Beginning a discussion about health care

[EMUJeff]

Next to religion and abortion there are few issues of the day that incite more vitriolic rhetoric than the issue of Health Care. However, regardless of which side anyone may be on, and there are many sides as we will discuss, or if you haven't formed an opinion yet, the issue is present and urgently being discussed. Being informed on the issue from as many sides as possible will help in the dialogue as we as a nation come to a plan of action or inaction as the case may be.
Due to the volume of information regarding this I will present several items over 9 posts in this thread. I ask only that these posts be read so that we can all conversate from a similar place of understanding. In these posts I will not advocate for any particular system, but try to present the most common offerings of health care critics and government agencies. It is important to note that, by definition, many of these groups have axes to grind. Where possible I will present as much fact with as little rhetoric as possible, but it will not always be fully possible.
As a jumping off point, the following information comes from the U.S. Census Bureau, August 2007. Included is table 6 from page 21, a section titled "Income, Poverty, and Health Insurance Coverage in the United States: 2006."

Overview
The problem of the uninsured is continuing to grow. The federal government estimates that 47 million individuals lacked health insurance coverage of any kind during 2006. Other research shows that tens of millions more Americans go without health coverage for shorter periods of time.

Recent Census Bureau data demonstrate that the problem of the uninsured continued in 2006. According to figures released in August 2007, 47 million people -- 15.8 percent of the total U.S. population -- were uninsured in 2006, up slightly from 15.3 percent in the previous year.1
The percentage of the non-elderly population that is uninsured has climbed steadily from 15.9 percent in 1994 to 17.9 percent in 2006 (with a slight dip of no more than one percentage point around the turn of the century).2Percentage of Nonelderly Americans Without Health Insurance Coverage, 1987-2006
http://covertheuninsured.org/databank/charts2008/22.gif
Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1988-2007 Supplements.
Note: 1987-2003 data are adjusted for Census correction announced in March 2007.

[EMUJeff]

Here is some information about who the uninsured are...
Age & Gender
The likelihood of being uninsured varies by age and gender. Men are more likely to be uninsured than women. More than 22 percent of men are uninsured, while 18.1 percent of women are uninsured.1 As a result, men account for more of the uninsured than women. Uninsured Nonelderly Adult Population by Gender, 2006
http://covertheuninsured.org/databank/charts2008/36.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
As most elderly people are covered by Medicare, nearly all the uninsured are under age 65. Children are more likely to have coverage than non-elderly adults, which reflects their much higher rates of public coverage through Medicaid and SCHIP.
After age 25, the probability of being uninsured declines gradually with age and greater connection to the labor force.2Percentage Uninsured Among Nonelderly Adults by Age, 2006
http://covertheuninsured.org/databank/charts2008/18.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Near-elderly people, those ages 55 to 64, who consume more health care on average than younger adults, account for about one in eight uninsured non-elderly adults (10.8 percent).3 Among the uninsured population ages 55-64, nearly 6 in 10 were working, while 17.3 percent were retired.Near Elderly (ages 55-64) Uninsured Population by Main Activity, 2006
http://covertheuninsured.org/databank/charts2008/34.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

People ages 25 to 44 account for one-half of uninsured non-elderly adults.4Uninsured Nonelderly Adult Population by Age, 2006
http://covertheuninsured.org/databank/charts2008/35.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Sources
1Employee Benefit Research Institute, estimates from the March Current Population Survey, 2007 Supplement.
2Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
3Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
4Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[EMUJeff]

Race/Ethnicity

Relative to their numbers in the overall population, members of racial and ethnic minority groups make up a disproportionate share of the uninsured population. A variety of economic and social factors underlie these disparities. When differences in income, occupation, employment sector and firm size, education, health status, age, gender, citizenship status, and geography are statistically removed, two-thirds of the difference in uninsured rates between Hispanics and non-Hispanic Whites is eliminated.1
Non-Hispanic Whites constitute nearly two-thirds of the non-elderly population. However, they account for under one-half of the uninsured non-elderly population. Overall, 12.6 percent of non-Hispanic Whites were uninsured in 2006. In contrast, 22.8 percent of non-Hispanic Blacks were uninsured, and 35.7 percent of Hispanics were uninsured.2Percentage Uninsured Among the Nonelderly Population by Race and Ethnic Origin, 2006
http://covertheuninsured.org/databank/charts2008/17.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Compared to non-Hispanic Whites, African-Americans and Hispanics are less likely to work in jobs that make health insurance available, they are less likely to be offered health insurance when it is available, and they are less likely to take it when it is offered.3
The Hispanic population is younger than the population in general, and younger people are more likely to be uninsured. Thus, the age distribution of the Hispanic population contributes to their higher uninsured rate.4
Even at higher income levels (above 200 percent of the federal poverty level) African-Americans and Hispanics are more likely to be uninsured than non-Hispanic Whites.5
Sources
1Institute of Medicine, 2001, Coverage Matters: Insurance and Health Care. Washington, DC: National Academy Press, p. 96.
2Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
3Institute of Medicine, 2001, Coverage Matters: Insurance and Health Care. Washington, DC: National Academy Press, pp. 96-97.
4Institute of Medicine, 2001, Coverage Matters: Insurance and Health Care. Washington, DC: National Academy Press, p. 86.
5Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[EMUJeff]

In any discussion of the uninsured most agree that insuring our kids is a paramount importance. Here are the most recent statistics on this...
Children
Nearly twenty percent of uninsured Americans – 8.7 million individuals – are children. The likelihood that a child is uninsured has fallen from 13.9 percent in 1998 to 10.5 percent in 2004. It has since increased to 11.7 percent in 2006. While children are more likely to be insured than non-elderly adults, health insurance is particularly important for children. Uninsured children are more likely than insured children to lack a usual source of health care, to go without needed care and to experience worse health outcomes.1
Percentage of Children Under Age 18 Without Health Insurance, 1994-2006
http://covertheuninsured.org/databank/charts2008/23.gif
Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1995-2007 Supplements. Note: 1994-2003 data are adjusted for Census correction announced in March 2007.
Characteristics of Uninsured Children

More than one-third (35.8 percent) of uninsured children are White, compared to 38.9 percent Hispanic and 17.7 percent Black.2Uninsured Children by Race and Ethnic Origin, 2006
http://covertheuninsured.org/databank/charts2008/33.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Hispanic children are far more likely to be uninsured (22.1 percent) than non-Hispanic White children (7.3 percent), Black children (14 percent), and children from other races (11.9 percent).3
About 3 in 10 children (32 percent) without coverage are under six years old.4Uninsured Children by Age, 2006
http://covertheuninsured.org/databank/charts2008/32.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
Income and Family Employment

Almost 1 in 3 uninsured (29.9 percent) children live in families below the federal poverty line. Another one-third (31.4 percent) live in families making between 100 percent and 200 percent of the federal poverty line.5Uninsured Children by Family Poverty Status, 2006
http://covertheuninsured.org/databank/charts2008/15.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

More than two-thirds (68.4 percent) uninsured children live in households in which the family head is employed full-time throughout the year,6 while only 15.8 percent of all uninsured children live in households headed by a family head who did not work the previous year.7

[EMUJeff]

