Reducing medical costs

[WendyBG]

Health care cost is a huge issue. It is probably the largest expenditure that I make, without knowing the cost in advance, and without any realistic way to comparison shop.

It's a big problem, especially for people who have high-deductible health insurance, or, especially, no health insurance, at all (which is 47 million Americans).

Gradually, in a small way, the logjam may be breaking.

http://www.nytimes.com/2007/02/27/he...i/7WT2SAtDAbLg


“The average provider — doctors or hospitals — has between 5 and 100 reimbursement rates for the exact same procedure,” said Timothy Cahill, president of My Medical Control (mymedicalcontrol.com). “A hospital chain with multiple locations may have 150 rates for the same procedure. Consumers don't know this.” [Yikes! I sure didn't know that! - W]

The varying reimbursement schedules, negotiated between the nation's 850,000 providers and more than 6,000 health plans, have been kept all but secret. Consumers almost never get information on prices before treatment. Even insurers do not know what other health plans are paying.

...
Over the next decade, health care spending in the United States will double, to more than $4 trillion a year, a fifth of the gross domestic product...

Despite the complexity, the Internet has begun to open a window on this surreal world, allowing consumers to compare costs and, occasionally, to discover affordable alternatives.

...
Extrapolating from federal Medicare data, Vimo (vimo.com), a small Web start-up in Mountain View, Calif., tries to estimate the fees negotiated by insurers for a variety of hospital procedures.

...
My Medical Control claims to know the lowest rate that a hospital or clinic has already accepted for a given service.

If a client is not being billed at that price, then the company's representatives will call and bargain for it. - — minus a 35 percent collection fee. [end quote]

This sounds quite worthwhile.

http://www.mymedicalcontrol.com/

I think it's just the opening wedge. As long as the U.S. has such a cockamamie system, there will be a big business opportunity, for anyone who can reduce medical bills.

If anyone else has hints about how to reduce health care costs, I sure would like to hear them.

Wendy

[kimbercuddles]

Just out of curiosity, Wendy, do you believe that a socialist system of health care would be better? There are pros and cons to every system, so I'm interested in your views on this.

[WendyBG]

Originally Posted by kimbercuddles

Just out of curiosity, Wendy, do you believe that a socialist system of health care would be better? There are pros and cons to every system, so I'm interested in your views on this.

That is a huge subject. No, that is a HUGE subject!!!!

In a nutshell, I believe that our current healthcare system is failing, on many counts. It's about as inefficient as it can be.

While Medicare spends only 2% on overhead, health insurers spend an average of 25% on overhead.

There is little support for healthy lifestyle choices and chronic care (which prevent very expensive crises).

Huge amounts of scarce medical resources are spent on non-productive intensive care. For example, the smallest preemie ever (born weighing only 10 ounces) was recently on the news...saved at a cost of millions of dollars, but will probably be permanently handicapped.

At the other end of life, people who are terminal are kept alive, on ventilators, at great expense. Terrible quality of life, then they die. Who benefits? Everyone pays.

These resources could be used to vaccinate children, to provide prenatal care, to provide preventive screening, that would enable intervention when diseases are starting, and less expensive to treat.

In the late 1980s, the state of Oregon developed a health plan, which was a model of wisdom, in my opinion. The state health experts developed a cost-benefit analysis, of hundreds of diseases and treatments.

The best benefit to cost ratio, right at the top, was vaccination of children. A few dollars provided a lifetime of protection, for the child and for all of society.

Partway down the list was screening, for chronic diseases, like diabetes, and breast, cervical and prostate cancers. The tests are relatively inexpensive, and treating these diseases, in the early stage, is much less expensive, than letting them get more advanced, before treatment.

Way down the list were rare diseases, that are expensive to treat, and prolonging the life of terminal patients.

The state of OR determined what it could afford, for health care. Then, they walked down the list, until they ran out of money. Anything below the cutoff would not be treated.

