.  Yes, you may pay for it your whole life and never once have a medical emergency.  You buy it, though, in the incidence that you MIGHT.  It does not ELIMINATE risk.  It isn't meant to.  It's meant to be a HEDGE AGAINST risk.  Again, if we were all so consumed by risk, we'd never leave the house, never drive a car, never buy a house on a coastline in California or on the Gulf...  Should a 22 year-old get a pass because they typically require less care than a 52 year-old?  Well, not a pass, no, but facts and reality suggests they should be entitled to pay less in for insurance.

So, some solutions:

Some select searches on eHealthInsurace.com show that, basically, for your average 25 year-old, non-student, non-smoker, in most states (except NY...more on that soon), a proper insurance plan can be had for $50-150/month, often with prescription coverage if you require it.  Not gold plated, no, but most of these 13+ million are generally healthy and may not step foot in a doctor's office for years, and just like this story illustrates, can we agree that a basic plan is better than no plan?

More:

From what I see, perhaps the biggest barrier to affordable insurance plans across the country are the artificial state-by-state lines drawn that prevent true competition in the market and essentially grant a few players regional monopolies. Think: cable monopolies. Again, to highlight NY, you mean to tell me Blue Cross Blue Shield wouldn’t be happy to provide the same $150/month plan to someone in the West Village that they do to someone in Hoboken right across the river? Well, they can’t --- the equivalent plan in NYC is over $400 --- and not because they’re evil. It’s because the regulations in this case are not allowing the market to actually work.  Insurance companies don't make legislation.  Call your representatives.  Open the doors to true competition.  There are like 1,500 insurance plans in the market.  Fairly competitive now.  Start by opening up state lines, it becomes more so.  You don't need a public option to do that.  (Tangental hypothetical: What if the public option for young people is $150/month?  Will any of the 13+ million buy it then?  What if no one buys it vs. the other options available?  Will they still collect the taxes to run the program?)

Thinking out loud: 

How about an experiment?  My object: make insurance more affordable (or let a lot of people know that it may already be a lot more affordable than they think now, in many cases).  On the lower end, how about in the next month or so, most of the 13+ million uninsured young adults went to eHealthInsurace.com, explored their options, and signed up for a health plan?  If they have jobs and are paid well enough, they can pay themselves.  If they're unemployed, living at home, let's say some of their parents contribute.  If they have a low-paying job and other expenses, then maybe they sacrifice some things, like cable, an iPhone or BlackBerry, they buy or lease a Toyota Tercel instead of a Camry, and they put that money toward insurance.

Take an average of, say, $100 per person. We decided above that even if lower priced plans are available, overlooking these bare-bones offerings is probably worth it.  Also, I'm estimating higher populations of uninsured young people in more densely populated and higher cost of living areas, like New York or New Jersey, both of which have several of these true market-distorting and price skewing mandates and community rating laws discussed above.  Digressing for a moment: These community rating laws, which, in the interest of "fairness," prevent insurance companies from offering less expensive plans to younger people vs. older, you know, how the market actually works based on reality, number of claims, general health, etc. is a failed experiment.  Again, this flies in the face of reality. An analogy would be if younger drivers were charged the same insurance premiums as older, more experienced ones, even though they are, on the whole, more reckless, have higher a likelihood of accidents, etc.  If community rating was applied to the auto insurance market, a 45 year-old with a perfectly clean driving record might pay twice what they do now.  What was meant to moderate prices  has just pushed many of these 13+ million completely out of the market, or the community pool, for insurance, negating its intention to keep costs down for older and/or more sick people.  Think: iPhone at $499 when launched vs. $199 for the second generation.  How'd that work out?  Again, wouldn't having these 13+ million paying *something* be better than them paying nothing, going uninsured, risking severe catastrophe, and then if and when it does occur, costing other insured people, hospitals, service providers, etc. far more than they should in the form of writing down losses in the case of hospitals. and higher premiums in the case of other insurance customers to make up for these losses?  You go snowboarding without insurance, break your arm, and everyone else has to pay for you?  That's fair?

