One Oregonian dies each day due to lack of health insurance.

http://www.kgw.com/news-local/stories/kgw_031208_news_oregonians_die_health_insu rance_.4991449e.html

So go out and get health insurance. I never understood the problem. I do not make much and my employer does not carry me but I have myself and my child covered.

I pay it out of my own pocket.

We pay out of our own pocket as well.

Easier said than done. Most people who are unisured cannot afford it. My 60 year old mother in law being one of them, who is employed, but not offered insurance.

To me it's not about health insurance. That's a scam in my opinion. It's about health care.

Well, when someone doesn't have "health insurance", the client gets to pay out of pocket for their "health care." We just paid a $400 dentist bill for the mother in law because she doesn't have insurance and couldn't afford to pay out of pocket, but needed to have the work done. What if she didn't have us to help her?

I too buy my own health insurance (self-employed). I'm in good health and my coverage is OK, but it's increased in cost a lot the last few years, not just because I'm getting older. In 20 years I won't be eligible for Medicare yet but I imagine my premiums are going to be sky high.

Health insurance isn't a level playing field for everyone. I have a friend who is Type I diabetic, meaning she must have insulin to live and must check her blood sugar several times a day. Not only is this expensive but insurance companies consider this a pre-existing condition. She's in college right now and even though she has insurance through college, the health insurance company there has extremely limited coverage for anything related to diabetes (they specifically limit the amount covered per year for pre-existing conditions). Any sort of complication and she's basically screwed - probably bankrupt. And she HAS insurance!!!

So no, Mc74, it's not always so easy for someone just to go buy health insurance. If my friend tried to buy it the way I do, they wouldn't even sell it to her to cover her basic insulin needs that she requires to live!!! No doubt Vitalogy's initial post about one person per day dying includes many people like my friend.

Andrew

"I pay it out of my own pocket"

Me Too.

Coupla things:

If you are paying out of pocket, for private insurance, and are healthy, few to no incidents, prices are reasonable and light service will happen as it should.

If you have prior incidents, good luck getting that policy. Also, if you end up in really serious shape, good luck keeping it.

Basically, it forced employer insurance onto us, meaning I *have* to work for somebody right now as a family member is uninsurable at any price, which they have to offer and cannot cancel like they do for personal insurance.

These are all legitimate problems and concerns. So, what should be done about it? We obviously need a solution.

Agreed.

There are some interesting ideas being tested out there. Oregon has it's health plan.

The states that have tried mandating coverage premiums have not had all that good of results. It's a gold mine for the insurance companies. Maybe this coupled with some other regulation shows promise. Don't know.

Don't have the link handy but pools of doctors have setup plans where people pay a monthly retainer. They will then deal with a lot of things, having the person only pick up the cost of supplies and medication.

I like that one because it's very preventative. Does not deal with big issues, but does nail a lot of little ones. Worth greater consideration.

Personally, I don't think we really need insurance companies at the center of things. They should be an option, not the only option. Dealing with them, on an individual basis almost requires an attorney --at the least it becomes a full time job for somebody, if you don't get canceled first.

Another good idea being tossed around is vetting procedures and equipment. Lots of things cost more due to a new formulation, or new engineering as these things see use that's not the adoptive kind.

What I mean by that is the new tech being adopted because it really adds significant value, not just that it's the latest greatest thing.

Older, cheaper means and methods could be used a lot more than they currently are and there is likely to be significant savings in doing that.

I believe Oregon is tossing around some ideas along those lines.

We could also put some serious R & D into improvements in testing. Anything to either reduce imaging costs, or maybe reduce the use of that expensive tech.

Another interesting bit is the difference between hospitals that operate as non profits and those that operate for profit. I've had to deal with both and it's fairly clear to me that reconsideration of the for profit model is worth some thought.

If the goal is dollars, then people suffer period. That's also related to the latest and greatest syndrome I mentioned above. That's all kind of broken right now.

Well somebody(s) are getting very rich off of people's fear about not having insurance. We make having insurance seem like we all need it.

We can afford insurance but choose to pay out of pocket because we get the better care. We have set up a good system with our health care professionals and our family is in excellent health. Our health care professionals tell us that dealing with insurance companies is a pain, so when we do pay out there is no extra paperwork. Also we get discounts all the time because we ask for them.

