Military retirees medical cost going way up


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Can'thavenuthingood
January 18, 2006, 01:58 PM
http://home.hamptonroads.com/stories/story.cfm?story=98244&ran=47396&tref=po

WASHINGTON — The Pentagon hopes to reap billions of dollars to pay for ships, aircraft and other weapons by doubling or tripling health insurance premiums paid by military retirees and driving 600,000 of those pensioners out of the military medical system, charges a coalition of veterans’ organizations.

Groups representing more than 1 million military pensioners – those who served at least 20 years – are organizing a telephone and letter-writing campaign to block the idea if it ever surfaces in Congress or to persuade the Bush administration to abandon it.

The retirees say the proposal breaks faith with former service members and their families and risks alienating thousands of active duty troops who may see it as eroding benefits they expect in retirement.

B ecause promises of free or low-cost health care are part of the military’s recruiting effort, new fees could be an obstacle to recruiting, the veterans argue.

“They sort of pit us against the active duty force,” said Michael Barrett, a retired Navy commander living in Williamsburg.

A Defense Department spokeswoman did not confirm that fee increases are in the offing and insisted that any discussion would be “predecisional.”

Yet Steve Strobridge, government relations director of the Military Officers Association of America, one of the more active retiree lobbies, said the group learned of the plan from several independent sources, each of whom provided the same list of proposed increases.

The officers association , with 370,000 members, is one of several retiree groups circulating that list, which asserts that by 2009, the Pentagon wants to more than triple the annual premiums paid by retired officers younger than 65 for coverage under Tricare Prime, the military’s premier health insurance program.

That would raise those costs to $750 per year for individuals from today’s $230 and to $1,500 from $460 per year for families.

Tricare Prime premiums for retired enlisted members younger than 65 would roughly double during the same period, the retiree groups say, as would the deductibles charged both officer and enlisted retirees participating in Tricare Standard, a less-generous, fee-for-service program. F or the first time, retirees would be charged an annual enrollment fee of as much as $300 for family coverage for Tricare Standard.

Veterans groups say the proposal includes increased co-pays for prescription drugs provided under Tricare for both active duty and retired troops. The charge would jump to $15 from $9 per prescription for brand-name drugs at retail pharmacies and to $10 from $9 for brand-name drugs from Tricare’s mail-order pharmacy.

Barrett said he can afford the increases, b ut after a 31-year career of extended deployments and – in the early years – low pay, “you would like to feel that you’re not going to see this sort of stuff happening.”

Defense Department officials have complained for years that skyrocketing health care costs, particularly for retirees, are cutting into money needed to equip today’s troops. The Pentagon’s medical expenses have doubled in the p ast five years and could reach $64 billion annually by 2015, according to Pentagon estimates.

At that level, health care would account for 12 cents of every dollar spent on defense, up from a nickel per dollar in 1995.

In a private meeting last week with retiree representatives, Dr. William Winkenwerder, the Defense Department’s top health official, apparently declined to be drawn into a discussion on specifics of the alleged Pentagon plan.

However, several retiree representatives who attended the meeting said Winken?werder did not challenge reports that officials want retirees to pay a larger share of their health care costs. They expect the Bush administration to roll out a plan to accomplish that as part of its 2007 budget submission next month.

The retirees groups say the increases are intended to trim $32 billion from the Pentagon’s health costs by 2015. Most of the projected savings would come from the movement of an estimated 600,000 retirees from Tricare to health insurance plans obtained through civilian employers.

More than 1.9 million veterans draw monthly retirement checks from the military, according to Pentagon figures compiled in 2004. More than 134,000 of them live in Virginia; only Florida, California and Texas have more.

Cindy Williams, a former Congressional Budget Office analyst now teaching at the Massachusetts Institute of Technology, said that because most service members retire while relatively young and take civilian jobs, they do not have to rely on the military for health insurance.

Thousands opt not to give up their military coverage, however, because Tricare’s relatively low fees encourage them to stay in the military system, Williams said.

“The government would really like to start shifting those costs back” to civilian firms, Williams said. Yet she was skeptical of suggestions that the higher Tricare fees being discussed would trigger an exodus from the military system.

“Even at the end, Tricare is going to be a lot better deal than people get in the private sector,” Williams said.

Several retiree advocates agreed. Although they acknowledged that Tricare fees have not been adjusted since 1995, they argued that comparisons between civilian and military health premiums ignore the hardships that go with military life.

“A military career demands sacrifices that very few other Americans are willing to put up with – and for 20 to 30 years,” said Strobridge . “Today’s retirees made those sacrifices. Military retirees paid far more for their health care than any civilian.”

Strobridge and other retiree advocates also argue that the Bush administration can hardly claim retiree benefits are unaffordable while it continues to push for billions of dollars per year in tax cuts.

“The country can afford to pay for both weapons and military health care,” the Military Officers Association of America asserted in a fact sheet e-mailed to thousands of its members last week.

