You have RIGHT to health care, you say?
Sounds good, doesn't it, feels good to demand it, doesn't it? Politicians demand it, "humanity" demands it, "compassion for your fellow citizens" demands it, health care is just...one of those "unalienable rights". Isn't it?
Well, you know, "Health Care" is not an abstract concept, and not just "something". Health care is what I personally do, an individual service from me for you. I requires preparation, a special setting and often help from other people. Health care is why I get up in the morning and why I go to work.
It took me quite a while to be able to give health care, by the way. 15 years of training, with countless sleepless night, plenty of sacrifices, low income for all those years, pressure and hard work.
And you state that you simply are entitled to this, that it is your right?
Did you do something for me? Did you help me get into medical school? Funny, I also did not see you paying for my medical school, and I did not see you paying for my residency training, nor I did not see you staying up at night with me, bringing coffee, holding my hand, nor helping me in any way at all. I passed all the exams quite well all by myself, and I do not remember you helping me to pass them. And now you claim a right to my success?
In short, you did not contribute to my 15 years of training, but now you say that day or night you have a right to my unique knowledge, my unique skills, my expertise, just because....?
Oh, because it is the "human" thing to do, the "compassionate" thing to do? Or is it because there was an "oath" that was written over 2500 years ago, at a time when we had no electricity, no technology, no paper money, an economic system of the most simple and underdeveloped form.....
Come on....
Ok, you say that you have a right to healthcare because it is really important to you and your really need it, you say it is a matter of life and death...
Well, well, don't we all have our needs..
Counting my needs, I would start with food, which is really, really important. Should food not be a right?
Well, go to your farmer, your supermarket or your grocery store and tell them that you have come to claim your right to food!
Let's continue with shelter, housing. Very basic. Just go to the construction company and tell them that you really, really need a house, and that you think housing is a right! Find out how well that goes over..
Next go to the Gap and tell them that you have a right to clothing! Listen carefully to their answer.
Money, well, that is really important. Money is handy, can be traded for a lot of other useful things. Please go to a bank and claim your "right " to money! Watch how pleased they are....
You might also want to call Warren Buffet and tell him you have a right to his expertise and his skills, after all, he is rich enough.....
Oh, I forgot....
Remind me, since you claim a right to MY work, do I actually have a right to YOUR work? NO? Why does this not surprise me?
To be frank, I think it is pretty nervy of you to demand that you have a right to my work!
To sum this up: I am a free individual and I can do with my life and my knowledge and my skills whatever I please. And no, you do not have any kind of "right" to my knowledge, my expertise and my skills. And, No, you do not have a right to my time, be it by day or by night, my past sacrifices, my blood, sweat and tears. No, you do not have a right to it.
Oh, so you don't really want to claim you right from me, you want to claim it from the government? You think "the government should provide health care"?
May I ask how this will happen? Do you expect the town clerk to provide care? The government as such cannot provide healthcare. Physicians provide health care. Should I assume that you want the government to lean on me, to force me to give you what is a "right"? Is that what you want?
You know, in the end it comes down to you, the patient, and me, the physician. Nobody else. That is health care. I do not see how the government matters in this.
And, no I will not give the government a discount. The government does not give me discounts either. And you remain exactly the same patient, regardless if you pay or if the government pays.
Just to be clear, I do not owe the government anything either. Neither does the government have a right to me, to my life, my skills, my expertise and my knowledge. To the government I am just the same as to you: an individual who is independent, to whose efforts and time neither you nor the government has any kind of "right".
We can trade though, at arm's length, and if we come to a mutually beneficial agreement I will be happy to give you my time and skills
Friday, May 8, 2009
Saturday, July 5, 2008
Sabotaging health savings accounts
Herre is a copy from the AAPS website, worth repeating here:
start of quote
"Sabotaging health savings accounts
June 18th, 2008
Nothing probably shows the potential of health savings accounts (HSAs) better than their enemies’ attempts to wreck them. An attempt to load on costly administrative requirements passed the House of Representatives but not the Senate. President Bush had threatened to veto it. Expect it to come back.