Uninsured Children by Work Status of the Family Head, 2006
http://covertheuninsured.org/databank/charts2008/45.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
Sources of Coverage

11.7 percent of children – or 8.7 million – are uninsured.8 An estimated 5 million uninsured children are eligible for Medicaid or SCHIP but are not enrolled.9
57.1 percent of children – 42.3 million – are covered through employment-based health insurance.10
In 2006, an estimated 22.1 million children – or nearly 3 in 10 (29.8 percent) – were covered by a public source of health insurance.11
Of these children, an estimated 20.1 million were enrolled in Medicaid, a public health insurance program that covers low-income children, financed through federal and state governments, or the State Children's Health Insurance Program.12
During 2006, an estimated 6.9 million children were enrolled in the State Children's Health Insurance Program (SCHIP) –which includes Medicaid expansion and separate state programs. (SCHIP was created in 1997 to cover children who live in families with income or resources that exceed Medicaid eligibility limits but who cannot afford private coverage. Like Medicaid, SCHIP is financed by a combination of federal and state funds.)13
The decline in employment-based coverage of children between 2000 and 2005 was offset by an increase in public coverage though Medicaid or SCHIP.14
In 1997, when SCHIP was created, about 22 percent of low-income children (living in families with incomes below 200 percent of the federal poverty line) were uninsured. By 2006, 18.2 percent were uninsured.15 This success is attributable to enrollment in SCHIP and increased enrollment of poor children in Medicaid (through outreach as well as simplified and improved enrollment processes).Uninsured Children by Family Head Characteristics
The likelihood of a child being uninsured is highly correlated with the education level of the family head, and the firm size of the family head, and varies with the industry, occupation, work status, and work hours of the family head.

More than one-third of children whose family head did not receive a high school diploma are uninsured as compared to 5.6 percent among children whose family head received a graduate or professional degree.Percentage of Children Uninsured by Family Head's Education, 2006
http://covertheuninsured.org/databank/charts2008/47.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

More than 84 percent of uninsured children are in a family with a working family head. More than two-thirds of uninsured children have a family head employed on a full-time, full-year basis.Distribution of Uninsured Children by Work Status of Family Head, 2006
http://covertheuninsured.org/databank/charts2008/46.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Children are more likely to be uninsured the lower the number of hours worked by the family head. Less than 15 percent of children were uninsured when the family head worked full-time, full-year, while over one-quarter of children were uninsured when the family head was employed part-time, part-year.Percentage of Children Uninsured by Family Head's Hours of Work, 2006
http://covertheuninsured.org/databank/charts2008/51.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Continued below...

[EMUJeff]

Nearly 2 in 10 children are uninsured if their family head is employed in the personal services sector. This compares with 12.5 percent uninsured in the manufacturing sector, and 4.9 percent in the public sector. Percentage of Children Uninsured by Family Head's Industry, 2006

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Less than 10 percent of children are uninsured if their family head is employed in a managerial or professional occupation. This compares with 26.7 percent uninsured in construction, extraction, and maintenance occupations. Percentage of Children Uninsured by Family Head's Occupation, 2006

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Nearly 3 in 10 children are uninsured if their family head is employed by a firm with fewer than 10 workers. This compares with 9.2 percent uninsured among children whose family head is employed by a firm with 1,000 or more workers. Percentage of Children Uninsured by Family Head's Firm Size, 2006

Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Sources
1Institute of Medicine, 2002, Health Insurance is a Family Matter. Washington, DC: National Academy Press, p. 111.
2Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
3Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
4Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
5Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
6Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
7Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
8Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
9coveringkidsandfamilies.org/press/releases/index.php?PressReleaseID=14 (http://coveringkidsandfamilies.org/press/releases/index.php?PressReleaseID=14). Accessed April 23, 2007.
10Employee Benefit Research Institute estimates from the March Current Population Survey, March 2006 Supplement.
11Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement. Because some children transition in and out of public programs, these numbers reflect the average number of children enrolled throughout the year (also known as "person years," rather than the number of children ever enrolled throughout the year.
12Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

13www.cms.hhs.gov (http://www.cms.hhs.gov/CapMarketUpdates/Downloads/2006CMSstat.pdf). Accessed April 23, 2007. 14Fronstin, Paul. "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2007 Current Population Survey," October 2007 EBRI Issue Brief Number 310, Figure 2.
15Employee Benefit Research Institute estimates from the March Current Population Survey, 1998 and 2007 Supplements.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[Harrison]

EMUJeff,

This is a hot topic to me! I thank you for bringing this subject to the forefront. Please let us know when you are finished posting and ready to begin discussion.

Harrison

[EMUJeff]

That all being said we need to think about what impact this issue has on us. The cost issue is part of it.
Life Span
As people live longer the life long cost of health care increases as the population increases. Also, more health issues that can now be addressed in the elderly mean that people live longer on maintainance medications and with chronic conditions, all requiring payment. This is not an arguement for "Logan's Run" style societies, but an issue the is before us and under reported.

Hospital issues
When an uninsured person doesn't have access to health care, for whatever reason, they are much less likely to seek preventative care. At some point issues such as diabetes or heart conditions create emergant situations and the person is seen in the hospital at greater cost. Not often noted is that these visits aren't "free" for the uninsured. they are charged for the visit and their care is given on a shoestring. By law, ER's are only required to stablize the patient. This means the patient leaves the hospital, in the case of heart disease or diabetes, stabalized with a bill and, normally, a prescription for maintainence medication which will, likely, never be filled. If the bill can not be paid in a timely fashion the hospital must recover the cost from those who are insured. Therefore, prices increase for both the insured and uninsured. Hospitals are also faced with paymient issues from medicare for the elderly and medicaid from the preelderly who are qualified for it. Both Medicare and Medicaid set the prices for proceedures often much lower than the hospitals price. This shortfall also goes into the prices we pay. For this reason, many hospitals in some areas have stopped offering ER care.

The nature of insurance
Most insurance companies are "for profit" organizations. They therefore logically set rates based on expected cost risks for the people they insure in a given year and add a percentage to provide for administrative costs and a profit. This automatically means that health care insurance costs more than the health care actually does. Their costs also increase yearly as more uninsured increase the costs being passed on to them.
This industry is heavily regulated but there are still no lack of companies ready to provide insurance to groups or, more profitably, to individuals, who are set at a higher risk.

Health Care Provider's issues
Doctors, clinics, labs and hospitals, have more than the cost of uninsued and medicare/medicaid shortfalls to consider. The cost of malpractice insurance for their practices increases as litigation increases. One way to battle this is to increase the number of safety net proceedures ordered. Though a doctor may know with a high degree of certainty the diagnosis for a patient, they will often order workups and tests to confirm their diagnosis. This is not because they are unsure of the diagnosis, but so if they are sued they can show they took every reasonable step to confirm their diagnosis. This leads to increase burden on the patient's insurance company which leads to increase premiums.

These are some of the cost issues that play into the cost of health care in this country.
EMUJeff
Stay with me, we're almost done.

[EMUJeff]

Lastly, let's consider the actual current cost of Health Care to this country, business, private, and government included.
National Spending on Health Care
Health care spending in the United States has grown rapidly since the 1960s, at an average rate of 10 percent a year.