In wartime, “today’s defense budget is less than 4 percent of Gross Domestic Product, about half the peacetime-year average since World War II,” the message said .

“There’s a great deal of concern in the retired community, and there’s also resentment about the way the costs of health care have been portrayed, ” said Joseph L. Barnes, executive secretary of the Fleet Reserve Association, a group representing 110,000, Navy, Marine Corps and Coast Guard enlisted veterans.

“In the minds of our members, they question: W hat are the priorities?” he asserted.

The Pentagon’s move against health costs for retirees younger than 65 comes in the wake of a series of defeats of its effort to block benefit increases for older military pensioners.

Tricare for Life, a Medicare-supplemental insurance plan launched in 2001 for military retirees older than 65, cost the military $8 billion in 2005. Congress has agreed to spend billions more to allow military pensioners with disabilities to combine their retirement benefits with the monthly disability checks they get from the Department of Veterans Affairs.

The success in securing such benefits has made the veterans and military retirees lobby one of the most successful in Washington. L eaders of The Military Coalition, an association of groups that works on veterans issues, say they wi ll do all they can to block any Tricare fee increases .

“Our members are viewing this as a voting issue,” said James Lokovic, deputy director for the 135,000-member Air Force Sergeants Association. He expects his members will tell their elected officials that “if you don’t work to stop it, you’re not getting my vote – period,” he said.


Vick

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wingman
January 18, 2006, 02:43 PM
I believe this issue is more wide then just military, the American worker continues to lose health/retirement benefits and it should be a concern for all no matter the age/wealth. We appear in my opinion "wandering" into a third world status for at least 50% of our population all in the name of greed, overall not a good path.:(

Crosshair
January 18, 2006, 02:51 PM
I think I know how to save money in the military.

1. Kill the Stryker program.
2. Upgrade our M113 APCs and use them instead of the stryker. (Talk to the Isralies on what to do, they have been upgrading their M113s for years.)
3. Kill pork projects that congress-critters come up with.
4. Close bases in Europe, mabee keep a few. We will save money and irk the Eurocrats at the same time. Keep most bases in S. Korea, I still see a possible need for them. I see a need for the air force bases to launch planes from, but move the army units back to the states.

There are others, but I will let other posters list them.

Sindawe
January 18, 2006, 02:53 PM
IMHO Health Care costs are the sole responsibility of the individual. It is very nice when an employer will cover part of all of those costs for their employees, but its not something the emplyee should expect.

The only deviation from that in my view is those who serve in the Armed Forces. These people are willing endure reduction of their liberties, live in harsh conditions and risk life & limb for this nation.

benEzra
January 18, 2006, 03:25 PM
I understand the feeling of broken promises here, but I am currently paying $700 per MONTH for family health coverage through a moderately high deductible group plan. And last year we paid $10,000 to $15,000 out of pocket in medical expenses that insurance didn't cover or left us with copays. And just so you know, if you make enough to pay taxes, SSI/Medicaid generally won't help you no matter how serious the medical condition...in that light, $1000/year doesn't sound all that bad...

FWIW (to stray off topic a bit), I have a good job and have a good income, and we are barely making ends meet due to medical costs. My 19-year-old car has 235,000 miles on it, and my wife's 12-year-old minivan has a broken transmission that I am spending weekend after weekend trying to fix myself because I can't afford to have someone else even look at it.

Our health-care system is broken. The quality of care is excellent, but the management and administration thereof is barely functional. I know people on different ends of the spectrum point fingers in different directions over this, but the fact is that the whole thing is a mess.

Sindawe
January 18, 2006, 05:43 PM
Discarded Heroes
Washington sends them off to war -- and screws them upon return.
By Denise Grollmus

Published: Wednesday, January 18, 2006

Walter Novak

Rick Clasen has trouble remembering little things, like names, doctor's appointments, and where he put his hat. But the 25-year-old Iraq war veteran has no problem with the details of July 27, 2004.

He emerged from the underground bunkers at Camp Steel Dragons to a clear Baghdad sky. It was 7 a.m., a comfortable 80 degrees, and he had a hot tip on where to find some powdered Gatorade -- a delicacy among infantrymen.

Clasen carefully placed the packets of lemon-lime powder atop the trunk of his Humvee, which he loaded up with water and ammo. To his right, 23-year-old gunner Mike Boozier stood in the turret of another Humvee. He slid his weapon onto the stabilizing pole and prepared his rounds. In the distance, speakers blared with the day's first reading of the Koran.

It was business as usual. Until the first blast.

Continues at: http://www.clevescene.com/Issues/2006-01-18/news/feature.html:fire: :fire:

Old Dog
January 18, 2006, 06:00 PM
I understand the feeling of broken promises here, but I am currently paying $700 per MONTH for family health coverage through a moderately high deductible group plan.I'm not sure if you're saying this to underscore a point, or what ... No military person is going to ask you to feel sorry for us, but one way or another, the system bones all of us. I have just retired, after more than twenty-six years on active duty, eleven deployments of three months or longer, seven deployments of six to twelve months ... and in addition to what I am now paying for TriCare Prime coverage, we have $600 a month coming out of my wife's paycheck for health care coverage ... My last year (this last year) on active duty, in fact, I paid more than $3000 out of pocket for medical expenses for my spouse and two children.