H.R. 5719 would have required every HSA transaction to be reviewed and verified as a legitimate medical expense. Currently, such expenditures are subject to an IRS tax audit, and many are made with a debit card that is only useful at a facility providing medical supplies or services.
A Wall Street Journal editorial called it “Health Savings Sabotage,” with a key player being Rep. Pete Stark (D-CA), who views HSAs as a “weapon of mass destruction.” While Democrats, including Barack Obama and Hillary Clinton, decry the high cost of medical care, including insurance overhead, “Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money” (Wall St J 4/19/08).
Cheating is a nonproblem, the editorial stated: “In any case if people cheat on their HSAs, they are only cheating themselves.”
Lobbying for the provision was EvolutionBenefits, which makes software used for “substantiation” of expenses in employer-owned Flexible Spending Accounts. H.R. 5719 would have enabled EvolutionBenefits to charge twice as much for administering HSAs.
“This is a near perfect example of the corruption of Washington,” writes Greg Scandlen. “A powerful member of Congress using his authority to benefit a single company at the expense of millions of consumers and taxpayers” (Consumer Power Report #123, 4/23/08),
“The message is clear,” writes Dan Perrin of the HSA Coalition, “we (the Democrats) think you cannot make your own decisions, so we are going to force you to pay a company to review your decisions and then we will give you access to your own money but only after we decide whether you made the right choice in the first place.”
Since HSAs were created in December 2003, 3.2 million accounts have been opened, covering 4.5 million Americans, one-third of whom were previously uninsured and bought coverage on their own. Thirty-three percent of new users are small businesses that previously had not offered coverage to their employees.
Consulting firm Watson Wyatt found that average health-insurance costs in the last two years rose 3.6% for employers who offered high-deductible accounts, versus 7% for employers who did not (Wall St J 5/1/08).
According to the U.S. Government Accountability Office (GAO), the number of tax filers reporting an HSA tripled between 2004 and 2007 (GAO-08-474R).
“The take-up rate is the fastest of any benefits innovation of our lifetimes, states Greg Scandlen. “Faster than IRAs, 401(k)s, and far faster than HMOs. The only thing that rivals it may be the conversion of HMOs into PPOs in the mid to late 1990s.”
“Which is probably one of the main factors in pushing H.R. 5719,” writes Frank Timmins. “HSAs are a threat to the SP [single payer] crowd. They need to slowly poison this baby before it grows to maturity.”
end of quote
start of quote
"Sabotaging health savings accounts
June 18th, 2008
Nothing probably shows the potential of health savings accounts (HSAs) better than their enemies’ attempts to wreck them. An attempt to load on costly administrative requirements passed the House of Representatives but not the Senate. President Bush had threatened to veto it. Expect it to come back.
H.R. 5719 would have required every HSA transaction to be reviewed and verified as a legitimate medical expense. Currently, such expenditures are subject to an IRS tax audit, and many are made with a debit card that is only useful at a facility providing medical supplies or services.
A Wall Street Journal editorial called it “Health Savings Sabotage,” with a key player being Rep. Pete Stark (D-CA), who views HSAs as a “weapon of mass destruction.” While Democrats, including Barack Obama and Hillary Clinton, decry the high cost of medical care, including insurance overhead, “Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money” (Wall St J 4/19/08).
Cheating is a nonproblem, the editorial stated: “In any case if people cheat on their HSAs, they are only cheating themselves.”
Lobbying for the provision was EvolutionBenefits, which makes software used for “substantiation” of expenses in employer-owned Flexible Spending Accounts. H.R. 5719 would have enabled EvolutionBenefits to charge twice as much for administering HSAs.
“This is a near perfect example of the corruption of Washington,” writes Greg Scandlen. “A powerful member of Congress using his authority to benefit a single company at the expense of millions of consumers and taxpayers” (Consumer Power Report #123, 4/23/08),
“The message is clear,” writes Dan Perrin of the HSA Coalition, “we (the Democrats) think you cannot make your own decisions, so we are going to force you to pay a company to review your decisions and then we will give you access to your own money but only after we decide whether you made the right choice in the first place.”
