Healthcare, SCHIP and a different view
Health Insurance and the SCHIP programs are political footballs on the 2007-2008 political landscape. This topic is like an erupting volcano, spewing molten lava, dividing two points (of view in this case). This debate is seldom observed in a logical, unemotional, common sense, and non political way. In this blog entry, I will attempt to add another point of view to the debate and avoid (if possible) partisan political rhetoric!
In general, I am not happy with my health care insurance. It often does not pay for services rendered and that can be costly. Last year I had a test that cost about $3200. I was relieved that everything was OK until the remainder of the bill arrived in the mail telling me that insurance only paid for $1900. I realized one thing though; insurance is not meant to pay the whole bill. Insurance is built to ensure that you are covered in the case of catastrophic illness. Deductibles can be high but it is unrealistic to assume that you would be covered from ‘dollar one’. We whittled away at that bill over a few months and were able to pay it off.
As a family, we pay around $4300 in bi-weekly employer deductions and over $1500 in deductibles yearly. That is an average of $100 per week for a family of four. Breaking down this scenario, it works out to be $25 per person per week. So what is prevention and good health worth? Is it worth a personal investment of $25 per person? I think that it is and our insurance is not a bargain and not as comprehensive as most plans.
Compare the investment in your own healthcare to a car payment, which is now averaging around $400 monthly or about the cost of annual health insurance. Interesting enough, the average family of four pays over $6000 in taxes, slightly more than the cost of health care and $12,800 for housing or three times that cost. In the scheme of things, health insurance is a fraction of the cost of most other ordinary expenses.
It is argued that health insurance is not available to employees and while that may be true about small businesses, any larger company offers at least a basic plan. I can tell you from experience that the 'opt out' rate by employees is large as many younger employees, either feel that they do not need insurance or do not want to pay the premiums that are deducted from their check.
One company that I worked with a few years ago offered a health insurance plan to all of their employees (over 250,000 worldwide) and 13% signed on. The weekly premium was $30 for a single plan and $70 for a family plan with a $500 deductible and $10 and $15 prescription drug benefits. I questioned that managers whose direct reports refused the insurance and they responded that they felt it was ‘expensive’. Many had brand new cars, frequented nail salons spending $100 monthly, always wore the latest fashions and were able to easily make their monthly obligations. I will admit that many were between the ages of 18-25, were healthy but today are more than likely a large portion of the 47 million of population that is uninsured. In fact, 46% of the 41 million of uninsured in 2005 were between the ages of 18-25.
9% of the 47 million that are uninsured are children; a fact being argued by the SCHIP advocates; if you total those two amounts, that is 56% of the population that could be covered. Add the illegal immigrant population to the equation and you have the lion’s share of the shortfall in the uninsured. To rectify the health and SCHIP debate, I have three suggestions. Although they may seem simplistic, they make sense and would do a lot to cover the uninsured.
1) Make it mandatory for employees to take the insurance that their companies offer to them. Have a qualification criteria so that employer MUST offer a realistic plan if they choose to.
2) Insure those not being offered insurance with a plan that covers the same percentage of health care as the average American is forced to pay outside of insurance. Do not cover illegal immigrants and keeping politics out of this, it is a separate issue to be addressed.
3) Rather than SCHIP, make direct refunds against income taxes paid. For instance, if a family spends $1200 on medical expenditures for their children, earn $30,000 and their income taxes are $2000 then $1200 is applied to their income taxes and if none is due and there is a refund, that $1200 is paid back to the family. That’s right, not a deduction but a full refund. A simple formula that rewards positive, responsible behavior!!!Their refund would be a product of math. Following is a rough idea of how this might work.
Income % refund
$30,000 100%
$40,000 80%
$50,000 60%
$60,000 50%
$70,000 40%
$80,000 30%
$90,000 20%
In this example if you spent $2000 on health care for your children and your household income was $50,000 then you would get a direct refund of 60% of what you spent or $1200. If you did not withhold enough from your paycheck then you would have that $1200 applied against your tax burden. If you have a tax refund coming that $1200 would be added to your refund check. This plan would incent parents not to take their children to the emergency room or the doctor’s office for frivolous reasons.
This would work and parents would take responsibility for both the preventative health and well being of their children, knowing that if they seek care, in the end, it will be reimbursed. It would be simple and could be taken care of when you file taxes. It also would not take another bloated bureaucracy to manage a system that would be far too complex for mediocre administrators. (Ok some politics here but they exist and are affiliated with both political parties).