So, some back of the envelope calculation:

13.7 million (last I saw) x $100/month x 12 months = @ $16.5 billion per year

into the system that wasn't there before.  The overall insurance pool would increase accordingly and the resulting increase could help offset costs, even if slightly, to customers at the higher tiers.  Remember, younger folks tend to be healthier and thus make far fewer, if any, claims than older customers.  The income from younger individuals' premiums would be quite near all profit. A $100/month break in the cost of a premium to an adult is nothing to sneeze at.

Also, the 47 million uninsured number is not entirely accurate.  We've all seen the stats FROM THE CENSUS BUREAU.

"Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled."

That actually whittles it down to just a few million, but for argument's sake, let's include some of the under-insured.  Call it 15 million.

Take that $16,500,000,000 annually from the kids / 15 million  / 12 months = $92 month

$92 bucks is a good amount per month to start with to provide basic insurance coverage to the remaining uninsured.  Maybe the government could kick in a bit here.  And hell, how about the other 135 million or so privately insured people pay an extra $1/month on top of their premiums into a pool? That's an extra $9/month on top of the $92 for these people.  How about $2? 3$? $10 to ensure that those people that truly slipped through the cracks were insured? $10/month would be an extra $90. $90 + $92 = $182.  Not bad.  Wouldn't you pay?

This sort of thing already occurs/has occurred in other industries.  I don't know if you ever had/still have a separate "long distance" plan on a land telephone line, but if you ever look at an old bill, there was always a charge for something called, like, "the access fund," or something.  Essentially, it was a surcharge on everyone to help pay for and provide phone service to rural, poor areas.  It was usually like a dollar.  Nothing you'd notice.  Helped those in need.

Did I just solve the health insurance conundrum in this country?  

;-)

Tort reform and third-party payment will have to come in another post...

To finish, instead of jibber-jabbing in a comments string, I'd wager the few of us in this thread could put together a campaign for her and get it spread around the internet in no time.  Recall the recent story of Eric de la Cruz. Eric's sister, CNN Internet Correspondent Veronica De La Cruz, turned to Twitter in an effort to help raise money for her brother's heart transplant.  Trent Reznor of Nine Inch Nails blasted the word out and raised $850,000 in a matter of days and many other large names got behind the effort, as well.  

It's already happening: Pa. restaurant raises funds for slay victim's son

http://www.philly.com/philly/wires/ap/news/state/pennsylvania/20090831_ap_parestaurantraisesfundsforslayvictimsson.html

If it hasn't already been done, we could start a campaign to raise money for the "Bridgeville 19."  Does anyone know if the families have set up efforts or appeals already?  Comment back if you hear of anything.

Thanks.

Hi Robin-

Thanks for the info.

I know what happened to Eric.  And, you know I'm absolutely 100% with you in believing what happened to him is shameful.  I won't even start in with the "Had he started buying insurance five years ago as an individual if his company wasn't providing it, then he wouldn't have had a break in his coverage, and the insurance company couldn't cite a pre-existing condition, etc." because I agree the pre-existing condition hang-up is bullshit.  Do note that the public options available failed him, as well.

...which segues well with what I said earlier about fostering REAL competition in the market, and, sure, while not "solving" the problem, at least providing a great start.  

Dennis Miller summed it up nicely last week:

"You can't go across State lines to buy your health care, and yet I can call up and say my keyboard's not clicking corrrectly and I'm talking to a kid in Delhi."

Break down the State lines.  Instead of 7 options available to you in your home state, you'll have 1,500.

Most of the ills facing health care buyers today —- costs, pre-existing conditions, losing insurance when you leave jobs or when you move —- could essentially be fixed with a one-sentence law:

“Lift regulations that prevent insurance companies from competing for your business across the country.”

Fine, two sentences:

“And tort reform.” (On which the 1,000+ page House bill does not contain a single paragraph).

You say you want to see "real reforms in place that insure everyone, drive down overall costs and improve quality," but you don't flesh out how the proposals being thrown around do any of that.

Magic "efficiencies?"

Some facts:

Despite the narrative, the average operating margins across the health insurance industry are about 1-2%.

According to Kaiser Health News, “With the nation's health care spending estimated at $2.5 trillion this year, even the elimination of insurers' profits and executive compensation would lower health care spending by just 0.5 percent.”

