Kitz for Prez in 08!

Yeah, Kari that is right. He said we spend 6.4 billion on health care, and we should bundle it all together and then restructure the entire system.

Did he give any details on what the new system would look like? Nothing.

The guy has held his "endowed chair" for what, two years now? And the sum total of what he proposes is "give me the money, I'll figure out what to do."

I'm sure what he has in mind is a state-delivered single payer system, but he won't say it because he knows it's just the same old "progressive" solution that most people don't want. So he has to fly it in under the radar with "details to follow."

His last great idea is still bankrupting the state.

Why would we think he has the answer? With his track record, we should immediately dismiss anything the guy has to say.

Kari, I'd take exception to your point here. Kitz said that the gov't should help pay for coverage by not allowing the tax deduction for employer paid health care. Thats a tax increase on businesses and not money already spend on health care.

It would also encourage small businesses to drop the health coverage, and either set up health savings accounts or simply increase wages and let employees get their own insurance or go uninsured (which most younger folks would do).

It would also mean Increased premiums for those who stay in plans and more taxes paid by businesses that already provide health insurance for employees.

Why Kitz wants to punish the employers who already pay for coverage for their employees is beyond me. A much better way of getting empoloyers to contribute would be to impose a health care tax on each employer equal to $100 (or whatever) per employee then let employers take a credit for any health care they provide.

I would prefer a system where we treated health care like a basic utility or capital resource/investment like education. Everyone should be entitled to basic health care through government run programs (like public schools), and private health care, like private education, is still available for those willing and able to pay for it.

This idea will go as far as a car with bald tires in the Portland West Hills in the dead of an ice storm. Give me all your money and I will solve your problems.

I like the idea of changing the frame of reference from providing "health care insurance" to ... "providing for the health of our citizens." As Kari stated Kitz was perhaps doing. Many people simply see universal coverage as buying health insurance for people who can't or won't take care of themselves.

Yet the government pays police and firefighters to protect my person and property and that protection extends to everyone regardless of what they pay as taxes. But we talk about funding public safety, not necessarily paying for my personal police services, or someone getting police and fire services for free.

If we viewed health for all citizens as we did the safety of all citizens and their properties, or the eduction of all citizens, maybe people would view a government facilitated health care delivery system as very reasonable and sensible as a bulwork of our capital/labor economy. (plus its just maybe the right thing to do)

So from now on I won't talk about universal medical insurance coverage, but of the basic health of our communities. And I'll include public safety, fire, education and health.

Kari writes:

"Paulie, Sasha, and MrFearless...

Are you arguing that our current health system is working perfectly?"

Hardly. My wife has been a physician in a large group for the past 20 years, so I've heard the stories about how it isn't working for a very long time. But the solution -- at least not in the US -- is NOT universal health care. It isn't for the usual reasons, however. As someone who has lived "up close and personal" to the health system in Oregon, Washington, California, and Connecticut for a looooooooooong time, the issues appear to me to be far more complex and involve solutions that health consumers might not like to hear. There are multiple drivers of health care costs. The main one, unfortunately, is that a very large number of Americans don't take ANY responsibility for their own well-being - even those who have health insurance. They simply don't. Oregon is one of the fattest states in the US and obesity has so many associated problems that the medical system is literally being crushed by treating people who didn't take care of themselves when they could or should have. Many people - again those with (as well as without) health insurance use the emergency room as the primary care provider. Do you have any idea what it costs to perform a CT scan at 2 a.m. as opposed to doing the same CT scan during an appointed time at 2 p.m.? It's about double because few hospitals can afford the expense of keeping full staffs at 2 a.m., and everybody who's called in, from the technologist needed to run the machine to the radiologist required to read the scan and report the results gets paid double for getting dragged out of bed in the middle of the night. And this is frequently for the "bad headache" that turns out to have been ongoing since 4 a.m. the day before but the person didn't want to use a sick day to go to urgent care during the day.

So, the first problem is solely one of personal responsibility.