I will not argue that some people will just not be able to afford care, some are not able to provide a living for themselves and still others are high risk, meaning that the rest of the population will have to ante up, providing a higher level of funding for those who fall into this category. Now, place them into a ‘universal’ pool if you wish.
The SCHIP program is needed and necessary, but the $80,000, family of four threshold is a sticking point. To refund money that a parent takes responsibility for spending in the first place is more reasonable as they become invested in their children’s health and have a reason to stay on top of it; understanding that if they do the right things, their money will be refunded in full.
As far as health care and insurance in general; a ‘universal’ plan takes away investment that people have in their own health and turns it into an entitlement and expectation. People must understand that health care is not a ‘right’; it is something that you take responsibility for. If we supply the choices and set the policy, the free market can work with incentives from government. The larger the pool of the insured, the lower the premiums will be. To completely scrap an existing system that serves over 80% of the people fairly well and replace it with an unproven system is just illogical.
Anything of value must be appreciated by those who take ownership in it. People must understand that just because they do not want to pay for something yet expect others to do so, it is unfair, unrealistic and irresponsible. Helping someone in need out is different that being my brother's keeper.
Much of this debate is about 17% of the population, a large portion of which opts out of paying for insurance premiums. We should help those in need but not those who refuse to help themselves. We also need to stop the drain that illegal immigrants are having on our health care system. (OK, some could call that politics; I view it as the governments failure to enforce existing law on both sides of the political spectrum).
I think I have addressed all points except nursing homes and long term care that could stay under a Medicare program. So there is some food for thought on the health care debate.
Telling it like you see it or how it really is?
Hey Wynter,
No misconcetion at all and I think you should do a little research, the $80,000 threshold is real and was originally mentioned in various speeches from proponents. Merit should play into it, the issue is that once the government gets involved their meddling gets deeper and deeper. We are saying the same thing but I propose that they take at least the responsibility to seek out the help and be reimbursed for it. In reality, they would get a full refund at tax time.
High pharmacy costs are part and parcel of research and the costs have to be covered somewhere. I would support less time until generics can compete but you have to allow the pharmaceutical companies the capital to come up with new medications.
Basic medical care is not too much to ask, but, as you implied should be covered on merit. Life is precious, we do need to help those less able to help themselves but we need to set parameters. Because someone needs help does not mean that everyone needs to be penalized or placed on the same health plan. We should help where help is needed.
Just provide universal health care that everyone is so fond of for the 17% that are in need. If it works, is effective and proves that the care is world class, then we can discuss a "universal" system. Let's see if that is the care what it is cracked up to be.
Illegal immigration is political. The Right does not want them to come here illegally and the Left wants them here to add to their voter rolls. Sovereignty and the rule of law should not be a partisan issue. We have laws that should be followed. Both political parties are guilty of allowing illegal immigration to get out of hand.
As far as letting illegals die in the streets....NO, I am not in favor of that. I do think that if a hospital treats an illegal and they do not have proper documentation, they should treat them and then turn them over to ICE. Offer humanity and then take care of the immigration issue.
A recent poll revealed that 42% of the population felt that health care was the most important issue facing the nation. In July a poll revealed that 82% of the population were in support of a border fence. Also in July, a poll revealed that 71% of the population felt illegal immigration was one of the top issue facing the country. Additionally, 67% were against immigration reform that would lead to amnesty. You know, what the Congress was trying to pass and shove down out throats. Supporters included liberals and conservatives as well as the President. It is NOT a far Right issue.
We keep hearing about health care but hear little about immigraiton reform in the press or from either party. That is a problem...politicians on both sides are gutless and frightened to address the issue. Therefore, they will not address it once elected and the drain on the health care system will continue!
You mention Right and far Right so I wonder if you consider both Left and Right points of view. FYI, I am not a Right or far Right partisan. I am looking for common sense solutions that allow self reliance, self determination and hold people responsible for themselves. I have compassion and those who can't provide for themselves should be helped.
It is good to have you on the blog. I look forward to you taking on both the Left and Right in your "Telling it like you see it" and calling out politicians on both sides.
I can hardly wait for you to call out Hillary on her millions raised from the Saudi's and other Arabic donors. I can hardly wait for you to call out Edwards on taking public funds. And, I can hardly wait for you to call out Murtha, Kerry, Reid and Durbin who trashed our soldiers calling them murderers, rapists, Nazi's, etc. but have the gaul to condemn Rush Limbaugh on the floor of the Senate. Limbaugh a private citizen who called out a 'fake' soldier who was speaking out as an expert on the war.