Unfortunately, President George H.W. Bush ordered the OR plan to be sued, by the Federal Government, for violation of the Americans with Disabilities Act. The plan was cancelled.

So, what do I think?

I would like to allow Americans, of all ages, to buy Medicare Insurance, since the Medicare system is so efficient (low overhead). I don't care if older people are subsidized, and I have to pay more (since I am younger than 65). I would just like the choice open to me.

I would like to see the government mandate low-cost, catastrophic care insurance for everyone. That means everyone,, including young people, many of whom are currently uninsured. The cost should be taken out of paychecks.

I would like to see the cost of the insurance to be tax-deductible, for the working poor and middle class (sort of like the Earned Income Tax Credit is, now), and not subject to a 7% limit (which it is now). The exact salary limits could be negotiated, by Congress.

I would like to see a shift of focus, from treatment to prevention. I would like to see a network of nurses and nutritionists, to keep patients on track with treatments and diets. This would pay off, enormously, in reduced costs.

I would like to see all out-of-pocket prices, for all in-network providers, to be posted on the internet, so I could comparison-shop.

I would like to see an Oregon plan implemented, all over the country. Already, 17% of the U.S. GDP is spent on healthcare. This is predicted to grow. I believe that a line needs to be drawn. Exotic, expensive treatments, which take resources from higher cost-benefit treatments, should not be paid for, by government programs.

For example, if terminal patients all are given expensive life-support, the cost will be huge.

I believe that expensive, non-productive treatments, such as extreme premature care and terminal life support, should not be paid for, by the government insurance pool. That includes Medicare, which currently does pay for life support. This will lower the cost, for everyone.

If people want to buy insurance that covers expensive treatments, that are not covered, by the public health insurance plan, that should be their option. They will pay more, but that would be their choice.

By shifting more resources to high-benefit health care, many people will benefit.

What is the trade-off?

Terminal patients will receive hospice care, not be placed on life support. Some tiny preemies would die. People with rare conditions would not receive expensive treatments.

Wealthy people, who could afford more expensive insurance, or could pay out of pocket, could still choose these treatments.

Poor people would be limited...but, the vast majority would be better off, since so many have no coverage at all, presently.

I don't consider that to be socialized medicine.

Wendy

[Wyody]

My doc and I e-mail. We're in different states. His attitude was that New Zealand had the first idea of socialized health-care that he thinks would work. I haven't looked at the plan yet - anybody?

[kimbercuddles]

Wow, Wendy, I didn't expect such a detailed response. I can tell that you feel strongly regarding this subject. I tend to shy away from any socialist form of medical care mostly because of the waiting list; first come first serve, which is fine when it comes to dinner, but not health care.

To be totally honest with you, I'm not in agreement with every point you've discussed, but I'm always interested to get different perspectives and opinions. One of the issues that you've brought up is preventative health care. I would support that wholeheartedly, but in a free society, it's difficult to persuade people to exercise, stop smoking and drinking excessively, etc., for their own good. And honestly, I'm not sure I want the government to tell me how to live. Sigh...not sure where I stand on that.

I realize that our health care system isn't perfect, but I think a substantial amount of the rising costs stem from malpractice lawsuits. It also makes me uneasy that anyone would be able to decide if another life is worth prolonging or saving. Who would have the ultimate say on this?

If I were terminally ill and had a chance to live a few more years, I would probably want to. Every case is relative, I think. I think it's dangerous to categorize life as more or less valuable or important than another.

Please keep in mind these are only my opinions. I haven't done extravagant research in this area, by any means. If I misinterpreted what you were saying, Wendy, I apologize.

[WendyBG]

I agree with almost everything that you have said. My feelings are really ambivalent, about what I wrote. I only did the best I could, but I know it's not perfect.

I especially agree, with you, that putting the decision, of when to decide to withhold care, into bureaucratic hands, is scary. When I wrote it, I didn't like it. I'm sure there must be better alternatives.

