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The Health Premiums Puzzle

Leslie Margolin, president of Anthem Blue Cross, at the Capitol in Sacramento, Calif., Feb. 23, 2010. She appeared to explain an attempt to boost premiums by up to 39 percent. (AP)

In March, President Obama signed health care reform into law. But skyrocketing insurance premiums are still a concern.

For now, regulation of rates is left chiefly to the states.

On Tuesday, Senate Democrats proposed a plan for the Federal government to step in when states can’t – or won’t – act to rein in hikes.

Is this the right move?

Or should we be focusing on medical costs and other factors that can drive up rates?

And is it the right time for another change, even before we start to roll out the last reform?

This Hour, On Point: premiums and the next step on health care.


Noam Levey, health policy reporter for the Los Angeles Times.

Gail Wilensky, economist and senior fellow at Project HOPE, an international health education foundation. She was an adviser to John McCain’s 2008 presidential campaign and a contributor to the McCain health care plan. She was administrator of the Health Care Financing Administration under President George H.W. Bush, directing the Medicare and Medicaid programs.

Carmen Balber, director of Consumer Watchdog’s Washington, D.C., office. Her organization supports allowing the federal government to regulate health care premium rates in states, when “state laws are inadequate to limit unjustified rate increases.”

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  • http://wellescent.com/health_forum/topics Wellescent Health Forums

    Now that the health insurers will be getting a larger pool of policy holders from younger people who must buy health insurance, there really is no justifiable reason for double digit percentage increases in policy costs. In a failing economy where people might elect to cancel a policy, some increases seem fair simply because the pool is shrinking but the costs to treat those who are ill remains the same. That argument can no longer hold when the costs are spread amongst a greater pool of people.

  • http://www.richardsnotes.org Richard

    Now we’re in for layer upon layer of complex political crap which few fully understand which leads to an environment ripe for dropping “death panel” memes into stupidville.

    As long as stupidville thinks Obama is a socialist anyway, why not make life simpler for everyone and have Medicare for all?

    I’m perfectly happy to pay higher taxes to have the same Medicare coverage that my 94 year old mother has (and loves).

  • david thomas

    U.S. Debt to Hit $20 Trillion in 10 Years

    The financial outlook for the United States is frightening if something isn’t done to rein in the deficit. The size of the federal debt is projected by the Congressional Budget Office to increase by nearly 250 per cent over 10 years, from $7.5 trillion to a whopping $20 trillion.

  • jeffe

    People need to remember that large portions of this bill were written or influenced by the Health Insurance Lobby.
    The mandate, that was their idea. Big Pharma made a deal as well. This is corporate bill designed to make them money and not take care of our health.

    It’s like Monsanto, they rule the agricultural landscape and woe onto anyone who dares to challenge them.

    I mention them because the way our food is produced is part of how we deal with our health and care.

    On Point could never do a show on Monsanto because they would sue them. Watch Food INC. fro a wake up call.

    You want to know what is un-American to me? Lobbyist calling the shots an buying legislation.

    Huge corporations like Monsanto who sue farmers for trying to use their own corn or soy seed.

  • Mark S.

    I would like an answer to a simple question. Why cannot the health insurance industry be regulated and run as public utilities as is the case in, for example, Switzerland?

  • Gary

    One would think that with ever increasing health care costs over the past 30 years, the media would be doing deep investigative reporting on where ALL the money goes. Where is the who, why, where investigation of cost running in prime time TV? …we can’t preempt yet another evening soap opera for greater national awareness?

    Without deep and honest media investigations, we are all arguing how to fix a problem, without knowing most of the FACTS at the root of the problems.

    The public needs MUCH, much more information about all national issues.

    When NAFTA passed the auto industry promised that without all that expensive US union labor, the cost of a car would go from $12K to $8K in a few years… within 2 years the average price had jumped to $16K, and now is at $21K. There is a BIG difference in what we are told and what is true.

  • Todd

    Ah, yes! Nothing like a little post-health-care-reform “meat tenderizing,” a la On Point, to soften up the quarry for the inevitable increase in their health insurance premiums. And remember, On Point is funded in part by…

    …”Liberty Mutual…(ir)responsibility…What’s your policy?”

    So, wow, are ya gettin’ a clue and seeing the bigger picture now folks? Are ya following the money yet? Doh!!!

  • jeffe

    Todd is Liberty Mutual a health insurance company?

    I know they do auto, life and home but as far as I know they are not in this market.

    I get your point though, and agree but will wait until I hear the show until I pass judgment. However for it’s a moot point as I think this bill is not going to solve any of the cost problems or the health care issues we have.

  • Ann Palmer

    The graying of America is the primary cause of the increase in health care costs. This should not be a suprise to anyone.

  • cory

    When healthcare is run as a “for profit” private industry, we can’t act suprised when these entities do everything possible to maximize profits. They will purchase the votes of politicians, distort facts in the public debate, and of course deny coverage in every possible instance.

    Better than Socialism, I guess.

  • Tom M.

    There is preventable and there is non-preventable when it comes to a persons health. We all must accept the non-preventable. As far as the preventable goes, the CDC website will clearly spell out a wide variety of illness and diseases that are preventable. Well more than 50% of all health care services rendered goes towards things such as type2 diabeties,high blood pressure, high cholesteral, sleep apnea, heart disease, some cancers, knee and hip pain, ect. For the past decade, the medical field has been pointing out the overweight epidemic in this country. Two thirds overweight and one third obese. This epidemic is the biggest factor in those above mentioned diseases, again the biggest majority.

    In 1972 Americans consumed 2100 calories per day, now it is more than 2700 per day. Information from National Geographic. And on top of that little or no physical activity in thier daily lives. Obesity among children is steadily climbing, that’s the worst part.

    You want to reform health care, then get healthy. People who CHOOSE to be healthy don’t need medical services as often. Case in point, “The Biggest Looser”, is an example of health care reform. Those people are riddled with disease and illness and taking numerous medications, but when they loose the weight, they also loose the diseases and illness; even thier need for prescrition medication goes away. Best example of health care reform hands down.

    If you want to smoke, drink excessivley, take elicite drugs, catch an STD because you didn’t use protection, live off of fast food, processed food drowned in High Fructose Corn Syrup, sit in front of the tv or computer for up to 40 hours a week, yes that is the average and that is after work hours. Then you CHOOSE to be unhealthy.

    Health insurance premiums would drop if fewer people used medical services. The industry would see that it had fewer payouts to doctors aqnd hospitals and would have no choice but to lower its prices. Competition. Walla oil industry, less demand lower prices, more demand higher prices.

    I am simply saying, American citizens have far more say so in this matter if they choose to. Again my comment recognizes PREVENTABLE and NON-PREVENTABLE.

    Getting healthy is the answer.

  • jeffe

    So Ann if I am to understand you correctly it’s people aging that is the problem with the rising costs of health care, and not the rise in premiums. Also what about the all the pharmaceutical corporations and medical devise companies that also contribute to the costs. I guess the dysfunctional aspect of our market based system has nothing to do it. Or that we spend twice what other industrial nations do for less coverage.

    What do you propose? A final solution for people over 65? Hmmmm that was a movie, Soylent Green.

  • Michael

    To the On-point Guest’S I ask does this have anything to do with the ruling against the Insurance Companies in Mass to raise rates over 4.5% each year and was viewed as excessive after they tried suing ?

  • Todd

    “Todd is Liberty Mutual a health insurance company?

    I know they do auto, life and home but as far as I know they are not in this market[...]”
    Posted by jeffe

    @ jeffe:
    Good catch! I do think you’re right about that. Though I it would not surprise me if they soon jumped into the health insurance game too. Likewise, it should not surprise anyone that health insurance premiums are poised to increase, now that it’s going to be mandatory.

    Has anyone ever seen a health insurance premium decrease, who’s still alive to tell about it?

  • Rick Evans

    Of course premiums WILL rise; just like in Massachusetts the health insurance law is the Democrats economic stimulus bill. Look who wrote the bill; providers’ lobbyists.

    Ask any economists where are the new jobs and they all say health care. The law has nothing to do with keeping you or anyone else well. The goal of the bill is for you to spend your money domestically on doctors, nurses, hospitals and pills instead of Chinese imports. Since you haven’t been doing it voluntarily it’s time to toss the carrot and apply the stick.

  • Ann Palmer

    The graying of America is the PRIMARY cause of the increase in health care costs. This should not be a suprise to anyone. Not the ONLY. Name something you think should decrease health care costs.

  • Larry

    The for-profit health insurance companies can’t help themselves.

    They need the premiums to pay their executives salaries and stock options fit for kings.

    It has become their way of life. They expect it. And it won’t end until it crashes down around them.

  • Alex

    In order to stop the rise of insurance cost we need either (a) hundreds of insurance companies and plans available at each location with a public option lurking on the background, or (b) a single payer Medicare for all covering the basic, with insurance existing as a supplement.