The second problem is related to medical liability. Because the US has, for whatever reason, adopted a "sue first, ask questions later" mentality, the cost of liability insurance dramatically drives up the cost of medical care. I'm not talking about the payments to insurance companies here; I'm talking about the practice of "defensive medicine". Instead of taking detailed patient histories, physicians just immediately order tests and procedures because the patient wants to feel like everything is being done AND the doctor wants to protect him/herself against charges that he/she didn't do everything reasonable. So, we have the case of my wife's hospital going from 1 MRI scanner in 1990 to the 6th scanner being installed later in 2006 - a 500% increase in the number of scanners and the number of scans - with a 50% increase in the number of paying customers. Guess who pays for all those scans - probably half of them completely unnecessary but for the exposure to litigation risk for NOT doing them.

In any case, these are a few of the reasons why the system has problems right now. And I see nothing about Universal Health Care that would solve the personal responsibility problem. Perhaps it would solve the liability issue but only if the Federal Government became the insurer. Unfortunately, the personal responsibility genie is too far out of the bottle to put back. I can see significant tort reform as one potential pressure valve to rising health costs, but the (lack of) personal responsibility factor is so profound that nothing short of major cultural change would solve that. I'd mention in here the problem of undocumented immigrants, but fear I might be accused of being someone who people who know me well know that I'm absolutely NOT.

So, if I'm reading this correctly, Kitzhaber is basically doing the following math:

We (Oregon) currently have about $6.4 billion worth of health-care expenditures that the state has some say in, or could potentially.

Oregon's population (men, women & children or people in the process of going from one state to the other) is about 3.5 million.

That means that the State of Oregon could potentially have about $1,828.57 to spend on health care for every man, woman and child in the state. I think that's per annum.

I think my employer currently spends about $800 a month on my health insurance, but it used to be more like $150 to $200 a month. Which is part of the problem.

So, I'm guessing that Kitzhaber's gamble is that if the state controls costs by limiting administration and overhead, it can provide health care for all 3.5 million residents of the state by working within this ~$1,800 per person annual budget.

If somebody wishes to purchase private insurance on top of that, great, but this would provide the baseline for health coverage within the state for all of its residents.

By repealing the health care deduction for businesses, this would (as I read the proposal) basically be taking health administration and funding out of the private sector and into the public sector. Health care delivery could still be either public or private. This could be the innovative solution that the state needs, and indeed the nation needs, to fix the current health-care quandary.

Finally, I believe that the focus on "health" rather than "health care" is equally important. Perhaps some of that money could be spent on health education, prevention, excercise promotion, nutrition information, and other variables that have the potential to reduce long-term health care costs by limiting the risk (i.e. ill health) of the general population.

Go Kitzhaber! I still wish he would knock that conservative jackass Gordon Smith out of his Senate seate, though. ;-)

cheers, ~Garlynn

Kitzhaber is Oregon's Jimmy Carter...earnest, ambitious, wonderful (if often impractical) goals, and a tremendously ineffective leader who can't gracefully bow out of the spotlight.

OK, Gordie, who do you consider and effective leader?

Robert wrote: Kitz said that the gov't should help pay for coverage by not allowing the tax deduction for employer paid health care. Thats a tax increase on businesses and not money already spend on health care.

The tax deduction means that we're forgoing taxes, thus, we are in essence spending public resources to subsidize the provision of health care by employees. So, yes, it is meant to be money spent on health care.

I'll keep an open mind until I read a detailed analysis of Kitzhaber's full plan. I do note that federal retirees get federal coverage at only a small direct cost to the Oregon taxpayer. The cost is now a national cost. We should examine the proposed plan to see if it would shift those federal costs to the state.

I'll keep an open mind until I read a detailed analysis of Kitzhaber's full plan. I do note that federal retirees get federal coverage at only a small direct cost to the Oregon taxpayer. The cost is now a national cost. We should examine his detailed plan to see if it would shift those federal costs to the state.