I also agree that government can't mandate lifestyle choices. What I meant was...if people asked for nutritional and nursing followup, and this was provided by the government, it would more than pay for itself. (Wouldn't you like free nutritional counseling? I would!)

Nursing followup is essential for critical programs, such as drug-resistant tuberculosis, where any lack of compliance would cause relapse. I'm sure that many patients, such as diabetics, would be more compliant, and suffer fewer complications, with followup nursing care. This would also pay for the nursing care, because diabetic complications (dialysis, blindness, amputation) are very expensive.

I worked for a company, once, that increased their subsidy of our health insurance, the more healthy a lifestyle we adopted. They did a thorough physical, including treadmill with EKG, sit-ups, body fat content, and smoking. The better we did, the more money they kicked in. That was a good incentive! I like incentives, like that. The company benefited, because a healthy employee loses less time, from the job. I'm not sure whether a government program could legally discriminate against fat, un-fit insureds... but I would be in favor of incentivizing healthy lifestyles.

You said something that I'd like to come back to. "If I were terminally ill and had a chance to live a few more years..."

The hospice definition of "terminal" is "not expected to live more than 6 months, even with aggressive medical care." So, if you are terminal, you don't have a chance to live a few more years...or you wouldn't be terminal. Depressing, but true.

A few people outlive a terminal diagnosis, but the vast majority don't. Hospice is brought in for palliative care, when medical treatment would not extend life.

I certainly don't advocate withholding any kind of medical care (such as ventilators, etc.), if there is a reasonable hope of recovery.

I do advocate withholding life support for a terminal patient who has died...that is, restarting the heart of a terminal patient, who has died, then putting them on a ventilator. As things stand, now, hospitals do that, by default. If you don't want that, you need a special directive.

I don't want to sound depressing, but here is information, on Advance Directives: http://www.helpguide.org/elder/advan..._life_care.htm

You wrote, "I think a substantial amount of the rising costs stem from malpractice lawsuits."

I agree with you, but I am also ambivalent, about changing this. On the one hand, you are right. On the other hand, how can the system be changed, while protecting patients, from malpractice? Thousands of deaths are caused by errors, such as medication errors. Should this be exempted, from lawsuits?

Ironically, the threat of lawsuits prevents medicine from honestly reporting and correcting errors, which has helped aviation become safer. Do the lawsuits do more harm than good? What about the family, of the person who has died?

These are such difficult and emotional issues!

On the one hand, it's hard to think of people suffering, and withhold any possible care.

On the other hand, our system, as it is now, does not give any care at all, to many who desperately need it. It breaks my heart, when I hear about a working person (say, a single mom, with kids), who is hurt, in an accident, and has no health insurance, and loses her home, because of medical bills. Surely, we have to do something, to help working people afford health insurance. But, our current system doesn't do that.

I have heard it said, "Don't let the perfect become the enemy of the good." These issues are so gnarly, and the potential solutions so imperfect, that nothing is done...and that isn't good, either.

It's definitely one of the toughest problems that America faces.
Wendy

[RAINBOWWAVES]

there is no doubt in my mind that socializing medicine is the only way to go. All ppl will get the exact same services and attention. England has had a socialized program since 1948. That year, the country passed the National Health Service Act, which provided free physician and hospital services for all citizens. Recently, the program has been amended to include small fees for doctor services; however, the concept is still intact.

[RAINBOWWAVES]

Have you all heard of the man who thinks he has found the cure for cancer? Sounds extremely promising but there is so much money being made from cancer that the gov may get rid of it. LOL...