    The situation right now where there are only a handful of companies (maybe two) available through an employer is not any kind of competition. A monopoly is going to dictate prices, that’s no surprise. While some of us are busy being afraid of the Government the insurance companies do whatever they want to us.

  • jeffe

    Get for profit insurance corporations, medical devise, and big pharma out of controlling how much we pay and you will see prices come down.

    Ann here’s a news flash for you, you’re going to get old and you know what you might get sick.

    Tom M good points, and it ties into what I was saying about how food is grown, produced and controlled in this country.

  • Eric

    What really needs to be talked about are the things neither Democrats nor Republicans would talk about during the health care reform debate.

    US tax payers currently fund Medicare, Medicaid, Chips, and Veterans benefits to an amount per person in the US that is enough for any European country to provide health care (including vision and dental) to every person from birth to death. Most US families have to purchase expensive health insurance after paying these these health care taxes.

    According to National Geographic the cost of health care in the US is $7,290 per person per year; in France $3,601, and in Canada $3,890. (I choose Canada as familiar neighbor, and France as representative of Europe and because France is widely considered to have the best health care system in the world.)

    In 1980 health care costs for the US, France, and Canada were essentially the same; they were within .1% of 4.5% of each country’s GDP. By 2007 the GDP figures were US 13.7% GDP, France 9.8% GDP, and Canada 9.4% GDP. Their costs doubled but ours quadrupled. Now US health care costs are nearly 18% GDP, an increase of nearly 2% per year. Unsustainable! Health care would be 25% GDP within just a few years had nothing been done. Why weren’t these figures part of the debate?

    “Obama Care” is inadequate and flawed, but it is far better than doing nothing.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    The graying of America is the PRIMARY cause of the increase in health care costs. This should not be a surprise to anyone. Not the ONLY. Name something you think should decrease health care costs.
    Posted by Ann Palmer

    Well, Ann … you must be a millennial. Planning to live forever, are you? And without “graying” one would assume?

    Maybe your solution would include “death panels” after all. People are obviously living too long for your tastes. Meanwhile, one much greater problem than “graying” has already been mentioned here, to wit, unhealthy eating and recreational habits. I can’t help wondering if you’re a smoker, or an over eater, or … well, you get the idea.

    People who are the greatest abusers of practices are so often the loudest critics when they see the same faults in others.

  • Charlotte Nehls

    As office manager of our small company (between 35-50 employees at any one time) I have seed multiple annual increases in double digits. We started with Wellmark Blue Cross/Blue Shield in 1999. Example of annual increases: 30.14% in 2000, 29.25% in 2002, 19.84% in 2003, 33.92% in 2007, 22.16% in 2009. In all the years we have had this insurance there was only one year without an increase. In order to try to continue to offer coverage we have raised deductibles, gone to 70/30 coverage and many other things. This is unsustainable and I cannot see any justification for these kinds of increases. Surely expenses for insurance companies have nto increased by these percentages. I am behind the reform bill but don’t think it addresses the costs of premiums in an effective way.
    Charlotte Nehls
    Charles City, IA

  • Todd

    “[...]it ties into what I was saying about how food is grown, produced and controlled in this country.”
    Posted by jeffe

    @ jeffe:
    Absolutely, 100%! In addition to “Food, Inc.,” check out “The World According to Monsanto,” available for viewing on YouTube. Quite an exposé!

  • ThresherK

    Re: The first caller, from Alabama, whose newly-granted healthcare policy was yanked when their AG decided to sue over “Consitutionality”: I guess it’s nice to live a “run it to ruin it” state.

    Too bad Our Liberal Media, after an exhaustive search, have determined this is the patient in those dozen states this has happened to. I guess it’s time to put more Teabaggers on the front page or on The Evening News.

    PS “Do you understand what’s in the law? Do you worry about being mandated to buy health insurance you may not be able to afford?”

    Any more right-wing memes you want to insert in there? You may have missed one or two.

  • BHA

    My daughter needed two stitches in her chin Jan 2009. The ER and Physician’s Assistant charges were nearly $1,600. The insurance company’s ‘agreed upon’ price was $1,200. Like the caller with asthma, this seems to be WAY out of line for the service provided.

    We need a LOT more ‘immediate care’ places (NON PROFIT!) that do not have to recover the cost of ‘handle any medical emergency’ emergency rooms. I know of 2 in my ares (for profit) but if you don’t know the name, you can’t find them. There is no entry in the Yellow Pages for ‘immediate care’.

  • Mary Lynn Cramer

    2010 premiums increased 52% for low-income elderly on Medicare Advantage HMO plans in Massachusetts. According to the 2009 and 2010 “Congressional Report on Medicare Spending,” Medicare Advantage HMO is the most efficient and less costly of all Medicare programs providing services at a lower cost than the traditional Medicare program. The “Congressional Report” also states that the administrative costs for Medicare Advantage HMO are 10% of income and the profit margin is 6% on average for Medicare Advantage HMOs. Nevertheless, under the Obama Administration, billions of dollars of funding was cut for Medicare Advantage HMO for 2010; and my insurance company officials all assure me that, as a consequence of the overhaul bill having passed, premiums for Medicare Advantage HMO plans will continue to increase in 2011. President Obama has repeatedly advised all insurance companies to “absorb” the increased costs now—not to wait until 2014. “Absorb” means raising premiums. If the Federal government accepts such obscene increases in the price of premiums for low-income elderly, how do you expect private insurance companies supposedly regulated by the State to do differently? Your guests should be demanding a rollback on these outrageous increased in premium prices for poor senior citizens.

  • John

    a key indicator of the fairness of competition since the public option is out would be able to view claims versus non claims and the costs to the insurance companies, how many of us pay into the system and never use it and for those that file claims what are the true costs to the insurance companies, the shocking results of ROI will push a movement, simple line item results so everyone can understand it will work fine. Healthcare by the way is not horse trading.

  • jeffe

    Monsanto are one evil multinational, they are in control of all the soy and corn seeds in the world. Think about that. They have driven almost all the soy and corn and wheat farmers in India out of business. They have destroyed our farmers ability to grow what they want, that’s for sure. Monsanto is another topic however.

  • BHA

    “Maybe your solution would include “death panels” after all. People are obviously living too long for your tastes. ”

    Logan’s Run
    - 1967 a novel by William F. Nolan and George Clayton Johnson
    - 1976 Movie

  • Jason

    Your guest has no clue what she is talking about. The public option doesn’t change healthcare costs one bit it only shifts the costs away from the consumer and onto the governments books. Because of this the costs will not be less, but government waste and fraud will eat up additional cost.

  • Ed

    The basic problem is that there aren’t enough young people to pay into the insurance system. And the reason we don’t have enough young people is that we killed 50 million of them over the last 40 years. I’m not sure what we can do now.

  • John

    The US should use its purchasing power to make sure that we pay no more than the lowest price any other western country pays for drugs. Of course the corrupt Congress (Republican at that time) made sure that we continue to pay top dollar.

  • BHA

    John: “Healthcare by the way is not horse trading.”

    It absolutely IS ‘horse trading’. Every self insured big company, insurance company and the like works out a price for drugs, medical services, etc. Like the seats on a plane, the price you pay for a drug or medical procedure can vary a LOT from one person in the waiting room to another.

  • John McMillin

    my point is that the the service of keeping you alive as oppossed to traveling on a plane should not be considered horse trading, healthcare is not for only those that can afford it or a system that provides peanuts for the less fortunate

  • ThresherK

    The basic problem is that there aren’t enough young people to pay into the insurance system.

    Ed, you may be getting your flashcards mixed up. Are you sure that’s not the talking point about Social Security being “bankrupt” (sic)?

  • Janet Deutsch

    I wonder if the suggestion that those opposed to HC reform have made that people be permitted to buy health insurance across state lines is based on their desire to buy from a place where health insurance is essentially unregulated.

  • Todd

    “Monsanto is another topic however.”
    Posted by jeffe

    @ jeffe:
    True. One which, unfortunately, will probably never be covered by On Point.

  • http://www.lit.org/author/fritzwilliam F. William Bracy

    Your guest has no clue what she is talking about. (Posted by Jason)

    You’re talking about the wrong guest and, unfortunately it’s you who doesn’t know what you’re talking about.

    Nothing you said in the post above is in any way accurate. The Public Option would have been an option, get it? … and it would have been open only to a few of those who qualify due to special circumstances of need and a few unique factors … like when your employer drops your health insurance even though he pays you only $8.00 an hour and claims to be going broke while he takes home $50 million.

    What will it take for the screaming shills who do nothing but parrot what they hear from Limbaugh and the rest of conservative talk radio, to just shut up? You have nothing to say, Jason! You’re not the solution — you’re the problem!

    I don’t normally talk like this, I’m sorry. I’m just frustrated beyond imagining and even my blog is beginning to show the strain.