In 2006, over $2.1 trillion was spent on health care in the United States. The amount of money spent on health care is expected to increase to nearly $4.3 trillion by 2017.1
Spending on health care accounted for 16 percent of Gross Domestic Product (GDP) in 2006. By 2017, the Center for Medicare and Medicaid Services (CMS) projects that health care will account for about 20 percent of GDP.2 National Health Expenditures (NHE), Aggregate and Share of Gross Domestic Product (GDP), 1960-2017

Source: Source: Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services and U.S. Department of Commerce. (2006-2016 data are projected.)
While health care spending has been increasing, the distribution of health care spending among different services has been changing.

Since the 1980s, the percentage of health care spending for hospital care has declined. In 1980, hospital care accounted for 40 percent of all health care spending. By 2004, it accounted for 30 percent, and is expected to remain at roughly 31 percent between now and 2017.3
By contrast, the share of spending for physician and other professional services rose over the same time period, from 27 percent of in 1980 to 28 percent in 2005. It is expected to fall slightly to 26 percent through 2017.4
The share of health care spending accounted for by prescription drugs increased from 5 percent in 1980 to 10 percent in 2005, and is expected to reach 12 percent in 2017.5 Distribution of National Health Expenditures, by Type of Expenditure, 1960-2017

Source: Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services. (2006-2017 data are projected.)
The share of private health care spending that health insurance covers has more than doubled since the 1960s.

In 1960, health insurance paid covered 36 percent of private health spending, while individuals covered the remaining 64 percent out of their own pocket. By 2006, health insurance accounted for 77 percent of private health spending, while out-of-pocket spending accounted for 23 percent of spending.6 Out-of-Pocket Spending as a Percent of Total Private Spending, 1960-2017

Source: Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services. (2006-2017 data are projected.)
The cost of providing health care services has been increasing faster than the Gross Domestic Product (GDP) since 1998, but the gap between the two declined recently as the economy recovered from recession and health care costs grew more slowly.

During 2001, health care costs increased 11.3 percent, while GDP increased by only 2.1 percent. By 2006, health care costs increased 7.7 percent, compared to 5.9 percent GDP growth.7 Annual Growth Rates for Spending on Health Care Services and Gross Domestic Product (GDP), 1998-2006

Source: Bradley C. Strunk, Paul B. Ginsburg, and John P. Cookson. "Tracking Health Care Costs: Declining GrowthTrend Pauses In 2004." Health Affairs Web Exclusive, June 21, 2005; and Ginsburg, Paul B., Bradley C. Strunk, Michelle I. Banker, and John P. Cookson. "Tracking Health Care Costs: Continued Stability But At High Rates In 2005.." Health Affairs Web Exclusive, Oct. 3, 2006.
Continued...

[EMUJeff]

Recent spending on health care services has slowed for all categories of health care, but cost increases for hospital outpatient services and prescription drugs continue to outpace those for inpatient and physician services.
Annual Per Capita Percentage Change in Health Care Services, by Category of Service, 2001-2006

Source: Bradley C. Strunk, Paul B. Ginsburg, and John P. Cookson. "Tracking Health Care Costs: Declining GrowthTrend Pauses In 2004." Health Affairs Web Exclusive, June 21, 2005; and Ginsburg, Paul B., Bradley C. Strunk, Michelle I. Banker, and John P. Cookson. "Tracking Health Care Costs: Continued Stability But At High Rates In 2005.." Health Affairs Web Exclusive, Oct. 3, 2006.

Sources
1Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services and U.S. Department of Commerce.
2Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services and U.S. Department of Commerce.
3Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services.
4Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services.
5Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services.
6Employee Benefit Research Institute estimates from Centers for Medicare and Medicaid Services.
7Strunk, Bradley C., Paul B. Ginsburg, and John P. Cookson. "Tracking Health Care Costs: Declining Growth Trend Pauses In 2004." Health Affairs Web Exclusive, June 21, 2005; and Ginsburg, Paul B., Bradley C. Strunk, Michelle I. Banker, and John P. Cookson. "Tracking Health Care Costs: Continued Stability But At High Rates In 2005." Health Affairs Web Exclusive, Oct. 3, 2006.
Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

Here endeth the primer. Let's discuss the myriad of ways we can deal with the cost of health care in this country in as efficient, economic, and with as much humanity as possible. I think we all agree that we would rail against a two tiered system, were it imposed. But it is my contention that we have one now. How can we resolve this issue properly?
EMUJeff
Special thanks to my friends at the Research Institute and the user friendly tutorial by the 'Cover The Uninsured" a project of the Robert Wood Johnson Foundation whose goal is to educate people about the issue and options.
Okay, go at it...

[EMUJeff]

Here are five views of Health Care options for individuals beginning with the one many of us are most familiar with, Employer provided health care... from the Cover the Uninsured website...

Employment-Based Coverage
Average annual increases in health insurance premiums for all firms escalated from 0.8 percent in 1996 to 13.9 percent in 2003, but then declined to 6.1 percent in 2007.1 Over approximately the same period, the percentage of workers without health insurance increased from 16.0 percent in 1996 to 18.8 percent in 2006, with workers accounting for 27.6 million of the 46.5 million uninsured.2
Percentage of Nonelderly Adult Workers Without Health Insurance, 1987-2006
http://covertheuninsured.org/databank/charts2008/21.gif
Source: Employee Benefit Research Institute estimates from the Current Population Survey, March 1988-2007 Supplements.
Almost one-half (49.2 percent) of all non-elderly, adult uninsured workers work in firms with fewer than 25 employees.3
Nonelderly Adult Uninsured Workers by Firm Size, 2006
http://covertheuninsured.org/databank/charts2008/43.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
Almost all employers with more than 200 workers offer health benefits (99 percent in 2007). In contrast, 45 percent of firms with three to nine employees offered health insurance in 2006.4
Percentage of Employers Offering Health Benefits by Firm Size, 1996-2007
http://covertheuninsured.org/databank/charts2008/44.gif
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits.
Uninsured rates among workers generally decline as firm size increases (from over 35 percent for those at firms with fewer than 10 employees to 13 percent for those at firms with 1,000 or more employees). Self-employed people, however, have a lower uninsured rate than employees in firms with fewer than 10 employees (26.9 percent vs. 35.4 percent).5
Higher-wage workers (those earning $15 per hour or more) in small firms tend to be offered health insurance at rates close to those of large firms.6
Although small and large firms differ with respect to offer rates, those that provide health insurance have similar eligibility, take-up and coverage rates.7
The self-employed and employees at very small firms (with fewer than 10 workers) account for more than one-third (34.2 percent) of all uninsured workers.8
One in five uninsured workers (22.4 percent) are employed in firms with 500 or more employees.9
2005 data indicate that only 20.9 percent of uninsured workers were eligible for health benefits from their employer in that year. Another 16 percent of uninsured workers were employed by a firm that offers health benefits but they were not eligible for them (often because they work under the minimum number of hours required for eligibility). The remainder (63.1 percent) of uninsured workers were employed by a firm that did not offer insurance.10

Sources
1The Kaiser Family Foundation and Health Research and Educational Trust, "Employer Health Benefits," 2007 Annual Survey.
2Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
3Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
4The Kaiser Family Foundation and Health Research and Educational Trust, "Employer Health Benefits," 2007 Annual Survey.
5Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
6Lee, Jason S. "Are Health Insurance Premiums Higher for Small Firms?" Research Synthesis Report No. 2, September, 2002. The Robert Wood Johnson Foundation, p 4; and The Kaiser Family Foundation and Health Research and Educational Trust, "Employer Health Benefits," 2005 Annual Survey.
7Lee, Jason S. "Are Health Insurance Premiums Higher for Small Firms?" Research Synthesis Report No. 2, September, 2002. The Robert Wood Johnson Foundation, p.6; see also www.kff.org/insurance/ehbs2003-5-set.cfm (http://www.kff.org/insurance/ehbs2003-5-set.cfm), accessed 3/19/04.
8Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
9Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
10Fronstin, Paul. "Employment-Based Health Benefits: Access and Coverage, 1988-2005," March 2007, EBRI Issue Brief No. 303, p. 13 and Figure 11.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[EMUJeff]

Source of Coverage
Employment-based health insurance continues to be the predominant source of coverage for the non-elderly population.