Today's top 10 health plans' profits as a percentage of national health expenditures ranged from a low in 2000 of .18% to a high of .57% in 2007.

Now, on to the single-payer system...

One giant payer presents a few problems.

Using Medicaid as a reference, here you have a single buyer with too much buying power.  People say insurance companies cut costs by denying care. Well, Medicaid cuts costs by paying doctors, hospitals, and service providers well below the market rate for care.  Ask the legions of doctors that have stopped accepting Medicaid patients.  And read any hospital's cost analysis and you'll see that most, at best, break even, though are more likely to see a loss on their Medicaid patients.  Now, this is fine with the current system, because it's only a small portion of their patients, and they are able to sustain themselves and absorb the losses by charging true market rates to the rest of their patients who can afford it.  When the President, or anyone, says "It will cost less," what he/she means is "We will pay less." The costs will stay the same.  Analogy: A single-payer automobile program that pays $25,000 for a Porsche.  The labor (they're hand-made), parts, R&D, and shipping for that Porsche doesn't suddenly cost $25,000.  It's still three times that.  The result?  Porsche goes out of business.  Fine, you say, then everyone can just drive a Kia.  Well, there you have the argument against a Medicaid-like system.  Instead of helping the few that don't have the higher level of care that 90% of people do, we'll bring everyone down to a level of mediocrity.  Because that's "fair." We can do better.

Medicaid's shortcomings epitomize one of the main issues with a single-payer, socialized system AND, yes, the current third-party payment system, as well (more on the ills of third-party payment in a bit): When people think they’re getting something for free — supposedly for free — that "somebody else is paying for," you create infinite demand.  Markets don't work that way.  Markets work best when there is a healthy amount of buyers and a healthy amount of sellers all competing for your business.  And as some of you said above, that it's offensive to treat medical care as anything other than a moral issue, and that everyone should be insured for every fakakta, freak incident, from being randomly shot to accidents while skydiving naked, then insurance --- public or private --- would cost 99.9% of GDP and you would never leave the house.  The real trouble is, we already have a finite supply of doctors, hospital beds, etc. and increasing demand artificially will only make that worse.  So, two things will occur: care will be "rationed," --- no, not maliciously, i.e. "death panels --- but by simple, practical, quantitative terms.  Too much demand, not enough supply.  The answer, or course, is "just increase the supply," i.e. more doctors, but if doctors aren't paid enough by this single, powerful buyer (it costs, what, $900,000 total to go through the decade or so of medical training required?), you get fewer people that can AFFORD TO BECOME doctors, and sure, some others that don't want to put in the effort for what is to be a smaller payoff than maybe the generation prior had when they entered the profession.  And so begins a vicious cycle...

The other problem with a single-payer system:

Using Medicare as a reference, you have a single buyer who thinks it has an unlimited budget.  The Federal Government can run deficits, i.e. it doesn't have to balance it's books, or pay-as-it-goes.  Unlike State budgets, which must be balanced and as you pointed out is part of the problem with Medicaid.  Medicaid is partially funded by States, which can lead to scenarios like the one Eric faced, where by he was unfortunate enough to live in a state that couldn't afford to cover the procedure he needed.  So, you agree in principle that State lines are artificially interfearing with the market.  Wasn't it the case that a doctor in California offered to do the procedure for Eric, but Nevada said no?  Again, getting rid of State lines would be among the top steps to take in my solution to the health care problem.  "Federalizing" Medicaid only trades one ineffective system for another.

Back to the Fed.  

It's a similar problem to the one you get with Medicaid.  Infinite demand because the actual consumer of the service --- the patient --- is not really the one dealing with the actual supplier of the service --- doctors, hospitals --- but instead it appears as if someone else is paying.  And this single buyer has too much power to continually tax to pay for the infinite demand, and no practical check to that power.  Once we agree to hand over this decision-making power to the government, there is the risk that true demand is distorted, coupled with a budget --- read: taxes --- that skyrockets to a prohibitive, eventually ruinous level.  Again, if you're okay with 50% tax rates, how about 60%? 75%? If it means, yes, you have "free" medical insurance, but 25% of Americans are unemployed and businesses stop investing and growth slows to a crawl?  How much will it cost to support all the unemployed?  Oh, just tax more?  Eventually, you'll run out of things to tax.  Like Margaret Thatcher once said, "The problem with Socialism is that eventually, you run out of other people’s money.”