Not sure what a legitmate solution is. Hearing these types of stories makes socialized medicine look decent.

Agreed.

However, I'm totally not opposed to a mix of private / public providers. Competition is good and it's American.

My primary issue lies with for-profit insurers being the primary gateway into health care. They present a *lot* of overhead. One doctor needs several people, or needs to tap into a pool of people, in order to deliver their services. Single pay would deal with that, and still permit choice, private providers, etc... I think I'm sold on that idea, but there are other options!

Another element to all of this is local small providers -vs- large corporate ones. My pharmacists are great people. They mostly compete on services as the larger chain stores have the better prices.

That part of things is no big deal. However, insurance companies will not give them the 90 day mail order deal the larger chains have. This service would be an excellent way for them to compete and come way closer on price, but they are denied that option.

Many of the people they serve would benefit from this, and home delivery of things as well. The home delivery option is very expensive when done through larger providers. They could do it cheaper and use their one on one knowledge of their patients to schedule and make good use of their resources.

The same kinds of things happen to doctors in smaller or individual practices.

IMHO, doing more to localize things would help us. That's part of why I posed the pool of doctors taking retainers. They use those dollars to help them compete with larger practices and to buffer the difference between insured, cost of having to deal with insurance companies and the uninsured.

Another good way to see that problem is to look at how smaller and startup companies run. Often resources are shared. Conference rooms, collaborative deals where everybody does their bit, billing through whoever can do it best, etc...

The regulatory scene is broken here too, often preventing these kinds of things to be done in the medical field, yet that same regulation does not address the medicine for dollars problems we currently face.

If we could relax some of that, we very well could see pools of people competing locally to add value where they can.

I don't buy the "free market" bit. Governments set the rules and business exploits those --and I use the word exploit in a good way here, not as a negative.

The rules are poorly setup, favoring big medicine, and insurance companies and their profit. The result of this is a distinct lack of innovation as profits are largely locked in, eliminating the need to actually innovate.

Also, good medicine is people taking care of people. Local can be really good at this and highly preventative too. Preventative is something big medicine is just not all that good at, largely because the most dollars are to be had elsewhere with new this and new that, lock in here, there, standard this and that...

All of that means our market is not working for us, when it could be.

I totally buy into the idea that businesses competing is good for us. So why not structure the market rules in a way that encourages that?

Answer: Big medical lobby, most likely wanting to keep the current status quo.

I do like your idea of local and or a pool of doctors on retainers. But it all gets back to money. You have money you can get health care, you don't have money, well it's a crap shoot.

I still think we've been fooled that we need health insurance.

What does a family of 4 pay out montly these days? In talking with neighbors and friends it can anywhere from $600-1200 a month!!! Then you add co-pays and little help on perscriptions....are you really getting what you pay for?

We put money away each month for our health care. Call it our own Personal Health Insurance (PHI). We get interest on that money and use it only when we need too.

If in the future we are required to carry health insurance...well I'll deal with that when it comes. And I will fight it.

Chris, although you always hope nothing terrible ever happens, what if you or a family member needs to go to the hospital and stay a week or two? If you've got no insurance, that hospital bill alone is going to put you into bankruptcy unless you've got a ton of money saved.

And if you go into bankruptcy because you can't pay it, who winds up paying when the hospital has to write it off? The rest of us do. That's the problem with everyone not having insurance. It doesn't hurt just you - it hurts the rest of us, too.

Andrew

Andrew-
I have heard that scenario played out many times. We go on a payment plan. Sure it may take time to pay it off but I'm not also paying an insurance company at the same time.

If the same thing happens WITH insurance you're still paying out the nose too.

We have looked into insurance plans. We had been on an MSA for a while but it was the same old crap. You get very little coverage and you have to deal with people who don't really care about your situation. They just want your money.

Is it risky? Life is risky. Why pay $10-15,000 a year and then pay on top of that? How is that helping?

Last year our total medical expenses were about $15,000. We paid it out of pocket. No extra insurance on top of that. Do you think with insurance we would have paid any less?

All you folks who are paying your own insurance, what does it cost?

