It was a pair of socks that turned me against our current health care system.
True Story:
It's fall of 2008. I'm in Prince William County Hospital, Woodbridge, Virginia -- the medical facility that tried to kill me.
I'm there with a chest full of pulmonary embolisms -- a baker's dozen blood clots spread across both lungs. They were a complication from surgery to reattach a torn Achilles tendon.
The hospital room was chilly, and my left foot was still in one of those immobilizing walking boots. Had to be elevated, which made my blanket too short to cover both my feet. The nurse comes in to check on me, and notices my 'good foot' sticking out at the bottom of the covers. She compassionately asks me if I'm cold. I say yes, and she promises to come right back.
She brings me a pair of socks. They are reasonably nice as socks go; cotton, gray, with little patches on the bottom to keep me from sliding around on the floor. I've seen similar socks since, at Wal-Mart. They retail for about eight bucks a pair.
I thank her for her kindness, and she rubs my arm.
I heal enough to go home, and later discover a pretty major insurance SNAFU. The paperwork shuffle sends the wrong documents to the wrong desks, and important deadlines pass. Ultimately I get stuck with the entire bill -- even though I was paying a significant amount to be "covered" before my accident.
Getting stuck with the bill meant I got to see all the charges. Almost $50,000 worth of individual pain-killing pills, Heparin, sleeping pills, meals, fees, and a $74.95 pair of socks.
Huh?
Double-checked it, and yep. It was a real charge.
Line 47.
Socks, Non-Skid: 74.95
Made me a little sick at the stomach. Friends and family had brought me lots of things I needed. I'd forgotten to ask for a pair of thick socks, no big deal. It was an oversight. I would have survived without them for a night or two. And if she'd asked me if I was cold enough to want some fing $75 socks, I would have said "thank you, but no. I'll be ok."
See those socks at the top of the page? I'd pay $75 for those. Hell, Maybe even $100. I don't know if you can see it or not, but they're shiny. Got what looks like hundreds of rhinestones on 'em. Plus .. THOSE socks are famous! Worn by a popular musician in his heyday. If I wore THOSE, everyone would look at them and say "damn, bro. now THOSE are socks. Where'd ya get 'em?"
And I'd prolly blush a little bit, and tell a story that would make me cool. And I'd feel GOOD about paying $75 for a pair of socks.
Instead, the now tattered gray socks with the non-stick tabs make me queasy. And probably will until the day I die. I'm not throwing away $75 socks.
Ever.
I listened to the health care debate for almost two whole years. I read all 2000+ pages of the bill Congress produced, and it makes me queasy too.
It is mysticism -- sort of like when religious people try to explain the plan of Salvation to me. I'm sure THEY understand it, but it's gobbledygook to me.
Here's MY solution, short and sweet enough to cram into ONE blog:
1. Allow everyone to buy a health care plan. Not just businesses buying for groups. Sell them in set amounts of coverage. $1M, $500k, $100k .. with varying deductibles. Allow anyone to sponsor them; businesses, churches, charities, private organizations, social clubs peopled by men named "Bob." Literally, anybody.
Also allow companies to sell term or life policies. Planning to skydive? Play semi-pro football on the weekends sans pads with your buddies? You sir, may need a $10M term policy, good for three years. That's gonna cost 'ya $10k/month ... OR you can gamble that gravity doesn't work, or Joe "wannabe-Brian Urlacher" Smith isn't coming across the middle to break your neck, and take your chances.
Now THAT money, is for catastrophic events. The things that we know will happen to each of us "eventually," that are completely fixable.
Heart attack? Insurance policy.
Rip your achilles playing parking lot pick-up ball when you're too old and fat? Insurance policy.
Having a baby? Insurance policy.
Insurance for all the mid-level stuff that's too big to fix at home, or with an outpatient doctor's office visit, but too small to require a second mortgage.
#2. Take away the mysticism of hospital pricing. One of the beauties that keeps insurance such a murky concept is that no one knows how much anything costs inside the doors of a clinic or hospital. Know why? Because there's no set price. They charge as much for EVERYTHING as an insurance company will pay. That's a recipe for two-way fraud and collusion.
Put up price lists.
Check-up: $20 (or $40, or $100 ... I don't care what an individual hospital charges for an individual thing, I only care that the provider and the patient both know it's cost/value at the beginning of the transaction..)
Cast for broken leg: $200
Allow Doctors to charge an hourly wage just like everybody else. Let me buy their time, and more importantly, their undivided attention.
Then allow them to explain my options with a menu that includes the prices, so I can understand the calculus and weigh the necessary vs. the luxurious. I'm not a moron, and neither are you. The doctor certainly isn't, so why can't we reason together about how far down the rabbit hole we want to go TODAY to figure out if I have indigestion, or esophageal cancer?
Plus, knowing how much something costs is an integral part of competition. Business slow? Let the hospital or doctor run a special; "back to school checkups, 40% off!"
Allow medical outfits to balance their books with supply and demand just like every other business in America. And let them actually get paid by the customer for their services, just like the grocery store, the gas station, and the morgue.
An outpatient procedure should not REQUIRE insurance. It also should not cost $10,000. It doesn't in lots of other countries.