[RodFarlee]

Some minor points:
- end-of-life care consumes 20-25% of our national health care resources.
- we pay for the uninsured, one way or another already anyway (Medicaid, markups on all paid services to cover unreimbursed services).
- the direct cost of malpractice lawsuits is small (I've seen numbers in the range of a few percent), but the indirect costs (excessively defensive medical practices) are incalculable.
- somehow, Europeans get comparable quality health care, at 1/3 to 1/2 the total cost of Americans. We really should try to figure out why. Hints: my mom's doctors' office employs 20 people providing direct care, 10 in the office on phones and computers arguing with insurers and pharmacists over bills, copays, generics, etc. The doc says he's spent 1/4 to 1/3 of his time over the last year simply moving patients from drugs not covered to generic or covered drugs, dealing with their side-effects and complications, etc.

[WendyBG]

Originally Posted by RAINBOWWAVES

there is no doubt in my mind that socializing medicine is the only way to go. All ppl will get the exact same services and attention. ..... Recently, the program has been amended to include small fees for doctor services; however, the concept is still intact.

I don't believe in socialized medicine, which did not allow anyone the choice to pay for better care (until recently, in a limited way).

I firmly believe in free market forces. Socialism always leads to scarcity, because the producers don't have the profit incentive, to offer more goods and service.

Rather, what I am suggesting is a mix of private and government insurance programs.

I would like to see the government offer a mandatory program, for anyone who does not buy private insurance. The cost would be low, and the premiums would be tax-deductible, for low-income persons. The benefits would be for preventive care, chronic disease care and catastrophic protection. Expensive, low-benefit treatments (such as rare diseases, early preemie care and terminal life support) would not be covered. Hospice would be offered, but not terminal medical care.

Who would be covered? Many, who don't have any coverage now -- the 47 million Americans, who do not have health insurance.

The waitress, who slips and breaks an arm, would not be bankrupted, by a huge ER bill. The inner-city grandmother, who develops diabetes, would get medicine, instead of an emergency amputation, later. The teenager, who gets into a car accident, and whose care would bankrupt his parents. The working dad, whose high blood pressure will be medicated, and who will be saved from a heart attack.

As in England, the people who have government coverage will have long waits, because the government would offer low reimbursement, to healthcare providers. However, their situation would be much better, than no coverage, at all.

Who won't be covered, by the government insurance?

Anyone who wants more complete coverage, would be free to buy more complete private health insurance. Anyone who doesn't want to wait, for the inevitable long lines of a socialist system, will pay more, to insurance companies who pay the doctors a higher fee. Many corporations would continue to offer the superior, commercial health insurance programs, because they need to ensure that their employees get rapid access to medical care.

Rich people will be free, to make private arrangements, with doctors. They already do this, in some areas. I read about some NYC doctors, who charge $10,000 per year, per patient, right off the top. But, these patients are assured of instant care, 24 hours per day. The doctor only accepts a few patients, the ones who can pay the fee (plus their additional visit charges, of course).

I think that a mixed system, like this, offers reasonable protection, to those who can't afford insurance, now, while not taking away the freedom to buy superior insurance, if you can afford it.

Wendy

[WendyBG]

Originally Posted by RodFarlee

- we pay for the uninsured, one way or another already anyway (Medicaid, markups on all paid services to cover unreimbursed services).

Although society does pay, for the uninsured, the situation is more complex, than you have indicated. More harm is done, than immediately meets the eye.

So, I agree with you...but I am pointing out that society pays much more, now, than it would, if everyone had access to early intervention.

Medicaid covers only the truly indigent, and not all of those. The exclusion rules are stringent. A healthy, non-senior person, who is indigent, will likely not be covered by Medicaid. Mothers with young children are covered. The disabled are covered. But, most poor people are not covered, at least not in some states. The rules are on a state-by-state basis.

It's no wonder that poor people have worse medical problems, and shorter life expectancies, than wealthier people. They don't get preventive care, and they don't get routine care, for chronic conditions, until these become severe.

The working poor are not covered, by Medicaid. These are the people that I am most concerned about.

It's true that we all pay, for markups on unreimbursed services, for uninsured people. But, the costs are much higher, than they would be, if uninsured people didn't wait, until their medical problems because emergencies.