Our health-care system is broken.This I agree with, but this:The quality of care is excellent,I do not. Quality of one's health care is totally a function of one's location (typically, nearer a desirable metropolitan area), the quality of one's HMO (some, obviously, are better than others) or regional medical facilities and the bottom line ... you get what you pay for.

MechAg94
January 18, 2006, 06:35 PM
Is health care getting more expensive or just health insurance?
Seems to me that everyone wants health insurance so the insurance company can pay all their medical bills. Maybe that disconnect is the problem. Who is getting all the increased money? Lawyers and bureacrats I bet.

No doubt there are a lot of changes that could be made to help.

wingnutx
January 18, 2006, 06:49 PM
Health care is getting more expensive, and insurance along with it.

One reason is that there is simply more of it available. Newfangled cures cost a lot of money. In my dad's day there were no statin drugs to be put on permenantly, for example. No MRIs, stints, or titanium joints.

Then there's malpractice insurance in the land of litigation. Even if a hospital is blameless in a malpractice case, jurors will often find for a plaintiff out of sympathy.

Those are just a couple of points. It's a complex issue.

Flyboy
January 18, 2006, 08:30 PM
IMHO Health Care costs are the sole responsibility of the individual. It is very nice when an employer will cover part of all of those costs for their employees, but its not something the emplyee should expect.
I agree wholeheartedly. However, there's more to the issue than just personal responsibility.

I was having this discussion with my dad just a few days ago. He's a government slug (his term, I just happen to like it), and retired as a Lt. Col. a year ago. Part of the reason he chose government service and military service is the benefits package, including the retirement package. In doing so, he forewent the opportunity to make the big bucks in the private sector, in favor of more modest pay and a good, secure retirement and benefits package. In short, the retirement and benefits package is part of the bargain he made for the job.

Ditto with military personnel: they agree to do a dangerous job, for comparatively little pay, in exchange for other compensation. Changing the deal after they retire is fundamentally dishonest--a breach of contract. The contract isn't in writing, but contracts don't have to be: a contract is formed any time two or more parties agree to a transaction in exchange for consideration.

I don't believe that it is the government's job, or the employer's job, to provide for the retirement of it's citizens or employees--that duty falls to the individual. However, when the individual takes responsibility for himself by securing a deal in which he exchanges his labor for a promise of future compensation--compensation which includes pension, medical, etc--then he has acted in good faith, and is legitimately owed the benefits he's been promised. Yes, the country owes my dad a pension and medical benefits. Not because he was born, but because he earned it through a career in government service, a career he chose based on the promises made to him by the recipient of his services. One party to the agreement has made good on his promises; it's time for the other party to do the same.

Welfare bums and other parasites can, of course, get bent. But we do owe it to those who've served to honor the commitments we made to attract them to service in the first place.

Zundfolge
January 18, 2006, 09:00 PM
Flyboy pretty much sums it up ... I certainly don't think anyone is "owed" health care, but if you promise someone something you're obligated to provide it ... out here in the real world we'd get sued for breach of contract if we didn't live up to what we agreed to.

that said...
[tangent rant]
Our health-care system is broken.

And there's the Big Lie (http://en.wikipedia.org/wiki/Big_Lie) we always hear about health issues put forth by those who want to throw out the free market for some sort of centralized planning approach.

For one thing we don't have a "health care system" any more than we have a "home electronics system" or a "fast food system" or any other "system". We have a marketplace and one of the many things bought and sold in this marketplace are health care goods and services.

A "health care system" would be socialized medicine.

Secondly, we do have the best quality of medical care available anywhere in the world, but yes you have to pay for it ... until they start taxing us at 85% like much of Europe, or start forcing medical students into indentured servitude for the rest of their lives, you're going to have to pay for the health care goods and services you use.

Most of you out there would be appalled if all of the sudden farmers were to be enslaved and grocery stores forced to give away their products for free (or at least less than their cost) and food is more important than health care. Yet y'all get all bent out of shape when a doctor or drug manufacturer wants a market price for their products.



The woeful lack of knowledge about economics that I see in this forum every day frightens the hell out of me ... I mean if an ostensibly more conservative/libertarian community doesn't realize how economics works and are clambering for the dismemberment of the free market in one area or the other, than I figure the Socialist police state must be just around the corner.
[/tangent rant]

dolanp
January 18, 2006, 09:20 PM
The problem with health insurance today is that it's not run like it was originally intended. Health insurance should be run like car insurance and home insurance, where you don't call on it unless there's a disaster or emergency. By doing this, premiums stay low. In today's health care system, health insurance is more like a membership fee to be a part of 'the system'. If people paid out of pocket for more of the costs and there was no such thing as a $10 co-pay then you would see the premiums seriously deflate. For some reason, our society has come to the opinion that some of the most educated and trained people in today's workplace (doctors) don't deserve to get paid for their services like any other professional. They neglect to think of this monthly premium they're paying and how most of the time they really aren't using that money. Young people on standard plans are heaving the burden of the elderly who tax the system with constant doctor visits (often unnecessary ones). This is starting to change a little bit with the introduction of Health Savings Accounts, which allow the individual to manage their own health care at lower premiums and invest the savings in tax-free growth accounts. I'm afraid things are getting worse overall though, and that if politicians have their way it's going to turn out completely state-run and become a Social Security clone.