  • Ken

    I was pleased to hear consideration of the underlying costs but dismayed to see real costs abandoned for consideration as “too complicated”. That is what our government has done. Find a bad guy; insurance companies. Beat him to death and pretend the government could do it better.

    Even more disturbing were the comments of listeners in favor of single payer solutions. They seem not to know or believe that government does not pay the costs of programs it pretends to offer. At our local hospital, if government really paid for the true cost of the services it claims under Medicare, Medicaid and others, everyone’s bill could be reduced by more the 35%. Belief in a single payer solution is a belief that price control works. It doesn’t. It won’t.

    The whole Congressional debate has ducked the real issue of how much it costs to deliver the services we demand. And so the health care bill we have passed does not solve the problem. It will take a few years of embedding the bill’s features into a still more complicated system and we will again face the reality; it costs too much.

  • http://arc-tv.com/the-corruption-of-health-care/ Adri Kalisvaart

    NPR should have invited Dr. Hendricks to the discussion on the Health Premium Puzzle. Dr. Hendricks is the famous brain surgeon in the book “Atlas Shrugged” (page 683).
    I agree with Dr. Hendricks that it is not safe to place my live in the hands of a doctor whose life we have throttled with 2000+ pages of rules and regulations. It is not safe, if he is the sort of doctor who resents it—and still less safe, if he is the sort who doesn’t.
    Jean Claison’s guests Gail Wilensky and Carmen Balmer seem to believe that a gun in the hands of a government enforcer is much better for my health than a scalpel in the hands of a killed doctor. I disagree!


    Geez Ed, So sorry women are no longer baby factories for you and your ilk. Considering we don’t have the resources nationally(don’t even talk globally)to support our current citizens and you want to add another 50+ million to the mix so they can cover your health insurance. Women are having less children by CHOICE because of a multitude of reasons. Just because you have the ability to have children doesn’t mean you have to keep having children until your body gives up or because some person thinks it should be your only role.

  • Rob

    I was typing a response that is very similar to Ken’s above so I will simply make reference to his comment. I would only add that the basic problem (challenge) of any government program is determining the proper price of any given product/service, which is impossible without a functioning marketplace.

    Ken, perhaps you and I are unaware that many of these callers are the “salary and price Gods”. They can determine exactly what the price of any given product or service should be and can also determine the salary of every business executive based purely on their left wing political notions of social justice.

  • Hana

    It has become impossible for physicians to continue to care for medicare & medicaid patients due to low low reimbursements. Another huge problem is that if medicare cuts a certain code, all commercial health insurances follow. Unless an improved and strong physician reimbursement structure is included in the bill, the healthcare reform cant work. Doctors are the backbone of healthcare and there can be no reform if you break the backbone….we still have 21% medicare cuts looming on our heads. We simply cant continue seeing more and more pts for less and less money….consquently the health ins companies will reduce payments even more and we’d be forced to become plumbers as they can charge whatever they please…

  • http://www.lit.org/author/fritzwilliam F. William Bracy
    Even more disturbing were the comments of listeners in favor of single payer solutions. They seem not to know or believe that government does not pay the costs of programs it pretends to offer.

    Here we go with another one — this time posted by Ken.

    My God, what will it take to make righties understand that Public Options and Single Payer plans are not government giveaways? Would you be shocked to find out that you would be paying premiums out of your own pocket in order to participate in Medicare? You’re not old enough, are you? You’ve never heard this before, have you?

    Medicare has personal premiums attached just as does Social Security. What will it take to raise your awareness?

    Stop. Just stop. This is serious stuff. We’re not talking about Veterinarians fees or Public Pet Options. We’re talking about people dying because they have nowhere else to turn! And come back at me only if I’m wrong and you can prove it.

  • Ann Palmer

    Mr. Bracy, why would you assume I am young(or old for that matter)? Why would you assume I am a Palin fan? Just from my comment that the graying of America causes a natural increase in health care costs? Wow! You really are one to assume aren’t you. Well since you were snarky first, you are at least the first 3 letters of assume. And oh yeah I think I know what the F stands for!

  • jeffe

    What is it about us? On the one hand you have people who complain about government spending and say nothing about the two wars we have been engaged for that last 9 years.
    The amount spent in Iraq alone would have been enough to cover everyone for years. What I see is dysfunctional government ruled by special interest.

    When Canada redid it’s health care system the bill was 5 pages long and they just got on with it. We on the other hand sit around or march around and in some sectors yell about “death panels” and socialism and complain about giving money to the government. All the while for some amazing reason these same people have not problems giving their hard earned dollars to the health insurance corporations and fatten the CEO’s six plus figure salaries. On the one hand people cry about wanting freedoms and on the other they willing pay to have it taken away by their health care insurance providers.

    I find this paradox quite astonishing.

  • jim penland

    The general tone of the broadcast is that profit is a dirty word.America is a capitalist nation and taxes are paid by businesses that make a profit. One commentator said the for profit insurances companies were driven by Wall Street investors. No,for profit companies are driven by shareholders from all over America. Insurance cost are driven by health care cost which congress just increased!

  • jeffe

    Ken you like your health insurance company? When they raise your premium by 30 to 40% will you still believe in this dysfunctional system? You seem not to mind in lining the pockets of the CEO’s and management of the insurance companies. I’m not sure what we can do but one thing is for sure the system as it stands now is broken and falling apart as we sit at our computers.

    Personally I think both sides of this issue are broken.
    The insurance corporations are in this for health care they are in it for the bottom line. This does not work, period. The government is so dysfunctional that it just looks incompetent and while I don’t agree with all of Ken’s comments I do agree about the Federal government no being able to do this without messing it up.

    I want a single payer system. I have had experience living with this system in Britain. It works, so much so that even the British Conservative party likes it.

  • Eric

    The reason for the excessive cost of US health care is changes made to US health care post 1980 when US health care costs were essentially the same as Canada and Europe. America is not having as much trouble regarding an aging population as Europe is. Health care in Europe is half what it is in the us (see my post above for history and depiction of costs). Privatization of US health care since 1980 seems the only cause. The easiest solution, extending Medicare to every citizen from birth to death was not seriously considered. The debate has been so lacking in thought that people happy with and making use of Medicare showed up at town hall meetings screaming about the evils of government involvement in health care, “Leave my Medicare alone!!!”.

    Today’s discussion, like all discussions I have heard in the news and on programs like this, did not address with specificity the cost of US health care, rate of increase of cost, and comparison with other countries. Again I refer you to my post above. A rational discussion cannot take place until the parameters of the situation are explicitly stated, understood, and directly addressed by all involved.

  • Paulio

    The amount of wealth lost in the Great Recession is equal to the size of our total national debt. If this does not underscore the importance of good policy, then I don’t know what does.

    Folks, you can’t solve the deficit problem by simply “cutting spending,” especially when half our elected representatives have taken defense and entitlements off the table (see how they squealed at 500 billion in savings in Medicare in the health reform bill… or was that just politics?).

    Folks, you can’t solve the deficit problem by blaming the Bush TARP (a sizable chunk of which has been paid back) or by blaming the stimulus. Few recall that 43% of that was ineffective republican tax cuts. Either way, we’re not getting it back.

    Rightfully, many are concerned about the burden their grandchildren will carry with our debt. I have an idea: if you’re so concerned about that burden, do your share to mitigate it… support a modest increase in the taxes you pay, support an increase in the retirement age and a reduction in benefits, support true health care reform… reform that, if done right, would save 400billion/year annually (See HR676… I know it ain’t happening, but at least understand what you’re lambasting).

    This is not rocket science, but it may as well be Greek with all the bad information out there.

  • Linda M

    While profit is not necessarily a bad thing, a health insurance premium should not include “profit”. What we are paying the premium for is health care and that is all we should be paying for. Otherwise we land up with what we have today…out-of-control premiums which fund out-of-control salaries and who knows what else. Health care is NOT a luxury, it is a necessity.

  • H. Seiler

    Go to UC-Berkeley labor center site to use a calculator to estimate how much a family will have to pay under the new health bill.


    Everyone will be asked to pay high “out-of-pocket” costs. The actuarial value of the subsidized plans for low-income people is predicted to be 70 percent, meaning the policyholder will have to absorb 30 percent.

    There is a cap, but families will still be burdened with crushing debt.

    Single payer–easier to implement, economical, equitable, humane.

  • Janet

    I can’t help but see a increase in health care insurance and the decrease in manufacturing in the USA. Many companies have either moved off shore or been put out of business. Additionally, local and state taxes have gone up dramatically too. The economists that have been pushing this idea of “free trade” were wrong and it’s killing us.

  • Alvin D Hofer

    The nonsense that premium regulation did not “make it” into the bill because of a technicality of the resolution process ignores the fact that if our changeling-President had wanted it in the bills he would have insisted on it in the beginning, when the bills were drafted and not at the end – in the resolution process. Our President is a devious person whose actions have for the most part not reflected his fine words and in many cases they have belied his words. His record of lying is 15 months long now going back to promises he made as a US senator not to support the FISA revision, the criminality of telecom evesdroppers et al.

