I was laid off in the middle of July, and was informed that my health insurance would end at the end of the month. I had an option to go on COBRA to retain that insurance, and one of the wiser and more interesting aspects of COBRA is that it lets you take a few months to decide whether you'd have wanted it retroactively. As Serach was also not working at the time, having just had a baby and not wishing to return to her job as a full-time special education teacher, we went on Medicaid instead.
Last night, Kayla had a high fever and was coughing very harshly. She'd had a mild cold for a couple of days, and hadn't been particularly interested in drinking that morning, but she'd overall been happy and smiling until late in the evening. We'd gone on a walk with the girls earlier, gotten pizza much to the delight of both, and Kayla fell asleep on the way home. (Scary Elianna memory story: There was a young woman waiting to buy a headband from Serach at our apartment, who had stopped by once before for a few minutes. Elianna saw her and said "That's Elisheva, right? Remember when she came to our house?") We called the doctor after her fever came up as 103.0 and 102.9 over a couple hours, and after hearing her cough over the phone, he recommended not waiting until the morning and to take her to LIJ (and he gave us directions!).
Pobody's Nerfect did us a huge favor, leaving her (birthday boy!) husband Shake to come stay with Elianna, while we drove to LIJ's pediatric emergency room. I parked while Serach registered at the desk, and after a short wait, we were asked to come in. The details aren't particularly important, but essentially, despite overcrowding and a lack of rooms, we were extremely well taken care of, got fantastic care, and were actually home in less than 3-1/2 hours from when we left. It helps obviously that what she had is rather common and easy to take care of (croup - steroids to reduce the swollen area in the back of her throat and cool mist to breathe... total A-Rod jokes: Two in the ER, three since). The total cost to us: $0. It seems almost hard to believe, and it's great - we now know that should we ever have another problem, we can make a quick trip to the ER to get it taken care of.
This is also one primary reason why universal health care for the country is a horrible idea. Our ER trip probably cost the United States government a few hundred dollars. One can argue whether or not it is fair or a good idea for Medicaid to exist, and personally, I can argue both sides of that. But the statistics from Medicaid show just how much more likely someone getting something for free is to take advantage of what's there than someone who has to pay nominally for the same. According to the Kaiser Family Foundation:
Among the uninsured who would have been without coverage for the entire year, health spending would more than double, growing from $1,686 to $3,673 per person in 2008.Better yet:
The visit rate for Medicaid patients (82 per 100 persons with Medicaid) was higher than the rate for those with Medicare (48 per 100 persons with Medicare), no insurance (48 per 100 persons with no insurance), and private insurance (21 per 100 persons with private insurance.Now, there are some reasons why Medicare is so much higher (more likely to have more children on it, etc.), but 4x those with private insurance is astounding. It's especially so when you figure that a large percentage of those with private insurance are not exactly spending a fortune on the service itself: Most people either have a small co-pay or pay 10-20% of the cost of service. It is important to note that the argument is not necessarily that the people did not need the care at all; but people will seek out greater levels of care than necessary when they are not the ones footing the bill.
Now factor in the wait time - we were lucky and had a short wait time, but other people there were waiting longer. Even so, we and two other families were being serviced in an inner wait area while they waited for rooms to open up - and this at 11:00 at night. If the number of people were doubled, hospitals would go from never really catching up to simply not being able to care for patients. (In Canada, wait times and inabilities to get an appointment continually rank as the highest difficulties.)
Just two of the reasons why universal health care is a bad idea in the US, clear from just a single observation.
What a well-reasoned argument, bolstered by your excellent first-hand account of an encounter with our health care system. And look at the result--even YOU are more likely to take advantage of services, now that you know they're free! And since there's no "free lunch" (or health care!) somebody has to foot the bill--and with all those wealthy CEOs being cut down to size, exactly who WILL pay for all those with little or no coverage? ...well, at least the government can always print more money, right?
ReplyDeleteNL - I'm quickly becoming the poster child of what's wrong with government. ;)
ReplyDeleteEzzie, living in Israel under socialized medicine, I think your argument is invalid. Here's why:
ReplyDeletePreventative care and early care go up under such a system. (Medicaid is somewhat of an exception, as regular doctor visits are hard to find, but hospital visits are easy.) Further, expensive tests are not ordered first, rather much cheaper tests that give an indication of need for the greater test.
Result, less serious things developing. Less excessive expensive tests going on. Doctors actually diagnosing rather than just sending for tests (just in case - in case they get sued).
