Ok, so for about a week, I've been listening, reading and watching lots of people. My focus, as I posted in the "Reset:" thread was framing and in particular, how many political variables were part of the discussion.

[that's the simple two way deal, the line, 4 way deal, the plane, and the cube --6 ways and more.]

There is a lot of chest thumping from Obama supporters! There also is a lot of looking for trouble among non-Obama supporters, with some mixed up folks just stirring the pot for ratings it seems.

What a mess! We need some solid reasoning tools people. A lot has changed, and I don't think we grok it yet. So, let's start fixing that!

So, what if things are possible? Let's take one, maybe others and talk about it. I'm looking for ideas, and why people are for things or against things and the WHY is why I'm asking the question this way; namely, what if it's possible?

Health Care for everybody that's affordable. Let's start with that one.

What if it's possible to provide this in a way that is reasonable, as in not making waiting too long, or it costing too much money, or denying people their choice of providers?

Why wouldn't any of us want this?

(I'm gonna try moderating CJ style. I might fail, or worse... Feel free CJ, to jump in here, if this is your kind of thing, and let's learn some core stuff we can reason with later on!)

To start, tell me about your health care experiences, good and bad. Just sharing right now, while we think about the questions to come.

Ok I will start.

I have had pretty abnormal and serious health problems since birth. I have been mistreated, misdiagnosed, but I have also been treated with amazing bedside manner as well as state of the art treatments. I have unfortunately been seen and or poked and proded by more doctors in my lifetime than even the most average American.

I have seen my life nearly come to an end not once but twice.

That I can remember and or recall in my life I have only been insured by 3 or 4 health insurers over my 32 years of life.

From around 87-88 to Dec of last year I was insured by Kaiser Permanente and saw first hand how they treat their "clients". It is very much a cattle car form of treatment. WHICH does surprisingly work but only under certain circumstances.

If you are a relatively healthy person who really only needs "maintenence" then the Cattle Car mentality works and probally is to both the insurer and patient to be cheaper.

Where Kaiser failed in my opinion is the way they address the patients needs in the times of urgent care. In cases of urgent care the Cattle Car method doesn't work as it is in the long term less effective what is currently used in ER's across the nation.

So I guess what I am saying is that if you educate and inform the workforce that they need to have bedside manner, treating the patient as a name and not a number and at the same time treating them as a person and not another member of the herd.

When it comes to special needs though that is where and why this universial health care thing needs to happen. Because in our current private system so many people are swept under the rug and left to their own devices or worse.

When I had my serious health problems and was hospitalized last spring I was at that time just newly reinsured after nearly 3 months without any coverage.

IMHO we have along way to go in acheiving UHC but it is possible and can be done properly.

Progress afterall has been made in recent years in making cheap prescription drugs avaliable to all.

My daughter has chrone's disease, diagnosed at age 16. Her treatments retail for 7 grand per treatment, although the insurance company gets a 1,100 dollar discount from the Pharm. company, which is every 7 weeks all year long, injectable drug, which is not yet allowed to be generic here in the US due to patent laws. Outside the US this drug is generic already and costs about 35 % what it does here. We pay full boat for this drug, or should I say my insurance company does, but in essence we all pay. A lot of these ;miracle drugs' are this way, the American System pays premium prices to the Pharmaceutical companies while the rest of the world gets a big break. What a crock !!

She will be 25 next year and unavailable for my insurance then, unless I put her on Cobra , which I will do until she finds a decent employer that has a good healthcare package with some kind of benefit package which lowers premiums, presumably. She will be an RN by then, as she is finishing up nursing school now.

So, that is my Healthcare story. It is a good one financially pretty much for me, and my daughter for the most part, but the stark reality of what it 'could' be scares the wadeen right out of yours truly.

