Obama’s Unhealthy Choices

Samuelson missed a scapegoat: supposed American exceptionalism in having bad health habits. I don't buy it, but many do, and you can bet those opposed to health-care reform will try to use it as a fallback argument. Even Jay Leno talks about it a lot. While there's plenty of room for improvement in that area, countries we're being compared to have their share of bad habits as well. Some are well behind the U.S. on smoking, and others have bad diets or too much alcoholism.

I think the useful stat was spending a third more than other industrial countries (controlled for incomes) and getting no benefit in terms of measured outcomes. Not only that, but we have tens of millions of uninsured or underinsured who get to worry day in and day out about something going wrong. Peace-of-mind doesn't show up in dollar figures, but costs there are substantial.

As others below pointed out, we can't comparison-shop medical care (except for elective procedures where insurance reimbursement is not involved) like we can cars or TVs. If I could, I would have done so.

Also, insurance companies won't cover you on the free market if you have a pre-existing condition. My husband has type I (juvenile-onset, not the age-related type II) diabetes. If he didn't have insurance through his employer, he would not be able to buy it on the open market. Period.

Healthcare costs don't go down when a new practice or hospital opens up because competition isn't really there. HMOs didn't help matters or foster competition, as has been said below.

So, given those facts, this makes it clear that health care doesn't follow open-market rules.

I do agreewith Mr. Samuelson that if someone is brain-dead with no hope of recovery, we shouldn't keep them alive at great expense to everyone else. I wouldn't want my family to do me that way.

Dedicated federal tax is a great idea. You get sick. You can choose between not getting the best care, and getting more sick or contributing to tax hike for everyone else. Of course everybody would choose getting more sick. In fact, they would instantly hang themselves for the fear of increasing everyone else's tax burden.

The real issue that liberals are so blithe about and refuse to address is that there is no way to control the health costs without infringing on the rights of the individuals. If you get sick, there are two possibilities: you decide what kind of treatment you get or the government does. If you decide that, you will choose the best one available, consequences be damned. If the government decides that, you will get nothing, period. Nobody in the government cares about your health, nor ever will.

It is interesting to note that the article totally ignores the cost of malpractice litigation, and more importantly, the cost of avoidance of malpractice litigation. Not only all the windfalls dolled out by the juries, but all the money quietly paid out in settlements by the malpractice insurance companies, hospitals, etc.; the stress and productivity loss it is causing for doctors, the extra medical services and overhead costs designed to avoid or protect from litigation, etc, How come nobody is spilling the beans on that?

I've been reading these comments and must confess that I am amazed. Maybe some good will come of the economic downturn.. Apparently most of the readers of Newsweek, or the commentators have never done a more difficult job than sitting in an ergodynamic-designed office chair, and reaped over-priced wages and salaries.
If one deducts the income of the top 1% of Americans, the average American earns 10-12 dollars an hour. Do the math! I saw someone said he managed his health care costs at 7,600 dollars a year because he required scant care. Duhhhhhhhhh..that means he spends a third of what most Americans have in income a year on health care despite his much proclaimed "scant care". Maybe when a few more of you high-flyers are working at Mickey D's or standing at a cash register, you will wake up and smell the coffee. A third of one;s income with just scant care..and if you require anything else, you are programmed to get into debt. (Which has been the basis of the economy for years here now). I am more than tired of hearing "Why don;t people manage their expenses better?", when the fact is that the average American's wage level does not allow him the cost of health care, shelter, food and transportation (even if only to get to work) without using some form of debt. I repeat: this downturn may be good for something yet...welcome to the real world!