I suspect, that you ... like me, get sick roughly the same number of times every year. You probably have since your 21st birthday. You could probably tell me, right now, within a range of 2 visits how many times you will go to the doctor or hospital in 2012.
That's something you can budget for, just like you budget for gas, and groceries, and new clothes. The most expensive item at the mechanic is only a few thousand dollars. And there's a mechanic on almost every corner in America. I cannot grasp why hospitals are so much different.
And when you have a procedure that WILL cost more money than you should reasonably be expected to have saved up for ... BLAMMO! You whip out that insurance policy, pay your deductible, and let the big boys pay for it... off the price list, not off some imaginary pay chart where gray non-skid socks cost $37.50 each.
Finally, there will be injuries and illnesses that nobody can see coming.
Your heart goes bad, and you need a transplant. Your child is born with a rare congenital condition that requires two years of in-patient care. You contract some off-the-wall virus from the crazy Outbreak monkey and we have to fly in Cuba Gooding Junior and Dustin Hoffman to race to the cure.
That's where I want Uncle Sam to step in. I don't need him to buy me an aspirin. I can handle that, if the price is cost + a reasonable percentage of profit. But if I need a new $20M liver, I don't mind having the rest of you kind tax payers chip in. And quid pro quo. I'll help out with your ten years of chemo if and when you require it.
I also don't mind if the hospital adds a few extra bucks to my bill that helps cover the people who can't afford care. There isn't a system that will cover everybody without it costing an arm and a leg. And as long as prices for the indigent are the same as what everybody else pays, I don't mind pitching in. I may need to tip in to the poor fund now and again, myself. Bad luck happens.
I acknowledge a couple of things. Becoming a physician is a difficult and expensive undertaking. In our system, they deserve to be paid well.
But they could be paid a bit LESS well if THEIR insurance rates weren't so absurdly high. In the current system, doctors get it from both ends. Bring down expense of care, and their malpractice rates plummet. Nothing helps inflate them quite like starting with a $50k patient charge for a hangnail procedure gone bad that ends up in court.
And the space-aged equipment American companies have developed is astronomically expensive. But that's true of a lot of industries. And I'm not so sure those costs aren't also tied to the collusion between insurance companies, big pharma, and big medicine.
I'm not a socialist (most of the time). I'm not a Communist. I'm just a guy who looks out at America and sees an over medicated country with horrible eating and health habits, and a medical system that is simultaneously underfunded, and overwhelmed.
This isn't capitalism. It's slow economic suicide.
That from a guy with ratty $75 socks on my feet.
Peace,
--Stew.
P.S. I don't believe my plan is perfect. I don't think it solves all the problems. I DO believe it's implementable, without creating a new agency, or tacking another $10T onto a debt that's sinking a sunken economy. What would you change? How would you fix it? I already know that you're smarter than Congress. Prove it.
I too have painstakingly read the 2,000 thousand pages; ok, I skipped the legal EEs and studied the summary principles. And the truth is, despite some minor differences, I kinda like it. The larger truth is I don't understand what the hell the Republicans are so upset about; the bill seems rather Republican to me. Most of the provisions allow for market forces while providing consumer protections.
ReplyDeleteI know why Republican leaders are upset... in their game of "no to everything coming from the White House" this was a big loss. But the average citizen will benefit greatly, especially those citizens whose employ doesn't provide for health insurance.
Your plan... I don't like it, but only because it seems too complicated, and no, I am not kidding. I like this. I pay $300/month; my employer pays $700/month; and my family seeks the medical care we need. All big things are covered, while some of the small things are not. I have copays for everything. Not being a GP, my GP tells me when it's necessary to see a specialist, and I choose that specialist based on my research. If I am lazy, my GP tells me whom to see.
My vision of health care: everyone in America should have this plan, though hundreds of providers get to bid to do the providing. The family's contribution is dictated by income level. Those who make less than I do pay less; those who make more pay more. No loopholes. If your employer can't afford to chip in for the employer portion, that company should link with groups (coops) of similarly economically challenged businesses to get the same rates as the big guys. If those businesses still complain, fuck 'em. As an employer, you are a financial steward of your employee; if you don't want the burden, don't be an employer. If we reach some economic pitfalls, I'll pay 50 more bucks a month so everyone can have this plan. I am my brother's keeper; call it my plan for salvation. Rich people need to pay more than me; poor people need to pay less. No loopholes. Like you, I know this isn't perfect, and I haven't really addressed the issues, but frankly, I don't think those issues need to be addressed. Addressing issues and discussing hypothetical situations retards progress. Much love, Stew, and if you were cold and asked me, I would get you a $75 pair of socks if you couldn't do so yourself, from MJ or otherwise
I have something else for you to read in a little while.
Let's take the differences one at a time. I think it will make for a more productive conversation. Since I don't think I have all the answers, I'm genuinely interested in hearing what you have to say. I'm not a zealot about my plan, and I'm wide open to adopting better ideas when I hear them.
ReplyDeleteThere ARE some things I like about what I understood of the new plan. But I think behind the noise of what opponents are saying are a few genuine issues with it.