NO, I am not a Limbaugh fan and I find him pompous and a caricature of himself, but the hypocrisy of these Democrats is astounding. If you truly call out politicians I await your condemnation of these individuals. Time will tell!
Just an FYI
But I know as fact that these same drug companies spend enormous amounts of money on marketing these drugs. It wasn't so long ago they were only allowed to smooze the medical professionals. Now they have national campaigns on TV, radio and print media. They sponsor or at least cater events at many of the conferences for doctors in places like Hawaii and Los Cabos , Mexico . I've seen the lunches and dinners for entire medical offices (from the M.D. to the lowly medical records clerk) that are paid for by drug companies in order to push their product. Do you know there are fleets of sales people who travel daily from medical office to medical office to hospital and everything in between hawking their wares like modern day soothsayers? How do you think they are compensated?
I am not saying these companies are big heartless corporate machines. They do provide samples to doctors who pass them along to patients unable to afford to buy the drugs, but these only go so far and only the most needy benefit. Many drug companies also have programs in place to assist in providing needed drugs to those who qualify within their guidelines. But who do you think is paying for these lunches, dinners and freebies? In the end, the person standing in line at the pharmacy is the one who foots the bill.
Drug companies aren't the only ones who do this, but they are the most prevalent. It is stuff like this that add to the growing problems in our health care system.
Drug Companies
Terri,
You are correct that the drug companies spend millions promoting drugs. I know this because the industry that I work in does sell to pharmaceutical companies. It is not a segment of customers that we depend or rely on but we do target them. I understand your point of view and I am sure that you either work in a medical office or have done so; I know why you feel this way.
When a pharmaceutical sales rep goes into a food place and purchases catering lunches, etc. it costs them a small fraction of what the research costs and it is necessary. It should not be looked at as a 'bribe' but as a way for the sales person to break the ice and get the doctor to give them a few minutes of their valuable time. You can't expect a company to spend billions on research and not promote their product. If that happened, promising new medications would never make it to market and would never be prescribed.
I know for a fact that these companies assign a given percentage of their research to advertising. Each representative is given a budget. Just like any other business.
If you are saying that some companies might be excessively selling with trips and other perks, I might agree. If they do not travel office to office though, how should they sell their newest drug? Is it not like any other industry?
Any marketing, advertising or promotion of any product adds cost to that item. You could say that the auto companies are ripping off the consumer because they have color brochures or that food companies who advertise formula for babies could sell it for less if they did not buy excessive television advertising.
This is a matter of capitalism versus regulation. Albeit pharmaceuticals are more of a need than automobiles or formula or clothes; how should they get the word out on their product?
Let me say that I am not wealthy by any means and I do not invest in companies. Like most average citizens, I live check to check and do what I have to in order to provide for my family. I also know that the economy is based on people who do invest in companies and by their investments, they create employment and growth so that those of us who do not invest, have it a little easier and are provided with an economy that grows jobs and provides opportunities.
Hearing that drug companies are 'cleaning up' and too profitable seems to be more class envy than reality. Some of these investors take a chance to invest in companies that develop new drugs and lose their money. By taking that risk, are they not entitled to reap a return? This is how the economy works.
Unfortunately, politicians and the press create this "us versus them" scenario that even I fall into once in a while. The truth is that investors have built the quality of life that we enjoy. Over the last 30 years I have watched as families who were dirt poor in my town, when I was in grade school, are now middle class; some are even wealthier. This did not happen because we redistributed wealth. It happened because of job creation and advancement opportunities.
I can tell you that in some states (23 to be exact) these drug representatives are not allowed to take in even lunch to hospitals and doctors offices.
A couple of things that might be food for thought...we need to consider the investment, yes...but we also need to look at it in the purest sense.
When a sales person from a pharmaceutical commpany spends on lunches, trips or events, they stimulate the economy. Thousands of food places add on staff to cover the production of sandwich platters and lunches. Hundreds of airlines and hotels and restaurants add on hours for those employees that they need on staff to cover events. That is called economy!
I am on a prescription that, without insurance costs $1,50 per day. On a recent trip, I placed it in my suitcase and the pills must have fallen out of my suitcase when it was screened. My co-pay is $15 but in this case, they would not pay it because it was too soon to refill. I had to pony up the $45.