But wait, Michael Moore says "They can afford it in France. Why not here?"

One, reality check.  They can't afford it just as much as we can't.  in the modern era, Europe suffers far more relative to the U.S. from the ills I highighted earlier.  Slower growth, dramatically higher unemployment, and their Social Security/Medicare programs are just as effectively insolvent as ours due to their higher social/tax burdens.  Don't kid yourself. The annual GDP of the United States is nearly $14 trillion and we've had historical growth of 2-4%. Incredible.  Number 2? Japan at $4 trillion. Number 3? Germany $2.8 trillion.  The Euro Zone as a whole averages about 1% growth.  Factor in inflation, and you see where that leads.  They haven't magically figured something out that's eluded us.

Another very good reason, one often overlooked, is that we, citizens of the U.S., effectively fund the R&D of the pharma/medical industries by paying "bust-out retail" on new drugs and treatments.  Yes, in France, any and every pill "only costs $5 under the government insurance plan."  Well, no, like the Porsche example above, that's just what they pay, and big pharma/device companies accept these volume deals abroad because we here in the U.S. are basically subsidizing them and making up for the losses.  Ask yourself, what's the last medical breakthrough that came out of Denmark?  Oh, right...  If the U.S. goes single-payer, there is zero way the government doesn't negotiate (read: strong-arm) the same type of low cost, but guaranteed high-volume deals for treatments like the rest of the world.

What's so bad about that?  Nothing, except you can forget about Pfizer ever bringing another new drug to market again.  The R&D costs would be prohibitively high vs. the potential payoff.  If they kept up the same pace of R&D, they'd go bankrupt trying.  Potentially, every malady that still affects us --- right this second --- would be around in perpetuity.

I'm not OK with that.  Unlike Dr. David Blumenthal, one of the President's three "experts" consulting on new policy who suggests that "the best way to control health care spending is to slow the development and diffusion of new technologies."   Just wow.  It's not in Americans' DNA to stop seeking progress.  Again, let's find a solution that brings those few left behind "up," instead of introducing ones that will bring the majority "down."

And now third-party (employer-based) payment.

You know what? Best I just refer readers to an interview with Milton Friedman, perhaps the 20th Century's most famed economist, on the subject.  He's already said it so well, there's no reason for me to try to re-explain.

Read the brief interview on 'How to Cure Health Care" here:

http://www.hoover.org/publications/digest/5831051.html

And for his mea culpa on the topic, see:

http://www.hoover.org/publications/digest/3459466.html

Highly recommended.

He gives the history of third-party payment in the U.S., ways in which this distorts the market, and thoughts on some other ills and how to fix things.

An incredible read.

To summarize his and my suggestions:

In short, I'm looking for more of a "two-party" payer solution. An actual, true market.

Bullets:

- Open up State lines.  Create a bigger market. No artificial, regulatory hurdles.  Same goes for mandates, community rating, etc.  With 1,500 plans all competing, these things will break down naturally.

- End the tying of insurance to employment.  Remove the middle man.  You buy the plan that's right for you.  You can attempt to do that today with eHealthInsurance.com.  Make more buyers, not less.  That's how prices come down for insurance.  When companies have to compete.  See: every other free-market industry, i.e. long distance calling post-deregulation, or LASIK for a health-relayed example.

- Building on that, as I said in the earlier post, stop looking at insurance as a means to get "free" health care.  That's not what it does.  Pay for physicals, eye exams, dental cleanings, etc.  Would end up costing about what you spend on haircuts each year.  If all insurance had to cover was true catastrophes, that would help bring costs down some, as well.  For routine procedures, the direct payment would preclude medical providers from generously billing insurance companies on your behalf over and above what they often shod be paid.  Again, LASIK is the poster child for market-based medical procedures.  Used to cost thousands per eye, now it's hundreds. What other medical procedure has come DOWN in price?

