Buses and Health Care

Two topics of discussion today:

First, I wish more people where I work rode the bus.

Yes, you have to get up earlier if you take the bus. Yes, it takes longer to get home if you take the bus.

But the bus is cheaper. By leaps and bounds cheaper. Or was, until people stopped riding the bus for whatever reason. And prices are going up. But still, they'll be cheaper than driving out to work unless we hit the time when gasoline once again drops to 69.9 cents a gallon.

Second, the individual healthcare mandate has been upheld as constitutional. (although CNN.com, in their commitment to solid journalism, briefly had the courts nullifying that portion of the law.)

(And, for the curious, when I decided to check in at Newsbusters to see the state of general conservative wharrrgarbl over the Supreme Court's ruling on healthcare, I got this. An amusing sign.)

It is meant, of course, to get everyone on the bus. To make health insurance more affordable because more people -- and more money -- are in the pot. We'll see if that happens. So far, the prices I'm paying for health insurance have gone in one direction only, and it ain't down.

But no one forces me to ride the bus. It is a decision I make based on the fact that the truck I drive would suck down two tanks of gasoline a week to get me to and from work, far more expensive than what I pay to ride the bus. There are also safety considerations. I like the fact that I don't have to drive. I can sleep. I don't sweat road conditions or fatigue. That's the bus driver's job. And our bus drivers are good at what they do.

But no one forces everyone to ride the bus. I'm not sure that forcing everyone to ride the bus is a good idea. Those who drive make their own decisions, maybe based on economics, maybe on other factors, such as sleeping in a bit later and getting home sooner. The cost of gasoline, obviously in their eyes, is less of a factor than whatever factor it is that persuades them to drive to work. Forcing them to ride the bus would make me happier because -- perhaps -- bus pass prices would go down, but they, in turn, would give up other tangible benefits they see in driving themselves to work or carpooling, rather than riding the bus.

If all things were equal -- if everyone were like me -- the buses would be so crowded they'd be less expensive and probably less comfortable and more likely to inspire Weird Al Yankovic parody songs.



But not everyone sees things like I do, which is too bad for me and my situation. But I don't see things like them, which maybe causes them some hardship along the way. Recently our company polled employees to see if they'd rather have a $50 a week carpooling incentive rather than bus access -- which, in addition to what we pay as employees for the bus passes, costs the company $450,000 a month. The poll I heard -- unofficially -- came out about even among people who adamantly want to continue having bus privileges, those interested in the $50 carpooling incentive and those who didn't give a fig either way.

Do I think health insurance prices will go down as more people are "forced" to buy health insurance? Not a chance. More people buying houses at the peak of the housing bubble -- which led to more houses being built and more people working in construction -- forced prices through the roof, not down. Those who look at increased demand -- whether through popular desire or governmental fiat -- to make prices go down are living in a fool's paradise. Only when the profit equation is taken out of healthcare might we see prices decrease. But that would be only a temporary dip, as costs outside of profits will still continue to rise. But that's socialism, which we will not see in this country any time soon.

PSST: CNN, you might want to remember that getting things right is far more important than getting things first.

Health Care Update IV

The true test of any American health insurance program is not whether or not it accepts you as a customer and takes your premium, but whether it actually does what it's supposed to. After our first doctor's visit and first bill from Regence BlueShield of Idaho, it seems we've found a provider that does what it says it will.

It's a curious thing, having a health insurance plan we actually dare use because it does provide some benefits. With our former insurer (Assurant Health) we got basically nothing and paid for the privilege. Going with the not-for-profit Blue Shield actually gets us some benefits at about the same price.

And the bills are certainly easier to read. Whether or not this comes from Obamacare doesn't matter to me. What matters is that BlueSheild tells us what coverage we've still got left on the wellness program as we use it, and how much of the family deductible we've met. Importantly, out of a bill of roughly $400 for some checkups for Michelle, they're paying all but $65. Yes, at this point, we've paid more in premiums than we would have if we'd paid the bills out of pocket, but I like the idea that we could have to go to the doctor again later this month and have some coverage again for the same premium price.

It's not that we're looking to hit the lottery here -- break an arm and win a prize. But it's just nice to know that if someone does get hurt or needs some medical attention, we don't have to plunge instantly into savings to pay the bills. So take me off the "moderately pissed-off" list and put me on the "cautiously optimistic" list for now. That's an improvement in my book.

And if these advantages are coming from Obamacare, kudos to Obamacare. I'd rather have Obamacare than what we had before, if this is indeed helping.

Healthcare Update III

So we’re back in the world of people only moderately pissed off at their health insurance provider.

That’s significant. And I think it gives Regence BlueSheild credit that, with only one premium paid, we’re only in the “moderately pissed off” category. At least we can go do a certain, fixed (small) number of wellness checks a year now and only have to pay $35 a pop for them. That’s solidly got us in the moderately category. For now. Until we decide that their definition of a wellness check doesn’t match reality’s. But, naïve folk that we are, we’re willing to give them the benefit of the doubt.

