Employer-Sponsored Insurance Premiums Rose 119% Over Past Decade

Four Assumptions Not Necessarily True

Much of the discussion around health care reform or health care insurance reform is made with certain assumptions: it is not wise to make assumptions.

• Insurance is essential for good health care. Why? US citizens are now paying the most money for health care in the world and receiving 38th place care! Health insurance companies do not exist in most of the world, they all figured it out years ago: no profits allowed from the misery of accident and disease, lean administration in provision of health care for all citizens by paying good salaries commensurate with other highly trained professional people to doctors and managing programs with competent professional managers who have no financial incentives to do anything other then effectively and efficiently manage the programs. Pay for the program with broad and progressive taxes as in keeping with democratic principles.

• Capitalism will make health care the best because Adam Smith opined that the “invisible hand” of the free market will bring about the most good for the most people. Really? Adam Smith was dealing with populations of around 10,000 people who could first hand determine who was doing the best job and could directly deal with those who cheated or did underhanded practices. This is a long way from faceless, global entities whose very names are fictional compositions of public relations firms.

• Our health care is so expensive because we develop cutting edge medical tools which cost a lot. Why? The proof is out there, if you understand that 85% of presenting problems patients bring to doctors will resolve themselves without intervention: the whole structure of interventional medicine becomes something very different from what the common assumption about the problem is. Public health probably is the most effective way of reducing the need for even that 15% calling for intervention. The US spends almost zero now on public health programs because there is little money to be made in its provision!

Lobbying is merely an extension of the right to free speech and since corporations are legal entities granted by our government to have the same rights as if they were individuals, they are the same as every citizen. Hardly! In law there is the accepted principle that judges will be expected to recues themselves should they have any self serving interest in one of the parties. How can a congressman/woman be unbiased if they, or one of their phantom entities, receives large donations from insurance companies or health care providers? This incongruity is so very blatant as to be screaming for attention in this democracy which is being used and mocked by such manipulation of essentially good operating principles

What a disgrace...What a rip off........

Insurance companies are making a profit, so why is it hard to figure out that so much of health premiums are going into private pockets??

Im not so sure everybody understands the importance of health care reform. Otherwise there would not be so much opposition. My family just had a baby. If we had to deal with the original bills the insurance company gave us...we would have lost the down payment on our house. ..So in my opinion government should have more to do with heath care! What about the police departments, fire departments, Army, Navy, Air force, Marines, all government run programs. So if you are one of those people say government cant get anything right, get out of my country cause I like the fact that if my house burns down I don't have to pay for the fire department to come put it out. I like the fact that I don't have to pay for freedom.

Let me give a sharply contrasting example, if a dated one, of health care in some places outside the US (my home country) and the US itself.

In 1997 I became ill with an odd illness; its two chief symptoms were bad debiitation and smallpox-like scabbed sores on the back of my neck and ears, with a very few of them, less severe, on my forearms. At the time, I already had a large skin cancer, as it turned out, on my chest.

I lived, and still do, in Bangkok, and had no insurance at all. But I went to one of the top 4 or 5 hospitals in the country, one founded by Americans and even today partly staffed with them, though several years ago the American partners turned over the hospital lock, stock, and barrel to Thailand, free -- after doing a multi-million dollar renovation and expansion of the hospital and its equipment.

For the initially-unidentified illness, I ultimately had as many as *7* doctors at a time, none of them American, but every single one trained in the US, and, in some cases, with additional training in England or Canada, etc. in some of their cases, that many because they had some trouble figuring out just what was wrong. Once they had it pinned down, I checked into hospital into a private room that was more like a hotel room than a hospital one, and stayed for 2 night/3 days, during which time I improved remarkably, as the doctor who ended up with me had 3 different IV's pumping stuff into me.

I returned a few weeks later to have the skin cancer removed, itself involving 3 doctors, an MRI, etc., though I had that done on an outpatient basis.

There were several medications I had to take afterwards in both cases, plus follow-up visits.

My total costs? About US$1750. That's not a typo: one thousand, seven hundred, and fifty US dollars.

I don't know how much all that would have cost me had I paid for it 100% out of pocket, as I did here, in my home area in the Falls-Fort Worth region, but I'm *quite* confident it would have been vastly more than I paid here.

Yet the hospital here remains profitable, and is a mecca of medical tourism. Of course, prices have risen here, too, rather dramatically. The first time I consulted a GP at that hospital here, the consultation base fee
was US$12.00; last time I went to a GP there, the price was nearly triple, in local currency terms, but because the local currency has devalued versus the US dollar, the 800 baht [baht being the local currency] I paid worked out to about US$23.50. And my income is entirely in US dollars.