Sindawe
January 18, 2006, 09:38 PM
Health insurance should be run like car insurance and home insurance, where you don't call on it unless there's a disaster or emergency. By doing this, premiums stay low.Spot on. This exactly that way I view health insurance. I carry it for the big stuff (over $5k expense), and pay out of pocket for the routine items like check ups, dental exams and cosmetic things like orthodontic work.

Flyboy: If the individual can get the employer to pay for it as part of the work agreement, I have no issue with that.

Old Dog
January 18, 2006, 09:41 PM
that said...
[tangent rant]

Quote:
Our health-care system is broken.

And there's the Big Lie we always hear about health issues put forth by those who want to throw out the free market for some sort of centralized planning approach.

Sorry, Zundfolge, you're plain wrong here. We not only have a health care "system" in this place, we have the most expensive health care system of any country in the world. It may be a patchwork, for the most part, of a combination of health care insurance programs and employer-sponsored plans, HMO or small group plans along with even those few people who "pay as you go" ... but it's a "system" nonetheless.

For most (the 80% or so of those Americans who actually are covered under some sort of medical program), the system is problematic, but eventually gets them some sort of medical care.

A health care system does not necessarily mean socialized medicine.

And yes, it's broken.

The woeful lack of knowledge about economics that I see in this forum every day frightens the hell out of me ... I mean if an ostensibly more conservative/libertarian community doesn't realize how economics works and are clambering for the dismemberment of the free market in one area or the other, than I figure the Socialist police state must be just around the corner.Let's see now ... you're saying that affordable health care insurance for everyone is socialism?

jungle
January 18, 2006, 09:49 PM
The government is in deep debt and the social programs and engineering are going to be the first to go when the brakes are finally put on spending. I feel for the people in the Military, and for the people expecting social security.
The government has made too many promises to pay in the future and many of those promises will be broken.
My only hope is that it will teach people to rely on themselves and not seek a government solution to their problems.

ScottS
January 18, 2006, 09:55 PM
I have just retired, after more than twenty-six years on active duty... and in addition to what I am now paying for TriCare Prime coverage, we have $600 a month coming out of my wife's paycheck for health care coverage

I don't understand. If you're a retiree enrolled in Tricare Prime, why are you paying another $600/mo for heath care coverage from your wife's paycheck also?

Just curious.

Scott
Tricare Standard/Extra with Supplement

Reddog1
January 18, 2006, 09:56 PM
IMHO, Our goverment and the money grabbing corperations has no fear of us.
We, as a people have lost what our forfathers fought and died for. God grant
the wilpower to our children and their children to stand up for what we won't.
SAD, SAD TIME IN THIS ONCE GREAT COUNTRY'S HISTORY. Join me in a small
prayer for our fallen and discarded heros

SIOP
January 18, 2006, 09:57 PM
I don't understand. If you're enrolled in Tricare Prime, why are you paying another $600/mo for heath care coverage from your wife's paycheck also?

Just curious.

Scott
Tricare Standard/Extra with Supplement

I was wondering the same thing.

Old Dog
January 18, 2006, 10:08 PM
I don't understand. If you're a retiree enrolled in Tricare Prime, why are you paying another $600/mo for heath care coverage from your wife's paycheck also?

Good question. Short answer, to gain faster access to specialty care at better facilities for my family. With TriCare Prime, in this region, one's Primary Care Manager is a civilian health care provider as the MTF's up here don't do retirees and their dependents. Also, the TriCare cap for some treatment is far lower than under my wife's plan.

The MTFs do take care of some specialty care, but not all. Plus, and this is the reality today: the MTF's have lost many of their best military physicians, nurses and service personnel to deployment. Filling the billets on the homefront are a lot of less-experienced contract staff. Some billets (positions -- case in point in this area, psychiatry) have gone unfilled. To get specialty consults at the nearest MTF's, the wait is usually at least 30 days, often much longer. I don't know that many outside the military have an understanding for what's happened to our military hospitals since this war's been dragging on.

Regrettably, I have two family members who require pretty consistent care for ongoing conditions; it's well worth it to have them seen under my wife's plan (which is actually excellent). We get them seen far faster, with more personalized care with health care providers who are going to be around for a while.

benEzra
January 18, 2006, 10:17 PM
And there's the Big Lie we always hear about health issues put forth by those who want to throw out the free market for some sort of centralized planning approach.
We don't have a free market in the health-care realm. Perhaps we should, but we don't. HMO's are bureaucracies just as much as the Canadian NHS and have a lot of the same problems, and the FDA is sometimes pretty asinine about keeping improvement out of the market.