The comment "a very large number of Americans don't take ANY responsibility for their own well-being - even those who have health insurance" is true. Any truly responsible medical care system needs to incorporate a substantial incentive for personal responsibility. Those of us who smoke, drink to excess, eat much too much, 2taj5don't exercise, and otherwise abuse our wonderful bodies should not think that society owes them medical compensation for their wrongdoing.

JesseO

I understand the concept of tax expenditures you describe, but you're missing the issue. Health care benefits have always correctly been identified as a business expense just like wages, paperclips, cleaning services, utilities and any other thing necessary to run a business and for which a business expense deduction is appropriate. Is the deduction I get on paperclips subsidizing my use of paperclips? By your reasoning it is.

Kitz apparently wants to single out health care costs as something that shouldn't be a business deduction. Such treatment will encourage employers to redirect those dollars to a tax deductible item like increased wages or individual Health Savings Accounts or cut benefits to employees. So its (perhaps) unintended consequence is to get employers to consider dropping, or reducing health care benefits. Menwhile the employers who don't now give health care benefits won't get any increase in taxes.

Thats right. Employers who pay the best benefits will pay more in taxes and those that allow their uninsured employees to continue to suck off the public teat will see no increase.

To put it mildly, thats just not well thought out, and theres a little Alice in Wonderland about that whole thing.

Robert - the point of Kitzhaber's plan IS to get businesses to drop their health benefits - in favor of a single payer plan that covers everyone.

Under Kitzhaber's plan, businesses in Oregon will be able to increase their competitiveness by eliminating health insurance expenditures. Meanwhile, health care costs are reduced through the advantages of single payer - a decrease in paperwork, a decrease in emergency room visits, and an increase in preventive care. The moral crisis of leaving so many Oregonians uninsured is also resolved.

Kithaber's plan makes sense.

"Meanwhile, health care costs are reduced through the advantages of single payer - a decrease in paperwork, a decrease in emergency room visits, and an increase in preventive care."

Clearly you're living in a dream world. If you think that single payer insurance will solve any of THOSE problems, you've been taking too many of the drugs the drug companies are peddling. Medicare is really cost-effective, isn't it? Medicare has stopped paperwork, decreased ER visits, and improved preventative care?

A majority of small businesses would jump with joy at the prospect of having the health insurance burden lifted from their businesses. We'll take the the decreased expense of health care insurance costs over the tax write-off from it any ol' day! Taking an expense off the ledger is way better than having it there as a write-off.

This plan is good for businesses.

And for anyone who thinks the current system is good for business, look at US auto industry.

I wonder why Toyota chose to locate its new plant in Canada rather then the US... hmmmmm... I wonder...

Robin: I stand corrected. If the idea is to get businesses to drop or reduce health care coverage for employees, taxing benefits will do that. (though if you really want to do that tax the employee for the benefit, that will raise even more money and encourage employers to cancel or reduce insurance. A TWOFER)

Unfortunatley, if thats really the plan its a little like having a person standing on a burning building with the firefighters below telling the victim to go ahead and jump and they'll have a net deployed before he hits the ground.

Also, heres a problem with your analysis of the true intent. If employers drop insurance, then Kitzhaber's funding source is reduced (no benefits to tax) and more people go into public assistance. So his plan would make no sense at all, at least in the short term, if employers started to drop ore redce insurance benefits.

I believe that a partial short term plan is to use the current system of privately funded insurance though employment. Youd have to tax employers who don't cover employees, using the funds to cover the uninsured, And open the OHP plan up to whoever wants to get insurance, including group rates for employers, making it very similar to SAIF. (this would get group rates and avoid the costly adminsitative and marketing fees charged, and allow OHP to negotiate rates). This would be a mix of public and private funding with the government not running all the hospitals and clinics, but using their power to negotiate rates and drugs costs and cutting out the expensive overhead of marketing health care and trying to sell their newest (but not most effective) drugs of the month

Private insurance rates should come down and stabilize, just like they did for workers comp, because there would be no, or fewer, uninsured to have to care for. So employers who now provide coverage could be an ally to this plan.