- As Friedman, points out, end the giant subsidy/tax break to employers for providing health care to their workers that essentially amounts to $100 billion per year the gvernment leaves on the table in potential tax revenue.  No other expense gets this treatment.  Why not give the same treatment to food shopping?  Transportation?  Just as essential, no?

HERE'S HOW OBAMA LOOKS LIKE A GENIUS - End the tax break for employers.  Have employers simply pay their employees higher salaries that they can then use to go out and shop for their own insurance plan.  For nearly everyone, this will be an infinitely better arrangement.  First, who knows best how to spend your money and what type of plan fits you best?  You, or the HR Department at your firm that selected a "group" plan for the entire company?  Oh, but you have 3 options to choose from?  And this is better than 1,500?  Same argument goes for the "public option."  Will "one size fits all" work there either?  Again, that vs. 1,500 choices?

I digress...

Yes, choose your own insurance plan.  You'll have a higher salary, so it will be affordable.  Now, here's where Obama wins on both sides of the aisle: Cut tax rates, but because salaries are higher, the government will take in the same amount of tax revenues.  McCain suggested something like this in the debates and was poo-pooed.  Seems like a strategic grand slam for O...

Now, because you'll be shopping for your own plan and because you know your situation and needs better than your employer or your government, you may be able to spend less on insurance and pocket the difference as additional income than what you'd normally take home.  Here:  latest report from eHealthInsurance.com revealing the average individual health insurance premiums nationwide: $161/month in February 2009; and for family plans: $383.  http://www.istockanalyst.com/article/viewiStockNews/articleid/3439729

Just know your options.  You can do this today.

Side note: spoke to a friend last week who lives outside of New Orleans. Self-employed. Married, he and his wife in their 40’s, with two young kids. Told me he pays about $1300/month for the family’s insurance. While on the phone, did a search for him on eHealthInsurance.com and came up with about 20 options, starting at around $250 and maxing out at $600/month. A far cry from $1300. He nearly threw up.

Say what, narrative?

Now, imagine the case of a small business.  Let's say an office with 4 people.  1) The proprietor, a middle-aged man, married, two kids.  2) A 40-something woman, single. 3) A 28 year old. 4) A 22 year-old with asthma.

Clearly the needs of each are starkly different, though an employer-provided plan would be one-size-fits-all.  Were these folks to go out and choose the plans best suited for them --- rather than a third party, the company --- I'd bet money the overall spend on insurance would be less.

Anecdote: My last job provided a plan with a sticker price of @$750/month.  Knowing what my options are from searching on eHealthInsurance.com, I would have never chosen that plan if I was shopping for myself.  Not because I couldn't afford it or wouldn't want it, but rather I don't need it.  Like the majority of the population, I'm generally heathy.  While I would never go without insurance of some kind, I can think of better things to spend that extra cash on than such a silver-plated health plan when I go to the doctor electively maybe once per year, if that.

Do you buy three times the amount of groceries you could practically consume in 30 days each month?

And, if you lose that job, COBRA's not cheap.  Not a good option.  You're unemployed now and the privilege of paying $750/month to keep your coverage is an ideal solution? Hardly.

- Some people are suggesting we expand COBRA for young adults so they can remain on their parents' plans?  While piggybacking on to a parent's policy sounds like a simple solution, it will be tremendously more costly.  For one, many parents' plans are higher tier (they're older) and, consequently, very, very expensive.  My mother, for example, is a public school teacher in NJ.  Her plan, if purchased in the market as an individual would be upwards of $1500-1600 per month.  So, even if I were to be able to latch on to her plan, what would my COBRA cost be? Even half? 40%? That's still hundreds of dollars per month.  Hardly accommodating.  Bad solution.  Like I said in the first post, let's just encourage young people to shop around and buy into the system directly, even a basic plan.  There are affordable options around.

- If you love to hate on the insurance companies, look on the bright side: this means less money for them.  A plan for all political leanings...

- Lastly, tort reform.  Medical malpractice insurance is killing doctors.

So, how is this not better than a single-payer system that either creates infinite demand and consequently rationed care, or alternatively potential runaway spending from consumers infinite demand "becaus it's free" paired with a buyer that can tax or run deficits indefinitely at the expense of the fical health of the nation?

Phew.

And I was going to try to make this short...