I have read this story carefully, twice. It has the ring of truth. Some suggestions: 1) Membership should not be voluntary. If every individual in America was eligible for the service, and participated in paying for it, the average cost of health care would decline. Ask any insurance actuary! That is Universal Health Care, and it works. 2) The idea of having a number of organizations offering health care services was great. It was assumed that this competition would hold down costs. Well it has not worked that way! They compete in many ways, mainly customer satisfaction, but it has not worked to keep down costs. Instead another layer of costs has been added, advertising, salespeople, customer care representatives and more. We need something else: A single payer system? Allow Medicare to negotiate with the drug companies? Some form of published prices for specific services, treatments, and pharmaceuticals? Individual Americans will continue to demand what they see as "the best". We need a way to satisfy these two conflicting demands. Perhaps Americans could enjoy a universal health care system AND use their individual disposable incomes to purchase luxury health care. 3) A long time ago Americans decided that every individual had the right to an education, regardless of the income or the education level of the parents. We solved the problem by taxing the land to pay for education (tenants pay through their rent), and by delegating to states the right to manage the schools according to local needs, while allowing Americans with higher disposable incomes to pay for their choices in education. Why can we not adapt some version of this system to Health Care?

Three illustrative cases from my own personal experience: I had two children without so much as an aspirin. Nor medical testing (I'm not saying I didn't have blood work done, just no medical tests, like ultrasounds). My sister-in-law, on the other hand, had four ultrasounds during which the technician swore she was having a boy. Instead of Nicholas, out popped little Nicole...

When my son was 18 months old, my chiropractor told me that I needed back surgery. You know it's bad when a chiropracter tells you surgery is indicated; my husband literally carried me into his office, I was in so much pain. I declined. I began swimming for exercise. It was excruciatingly painful at first, but it helped. Ten years ago, I began spinning (studio cycling). Now I teach classes. Today, fifteen years later, I take a couple of ibuprofen a few times a week. My friend, Carrie, now on her fourth back surgery, gets worse after every one...

Third case in point: when I moved to Cincinnati from Columbus twenty years ago, I needed a prescription for a dermatology product. I went to a physician in my building (I worked at UC Medical Center at the time). We spoke for, say, five minutes. She wrote a prescription (I even told her the name of the product I needed). A few weeks later, I got the bill. It was for a level V visit: full medical history and exam, normally an hour or more of physician time. When I called and pointed out the discrepancy between my experience and my bill, I got a revised bill, labelled professional courtesy discount. The level of treatment didn't change, only the cost...

I relate these three experiences because I have learned to distrust the medical-industrial complex and take charge of my own health. In fact, I don't consume half the health care I'm entitled to because I've chosen a path that creates wellness for me. Why is it that we don't require all Americans to take responsibility for their health, too? By building in incentives for people to pursue wellness (you lose weight, you save money on premiums) and freeing up health care dollars, more would be available to those who cannot afford health care and do not have access to it by virtue of their employer.

Three illustrative cases from my own personal experience: I had two children without so much as an aspirin. Nor medical testing (I'm not saying I didn't have blood work done, just no medical tests, like ultrasounds). My sister-in-law, on the other hand, had four ultrasounds during which the technician swore she was having a boy. Instead of Nicholas, out popped little Nicole...

When my son was 18 months old, my chiropractor told me that I needed back surgery. You know it's bad when a chiropracter tells you surgery is indicated; my husband literally carried me into his office, I was in so much pain. I declined. I began swimming for exercise. It was excruciatingly painful at first, but it helped. Ten years ago, I began spinning (studio cycling). Now I teach classes. Today, fifteen years later, I take a couple of ibuprofen a few times a week. My friend, Carrie, now on her fourth back surgery, gets worse after every one...

Third case in point: when I moved to Cincinnati from Columbus twenty years ago, I needed a prescription for a dermatology product. I went to a physician in my building (I worked at UC Medical Center at the time). We spoke for, say, five minutes. She wrote a prescription (I even told her the name of the product I needed). A few weeks later, I got the bill. It was for a level V visit: full medical history and exam, normally an hour or more of physician time. When I called and pointed out the discrepancy between my experience and my bill, I got a revised bill, labelled professional courtesy discount. The level of treatment didn't change, only the cost...