Emergency care is far more expensive, than routine care. The working poor are billed, for these services. If they own any hard-earned assets, they could lose these, in a bankruptcy. If they take a home equity loan, to pay their medical bills, they could even lose their home (which most states protect, from bankruptcy proceedings).

If a child is injured, or becomes ill, the whole family could go down.

I agree with you, that the U.S. should study, and model ourselves, on more successful, efficient health-care systems, in other countries.

Wendy

[RAINBOWWAVES]

Originally Posted by RodFarlee

Some minor points:
- end-of-life care consumes 20-25% of our national health care resources.
- we pay for the uninsured, one way or another already anyway (Medicaid, markups on all paid services to cover unreimbursed services).
- the direct cost of malpractice lawsuits is small (I've seen numbers in the range of a few percent), but the indirect costs (excessively defensive medical practices) are incalculable.
- somehow, Europeans get comparable quality health care, at 1/3 to 1/2 the total cost of Americans. We really should try to figure out why. Hints: my mom's doctors' office employs 20 people providing direct care, 10 in the office on phones and computers arguing with insurers and pharmacists over bills, copays, generics, etc. The doc says he's spent 1/4 to 1/3 of his time over the last year simply moving patients from drugs not covered to generic or covered drugs, dealing with their side-effects and complications, etc.

That is a great point about how many there are in the docs office...absolutely rediculous! I was just having that discussion the other day...and with all those ppl in the office, no one answers the damned phone!

[MyAzi]

I thought this link might be of some interest in this thread:

http://www.msnbc.msn.com/id/17372104/

[RodFarlee]

Originally Posted by WendyBG

I would like to see an Oregon plan implemented, all over the country. Already, 17% of the U.S. GDP is spent on healthcare. This is predicted to grow. I believe that a line needs to be drawn...

You're talking about prioritizing and rationing health care.

It is inevitable. Health care will sink the entire economy.

Medicare is an unfunded liability roughly triple the size of Social Security.

Fed Chief Warns That Entitlement Growth Could Harm Economy
New York Times, Jan 19 2007.

Warning against complacency over the federal deficit, Ben S. Bernanke, the Federal Reserve chairman, said Thursday that recent positive trends on the budget were a ''calm before the storm,'' masking a long-term danger posed by looming deficits in Social Security and Medicare.

''The longer we wait, the more severe, the more draconian, the more difficult the adjustment is going to be,'' Mr. Bernanke said in response to a question at a Senate hearing about when lawmakers should tackle the growth of spending in the twin entitlement programs. ''I think the right time to start is about 10 years ago.'' ...

He cited recent long term projections by the Congressional Budget Office that Social Security and Medicare outlays will rise from 8.5 percent of annual economic output to 10.5 percent in 2015 and 15 percent in 2030.

These costs, in turn, would force the United States to keep borrowing, pushing the ratio of publicly held federal debt from its current level of 37 percent of the economy to about 100 percent in 2030, a level reached in the past only during World War II.

''If government debt and deficits were actually to grow at the pace envisioned by the C.B.O.'s scenario, the effects on the U.S. economy would be severe,'' Mr. Bernanke told the committee. He said the trends would slow economic growth, drain away funds for private investment and sap confidence of consumers, businesses and investors.

Read: Medicare + do nothing = Depression ~2020-2040.

And we worry about relatively trivial passing things like Iraq, taxes, stock market, American Idol, ... oh, well.

[WendyBG]

Originally Posted by MyAzi

I thought this link might be of some interest in this thread:

http://www.msnbc.msn.com/id/17372104/

Thanks for this article. It illustrates so many of the concerns, in the thread. How sad! What a terrible situation!

The lack of healthcare providers who will take Medicaid and Medicare patients is a real problem. The government agencies reimburse doctors at a lower rate, than the insurance companies.

In our rural area, there are fewer doctors, than in urbanized areas. When I called, to enroll myself as a new patient, the first question was, "Who is your insurer? We aren't taking any more Medicare patients."