I'm not saying that a British style system is the answer; I've met a lot of Brits at Children's Hospital Boston, coming to get care for their kids that their NHS can't or won't provide. But HMO-land isn't a free market at all.

Zundfolge
January 18, 2006, 10:20 PM
Let's see now ... you're saying that affordable health care insurance for everyone is socialism?

I'm saying that health care services and health insurance that at any rate other than that established by the free market is socialism.


We don't have a free market in the health-care realm.
Yes we do have a free market in health care ... you are free to pay doctors directly for their services and not use HMOs, PPOs or any other form of health insurance. That is a free market.

Just because you don't like the deal you have with your HMO doesn't make the market any less free ... nor is it a good idea to call health care a "system" because some people have a bad deal with the HMO they subscribe too. All that does is pigeonhole the problems as "systemic" and thus requiring of a "systemic solution" ... and any "systemic" solution is going to involve some form of government run socialism.

Waitone
January 18, 2006, 10:42 PM
What we call medical insurance is in reality pre-paid medical expenses. As such we have a third party standing between a buyer of services and a seller of those services. Under those conditions two things will happen: costs will increase and quality will decrease. Thirty years ago I said to who ever cared we, as a society, had better sever the relationship between employment and healthcare or we will pay a frightful price at some point. Government control over medical care is just one more lever of power over the masses. Gov't will not willingly get out of the medical control business.

ScottS
January 18, 2006, 10:59 PM
Good question. Short answer, to gain faster access to specialty care at better facilities for my family. With TriCare Prime, in this region, one's Primary Care Manager is a civilian health care provider as the MTF's up here don't do retirees and their dependents. Also, the TriCare cap for some treatment is far lower than under my wife's plan.

The MTFs do take care of some specialty care, but not all. Plus, and this is the reality today: the MTF's have lost many of their best military physicians, nurses and service personnel to deployment. Filling the billets on the homefront are a lot of less-experienced contract staff. Some billets (positions -- case in point in this area, psychiatry) have gone unfilled. To get specialty consults at the nearest MTF's, the wait is usually at least 30 days, often much longer. I don't know that many outside the military have an understanding for what's happened to our military hospitals since this war's been dragging on.

Regrettably, I have two family members who require pretty consistent care for ongoing conditions; it's well worth it to have them seen under my wife's plan (which is actually excellent). We get them seen far faster, with more personalized care with health care providers who are going to be around for a while.

Well, now I'm really confused. If you need access to specialty care, why would you sign up for Tricare Prime?

I don't mean to 'jack the thread, but why wouldn't you simply go with Standard/Extra with a good sup? I guarantee your out-of-pocket expenses will be less than the $600/mo you're paying now, and the sup pays all your cost share.

I agree with everything you said about Military care. I've been retired for 5 years (where does the time go?), and have been using Tricare Standard/Extra for the last 15 years. No gatekeeper bull????, no referrals, specialty care when I need/want it. I'm not asking "mother may I" to take my son to a specialist. And no military physician has ever seen/treated my daughter, nor my son except for his first well-baby check-up.

Sorry to hijack the thread, but the military likes to coerce people into Tricare Prime, because as an HMO they can control your access to care, but they neglect to inform you there are other options under Tricare.

Good luck.

Scott

Old Dog
January 18, 2006, 11:24 PM
If you need access to specialty care, why would you sign up for Tricare Prime?

I don't mean to 'jack the thread, but why wouldn't you simply go with Standard/Extra with a good sup? I guarantee your out-of-pocket expenses will be less than the $600/mo you're paying now, and the sup pays all your cost share.It certainly would be less ... but ...
Fewer and fewer providers in this area accept either Standard or Prime ... and many of those that do, are not taking on any more TriCare patients. In areas such as Norfolk, Arlington/Bethesda/D.C., San Diego ... perhaps TriCare works out better. But in some regions, for retirees, the system is ailing. I pity the retirees who don't live in military-concentrate areas, or who may not have access to MTFs or urban or university medical centers due to not living in highly populated areas.

Bottom line, depending on where one lives, one's enjoyment of military retirement benefits may not be anywhere near what another retiree experiences ...

ScottS
January 18, 2006, 11:27 PM
It certainly would be less ... but ...
Fewer and fewer providers in this area accept either Standard or Prime ... and many of those that do, are not taking on any more TriCare patients. In areas such as Norfolk, Arlington/Bethesda/D.C., San Diego ... perhaps TriCare works out better. But in some regions, for retirees, the system is ailing. I pity the retirees who don't live in military-concentrate areas, or who may not have access to MTFs or urban or university medical centers due to not living in highly populated areas.

Bottom line, depending on where one lives, one's enjoyment of military retirement benefits may not be anywhere near what another retiree experiences ...