Kari writes:

"MrFearless proposed tort reform, and while that's a fun conversation, it only contributes something less than 1% of the total cost of health care - and almost none of the hyper-inflationary pressure. In any case, it makes no sense to reduce victim's right to sue and then pray the malpractice premiums go down. Better idea to just cap the malpractice premiums directly. Worked for California."

Kari. You totally misunderstood and misread what I wrote. I did write about "tort reform", but in the context NOT of what insurance premiums cost and what juries award, but the practice of "defensive medicine", a completely different cost driver than big jury awards and high malpractice premiums. The actual cost of all the unnecessary procedures and tests is FAR MORE than 1% of the cost of medical care. Current estimates from medical practicioners place the indirect cost of defensive medicine at closer to 10%. To get at this would require BOTH the reform of the liability system AND inside quality assurance that reviews (with teeth) the medical necessity for doing the tests and procedures in the first place (a type of rationing, but for different reasons). As I noted before, the fact that hospitals are adding MRI scanners (a single example) at the rate of 500% to do 500% more tests on 50% more patients is NOT a sign that the the technology is diagnosing more or that people are sicker. It is just that a picture is worth a thousand words and it is a lot easier to assuage a patient's anxiety with a picture that is unnecessary than for the doctor to try to explain the same thing to the patient. It would be easy to say that the doctors should resist, but when you're forced to see 3 patients per hour, it becomes a little tough to spend the extra time and a lot easier and a lot safer (for the doctor) to order up a test or procedure and move the patient along. (That's also one of the reasons that so many prescriptions are written, along with the blasting drug ads -- that should be banned completely -- seen everywhere).

Perhaps you should spend a week or two walking in the shoes of a primary care doctor as well as a specialist to understand. It doesn't take a genius to figure out how much completely unnecessary medical testing and procedures are done, none of which answer any crucial question or provide any relevant diagnostic information. When every MRI scan costs at least $1000 (again, a single technological example) for delivery, diagnosis, and equipment/space amortization, it isn't any wonder that medical care is expensive. It is defensive medicine and patient demand (often interrelated) driving a great deal of this and the system provides no incentives or protections to stop it.

Kari writes:

"Fair enough. Ferreting out all the unnecessary nickels and dimes (and Benjamins) that get spent is important - but difficult. Presumably, adjustments in these kinds of areas would be part of the details within the Kitzhaber plan."

This didn't happen in the OHP. The rationing applied to treatments, not to diagnostics. And the OHP did nothing to reduce defensive medicine, reduce doctors' exposure to liability, or do QA on the plans. People revolted when managed care services (not OHP, but other large managed care organizations) tried to insist that all specialist visits be approved in advance by visits to primary care providers. It overwhelmed primary care providers and completely pissed off patients and has led to largescale acquiescence from managed care services to NOT limit patients' access to specialty care.

Universal health care is a very expensive, utopian, and impractical idea. Managed care can work and can reduce the costs of medical care and permit more people to have access to medical care than they now have. BUT, besides the other issues I've identified in earlier posts, people HAVE to accept the concept of some degree of rationing of services. People have to be provided with incentives to practice healthier lifestyles. People have to be disincented from practicing unhealthy lifestyles (smoking, drinking, lack of exercise, overeating). [Universal healthcare doesn't address this problem at all and is no more a solution to that problem than the current system]. Preventative medicine WORKS, but it requires patient compliance. Rationing works, but it requires that patients accept that some treatments are inappropriate at certain stages of life. It requires that people accept death as a natural part of the human experience.

Just thought I'd pop by to praise the conversation here and to introduce something that isn't getting much attention. I'll begin by admitting that I'm talking just a bit out my ass, but I'm curious about the role the American Medical Association plays as a driver of cost - mainly by perpetuating practices that see already well-compensated specialists receive double the pay for coming in on off-hours. I'm not arguing that they should receive no compensation, but double?

I'm sure one could have a field day with some of these things. Yes, medical school is expensive and insurance premiums are high...but it's not for nothing that doctoring has the reputation as a good money field, is it?