    The bottom line is there is no need or place for insurance companies in the health care system at all.

    (Liberty Mutual, your sponsor, is an insurance company, and I am sure they are sympathetic to their brothers who are providing health insurance at great profit. LM may be linked to them in the web of corporate ownership and sharing of board directors.)

  • http://FlusterCucked.blogspot.com Frank the Underemployed Professional

    We’re talking about this subject because our government still hasn’t addressed the fundamental problem with our health care system–the insurance company middlemen and other costs associated with insurance–are just too danged expensive. The solution is to scrap our current system and to adopt real socialized medicine which has proven to be superior and less expensive in all of the other first world countries. Let’s do a side-by-side comparison:

    United States:

    •17% of GDP and growing spent on health care
    •Tens of millions uninsured or under-insured
    •Insured people living in terror of losing their jobs and health insurance
    •Hundreds of thousands of medical bankruptcies each year, many of whom had insurance
    •Businesses burdened by insurance concerns and costs.
    •Wealthy insurance executives (and a thriving yacht industry)

    Nations with Real Socialized Medicine:

    •Much smaller percentage of GDP spend on health care
    •100% coverage
    •Zero medical bankruptcies
    •Often more doctors per capita
    •A more content populace
    •Businesses not burdened by insurance concerns
    •Fewer wealthy insurance executives (oh noes! Whatever will happen to the yacht industry?)

    The solution to our health care problem is blatantly obvious. Perhaps this issue will be revisited after health care consumes 25% of our GDP.

  • http://FlusterCucked.blogspot.com Frank the Underemployed Professional

    In response to Jenny’s question at 32:00:

    What’s going to happen is that these people will receive the Republicans’ and free market dogmatists’ plan for health care: “Don’t get sick, and if you do get sick, die quickly.”

    Seriously, that’s their plan.

  • John

    The basic problem is that there aren’t enough young people to pay into the insurance system. And the reason we don’t have enough young people is that we killed 50 million of them over the last 40 years. I’m not sure what we can do now. Posted by Ed, — That’s why we need the Death Panels!

  • Christine

    John, Abortion has absolutely nothing to do with any of this. If anything, when poor women have abortions it SAVES THE GOVERNMENT MONEY because then society won’t have to pay for the cost of welfare, health care, education, and any related criminal justice costs for raising these children. For this reason, it would be good if the government funded abortion. Furthermore, abortion is not murder because no God exists and fetuses do not and cannot possess anything resembling a human consciousness or personality.

    What you are advocating with regards to population is, in essence, a Ponzi scheme. If we had 50 more million young people to pay for health care, we would need to increase our population by one hundred million more people to pay for those fifty million people’s health care when they get older

    Your awful reasoning is just more evidence that opponents of abortion are religious morons who are disconnected from reality and who have foresaken reason and rationality.

  • Rob

    @Jeffe asked “…you like your health insurance company? When they raise your premium by 30 to 40% will you still believe in this dysfunctional system?”

    Yes. I am very perfectly happy with the quality of my private health insurance. I personally prefer having some choice regarding the extent of my health insurance, rather than having it dictated by the federal government. I am also willing to pay the market premiums, although I do expect these premiums to go up based on the volume of government mandates contained in the new healthcare law. As an example, the new law does not force insurance companies to compete across state lines or do much of anything to promote cost savings or create any competition in the marketplace.

    As a side note, here is a very simple idea that might help reduce premiums for those Americans who engage in healthy lifestyle choices and one that would encourage certain people to take some personal responsibility for their unhealthy life style choices Our state and federal laws should allow and encourage both private insurance companies and government agencies to discriminate against people on the basis of unhealthy lifestyle choices (e.g. NOT TO BE CONFUSED WITH DISCRIMINATING AGAINST THOSE WHO ARE GENETICALLY PREDISPOSED TO CERTAIN DISEASES). As an example, there is absolutely no reason why both private insurance companies and government programs should not be able to charge smokers and extremely obese people (e.g. with a percentage body fat greater than….pick a number…… 25% ,30%, more, etc…) higher premiums, or that states should not tax soda and junk food products at higher rates.
    I realize that I have a strong personal bias toward healthy lifestyle choices (e.g. a little personal bragging as I have completed ten Ironman triathlons including Hawaii and many marathons including Boston), but there is no health care system that can protect people against poor lifestyle choices. The increase in obesity (particularly among children) is frightening. Many Americans are eating themselves to an earlier death and “Big Brother” can save a person from his or her own irresponsible behavior!!!

  • Rob

    Typo. I meant to say “The increase in obesity (particularly among children) is frightening. Many Americans are eating themselves to an earlier death and “Big Brother” can NOT save a person from his or her own irresponsible behavior!!!

  • jeffe

    Rob I hope you don’t lose your job. How nice of you to be so content with your status quo. Wow and you run as well.
    Your so perfect and a shining example of the uber-citizen.

    You know Rob in Canada they have a single payer system and there you can chose your doctor, not lists or anything.

    Your coverage has doctors that are in the network. IF you had to go out of network they could deny payment.

    I’m real happy your so content with YOUR coverage while people of lesser means go without. Your part of the problem, and not offering anything in the way of a solution other than to prove how selfish we are as a people.

  • david

    Government is getting bigger and bigger as we speak. Binding the insurance co. to a limit on prems. increases sounds good if the cost of healthcare remains the same. No chance of that. As these companies try to pay for the coming tsunami of sick people with restrictions on raising prices, things will start to happen. They will one by one go out of business.
    As the Govt. states: never let a good crisis go by. They will step in telling the people the crisis can only be solved by the Govt. Enter Govt. run healthcare, just like the European system that we all want so badly.
    This creates the next problem, enter the VAT tax. The Govt. will adopt it as the only means to pay for YOUR healthcare, just like the European model we so want.
    Problem: the day after the VAT takes affect, EVERYTHING
    goes up by 18-20%.
    Gas will go up $.60 and remember the last time gas hit
    $4.00 a gal. what happened.
    The irony of all this is that we will be worst off than before, because the root problem to this crisis will never have been addressed and solved.
    That is, Americans with unhealthy lifestyles, something nobody wants to address.
    Comparing us with Europe is like comparing a bowling ball with a golf ball, or 309,000,000 people to 60,000,000 people. Roughly, 5 times more people to insure and we are one of the fattest nations around.
    No one ever asked WHY Anthem in California tried to raise it’s prems. ???? They just heard 30+ %
    Jobs!!! Jobs!!! jobs!!! will go a long way in helping solve some of this problem.

  • Sara

    Won’t work. Publish and regulate costs instead. If an x-ray cost $100 any and everywhere, regardless of coverage THAT would engender competition between the insurance companies. Whether you had coverage that paid $80 or $20, you would KNOW what it was going to cost you going in. It is unconscionable that doctors and nurses can’t say what it will cost because “it depends”.

  • David

    Like everyone else, I don’t like large health insurance premium increases and I know real change is needed in healthcare. But have those listening to those critical of the insurance company increases actually looked at the data?

    Wellpoint (the company receiving such ‘hate-mail’ because of their CA increases) recently announced their full-year results and, if you go on their website, you’ll see they earned operating margins on sales of between 3-4% (down from approx. 5% the year before) which, since they’re a large company, came to an operating profit of about $2 billion if exceptional items are removed. Size aside, these are very modest margins and well below the expectations of most businesses – both large and small – in the US or elsewhere. They are also approx. half the margins earned by most non-health insurance companies I looked at (e.g. MetLife).

    So, given the criticism of Wellpoint being expressed by our President, his cabinet and supporters in the House and Senate, and many in the liberal media, should we now expect them to tell us that every business in America should reduce their margin expectations to somewhere below this or face the same criticism? Or, if it’s really the absolute dollar amounts of profit which they deem to be too big, should we expect them to tell every large company that they need to break up or face the consequences?

    In reality, this whole thing is all about politics and not about the truth. Our challenge is to remind our politicians that their job is to serve our country first and that party, ideology, and their re-election need to come far behind in their priorities. And to remind our media that their challenge is to put their personal ideologies aside and report objectively and honestly.

    Washington, Lincoln and our other great leaders knew what was required and acted accordingly. Our leaders of today (irrespective of party) need to get this message soon and take it to heart; if they do not, we should fear greatly for our future because they will not be able to solve the many problems which threaten to overwhelm us.

  • Elizabeth Demaray

    How about NOT FOR PROFIT health Insurance. Is there anything stopping large numbers of individuals from banding together and providing coverage?

    Please ask this question.

  • Estelle

    What about regulating reimbursement rates instead? Like Maryland?

