“Create an add-on to Medicaid (for people like your daughter) that subsidizes treatment for the excluded pre-existing conditions on a sliding scale, so that those whose care is uninsurable are assisted to get needed care, IF THAT ASSISTANCE IS NEEDED. In your case, if you and your wife earn a great income, that might be very little help, but the fact is, if you have a great income, why should you be the beneficiaries of other people’s compelled charity? Why should I, for example, have to give up my vacation to pay taxes so that you can spend your money on vacations for your family rather than your own daughter’s care?”

While I, of course, would not want you to give up your vacation to pay for my daughter’s care for me, that’s a false choice, for a very simple reason – =I=, and my family, have been PAYING for insurance our entire lives. I’m not looking for a handout here, I’m just looking for what is owed to me – all those years where I paid into the system without (rightly, I might add) getting anything back, because that’s what insurance IS. I’m not sure where my situation falls in regards to your idea that a reformed system should “allow exclusions for known pre-existing conditions”, given that we are currently being treated in exactly that manner, but regardless of our financial situation we are folks that have played by the rules and now find the rules no longer apply to us because we are no longer cost effective.

You are right that your situation reflects a problem with our health insurance system that DOES need reform (unlike the problem with someone who just doesn’t want to pay for health insurance until they get sick).

The problem that needs to be corrected is the linkage of insurance with employment – a problem created by government intrusion into the insurance market.

This arose during the wage controls imposed during FDR’s administration, when employers were forbidden to raise their employees’ wages but were allowed to offer tax-free health insurance as additional compensation.

The result was a huge market distortion. Workers being, by and large, healthier than the rest of the population, and large employers having better negotiating clout, the market for individual policies has suffered ever since.

In the meantime, workers, and especially unionized ones, started demanding lower deductibles and more and more non-insurance type coverage from their plans – coverage for preventive care, office visits to doctors, routine lab work, etc. – so even with their healthier pool and better negotiating abilities, the prices of their plans soared and people’s expectations for what health insurance should cover grew exponentially. Then, as people realize they are paying thousands of dollars a year for “insurance,” they feel entitled and even pressured to make sure they use it rather than “waste” it, so restraint in seeking care went out the window for insured people.

The true reform solution would be to de-link insurance coverage from employment. Take away the tax deductibility of employer provided insurance and give a tax deduction for individual plans. This would create a huge and much better market for such plans. Additionally, allow plans to market across state lines and limit the ability of state and federal politicians to add mandated coverage to plans, but require guaranteed renewal. Impose some limits on denial of coverage for unknown pre-existing conditions, but allow exclusions for known pre-existing conditions.

Create an add-on to Medicaid (for people like your daughter) that subsidizes treatment for the excluded pre-existing conditions on a sliding scale, so that those whose care is uninsurable are assisted to get needed care, IF THAT ASSISTANCE IS NEEDED. In your case, if you and your wife earn a great income, that might be very little help, but the fact is, if you have a great income, why should you be the beneficiaries of other people’s compelled charity? Why should I, for example, have to give up my vacation to pay taxes so that you can spend your money on vacations for your family rather than your own daughter’s care?

There is no reason the health insurance market should not work just as well as the auto or homeowners insurance markets for 95% of the population. Conversely, if the government did to those markets what it has done to the health insurance market, they would likewise be in just as much trouble. Imagine having most auto plans obtainable only through employers, having them mandated to pay for new tires, oil changes, detailing, tune-ups, and every additive sold a company with a strong PAC and good lobbyist. Imagine the premiums if companies were required to issue coverage after you crashed your car, or to people with three DUI convictions. Would anyone who loves to peel out from a stoplight and hates to worry about maintaining proper tire pressure have an incentive to restrain themselves if they were entitled to new tires every 20,000 miles?

What about the other 5% who might not be well served by such a system? 95% success may not seem like enough to people who demand perfection from human systems, but there is no such thing in the real world. Every system is going to have a certain number of losers. A sensible system can address the needs of your daughter, but may not be able to provide “coveraage” for the schizophrenic drug addict who visits the ER two or thre times a week seeking drugs or the chronic alcoholic who needs a liver transplant. I have known such people, and no health care delivery system can be devised that will deal with everybody perfectly.

Every poll taken about satisfaction with one’s own personal health care shows Americans as much more satisfied, by and large, than participants in single-payer or government-run plans. This is a track record that should be messed with carefully as we talk about how to pay for it.

I am 47-years-old, my wife is 46. For our entire lives, we have had health insurance, first on our parents policies, then group policies from my job or hers. We’ve been paying into the system in one way or another for nearly half a century, with very little in the way of payouts over the years, for the most part.

In December, my wife (the primary wage earner in our family) was laid off. She had a severance period where she got payments and we were still covered under the group insurance, and she was lucky enough to find work shortly after her severance ran out. But the work she found was as a consultant, and it didn’t include health insurance.

We started on COBRA, which costs us nearly $1500/month. Everyone says, “Don’t do COBRA, an individual policy is usually cheaper.” Only problem is, my 12-year-old daughter was diagnosed with Crohn’s Disease when she was 10. She hasn’t had any problems requiring treatment (beyond the checkups and medications) in nearly 2 years now, but we’ve been told that no one will write us an individual policy that covers her until they are forced to by HIPAA eligibility when we have exhausted our COBRA coverage, and even then it will be very expensive. We’re lucky, because her consulting job pays well and we can manage the COBRA payments. But how many people in our situation wouldn’t be able to put out $18,000 a year for health insurance?

I understand arguments about pre-existing conditions where folks wouldn’t pay for coverage until they were already sick, but I think the problem is with folks like us, who have been covered forever and can’t get coverage due to an employment change.

And for all of you who are happy with what you have and are afraid of reform because you think your current coverage will be hurt – you are quite possibly only a job loss away from being in a world of hurt.

Everyone hears the downside of public medicine, but with advances in healthcare, it may not be as bad as what we feared 20 years ago.

My wife is from El Salvadore, and the quality of care for most common diseases is not that far removed as from here….

I think health care costs are rising and we will have to do something. $5000 for outpatient procedures is simply too much – it takes 2 hours! Doctor’s scream about their rising costs – but how many live in a small home or drive an inexpensive car. It is time for some change.

Excellent article today at CNN.

http://videocafe.crooksandliars.com/media/play/wmv/9444/30453

I again go back to the auto insurance example. You buy auto insurance to protect yourself against loss due to theft or collision. But you’re auto insurance doesn’t pay for annual maintenance and routine repairs. If it did youy’re be paying triple at least!

IOW, your auto insurance doesn’t pay for oil changes, annual inspections, new brakes and tires, a new muffler, etc. And as your car gets old, like a human body, more things are going to fail costing more in repairs. But you don’t expect your auto insurance to pay for it.

Same with what health INSURANCE *should* be. It’s expected babies will need vaccinations, teens will need medical approvals for school sports, you’ll want an annual check up, you may need to see a doctor if your cold doesn’t go away, you will get bad cuts and burns, etc. That’s all routine as part of life. OTOH, if you suddently develop cancer that is unforeseen (inspite of some possible risk factors). So therefore insurance should pay.