Anyway, I think the basic intention of Kitz's plan is sound - e.g. basic coverage for all with bonus coverage for those willing to pay - is fundamentally sound. The question comes with containing costs and getting his hands on the cash - that sounds deadly hard.

If the closing weeks of 2005 are any indication, 2006 is rapidly shaping up as the year of the health care coverage crisis in the United States. Middle class Americans will join the 46 million uninsured in feeling the pain as companies trim benefits and shift costs to their employees under the guise of so-called consumer-driven health care. Judging from the results to date, the experience won't be a pleasant one.

For the full story, see: "Unhealthy Trends for 2006"

Jeff Bull asks:

"mainly by perpetuating practices that see already well-compensated specialists receive double the pay for coming in on off-hours. I'm not arguing that they should receive no compensation, but double?"

It isn't the AMA that is perpetuating the practice - it depends entirely on the group, the local practices and custom, and the job market. I wasn't arguing from local experiences, but from experiences in other states. In my wife's practice, she receives pay for the time she's scheduled to work, and extra (but simply the equivalent of hourly overtime) for coming in for "call backs" (unscheduled work). But that doesn't hold for technicians who are mostly unionized and who receive double and sometimes triple time for an unscheduled call back. And in California, where people in my wife's specialty were in short supply, the physicians would receive "bonus" compensation for coming in on call-backs. On the other hand, in some private practices, the on call services are billed as double and the excess is distributed back to the medical group partners as end of year profit-sharing. (Of course in those groups, they're also paying for the equipment costs and the costs of the techs coming in after hours).

So it ain't the AMA that's perpetuating this; there are a lot of other factors involved including employee unions who've negotiated these benefits for their workers, and the shortage of or excess of specialists in a particular field. It happens right now that in my wife's specialty, there are about 5 jobs for every newly minted specialist - we could move almost anywhere in the nation's interior and my wife would triple or quadruple her salary. Demand for services far outstrips the supply of people needed to perform the services. Why do you think that might be?

I don't want to get into a debate about physician compensation. Let me just say that my not-unbiased opinion is that physician compensation should be the least of your worries. (And trust me, universal health care will only make the supply and demand problem worse, not better).

Many of us were radical in our youth and some wondered what anarchy would look like. If you still want to know, wait 5 years and watch the US health care system implode. Seniors get free care via Medicare. The poor get free care via Medicaid. Around 40 million of our fellows are uninsured and either rely on emergency room services or just go without. And the rest of us rely on plans which cost us (or our employers or a combination thereof) around $1000.00 a month for "family" coverage under a "Blue Cross" or "Kaiser" style plans. At some point the laws of mathematics are going to kick in. Too many elderly, poor and uninsured. Too few who can pay the $1000.00 a month for coverage. And so the house of cards will collapse.

The solution is universal coverage via expansion of Medicare. Anything else is smoke, mirrors and denial. Medicare is not perfect, nor is the concept of universal single payer health care. But I have not seen anybody propose anything else that looks feasible.

Pat Ryan writes:

"I really like having Mr. Fealess join our merry little band here. Great commentary, and although I disagree here and there, to do so in the comments section without through research would undoubtedly be deadly.

I hope he continues keeping an oar in here......."

Pat, thanks for your kind words. There are three subjects on which I feel qualified to offer commentary - higher education, health care, and PERS. I have professional level knowledge on the first and last subject, and have intimate knowledge on the second. All other information is simply my personal opinion. BlueOregon is now on my permanent radar and I visit several times a day to check in on subject matter.

Glad to be here and to contribute what I can.

Frank asks:

"Then how do other industrialized countries manage to do it?"

This is a softball pitch. 1) significantly higher income taxes, 2) very strict rationing of treatments, procedures, and tests 3) no medical liability for medical care, no tort access for patients (i.e. no defensive medicine, no liability insurance, no insurance companies except in a few countries where those unhappy with the "free" care purchased access to care they paid for, 4) strict rationing on the number and types of doctors, number of hospitals, and number and types of equipment, 5) long waits for non-emergency conditions, 6) cheaper drugs and looser restrictions on drug testing and shorter waits for drugs to go on market, 7) typically more homogeneous population than US (less open borders) 8) fewer cars and more walking (and therefore more healthy populations in general) 9) and a generally greater respect for personal responsibility in health maintenance.