Since HSAs were created in December 2003, 3.2 million accounts have been opened, covering 4.5 million Americans, one-third of whom were previously uninsured and bought coverage on their own. Thirty-three percent of new users are small businesses that previously had not offered coverage to their employees.
Consulting firm Watson Wyatt found that average health-insurance costs in the last two years rose 3.6% for employers who offered high-deductible accounts, versus 7% for employers who did not (Wall St J 5/1/08).
According to the U.S. Government Accountability Office (GAO), the number of tax filers reporting an HSA tripled between 2004 and 2007 (GAO-08-474R).
“The take-up rate is the fastest of any benefits innovation of our lifetimes, states Greg Scandlen. “Faster than IRAs, 401(k)s, and far faster than HMOs. The only thing that rivals it may be the conversion of HMOs into PPOs in the mid to late 1990s.”
“Which is probably one of the main factors in pushing H.R. 5719,” writes Frank Timmins. “HSAs are a threat to the SP [single payer] crowd. They need to slowly poison this baby before it grows to maturity.”
end of quote
Friday, July 4, 2008
The Car Care Crisis: A Metaphor
I owe this very good illustration and metaphor to a colleague on Sermo - DoctorCottle. Here is the copy of a recent post of his on my favorite website, sermo.
In the ten years since most automobile insurance companies were either bought out by health insurance carriers or reorganized along the lines of the "third party payer" health insurance model, it has become increasingly obvious that a crisis in car care is looming in the country. In the last twelve months alone, the average monthly cost of car insurance has increased by almost 200%.
"The cost to fill up my tank is outrageous," says New Jersey motorist Alan Duke. "A tank full of gas now costs me a $15 co-pay. Who can afford this?" Duke is not alone in his criticism of an automobile insurance system that costs drivers more and more, yet seems to deliver less and less. "I haven't had the oil changed in my car for almost 500 miles," complains Janice Taylor as she waits in a seemingly endless line at service station in her home town of Sacramento, California. Just a few short years ago, Taylor used to get oil changes two to three times a month, but like an increasing number of Americans, she has experienced repeated frustration with obtaining even basic automotive service.
Motorists are not the only ones affected by the failure of our car care system. "This will get rejected," sighs Eric Rasely, the owner and operator of a service station in Dayton, Ohio as he fills out the paperwork for a prior authorization for a wiper blade change. "It'll get rejected and then the customer will jump all over me because he has to pay out of pocket. And besides, he just had the blades changed last month. They're fine." Rasely has had to hire extra personnel over the last several months just to help him fill out and submit prior authorizations, billing claims, and other paperwork that he says takes up more man-hours than actually servicing cars.
Few would dispute that America's car care system is broken, but there is little agreement on how to fix it. Caraid, the federal automobile service assistance program for low-income motorists implemented five years ago by the President and Congress, has been plagued by skyrocketing costs and poor reimbursement for car service providers, prompting many mechanics and gas station attendants to "opt out" of the system. This has given political ammunition to Democrats whose proposed nationalized car service initiative, based on Canada's universal car care system, was rejected several years ago. While opinion polls show that an increasing number of Americans are receptive to the idea of so-called "socialized car care," concerns about waiting lists for brake jobs and rationing of gasoline, tires, spark plugs, and transmission fluid under the Canadian system have curtailed widespread acceptance of a universal car care system.
One radical solution that a small but growing number of drivers have chosen is returning to the old model of carrying catastrophic car insurance that covers only unlikely but serious and very expensive contingencies such as theft and accidents, paying for routine expenditures out of pocket. "To me it makes sense," says Ryan Smith, an economics major at the University of Alabama, as he pays at the pump with his debit card at one of Birmingham's "cash only" service stations. "Comprehensive car insurance premiums would cost me a lot more than I spend for routine stuff like gas and oil changes. I bet you'll see more and more people doing this sort of thing in the future. It just makes economic sense. Heck, I bet it would even work for healthcare."