Almost two-thirds (62.7 percent) of the non-elderly population had employment-based health insurance in 2006. About one-half (31.9 percent) were covered in their own name and about one-half (30.3 percent) received coverage as a dependent.1
Only 6.8 percent of the non-elderly population purchases insurance in the individual market (otherwise known as the non-group market).2
17.5 percent of the non-elderly population gets coverage from public sources (Medicaid, Medicare, and the health care systems for active and retired military personnel and their families).3
In 2006, 46.5 million (17.9 percent) non-elderly people were uninsured.4
A national survey conducted in 2003 found that almost six in 10 uninsured adults (59 percent) have been without health insurance for two years or more.5Health Insurance Coverage of Nonelderly Americans, by Source of Coverage, 2006
http://covertheuninsured.org/databank/charts2008/25.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Sources
1Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
2Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
3Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
4Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
5Kaiser Family Foundation, A Primer on the Uninsured, 2003, p. 5. Data are from the Kaiser 2003 Health Insurance Survey.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[EMUJeff]

Here is a bit on the "Legacy" costs which have dogged the auto industry and others in this state when the company provides health care into retirement.

Industry and Occupation
More than one-third (36.3 percent) of workers employed in agriculture, forestry, fishing, mining and construction are uninsured, compared to 22.5 percent in personal services, 18 percent in wholesale and retail trade, 15.1 percent in manufacturing and 6.1 percent in the public sector. Workers in wholesale and retail trade and personal services account for 61.4 percent of all uninsured workers.1
Nonelderly Adult Uninsured Workers by Industry, 2006
http://covertheuninsured.org/databank/charts2008/41.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
The uninsured are disproportionately concentrated in blue collar jobs. Whereas about one-quarter of the workforce is employed in such jobs as construction, transportation, maintenance and farming, these workers account for 35.3 percent of all uninsured workers.2
Nonelderly Adult Uninsured Workers by Occupation, 2006
http://covertheuninsured.org/databank/charts2008/42.gif
Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Sources
1Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.
2Employee Benefit Research Institute estimates from the March Current Population Survey, 2007 Supplement.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[EMUJeff]

How coverage affects the amount of preneed care obtained by people...
Health Behavior
Health insurance coverage is an important predictor of whether individuals obtain health-promoting and life-extending health screenings.

The American Cancer Society and other groups recommend that "...women who are, or have been sexually active, or have reached age 18 years, have an annual Pap test and pelvic examination. After a women has had three or more consecutive satisfactory normal annual examinations, the Pap test may be performed less frequently at the discretion of her physician."1 Data from 2005 show that insured working women, ages 18-64, are far more likely to have had a Pap smear within the last year than working women in the same age group without insurance (65 percent versus 45 percent, respectively).2Time Since Last Pap Smear, Female Adult Workers by Insurance Status, 2005
http://covertheuninsured.org/databank/charts2008/37.gif
Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey.

The American Cancer Society recommends that women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.3 Among female workers ages 30-64, 45.6 percent of insured women had a mammography within the past year whereas only 25 percent of uninsured women had.4
Data from 2005 also show that insured working men are far more likely than uninsured working men of the same age to have had a PSA test.Time Since Last Mammogram, Female Workers Ages 30-64, by Insurance Status, 2005
http://covertheuninsured.org/databank/charts2008/38.gif
Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey.
Time Since Last Prostate Specific Antigen (PSA) Test, Male Workers Ages 39-64, by Insurance Status, 2005
http://covertheuninsured.org/databank/charts2008/39.gif
Source: Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey.

Sources
1American Cancer Society, www.cancer.org, accessed 2/10/2004.
2Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey.
3American Cancer Society, www.cancer.org, accessed 2/10/2004.
4Employee Benefit Research Institute estimates from the 2005 Medical Expenditure Panel Survey.

Please note that EBRI's analysis defines children as individuals ages 0-17, whereas other sources may define children as ages 0-18. This difference accounts for the variance between the reported numbers of uninsured children, depending on the source and method of analysis.

[EMUJeff]

Really, I'm done this time.
Honestly,
EMUJeff

[Harrison]

Excellent, excellent Topic and Research, Jeff. This is a topic near and dear to my heart.

My input may have to come in "parts" as well; we'll see how it goes.

[Harrison]

Men are more likely to be uninsured than women.

This is SO true. There is a great misconception about this very fact. So many people ASSUME that if you're a guy, you are insured. I don't know if it's because it is assumed that the man has the better job--who knows. But I know for a fact that in discussions years ago, I would mention that "John Doe" doesn't have insurance and I cannot tell you how many times I heard, "What do you mean he doesn't have insurance??? He's working, isn't he?"

[Harrison]

More than two-thirds (68.4 percent) of uninsured children live in households which the family head is employed full-time.

Again, so true.

My children went years without medical insurance. If they got sick, I had to try to get them better myself. If it got really bad, I had to take them to the emergency room, which was always at least $300-$500 and this was in the 1970s-1980s. Of course, I was unable to pay it and then got hounded for the unpaid bills.

In the 1980s, I found a "free" clinic for a little while in Sumpter Township where they got their immunization shots and basic dental care. It was REALLY basic, but at least they got a cleaning (such as it was) and an occasional filling and they were caught up with their immunization shots.

[Harrison]

Hospital issues
Not often noted is that these visits aren't "free" for the uninsured. they are charged for the visit and their care is given on a shoestring. By law, ER's are only required to stablize the patient. This means the patient leaves the hospital, in the case of heart disease or diabetes, stabilized with a bill and, normally, a prescription for maintainence medication which will, likely, never be filled. If the bill can not be paid in a timely fashion the hospital must recover the cost from those who are insured. Therefore, prices increase for both the insured and uninsured. For this reason, many hospitals in some areas have stopped offering ER care.



This is true, sometimes.

I have two (2) very different experiences with hospitals---one with me years ago and one with my youngest son only a couple of years ago.