  • Harry C. Ballantyne

    I am a retired Federal Employee, insured under FEHBA. i am insured under the Aetna HMO. (Bill Moyers said the CEO of Aetna “is the richest of them all!”) I can believe that, because the Federal Government, who oversees health insurance premium increases requested by HMO’s has never been able to explain the premium increases to my satisfaction! (I was Chief Actuary of SSA, when I retired.) Maybe, finally, under this health insurance legislation, we can get some relief from exorbitant premium increases

  • jeffe

    We can go back and forth on this until we are blue in the face. The reality is that countries such as France, Germany, Canada, and the Netherlands all cover 99.9% of the population for about half of what we do here and we are leaving out 40 to 50 million people and that numbers going up. I don’t see any other countries rushing to emulate our health care market based system. Sure we have some of the best doctors and cutting edge medical devises as well as drugs, but to what end?

    If 30% of cost is going the health insurance corporations it stands to reason that that is part of the problem.

    David I’m shedding crocodile tears for Wellpoint’s profits. You forgot to mention that Wellpoint is also is using an algorithm to identify women with breast cancer for the express purpose of dropping their coverage.


    I don’t look at the health insurance corporations as villains as they are just answering to their shareholders. I find this a problem. Instead of dealing with the issues of health care they are dealing with profits and to maximize them.

    Our system is failing, the health care bill was an attempt at trying to fix it and alas it seems to have come up very short of that. At least from what I have read of it and the fact that all the single payer advocates were kept out of the negotiations.

    As I said we can go back and forth on this all day and it seems to me that we as a nation are not able to come to any consensus on how to fix this mess.

  • http://www.beccar.wordpress.com Eugenia Renskoff

    Hello, Jane, I agree with the doctor who called yesterday. Medical insurance is a business and businesses exist to make money. I am an uninsured and unemployed person with chronic back pain. I guess that would be called a pre existing condition. The more I hear about health insurance, the more frustrated I get because the new bill will not help me and I still need medical help.Eugenia Renskoff

  • Marc

    If we decide to control insurance premiums, where do we stop. People need food, they need housing, most even need gas. Is it fair that some should do without things that keep them healthy. Shouldn’t the government regulate prices here too?

    Ok, but let’s just say we decide to control premiums … while costs go up. Almost nothing is in the recent bill to control the costs of excessive tests, frivolous lawsuits, allowing docs to control both supply and demand, unnecessary procedures, etc. So what will happen – insurers will not cover some people. So regulate who they have to cover. In that case, insurers will leave the state. So, do you keep piling legislation on to say who has to cover what states. And then pile more on to say what they cover. And at some point, you’ll have to pile on even more to ensure quality is maintained.

    One of the speakers was incomplete to the point of being dishonest. Mass hasn’t just matched the premium increases of other states, they’re one of the highest if not the highest in the country. So, maybe they should just regulate premiums for health insurance. Coincidentally, until recently, auto insurance rates were regulated. Not surprisingly, Mass had some of the highest, if not the highest rates in the country, at a time when rates were regulated by the state.

    Noam Levey was asked if the industry was highly profitable. He gave an answer so vague as to be useless. Essentially, some are profitable, some are not. Quite an expert. In fact, the health care insurance industry is in the bottom third of all industries in terms of profitability. Much as we’d like to think of them as wall street fat cats or the insensitive criminals of big tobacco, they’re not. But they’re not angels either. They’re an industry who’s costs are rapidly escalating because of new procedures that everyone thinks they need, drugs that take $1B to bring to market, lawyers who see deep pockets and easy juries, doctors who are $500K in debt when they get out of school and a media that loves a good story about some poor person being denied coverage. I think health care is such a mess in this country, that I’m reluctantly for single-payer. Unfortunately, what we got recently may be the gross incompetence and corruption of government combined with the worst aspects of capitalism.

  • Dan

    Maybe to put things in perspective a little bit for people as to health care costs..

    My younger brother had to have an appendectomy in late 2009 (of course not an elective procedure). He’s in his senior year in college, so he still falls under our parents health insurance, and although it was definitely competent and quality health care, it cost
    around $21,600.00 give or take a few hundred dollars ( This is in MA, near the cape). Health insurance picked up about $20,500.00 of this, leaving my parents with the rest.

    Without coverage, he would’ve had a $22,000 bill on his hands with no way to pay. I’m sure no one would want that for something there may be no real way of preventing, like appendicitis.

  • Rob

    @Jeffe, here is a continuation of our debate from yesterday afternoon regarding health insurance reform. I will not sink to the level of hurling personal insults by accusing people of being selfish, etc….for expressing a different point of view. I actually favor a varying form of national health insurance, but I am very much opposed a single payer system

    There are some good elements of the new healthcare law. For example, I actually like the idea of ending the ban on preexisting conditions and the individual mandate to purchase health insurance (but think the penalty for not purchasing insurance should be much higher for those who have the means to purchase health insurance and choose not to do so). However, this new law completely ignores the cost side of the equation. Here are some other ideas that I would like to see debated that were generally not included as part of the health care debate:

    1. Allow Americans to buy insurance across state lines. Federal and states laws should be reformed to encourage far more competition across state lines and allow Americans to shop for coverage within the entire states — whether from lower-mandate states at lower prices, or from higher-mandate (additional-coverage) states at higher prices.

    I would also like to see insurance regulations changed under federal law where possible,to force the larger insurance companies (e.g. United Health, Aetna, Wellpoint, etc…) to actually compete against one another in many states/ regional markets. Most of these large insurance companies are nothing more than holding companies that were built through acquisitions and are in many cases legally prevented from efficiently integrating their underwriting operations and systems by outdated state laws. I would envision the emergence of a highly competitive national insurance marketplace, where there are several well capitalized and tightly regulated insurance companies that compete against one another across state lines.

    2. Either treat employer provided health insurance as income (e.g. politically difficult) or end the unfair tax on the uninsured and self-insured, giving them a tax-break similar to that which is already available to those with employer-provided insurance. CBO estimates indicated that this probably would cost about $25 billion per year

    3. Allow lower premiums for healthier lifestyles (and higher premiums for unhealthy lifestyles, such as smoking, obesity, etc…) Existing federal regulations ban private companies from offering more than a 20 percent discount to those who eat and drink in moderation, exercise, or don’t smoke. Such regulations handcuff private efforts to reward healthier lifestyles and to thereby cut health costs — and they should be eliminated. As noted in my post last evening, there is no insurance policy that can protect people from poor lifestyle choices

    4. Cut costs by preventing runaway malpractice lawsuits. Relieve doctors from having to practice defensive medicine, by capping punitive damages at $250,000 per provider and $750,000 total, while continuing to allow unlimited economic damages to compensate for financial loss. (Increase in government spending: none.)

    5. Expand Americans’ ability to keep their insurance when they leave their job. COBRA allows former employees to pay the costs of their insurance premiums (including the employer’s former share) and thereby keep their insurance in effect, but only for 18 months. Expand COBRA by 12 months, allowing people to keep their insurance for up to 30 months if they have not yet secured a new job with an employer-sponsored plan. I would also like to see studies that further explore the cost of expanding unemployment insurance programs to provide COBRA coverage in the same manner as unemployment insurance for a certain period of time.

    6. Explore the creation of an uninsured health insurance pool to cover people without the means to purchase health insurance. I would envision this working in a similar manner to state uninsured motorist pools, whereby all policies are charged a small excise tax to subsidize coverage for those who are truly poor and cannot purchase private health insurance.

  • zack

    It’s not surprising that it took a caller, Adrian, to bring some common sense to the discussion. Your farce of a panel just carries water for the state (Dem and GOP). The healthcare “reform” is in fact yet another assault on our liberty. Government intervention is causing the problems in our existing system, and the guests all sagely pontificate that more intervention is the answer. Lies.

    The best way to lower costs and improve quality would be to remove the laws that have created healthcare cartels in every state.

  • http://www.cardiffquay.com/ Rick

    The basic problem is that there aren’t enough young people to pay into the insurance system. And the reason we don’t have enough young people is that we killed 50 million of them over the last 40 years. I’m not sure what we can do now. Posted by Ed, — That’s why we need the Death Panels!

  • d-Arcy

    * Talk about a convocation of True Believers! Jane and most, if not all, of the panelists had “insurance companies” down as bad guys, Obamacare as “good”, and just would not hear otherwise.

    * The fundamental notion that an independent insurance company, whether for-profit or not, must at least break even seemed foreign to them. Do they even have an idea of how an insurance company works? Do they realize that a company must have a reserve to cover a sudden burst of payouts? Do they realize that in normal times a large part of a company’s revenue comes from income on investment of the reserve, but that these are not normal times and such income is down? That which is not coming from investment income must come from premiums?

    * The last I heard typical profits for medical insurance companies were about 3%; not really that much. So let’s hear less bloviating about “big” or “excessive” profits by insurance companies. If Jane, et al, think they’re so profitable, are they buying stock in them?