If you made it to the end, thanks for reading!

/rant

M. Rosen,

Your simplistic response to the healthcare issue, while wordy, misses many points.  A true market does not exist in this country and it is not due to regulation.  It comes from a desire to maximize profits at any cost.  Enron and Wall Street came up with ways to distort the market to their advantage.  Health insurance companies do the same thing.  Those companies get a 14% bonus to provide Medicare Advantage.  They cheery-pick the healthiest seniors, get higher rates, and dump seniors who get sick.  Don't get me started on Medicare D.

None of the solutions that you offered did anything for people who have conditions that require them to get medical care on a regular basis.  You only talk about people who are relatively healthy.  What kinds of plans does eHealthInsurance.com have for people who cannot get insurance at all, or at least affordable insurance in the "market"?  The average premium for a family is $12,800/year.  If someone in the family has a chronic condition, that figure could be much higher.  Factor in co-pays, deductibles and co-insurance and even a family earning $60,000/year would have trouble paying that.  It is almost as if you feel that if the sick people die sooner, then it would be better for the rest of us.  The Urban Institute estimates that about 22,000 people die prematurely every year because they do not have health insurance.  About a million go bankrupt due in part to medical expenses.  Three-quarters of those going bankrupt had insurance when they got sick.

You talk about removing the state restrictions on selling health insurance.  How will this save money?  How will this make it easier for people to pick an insurance policy?  You seem to think that insurance companies will not spend more in marketing if they are able to compete in other states.  Where will they get the money to do that?  Do you really think that insurance companies in other states have better policies than ones in your state?

In choosing a model for single payer, you should use Medicare.  It is closer to the one proposed in HR 676, although 676 provides better coverage than current Medicare.  Just as you left out marketing costs in your recommendations for eliminating state restrictions, you did not consider the savings that a single payer would provide.  Eliminating profits from the current insurance scheme is only part of the problem.  Marketing, underwriting, and seeking out ways to deny coverage and care take a huge bite out of the health care dollar.  A single payer would eliminate much of that.  With a single payer, providers would not have to have large billing departments.  Doctors would not have to have large staffs to deal with the various compensation schemes of insurance companies.

Take the time to read HR 676.

"You talk about removing the state restrictions on selling health insurance.  How will this save money?  How will this make it easier for people to pick an insurance policy?  You seem to think that insurance companies will not spend more in marketing if they are able to compete in other states.  Where will they get the money to do that?  Do you really think that insurance companies in other states have better policies than ones in your state?"

If they are ALL in collusion and set prices accordingly, as your comment presumes, then why the need to spend more money on advertising when there is no real competition? The only reason to advertise is to increase your market share. 

How do you increase your market share and thereby make mor evil profits?  Offer the same or better product at a cheaper price. 

This assumption that one insurance carrier wouldn't just love to take over the customers from another carrier (competition) is just ludicrous.  But if there are only 2, 3, 4, 5, 6, companies to choose from because others are restricted from, or don't have tge capital to break into the market, then the consumer loses bigtime.

So to suggest that 4 carriers competing against each other will yield the same result to the customer as 1 thousand competing against each other is simply wrong.  It presumes a great "conspiracy theory" that simply does not exist, and that competition is illusory.  Monopolies and collusion are illegal, but minimal competition is as close as you can get.

If we had single payer, tort reform would be a moot issue. People sue because of the high costs of insurance and medical care. Not only would lawsuits go down, but we would also eliminate l&i insurance that companies now pay for their employees in the event you are injured on the job.

@James - Insurance industry is exempt from anti-trust laws. We do NOT have thousands of insurance companies. There really are only about a dozen companies that have LOTS of subsidiaries to make it seem like it's another company. There is NO competition. There will NOT be competition by opening state borders.

Wrong.  Actually there are at least 1,296 and they are not an illusion, although SOME are as you say.  And you fail to acknowledge the new carriers that would come into existence.  But feel free to direct me to some irrefuteable proof and I will concede the point.  But you impliedly acknowledge the virtues of broad competition in your statement where you erronneously state there is none.  You should be advocating for the competition and breaking of monopolies.