I guess. I live in a little town way away from any military, and almost every single provider in the area accepts Tricare. Guess it's different where you are.

Lone_Gunman
January 18, 2006, 11:37 PM
I live in a little town way away from any military, and almost every single provider in the area accepts Tricare.

I am a surgeon, and I take Tricare, but our group has strongly considered not taking it. It pays very poorly, on par with Georgia Medicaid. The surgeons in several other towns don't take it, and we get referrals from those towns simply because we take Tricare.

You should anticipate that fewer and fewer physicians will take Tricare, unless they start paying better.

atomchaser
January 19, 2006, 11:17 AM
Tricare has very low reimbursement rates. I work in the Military Medical System and there is a continuing exodus of network providers. Many want to provide services to the military but are losing money.

The third party payer system that we have in this country is a disaster. We need to allow the consumers to balance cost against need just like many other areas of our lives. I think catasrophic insurance is necessary, but the nickle and dime stuff is what makes it so expensive.

I read a quote the other day: If you think the price of health care is expensive now, just wait until it's free.

CentralTexas
January 19, 2006, 11:35 AM
If it happens we need to show up "carrying" in DC anc camp out.

Sadly, it would probably end like the "Bonus Army Rebellion".

CT

Manedwolf
January 19, 2006, 11:45 AM
IMHO Health Care costs are the sole responsibility of the individual. It is very nice when an employer will cover part of all of those costs for their employees, but its not something the emplyee should expect.

It is my sincere hope that one of these days, people will realize that, in the face of how much health care COSTS now, (heart surgery, $250k, can't pay, go ahead and die)...that people who think this way and vote this way might as well be a chicken voting for Colonel Sanders.

Manedwolf
January 19, 2006, 11:47 AM
Our health-care system is broken. The quality of care is excellent, but the management and administration thereof is barely functional. I know people on different ends of the spectrum point fingers in different directions over this, but the fact is that the whole thing is a mess.

There have been writings that even with all the advances in healthcare, the "Average" American now would have recieved better care in the 1950's and 1960's...simply because at that time, you could AFFORD a stay in the hospital, tests, and surgery.

Now, it would financially kill you.

Manedwolf
January 19, 2006, 11:52 AM
If people paid out of pocket for more of the costs and there was no such thing as a $10 co-pay then you would see the premiums seriously deflate.

The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...

Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?

We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.

Kharn
January 19, 2006, 11:56 AM
I think I know how to save money in the military.

1. Kill the Stryker program.
2. Upgrade our M113 APCs and use them instead of the stryker. (Talk to the Isralies on what to do, they have been upgrading their M113s for years.)Stryker's already paid-for and deployed, no going back now. The FCS is on the horizon and much more capable than an M113 solution would be.

Kharn

Waitone
January 19, 2006, 11:59 AM
The situation will only get worse as the boomer wave begins splashing on the shore. We had a small window of opportunity to fix the medical mess we are in. Instead our elected idio. . . officials opted to make the situation worse. We are headed for a number of financial meltdowns; Medicare and social security leap to mind. Because of our unwillingness to deal with economic reality we will be faced with truly horrific decisions as a matter of government policy. The future is ugly. :fire:

Malone LaVeigh
January 19, 2006, 12:30 PM
...For one thing we don't have a "health care system" any more than we have a "home electronics system" or a "fast food system" or any other "system". We have a marketplace and one of the many things bought and sold in this marketplace are health care goods and services.

A "health care system" would be socialized medicine.
So I guess there's no such thing as an ecosystem, or a watershed drainage system.

Of course, we have a system, and it is partially a market-driven system. It is also highly influenced by governmental and corporate powers.

Secondly, we do have the best quality of medical care available anywhere in the world, but yes you have to pay for it ... until they start taxing us at 85% like much of Europe, or start forcing medical students into indentured servitude for the rest of their lives, you're going to have to pay for the health care goods and services you use.
So the bottom line is that a kid born into a poor family who needs an organ transplant can just die. Or depend on charity, I suppose. Nice if it happens.

Most of you out there would be appalled if all of the sudden farmers were to be enslaved and grocery stores forced to give away their products for free (or at least less than their cost) and food is more important than health care. Yet y'all get all bent out of shape when a doctor or drug manufacturer wants a market price for their products.
The market certainly has a place in an effective health-care system, but it's really more about what works. We don't have a free-market system in agriculture, either. "(F)orced to give away products for free" is a ridiculous straw man. On the contrary, farmers are subsidized, and damn few complain about it.

The problem is that in the Great Depression, farmers were plowing their crops under while people in rural areas and cities were starving. The free market failed.

You don't have to go far to find examples of how the markets fail in regard to health care, either.

The woeful lack of knowledge about economics that I see in this forum every day frightens the hell out of me ... I mean if an ostensibly more conservative/libertarian community doesn't realize how economics works and are clambering for the dismemberment of the free market in one area or the other, than I figure the Socialist police state must be just around the corner.
"Knowledge of economics" <> religious adherence to market outcomes.