    * So CEOs make big bucks. They have a lot of responsibility. Cut the CEO’s pay to $1 per year and you’ll get some bozo who doesn’t know what (s)he’s doing and your $8,000 annual premium might go down to $7,998, if it doesn’t go up due to the cheap CEO’s incompetence.

    * The panelists’ surprise that premiums are going up even though “reform” was passed is either disingenuous or delusional. They couldn’t all be that misinformed. Anyone with any sense could tell that “reform” would result in higher premiums, higher taxes, higher co-pays, higher deductibles and lower quality of care, and many said so.

    * The (alleged) rise of “health care costs” as a fraction of GDP was viewed with alarm and also as a justification for — well, it wasn’t clear what they were trying to justify thereby. Did none of these people pass fifth grade arithmetic? Did they hear there was a major recession during those years? HINT: When GDP shrinks in dollar terms, any sector that stays the same in dollar terms increases as a percentage of GDP. It’s automatic. It’s a piechart! Anyone who tries to make anything else out of it is either dumb or disingenuous.

    * I was appalled, but not surprised, by the way the caller that pointed out the socialized medicine aspects of Obamacare was dismissed. From the outset “On Point” and various other public radio programs have been quick to deny that Obamacare is socialized medicine, although they never seem to actually define the term. I submit: Obamacare says who must be covered, what services must be covered, what services cannot be covered or even provided, what providers can charge, and, under Feinstein, what insurance companies can charge.

    * One of the panelists said that if a state didn’t comply the feds would come in and make them. How? I would have been most interested in hearing that point expanded.

    * One of the callers said that in poorer states virtually everyone in the state would be on Medicaid. That’s a challenge. Where, exactly, would the funds come from? If most of a state’s residents are too poor to buy insurance except from Medicaid they’re also going to be too poor to pay much in taxes to support the state’s Medicaid system. A state with huge Medicaid bills and no income: Instant state bankruptcy.

  • jeffe

    Rob you said that people who are not as healthy as you should pay more. Smokers already do through the taxes they pay on tobacco. Instead of trying to treat people for the diseases they have you want to charge them more. That across state lines idea is an absurd notion as it takes the rights of states to control these health insurance corporations away from them and there is not one single shred of evidence to support that his would lower premiums without effecting the care.

    As for charging people who are overweight or obese that sounds like a clear case of discrimination to me.

    I don’t support people who have bad diets, but there are so many reason why this is the case, from poverty to lack of education on how to eat right. How are you going separate out the poor who eat cheap junk food because that’s what they can afford?

  • Chris

    I am a physician and share the following thoughts.

    1) The biggest thing we can do to reduce costs is to take responsibility for our own health (and its costs). Each group:obese, smokers, drinkers, terminally ill, extreme old age, young unwed mothers with multiple children, etc will cry “discrimination” when asked to change their lifestyle and/or use less healthcare.

    2) Care like we are used to in the USA is expensive. If we want it to stay high quality, someone is going to have to pay for it. If no one is going to pay, I promise that the quality and advance will go down.

    3) To the writer who paid $1600 for stitches and the caller who paid $1700 for asthma treatments: You are paying for all those who currently don’t pay (read: people who are letting the government pay for them-medicare, medicaid. These plans do not pay enough to doctors and hospitals to provide the current service you demand.

    I agree we need to change, but go slowly and be careful. This should not be being driven by politics or politicians!! But by leaders of society along with caring healthcare professionals. If not, the consequences will be great and far reaching.

  • Brett

    Yeah, okay, so those who are terminally-ill and extreme old-agers need to change their lifestyles, and use less health care? Beyond a kind of rant, that makes little sense. A physician such as yourself could offer a lot of insight; instead, you’ve offered little more than what amounts to tired platitudes, subtle fear-mongering and veiled bigotry in the form of black and white absolutes disguised as some kind of expert knowledge. Take the asthma emergency; even taking into consideration the operating costs of an ER and the fact about how those who can pay are also paying for those who can’t, you’ve got to admit that a little bit of Albuteral in a nebulizer shouldn’t cost $1700! The mark-up of pharmaceuticals and equipment is a travesty, and even the strictest, self-regulated, health practices by the individual or an end to social programs won’t reform that! But instead of maybe using some of your experiences to bring ideas, you characterize all Medicaid and Medicare recipients as demanding and letting the government pay for them, as if they are all nothing more than molleycoddled. How about painting with a brush that isn’t quite so broad?

    Instead of admonishing the general public with cautionary tales about what would happen if no one paid for medical care, or how those irresponsible folks who have unhealthy lifestyles play some discrimination card at every turn, maybe make an attempt to offer some sort of solution that isn’t part of a perfect and self-righteous world.

    I agree that Medicaid and Medicare should be cut, and I also think that reimbursements should be higher for doctors, If one were to infer a conclusion about what you think about those programs, though, it would be that you’d like to see them done away with all together. Many do truly need Medicaid and Medicare, or do you think those truly in need simply lose?

    Also, whom do you mean by “leaders of society”? And, with all due respect, part of being a “caring health-care professional” is sounding like a caring health-care professional. Sorry, but you sound neither caring nor professional.

  • jeffe

    Chris are you serious? People who are terminally ill, are old, and those with preexisting conditions should change their life styles? I suppose the terminally ill should die faster, the old as well. People with asthma should stop breathing.

    As Brett said you seem to be in the wrong profession.
    I feel sorry for your patients.

    Instead of coming up with some ideas and solutions you blame people without knowing the cause and effects of their situations. Could it be that obesity is the result of the industrial food complex’s complete control of the food in this country? I live in a mixed income neighborhood and the Stop and Shop by me sells a lot cheap junk food and in one isle its nothing but high fructose corn syrup based drinks for under a $1 and sometimes two for the price of one. The produce in this store a hit or miss situation as some is bad or it’s old. There are days when you can get some good fresh produce, but you have to know when the new deliveries come in as they let it sit around for ever.
    I was at the checkout counter the other day and the young woman at the register held up my leeks and asked me what they were. This is not about lifestyle change as it is about education and getting the way we grow and produce food in this country. We produce way to much meat on feed lots which in turn contaminates the food chain. If you’re low income or poor you can’t afford decent food or the stores just don’t stock fresh produce. People go to the Burger Kings and McDonald’s for their “happy meals”. How do we deal with this? What’s the solution to how the majority of people eat in this country? You want an eye opener, go to a French Kindergarten or 1st grade class and you will see them eating fresh well cooked food. Why? because they believe that food is part of the education system. The children sit down and eat courses, they learn table manners and how enjoy good food. What do we serve our kids? Junk food.

    Now if I go to Wholefoods about 20 to 30 minutes from this store and it’s all extremely fresh and there are no isles of high fructose corn syrup based drinks.

  • John

    I generally agree with the points made by Dr. Wilensky during her appearances On Point but she is always identified as a Project Hope Director and former HCFA (now CMS) director. She has also been on the BOD of United Health Group (UNH) since 1993 and the proxy indicates she has stock and vested options for over 340,000 shares (approx $30 per share). She also chairs the UNH Public Policy Strategies and Responsibility Committee. That is an important disclosure.

  • Chris

    Thanks for your comments Brett and Jeffe.

    I guess I have heard little in the current talk of reform of individual responsibility. If I had heard this in even one health care proposal, I too would feel that this simple suggestion was a platitude.

    Too often, when there is little hope of true helping, the terminally ill and elderly are not offered compassionate care, but often expensive and unhelpful care (sometimes to put their family members at ease.) Daily, my colleagues and I see this. I am trying to share this insight with you.

    “People with asthma are not supposed to breathe”- how about “people with asthma are not supposed to smoke”. Or “people with asthma should keep their prescriptions filled” so they don’t go to the expensive ER to get their meds. Personal responsibility will help contain costs.

    Almost daily I see and care for young (teen mothers with multiple children, having more. This is not the exception, but happens day after day in my practice. I realize that this is a societal issue, but until it is fixed it will feed into our healthcare problems greatly.

    I realize the sensitivity of targeting the obese, again it is a complex subject. Jeffe, there are many contributing factors, and it is never easy. But the reality is that we all have choices, and it is often easier to blame our situation/society than to take responsibility for it.

    Caring and compassion are action words-I will always be compassionate and caring no matter what I might feel about a persons choices.

    I never tell them these things that I have written here, unless they would ask. But seeing this type of thing day after day, I can tell you that these thoughts often arise in my mind.

  • Brett

    I won’t argue that personal responsibility shouldn’t be part of any kind of management of people’s health. I have had asthma my whole life and am 55, which requires a lot of personal responsibility to manage. You’re right that people with asthma shouldn’t be coming to the ER to treat their asthma because they didn’t at least put a little effort into managing the underlying condition, or to compensate for the fact that they didn’t get a rescue inhaler of Albuteral that would have cost them around $60 for a supply that should last them for months, lasting particularly if they have managed their asthma with some kind of reasonable responsibility. As you know, though, Albuteral alone won’t manage asthma well on its own.