In the US, with a large family under a major medical plan, with deductibles per family member and for prescriptions per family member, I self diagnosed and self treated at the start of every new year - delaying doctor visits as much as possible. I saved unfinished prescriptions and started family members on them for seemingly similar symptoms. Finally around May, after dropping $2,000 on deductibles, then we hesitantly headed to the doctor oly having to deal with co-pay ($20 per visit) and medicine co-pay (seemed to be about $30 per prescription, variable by price). That was on a top tier plan by a Fortune 50 employer.
Israel's system isn't as convenient, I can't run to whatever kind of doctor I want anytime I want, and customer service is a limited concept. But it does have some advantages.
BTW, they do have co-pays. SMALL, say $2.50 per visit and about 20% on the medicine, but co-pays nonetheless.
(Another interesting note, they never start you on a stronger medicine, always the cheapest first. Basic penicillin, then stronger if that is ineffective. LESS issues with drug resistance here because of it.)
This post is beyond hypocrisy. I don't even think the word "chutzpah" covers it. You CHOOSE to live off the state, when you could have paid for COBRA like a responsible citizen, and then you criticize the system?
ReplyDeleteAs to the substance of your argument: First of all, there is at least one study showing that people with free access to health care DO NOT, in fact, use it more often than those who don't, contrary to what the economic models predict. (Imagine, economists being wrong. That hardly ever happens).
Second, what should the under-insured do when their children, God forbid, get sick with something more serious than croup? How will they pay the medical bills, which even at 1/4 the cost of Medicaid, pile up and up, especially now that Congress, when it was Republican, eviscerated the personal bankrupcy laws?
A social conservative on welfare lecturing the rest of us on social policy--spare me.
Akiva - The statistics don't back up your assertions, and perhaps most importantly, there's a far cry between a country of 6 million and one of 300 million. Plus, I'll argue personally that government SHOULD do certain things - help make everything electronic, make it easier for people (especially children) to get the preventative care they need, etc. Those are some of the rare areas where government might be able to actually do things more cheaply than private practice, since it's a universal need that is quick, cheap, and easy.
ReplyDeleteAlso, I'd argue that even the small co-pays in Israel have an effect on how many people seek care. In addition, the mentality in Israel in terms of getting care and how people go about seeking care is far different than in the USA.
Katrina - This post is beyond hypocrisy. I don't even think the word "chutzpah" covers it. You CHOOSE to live off the state, when you could have paid for COBRA like a responsible citizen, and then you criticize the system?
That's ridiculous. I couldn't have afforded COBRA for the interim unless I had found another job in that time period. Don't know if you heard, but the financial sector has laid off about 500,000 people. Unemployment covers my rent; COBRA for the family would have been close to $1000/month. All that would have happened is that after a couple months I'd have had to do the same thing, but take things like Food Stamps and the like on top of it. And absolutely I'll criticize the system - if it were run right and efficiently, I'd never have been in such a situation in the first place. I paid 25,000 in taxes(!!) in 2007 as a struggling but responsible young couple with a child trying to dig out of debt. Give me back that 25k, and I'm debt free, have better credit which would let me get a cheaper rate on my car, and buy a house - not to mention pay COBRA when I get laid off.
First of all, there is at least one study showing that people with free access to health care DO NOT, in fact, use it more often than those who don't, contrary to what the economic models predict.
ROTFL. Except every other study shows the reverse, and more important than predictions, the ACTUAL DATA when you compare those who have free healthcare to those who do not shows that you're wrong!
Second, what should the under-insured do when their children, God forbid, get sick with something more serious than croup? How will they pay the medical bills, which even at 1/4 the cost of Medicaid, pile up and up, especially now that Congress, when it was Republican, eviscerated the personal bankrupcy laws?
!? Firstly, read the post again. As I said, I can argue about Medicaid (which includes SCHIP) on either side. More importantly, I never said they shouldn't have coverage - I said quite clearly that universal health care is a horrible idea. What would be MUCH better is one of the few McCain suggestions that was actually quite good, and which coupled with Bush's suggestion from a couple years ago would actually help a lot: A large tax credit for people to get qualified health care plans. An added benefit to this is that by turning the people into consumers, it would force insurance companies to actually compete for business, bringing down costs to the people on top of the credits.
Katrina and Ezzie
ReplyDeleteHow about showing the studies.
HH - Go to the KFF website. It's all there. I can also send you a short paper on the subject I helped put together. :)
ReplyDeleteI don't get the point of this story. You are without health insurance and your daughter had a minor health problem that was treated at the hospital on the government's dime. That *is* de facto government health care -- it's just that you got lucky in that your daughter had croup rather than (Darwin forbid!) cancer or something.