I am a Type 1 diabetic (typically referred as juvenile but now children get Type II due to obesity). In 2001, I had Blue Cross Blue Shield of Maryland (my employer was based just outside of Baltimore). It was great coverage. I got all of my meds and insulin with $15-$25 copays depending on the item. Then I was let go. I got onto CoBRA. For six months I was also ok. Then I couldn't find a job that offered health benefits. One employer offered benes after being on for 6 months. Yeah, I didn't make money at that job (commision based salary). I'm an ok salesman but the travelling and pressure were too much for me to stay on there. Right now, I am verging on bankruptcy due to a $450+ per month "drug" bill. That's my insulin, my insulin pump supplies and the other two medications I am on. I can't afford it. That's why I am hoping Obama gets something through quickly as far as health care goes.

One of my closest friends is Type I. She worked at Fred Meyer for years and was covered with their insurance. In 2007 she moved out of state to go to grad school. COBRA was like $650/month - way too expensive obviously. While her new university offered cheap student insurance, it limited her coverage (pre-existing condition) to anything diabetes-related (which could be a lot) to $5,000 a year - which is enough for insulin, test strips, and a few Endo visits a year but if she has any sort of complications, forget it. And she still has high co-pays and deductibles anyway.

FYI, when my friend was completely uninsured a few years back, she found some sympathetic nurses up at OHSU who would give her test strips and insulin (not the type for a pump, mind you). (She had previously seen a noted Endocrinologist who works up there, so they knew her from previous visits.) There are ways to get free supplies if you need them. No one should have to pay $450/month for basic meds and supplies for a condition that was completely out of control - that's bullshit. Now if you have Type II because you are 100 pounds overweight, that's one thing; lose the weight, you may get off of some of the meds and such. But having something like Type I where you have zero control over getting it is something else.

Andrew

She worked at Fred Meyer for years and was covered with their insurance. In 2007 she moved out of state to go to grad school. COBRA was like $650/month - way too expensive obviously.

This reflects the quality of the health care plan does it not?



A counterpoint to the Kaiser comments . . .

I've found that Kaiser in this area is anything but a "cattle call". The very best service and care we've had has been at Kaiser. In fact we've dumped my wife's Providence COBRA plan in favor of a straight individual plan from Kaiser. So far so good.

Ok, so this is good. I'm not the only one, who had dealt with health issues. I wanted to know because I know I have a bias. A big ass bias! Been through the ringer on this stuff, and have posted it here, meaning I don't have to do it again.

Next question:

Can you afford it?

A coupla follow ons:

What does "affording it" mean in terms of cost? Can you do the stuff you want to do, need to do?

Should you be able to do these things?

"Can you afford it?"

You mean premiums? No. But that doesn't matter anyway because of my "pre-exsisting condition" no private insurance would ever take me and IF they did it would ammount to the same as paying out of pocket.

"What does "affording it" mean in terms of cost? Can you do the stuff you want to do, need to do?

Should you be able to do these things?"

I need quarterly blood test, haven't gotten one in over a year. I should meet with my endocrinologist (hormone doctor, insulin is technically a hormone) every 6 months I haven't seen him in 6 years. My eyes are showing early signs of myopathy (where the blood vessels in the retna burst, leading to blindness). I see my optomotrist annually. Luckily, he is very strict with his diabetic patients and he says my retnas are not that bad off as long as I maintain my blood sugar levels. Complications from my disease are staggering. While I have a pump for now and it vastly improves my overall health, how much longer can I go down this road of overcharged medical supplies? I dunno.

To answer your final question, Missing, yes absolutely without a doubt. We HAVE socialized medicine in this country. A lot of people don't realize it but Medicare and the Veterans Administration both have huge budgets and see to it that the elderly, disabled and veterans that have served with honor for our country have the care they need. Regardless of "pre-exsisting" conditions. FFS.

I should meet with my endocrinologist

Well this is interesting. My wife has a need for one, although not for diabetes. Providence apparently only has one endocrinologist between Salem and Eugene and he was not particularly good. He seemed to be in medicine because of his parents who apparently were also doctors. He didn't have a liking to patients who checked stuff up on the internet.

At any rate, she had a pre-existing condition and Kaiser took her anyway abeit with a $1500 first year deductable on prescriptions, although the drugs needed for that ailment is dirt cheap anyway.