You’ll recall in past posts I’ve lamented about the state of healthcare in our nation. I’ll not weary you with a recap, but provide a link here.

In case you’re curious, I never did hear back from our congressmen on the questions I wrote them concerning health care, aside from the boilerplate messages I received from them. They’ve moved on, protecting us from the dragon that is the national debt, which, obviously, wasn’t nearly as scary as when there was a Republican president in office shoveling money into the rathole. Didn’t expect to hear back from them, but you know, me voting them into office and all, it would have been nice. (Yeah, I know they’re busy. But this is exactly why I don’t make political contributions, hang up on pollsters, and otherwise do what I can to avoid shaking hands with politicians, because they only want to talk with me when it’s time to vote again. Other than that, they’re too busy.)

So we’ll see how Regence BlueShield works for us. First wellness visit comes Tuesday.

Healthcare Update, or More Potential *&@*#!

With our end-of-the-month deadline looming to find new health insurance approaching, we’re holding our breath. Our hopes are not high. And I still haven’t heard thing one from my congressmen aside from boilerplate email responses.

Here’s what’s going on:

• Sayonara, Assurant Health. Fie to you and your more-than-our-mortgage premiums.
• Private individual market for health insurance sucks, according to my wife’s aunt who is in the business, and ObamaCare has made the situation worse.
• Regence Blue Cross/Shield of Idaho, take pity on we poor, simple folk.

Yeah, we’re going to give Regence a try, though our hopes aren’t high. We sent off our application material yesterday and hope that this company will actually offer us something besides the same old crap. Again, expectations are not high. Oh, we will likely be offered a policy. Whether it offers the care we’re interested in at the price we can afford is a different story.

How ObamaCare is making the situation worse, I’m a little fuzzy on. Though this report (sorry, registration required) from McKinsey & Company paints a pretty appalling picture. (This is only one report, I know. I’m still open to reports that have more rainbows and unicorns in them, but this is the one making the Internet rounds right now.)

Basically, the report says that of 1,300 employers contacted by the company, upwards of 30 percent are likely to drop employee health insurance as the ObamaCare provisions come into play in 2014 – this even despite penalties that will kick in further down the road.

Here’s the report’s key finding:

Starting in 2014, people who are not offered affordable health insurance coverage by their employers will receive income-indexed premium and out-of-pocket cost-sharing subsidies. The highest subsidies will be offered to the lowest-income workers. That reduces the social-equity advantage of employer-sponsored insurance, by enabling these workers to obtain coverage they could not afford on today’s individual market. It also significantly increases the availability of substitutes for employer coverage. As a result, whether to offer ESI after 2014 becomes mostly a business decision. Employers will have to balance the need to remain attractive to talented workers with the net economics of providing benefits—taking into consideration all the penalties and tax advantages of offering or not offering any given level of coverage.

Not pretty. The subsidies will be nice – as far as I can tell, we’ll qualify for some amount – but if we’re looking to the individual insurance market to keep prices down even with this potential influx of new insurees, well, I guess we’re also likely to buy swampland in Florida. (Yes, there are bright spots. The study also points this out):

This development should not suggest, however, that employers considering the elimination of ESI are focused exclusively on the bottom line, at the expense of their employees. In fact, because of the subsidies, many low-income employees will be able to obtain better health coverage, for less out of pocket, on an exchange than from their employer.

So we’ll see what happens. Feeling pessimistic, however.

*&#*$&@*# Follow-Up

Used under the fair use doctrine for commentary purposes. Wish my health care was this clear-cut.

I’m doing this, yet it feels as effective as yelling into an empty room:

Congressman Simpson,

What's a guy to do when he gets a letter from his health insurance provider saying that come the end of June he's going to have to pay more for health insurance than he's currently paying for his home mortgage?

The individual health insurance market is murder. And yet all I hear from the GOP is that we need to turn to the private market for health care solutions. The private market sucks rocks, congressman.

What's worse is that I don't feel that writing to my congressional delegation will do anything to fix the problem, or that it's even fixable by anyone outside of those guys who write those utopian novels.

Feeling slightly depressed,

Brian Davidson

Sheesh. That depressed me even more, just writing it out. I sent that to Mike Simpson, and a similarly-worded missive to Sen. Mike Crapo as well. Expecting back the traditional form letters, the glass of water and the pat on the head, because this kind of rhetoric just isn’t heard over the partisan noise in Washington except at election time, when such drivel can be used a fodder for campaign stops when all sorts of wild promises are made with 99.9 percent of those in the audience cheering them on while at least fifty percent of us know such promises won’t be kept. At all.

Used under the fair use doctrine for commentary purposes.

Health Care, or #*&*#**@*!

Image used for commentary purposes under the fair use doctrine.

We're looking for new health insurance.

Why?

