Health Care & Insurance is Not a Free Market

As someone who purchases family health insurance not through my employer but as an individual consumer, I have carefully watched the Supreme Court hearings on the Affordable Care Act - pejoratively reviled by insurance holding members of the GOP as "Obamacare." As arguments about the "market" and the commerce clause applicability have been made to the insurance issue, many consumers have frustratedly tried to remind critics, this is not a free market issue. It's not an open market.

And, I have been baffled by the inability of the Obama administration to make this argument both in the public and in the actual court hearing. Now, finally, op-ed writer Donna Dubinsky has effectively and succinctly clarified these concerns:

As best as I can tell, the recent arguments at the Supreme Court did not touch on a critical part of the discussion about government’s role in health care: the broken market for private insurance. It was as if the court forgot that the private insurance market does not function as a normal market. If you are not employed and you want to purchase insurance in the private market, you cannot unilaterally decide to do so. An insurer has to accept you as a customer. And quite often, they don’t. Insurers prefer group plans, with lots of people enrolled to spread the risk. Can you blame them? The individual consumer is a lot of work, is a higher risk, and produces relatively little revenue.

The justices repeatedly asked: If the government can require you to purchase insurance, what else could it require you to do? What are the limiting conditions to this breadth of control?

The government muffed its response. To me, the answer is obvious. There are two simple limiting conditions, both of which must be present: (1) it must be a service or product that everybody must have at some point in their lives and (2) the market for that service or product does not function, meaning that sellers turn away buyers. In other words, you need something, but you may not be able to buy it.

Let’s test the examples presented to the high court: Can the government force you to eat broccoli? This proposition fails on both counts. Nobody must eat broccoli during their lives, and the market for broccoli is normal. If you want broccoli, go buy it. Nothing stops you.

Clearly, these are the issues which drove the move for universal coverage in the first place. And I have significant criticisms of the ACA - especially the mandates it requires for coverage to be provided for free. While I agree colonoscopies and well-visits should be covered - nothing should be for free. The consumer must contribute to the payment for all health services.

But, the private market is in serious trouble. It's not a free market, and no GOP alternatives to the ACA address that disparity.

Republican on Health Care

After visit to the Italian Fest in Denver - and watching people "enjoy" plenty of pizza and cannoli -I felt a slight philosophical shudder, a shift in my political center. All I need to do is go to a food festival or go to the mall or even go to the supermarket, and I feel an urgent need to "go Republican" on health care.

By that I mean, the issue of personal responsibility for health care is becoming more and more significant to me. Americans who give little thought to their diet, exercise, and health are literally costing me money. And, as cold as this may sound, I don't want to pay for their Medicare. And it may not even be about retirement - the poor eating and exercise habits of many Americans are clearly driving up my private sector premiums right now as well.

Obviously, increased demand and consumption - and advancements in technology/treatment - is what is driving up prices. And, on the national level with Medicare, it is only going to get worse. The biggest problem with our deficit is the millions of Baby Boomers who are retiring and signing up for their "all but free" health care for the next twenty or so years. And, let's face it, millions of these people are doing nothing to decrease their health care costs. They're not trying to get off their blood pressure medicine, they're not trying to decrease their risk of coronary hearth disease, they're not doing anything. And, we're going to be paying for it for decades and decades. And that really bothers me.

Now, of course, there is another side to this. I am under no illusion that this problem is entirely the fault of consumers - especially people like me and my family. Insurance companies are posting record profits, and they are jacking up premiums simply because they can. Some state governments are considering legislation that forces companies to spend a set percentage of medical services and lowering premiums. The insurance companies are certainly taking advantage of the fact that we are all terrified of getting cancer or getting in a car accident or tearing our ACL. And, so we could all get amazingly healthy, and the companies might still raise rates.

But, still. With the survival of Medicare in mind, I'm thinking, "Come on, people. Get a clue." Even conservative Bill O'Reilly has argued for years that we all have a interest in the health of others because their behavior directly affects our pocketbook. As much as a the libertarians want to whine when people seek to restrict and regulate consumption of "crap," one man's heart attack or high blood pressure or type II diabetes is certainly my business. So, lay off the fast food people. Period. Enough with the sodas. I'm serious. Stop plying your kids with processed versions of food, and get a clue about a little exercies.

Recently, after I criticized President Obama's jobs plan, I friend of mine said, "You're turning into a Republican." I laughed, knowing it's not about party for me. It's about money.

Now, go take a walk. And ask someone to go with you.

Be Very Afraid of Dr. Watson

Here's food for (disturbing) thought:

WellPoint Insurance plans to use the IBM super-computer "Watson" to assist doctors in diagnosing illnesses. Watson, of course, is the computer known for beating the top Jeopardy! champions at the game of trivia. Now, a major insurance company is counting on the computer's vast resources and lightening speed to provide guidance to doctors as they seek diagnosis and treatment options.