I haven't shared my own situation on this question. Basically, we can afford to do the things Mrs. KSKD needs, and the kids, but not for me personally.

I'm pretty low maintenance right now, but am getting older. I don't know that it will last, or if ignoring things might cause other things. That's always a worry.

The cost to us, for being able to do the absolutely necessary things has been high. We've moved out of the city, scaled life way back, and it's working, but ugly.

I think everybody should be able to do the basic preventative care and maintenance care. Not doing that means lower quality of life, and in many cases, a shorter overall life. With discussion about retirement ages being raised, it seems to me a significant fraction of us face the very real prospect of not having a retirement, however modest it might have been otherwise.

Skep let me clarify myself on the Kaiser "Cattle Call" comment I made.

I found that if your a relatively healthy person only going to the doctor for maintenence and check-ups thats how they treat you.

If you have serious medical issues they are great but you must develop that report sp? with the staff to get to that point.

I cannot even begin to calculate the numerous times when with Kaiser that I was forced to go to Administration to get things accomplished.

...and so why do we need health insurance coverage?

Prexisting conditions are the big sticking points in all this, IMO. Depends upon the provider and many times upon the employer pool base. This is what Obama has talked about on the Campaign trail, talking about offering insurance to those at a 'reasonable price' what ever that is, and coverage equal to what those in Congress realize, essentially extending that pool base to include millions of people not connected with the Federal Government or Congress in any way. I will believe that when I see it !

Right now HIPPA rules in WA. State anyway say that a provider may deny coverage on a pre-existing condition for the first year of new coverage, if that individual has had a break in coverage of 3 months or longer from ANY past health insurance. Of course we all have COBRA to take some advantage of. However, the COBRA cost is arbitrary and is subsidized to some degree or another by the primary 'former insurance carrier' and the associated employer pool base that it originated from. Which means of course that the cost of adding , say , an 'aged out' dependant to a COBRA extension, may cost as little as $100/mo or as much as 700/mo depending on your employer, your provider, and the state that you live in !

What a' mess Huh???

When I left RKO and moved back to Pdx to start my own Research company... I did the COBRA dance as long as I could, then bit the bullet and bought individual health care from Blue Cross/BS of OR. I didn't have a car, or a dishwasher, but I had health insurance.

After more than a dozen cancer related surgeries and drug/medical supply bills which would run more than $500 a month without insurance, I can guarantee you that even at $486 a month for insurance for one person, (with a healthy deductable and 20% co-pay on the first 15K), Blue Cross will never break even on me. They have shelled out well over a hundred thou on me, and continue to do so.

If you can afford a car, a beer, or a smoke -- you can afford to give those up if you have to to make sure you have at least Major Medical coverage.

Everybody thinks they're bullet-proof.... right up to the moment when they learn they aren't.

Hoops, hoops and more hoops. Where's the health care? Where's the taking care of people?

Cha-ching, cha-ching, cha-ching is all I hear from these stories. None of you are truly selling me on getting coverage. What a pain. It shouldn't be like this.

I know I'm not bullet-proof but good Lord.

To be fair, I finally had a physical this year after a long time. Fortunately, all was well except my blood pressure had creeped higher. (High BP runs in the family - mom has been on meds for it for years.)

Anyway, my experience with my insurance was incredibly good. I had some lab tests and a few visits to my doctor to check blood pressure again, etc. Besides $20 co-pay for each office visit, insurance paid for all but $17 of one lab test. I had always assumed I would pay for most of it til my deductible kicked in.

So no hoops to jump through for me.

Andrew

Ka ching...is right...Chris you are spinning the roulette wheel down at the Casino by not having at least some basic health insurance. Its OK as long as you dont come up snake eyes .....

All it takes is a twist of latent mutated DNA strands in your genome that sends a chemical messenger to some tissue site creating a tumor or a condition that , the treatment, can financially devastate you or your family. To say nothing of Accidents.

Prexisting conditions are the big sticking points in all this, IMO.

Amen thats it in a nutshell.