In the ten years since most automobile insurance companies were either bought out by health insurance carriers or reorganized along the lines of the "third party payer" health insurance model, it has become increasingly obvious that a crisis in car care is looming in the country. In the last twelve months alone, the average monthly cost of car insurance has increased by almost 200%.
"The cost to fill up my tank is outrageous," says New Jersey motorist Alan Duke. "A tank full of gas now costs me a $15 co-pay. Who can afford this?" Duke is not alone in his criticism of an automobile insurance system that costs drivers more and more, yet seems to deliver less and less. "I haven't had the oil changed in my car for almost 500 miles," complains Janice Taylor as she waits in a seemingly endless line at service station in her home town of Sacramento, California. Just a few short years ago, Taylor used to get oil changes two to three times a month, but like an increasing number of Americans, she has experienced repeated frustration with obtaining even basic automotive service.
Motorists are not the only ones affected by the failure of our car care system. "This will get rejected," sighs Eric Rasely, the owner and operator of a service station in Dayton, Ohio as he fills out the paperwork for a prior authorization for a wiper blade change. "It'll get rejected and then the customer will jump all over me because he has to pay out of pocket. And besides, he just had the blades changed last month. They're fine." Rasely has had to hire extra personnel over the last several months just to help him fill out and submit prior authorizations, billing claims, and other paperwork that he says takes up more man-hours than actually servicing cars.
Few would dispute that America's car care system is broken, but there is little agreement on how to fix it. Caraid, the federal automobile service assistance program for low-income motorists implemented five years ago by the President and Congress, has been plagued by skyrocketing costs and poor reimbursement for car service providers, prompting many mechanics and gas station attendants to "opt out" of the system. This has given political ammunition to Democrats whose proposed nationalized car service initiative, based on Canada's universal car care system, was rejected several years ago. While opinion polls show that an increasing number of Americans are receptive to the idea of so-called "socialized car care," concerns about waiting lists for brake jobs and rationing of gasoline, tires, spark plugs, and transmission fluid under the Canadian system have curtailed widespread acceptance of a universal car care system.
One radical solution that a small but growing number of drivers have chosen is returning to the old model of carrying catastrophic car insurance that covers only unlikely but serious and very expensive contingencies such as theft and accidents, paying for routine expenditures out of pocket. "To me it makes sense," says Ryan Smith, an economics major at the University of Alabama, as he pays at the pump with his debit card at one of Birmingham's "cash only" service stations. "Comprehensive car insurance premiums would cost me a lot more than I spend for routine stuff like gas and oil changes. I bet you'll see more and more people doing this sort of thing in the future. It just makes economic sense. Heck, I bet it would even work for healthcare."
Monday, June 9, 2008
Singapore Health System - Responsibility Works
Healthcare reformers often look to Europe or to Canada for models of change. This might be due to the fact that it is geographically closer and more Americans are familiar with Europe from personal visits, or it may be due to ideological reasons. Most European nations have a more or less socialistic approach to health care systems. In "The American" of May / June 2008, Rowan Callick investigates the city-state of Singapore and finds it may have a prescription for America.
Singapore has eschewed the European government-payer-model of health care with a great deal of success. The reason for Singapore's successful health care system is not government spending, says Callick. Compared to the American system, Singapore keeps it citizens healthier for much less cost per person:
Singapore residents are considerably healthier than Americans, yet pay, per person, about one-fifth of what Americans pay for their healthcare.
In Singapore, the government funds only about one-fourth of total health care costs, while individuals and their employers pay for the rest.
According to the World Health Organization's (WHO) report on global health statistics:
The United States spends 15.4 percent of its GDP on healthcare, while Singapore spends just 3.7 percent.
Singapore's government spends only $381 per capita on health- or one-seventh of what the U.S. government spends.