How's that for the short list off the top of my head?

The US has the most expensive health delivery system, The most uninsured people and the best emergency care in the world. It spends almost twice of its GPD per capita on health care as some systmes, like Sweden, that have better outcomes. And in comparison to other major industrial countries (and even in coparison to coutries like Saudia Arabia) the US a high infant mortality rate and low life expectancy.

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

If government was already running this system, the conservatives would have a field day quoting these statistics and demanding immediate changes.

So other countries do a much better job, cover everyone, and spend less money doing it. The problem is that there is so much money at stake, for doctors (the highest compensated in the world), hospitals, drug companies and insurance brokers.

I wish good luck to Gov. Kitzhaber, for the most part his plan makes sense. But the plan has to be incremental in converting the system so vested interests have time to adjust. At some point we can then reach a tipping point and make the conversion 100% into a system that provides health security to all Americans.

Robert Harris writes:

"The US has the most expensive health delivery system, The most uninsured people and the best emergency care in the world. It spends almost twice of its GPD per capita on health care as some systmes, like Sweden, that have better outcomes. And in comparison to other major industrial countries (and even in coparison to coutries like Saudia Arabia) the US a high infant mortality rate and low life expectancy."

I wouldn't dispute one of these points, but you're missing some of the issues. The US also has the largest percentage of recent immigrants, comparatively low taxes per capita, no formal rationing of care, number and types of providers, and equipment, and relatively lame regulation of hospital siting, considerably heavier and more costly regulation of drug companies and their products, almost no regulation of insurance companies, few limitations on tort liability, and absolutely NO incentives for good health and no disincentives for bad health. In fact, the system is so perverse that patients and the system are rewarded for treating acute illnesses, while the system penalizes providers and hospitals and patients for health maintenance.

So, explain how universal health care can address all the allied issues that currently plague the health care system without a systemic overhaul of a lot of other elements of society, without putting lots of businesses out of existence or significantly limiting/regulating their activities, by disincenting people to go into medical practice, by more stringently regulating immigration, by actually rewarding good health and penalizing poor lifestyle choices etc, etc, etc.

The US is significantly and demonstrably different than any other nation that has some form of universal health care that any comparison is largely undermined from the outset.

Kari writes:

"Can we please discuss what improvements can be made to improve things - not how the system is so irretrievably broken that we can't possibly do anything at all?"

You don't seem to read very well. In my earlier posts on this topic I made a series of suggestions that could free up resources that could be put to use to provide better health care for all. These include (in no particular order):

1. Rationing of care in a rational and thoughtful way (remove the tax benefit to companies for providing cadillac coverage; simply decide what base coverage that companies can get a tax credit for and then simply allow employees to enhance the coverage with after tax dollars or to use HSA's to supplement the basic coverage).

2. Place strict limits on medical liability to only cases of egregious negligence or malpractice instead of letting people sue for any "bad outcome" regardless of cause.

3. <h1>2 would reduce malpractice costs, insurance costs, and virtually eliminate defensive medical practices and would probably save about 10-15% of all current medical expenditures.</h1>

4. Require insurance companies to reimburse fairly for preventative measures, and reduce the current perverse incentives to concentrate on payment for acute interventions (see today's NY Times article on diabetes for a very good discussion of how the current system provides no incentives for patients or doctors or hospitals to encourage preventative care, while richly rewarding the kinds of irresponsible behaviors that lead to acute events).

5. Try to understand and then address the relationship between illegal immigration and health care costs. I'm not being racist here, but simply reporting from close second hand experience of what it is like to work in hospitals (UC San Diego Medical Center; Hartford Hospital; LA County General Hospital) that have huge numbers of undocumented patients in their ERs every day of the year. I don't have a solution to that particular problem, but I think you put your head in the sand if you don't at least acknowledge that this is a significant cost driver in our system that is NOT part of the systems where Universal Health Care exists.