My point is that I understand the cost of a drug that you need. I also understand that some cost hundreds per month and there should be some kind of universal co-pay for those drugs that brings them down to a cost that regular people can afford. There could be a test of need and we should take care of those who can not afford these drugs.
One more point that I need to make. I know many people who complain about even the co-pay or premiums taken from their checks (including state employees). They all feel as if health care and drugs are an 'entitlement'. That bothers me when I see them taking trips to resorts, purchasing new vehicles, going out to eat, getting their nails done, etc. Yet, they prioritize health as secondary to these things.
Terri, I understand your point and there may be some excess and we should stop that and I appreciate that you are not pointing fingers at the companies as being 'big heartless corporations'. Once again, there needs to be a shorter waiting period before drugs are allowed to go generic; that is the real solution to the issue.
One more point that you probably are aware of is that drug reps turn over quickly and it is a burn out job. Yes, some last but there always seems to be a new person coming on. Also, most are entry level right out of college. I think that is a good starting place for a recent college grad and it does stimulate those ranks.
Keep up the good blogging and thanks for commenting. I may or may not agree with you all of the time but I love the perspective and enjoy your writing.
Thanks,
Bill
Follow the money trail...
I know there has to be marketing, but yes, I do think there is excess when you consider how hot this topic has become. I'm not saying that drug companies shouldn't make some money. I realize that if they can't sell the product, they won't have the capital to develop more life-saving, life-enhancing drugs. What does providing lunch for a medical records clerk or receptionist have to do with convincing the doctor to use their product? The companies that develop new fangled equipment don't go door to door buying lunches for entire offices to convince a doctor that their product is worth a try. The salespeople get their due course with the doctor when they catch the docs between patients in the office and/or take the doc out to lunch.
Even commercials aimed at the general public encouraging "ask your doctor" has both it's good and bad side. I could argue that it's unnecessary to target the public, that only the doctors should be targeted by marketing. I could also argue that these commercials help educate people about what is available out there. These are arguments that should be brought up. I don't have the answers; if I did, I'd be running for office.
I was just looking to inform in my response. People tend to read something in print or online and take is as gospel without doing much research. Saying that the cost of drugs should be accepted without question about how the money ends up being spent is not something that should be encouraged. We beat up medical professionals over their costs, complaining about how much an office visit is and point to doctors who live in nice homes, drive nice cars and vacation in exotic places. We don't stop to think how much money is needed to run a practice; pay employees, pay malpractice insurance, pay heat and electric bills, and pay off any loans for the 10+ years they dedicated to education and living on a shoestring budget. We demand that medical professionals answer to these "excesses", yet say it's okay to pay for the excesses of drug companies?
Since healthcare has become a political nightmare, we must expect that such costs are going to be scrutinized. The nightmare isn't that everyone should be entitled to healthcare, I think we all agree it's important that everyone be covered somehow. The nightmare centers almost entirely on money: who pays the bill? How much is too much? Who should reap the benefits? Should anyone profit and if so, how much is acceptable? Those questions are really at the heart of the issue.
Some Good Points
Hi Terri,
Thanks for the perspective and I don't think that we are that far apart. In reading your response I came up with a couple more thoughts.
The one thing that never gets addressed is the fact that malpractice insurance costs the doctors enormous premiums. That plays into their prices. Still, most of our representatives are what?.....LAWYERS!!!!! They protect their own.
I know that you have a very strong opinion about the cost of drugs and competition with generics being allowed earlier would solve alot of that.
I take exception with your thoughts about how much drug companies can spend on promoting drugs. The economy does not work that way. I guess my issue with all of this is that at some point, people decided that their health and medicine are something that they just do not want to pay for. For some strange reason, people are starting to think that health care is an 'entitlement' or 'right'. If we start down that slippery slope it will wind up placing everyone in poverty.
I am not a cold hearted person but we need to help those who need it and the rest of us have to take responsibility for ourselves.
In my original post I stated that I thought we should cover the 17% and that we should have a sliding scale of SCHIP. To me, that is more than fair and would cover everyone without breaking the bank.
As far as should anyone profit??? If investors decide that their return is going to be a minimum and it is not worthwhile to invest, it will be disasterous as new development will cease. Then we will fall back into the dark ages on medical care.
I do feel for the doctors. Their position is unenviable and they earn everything that they take home. Unfortunately, in this current political climate, health care has been used as a wedge between income groups for political gain.