Life expectancy at birth in the United States is 78 years; in Singapore, it is 82 years (I am including this with the limitation that life expectancy is not a good measure for the quality of a health care system, this is included since the single payer supporters always quote these figures)
The U.S. infant mortality rate is 6.4 deaths per 1,000 live births; in Singapore, is it just 2.3 deaths per 1,000 births.
Now, here is the decisive point:
Singapore's system requires individuals to take responsibility for their own health and for much of their own spending on medical care. The system works so well because it puts decisions in the hands of patients and doctors rather than of government bureaucrats and insurers, says Callick.
Source: Rowan Callick, "The Singapore Model," The American, May/June 2008.
Singapore has eschewed the European government-payer-model of health care with a great deal of success. The reason for Singapore's successful health care system is not government spending, says Callick. Compared to the American system, Singapore keeps it citizens healthier for much less cost per person:
Singapore residents are considerably healthier than Americans, yet pay, per person, about one-fifth of what Americans pay for their healthcare.
In Singapore, the government funds only about one-fourth of total health care costs, while individuals and their employers pay for the rest.
According to the World Health Organization's (WHO) report on global health statistics:
The United States spends 15.4 percent of its GDP on healthcare, while Singapore spends just 3.7 percent.
Singapore's government spends only $381 per capita on health- or one-seventh of what the U.S. government spends.
Life expectancy at birth in the United States is 78 years; in Singapore, it is 82 years (I am including this with the limitation that life expectancy is not a good measure for the quality of a health care system, this is included since the single payer supporters always quote these figures)
The U.S. infant mortality rate is 6.4 deaths per 1,000 live births; in Singapore, is it just 2.3 deaths per 1,000 births.
Now, here is the decisive point:
Singapore's system requires individuals to take responsibility for their own health and for much of their own spending on medical care. The system works so well because it puts decisions in the hands of patients and doctors rather than of government bureaucrats and insurers, says Callick.
Source: Rowan Callick, "The Singapore Model," The American, May/June 2008.
Friday, June 6, 2008
HSAs - common misunderstandings
The HSAs (health savings accounts) are in my view the best answer that I know to the question: How do you increase people’s responsibility in health care spending in a fair way that balances compassion (giving the sick all they need) and responsibility (discouraging waste and overspending).
One of the main drivers of health care cost is the moral hazard, the fact that we are “shopping with someon else’s credit card” and therefore do not mind at all to spend generously and overspend. Unless you adress the moral hazard, you will never curb the spiraling health care costs. Obviously everybody wants to best, most complete, most modern etc…...This desire leads to cost overruns and it is often not necessary to reach the goal of diagnosis and or treatment.
People only get a bit more selective and cost conscious when they have to pay pat of the bill themselves. Then, and only then, they will ask the question: “Doctor, how can we manage my condition in a cost efficient way” and if their own money is at stake, they will keep an eye on the doctor’s spending.
The only other way is the top-down, one size fits all, anonymously handed down by committee cost reduction through rationing and through making resources simply unavailable - as it is done in single payer systems such as Canada and the UK - with al the disadvanatges that come with it.
The HSAs are a intelligent, balanced and fair way of adressing this problem, my favorite solution so far. I still have not found anything better. That is why HSA deserve publicity.
Here is a quote from John Goodman" excellent Healthcare blog, a comment left by Greg Scandlen, whose website "www.hsaeducator.com" I highly recommend. I could have called this "debunking myths about HSAs" but that expression is so overused...
begin quote:
"Greg Scandlen Says:
May 21st, 2008 at 3:52 pm
The week was not enhanced by the hearing on HSAs held by the Health Subcommittee of the House Ways & means Committee. Chairman Pete Stark (D-CA) has long been contemptuous of HSAs or anything slightly similar. He seems to think that the federal Medicare program is the Nirvana of health care financing - never mind that it has $34 trillion in unfunded liabilities and even then it pays only about half of the average senior’s health expenses.