Match that anywhere in the US, except in charity organizations and public health centers.

Returning to my illnesses, if I apply the same increase to my costs for treatment of them that has applied to consultation fees, today I would pay about US$4667.00 -- still a steal. Especially since, as I said, the rooms are very much more like those in a 4- or 5-star hotel than anything else, complete with a sofa, easy chairs, a coffee table, cable TV, etc. And top-flight, English-speaking medical personnel. (By the way, that particular hospital has smaller groups of medical employees fluent in other languages; about half of the patients come from abroad, and while many speak English, some do not, and the hospital management has been working for years to be sure they can handle all comers.)

Don't misread me: though I live abroad and have done so for upwards of a quarter of a century, I love America as much as anyone. But I want us to realize our full potential, and in health care we're falling way short of the mark.

Just a few weeks ago I stumbled across an insurance company online that seemed perfect, at first, as it would let me tailor an individual plan. (I should say I'm single -- well, divorced for years -- with no other dependents at all beyond myself.)

I set it up for a US$25,000 deductible, treatment only *outside* the U.S., with my base country Thailand, and a lifetime max payout by the company of US$500,000. I'm 58, and a smoker -- but the only question asked that might worry me was my age. Nothing about pre-existing conditions or medical history. Oh, I did have to put my weight in, but after decades of fighting being fat, I finally got that under control several years ago and am squarely where the doctors want me to be in that regard, so that wasn't a worry.

When I clicked the "Calculate my premium now," when the result popped up, I thought there *had* to be an error. So I had it recalculated several more times, always with the same result: US$1,100 -- per *month." This company is a US one, though I don't remember which it was -- one of the biggies, as I learned when I researched it at some length before filling out the premium-calculation page.

An $1,100 premium over a years time adds up to the range of the gross income of a person working for US minimum wage, premiums of $13,200 annually.

There's something wrong with such a picture.

In my case, I'm squarely in the middle of the middle class. Not rich, but far from poor, too. But after paying a total of about 40% of my gross income in taxes to over 30 agencies that come around yearly to take their cuts (federal, state, and local), I simply can't *reasonably* afford an $1,100/month premium. Yes, I *can* afford it -- if I stay home, almost never going out even to a movie or a fast-food place, forget holidays (especially visits to America), continue to live in ordinary (but comfortable enough) housing, watch my utilities like a hawk, and so on. By the way, I don't own a motor vehicle of any type, but my transportation expenses are still very, very low, as I rarely travel even as much as a mile, and taxis and buses here are dirt cheap. (Flag-fall in a taxi is a tad over a buck, for instance; if I go the 20 miles or so to the international airport, the fare plus tolls averages about $6.00!) So, transportation isn't a worry, financially.

Something has to give. Personally, I lean towards a public option, even if my taxes go up somewhat and even if I have to pay a premium -- I don't suppose a public option premium would be anywhere near $1,100 per month. I agree with the Democrats we need something along this line. At the same time, I agree with the Republicans who want to ensure that private options remain inviolate for anyone who wants them, particularly regarding decisions about courses of treatment.

But extremists on both sides of the aisle, if of late more on the Republican side, it seems, are sensationalizing the issue, muddying the waters with often downright falsehoods. (Well, okay, let's call a spade a spade: "Lies.")

The people who have offered comments here before me all have very good points to make. I particularly agree with "Retired's" observations regarding lobbyists (about whom I have a bit more to say shortly). "Edy's" assertion of "disgrace" is arguably (I personally think beyond any argument) right on target, too. "Lita" makes a point that is both true and blindingly obvious, although I'm not sure which direction she (is that person a she? I'm guessing, from the name.) might go were she to expand on her brief comment. And Jason's right, I believe, when he notes he's "not so sure everybody understands the importance of health care reform. Otherwise there would not be so much opposition." I will say to Jason we *do* pay for our freedom -- which is 100% fine with me -- supporting the various people you mention, and others: police, fire personnel, teachers, well, just about all front-line public employees, right across the board, including normally noncontroversial ones such as park maintence workers. *They* are why I don't moan about a 40% tax burden, though I rarely have need of their services, considering I rarely go to the States (like every 4 or 5 years, normally, and even then just for a few weeks).

It happens my Congress-critter and both Senators are Republican, and they all oppose any public option as well as oppose with much more than tinkering with the existing system; one is particularly open about preserving profits for the private sector, though even that person -- I don't want to identify which, even by gender, as 2 of the 3 are men, the 3rd a lady -- supports making the private sector more efficient and responsive, arguing that such reforms alone would go far enough towards reining in health-care costs.