    I haven’t had any serious problems for years, but there were those rare occasions in the past when I did everything right yet couldn’t catch my breath, began to wheeze, couldn’t exhale, etc., it was 3:00 am on a Sunday morning, and after several attempts at inhalations in the course of two hours, I had to go to the emergency room. As you know, the first approach in an ER is to put some Albuteral in a nebulizer and see if this delivery system will give the person having an attack enough of the short-acting bronchodilator to restore breathing. Most of time this will work with no further treatment such as adrenaline or other combinations of anticholinergic agents together with beta-2 agonists.

    I didn’t find myself in the ER because I lacked personal responsibility, nor can you know the background/situation of the person who said he’d gone to the ER, “received two ampules of Albuteral, and was charged $1,700.” You have to admit, irrespective of any flaw in a social program, or lack of personal responsibility, or overhead costs in maintenance, etc., nobody should be charged that kind of money for a basic procedure to treat an asthma attack.

    I also have had Type-1 diabetes since childhood. I am very responsible in taking care of myself, and I haven’t had an emergency requiring a rescue squad for 30 years. Yet, there is still that potential, no matter how well I take care of myself.

    Because of my age and pre-existing conditions, and the fact that I am self-employed, I can’t get good insurance, although I do have catastrophic (this doesn’t cover medications or certain procedures, nor would it cover an emergency-room visit due to an asthma attack or an insulin-related problem). You know that most non-systemic inhaled steroids used for treating the underlying conditions with asthma are going to cost, minimally, $150 a month (Advair is around $290 a month without insurance). Add to that a rescue inhaler, a long-acting bronchodilator, maybe an antihistimine, and a person is looking at several hundred dollars a month at the least to “take personal responsibility” for his/her asthma. Add to that another chronic condition, and a person could be facing something akin to monthly rent. I’m fortunate in that I can afford to refill all of my monthly asthma and diabetic meds and supplies, not everyone can.

    Not getting aerobic exercise to keep heart and lungs strong (exercise-induced asthma notwithstanding), not understanding environmental conditions to avoid (so as to minimize asthmatic reactions), and smoking, show profound disregard for one’s health; but, by the same token, treating asthma properly can not be achieved, generally, by poor people without some type of social program.

    I’m sure you see all kinds of people suffering from all manner of illness in your daily work life, and you wouldn’t be human if you didn’t at least question in your mind how some aren’t going to be properly treated or are not going to manage a chronic condition if they don’t adhere to some form of personal responsibility, but I guess I was objecting to too much generalization toward lack of personal responsibility and condemnation of social programs in the way you framed your concerns.

    I’ve had some dentists in the past question my oral hygiene when weakened gums have been an issue. I know I brush 3 times a day, floss 2x a day, etc., and I also know that diabetes, the occasional prednisone after a lung infection, as well as regular inhaled steroids, have made for constant attention in that regard. I usually don’t go back to dentists who display an attitude that I have not been responsible, particularly when my teeth are clean, strong, and it is common knowledge that steroids, as well as diabetes, can weaken gums. So, I guess when I hear a physician only talk about people lacking personal responsibility in discussing the health care issue, I find this kind of language suspect, and wonder if ideology plays more of a role than practicality.

    I wonder how we can, in a practical way, get people to participate in their health concerns more responsibly? And, if irresponsibility is clearly present, how does the health care industry deal with these problems? What consequences can be implemented that still keep in line with professional, ethical and compassionate treatment? Perhaps more than anything, I would be interested to hear you thoughts on answers to these questions.

    By the way, you didn’t elaborate on what you meant by “leaders of society” from your first comment?

  • david

    Chris, you may find that reform of individual responsibility is a no,no on this site. Many of the people on this site never see the abuses of the system that you see daily, only that there are sick people,no matter how they got sick. Many feel that the health problems caused by poor health choices are caused by the system and not by the individual making the choice.
    Iam a EMT, by choice, volunteer, a basic no life of death Ambulance ride cost around $600 or so.
    We have 360+ calls a year, we do not charge for our service. Half of the transports are not neccessary, but by law we must transport if requested.
    I transported a patient to the ER once, the only complaint was that his big toe hurt.
    Imagine as a ER Doc. the look on your face when I call this one in.
    If this happens in one small town 150 times a year, what is the cost to healthcare if every town has the same problem??

  • Chris

    Brett, thanks for continuing the dialog. David: thanks for your wisdom.

    I do realize that all that appears to be irresponsibility is not so. Although, I do feel that there is a large subset health care costs that could be reduced by more responsibility.

    How can we motivate people to take more responsibility? First, what would you say about the idea that if your way is being paid by others, that you may be held to a higher standard of accountability than if you pay your own way? Like, when you are spending other people’s money it is okay for them to hold you accountable? If we can buy into this idea then the gov (read taxpayers, read us) can use a little leverage to educate, motivate, or perhaps control the spending of those who act irresponsibly with their bodies and health, but then request $$$ to bail them out.

    Personally, as an aside, I feel there should be a gentle shift from health care as a right to a privilege of our society. I just think that when people feel entitled to things that appear to have no cost to them, they tend to take advantage of these things instead of valuing them. It is as if health care is a “right” for others to provide for them, but it is not a “right” that they are willing to provide for themselves.

    Start with a nine-step plan:
    1) Study behaviors tied to co-morbidities that increase need for care (read: need for spending more $$)
    -Some will be obvious: If you weigh 400lbs you will do poorly with your total knee surgery and be wasting resources.

    -Study procedures that are low yield and don’t use taxpayer $$ to pay for them. (maybe total knee replacements in 400lb people?)

    2) Identify high risk groups. Start with a few. Drunk drivers. People stopped with out seatbelts on. Super-morbid obesity. Tobacco addiction. Teen mothers likely to have additional babies. Be compassionate, but also clear: There are behaviors here that can largely be modified and controlled. By not trying some simple proven techniques, kindly teach them that they are being a greater burden to themselves, their family, their fellow citizens who are paying for their care.

    3) Educate the high-risk groups. (Make it mandatory to take classes- offer at local schools or hospitals and sign-in)

    4) If you get taxpayer money it cannot be used for tobacco, alcohol or study-proven junk-foods.

    5) Create healthy alternatives for exercise, mindfulness training. Make these available and mandate those receiving taxpayer $$ to participate. Give people a card to swipe- becomes part of their health record.

    6) If you don’t attend classes, you don’t get your gov. $$. Many who receive gov. health care $$, also receive other gov. $$. To pick up your check you need to show you are at least trying!
    -If you are repeatedly non-compliant, you get the less expensive treatment options first.

    7) Make available to all women of childbearing age effective birth control along with mentoring and advice as needed. Remove all taxpayer $$ incentives that might encourage people without an income to have more children. Have hospitals follow up and report on high-risk groups of teen mothers.

    8) Motivate all gov. run organizations to mandate healthy behaviors. (schools, offices,-foods, exercise, meditation, smoking, etc)

    9) Institute torte reform in medicine. This is probably one reason why personal responsibility is not currently dealt with- fear of being sued.

    I would define leaders of society as: Spiritual leaders, teachers (principals and superintendents), physicians and nurses, local company executives and business leaders. I know who they are in my community. Physicians have been historically poor leaders, but they seem to be changing.

  • david

    Close to 500,000 people die a year from smoking related problems. Many of these deaths could be prevented. As a doctor, please educate this forum on how much it cost to treat smoking related diseases. Cost per person times 500,000 a year.

  • Brett

    Why impose these terms only on people using social programs? You say you are a physician; you then know how private insurance works: everybody pays for everybody else; plus, more than 90% of private insurers get some kind of government subsidy. So, everybody’s health affects everybody else’s health care costs. So, your idea of “held to a higher standard of accountability” for “people taking money from others” applies to anyone and everyone seeking health care services, not just those getting so-called government help; that’s just a reality you’re not factoring into your solution.

    Also, you want anything to do with a person’s health condition and its treatment to have a mandated set of provable positive behaviors attached to get treatment. How can those be policed? Circumstantial evidence would have to be used/essentially, there would have to be a whole system of monitoring beyond a physician suspecting someone isn’t taking care of himself. As you’ve agreed, irresponsibility isn’t always apparent or clear-cut.

    As a physician, you also know that behavior has different consequences for different people. One person can eat a cheeseburger and his cholesterol won’t budge a point, another can eat a cheeseburger and his cholesterol will go through the roof. Sometimes a person’s cholesterol can jump without any discernible factor. Then how will the person with high cholesterol be policed? Will the patient having trouble with high cholesterol, and saying he has been doing everything right, be subjected to private detectives spying on him? What if the nurse tells you privately she saw him coming out of TGI Fridays last week? It seems this is what your solution would have to involve in many respects.