The witnesses at the hearing included three long-standing opponents of HSAs — Linda Blumberg of the Urban Institute, Judy Waxman of the National Women’s Law Center, and Michael Chernew of the Harvard Medical School. What these folks had to say was boringly predictable and I’m not going to repeat it here. You can go to the Committee’s web site and download their testimony if you are feeling masochistic.
But we responded by submitting a statement that tried to rebut some of the distortions. Part of our statement said –
Most of what you have been told in the testimony to date is either mistaken, based on suppositions or surveys of uninformed people, or simply irrelevant to CDHC. For example –
• You were told that lower-income people cannot afford the out-of-pocket responsibility that comes with an HSA. You were not told how those same people could afford the higher premiums that are required to avoid that cost. In fact, money that is paid to an insurance company for first-dollar coverage is money that is lost forever. Lowering the premium and using that saving to pay directly for services gives the low-income consumer a chance to save money that would otherwise be lost.
• You were told that the tax break associated with HSAs is unprecedented and a boon to the “wealthy.” In fact, the tax treatment of HSAs is precisely the same tax treatment afforded to employer-sponsored health insurance. Premiums are untaxed and benefits are untaxed. It is true that the “wealthy” get a larger tax benefits than the unwealthy, but that is the case for employer-sponsored comprehensive coverage as well as for HSAs. Further, the opportunity to save, say, $2,000 a year that would otherwise go to an insurance company is of far greater benefit to the low-income worker who earns $20,000 a year than to the wealthy executive who makes $200,000, regardless of the tax treatment.
• You were told that “the sick” do not benefit from HSAs because of the higher out-of-pocket responsibility. In fact, both the healthy and the sick have less out-of-pocket exposure with an HSA, a point that was well documented in a recent Health Affairs article. In fact, HSAs limit a patient’s out-of-pocket exposure, something that is not true for the Medicare program, for instance.
• You were told that most health care spending takes place above the deductible associated with an HSA, so they will not have “a significant effect on overall spending.” This is probably true, but irrelevant. HSAs are having a profound effect on lower-cost routine spending and that is significant by itself. Other strategies are needed for high-cost services with or without an HSA.
• You were told that many people with a high-deductible health plan do not open up an HSA. That, too, is true but irrelevant. The HSA itself is attractive for those people who are able to get a tax benefit from passing their direct payments through the account. Other people, especially those who pay no income taxes, may find it more suitable to simply pay cash at the time of services or to keep their funds in some other, non-HSA, account. Further, there is likely to be a lag time between the point of enrollment and opening up that account. This is not a problem.
• You were told that some people who have to pay directly for care or for prescription drugs may fail to do so to save the money. That also may sometimes be true. But there is never any guarantee that people will always fill their prescriptions and take their medications regardless of the financing scheme. In fact, we know that many health conditions are caused or aggravated by patient behavior under all health insurance systems. But, to the extent that people with CDHC are more knowledgeable and more invested in their own care, their compliance will be better than it is for other benefit programs. And that is precisely what we are seeing in the market."
end quote
One of the main drivers of health care cost is the moral hazard, the fact that we are “shopping with someon else’s credit card” and therefore do not mind at all to spend generously and overspend. Unless you adress the moral hazard, you will never curb the spiraling health care costs. Obviously everybody wants to best, most complete, most modern etc…...This desire leads to cost overruns and it is often not necessary to reach the goal of diagnosis and or treatment.
People only get a bit more selective and cost conscious when they have to pay pat of the bill themselves. Then, and only then, they will ask the question: “Doctor, how can we manage my condition in a cost efficient way” and if their own money is at stake, they will keep an eye on the doctor’s spending.
The only other way is the top-down, one size fits all, anonymously handed down by committee cost reduction through rationing and through making resources simply unavailable - as it is done in single payer systems such as Canada and the UK - with al the disadvanatges that come with it.
The HSAs are a intelligent, balanced and fair way of adressing this problem, my favorite solution so far. I still have not found anything better. That is why HSA deserve publicity.