Regarding lawsuits, that is not true.  People sue because a doctor has injured them and/or they want money.  The only way a single-payer would eliminate it is by eliminating the right to sue under the principle of sovereign immunity.

What makes you think new carriers would come into existence? If their profit margin is as small as what Matthew stated above (although I don't believe his figures), what would be the enticement to start a health insurance company?

I didn't imply anything in my statement about the virtues of competition. I simply stated that there isn't any competition and your argument is moot. Show me your source for the number of insurance companies. How many of them are subsidiaries of larger ones?

People sue when a doctor injures them because they will have a lifetime of chronic problems and insurance companies won't cover them due to pre-existing conditions. Most people who sue in these situations are not looking to create frivolous lawsuits (a common lie being spread). If a doctor does something wrong during his practice of medicine, he should be responsible for the outcome. The answer is not taking away a person's right to sue or reducing the amount of the award.

What makes you think new carriers would come into existence? If their profit margin is as small as what Matthew stated above (although I don't believe his figures), what would be the enticement to start a health insurance company?

I didn't imply anything in my statement about the virtues of competition. I simply stated that there isn't any competition and your argument is moot. Show me your source for the number of insurance companies. How many of them are subsidiaries of larger ones?

People sue when a doctor injures them because they will have a lifetime of chronic problems and insurance companies won't cover them due to pre-existing conditions. Most people who sue in these situations are not looking to create frivolous lawsuits (a common lie being spread). If a doctor does something wrong during his practice of medicine, he should be responsible for the outcome. The answer is not taking away a person's right to sue or reducing the amount of the award.

Oops. sorry for the duplicate post.

For the same reason they came into existence in the first place.  Matthew's figures regarding profit are correct.  Your answer highlights the problem; you will not accept facts that contradict the pre-determined conclusion you advocate.

Implications are not always intentional, but when they are fundamental to your argument they are unavoidable.

I believe the burden is upon you to do the research and connect the dots between all the insurance companies to prove your contention.

And speaking as someone who made a living suing insurance companies on behalf of injured people, the motivaton was not what you suggest.  It was compensation for mistakes that resulted in pain, suffering, lost wages, as well as medical bills.  In fact, one is entitled to recover for medical paid by carriers as they are not penalized for insuring themselves.  So I agree that some, but not most, are frivolous.  And I do not advocate taking away a person's right to sue.

Since Matthew did not provide any link to where they are making such a low profit rate, I have the right to question it. When the United Health Care CEO is making $102K an hour, I have to question that they are making that low of a profit. It has nothing to do with not accepting facts that contradict my pre-determined conclusion. I am aware that they regularly deny coverage and claims to existing paying insureds. That equates to profit. And salary for the CEO and bonuses.

You are certainly free to question it, but I am questioning your lack of effort in doing research to verify or challenge facts when it may contradict your conclusion.  A minute or two on google would have gleaned this:

Profit Margin: Health Insurance Industry Ranks #86

http://mjperry.blogspot.com/2009/08/health-insurance-industry-ranks-86-by.html

And there are other ways to reform these issues a lot simpler and less costly than what you propose, even if it were being considered by the US.  But this is academic as we are not going that route.

I enjoyed the debate nonetheless.   Thanks.

Actually, I find this link quite interesting, especially some of the comments:

http://www.healthinsurancecolorado.net/blog1/2009/06/08/profitability-and-the-health-insurance-industry/

And they are correct, profits are factored in AFTER bonuses and salaries. Insurance companies use premium money to invest in various brokerage products and don't just use it to pay claims. Is it possible the lower profit amount could be due to:

1) bonuses and salaries paid to execs

2) money lost on investments due to the wall street meltdown?

THe shooter died with significant assets.  She should file suit against his estate to recover her damages.

What i find fascinating about this discussion and other like it, is that the defendersfo the status quo seemto be able to find a different bureaucracy for every situation.  I t is either find health insurance.com of this or that state medicaid program or this or that state insurance regualtion, or the sue the sucker.

Yet they fear that thealth care reform would creat a healthcare bureacuracy.

Why not a health care system that streamlines all the existing goofy health care silos into one system.  OK may be a couple.  But certainly not a gazillion.

A single payer system could do that.

www.thehealthcaremaze.us