Comments on: A NOBEL LAUREATE ON HEALTH CARE REFORM

By: Marc Brown

Marc Brown — Sat, 26 Jan 2008 18:55:46 +0000

Matt Horn said:

‘the bottom line is that you get to make the decisions with your patients on a course of treatment in the current system. In a single payer system, the government makes those decisions for you and your patient.’

Are you actually trying to say that all our many private schemes - with their many exclusions and conditions - offer more choice than say the French or British state systems? I think you’ll find that the reverse is true, as your ’system’ is driven by expediency and cost, which is why, for example, your mastectomy rate is much higher than in Europe, where rates of breast conserving treatments are higher. You also have much greater protectionist working by doctors, who don’t like to relinquish profitable patients into the care of others offering different treatments.

By: drmatt

drmatt — Fri, 25 Jan 2008 19:19:19 +0000

it will have the most important impact on the “plight of the uninsured”. anything else is a joke to them, try being one. The remainder of the plague will have to be dealt with in a multifaceted approach, you can’t just burn the bodies, you have to get rid of the waste and the rats. and the question on symptoms and diseases (SARCASTIC JOKE ALERT, i am from the northeast afterall).

By: Catron

Catron — Fri, 25 Jan 2008 18:49:00 +0000

I was obviously using the words “symptom” and “disease” metaphorically, drmatt. I do know quite a lot about health care economics, which is why I understand that simply removing the “profit motivation” will have no effect on the underlying affliction (metaphor alert!) that plagues (metaphor alert!) the system.

By: drmatt

drmatt — Fri, 25 Jan 2008 18:00:11 +0000

“the plight of the uninsured is a symptom” this is an incomplete sentence, allow me.
the plight of the uninsured is a symptom of a for profit system, remove profit motivation, remove uninsured/uncovered/deviant access to health care. David, what do you know about treating diseases and symptoms?

By: Matt Horn

Matt Horn — Fri, 25 Jan 2008 16:32:47 +0000

Hi Leslie, thanks for relating your experiences. I would like to thank you for your contributions in helping those in need. The Free Market Cure Pieces are meant to debunk common misconceptions. The biggest is the number of uninsured and why they are uninsured. Others surround the misconception that the single payer system is superior to the market system. Really, the bottom line is that you get to make the decisions with your patients on a course of treatment in the current system. In a single payer system, the government makes those decisions for you and your patient. Our system does have warts, but I would rather have warts than tumors.

By: Catron

Catron — Fri, 25 Jan 2008 12:36:43 +0000

The plight of the uninsured is a symptom. It is impossible to cure the disease by treating this symptom. Attempts to do so result in the kind of idiocy that we see in Massachusetts.

By: Leslie Akins

Leslie Akins — Fri, 25 Jan 2008 11:58:40 +0000

I am a Nurse Practitioner who works in a clinic for the working uninsured. My husband is a surgeon. We are living both sides of this issue. I can tell you–from 30 years of experience–that the American hospitals and health care providers are shouldering the burden of the uninsured–for whatever reason a person is uninsured. Insurance companies totally control the healthcare industry and operate relatively unchallenged. For instance, among my patients, the 50-64 year old group is primarily uninsured. Why?? Because the women fall out of childbearing years (and aren’t covered by gov’t programs) and they are too young for Medicare. They are also at a “less-employable age” than their younger counterparts–and more likely to have health issues, which makes the employers’ health insurance premiums go up. My BIGGEST complaint is the fact that an insurance company can declare a person “uninsurable”. This can happen to ANYONE–regardless of your income. Once this happens, you can’t obtain commercial insurance, and even if you are poor as dirt, you may not qualify for the state Medicaid programs. It is TOTALLY UNTRUE that the poor can always get state Medicaid. In Tennessee, you can only get on our program is you are a single parent of minor children and are at 100-150% of the Federal Poverty Guidelines (which is another subject), pregnant, or declared disabled. If you are a 50 year old woman with ovarian cancer and are uninsured—you are out of luck. Period. Who shoulders the burden of care? The hospitals and doctors who operate for free. This is okay in small doses, but with the rampant diabetes and heart disease in America (All uninsurable conditions), the system is at a breaking point. I do not see this issue addressed in the Free Market Cure videos, and do not see how HSA’s would help this group. The people I care for are primarily 40-64 y/o, working at minimum or lower wage unskilled jobs, and would never have enough $$ to put towards an HSA. In Murfreesboro, it takes 2-2 1/2 weeks of income below 200% of the Federal Poverty Guidelines to just pay housing and utilities. I do not see these people represented in the Free Market Cure discussions, but they are there, costing our hospitals and physicians millions of dollars. This can happen to anyone, believe me.

By: Matt Horn

Matt Horn — Thu, 24 Jan 2008 15:59:33 +0000

Lisa, you may want to keep your eye out on the OV for some plans. There are some plans that exclude injectibles from the drug card, but cover them deductible and co-insurance if done in the office. I know some of the MS meds are administered multiple times a day, so that might not be an option either. Sounds like the union plan may be worth looking into further. My thought is that if ithere is a co-insurance benefit, there may also be an out of pocket max. Also most group plans wont cap out, just in case it does fall under the tiering.

By: opit

opit — Thu, 24 Jan 2008 15:28:35 +0000

News releases I’ve been seeing indicate federal interference with state initiatives on healthcare.
The “elephant in the room” on healthcare is the mess multiple ‘insurers’ make of accounting : a diversity of sources with different qualifications all trying to evade paying yet seem to provide the best options. ( Bullshit is cheaper than payouts.) This in a dynamic situation which does not allow a private party to ’shop’ normally - and pressures for discounts !
Talk to a doctor. He will tell you the American ’system’ -isn’t.
You can downrate Klein all you like. I’ve been very impressed with the way he worries at the situation like a dog with a bone and continually researches the situation. He’s been doing that for years.

By: Lisa Emrich

Lisa Emrich — Wed, 23 Jan 2008 23:29:59 +0000

Matt said:”Lisa, I never commented on your blog, but have read you because I have family that have the same concerns.” Stop by any time you want.

“You stated that the policy read that after the drug cap it was paid under co-insurance. I am assuming that you pursued that?” Yes I did.

“What was their answer?” No, that once the cap was met, I no longer had benefits, thus nothing to apply the coinsurance to. It’s a little confusing as the main policy specifically excludes pharmacy benefits, but they are included in a separate rider. The coinsurance doesn’t apply to terms of the rider, although the coinsurance would apply if the main policy included the benefits directly. Crazy, huh? And Virginia Department of Insurance makes no claim to regulating insurance riders.

“Also, do your drug cost accrue towards your out of pocket max under the plan?” No, costs incured beyond covered benefits do NOT count towards the out-of-pocket max which is $3000 in my case.

“Since you are self employed, have you ever considered going into partnership with someone that does similar work? It may allow you to get into a group plan, and also give you some more clout in other business ventures.” I am a member of the Musicians’ Union through which I could apply for a guaranteed policy during open season. However, last year’s premiums exceeded $9000 for an individual and the drug benefit had a strange wording regarding self-injectable meds - subject to 50% coinsurance, although tier 4 drugs are listed as having a $75 copay. I was unable to get a clear answer, before signing up, as to what my costs would be.

Thank you Matt