I relate these three experiences because I have learned to distrust the medical-industrial complex and take charge of my own health. In fact, I don't consume half the health care I'm entitled to because I've chosen a path that creates wellness for me. Why is it that we don't require all Americans to take responsibility for their health, too? By building in incentives for people to pursue wellness (you lose weight, you save money on premiums) and freeing up health care dollars, more would be available to those who cannot afford health care and do not have access to it by virtue of their employer.

I disagree that market mechanisms won't work.

I switched in 2008 to a high deductible health plan plus a Health Savings Account. The sum of my premium + my HSA contribution = my premium for the higher-premium low-copay plan type I had chosen in prior years. The premium savings ($178 biweekly) were enough to fund my HSA at an amount just above the plan's $4K annual out-of-pocket cap (in-network; same for either option; same carrier for eithe option).

I had $1500 left in my HSA at yearend, which is available for future years' medical expenses. Yearend leftovers in a Flex Spending Plan (which I had used in prior years) can't be carried forward for future years. My HSA experiment was a raging success. HSA's are fabulous! Their use should be expanded and encouraged.

Samuelson makes it sound so painful. It doesn't have to be.

In 2007 and prior years, I chose a (employer-sponsored) health plan with lower copay, higher premium, and supplemented it with a Flexible Spending Account to pay for the copays, deductible, and not covered out-of-pocket expenses with pre-tax dollars vs. after-tax dollars. I funded my FSA at about $150 per pay period.

In 2008, I switched to a high-deductible employer-sponsored plan plus a Health Savings Account (works just like the Flex plan, but without the annual use-it-or-lose-it hassle). Same carrier, same annual out-of-pocket caps, same safety net for major medical expenses. But my premium is much lower ($178 per biweekly pay period). I funded the HSA with the premium savings ($178 per pay period).

The amount withheld from my 2008 pay is the same as if I had chosen the low copay option and not contributed anything to a 2008 Flex Spending Plan. That saved me the total amount of my 2007 FSA contribution ($3600). Plus, I had $1500 left in my HSA at 12/31/08, which is available for future years' medical expenses. FSA money left at yearend would be forfeited, and unavailable for future years.

HSA's are fantastic! Their use should be encouraged and expanded. By accepting the risk for the first $4,000 of annual out-of pocket expenses for my family, I save enough in premiums to fund the HSA with $4,000 out of pocket cap, and get to keep the leftover for use in future years. Everyone should do this.

Samuelson is right that the HMO system enables decoupling of costs- ironically congress created HMOs in 1973 to try and control costs and increase access. "Decoupling" - the economic term for when someone's purchasing decisions are detached from the burden of paying, is only a partial cause. While this explains patient's desire for additional goods and services, it doesn't explain the doctor's- who get to fight with insurance companies for every dime they want to spend. Doctor's are incentivized to run unnecessary tests and procedures to expunge themselves from liability due to inaction: the threat of being sued has not only increased liability insurance premiums (also increasing costs) but has make doctor's more likely to overtest. A oft-quoted study by law firm Towers Perrin pegs the cotsts of frivolous lawsuits at approximately 2.2% of GDP, a significant portion of which is in medical "malpractice". Aggressive Tort reform at both the state and local level could take a significant bite out of growing costs.