We got a letter from our health insurance company this week informing us that because of rising medical costs, our premiums are going to go up nearly $200 a month. This is after two years in which we submitted the following claims:

• $200-some-odd for a visit to a community care facility to get an enormous sliver removed from under the fingernail of our youngest son. Claim denied because we hadn't paid any of our deductible.

I'm sorry if you were waiting for a longer list. That's it. Two years, one denied claim, and because costs are going up, up, up, we're now being asked, starting at the end of June, to pay more for health insurance than we are currently paying for our home mortgage. Am I the only one who sees something wrong with that situation?

It's malarkey, this so-called private market for health insurance. And though our letter made grandiose promises about what Obamacare regulations is doing to the health care industry, all I'm seeing is that our premiums are going up on a product we can't use because our deductibles are so high we'd only hit them in a given year if we were all involved in a horrible traffic accident. And then our rates would go up.

A few weeks ago Michelle jokingly said she'd like to see the church offer members a health insurance plan, and I joked back, "You know, I'd pay an extra 10 percent in tithing to see that happen." Now though it's still a farfetched idea, it sure sounds a lot more attractive. Maybe I'll send that on down the line to Salt Lake City . . .

Telling Us What We Want to Hear on Health Care

It’ll probably come as no surprise to find that I’m still confused by ObamaCare.

As far as I can tell, ObamaCare does little to control what health care costs. Yes, I can probably get tax credits to pay for insurance, but in order to qualify for the credits, I’d have to spend more on insurance than I’m already spending. And that does nothing to prevent private insurers from raising rates, or to prevent hospitals or pharmaceutical companies from charging the prices they do for what services they offer. We’d just be throwing more money into that hole.

How can I call it a hole when it’s insurance meant to pay for my family’s ills if, heaven forbid, we had an accident? Well, for the past two years I’ve paid into the insurance system. Have not filed a claim. Yet our premiums rise. Prices are going up, and even though I’ve done nothing but pay premiums, I’m still getting spanked by those rising prices.

Conversely, we haven’t had a claim on our auto insurance or homeowner’s insurance ever. Not in 13 years of marriage. And guess what? Those premiums are going down. Good job, our insurers say. You’re a good risk. We can reward that.

Not so the health insurance companies.

Robert Samuelson, writing for Newsweek, agrees (emphasis mine):

Though it seems compelling, covering the uninsured is not the health-care system's major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets. Obama claims his proposal checks spending. Just the opposite. When people get insurance, they use more health services. Spending rises. By the government's latest forecast, health spending goes from 17 percent of the economy in 2009 to 19 percent in 2019. Health "reform" would probably increase that.

Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. Obama might have attempted that by proposing health-care vouchers (limited amounts to be spent on insurance), which would force a restructuring of delivery systems to compete on quality and cost. Doctors, hospitals and drug companies would have to reorganize care. Obama refrained from that fight and instead cast insurance companies as the villains.

I've read the stories in which Obama villifies the insurance companies. It's good public relations -- nobody likes health insurance companies -- but making them the villains isn't addressing the core issues, Samuelson says (again, emphasis mine).

He's telling people what they want to hear, not what they need to know. Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system. In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion.

I’m not sure what he means by vouchers, or how such a system would “force a restructuring of delivery systems to compete on quality and cost,” but I’d like to think there’s something we could do to keep these costs under control. What’s currently being proposed, however, doesn’t do that. Why do Democrats think shoveling money at social problems is the way to fix them? And why do Republicans think that the private sector is the answer to everyone’s woes? The private sector is keeping those prices up and spiraling higher. And throwing money at the problem isn't going to make prices come down.

To those who don't believe we're being priced out, I challenge you to ask your employer how much they pay for your healt insurance (if you're lucky enough to have an employer who does pay for a portion or all of your health insurance; I am not one of those). You'll find out quickly that it's an expensive proposition. My wife and I pay out of pocket for a bare-bones plan that'll cover us if we're in an accident or get cancer (at least up to a point) and maybe that's good enough for now. But for later? I don't know. My in-laws, both retired, buy their own insurance, at a better level than ours. It's expensive, even with the Medicare supplements they get. And they travel to Mexico to buy their drugs. They pick up some for us, too.

Not having insurance isn’t the problem; the problem is as Samuelson says: We’re being priced out of the system. The private sector currently has no motivation to keep prices low. Most everyone, when the time comes, will plunge headfirst into the healthcare system, costs be damned, because either they’ve got insurance or they know the government will somewhere, somehow pick up the tab, or at least most of it. Yes, there are people, like my wife and I, who avoid going to the doctor because we know we can’t afford it, and know that we don’t qualify for any government handout. But our window of taking such an approach is closing. We’re both getting older. Our kids are getting more active and, frankly, more likely to get hurt.

An update: The last time I blogged on this topic, I mentioned that I'd e-mailed the White House health care e-mail box with a question on ObamaCare. I have not received a response.