I say, let's fix it but not have to change the entire economy to do so. Cover those who can not fend for themselves and help people in need as they need it. AND...make brand drugs generic on an accelerated scale. The lunches are a crumb compared to what they spend on research. On the surface it looks excessive to people like you and me, but in the scheme of things, it is pretty small.
Once again, I like your writing and appreciate you participating. I responded to your blog and enjoy your personal points of view. Thanks for participating and I look forward to lively debate!
Rightwing double speak and lies.
Your comments sound like Faux News talking points. Do you take your marching orders from Sean Hannity and Bill O'Reilly? You might have valid points, but your rightwinger speech is not convincing, Mr. Bunker. More times than not you have not done your homework and you cite rightwing sources. Often you sound like a true bigot.
Thanks Mike
Glad to see that you are continuing here to react in an emotional and angry way.
I took these facts from the legislation, not O'Reilly or Hannity. I am open minded and I am glad that you feel I have valid points.
Can you ever respond in a thoughtful way or is it always out of quick hits and knee jerk filled over reaction.
This isn't the Letters page on the Monitor where you have to condense thoughts into 200 words, you can make as many coherent points as possible and put them into a response that is rational.
I do my research and I do it thoroughly, taking into account both sides. Can you say the same?
On global warming, I have read Al Gore and The Politically Incorrect Guide to Global Warming, can you make the same claim...I doubt it...your mind is made up. Isn't that just as closed minded as those "fundamentalist Christians" and "religious zealots" that you always claim to find distasteful.
Disagreement is fine and it is enjoyable; name calling exposes ones true agenda and lack of intellectual ability to respond in a way that builds consensus. If we are ever going to unite this country, we need to be civil. I have opinions, YES, but I listen to others and give those ideas and thoughts a fair look.
As a liberal, where is your sense of 'inclusion' of points of view and understanding of 'diversity' of opinion. I guess those only apply if you agree with certain points of view.
I have explained and demonstrated that I am informed about all points of view, so does that make me a "bigot".
A bigot as defined by Websters is a person who is utterly intoleraant of any differing creed, belief or opinion.
A bigot as defined by the American Heritage Dictionary is one who is strongly partial to one's own group or politics and is intolerant of those who differ.
I am not a student of the English language but I think that definition might apply to those who are unwilling to take a look at both sides and become informed, understanding both points of view before making a decision. Sound's like that might apply to people who accuse and imply versus make valid points.
Bigot is used to describe anyone who is not politically correct or who disagrees with partisan zealots. It is a word that is constantly misused to stir an emotional response. After all; to every action there is a reaction and using the "b" word is the easy way out for those who are unable to express themselves.
Once again, thanks for responding but it would be great if you could respond more fully an explain your viewpoints. Debate requires that, not just innuendo and accusation. I know you are a smart guy. Give us all some points of view that we can chew on a bit!
Do I need a different
Do I need a different health insurance for these Mediterranean Cruises?
Bill,
You seem to have a misconception that anyone making $80K with a family of four would be accepted under this program. The SCHIP program threshold is just a ballpark estimate put forth by a politician wanting to kill it. The fact is that each family is considered on the merits of their financial situation. It may just be that someone making that much might actually be accepted if their family was suffering from expensive medical issues that would make their adjusted income that much lower.
I also have to take exception with your view that a universal plan would be illogical and that 17% of the population is all that this is about. You are missing the big picture here. We are all suffering from the plight of the healthcare issue. High pharmacy costs, expensive price tags for necessary life giving procedures. Its all around us. The healthcare system is run illogically as a profitable business with all the problems that entails. I am not saying universal healthcare is a social entitlement. But basic minimal healthcare for all is something that we shouldn't be putting a price tag on. Life is priceless whether its Bill Gates or a low income child in the projects with cancer. We cannot simply treat them both based on their wealth or income. This is where the system fails us. Many politicians on the right love to complain that its socialist heathcare. Universal healthcare is nothing close to that. It's simply saying that we won't turn away someone based their income or ability to repay the hospital for a lifegiving procedure.
And yes, your comment on illegal immigrants is politics. So are you saying that we should let those that are here illegally to die on the sidewalk if they show up at the hospital? That's exactly what you are allowing. The enforcement problem with illegal immigration is a political minefield that the far right enjoys to bring out whenever they don't like something. It doesn't belong in the healthcare debate.
Telling it like I see it,
Wynter