Samuelson conveniently forgets that medical care in this country is a commodity,not a right. Private insurance companies do not exist to provide health care, they exist to provide a proft to their investors. Right now the acceptable profit margin is about30 to 35%, so that for each dollar we invest in healthcare - about 30% goes into the pockets of insurance companies.
According to a recent survey conducted by the WHO, France has the world's best medical system. It's cheaper than ours. Why? I was in Austria about two years ago. Austria's system occupies 9th place in the WHO survey. It's also cheaper than our system. According to the article I read in the Neue Krone Zeitung, most Austrias are pleased with their medical care. Why do these systems work and why does our system fail.
Furthermore, Samuelson refuses to look at ways that increase the cost of medical care. Bush's veto of SCHIPS means a lot of sick children will become sick adults. Acceding to vide presidential candidate Sarah Palin's request, California Governor Arnold's Schwarzenegger vetoed a plan to clean up the air around LA;'s harbor. That means more sickness and higher insurance. Our failure to safeguard the environment causes higher medical bills.
In addition, addictions to smoking and fatty foods - not to mention our subsidies for beef and pork also result in higher medical bills. There's a whole list of other unhealthful practices that cut medical care costs.
Samuelson, a shill for private insurance companies, doesn't want to tell the truth. Obama's proposals do include a number of ways to contain health care, so do the plans proposed by the AARP.. I also suggest that people be allowed to enroll in Medicare at any age. Or, they could opt for the same health care plan offered to members of Congress Or perhaps we could merge the medical care plan that Congress enjoys with Medicare. Providing health insurance for everyone, practicing preventative, proactive medicine - and eliminating the pharmaceutical companies; profiteering from Medicare D would make a more affordable system.
Other counteries can provide high quality medical care at a cheaper price. Why can't we?
P.S. In the WHO study, the US ranks 37th. Cuba is 39th - albeint Cuba has a lower infant mortality rate than the US. Why?

???On paper, there are various ways to control health spending: impose stricter regulations on prices and the availability of care; adopt "market mechanisms" that push consumers toward more efficient, more effective or skimpier care.???

Gee, I wish I worked for Newsweek so I could get Samuelson???s lavish healthcare plan. Where I work, I have a PPO plan (preferred provider organization). What my company???s medical and dental insurance company will pay for is STRICTLY limited. I???m not in the age group where I have to worry about the ???luxury??? of getting a hip or knee replacement that Samuelson is obsessed with, but this hardly seems to be a luxury to me.

Samuelson is one of those free marketeers who think the magic of the market place cures all ills. Yeah. Look what unfettered and predatory capitalism has done for our economy. The insurance companies are NOT in business for YOUR health.

Wh not simply regulate charges and define appropriate care? Why does a CT or MRI need to cost what it does, and be used so often?Why do we do so many knee and hip replacements? These are simply examples of oligopoly pricing and the prescription of resource use which benefits the prescriber. Transferring the cost of care to the patient is not the answer - patients will simply avoid care, and the result will be decreased health for many. Sick people do not shop costs as we do for a TV, nor do they have the necessary information - there is an asymmetry of information between patient and provider. Therefore the use of "consumerism" as a solution breaks down. Plus every interaction is unique to that individual and fraught with anxiety - I guarantee that no matter your thoughts on healthcare policy you will not shop around when you have a perceived emergency. Societally we must assume the willingness to provide affordable healthcare for everyone, and the most honest and direct way to do that is to define costs and appropriate care with broadly accepted guidelines issued by a central authority. One must be honest enough to acknowledge that health care is not a usual consumer good and not cling to economic theories that do not apply in this circumstance.

The only way to bring down the cost of health care substantially is to limit the options available. The cost of any procedure is not going to come down unless we limit the procedural options you have to address a given problem. For instance, a large part of drug cost is in research and development. If you limit the amount of r and d a drug company spends the cost of the drugs they are selling can come down as they will not need the excess profits to cover the costs of drugs that never make it to market. The downside is that there will be far less inovation in bringing new life saving drugs to market and we will just have to make due with what has already been developed. This is why drugs negotiated by the VA and foreign governments such as Canada are cheaper. They do not have access to the full range of drugs and the rest of us are obliged to pay full retail plus in order to cover the shortfall.
Also, a government run sytem would try to cut costs by not allowing you to chose what procedure you wish to have for your situation. Today you can schedule a knee replacement surgery to aleve the pain caused by normal wear and tear at your discretion. In a government run system you have to apply for permission to have the surgery and you are likely to be told that your situation is not dire enough in the grand scale and you will be denied. The rich willl still be able to buy the same procedure out of pocket while the rest of us will just have to suffer.