Just because you may not have a serious preexisting ailment, you can bet that someone in your immeadiete family does. Probally more so.

For UHC to work it is gonna have to be a situation where some pay more than others based on economic and other indicators. But that ultimately everyone is at least blanketed.

Kennewick-

We have looked and we have looked and we have had one agent after another come through our house. It's the same crap over and over again. Plans change without reason, no coverage when you thought you had coverage...oh yeah then for some reason the insurance company changes hands without notification and it starts all over again.

We have been paying out of pocket for years. Some big expenses too. I realize not every plan is perfect, but if I'm going to layout $400-600 a month with no guarantee on investment I might as well put that money in the toilet.

I think many American's have been sold a bad bill of goods. If Obama's plan shows me some kind of inclination to buy into this rip-off system I will take an ernest look.

I carry some coverage for what's called Type A & B events...heart attacks, stroke....what I get is cash to help pay the initial costs. When the agent who sold me that showed me other options and what I would get, it just didn't convince me it was worth it.

Listen I am open to the idea of medical coverage that actually does what it's intended. I've looked at the highest possible deductibles. Even asked if I can go higher.

My wife and I just had our physicals with lab work. We paid it all out of pocket. We got a nice discount for paying in cash. We're in good shape. It helps that I'm a total fitness freak and take advice from my Naturopathic Doctor.

We have good rapport with our healthcare professionals. First name basis. They cut us deals all the time. We do plenty of maintenance and preventative stuff too.

Certainly no guarantees and I have had a few issues that got resolved because I was proactive.

I know I am stepping on toes here and I know some have told me in no uncertain terms they hate it when I preach good health choices. Good health starts with you. I know some come out of the shoot with some disadvantages that are out of your control. But for the things you have control over do the right thing.

Shyguy says: "For UHC to work it is gonna have to be a situation where some pay more than others based on economic and other indicators. But that ultimately everyone is at least blanketed."

I am willing to pay into a UHC even if it means we pay a bit more. You see I'm for not only helping out my family but the guy next door too. If we combine our money then we help each other out.

Since my wife and I don't have any real vices we need to cut out of our lifestyle it wouldn't be a big sacrifice for us.

Shyguy, no problem. I'm just saying there are highs and lows with each health provider organizations.

Chris, how about this angle to consider: end-of-life bank account drain syndrome. I took care of my elderly grandparents at the end of their lives . . . they had medicare but not the supplement that should have bought. Their decent bank account they worked for all their lives (they live simply and saved regularly) couldn't handle the load. As they approached their mid 80's I was starting to wonder how we were to provide the care they were used to. Fortunately I had impeccable timing and things worked out in tandem with mother nature. However, they had nothing of value to leave behind for their offspring at that point.

Indeed, the medicare people did a pretty good job of tracking their assets to ensure we weren't hiding property recently signed over to family members. Once they were satisfied, medicaid kicked in providing them with better standard of living during the last few months.

Skep-

I have always felt that my folks money is there's not mine. My mom died 2 years ago this month just after Thanksgiving. Dad still has his house and is 82 and lives off his pension and few other investments.

He and mom really didn't start investing until their early 40s and did quite well. If we need to eventually move dad to some kind of retirement center, many of them take care of patients who outlive their money.

My dad is in pretty good shape for being 82. He works out 3 times a week and eats decently. He's got a great quality of life going and no major health issues. His medicare is working well for him as it did with my mom when she was alive.

My parents have been good stewards of their assets and we continue to monitor dad's physical and mental health. He has told us that if we as siblings begin to see changes in him that we need to speak up and make decisions he might not be able to make himself.

Thankfully I come from a family that communicates.

Skep - I'm sure you meant that they left nothing of monitary value behind... their values, their hopes and dreams, their families all survived them.

It has been repeatedly written that American boomers are the first generation to actually expect their parents to leave them more than tokens and intangibles. Outside of the very wealthy, no generation has ever expected to "inherit"; they have assumed that their parents will outlive their money. And that their parents will spend their final years dependent upon their children, the yang to the ying of children's total dependence on their parents.