The company spokesperson was quick to assure consumers that patients need not fear that WellPoint will deny care if in making a diagnosis of choosing a treatment option a doctor chooses to ignore the advice of the computer. In those cases, the insurer "will have a clinician review the case." A "clinician"? What the heck does that mean?

Is this an example of "trivializing" health care? Or is that just redundant at this point?

Be afraid people. Be very, very afraid.

Health Care Reform

While I was a little put off by the speed and scope of the Affordable Health Care Act, I am not on the bandwagon for repeal. There is too much good, and necessary, reform in that bill to be repealed. Modification is fine - though the arguments for how to provide access and make sure there is a large enough risk pool to keep costs down is complicated. Eugene Robinson of the Washington Post identifies the keys to the law that should not be compromised:

Already in effect are parts of the reform package that no self-interested politician is going to vote to take away.

No child can be denied insurance coverage because of a pre-existing condition. Coverage can no longer be canceled when the policyholder gets sick. Insurance companies can no longer impose annual or lifetime limits on payments for care. Adult children can remain on their parents' policies until they turn 26. Policyholders cannot be charged extra for seeking urgent care at an emergency room that is not in the insurance company's approved network of providers. Those measures took effect in September. Another set of provisions became law on Saturday: requirements that insurance companies spend a certain percentage of the premiums they collect on actual care; a discount on prescription drugs for some seniors covered by Medicare; a rule that gives seniors free screening for cancer and other diseases.

Republican leaders aren't dumb enough to explicitly propose taking all these benefits away. But Democrats can, and should, force them to have that debate.

Fix it, but stop this nonsense about the symbolic act of a "repeal vote."

Expensive Urgent Care

Several years ago, I took my family off my employer-sponsored health care because the premiums had become astronomical. Even with the district sponsored contribution, my out of pocket expenses for my wife and two was exceeding $12,000 out of pocket. And my family doesn't consume much health care - often not much more than our yearly check-up and immunizations. Thus, we pursued a catastrophic plan for them - with $7000 deductible. So, over the years we have saved a lot in premiums, though we haven't actually had "extra" money to put into the HSA that we qualified for.

It all came around this month when my wife sliced her finger while cutting vegetables. It was bare a half inch long, and not that deep, but it would not stop bleeding for nearly forty-five minutes. So, after a call to the doctor - it was a Sunday evening - we headed off to the urgent care clinic for five stitches. Initially, the clinic was deceptive, as always, about the cost, but we made our insurance situation clear. The clerk took our insurance and said it looked like we simply had a $100 co-pay for this procedure. That would have been nice.

The clinic's bill came this week - the bill is $1,500. For twenty minutes in a room and five stitches. And that doesn't even cover the doctor's bill - we're still waiting on that one. We haven't begun to negotiate, but conventional wisdom says they'll shave off 10-15%.

And that is the problem with American health care.

Health Care Debacle

It's the health care system, Stupid.

Currently, I carry a low-premium (not really that low) high deductible, catastrophic health care plan for my family because the family coverage through my employer is not only cost-prohibitive, but it would require that my children give up the pediatrician they've always known.  I remembering hearing that as a major criticism of the Clinton nationalized health care system, yet, alas, here it is in the same old system we're stuck with.  And, considering that my children are incredibly healthy - that is, in six years they have only seen the doctor for their yearly well visits - my wife and I concluded this is the best plan.  Though it's far from optimum, and here's why.

On vacation this summer, my daughter developed an ear infection (first time for any serious sickness) and we were faced with the issue of finding a doctor.  Normally, for ear infections there is little that can be done, and we weren't going to go with any antibiotics.  However, we had been out in rural Wisconsin, where the kids were playing in the woods which are known for ticks, and we were a little worried that something had crawled in her ear.  All we wanted was a nurse or doctor to take a look, so we visited the Urgent Care Clinic of Anderson Hospital in Maryville, Illinois.  After a quick look from a physician's assistant, followed by an even quicker look from the doctor, our fears of a tick were relieved, and we left.  The ear cleared up in a couple days.

Fast forward to a couple weeks ago when we received a bill from the hospital for $200, which is not covered by our insurance.  We negotiated that down to $160, though we were still livid, having expected it to be half that.  However, the situation got worse when we received an additional bill for another $150 from the doctor who is apparently represented by Midwest Emergency Management, Inc.  Needless to say, we are completely baffled by this ridiculous billing, and our negative opinion of health care continues to grow.  For me, at this point, future elections may be all about health care.