Well, I pay a pretty penny, for private health insurance. The doctor is in-network. I was accepted.

A clinic, in Port Angeles (the next town over), was slated to shut down, because it wasn't profitable, last year. Many of the patients (hundreds of them) are Medicare (elderly) patients. Most of the local doctors aren't accepting any more Medicare patients. What are they supposed to do? The doctors are trying to negotiate a way, to keep the clinic open. The story isn't ended yet.

Since this is Talk States, it is appropriate to raise the issue of medical care, and also of availability of health insurance, when considering the choice of the State to live in.

The State of WA has favorable health insurance regulations, much better than DE. For people who have pre-existing conditions, which causes insurance companies to reject them, WA State has a special insurance pool (fortunately, that isn't me, but it affects many people).

Wendy

[WendyBG]

Originally Posted by Wyody

My doc and I e-mail. We're in different states. His attitude was that New Zealand had the first idea of socialized health-care that he thinks would work. I haven't looked at the plan yet - anybody?

Why don't you look into it, and let us know?
Wendy (always happy to delegate )

[MyAzi]

Originally Posted by WendyBG

Thanks for this article. It illustrates so many of the concerns, in the thread. How sad! What a terrible situation!

The lack of healthcare providers who will take Medicaid and Medicare patients is a real problem. The government agencies reimburse doctors at a lower rate, than the insurance companies.

In our rural area, there are fewer doctors, than in urbanized areas. When I called, to enroll myself as a new patient, the first question was, "Who is your insurer? We aren't taking any more Medicare patients."

Well, I pay a pretty penny, for private health insurance. The doctor is in-network. I was accepted.

A clinic, in Port Angeles (the next town over), was slated to shut down, because it wasn't profitable, last year. Many of the patients (hundreds of them) are Medicare (elderly) patients. Most of the local doctors aren't accepting any more Medicare patients. What are they supposed to do? The doctors are trying to negotiate a way, to keep the clinic open. The story isn't ended yet.

Since this is Talk States, it is appropriate to raise the issue of medical care, and also of availability of health insurance, when considering the choice of the State to live in.

The State of WA has favorable health insurance regulations, much better than DE. For people who have pre-existing conditions, which causes insurance companies to reject them, WA State has a special insurance pool (fortunately, that isn't me, but it affects many people).

Wendy

However good in Wa to have that... you still pay through the nose. We had a wonderful PPO plan in Ca and can't even begin to afford personal plans for the family here in WA. So the only one insured is the kid because he has to be to play sports in school.

WA rates are very high as compared to CA.. I wonder what it is like in other states.

[WendyBG]

Originally Posted by MyAzi

So the only one insured is the kid because he has to be to play sports in school.

WA rates are very high as compared to CA.. I wonder what it is like in other states.

The only other state I bought private health insurance in was DE. It was much more expensive, than WA.

Please, please, please consider buying health insurance for your family. Catastrophic insurance, with a high deductible, isn't very expensive. It covers hospitalization, in case of accident or serious illness.

The Wall Street Journal reported that uninsured patients are often charge 3 to 5 times more, for exactly the same procedure. If you have insurance, even high-deductible insurance, you will get the lower price, that the insurance company has negotiated. So, even if you have to pay, out of your own pocket (because you haven't met the deductible), the price will be lower.

Wendy

[MyAzi]

Originally Posted by WendyBG

The only other state I bought private health insurance in was DE. It was much more expensive, than WA.

Please, please, please consider buying health insurance for your family. Catastrophic insurance, with a high deductible, isn't very expensive. It covers hospitalization, in case of accident or serious illness.

The Wall Street Journal reported that uninsured patients are often charge 3 to 5 times more, for exactly the same procedure. If you have insurance, even high-deductible insurance, you will get the lower price, that the insurance company has negotiated. So, even if you have to pay, out of your own pocket (because you haven't met the deductible), the price will be lower.