It's very clear that there's a huge amount of waste in the overhead caused and encouraged by the insurance companies- I've personally spent MANY hours since January dealing with the insurance bureaucracy for what should have been a very simple antihistamine prescription. United Healthcare just threw up roadblock after roadblock with the only apparent purpose of trying to wear me down and make me give up on trying to get them to pay what they owe.

IMO the only real solution is a single-payer arrangement like they do in Canada. Healthcare should not be a for-profit enterprise unless you're a doctor.

Of course the insurance lobbies have the politicians in their pocket, so that's not going to happen anytime soon.

My employer provides mine, and I believe they pay appox $6000 for just me. No deductibles, no monthly cost either. I certainly don't use $6000 worth of services per year though.

Chris_Taylor writes:
Last year our total medical expenses were about $15,000. We paid it out of pocket. No extra insurance on top of that. Do you think with insurance we would have paid any less?

Well, I'm only paying for myself. My coverage is average - deductible is decent good at $500 (Regence Blue Cross) and I pay just under $3,000 a year (being self-employed, I get to deduct that on my taxes, however). I could get cheaper "catastrophic" insurance that would pay only for hospitalization - because I really don't want to be saddled with a $250,000+ hospital bill, which could happen really easily to anyone, and wipe me out.

Yes, life is full of risks, but if I can reduce my chances of being financially ruined by a simple medical emergency, I will.

Andrew

Each of us has different needs and different situations when it comes to health care. A one size fits all health insurance system is not the answer.

I am also self-employed and every dollar counts. Being wasteful is simply not tolerated when it comes to money. We choose alternative medicine for most of our needs.

Our health care professionals have also become our friends. Insurance companies are the enemy a I simply won't let them take my family for a ride.

If someone comes up with a plan that is wise and helpful I'll be the first in line.

I've been carrying my own insurance since I became self employed in '95. It just keeps going up and up. So much so that I have had to increase the deductible to $2500 to keep the monthly payment under $300. As you get older it also goes up and up. That's two forces driving it up and no way to change that.

If you don't get older, you wonn't need life insurance.

Medical costs are so high due to 2 factors, doctors and hospital liability insurance. And the new equipment, which is very costly, and has to be paid for.

So Andy you're paying nearly $3600 a year for health insurance and have a $2500 deductable.

So if you meet your deductable this year you're now at $6100 out of pocket. What do you pay after you meet your deductable?

So is anyone really happy with their health insurance? The price verses the coverage. Is it worth what you're paying?

I'm fine with our health insurance.

However, ours (and it sounds like Vitalogy's too) are the exception.

We are covered by my wife's employer (Clark County Sherriff) insurance and there is no premium or employee "contribution" that we pay. They pay 100% of the premium.

It's the standard 85% - 15% and I think there is a $200 deduction per family member but preventative Dr's visits are 100% covered after our $15 co-pay.

The prescription plan has a $20 co-pay for generics and $30 for name brands. One of my prescriptions would cost me about $212 per month if I had to pay it out of pocket.

They also cover my diabetic testing supplies with just a $20 co-pay. Although if I lost about 100 lbs or so, I probably wouldn't have to even take my diabetes pills!

I know it's something I need to do but I like food too much!

Chris writes:
So Andy you're paying nearly $3600 a year for health insurance and have a $2500 deductable.

No, $500 deductible and nearly $3000 a year (I think it's actually $233/month so more like $2800). And I do get discounts because I'm with Regence Blue Cross (e.g. 50% on prescriptions), even if I haven't reached my deductible.

Andrew

Your wife's employer can thank the tax paying citizens of Clark County too.

And I will, somewhat teasingly, take your choice of not losing weight to task.

It's about choices. I bust my butt weekly to stay in shape. I'm weird that way. I love working out and I have been consistent for over 20 years. I have seen many benefits with exercise and diet. I don't starve I just watch what I put in my mouth.

So I challenge you Skybill. Save some money, put in some sweat equity.

I don't exhaust the deductible. At least not yet (since I increased it).
Insurance pays for the doc visits and gets me the good buddy price on labs and meds are 50%. Labs count against the deductible but meds don't. Without the insurance I might save if there is no major illness, but then I have no insurance and meds are 100% and labs become more expensive. If I had kept the old lower deductible, the rising rates would increase my payments to the point it was a wash. (12 x $400) + lower deductible = (12 x 300) + higher deductible.