You can safely assume all of them are well-familiar with my contrarian views, as I have communicated via e-mail with them several times since this issue arose. Not that I have the slightest influence with any of them, not even the one with whom I grew up (but whom I haven't seen in quite a few years, true enough).

Back to lobbyists. A what we might call "proper lobbyist" is a person with valuable expert knowledge about a particular topic. We can't expect our public servants to know everything about everything, nor their staffs to be able to do so, even collectively. Some outside input is required, and a good lobbyist ("good" meaning one who contributes relevant information to the discussion) often provides that.

So, the problem as I see it isn't the information-providing role of lobbyists.

Instead, the problem is centered in the lack of neutrality in the *presentation* of that information, especially in the areas of (1.) ignoring contrarian data, and, (2.) fluffing up a presentation to favor a particular sector -- the private health-care sector, in this case.

I don't have answers for those problems. Have Congressional staff members research opposing views prior to testimony by a given lobbyist? Do staff members have *time* to research the enormously varied topics that come before Congress?

Perhaps a more effective tool is to require FULL public disclosure of various bits of data, data compiled in easy-to-read charts, tables, etc. Disclosure regarding members of the House and Senate. And oh, by the way, the President and Vice-President as well, especially the President, since he is the one who signs or vetos any legislation coming from Congress.

For starters, campaign contributions. Don't try to curb them: require disclosure of their *exact* amounts, right down to the penny, along with the dates and sources. Not the current vague requirements of having, say, a Congress-critter report "Um, I got somewhere between 100k and 500k from folks in such-and-such a company over the last X months/years." I want to know PRECISELy how much, and when -- plus any accompanying communications regarding said contributions (i.e., e-mails, transcripts of meetings, etc. between the Congressperson and representatives of the contributing company and/or, indeed, lobbyists for the industry at large, even if they aren't directly employed by a particular contributor).

Combine that information with information about appearances before Congress by representatives who have an interest in influencing legislation -- *detailed* information. Word-for-word transcripts. Datges. Lengths of presentations. Congresspeople or Senators present and whether or not any of them fled the scene immediately after appearing on C-Span to provide a sound bite. And so on. Too much happens in the shadows as matters now stand.

"But," some will cry, "what about *secret* stuff that we, the voters, have no reason nor reasonable right to know?" That's a fair question. The field of intelligence is particularly fruitful in any such discussion.

Just to go to extremes for the sake of clarity, let's say scientists were to figure out that in theory, they can build a mind-reading machine that will be accurate -- but will costs, let's say, a billion dollars to develop. Naturally, the company/companies that develop any such device are going to want certain protections, and a payoff at the end of the day, both fair enough. (Let's conveniently ignore dangers to civil liberties any such device might present; those liberties aren't my present point, though I share concerns about them. Humor me.)

Were folks testifying before Congress, or talking to the White House, to be forced to publicly disclose technical details, details regarding the precise predicted capabilities of a mind-reading machine, and so on, much of the device's promise -- perhaps all of it -- would be negated. Most of us lack the training to understand it anyway. How many of us genuinely understand something as basic as electricity? I get the idea, but the actually functioning of electricity remains pretty much magic to me, despite my having learned how to manipulate electrical data via equations. Relativity? String theory? -- most of us can forget it.

However, that doesn't mean we can't have checks and balances. In this example, call in relevant members of, say, the American Academy of Science (after they've been vetted, both in terms of their knowledge and for security reliability), give them the whole enchilada of knowledge -- without comment -- and ask them what they think.

Now, after such an independent review, members of Congress can honestly go to their constituencies and say, "Look, there's promise of a device that by it's very nature demands a cloak of secrecy. We've been asked to help fund it, either through grants, loans, tax breaks, or some combination of those. The possibilities have been overwhelming endorsed by X (a number) of members of the American Academy of Science. And I'll be closely monitoring costs, trying to ensure ther aren't cost overruns and that if such a machine does indeed succeed, it won't be priced way beyond what it cost to develop and make in the first place. And I'll provide full data -- right down to the last cent -- regarding those costs, including costs of my staff researching the matter, getting photocopies, etc."

Congress-critters in both houses, and folks in the White House, will of course squirm, squeal, cry, and moan. Tough. They chose public service; let's get back to the "public part," which far too often is nowadays replaced with "self" as in "Self-service."

Meanwhile, I'll be holding my breath, thinking, "Yeah, right". . . .