ReplyDeleteOBVIOUSLY, most people will pay more into health insurance than will get out of it. That's because there's such an enormous gap between the cost of the average medical visit and the cost of the most expensive one. So yay, you were able to go to a fancy hospital supported by all the rich people you live near and get your daughter's minor medical issue resolved. I'm sure that's exactly the same as the waitress in Appalachia whose kid needs round-the-clock care.
Akiva,
ReplyDeleteIf that was a top tier insurance plan you had here in the US, it was in the bottom of that tier. Hubby's company is first raising the co-pay to $15 per visit this March, and there is no co-pay for dental or vision care. Drugs are handled two ways: those taken regularly have to be ordered through a mail-order drug company. You get a 3-month supply--$5 for a generic drug for the three months and $10 for a name brand, regardless of price. Those for acute illnesses follow a similar plan. All major drugstore chains are affiliated with the plan. Again, $5 for a generic prescription unless the cost is less in the plan's contract, so you pay the smaller amount and $10 for name brands up to $50, $15 for name brands up to $80 and then 20% of drugstore price for name brands over $80.
Re the medical care in an ER as opposed to in a doctor's office, yes, when no other coverage is available then go to the ER. However, using the ER means that you will see a different doctor each time, that you won't have a comprehensive medical record all in one place accessible to each doctor that sees you and no one will be able to spot a situation in the making. Routine preventitive care will be lacking.
JA - (First para) That's exactly my point. Except I can go anytime I want to and take advantage of the system - and not selfishly or irrationally, but by taking extra and unnecessary precautions.
ReplyDeleteOBVIOUSLY, most people will pay more into health insurance than will get out of it.
But that's just it. Once you switch to government health care, it will be reversed. You'll have a small percentage essentially being responsible for the upkeep of the majority, and above and beyond what's actually necessary.
So yay, you were able to go to a fancy hospital supported by all the rich people you live near and get your daughter's minor medical issue resolved. I'm sure that's exactly the same as the waitress in Appalachia whose kid needs round-the-clock care.
LOL. Right - I'm surrounded by "rich people", I went to a "fancy hospital", and I'm sure that while I was poor, all the other people in the waiting room were actually quite well off. In fact, I'd have loved to see you go and tell them that. I'm sure they'd have loved it.
While certainly there are many wealthy minorities, that 90% of the people in the hospital were minorities and showed nothing that would make me think they're wealthy, it makes me suspect that in fact, most were as wealthy as me. (Not very.)
Don't be an @$$, it's really obnoxious and unbecoming.
>So yay, you were able to go to a fancy hospital supported by all the rich people you live near and get your daughter's minor medical issue resolved.
ReplyDeleteWhat IS it with this rhetoric against god forbid being rich?
And guess what, there are people out there not rich, that pay, that help hold these hospitals.
I wish we had some doctors commenting on these issues and see what they feel are the pros and cons.
ReplyDeleteDon't be an @$$, it's really obnoxious and unbecoming.
ReplyDeleteI apologize if I was an ass, but it really gets my goat when people make dumb arguments against the richest country in the history of the world providing adequate health care for those who can't afford it.
What IS it with this rhetoric against god forbid being rich?
I said nothing bad about being rich. I'm just pointing out that Ezzie benefits from living in a rich (and probably more importantly, upon reflection, DENSELY POPULATED) area. It's a lot different in Appalachia.
HH - They would, but they're too busy taking care of extra patients on Medicare. :) (joke)
ReplyDeleteJA - Except the reason this country is the richest in history is because of its free market economy and encouraging people to do enough to support themselves. Not by giving out all the necessities and work is only if you want the extras.
More importantly, the people who can't afford it CAN GET IT FOR FREE ALREADY. It's called Medicare, it's called SCHIP, it's called Medicaid.
And finally, I don't live in a rich area at all. I live in Flushing, NY. Queens has the highest COL in the country besides Manhattan, and nowhere near the income to match. My neighborhood is a mix of numerous minorities, none of whom are wealthy, and the surrounding neighborhoods are similar if not poorer.
Except the reason this country is the richest in history is because of its free market economy and encouraging people to do enough to support themselves.
ReplyDeleteNothing to do with natural resources, excellent publicly-funded sciences, being the only major power undamaged after WWII? Really, it's all the "free market?"
More importantly, the people who can't afford it CAN GET IT FOR FREE ALREADY. It's called Medicare, it's called SCHIP, it's called Medicaid.
LOL, so there's nobody who needs health care that can't get it in this country? Wow! It's a completely made-up problem, like global warming or cigarettes being bad for you!
And finally, I don't live in a rich area at all. I live in Flushing, NY. Queens has the highest COL in the country besides Manhattan, and nowhere near the income to match. My neighborhood is a mix of numerous minorities, none of whom are wealthy, and the surrounding neighborhoods are similar if not poorer.