6. Better funding for medical training. People may not grasp this point, but part of the reason why medical school tuition is skyrocketing is that government support for training (not research) new physicians has declined significantly in the past 15 years. My wife was fortunate enough to come out of medical school with almost no debt, but recent graduates of the same medical school today are averaging $300,000 debt by the time they graduate. Given the high tuitions and limited government support, the number of physicians who graduate from medical school today has declined significantly in the past 15 years. While this may not seem to be the case given the competition for slots, do understand that the number of spots in medical schools has actually decreased and so fewer numbers of people are competing for fewer spaces. As I've noted before, in my wife's field right now, there are roughly 5 open positions for every person finishing residency. Her own practice has 3 openings they've been trying to fill for more than a year. Salaries on the coasts are significantly lower than the interior and so most of the newly minted people are choosing to accept positions paying the most so they can get out of med school debt in a reasonable length of time. They then grow comfortable making high incomes in places with significantly lower costs of living (e.g. South Bend, Indiana) and so they end up staying. When my wife finished her fellowship (an extra year after a 4-year residency), she was offered jobs in the midwest that were paying $750,000 per year 20 YEARS AGO. Since she's a native Oregonian, she chose to come back and still earns hugely less than what she could have made 20 years ago.

So, starting out with a shortage of physicians and diminished government support for training of new ones, high tuitions and unattractive salaries leaves the country in even more jeopardy from poorly thought out "solutions" than from more "incremental" changes.

Unfortunately, the changes I suggest are unpopular and they involve people thinking thoughts they might not like to acknowledge.

The above academic discussion is fascinating, but here are the monthly premium rates which my firm is being quoted for renewing our group insurance effective April 1, 2006

Plan option 1 (highest benefit and cost)
Single $386.85
Two-party $768.70
"Family" (Employee + 2 or more) $1150.55

Plan Option 2 $20 office visit, $500 deductible, 20% coinsurance

Single $325.07
Two Party $645.14 "Family" (Employee + 2 or more) $965.21

My firm heavily subsidizes the above rates, so our employees do not pay the entire stated premium themselves, but we view "total cost" in determining our compensation levels, raises, etc. My firm is relatively healthy and able to continue to offer group medical as a fringe benefit, but we will not be able to do this indefinitely, and particularly if our competitors begin to drop their coverage to maintain a lower price point for their goods and services.

The employer provided health care model is broken and nobody has offered any suggestion as to how to fix it. Going to a single payer plan - based on the Medicare model - is the only solution that makes any sense to me. Our competitors in Canada have such a system and to my knowledge they view it as successful. Yes there are waiting lists and reports of patient dissatisfaction. No you can't get your tummy tuck paid for by the government. Yes the physicians are paid much less in Canada than they are here. But viewed from the standpoint of society as a whole I believe we need a single payer system and we need it now, but I am confident we won't get it until something major breaks down in our current hodge podge system. Perhaps we should all just sit back, self-administer a generous dose of medical marijuana, and watch to see what happens next.

bluenote comments:

"The employer provided health care model is broken and nobody has offered any suggestion as to how to fix it. "

What part of my "academic" discussion doesn't address significant pieces of the employer-provided health care model. You've made the point about the cost of your healthcare plan. Your health costs are a little high, but not out of line without knowing more about your firm's demographics.

But you haven't asked the obvious question of WHY those rates are so high? If you look closely at my suggestions (in the message above), you'll see both the reasons why the rates are so high and possible ways of reducing those rates significantly.

I think you misunderstand what the Canadian system entails and how Canada differs in unchangeable ways from the US. Draw whatever comparisons you want with Canada, but the differences between the US and Canada are so profound that imposing that kind of model on the US simply will not work. It is doomed to failure from the outset. It is far better to make incremental changes to the existing system that offer opportunities for significant savings than to move to a system that simply won't work.

Good article in the NYT today that nicely illustrates the difference between providing access to health care and managing for health:

http://tinyurl.com/8f8xk

-tk