Malone LaVeigh
January 19, 2006, 12:46 PM
Spot on. This exactly that way I view health insurance. I carry it for the big stuff (over $5k expense), and pay out of pocket for the routine items like check ups, dental exams and cosmetic things like orthodontic work.
... Yes we do have a free market in health care ... you are free to pay doctors directly for their services and not use HMOs, PPOs or any other form of health insurance. That is a free market.
The problem is you do not negotiate for your services in an unconstrained "free" market. It's distorted by cartel power on the selling and buying ends. The old bugaboos of the market systems.

If you don't have or use insurance, you actually pay more than the negotiated rates that the major carriers pay. You don't have their market power. I go through this every time I go to the dentist.

Praxis
January 19, 2006, 05:05 PM
The problem is you do not negotiate for your services in an unconstrained "free" market. It's distorted by cartel power on the selling and buying ends. The old bugaboos of the market systems.

If you don't have or use insurance, you actually pay more than the negotiated rates that the major carriers pay. You don't have their market power. I go through this every time I go to the dentist.

Malone is exactly right. My significant other has had some serious health problems over the past two years. At one point, she had some in-patient testing. The billing office forgot to include her insurance information and gave her an estimate of $1500 for one procedure. She reminded them about her insurance and suddenly the cost of the procedure (not what she owed, but what would be billed to the insurance company) fell to around $200-300. There is no level playing field in the health care industry. Those with little or no insurance often subsidize the cost of health care for those with insurance. It's like joining Costco or Sam's Club. You pay your fees and then get cheaper prices on items because the company (your insurance provider) is paying a bulk rate for goods and services.

dolanp
January 19, 2006, 05:09 PM
The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...

Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?

We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.

Yet they can toss out that amount per month on the insurance? The fact is that those prices are also inflated because doctors have to overcharge for their services since the insurance company negotiates it lower. Some doctors are going to no-insurance for those who choose to pay out of pocket and they charge less because they don't have to hire staff and deal with insurance overhead to get paid.

Art Eatman
January 19, 2006, 05:19 PM
"So the bottom line is that a kid born into a poor family who needs an organ transplant can just die. Or depend on charity, I suppose. Nice if it happens."

Fifty years ago, even a Rockefeller's kid was in the situation of "...can just die".

Fifty-five years ago this month, my grandmother died of a stomach tumor. Thirty-five years ago, my mother recovered nicely from surgery for a quite-similar tumor. Two years ago, I recovered quite well from a far more serious cancer.

It's not the quality of the medicine that's anywhere near being a problem. It's the never-to-be-ended inequity of an individual's financial circumstance. The money does not exist for everybody to have equal medical care.

Put it this way: More people in this country, whether from insurance or Medicare or Medicaid, have more access to basic medicine than anywhere else. Even advanced medicine, for many on Medicaid. You can't judge the system by the amount of private medical insurance coverage.

We're apparently going broke from our system, but a fullbore government program would merely have us going broker, quicker.

Art

Malone LaVeigh
January 19, 2006, 06:28 PM
It's not the quality of the medicine that's anywhere near being a problem. It's the never-to-be-ended inequity of an individual's financial circumstance. The money does not exist for everybody to have equal medical care.
Well, first of all, my statement you quoted doesn't say anything about quality of care. We all know medical science has advanced, "quality" in general is higher if you can afford it or have a good insurance plan. That was my point, under the approach that was proposed, if you are poor, you can just go die, higher quality health care notwithstanding. As to the second point, no one is saying that everybody should have equal care. There is a place for market forces, but if we want to have the best health care system we can, it will have to find some way to address the problems.

We wouldn't be talking about it if it worked.

Put it this way: More people in this country, whether from insurance or Medicare or Medicaid, have more access to basic medicine than anywhere else. Even advanced medicine, for many on Medicaid. You can't judge the system by the amount of private medical insurance coverage.
Sorry, but the first statement is not accurate. Unless you're talking gross numbers, in which case you might be right that "more people" have access. But a higher proportion of people in most European countries have access to very high quality health care than in this country. Even Cuba, for all the many many problems of that country, provides first-world health care to all of it's population. I agree with the last sentence.

We're apparently going broke from our system, but a fullbore government program would merely have us going broker, quicker.
Are you basing that on anything other than your prejudices?

Lone_Gunman
January 19, 2006, 07:01 PM
But a higher proportion of people in most European countries have access to very high quality health care than in this country.

Why do so many foreign elites choose to come to the USA for medical care then?

Zundfolge
January 19, 2006, 07:48 PM
The problem is you do not negotiate for your services in an unconstrained "free" market. It's distorted by cartel power on the selling and buying ends. The old bugaboos of the market systems.

If you don't have or use insurance, you actually pay more than the negotiated rates that the major carriers pay. You don't have their market power. I go through this every time I go to the dentist.
Then you must be a lousy negotiator.