    Education for people about diet, exercise, mindfulness…yes, this is a good idea, particularly for kids in schools. Even having patients take classes with measures/grades attached to acquired knowledge doesn’t sound like a bad idea. Attaching treatment to acquired knowledge/denial of treatment for lack of acquired knowledge? Again, how, ethically, can that really work. You can say the word “mandate” a thousand times, but the concept of “mandate” is meaningless without an ethical way of implementing enforcement.

    #1) Sounds good on its face, but again, something like this would have to be written and implemented very carefully. There’s nothing wrong with asking someone to lose weight to ensure a successful operation. But, what if the person loses weight, has the knee surgery; then, later, gains back the weight? And how is the criterion for weight regarding knee surgery determined? On and On.

    #2) Again, identifying high-risk groups to determine either provision or denial of health care is a risky business. So, someone forgets to put on a seatbelt and he/she is denied health care in some way? And, how do you identify and label “mothers likely to have additional babies”? This sounds like punishing people who “may” commit crimes in the future. You are a bit too general and vague in how you propose to “teach” people using “simple proven techniques” to be more responsible.

    #3) Again, “mandating” taking/passing a class in, say, nutrition, to determine eligibility to be treated for, let’s say, high cholesterol, is unethical. I work part-time as a MH group-home counselor (they have severe conditions, e.g., schizophrenia, bipolar, chronic clinical depression, etc.). Some are not even their own guardians. I have worked with dually diagnosed people before who have limited cognitive abilities, some even to the point of intellectual disability. My work has underscored a point to me over the years: some people will always be incapable of seeing a causal relationship between their behavior and consequences to those behaviors. So, what then, have people take I.Q. tests to determine eligibility/waivers to eligibility of health care services?

    #4) Sounds good; again, you’d have to find someway to measure that a person truly understands the consequences of what you and I might consider unhealthy. Also, you can’t buy cigs. or alcohol with Food Stamps (and my private view is that I’d like to see junk food be part of that list of prohibited items, as well), but if someone has cashed a check, cash is cash! Are we going to install security cameras everywhere to be monitored for purchases off the grid, so to speak/are we going to get cashiers at grocery stores to play police detectives for us? How ’bout tattooing the recipient in a conspicuous area on his person so that the cashier can deny him that purchase of a doughnut?

    #5) With a little tweaking, this sounds doable.

    #6) Oh, no, Chris, and we were so close on agreeing on something! Darn it! Do realize how much oversight such an idea would need to have to be monitored???? Also, it is simply unethical to deny proper medical treatment because a person has not shown satisfactory participation in an education class.

    #7) Again, some tweaking, and you might have something. I wonder how many religious types would go for the implications of such a concept, though? Also, while you didn’t mention “mandate” you seem to want to mandate everything, so I’ll assume you want to mandate this (again, have fun convincing religious leaders). When you say “have hospitals follow up and report” are you saying they should be devoting resources to having detectives on the street? Speaking of “mandate,” I agree that schools should be providing lots of exercise, strict policies of no drugs, alcohol or smoking, and only nutritional food; so, how do you bring them to this point…the government? Would children then not be allowed to bring food from home because the system can’t control what parents feed their children? Or would children be allowed to bring food from home if it was healthful and then the school system would have to spend most of its day searching lunch boxes? In what ways should offices mandate personal behavior? Have employees keep a log of types of food eaten away from work and have it needed to be verified for the employee to continue employment or get raises?

    #9) Torte reform, yes, if it addresses “defensive medicine” and frivolous lawsuits, but NOT caps on settlements or judgements.

    I have to say, what you propose, overall, while some points might be workable in some small, practical way, mostly it has a police-state aroma to it. On the scale you suggest to really change society, the government would have to be a lot more intrusive than you or any other conservative would be comfortable with. And, if not the government: whom? Should there be private corporations in charge of such an intrusive system? Religious institutions? Physicians themselves? Nurses?

    If I might ask, what type of physician are you?

  • Brett


    I don’t think anyone would disagree with the fact that smoking is one of the most prominent causes of disease, and this could be prevented (which is the saddest part). That’s the easy statement, to say this is a problem. The costs to our society are tremendous, on so many levels. The hard part would be to propose a reasonable way to solve the problem. There’s plenty of information that has been around for half a century that it is a killer. Advertising is almost nonexistent, and will become even more restricted in the next couple of months. The monetary cost of the habit is exorbitant, and going up all the time. Most places have smoking bans almost everywhere. If there would be any tighter regulations on it, it would have to be made illegal (I personally wouldn’t mind this), but short of this, how do we police the individual? Deny them treatment if they don’t comply with cessation? Charge them more for treatment? This sounds good, but how would that play out?

    If you go for a stress test or an angioplasty, and a smoker goes to a doctor for the same treatments, shouldn’t the cost of that be the same for each of you? See, the actual cost of the procedure is not more expensive, it’s the overall impact on the system by smokers having more illness and needing more frequent service that is the problem. This makes the management of the problem more difficult. Though, I’ve yet to hear anything by anyone that could be reasonably implemented without abandoning the Hippocratic oath. Maybe the concept of the Hippocratic oath should be abandoned? Or should another solution be thought of that still accommodates the common good, as well as upholds a standard of ethics?

    You are an EMT, and you volunteer, and the service is free. On the one hand this is admirable; on the other hand, no emergency service should be free, but most likely your community has this system function in such a way because it has to. As you seem to suggest on a national level, it would be easy for a powerful entity to step in and say no more of this in your community, so why hasn’t your community rejected such an idea.

    Where I live, there are all kinds of fees for people needing to use emergency medical services, and there are all kinds of consequences for people abusing emergency medical services, but I live in an area where people are fairly well off and taxes are high. All emergency medical personnel are paid in my community, as well. Do the tax rates not support that in your community? If the local government in your area suddenly raised taxes to support a better emergency medical system, and people were made more responsible to pay their fair share, how would that go over among the citizenry? If they like it the way it is, or need it the way it is, should a state or Federal agency step in and force something different on the community? What about if a private corporation served that purpose in conjunction with higher state and local taxes and higher fees to the patient/customer? Would that solve your problems? If not, how can changes truly be instituted in your community? I know we don’t have the problems in my small southern town that you complain of with your emergency medical services in your town. Clearly your town is doing something wrong, so how to change it?

    I’m curious about why your community is structured the way it is. In rural places where I’ve lived, the community was just too poor to support a good emergency medical system. Doesn’t the very system in which you participate in a very real way promote the wrong idea? Send the wrong message?

  • http://www.indexaudio.com/ Simon

    Maybe to put things in perspective a little bit for people as to health care costs..

    My younger brother had to have an appendectomy in late 2009 (of course not an elective procedure). He’s in his senior year in college, so he still falls under our parents health insurance, and although it was definitely competent and quality health care, it cost
    around $21,600.00 give or take a few hundred dollars ( This is in MA, near the cape). Health insurance picked up about $20,500.00 of this, leaving my parents with the rest.

    Without coverage, he would’ve had a $22,000 bill on his hands with no way to pay. I’m sure no one would want that for something there may be no real way of preventing, like appendicitis.

  • http://www.balticbeast.com/ Tony

    Close to 500,000 people die a year from smoking related problems. Many of these deaths could be prevented. As a doctor, please educate this forum on how much it cost to treat smoking related diseases. Cost per person times 500,000 a year.

Aug 21, 2014
In this November 2012, file photo, posted on the website freejamesfoley.org, shows American journalist James Foley while covering the civil war in Aleppo, Syria. In a horrifying act of revenge for U.S. airstrikes in northern Iraq, militants with the Islamic State extremist group have beheaded Foley — and are threatening to kill another hostage, U.S. officials say. (AP)

An American is beheaded. We’ll look at the ferocity of ISIS, and what to do about it.

Aug 21, 2014
Jen Joyce, a community manager for the Uber rideshare service, works on a laptop before a meeting of the Seattle City Council, Monday, March 17, 2014, at City Hall in Seattle. (AP)

We’ll look at workers trying to live and make a living in the age of TaskRabbit and computer-driven work schedules.

Aug 20, 2014
In this Oct. 21, 2013 file photo, a monarch butterfly lands on a confetti lantana plant in San Antonio. A half-century ago Monarch butterflies, tired, hungry and bursting to lay eggs, found plenty of nourishment flying across Texas. Native white-flowering balls of antelope milkweed covered grasslands, growing alongside nectar-filled wildflowers. But now, these orange-and-black winged butterflies find mostly buildings, manicured lawns and toxic, pesticide-filled plants. (AP)

This year’s monarch butterfly migration is the smallest ever recorded. We’ll ask why. It’s a big story. Plus: how climate change is creating new hybridized species.

Aug 20, 2014
A man holds his hands up in the street after a standoff with police Monday, Aug. 18, 2014, during a protest for Michael Brown, who was killed by a police officer Aug. 9 in Ferguson, Mo. (AP)

A deep read on Ferguson, Missouri and what we’re seeing about race, class, hope and fear in America.

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