Nothing scares a financial planner more than seeing a middle aged client whose plan for their retirement and old age is based on the assumption of an inheritance from parents.

And even those who are lucky enough to receive a cash inheritance will almost certainly be the last generation to do so. The vast majority of boomers have failed miserably to prepare financially for their own old age, and will wind up leaving nothing of monitary value to their own kids.

Bottom line: Barring extrordinary circumstances, assume that your folks will probably outlive their money. And bet on the fact that you will.

Agreed.

Should we be compelled to take the risk Chris is? Isn't that only a viable position, if it's not possible to provide some minimum level of care for people?

Let's continue with the assumption it's possible.

Why not do it?

All that's been presented so far is:

we don't need to, given people just live healthy, and that comes with risk

we might end up with cattle call type issues, so that's scarcity.

Anything else?

Chris asked why, I'm asking why not?

I think the stories presented here answer the why pretty well. Not everybody is healthy, and Tdanner summed it up nicely:

it all works until it doesn't.

Having risk come home to roost has really impacted my family. Hammered me personally, and to a high degree professionally too. (unable to do self-employment right now because the current insurance scene is just not viable for anybody other than healthy, low risk people)

The discussion on parents and money is a good one too. I'm in the don't expect anything camp. If we work to provide for our families, make good life choices, and save for when we are old, the expectation that there is something to pass on should be the exception, rather than the rule.

Given that, isn't some kind of baseline coverage, to mitigate major risk, kind of important? When risk comes due, the impact is often not only on the person suffering some health issue, but their family and kids too.

Say we don't do this, and people then are expected to save and live making the best possible choices. Shouldn't we then be encouraging the best of opportunities, and protecting those choices?

This all comes down to unfair risk management, IMHO. People save to retire, pay for health care, homes, etc... pensions are lost over corrupt management, are exploited in terms of cost for the services, and with that we have downward wage pressure, good jobs exported, leaving us baristas, laundry, etc...

I'm not seeing a good reason not to do this, is anyone?

Maybe the scarcity argument is valid, but I don't know, and if so, I'm not convinced we can't address it. Hell, it's a good source of new jobs, that pay well, isn't it?

Its a crap shoot any way you look at it.

There are all kinds of scenarios out there. This guy that lives behind me is about 75. He is a retired city employee, so I assume has a decent retirement along with Social Security.

He had open heart surgery a few years ago. Medicare didnt pay all of it, and evidently he didnt have supplemental insurance. He told me that he and his wife " were going broke". I asked him about it and he said between the medical that he had to pick up, and his wife's health problems, with home care required, they had one of their daughters move in with them to help pay expenses, and they in turn help to raise her daughter, she being a single mother.

We live in a place populated by double wide manufactured houses. I think they sold their home and bought this place cash, but they still have a hard time making it??

I can hardly wait ! Going thru something like this, cause I am older and dont have a lot of maneuvering room...keep working till u drop...stay on whatever gravy train you are on, never die and when you do, it wont matter anymore anyhow !

Well, after my father in law lost his major pension, through shady corporate dealings, he's left with a little over 1K / month. If he owned a place outright, he couldn't eat, pay utilities and buy meds.

He lives with us, and we carry that burden.

Somehow, that's wrong, given the health care deal. What little I might have been able to sock away, to mitigate this mess that happened, was consumed because some CEO somewhere took it all on his way down.

He worked well into retirement too. Was no slouch. Got it done until he couldn't.

It's not hard to see an older couple being drained on this stuff. IMHO, that's not how it should be.

We are headed out of this mess, so we will build. But it could happen again. Makes me wonder if we should just live in the moment and say fuck it for later on.

If the health care deal isn't addressed, that's exactly what I might choose to do. There is absolutely no way I plan to have to work, until I can't, unable to enjoy a little adult time.

I'll take it sooner, rather than later, if I must. Seems a fair trade for all the wealth I helped send up stream.

and evidently he didnt have supplemental insurance.