I don't know. I haven't been convinced that paying monthly premiums plus co-pays is worth it. I view most everything I buy as an investment.

If forced to go purchase insurance I would certainly take the highest deductable I can. (we currently do that with our auto insurance) I'm used to paying out of pocket. It's that monthly premium that goes nowhere that bothers me. I keep thinking, " I can do something better with that money."

You know everytime this comes up I go out and research what's available. Even the companies mentioned here. And everytime I come away with "no way that's robbery."

So Chris, seriously, what will you do if you get a $250,000+ hospital bill someday? Would you lose your house? Is it really worth the risk not to have catastrophic health insurance - which at least covers a big chunk those huge hospital bills should they ever happen? You can get such coverage surely far more cheaply than regular health insurance and still pay your regular medical expenses mostly out of pocket.

Andrew

Your wife's employer can thank the tax paying citizens of Clark County too.

I fully understand and appreciate that fact! Before she got the job, we were on my insurance which at the time cost me about $148 per pay check (26 checks per year) and that was just medical and vision. I paid the dental out of pocket because it was cheaper.

Now, with the increase in premiums at my work, if we didn't have my wife's insurance it would be $200-$210 per pay check.

Although in reality thanking the taxpayers is really no different that thanking the consumers of any other company. Every time you buy a product or service, a portion of that goes to pay the company’s employee's premiums.

I'm very thankful for her insurance!

I'll look into it Andrew.

Again I first would negotiate with the hospital and talk about a discount. Find a payment plan that would be acceptable.

There are people who are paying off $300,000 mortgages and more.

Yes, Chris, they are paying off $300K mortgages, but they have to live somewhere. And they could still sell their home and get most of their money back. You can't sell a hospital debt.

And perversely, hospitals give discounts to people with insurance and not to individuals without insurance! You may be able to "negotiate" for the same discount I already get.

Andrew

Negotiate with an insurance company? You'd have better luck with al-Queda, or Herb.

When our first child was born we had insurance. Total cost: $6500.

Less than three years later we had child number two. No insurance. Our OBGYN offered a 25 percent discount. I went to the hospitals accounting department and they gave us a 30 percent discount if we paid off our bill in an allotted time frame. Total cost $3500.

In 2006, my wife, daughter and I had food poisoning while on vacation at Sunriver. Two ambulances and a 4 hr hospital stay.
Both the hospital in Bend the ambulance services gave us discounts and payment plans. Total cost $4000.

We had it paid off within a year.

Albeit we weren't talking $250,000 but I would approach it the same way.

It's not the best situation but I refuse to make decisions based on what ifs and fear.

My advice would be to get some sort of catastrophic insurance to protect yourself against a total loss should something really bad happen. My co-worker is going through chemo for the second time, and the last round of treatments (with all the other stuff included) was well north of $100K. And, she ran every day and was as healthy as could be.

With a house that's paid off, you are taking a chance that should not be taken. There has got to be some sort of umbrella policy out there that would be reasonable that would allow you to protect your assets.

Again I will look into it.

Chris, what Vitalogy is suggesting is something similar to the Medical Savings Account approach. What you do is purchase a high deductible catastrophic policy, something in the $5,000 to $10,000 range. You are then allowed to open a savings account (called an MSA), and you are allowed to deduct your contributions to that account from your Federal income tax. You can then use the MSA money you have accumulated to pay medical expenses not covered by the high deductible plan. You are not taxed when you draw money out for the purpose of paying a medical bill.

I for one don't think the MSA approach is the answer to our health insurance crisis, but in your situation, it seems well suited to giving you some protection.

Deane

Our credit union also offers a Health Savings Account (HSA) and it works somewhat like an MSA but not as clunky. Again we would go for a high deductible and have some tax benefits, but we could also use the money for non-medical things too. I believe it ties in with some kind of catastrophic insurance.

I'm looking into it.

Ahem, full Teamsters medical here, and for the spouse, full UFCW medical. We both deliberately set to find jobs offering full union backed coverage. We knew we were going to have kids and early deaths runs in our families. Many of you can take this path too. Its not rocket science.