Me: I was uninsured at the time and I had developed pneumonia. I was really having trouble breathing so I went to what was then Westland Medical Center on Merriman (formerly Wayne County Hospital). As soon as they found out that I had no insurance, they said they could not treat me and that I would have to leave. I couldn't believe it! I said I am having trouble breathing. It didn't matter. They sent me on my way. I didn't know about Detroit Receiving where you could go as an "indigent" and they would treat you. So I just went home. I was so sick that I couldn't take care of my kids. I had to have my sister move in with me. I was in bed sick for a month and lost 25 pounds. I actually got to the point where I wondered if I was going to get better or not. I was really frightened for my children. Slowly and gradually, I was able to eat and drink and got my strength back. I will never, never forget that experience.

My son: A couple of years ago, my son was working as a court officer at the City of Southgate. He was a full-time employee with no medical insurance. He began having chest pains at work that would not go away. The other court officers sent him next door to the Fire Department where they took his blood pressure. It was elevated. When my son mentioned that he had lost a parent at age 29 of a heart attack (my son was 27 at the time), they told him he'd better go to the hospital immediately. But did THEY take him? No, they called an ambulance.

They took him to Henry Ford Wyandotte. They ran a whole gamut of tests on him after asking him where he worked and he informed them he had no insurance. All of the tests came back negative. They kept him overnight. The next day, they ran all of the tests again. Still negative. They kept him 2 1/2 days, despite the fact that all of the tests were negative.

The bill? Over $17,000 dollars--this RUINED MY SON FINANCIALLY. He is now in the process of filing bankruptcy.

Now we all know that if my son had insurance at the time, the hospital would have sent him home that very night or the next morning. There is NO WAY the insurance company would have allowed the hospital to keep him there for 2 1/2 days, let alone run the same tests over and over.

[Harrison]

Health Care Provider's issues
Doctors, clinics, labs and hospitals, have more than the cost of uninsued and medicare/medicaid shortfalls to consider. The cost of malpractice insurance for their practices increases as litigation increases. One way to battle this is to increase the number of safety net proceedures ordered. Though a doctor may know with a high degree of certainty the diagnosis for a patient, they will often order workups and tests to confirm their diagnosis. This is not because they are unsure of the diagnosis, but so if they are sued they can show they took every reasonable step to confirm their diagnosis. This leads to increase burden on the patient's insurance company which leads to increase premiums.



It is my understanding from speaking with Canadian citizens that they don't sue their doctors. Hence, there would be little or no need for medical malpractice insurance if we had socialized medicine in this country.

[Harrison]

Employment-Based Coverage
Average annual increases in health insurance premiums for all firms escalated from 0.8 percent in 1996 to 13.9 percent in 2003, but then declined to 6.1 percent in 2007.


This is certainly NOT true in my case. Every year, my premium has gone up and this year (2008), my prescription co-pay has taken a big jump. Name-brand prescriptions went from a $40 a month co-pay to a $50 a month co-pay (25 percent increase). The same for generic.

I was able to find my generic medication cheaper at Wal-Mart for $10 instead of $20 (now $30). However, that $10 is now $15, which is a 50 percent increase.

[Harrison]

As far as the "well care" for men and women, I have found that really biased in many insurance plans.

At my firm, men's well care (such as prostate exams) is fully covered. However, women's well care is not. The women are required to meet the deductible before the insurance starts kicking in at "80 percent." I have a coworker whose out-of-pocket expense for her mammogram is $250!!!! Yet, a male coworkers exam for his prostate is fully covered.

Also, it is rare that birth control pills or other contraceptives for women are covered. I don't get that.

[Harrison]

What also needs to be addressed is gouging of the medical insurance plans by unscrupulous doctors, clinics, and hospitals.

I already explained my son's scenario, so that covers my hospital point.

A number of years ago, the mole on my face became inflamed so I had to go get it checked out to make sure that it wasn't cancer or anything.

While I was there, they put this scope down my throat. For what, I had no idea.

I go to "checkout" and see on my invoice that there is a $90 charge for this scope they crammed down my throat. I said WTH--I'm not paying for this! This has nothing to do with why I came in here. They tell me, don't worry, we charge the insurance company for that---we give that test to ALL our patients.

[Scotto]

The bill? Over $17,000 dollars--this RUINED MY SON FINANCIALLY. He is now in the process of filing bankruptcy.


EMUJeff;
Great job covering this topic, well done!
I recently had my knee operated on which took a day in the hospital, there was also a few preliminary appointments and a couple after the surgery, total cost was $0.
I never worry about the cost when my kids get sick or hurt, it's all taken care of.
Many countries have health care, but not the US???

[Harrison]

EMUJeff;
Great job covering this topic, well done!
I recently had my knee operated on which took a day in the hospital, there was also a few preliminary appointments and a couple after the surgery, total cost was $0.
I never worry about the cost when my kids get sick or hurt, it's all taken care of.
Many countries have health care, but not the US???

Scotto,

I appreciate your comments. It is amazing to me that a country as wealthy and wasteful as the USA does not have universal health care. This is an issue near and dear to my heart because I truly believe that universal health care in the U.S. is the answer. Costs could be capped.

What they are trying to push at companies now (including my own) is a Health Savings Account (HSA), which is set up like an Individual Retirement Account (IRA). You save your own money towards your health care and eventual long-term care. I don't like this idea, because our costs for everyday living (without luxuries) has become so high now, it is nearly impossible to save for this, even though it is so important. I have to do more investigating on it, but I believe that you can be penalized with the HSA like you can with an IRA if you withdraw too soon, but I need to find out about that.

[Harrison]

Are you really covered?

Why 4 in 10 Americans can’t depend on their health insurance

Consumer Reports
September 2007

You might think that you don’t have to worry about paying for medical care if you have health insurance. But you would be wrong.
From escalating medical debt to postponed retirement, our exclusive national survey of working-age adults shows the depth of jitters even for those lucky enough to have insurance through their jobs or families:

29 percent of people who had health insurance were “underinsured,” with coverage so meager they often postponed medical care because of costs.
49 percent overall, and 43 percent of people with insurance, said they were “somewhat” to “completely” unprepared to cope with a costly medical emergency over the coming year.
20 percent of people said they were so disappointed with their HMO or PPO that they wanted to switch plans.
16 percent had no health plan at all, including many working respondents whose jobs didn’t offer insurance, or who couldn’t afford the premiums or deductibles of the available plan.Insured but not covered

Our survey found evidence of the increasing frailty of our system of health insurance almost everywhere we looked.
Between 2001 and 2005, the percentage of middle-income families - those who earn between $40,000 and $80,000 for a family of four - who had job-based health coverage dropped by 4 percentage points. Half lost benefits because their employers dropped health insurance altogether or quit offering dependent coverage. But 15 percent gave up their employer-based insurance because they could no longer afford the premiums.
But even those who have managed to hang on to insurance have found it more difficult to pay their medical bills.
In our survey, the median household income of respondents who were underinsured was $58,950, well above the U.S. median; 22 percent lived in households making more than $100,000 per year.
An explanation isn’t difficult to find: Health plans are offloading more and more expenses onto consumers. Co-pays and deductibles have risen steadily in the past several years.
This combination of deductibles and co-pays can quickly add up to serious bills in the case of a major illness. A 2006 study found that 10 percent of insured patients with cancer had out-of-pocket expenses of more than $18,500.

How to pay?