I've spent most of my adult life with no form of health insurance (in fact I carry it now only because my wife insists on it). I've always gone to the doctor and before the evaluation of whatever ill I'm there for is discussed I tell him I'm paying out of pocket and would like to know what the terms are ... invariably I've paid less than other people I know who have gone to the same doctors for the same health issues (or more to the point I've paid less than their insurance companies did). One time I had to make arrangements to pay the doctor off in several payments, but I was still able to pay him (and it all cost me less than what a year's worth of insurance premiums would cost). All that applies to my dentist as well.


And I'm by no means wealthy ... I have never made more than $40k/yr (although I have a feeling that this year may be the year!). Back when I had the problem I described above I was making about $20k

Of course your retort is going to be that I'm somehow special or privileged or lucky or some other nonsense that requires you to take from me at gunpoint to pay for someone else who's not :rolleyes:



Keep in mind that many doctors will accept less than what the insurance company will pay because you're going to pay them much faster and with much less paperwork than with the insurance company ... remind your dentist of this and maybe we'll see you get a better deal ... or better yet go find another dentist that will agree to better terms.

benEzra
January 20, 2006, 03:46 PM
If people paid out of pocket for more of the costs and there was no such thing as a $10 co-pay then you would see the premiums seriously deflate.
*We* are. In addition to our $700/month insurance premium, we shell out maybe $600 in medical expenses out of pocket. We paid maybe $15,000 out of pocket last year, and only stayed afloat thanks to the charity of family and friends. Now, we're a special case because our son is a special-needs kid, but the majority of our medical-related expenses insurance won't pay (non-covered stuff), or they'll pay 50% of the cost and we cough up the other 50%. Which is why I'm a bit jaded when the UAW throws an absolute fit that GM wants to raise their copay to $10 or $20 or whatever...

If I made a bit less per month, we'd qualify for Medicaid and SSI. As is, we don't (Medicaid and SSI are essentially fiction if you make enough to pay taxes...we learned that the hard way.)

The problem with that idea is that because of the inflated costs, you'd have to pay $250 for every office visit checkup, $200 for your prescription antibiotic if you needed one in some cases, etc...
Exactly. Been there, done that.

Also, once you've been treated for a particular disease, you often can't get insurance that will cover future episodes of that disease. Example, my son's heart condition. If insurance companies weren't required by NC law to cover preexisting conditions when you join a group health plan, the only people able to get insurance would be those who are healthy enough to not need it. Can't get an individual plan.

Who among the middle class could just toss $400-$500 out the door when they get a case of pneumonia?

We'd see a return to 19th century self-remedies, quack and folk medicine, tonics and snake-oil in the worst way. And a lot more people dying of easily cureable illnesses in a way that looked like the third world.
We're in that boat right now. After paying for the roof over our heads, food, electricity, and water, we spend practically all our disposable income paying for our son's medical care. Our vehicles are 19 and 13 years old, and the newer one (a Plymouth) is currently broken; I am fixing it myself b/c I can't afford to pay someone to do so. I haven't bought a new pair of glasses in ten years, though I badly need a pair. My wife needs some dental work, but we can't afford it, and the dentist wants payment up front. I've got a couple spots that probably put me at elevated risk of skin cancer, but I can't get them removed right now because I can't afford the deductible. I don't even have a primary care physician right now (haven't had one for ~3 years) because I can't afford the out-of-pocket costs; have to pay for my son's specialists instead. Good thing I'm pretty healthy.

If I took a job as a janitor instead, I'd qualify for Medicaid in 6 months, my son would qualify for SSI (he already does, except we're above the income limits), and we'd have free care for most of our needs, and access to all the doctors we have now...and I know one college-educated man who has done just that, for precisely that reason. But if we did, we couldn't afford some stuff that Medicaid won't cover, like nutritional formula (our son can't eat), and we'd go bankrupt and/or lose the house in the six months before Medicaid would kick in...and we'd have no insurance during that six-month period, either.

I understand the free-market-based arguments perfectly. I also know that the British NHS has problems with institutional coverups of medical malpractice (wouldn't want to make the government look bad, you know), and there is a strong tendency for doctors in a government-run system to develop the Doctor-Is-God complex. I don't know what the ideal solution to the current problem is. But the current approach IS in trouble.

Malone LaVeigh
January 20, 2006, 11:18 PM
Then you must be a lousy negotiator.

Etc.
Then I'm very happy for you that you obviously haven't had to contend with a serious illness. Last year my brother was dieing of lung cancer without insurance, and we went through all of that. Sure, we negotiated a lot of his bills down, quite significantly. I don't deny it can be done. But every time we went through a medical door it cost thousands of dollars. Courses of treatment were routinely in the tens of thousands. You can feel good and smug while you're healthy, but when you get older or if you get sick, you'll thank everything you believe in your wife made you get insurance.

Of course your retort is going to be that I'm somehow special or privileged or lucky or some other nonsense that requires you to take from me at gunpoint to pay for someone else who's not
That's right, stick'em up, Karnak.

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