Side note to Chris: Another thing to consider is the possibility of one of the kids having a major health crisis. The last thing a parent wants to be doing during this time is trying to find a doctor that will treat your child at low or no cost up front and/or finding someone that will do the expensive treatment/surgery needed to save your child.

Its one thing for an adult to forgo expensive life-saving medical treatment, but for kids, that'll be tough to deal with.

Just my opinion.

Skeptical,

I'm union for the same reason. In fact my detour away from working in mass media was due to getting married and wanting to have kids. My first priority was to their health and well being, so off to teacher school I went. It's a good career, one of many, no regrets. Pay's OK, I'll never be rich, but it's the medical bennies that keep my life essentially stress-free. My son got an injury that put him in Doernbecker's for a week last year. My cost? - $75.

And the thing about it is, in America today my kind of situation should be the rule, not the exception.

"America today my kind of situation should be the rule, not the exception."

Exactly. Its one thing for higher tiered white collar workers earning big bucks to have to buy their own insurance, but when you have a large percentage of the population working for just a few bucks over miniumum wage unable to afford health insurance for their families, something's wrong.

I do appreciate everyone's concern and input. And I do not take it lightly. And have been researching since this thread started.

We do have a great group of health care professionals that our entire family has been seeing for many years. We also like alternative medicine a great deal.

A philosophical note:
I would never choose a career based on what kind of health benefits I receive. Too many people are doing jobs they don't like. I do what I love to do and what I feel I was born to do. Everyday is a joy and different. This is not to say you can't find enjoyment in the fields you did choose for the benefits and health coverage.

We don't mind paying for the health care we already receive. We have overcome a few hospital visits already. I also believe those of us who are self-employed should be offered benefits that are as flexible as we are. This is not to slam anyone else’s benefits, but when those of us who take the risk of being our own boss we should at least be shown some alternatives that better suite our situation.

"I would never choose a career based on what kind of health benefits I receive."

Enjoy your good health and your freedom to make that choice. It's a gift man.

I'm in a similar situation, healthy and not really tied to bennies of any kind. However, my wife just isn't...

It's a brutal choice to have to choose employment for health care, or being broke for the next 10 years to pay what is probably gonna be a low 6 digit bill, or let the disease run it's course.

Without health insurance, I don't think I would be able to keep a house, etc... I also don't think I could get the treatment necessary.

Agreed completely on what self-employed people should get. It's the SHOULD part that made self-employment a non-option for me. Finding out the hard way just what is available and what isn't wasn't pretty.

Major bummer too. After a time, I saw that I could make it fairly easily and enjoyed the quality of life and ability to deliver quality of services that came with that.

It it totally true to find enjoyment in various fields. I'm actually working at doing a lot of what I love to do.

The major bummer for me is not being able to make the tough calls --having to live with somebody who will not go the distance to do things right, largely because the highest profit comes first, no matter the longer term consequences.

When I was self-employed, I didn't have to worry about that, or working hard to make up for end of year foolish spending... (hate that Is it that hard to just have some self control?) It was easy to just be sane with the income, sock some away just because you never know, and when something had to be made right, just make it right.

To me, that's one of the biggest disadvantages being employed has so far.

Thanks Doug.

I hope my posts don't come off sounding like I'm some kind of holier than thou.

We are blessed with excellent health at this time. We are also doing preventative stuff too. There have been a few bumps along the way but we've been able to handle them.

My wife and I know we are in a good place. You are correct it is a gift and we do not take this or anything for granted. We know this because we have been on the other side.

We made some tough decisions years ago that have proven to be wise. One being not living beyond our means. It's a simple concept but man it pays off big time when money can be tight.

Your wife's health issues are something else again. I think you are being very responsible in your choices in doing what's right for that situation. Sometimes the choices are bad and really bad. I hate that.

I am a fitness freak. I don't have any bad vices, but I'm smart enough to know that there are no guarantees. So this thread is probably a good reminder for me re-think some of my own philosophies. For that reason alone I have appreciated this thread.

So maybe now would be the time for Chris to admit his double life?

LOL ?!?