Consumers faced with higher health costs have to find the money somewhere, and many in our survey found that tough to do. Overall, 37 percent said their health insurance and checking accounts together weren’t enough to pay for their medical expenses over the previous year. But 59 percent of underinsured respondents fell in that category. They had to raid their retirement accounts, run up credit-card balances, and borrow from friends and family to pay their medical bills. Twenty-seven percent said they were still in debt to doctors and hospitals, and 3 percent said medical bills had forced them to declare bankruptcy.
Almost 4 in 10 underinsured respondents deferred needed auto or home repairs. Almost 3 in 10 said they made decisions such as changing jobs, postponing retirement, or changing their marital status mainly to preserve access to health insurance.

But the most worrisome result of underinsurance is reduced access the health care itself. Forty-three percent of underinsured respondents said they had postponed going to the doctor because they couldn’t afford it, and 28 percent had put off filling prescriptions.

http://www.consumerreports.org/cro/index.htm (http://www.consumerreports.org/cro/index.htm) (subscription required)

[Harrison]

How many times have you been at the pharmacy counter anywhere and you are standing behind some old lady and the pharmacist or technician says to her, "Mrs. X, that will be $543 (or $735 or whatever)." The senior citizen stands there, obviously in the state of shock, like a deer in the headlights! I'm just as stunned as she is!!!! This is likely as much or more than what they receive monthly in their Social Security check!

The old lady proceeds to say, "Well, can I have maybe 4 of them? How much would that cost?"

I have witnessed this scenario at least a half-dozen times. It breaks my heart because I wish I could just hand this old lady the money and say, "here you go," but I can't. I don't have the money, either!

[Harrison]

I have someone in my family who went for a mammogram on January 9, 2008. That evening, she received a telephone call from the clinic advising her that she needed to come back for a re-test because something came up on the mammogram.

She was told that they would "just use the same prescription from the original mammogram" so not to worry. For those of you who don't know, you need an Rx script from your regular doctor to go to radiology to have this done.

So, five days later, on January 14, 2008, she went back for the re-test and thank God, it turned out to be nothing. What had happened was they hadn't gotten the breast flat enough on the surface and some tissue was overlapping other tissue, thereby creating a sort of shadow.

Well, that's great news, right?

Well, now the bills have all come in. She is being charged for out-of-pocket expenses for two mammograms. So the crock about "don't worry, we'll just use the same prescription" is a load of bull.

[Harrison]

I have a coworker who has an 8 year old stepson with Down Syndrome.

He has been rejected over and over by various insurance companies who refuse to cover him and his family due to his son's preexisting condition.

He is currently paying $1,500 a month for health insurance (he is a contractor employee in our accounting department). His son was taking speech development classes beginning last year in 2007. For the first four months, his insurance carrier paid for the classes without incident. After the fourth month, they stopped paying.

His insurance carrier failed to inform him of this and on the last day of the year, December 31, 2007, he received a letter from his insurance carrier indicating that not only were they ceasing to cover his son's speech development sessions, but they were terminating his insurance, and demanding payment from him for the four months they paid in early 2007.

He is currently trying to obtain legal services to take them to court. Meanwhile, he is unable to find insurance for his son.

[Harrison]

Obviously, the pharmaceutical companies and insurance companies are making HUGE PROFITS and have very strong lobbies and are not about to let go of their reins without a fight.

It is no longer about medicine. It is about business and profit.

[Harrison]

It is my understanding from speaking with Canadian citizens that they don't sue their doctors. Hence, there would be little or no need for medical malpractice insurance if we had socialized medicine in this country.

Strike that "socialized medicine" and replace that with "national health care." My future posts will explain why.

[Harrison]

Busting the Myths about Canada's Health Care System

What Our Country Does Not Want Us to Know

1. Canada’s health care system is “socialized medicine.”

False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.
The proper term for this is “single-payer insurance.” In talking to Americans about it, the better phrase is “Medicare for all.”

2. Doctors are hurt financially by single-payer health care.

True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:

First, as noted, they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself/himself in the course of a standard workday.

Second, they don’t have to spend several hours every day on the phone nagging insurance company bean counters into doing the right thing by their patients. A doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. A Canadian doctor, on the other hand, works a 35-hour week, period.

Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor’s debt is roughly half that.

Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a family’s major expenses, expectations tend to run very high. A doctor’s mistake not only damages the body; it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, it’s no wonder people are quick to rush to court for redress.

Canadians are far less likely to sue in the first place, since they’re not having to absorb devastating financial losses in addition to any physical losses when something goes awry. The cost of the damaging treatment will be covered. So will the cost of fixing it. And, no matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards don’t have to include coverage for future medical costs, which reduces the insurance company’s liability.

3. Wait times in Canada are horrendous.

True and False again — it depends on which province you live in, and what’s wrong with you. Canada’s health care system runs on federal guidelines that ensure uniform standards of care, but each territory and province administers its own program. Some provinces don’t plan their facilities well enough; in those, you can have waits. Some do better. As a general rule, the farther north you live, the harder it is to get to care, simply because the doctors and hospitals are concentrated in the south. But that’s just as true in any rural county in the U.S.

4. You have to wait forever to get a family doctor.

False for the vast majority of Canadians, but True for a few. Again, it all depends on where you live. I live in suburban Vancouver, and there are any number of first-rate GPs in my neighborhood who are taking new patients. If you don’t have a working relationship with one, but need to see a doctor now, there are 24-hour urgent care clinics in most neighborhoods that will usually get you in and out on the minor stuff in under an hour.

It is, absolutely, harder to get to a doctor if you live out in a small town, or up in the territories. But that’s just as true in the U.S. — and in America, the government won’t cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do.

5. You don’t get to choose your own doctor.

Absolutely False. Somebody, somewhere, is getting paid a lot of money to make this kind of stuff up. The cons love to scare the kids with stories about the government picking your doctor for you, and you don’t get a choice. Be afraid! Be very afraid!

For the record: Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the country’s top specialists that rich ones do.

6. Canada’s care plan only covers the basics. You’re still on your own for any extras, including prescription drugs. And you still have to pay for it.

True — but not as big an issue as you might think. The province does charge a small monthly premium (one wrote that theirs is $108/month for a family of four) for the basic coverage. However, most people never even have to write that check: almost all employers pick up the tab for their employees’ premiums as part of the standard benefits package; and the province covers it for people on public assistance or disability.

7. Canadian drugs are not the same.

More preposterous bull. They are exactly the same drugs, made by the same pharmaceutical companies, often in the same factories. The Canadian drug distribution system, however, has much tighter oversight; and pharmacies and pharmacists are more closely regulated. If there is a difference in Canadian drugs at all, they’re actually likely to be safer.

Also: pharmacists here dispense what the doctors tell them to dispense, the first time, without moralizing. I know. It’s amazing.

8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.

False!! The papers would have a field day if there was even a hint that this might be true.

One of the things that constantly amazes me here is how well-cared-for the elderly and disabled in Canada are. No, these people are not being thrown out on the curb. In fact, they live longer, healthier, and more productive lives because they’re getting a constant level of care that ensures small things get treated before they become big problems.

The health care system also makes it easier on their caregiving adult children, who have more time to look in on Mom and take her on outings because they aren’t working 60-hour weeks trying to hold onto a job that gives them insurance.