It's still in a rich (and blue) state with far-better-than-average services, etc. But as I pointed out in my last comment, it also has a lot to do with living in a densely-populated area. The poor are far better off in NY than in, say, Alabama.
Nothing to do with natural resources, excellent publicly-funded sciences, being the only major power undamaged after WWII? Really, it's all the "free market?"
ReplyDeleteEr, yes. Our natural resources, while good, aren't spectacular across the board; only through an incredible free-market system have we turned what we have into this spectacular thriving nation. Many other countries have fabulous natural resources, but don't get nearly the utilization out of them. I was just reading a great book over Shabbos that cites a rather brilliant example Milton Friedman once gave on TV by picking up the pencil in front of him and talking about it.
LOL, so there's nobody who needs health care that can't get it in this country? Wow! It's a completely made-up problem, like global warming or cigarettes being bad for you!
ReplyDeleteEr, I didn't say anything like that. I'm just saying that the numbers are vastly overexaggerated, and the solutions suggested would not solve them at all.
Global warming is getting increasingly slammed by serious scientists.
Cigarettes I've yet to hear be defensed by anyone. I've never smoked a single cigarette; have you?
It's still in a rich (and blue) state with far-better-than-average services, etc. But as I pointed out in my last comment, it also has a lot to do with living in a densely-populated area. The poor are far better off in NY than in, say, Alabama.
Then what was your point at all? Since almost nothing applies to me except that I happen to be lucky to be a densely-populated area, and the net effects of UHC would actually make those *worse* off due to overcrowded hospitals, what were you proving?
Oh, so now there's no global warming/climate change? Way to bolster your credibility, Ezzie. What about under-insured adults, as JA talks about? You don't like paying taxes, so I assume you also don't approve of people paying every dime that they have (or will have, in the future, thanks to the bankruptcy laws) to cover their medical bills. Sen. McCain's plan would not have provided insurance coverage for people who are already sick. How do you propose to deal with that?
ReplyDeleteKatrina - Oh, so now there's no global warming/climate change?
ReplyDeleteEr, I said that it has gotten continually slammed by serious scientists, who call into question the assumptions made by global warming activists. I don't think we know nearly enough about the subject to make assumptions and judgments, much as you don't know nearly enough about my opinions on global warming to make a judgment about it.
What about under-insured adults, as JA talks about?
Which ones? The 35 million or so who make a conscious decision not to have insurance, because it costs them more than it's worth? [Of the 47 million uninsured in the USA, 75% are under 35 and healthy.] Or the extremely difficult to insure ones with prior illnesses - who should pay for it, and where would you draw the line?
You don't like paying taxes
Do you? Does anyone? The question is not if people like them, but if they serve a positive purpose.
so I assume you also don't approve of people paying every dime that they have (or will have, in the future, thanks to the bankruptcy laws) to cover their medical bills
Medical bills serve a positive purpose.
The better question is how much each person is responsible for the OTHER person's needs and bills.
Sen. McCain's plan would not have provided insurance coverage for people who are already sick.
Actually: "While Senator McCain's proposals will not solve all of the problems of those who are high-risk and have pre-existing conditions and do not have insurance, it makes great strides in encouraging most of the people who are uninsured to get insurance without having a strong negative impact on either the government (and therefore, taxpayers) or insurance companies." The idea would be to solve the problem for the future and not mortgage the future for now, as Obama's plans from the campaign call for in getting "everyone" under insurance while disregarding the costs involved.
Ezzie, in a general sense, I agree with your assessments.
ReplyDeleteMy one thought to add is, regarding the number of visits of patients on Medicaid vs. those who are privately insured, are these figures taking into account that some people eligible for Medicaid are part of a high-risk health group to begin with? (Think low-income, more likely to have poor nutrition (specifically regarding children), increased drug use, lack of prenatal care, leading to post-natal health problems, etc...
This point doesn't really address the problem; just something to keep in mind.
S - Granted, and in a piece I helped write on it I believe that was noted. Nevertheless, that doesn't change the mindset, and it's why I cited the KFF info, which is not quite double instead of 4x as often.
ReplyDeleteall i can say is, that with my being unemployed and unable to get a job at the moment, it's a good thing i'm not dying from lack of medication and doctors visits! the amount of time it takes medicaid to process applications of those who are not:
ReplyDeletea)pregnant
b)below the age of 18 or
c)on their death beds is atrocious!
(official wait time for the above is less than a month, if you are not in one of those categories, it's six to eight weeks. i believe i'm past ten weeks now...)
that said, i think i'm with you ezzie, medicaid vs private insurance? i can argue both!