Wendy

I have experienced the opposite with my son.. He was insured and due to an error on the paperwork they canceled his insurance AFTER the fact... The costly hospital stay... he got a settlement from the agent and when we went to pay cash... they lowered the price sometimes by 10% up to 60% but in all cases, the prices were lowered. And I was told that they usually charge more to the insurance companies.

[WendyBG]

Originally Posted by MyAzi

I have experienced the opposite with my son.. He was insured and due to an error on the paperwork they canceled his insurance AFTER the fact... The costly hospital stay... he got a settlement from the agent and when we went to pay cash... they lowered the price sometimes by 10% up to 60% but in all cases, the prices were lowered. And I was told that they usually charge more to the insurance companies.

That is very interesting! The next time I have a medical visit, I will ask them which way would be cheaper, submitting to the insurance, or paying cash. I guess that they would have to call the insurance, to find out what the insurance price would be.

Wendy

[MyAzi]

Originally Posted by WendyBG

That is very interesting! The next time I have a medical visit, I will ask them which way would be cheaper, submitting to the insurance, or paying cash. I guess that they would have to call the insurance, to find out what the insurance price would be.

Wendy

Let me know what they say.. I am curious if WA is the same as in CA.

[Jenbar]

The State of WA has favorable health insurance regulations, much better than DE. For people who have pre-existing conditions, which causes insurance companies to reject them, WA State has a special insurance pool (fortunately, that isn't me, but it affects many people).

Oh... well here is where I can finally step into this discussion! :)

The state of WA has ridiculously high costs for private insurance - and it's typically hard to get, unless you have NOT been diagnosed with ANYTHING - and/or you haven't had any medical issue within the last 2 years.

If you aren't accepted through private insurance - yes, they do have a "special" insurance pool - but the coverage is no where near as complete as if you were purchasing a plan... and at least 2 times more expensive than a private plan. Literally, I would almost say this "special pool" is a total waste - because I don't know anyone who could afford it.

I don't know anything about DE's insurance programs. For a family of 5, we paid $650 a month for our private health plan through Regence Blue Shield. Of course, even the best plan only covers 80% - so we still had the deductible to meet, the copay (anywhere from $20-75) and the remaining 20%. As well as any appts not covered - for example, they allowed only a certain dollar amount for pediatrician appts - maybe $200? Yeah, that was met quick.

When my son, with several ongoing issues and preexisting conditions was denied for the regular plan, he was put into the pool. Of course, it's also not a guarantee he would get in - we still had to apply... and the costs were much more than what I have listed above.

Luckily, we were able to appeal, have his Heath Questionaire rescored, and he was accepted.

[jabm67]

Actually, I have a question bearing on this thread, one I hadn't thought of before but turns out to be work-related for me. I don't think people generally think of things in these terms, but it might be it's just me who is that way.

Suppose a medical program, procedure, whatever becomes available or could become available. This is a public health thing, like vaccination program, or a food additive or treatment (like enriched bread or milk pasteurization), disease screening (like a pap smear or TB test program), so the cost can't be put strictly upon the individuals who have the disease; in fact, the effect of the program is to prevent people from falling to an illness of some kind. It works out that the dollar cost per year of life saved is X.

Where do you draw the line on X and say "it's worth it"?

[RodFarlee]

Originally Posted by jabm67

...It works out that the dollar cost per year of life saved is X.

Where do you draw the line on X and say "it's worth it"?

That is the second most important question.

To even ask it in a meaningful way, one first has to rank all health procedures by this same metric: cost per year of healthy life gained. That is what the "Oregon Plan" did. That is not what our Medicare, Medicaid, or private insurance programs do today. The most important question is: why not?

Anyway, if we did rank procedures by cost/benefit, then we could pour money in, covering the lowest cost/highest benefit items first, until our budget was spent. Then we could ask your question about the next, unfunded items in a rational way. We don't do any of this rationally. We have a very uneven system.

Demographics will force this on us as Medicare explodes over the next twenty years, though.