9. People won’t be responsible for their own health if they’re not being forced to pay for the consequences.

False. The philosophical basis of America’s privatized health care system might best be characterized as medical Calvinism. It’s fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for one’s own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For One’s Own Health.

They’ll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to a regimen of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, you’ll never get sick. (Like all good theologies, there’s even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it’s a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can’t complain. It was their own darned fault; and it’s not our responsibility to pay for their sins. In fact, it’s recently been suggested that they be shunned, lest they lead the virtuous into sin.

Of course, this is bad theology whether you’re applying it to the state of one’s soul or one’s arteries. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us — even the most careful of us. The economics of the Canadian system reflect this very different philosophy: it’s built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.

This difference is expressed in a few different ways. First: Canadians tend to think of tending to one’s health as one of your duties as a citizen. You do what’s right because you don’t want to take up space in the system, or put that burden on your fellow taxpayers. Second, “taking care of yourself” has a slightly expanded definition here, which includes a greater emphasis on public health.

Canadians are serious about not coming to work if you’re contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they’re still small and cheap to fix.

Third, there’s a somewhat larger awareness that stress leads to big-ticket illnesses — and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there’s a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.

10. This all sounds great — but the taxes to cover it are just unaffordable. And besides, isn’t the system in bad financial shape?

False. On one hand, our annual Canadian tax bite runs about 10% higher than our U.S. taxes did. On the other, we’re not paying out the equivalent of two new car payments every month to keep the family insured here. When you balance out the difference, we’re actually money ahead. When you factor in the greatly increased social stability that follows when everybody’s getting their necessary health care, the impact on our quality of life becomes even more signficant.

And True — but only because this is a universal truth that we need to make our peace with. Yes, the provincial plans are always struggling. So is every single publicly-funded health care system in the world, including the VA and Medicare. There’s always tension between what the users of the system want, and what the taxpayers are willing to pay. The balance of power ebbs and flows between them; but no matter where it lies at any given moment, at least one of the pair is always going to be at least somewhat unhappy.

But, as many of us know all too well, there’s also constant tension between what patients want and what private insurers are willing to pay. At least when it’s in government hands, we can demand some accountability. And my experience in Canada has convinced me that this accountability is what makes all the difference between the two systems.

It is true that Canada’s system is not the same as the U.S. system. It’s designed to deliver a somewhat different product, to a population that has somewhat different expectations. But the end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time.

I hope and pray for the day when we can do the same.

[EMUJeff]

This is certainly NOT true in my case. Every year, my premium has gone up and this year (2008), my prescription co-pay has taken a big jump. Name-brand prescriptions went from a $40 a month co-pay to a $50 a month co-pay (25 percent increase). The same for generic.

I was able to find my generic medication cheaper at Wal-Mart for $10 instead of $20 (now $30). However, that $10 is now $15, which is a 50 percent increase.
I know this varies widely between companies and their many different products. Some years it's the HMO's that seem to get his hard, another it's the PPO's that take the brunt of it. There are reasons given each time, but I am always interested in how the type of coverage hit is the the area where the numbers of insured have been expanding.
EMUJeff

[EMUJeff]

What also needs to be addressed is gouging of the medical insurance plans by unscrupulous doctors, clinics, and hospitals.

I already explained my son's scenario, so that covers my hospital point.

A number of years ago, the mole on my face became inflamed so I had to go get it checked out to make sure that it wasn't cancer or anything.

While I was there, they put this scope down my throat. For what, I had no idea.

I go to "checkout" and see on my invoice that there is a $90 charge for this scope they crammed down my throat. I said WTH--I'm not paying for this! This has nothing to do with why I came in here. They tell me, don't worry, we charge the insurance company for that---we give that test to ALL our patients.
This seems true. As well as shoring up their legal standing by providing tests for all diagnosis, some perform more profitable tests to increase the profitablity of the visit. Unfortunately, many doctors know what tests can be written for under different insurances according to what symptoms the patient presents with.
EMUJeff

[EMUJeff]

EMUJeff;
Great job covering this topic, well done!
I recently had my knee operated on which took a day in the hospital, there was also a few preliminary appointments and a couple after the surgery, total cost was $0.
I never worry about the cost when my kids get sick or hurt, it's all taken care of.
Many countries have health care, but not the US???
Who covers you these days, Scotto?
EMUJeff

[EMUJeff]

Scotto,

I appreciate your comments. It is amazing to me that a country as wealthy and wasteful as the USA does not have universal health care. This is an issue near and dear to my heart because I truly believe that universal health care in the U.S. is the answer. Costs could be capped.

What they are trying to push at companies now (including my own) is a Health Savings Account (HSA), which is set up like an Individual Retirement Account (IRA). You save your own money towards your health care and eventual long-term care. I don't like this idea, because our costs for everyday living (without luxuries) has become so high now, it is nearly impossible to save for this, even though it is so important. I have to do more investigating on it, but I believe that you can be penalized with the HSA like you can with an IRA if you withdraw too soon, but I need to find out about that.
There should be a way to cover nearly everyone since we end up paying for it anyway, either through taxes or higher bills at the hospitals and clinics.
I have to believe that with a combination of personal contribution, employer support spread more equally across than now occurs, cost controls, and greater focus on healthy living more coverage can be possible.
Continuing as we are, where there is little incentive for companies to cover their employees and increasing numbers of uninsured this problem will only tax us more the more we ignore it. IMO.
EMUJeff

[EMUJeff]

How many times have you been at the pharmacy counter anywhere and you are standing behind some old lady and the pharmacist or technician says to her, "Mrs. X, that will be $543 (or $735 or whatever)." The senior citizen stands there, obviously in the state of shock, like a deer in the headlights! I'm just as stunned as she is!!!! This is likely as much or more than what they receive monthly in their Social Security check!

The old lady proceeds to say, "Well, can I have maybe 4 of them? How much would that cost?"

I have witnessed this scenario at least a half-dozen times. It breaks my heart because I wish I could just hand this old lady the money and say, "here you go," but I can't. I don't have the money, either!
A crime against ourselves.
EMUJeff

[EMUJeff]

I have someone in my family who went for a mammogram on January 9, 2008. That evening, she received a telephone call from the clinic advising her that she needed to come back for a re-test because something came up on the mammogram.

She was told that they would "just use the same prescription from the original mammogram" so not to worry. For those of you who don't know, you need an Rx script from your regular doctor to go to radiology to have this done.

So, five days later, on January 14, 2008, she went back for the re-test and thank God, it turned out to be nothing. What had happened was they hadn't gotten the breast flat enough on the surface and some tissue was overlapping other tissue, thereby creating a sort of shadow.

Well, that's great news, right?