Thanks man! Needed that humor this morning!

Thanks back Chris!

And no, it's not coming across that way.

You know I do all I can to preserve my true identity but I guess the mask and cape aren't working for me.

"Is it risky? Life is risky. Why pay $10-15,000 a year and then pay on top of that? How is that helping?

Last year our total medical expenses were about $15,000. We paid it out of pocket. No extra insurance on top of that. Do you think with insurance we would have paid any less?"

The reason people get insurance is to mitigate financial hardship. Over the last four years, I've paid about $5,500 to my auto insurance company. What have they paid for on my behalf in that amount of time? About $500 for a new windshield once, some rock chips on another occasion that totaled less than $100, and a $75 pop-a-lock call when I locked my keys in the car. So, they came out way ahead. But that ratio could be turned upside down on my way home from work tonight if I cause an accident. It's piece of mind, and I prefer a managable monthly payment over sudden giant bills (which I can't afford).

BTW- I know this discussion is about health insurance, the the insuance concept is the same.

I look at auto and health insurance with different eyes. By law I need to carry auto insurance. That is not the case with medical insurance, although some politicians are pushing for some kind of mandatory insurance on those of us who can afford it.

However I am changing my tune on the medical insurance front and have been researching options. I still think medical insurance is robbery and I would say the same for the pharmaceutical industry BUT I am given it a far shake.

So for those of you who have cared enough considered your words heard.

I don't think insurance companies add any value to the consumer. They're just middlemen who skim off our money. While I'm a believer in the free market for most things (cell phones, computers, appliances, cars, etc.), insurance isn't one of them. I'd like to see the government take it over insurance the government itself requires (for auto and maybe soon health).

Can anyone point out how, I'm better off being forced to buy auto insurance from a private company vs. buying it from the government? I can see the argument for keeping hospitals and doctors not controlled by the government - but insurance?

Andrew

I don't think mandatory insurance programs do us any good, if the insurance providers are private and for profit.

The general idea is that the risk pool would be of the greatest size. However, doing that does not deal with the primary goal of the insurance company being to make money --profit for it's share holders.

The ONLY way it can do that is to deliver the lowest care for the highest dollars collected. And what does quarterly growth in that model mean? Lowering overhead? Well, maybe. Getting more picky about who is covered and who is not and or for what? Very likely. Not a good scene.

At the fundamental level then, the goals are not well aligned, meaning no combination of mandated private insurance is gonna do us real good for health care.

Maybe there is a case for very strong regulation, so that profit can be realized, but still that brings forward all the overhead associated with these companies. We might see good coverage then, but that overhead would still be there.

The incentive to reduce overhead would be strong going that way too. I could see that working better than what we have now, but why bother?

One doctor cannot practice in this environment, without having to either pay for billing services, work extra hours outside those the practice would require to do billing, or very sharply limit the patients they are willing to see.

That used to not be the case and somehow we need to get back there. That's an efficiency metric worth thinking about.

Totally agreed Andrew. I like the idea of private providers working with government insurance. Really, that comes down to a single pay system at some point.

We then might see that one doctor being able to practice again. There would be one organization to deal with and that's going to be a significant gain.

At the least, I've read overhead metrics running in the high 20 percent. A single payer system would run in the high single digits. That's a pretty significant savings right there.

The mandate for the government program would be to operate as a non-profit. Should it go well, those premium dollars could be stashed away for when it does not go so well, buffering premiums for everybody.

The goal is health care, not making money by getting between people and health care.

I had not thought about auto insurance, but really it's a similar scene. All people need health care, all drivers need insurance, all people need the safety and security both provide. I'm there.

Andrew2,
I suppose the argument would be that a government-controlled auto insurance system could be assumed to operate only as efficiently as other Government entities, such as the DMV. Auto insurance quotes can vary quite a bit based on different companies, so I'd say the free-market forces are working with this product. Health insurance is another issue though because it often is not affordable.

Maybe that's just scale?

shane said: "I prefer a managable monthly payment over sudden giant bills (which I can't afford)."

That's a good way of putting it.

Well here's some news I thought would fit on this thread.

http://news.yahoo.com/s/nm/20080320/hl_nm/business_health_dc