Here is a quote from John Goodman" excellent Healthcare blog, a comment left by Greg Scandlen, whose website "www.hsaeducator.com" I highly recommend. I could have called this "debunking myths about HSAs" but that expression is so overused...
begin quote:
"Greg Scandlen Says:
May 21st, 2008 at 3:52 pm
The week was not enhanced by the hearing on HSAs held by the Health Subcommittee of the House Ways & means Committee. Chairman Pete Stark (D-CA) has long been contemptuous of HSAs or anything slightly similar. He seems to think that the federal Medicare program is the Nirvana of health care financing - never mind that it has $34 trillion in unfunded liabilities and even then it pays only about half of the average senior’s health expenses.
The witnesses at the hearing included three long-standing opponents of HSAs — Linda Blumberg of the Urban Institute, Judy Waxman of the National Women’s Law Center, and Michael Chernew of the Harvard Medical School. What these folks had to say was boringly predictable and I’m not going to repeat it here. You can go to the Committee’s web site and download their testimony if you are feeling masochistic.
But we responded by submitting a statement that tried to rebut some of the distortions. Part of our statement said –
Most of what you have been told in the testimony to date is either mistaken, based on suppositions or surveys of uninformed people, or simply irrelevant to CDHC. For example –
• You were told that lower-income people cannot afford the out-of-pocket responsibility that comes with an HSA. You were not told how those same people could afford the higher premiums that are required to avoid that cost. In fact, money that is paid to an insurance company for first-dollar coverage is money that is lost forever. Lowering the premium and using that saving to pay directly for services gives the low-income consumer a chance to save money that would otherwise be lost.
• You were told that the tax break associated with HSAs is unprecedented and a boon to the “wealthy.” In fact, the tax treatment of HSAs is precisely the same tax treatment afforded to employer-sponsored health insurance. Premiums are untaxed and benefits are untaxed. It is true that the “wealthy” get a larger tax benefits than the unwealthy, but that is the case for employer-sponsored comprehensive coverage as well as for HSAs. Further, the opportunity to save, say, $2,000 a year that would otherwise go to an insurance company is of far greater benefit to the low-income worker who earns $20,000 a year than to the wealthy executive who makes $200,000, regardless of the tax treatment.
• You were told that “the sick” do not benefit from HSAs because of the higher out-of-pocket responsibility. In fact, both the healthy and the sick have less out-of-pocket exposure with an HSA, a point that was well documented in a recent Health Affairs article. In fact, HSAs limit a patient’s out-of-pocket exposure, something that is not true for the Medicare program, for instance.
• You were told that most health care spending takes place above the deductible associated with an HSA, so they will not have “a significant effect on overall spending.” This is probably true, but irrelevant. HSAs are having a profound effect on lower-cost routine spending and that is significant by itself. Other strategies are needed for high-cost services with or without an HSA.
• You were told that many people with a high-deductible health plan do not open up an HSA. That, too, is true but irrelevant. The HSA itself is attractive for those people who are able to get a tax benefit from passing their direct payments through the account. Other people, especially those who pay no income taxes, may find it more suitable to simply pay cash at the time of services or to keep their funds in some other, non-HSA, account. Further, there is likely to be a lag time between the point of enrollment and opening up that account. This is not a problem.
• You were told that some people who have to pay directly for care or for prescription drugs may fail to do so to save the money. That also may sometimes be true. But there is never any guarantee that people will always fill their prescriptions and take their medications regardless of the financing scheme. In fact, we know that many health conditions are caused or aggravated by patient behavior under all health insurance systems. But, to the extent that people with CDHC are more knowledgeable and more invested in their own care, their compliance will be better than it is for other benefit programs. And that is precisely what we are seeing in the market."
end quote
Wednesday, May 28, 2008
What Physicians Have In Common and Can Agree On
A few weeks ago this post on Sermo.com received over 300 votes with an outstanding 95% of "yes" answers.
I see these few points as a declaration of independence of physicians and physicians should read and remember this from time to time.