Well, now the bills have all come in. She is being charged for out-of-pocket expenses for two mammograms. So the crock about "don't worry, we'll just use the same prescription" is a load of bull.
This happened to me in a different way. I went to a clinic with bleeding from the upper clef near my tailbone. It's called a polyodnal cyst and is genetic. I didn't know it at the time but it should have been lanced and treated and I should have been sent on my way. Instead the doctor took one look at it and advised me to go to the hospital to have it cared for.
I did. In time the bill arrived and the proceedure wasn't covered by my insurance because I went to the ER for a "non-emergant" proceedure. The fact I was sent there on a recommendation by a doctor at a clinic didn't seem to matter. It took nearly three months to clear this up and I still ended up out of pocket over $300. This was back in '87.
EMUJeff

[EMUJeff]

Those who claim that covering everyone will lead to a two tiered system might not be aware or recognize that it is what we have now.
Finding ways to insure more people helps, along with "best practice" use, consistent pricing for proceedures, and healthier life styles, to cut the cost to us all in the long run.
EMUJeff

[Harrison]

To Scotto:

Please feel free to correct me in any of my postings regarding Canada's healthcare system. I am learning as I do my research. I really appreciate your input since you live in Ontario.

The more knowledge we are armed with, the better. Thanks!

Harrison

[Scotto]

Who covers you these days, Scotto?
EMUJeff
As covered in Harrison's post "Busting the Myths about Canada's Health Care System" the Provice of Ontario has always covered my family and myself for health care. There have been some minor cost over the years that the government has stop covering. One example would be a note for time missed at work, many doctors will now charge a fee for this as it isn't part of the coverage anymore. My doctor has never charge me for this, but it's very rare that I ask. The cost for a note is usually around $20.
The only money I have ever paid to use a hospital for myself or my family is for parking my car.

Lets not forget, it still isn't free. I do pay through taxes for my share of the coverage, the more you make, the more you pay at tax time.
But really, it isn't a big cost.
Lastly, I been issued a card with my picture on it showing that I'm covered.
I don't know anyone who isn't covered. I would imagine that you would get billed if you didn't have a health card.

[Scotto]

To Scotto:

Please feel free to correct me in any of my postings regarding Canada's healthcare system. I am learning as I do my research. I really appreciate your input since you live in Ontario.

The more knowledge we are armed with, the better. Thanks!

Harrison
Most of your post seems to be correct as I see it, I would have to say though that the system isn't perfect.
There is a shortage of doctors in most areas, which does back up some surgeries. There is still backlogs with things such as MRIs, some people won't wait and do pay down in the US. (You seem to have no back logs in the States)
My father-in-law has spent some nights in hallways because there just isn't any room left. He still gets care for, he just doesn't get into a room or a ward until one is open.
I recently had a family member pass away with a lengthy illness. She was expected to last only a week or so at best. She didn't pass away for over two months. In this time she went back home to be with her family. The Province paid the full cost of a delivered hospital bed, a daily visit from a nurse and all medication was covered (this would of been a huge bill). I'm lucky enough to live in highly populated area with many hospital and good doctors, but at time it's not enough and you can wait hours for your turn at a hospital.
To be clear though, if someone who is badly injured comes to a hospital for help they will be taken care of immediately

[Harrison]

My father-in-law has spent some nights in hallways because there just isn't any room left. He still gets care for, he just doesn't get into a room or a ward until one is open.





Scotto,

That happens here a lot, too.

I am sorry about the loss of your family member. Lengthy illness or not, it is always difficult.

[Scotto]

There should be a way to cover nearly everyone since we end up paying for it anyway, either through taxes or higher bills at the hospitals and clinics.
I have to believe that with a combination of personal contribution, employer support spread more equally across than now occurs, cost controls, and greater focus on healthy living more coverage can be possible.
Continuing as we are, where there is little incentive for companies to cover their employees and increasing numbers of uninsured this problem will only tax us more the more we ignore it. IMO.
EMUJeff

I know there will be some members who will not like what I have to say, but what is the cost of Iraq war (12 billion a month, 3 trillion so far) add that to what people pay insurance companies and one would think that the bills would be paid, but that's just my thinking.
I'm very surprised that you don't hear the end of America as we know it because universal health care will bankrupt the country or the other one I hear is "look at public housing, that is what will happen to our hospitals".
Many countries have universal heath care and they aren't bankrupt from it and I really don't see the correlation between public housing and health care.
We also have public housing and yes it is mess, but the hospitals are doing still doing their job.

[Harrison]

Scotto,

You won't hear any argument about that from me.

The so-called "cost of war" is a joke. When our officials send billions of dollars in cash to Iraq and then can't "find" it or "account for it," something is definitely rotten! Especially when our troops aren't properly outfitted with the right type of gear.

As for public housing or what I think you're referring to around here as Section 8 housing, it gets bad because it is allowed to get bad. It seems like around here, a lot of "bad eggs" move into Section 8 housing and then the development is nothing but trouble. But with the right type of enforcement, that could easily be remedied.

There is a nearby downriver city to me, Taylor, which I lived in for a long time. We had a long stretch of Section 8 housing down this one main road and the mayor decided to have a lot of those back-to-back developments torn down and people were driven out. It had a good effect. Some of the remaining developments were converted to condominiums. It was previously known as "Sin City," and for good reason. It is still a trouble area, but it has greatly improved from what it was.

[EMUJeff]

As covered in Harrison's post "Busting the Myths about Canada's Health Care System" the Provice of Ontario has always covered my family and myself for health care. There have been some minor cost over the years that the government has stop covering. One example would be a note for time missed at work, many doctors will now charge a fee for this as it isn't part of the coverage anymore. My doctor has never charge me for this, but it's very rare that I ask. The cost for a note is usually around $20.
The only money I have ever paid to use a hospital for myself or my family is for parking my car.

Lets not forget, it still isn't free. I do pay through taxes for my share of the coverage, the more you make, the more you pay at tax time.
But really, it isn't a big cost.
Lastly, I been issued a card with my picture on it showing that I'm covered.
I don't know anyone who isn't covered. I would imagine that you would get billed if you didn't have a health card.
Thank you for your reply on this.
I think the fact it's not free is fine. I understand that the "premium" is in the tax you pay. I don't think any of us here are looking for another bill but we end up paying for health care for the uninsured in higher health care costs and higher premiums.
One thing the free market system in the US does aid with is the availability of things like MRI's and CT scans as they are money makers. But I would rather have a bit of a line with whatever system we end up with. I know some people in Canada have had fatal results due to waiting and that is a crime.
I have noted on "The National" that storys run often on the shortage of doctors and nurses, especially outside the major urban areas.
Thanks again Scotto for your input on this issue.
EMUJeff

[EMUJeff]

Here is an article recently printed about this issue from the Detroit Free Press today about the cost of the uninsured... http://www.freep.com/apps/pbcs.dll/article?AID=/20080313/BUSINESS06/80313034/1002/BUSINESS

EMUJeff

[Harrison]

Thank you, EMUJeff. What a powerful article. This particular quote really got me:

The problem is largely unrecognized, said Sister Mary Ellen Howard, director of the Cabrini Clinic, a free clinic in Detroit that is the nation’s oldest such center in the United States. “You will never read that this person died because they are uninsured,” she said. The cause of death will be listed as stroke or cancer, for example, she said. “It won’t say this person didn’t have screening for cancer, was diagnosed late and not treated appropriately because she was uninsured.”

[EMUJeff]

My sister worked with Sister Mary Ellen on a committee regarding the uninsured. Sister Mary Ellen is a pillar of her profession and a powerful speaker on this issue. If everyone were exposed to what she has seen we wouldn't even be talking about this anymore. It would be a done deal.
Thanks, Harrison.
EMUJeff