#1: I don't like the notion of health care being absolutely tied to my employer. From the individual side, it limits my ability to gamble on a better opportunity -- especially if I'm sick or have a preexisting condition. And right now, in an era where we're trying to spark industry and creativity so we can dig out of a massively stunted economy; we need as many people as possible to be willing and able to jump out and "do" new things. That's where the next generation of commerce comes from.
Form a corporate standpoint, $700/month per employee is a lot to stick a company with. If every dollar is "real," and has to come from somewhere, that means for every 12 employees I hire, I have to generate 100k JUST to cover their insurance for a year. For lots of small businesses that's an added cost of doing business that brings literally NO return. And small business hires more than 50% of the private work force (http://www.dol.gov/odep/pubs/ek00/small.htm)
When you work for the government, it's not as big of a deal. Tax dollars are "bottomless." They aren't real pots of money, and the organization can run an endless deficit if they don't have enough "cash."
But what keeps it from killing the little guy? What if I run a retail store, or web site or pizza joint? If my first $8500 of sales go to cover insurance for ONE employee, at what point do I get into profits -- which is my real reason for being in business in the first place?
I get that it might be better NOT to have insurance tied to your employment; it just didn't work for me very well. I was without insurance for 3 years before the Army and about the same time-frame after the Army. And what I can say is the mobility was more than mitigated by the cost. I'm not sure what governmental changes would do to change that.
ReplyDeleteAs far as the $8,500, we're going to have to respectfully disagree. The way I see it, if you can't come up with $8,500/year from your business, you probably don't need another employee. After all, there is a tacit implication of obligation when you decide to employ people. In our society, we tend to see it the other way - the employee has all the implied obligation. Bad work = dismissal. But here is where I give a nod to the Japanese; they get it right where we fail as it pertains to employment.
Let me explain, based on my time (about a year) with a start-up bouncer company in Japan.
The most rudimentary part of the agreement is that the employee performs work for money, and this is generally the long AND short of it for Americans. The attitude I see and saw is "we paid you, what else could you possibly want?" But for me, and for the Japanese, that is almost the least important part of the equation.
The Japanese understand that an employee's work has a much greater value than the wages paid. Employees sustain the company, and their work betters profits. Further, in addition to the work they have given, the work that allowed your company to exist, the employee has also given you time, a portion of his/her life where the greatest amount of his/her energy has been devoted to you. Moreover, an employee has at most, 50 years to do so. Every day that employee has given to you, s/he has taken a chance and committed a portion of hope attached to your COLLECTIVE success. These other benefits should be recompensed, but in the States, they are not even acknowledged. In Japan, when a company is in trouble, management takes the hit, not the worker. Managerial bonuses are the first employee compensation to be reduced, not the last.
$8,500... compared to a year of full-time devotion, that's the least a company can do. But to help, call it a tax write-off.
So why stop at health insurance? Why not auto insurance, groceries, child care? clothing? It's not that I think a company should NOT offer insurance benefits...i DO. but I don't think that should be the sole source for medical coverage.
ReplyDeleteI'm fine with the Japanese premise, but this would be a weird starting and stopping point to snag that solitary piece of culture from them.
I worked for a Japanese company -- the recording company that I did my singing for. And you're absolutely right, there is a completely different setup there, than here. BUT ... Japan has socialized medicine, so the company isn't responsible for their health care.
Why stop? I would suggest that health care, and this may be another point of disagreement, has become a fundamental right in a way that auto insurance, groceries, and the rest R not because health care saves lives, and in some sense, is not a matter of choice. Indeed, I do have some backing in this regard; it's why our nation's emergency rooms are full of the uninsured. Groceries, however, and the rest sustain life, and only you can choose how to sustain yourself.
ReplyDeleteA choice of hamburger versus a hotdog is just that, a choice. That's why you are given money, to make a choice about how to sustain yourself. But a malignant lump is a malignant lump; it needs to be removed. You don't choose to get it or not get it; it either happens or it doesn't. You can't go to a store and get a lump removed, and in that way, medicine is thus, part of the public trust. There's nothing you can do by yourself to get rid of that lump; you must rely on society for assistance.
As far as annexing other elements of Japanese culture, I don't see why not. Just as you know you don't have all the answers, you also know America doesn't have all the answers, either.
But after it's all said and done, we essentially agree, at least based on your first expository sentence. "It's not that I think a company should NOT offer insurance benefits...i DO." That for me is the crux of the mater. All employers must offer health benefits. And I would certainly think nonemployer - sponsored health insurance should also be an option. My plan is the employer insurance would be a minimum offering
ahhh...well THAT'S the part i missed the first time, lol.
ReplyDeleteI wrote "Allow everyone to buy a health care plan. Not just businesses buying for groups."
... meaning that businesses buying for groups would STILL be able to provide insurance if they chose.
I don't think it can honestly be the minimum because there are always so many people without jobs. BUT ... if that's where we choose to take the temperature, i'm good with it.
As a MINIMUM ... you should be able to get insurance from your job.
I'm actually VERY okay with that...
Question two: pricing.
ReplyDeleteWhy should it not be a consideration in the out-of-control costs of American health care?