"What we physicians all have in common"
1. We want to serve our patients, not insurance companies nor the government
2. We want to practice medicine independently according to our knowledge and judgment, and not be told what to do by insurance companies nor by the government
3. We want to make a living on our own, we do not want to be given what insurance companies and government deem "appropriate" for us
We want to be an independent, noble and free profession!
Because WE have the knowledge, the expertise and the skills, and the insurance companies and the government do NOT! "
I see these few points as a declaration of independence of physicians and physicians should read and remember this from time to time.
"What we physicians all have in common"
1. We want to serve our patients, not insurance companies nor the government
2. We want to practice medicine independently according to our knowledge and judgment, and not be told what to do by insurance companies nor by the government
3. We want to make a living on our own, we do not want to be given what insurance companies and government deem "appropriate" for us
We want to be an independent, noble and free profession!
Because WE have the knowledge, the expertise and the skills, and the insurance companies and the government do NOT! "
Monday, May 26, 2008
Time to Nationalize the Educational System
The following statistics are from the National Institute for Literacy: http://www.nifl.gov/nifl/facts/facts_overview.html
In the International Adult Literacy Survey (IALS) assessment, 1994-98:
The average composite literacy score of native-born adults in the U.S. was 284 (Level 3); the U.S. ranked 10th out of 17 high-income countries;
The average composite literacy score of foreign-born adults in the U.S. was 210 (Level 1); the U.S. ranked 16th out of 17 countries.
In the International Adult Literacy Survey (IALS) assessment, 1994-98:
The mean prose literacy scores of U.S. adults with primary or no education, ranked 14th out of 18 high-income countries;
The mean prose literacy scores of U.S. adults with some high school, but no diploma or GED, ranked 19th out of 19 high-income countries;
The mean prose literacy scores of U.S. adults with a high school diploma or GED (but no college), ranked 18th (tie) out of 19 countries;
The mean prose literacy scores of U.S. adults with 1-3 years of college, ranked 15th out of 19 countries; and
The mean prose literacy scores of U.S. adults with a bachelor's degree or higher, ranked 5th.
end of quote
These statistics show very clearly that we have a literacy crisis on our hands. I believe that literacy is a basic human right! The educational system needs to nationalized! Since we are underperforming the other industrialzied nations, the government needs to take over our education system - immediately!
But, uuuhooooh, wait, wait, the educational system is already nationalized! The government is already running it! So, how come we are not doing that well compared to other industrialized nations? How is this failure possible? I thought that "government run" is a recipe for complete and utter success!
Now, do you still think we ought to nationalize health care? Should we, really?
In the International Adult Literacy Survey (IALS) assessment, 1994-98:
The average composite literacy score of native-born adults in the U.S. was 284 (Level 3); the U.S. ranked 10th out of 17 high-income countries;
The average composite literacy score of foreign-born adults in the U.S. was 210 (Level 1); the U.S. ranked 16th out of 17 countries.
In the International Adult Literacy Survey (IALS) assessment, 1994-98:
The mean prose literacy scores of U.S. adults with primary or no education, ranked 14th out of 18 high-income countries;
The mean prose literacy scores of U.S. adults with some high school, but no diploma or GED, ranked 19th out of 19 high-income countries;
The mean prose literacy scores of U.S. adults with a high school diploma or GED (but no college), ranked 18th (tie) out of 19 countries;
The mean prose literacy scores of U.S. adults with 1-3 years of college, ranked 15th out of 19 countries; and
The mean prose literacy scores of U.S. adults with a bachelor's degree or higher, ranked 5th.
end of quote
These statistics show very clearly that we have a literacy crisis on our hands. I believe that literacy is a basic human right! The educational system needs to nationalized! Since we are underperforming the other industrialzied nations, the government needs to take over our education system - immediately!
But, uuuhooooh, wait, wait, the educational system is already nationalized! The government is already running it! So, how come we are not doing that well compared to other industrialized nations? How is this failure possible? I thought that "government run" is a recipe for complete and utter success!
Now, do you still think we ought to nationalize health care? Should we, really?
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