Its almost as if you're not going to get the supplement then why bother with Medicare in the first place. (But honestly, Medicare is a bargain and you should get it along with the supplement. Kaiser's supplement cost is $104 dollars.)

lost his major pension, through shady corporate dealings

Kind of hard to imagine this when I have 2 pensions (Teamsters and UFCW), both run by trusts -- neither the unions or the companies can take out the funds in the trust. Its a mystery to me why more employees aren't insisting this kind of set up.

You can get medicare supplemental insurance that is targeted to cover what medicare doesnt cover or a good deal of what it wont cover. More companies are offering this kind of insurance now.

Well you just said it yourself. This was a few years ago now, and somehow he didnt have it. Might have been from shear ignorance as far as I know.

OH hey there are all kinds of stories
in he Naked City" regarding mishandled pension funds.

IMHO, that crap should be mandated, and insured in a way that makes it hurt, should something go wrong. Worker is protected, pension stands, company and creditors get jack. It's not like the person working can have the years back to try again is it?

Nobody should work for years, only to have the pension put at risk for the chance at making those last few quarters work through bonus time. This is exactly what happened in our family. It's criminal.

-->and why the hell are there bonuses for what is essentially failure anyway? What? They get an "A" for effort? Sign me up for that deal.

Well, it's getting somewhat off track.

It might be the quiet time, but I'm seeing the conflict over health-care being over it actually being possible, not doing it.

Some minor exceptions exist, but nothing that would stop the nation from doing this, like many other nations have.

Is that the read you guys get?

Yes, I agree. It can be done, period ! Thing is...
Most of 'those nations' that do it are somewhat smaller than we are...makes it a little easier, ...and they have 55% tax rates , or thereabouts.

makes you pause , doesnt it?

A lot of the new meds developed in advancing medical technology are performed here in the 'States". Or in American based Pharmeceutical companies. This is one of the reasons why we Americans pay through the nose for meds , especially the new advanced tech meds, which are still patent protected for many many years, before they go generic in the States. The Pharm' company protects their product exclusivity. Yes, they did spend millions developing the medication when they did the required FDA trial proceedure, but how much is enough?? When some Pharmaceutical company has a 20 year exclusive on a brand name product is that fair...?"??

Most of these meds go generic overseas much sooner, but not here, and that is why we ( Our ) insurance carriers pay 300 or 400 % more for the medication.

Well, 55 percent tax rate, vs a lower one, but higher risk.

Truth is it does not matter about the tax rate for me. Got wiped out, so that means wiped out at a lower rate or a higher one.

So, no I don't pause on that. If we have good jobs, that deliver a good amount of buying power per hour worked, and things are fairly low risk, then it's always possible to save and build for the future.

I can do that.

What I can't do is tolerate the higher risk. Happy to pay to insure it, and frankly it's either that or taxes. Given how the law is structured, I've no real assurances an insurance plan will actually pay out as I might need it to.

Why not distribute that widely, so costs are low, and confidence is high?

Had that been in place, I might be self-employed still, or at the least not building from scratch again.

My big issue with focusing on the high tax angle is that we all too often ignore the cost of risk, and we don't factor in buying power per hour worked.

Most focus on what amount their wages are, not WHAT THEY WILL BUY.

Say the tax rate is fairly high, but risk is low, and the dollar is worth something. Isn't that more or less the same as a lower tax rate, higher risk, or a devalued dollar, in terms of what the average person could reasonably expect to do with their free income?

These are the questions I'm beginning to ask now. Get away from the percentage amounts, and focus on just what choices are available to me, and what risk I have to bear.

So, when you say 55 percent, some people will react, "oh man, that's way too high, I prefer 25 percent", or some such thing. Betcha not a one of them has considered risk and buying power per hour worked.

Ask them if they would take 25 percent and a weak ass dollar, or 30 percent and a stronger one. Won't have a clue, and they should.

I know I've done better thinking that way.

I don't know that smaller makes for easier too. I'll bet this is another ratio or two as well.

Perhaps it's available services, administration cost over population to serve, or something. Perhaps our balance isn't optimal, but it can be, and if that's done, we then are in a position no different than any other nation, small or large.