I Don't Want Your HSA!
Tina has requested smaller more frequent posts in between my major posts. I can understand that, it's been about a month since I've started the "Why I am an Atheist" series and there's usually a week or more in between parts. So, here's a small post for you to read while you're waiting for "Why I am an Atheist Part III." If you are a new visitor to The Misanthrope's Sanctuary who came here looking for the "Why I am an Atheist" series, welcome, please scroll down to read it.
You know, I typically a very laid back and calm person. It normally takes an Act of Congress just to get any kind of emotional reaction out of me. Tina can tell you how hard it is to get me angry. Things that will have her flying off the handle in rage (such as our next door neighbors) will produce a shrug and a "What's the big deal?" from me. That being said recently I have noticed myself getting increasingly angry more frequently and much more easily. Perhaps the constant 70+ hour work weeks are finally getting to me, or perhaps I'm not getting enough nicotine in my diet. I don't know, but it certainly is strange.
I read an interesting article a few minutes ago that had me flying off the handle. It is titled "It's time to start shopping for your health." This article talks about the rise of the "high deductible" insurance plans and their counterpart, the Health Savings Account (HSA). For those who haven't heard of the high deductible plans yet essentially the idea is you pay a lower premium each month for it but each year you are personally responsible for the first $1-2k of your medical care. Only after you've paid this money out of pocket does the actual insurance start kicking in. To make it a little easier for you to make those out of pocket payments we now have HSA accounts which essentially work like a 401(k) for your medical care. You get to have pretax money deducted from your paycheck each week to go into these plans. When you need to go to the doctor you pull money out of your HSA to cover it.
The article talks about how the government is trying to create "consumer driven" health care. They envision a system where people shop around for the best cost for medical care. Since we are paying so much out of pocket we are going to be inclined to go after the best deal. Actual medical costs are supposed to become more transparent so that we as consumers know what the average person is paying for a particular procedure and then we go and shop doctors trying to negotiate for the best deal.
What the fuck? Under this system we have to negotiate for our health care? As I wrote the above paragraph the first thing that came to mind was a used car salesman. That's essentially the system we're talking about. Pretty soon we'll be hearing doctors say "So what can I do to earn your business today?" This is insanity!
The Bush administration feels that this will save people money in the long run. They argue that since some people don't go to the doctor as much as others (those with chronic conditions for example) then they shouldn't have to pay as much. The HSAs, they argue, will allow people to set aside just what they need without paying high insurance premiums for insurance that they may not need to use.
That is logical I suppose but the keyword here is "may." I never go to the doctor so the argument here is it would make more sense for me to put a minimal amount of money in an HSA and pay lower premiums for the high deductable insurance. In the long run I stand to save a lot of money because I'm not shelling out tons of cash to insurance that I don't use. But medical conditions, for the most part, are not predictable. Suppose on the way home I am in a car accident? I've now have to pay $2k or more out of pocket for medical expenses. As I was one of those people who never go to the doctor and therefore wasn't putting a lot into my HSA I now owe a significant amount of money that I gotta come up with somehow.
Great. This high deductible/HSA combination makes perfect sense for someone who has a high level of disposable income. But in typical republican conservative fashion no thought is given to the average middle class person. If the average middle class person, the person who is working hard to pay the bills, has very little savings, lives paycheck to paycheck, gets into an accident and now needs more then is in his HSA what the fuck is this person supposed to do?
The average middle class person has enough to worry about financially without having to worry if they've got enough in their fucking HSA to cover them and their family should something happen! This idea that there is a huge difference in premiums between normal insurance and high deductable plans is simply wrong. My company offers both (thankfully they have not gone with just the high deductable plan) and the difference in premium for them is minimal!
This is a great idea for companies and insurers. Companies pay less to insure their employees and insurance companies pay less in claims. What a great idea to further line the pockets of the rich bastards!! (no offence Onanite!). Let's make the middle and working class people struggle harder so the rich can make more money! That's republican think if I've ever seen it!
I don't want to negotiate with my doctor for medical care like she was a used car salesperson! This system will reward those people with very strong negotiating skills and those people who don't care about constantly going to different doctors or hospitals. The article that I referenced discussed how a person who wants to stick with one doctor or hospital is going to be at a disadvantage under this plan; they are more liable to pay higher costs out of pocket.
This plan is bullshit for doctors as well. Doctors should worry about treating their patients, about giving them appropriate care. That is their focus. Under this plan now they also have to worry about marketing, about undercutting the competition. Soon we'll be seeing advertisements: "This week only save 50% on all hip replacement surgeries! If you act now we'll also throw in local anesthesia absolutely free!!" Poorer consumers, they one's who can barely (if at all) contribute to their 401(k)s, will be crushed by this. How can they be expected to also start contributing to an HSA as well? This system will just create what I call the "uninsured-insured." People who have insurance but cannot afford to use it because they can't afford the out of pocket deductible.
Again, this is just a scheme to help the rich and powerful enjoy ever increasing profits at the expense of the regular working guy.
We should be moving toward socialized medicine, not away from it you fucking republican assholes!
posted by Chris @ 8:43 PM
6 comments
6 Comments:
Everything this adminsitration does is designed to help big business, not the people of the U.S.
That being said - I personally don't have a lot of faith in doctors. They're as fallible as you or I and it's a virtual impossibility that they can know everything about the human body, which is what gave rise to the system of specialties that we have today.
But I'm not a haggler, my SO is. Today we were in this little Asian shop and he was going back and forth with the girl running the shop. He wanted this particular pillow for a project he's working on and she told him it was $25. He looked her straight in the eye and said, "How about $15" and she agreed.
Holy freaking crap he's talented. He'd be a good con artist, which is what most of the medical profession is, particularly the whole notion of private insurance and HMO's. After all, wasn't that supposed to save us a bundle on health care? Yet what has it done?
This is scary. Allie has to go to doctor visits to keep up with her shots, and her growing, and everything. I have hypothyroidism, so I have to visit my doc, and usually a hospital to get blood work every 6 weeks. Not to mention as a woman (women will not what I'm talking about!) we have seperate doctor visits for girl parts and checkups for prevention.
Having to pay out of pocket for all this would be terrible. Knowing that each time I had a scare for Allie's health, I had to put it off as long as possible, just because I either couldn't or didn't have the funds, would terrify me. They would be putting parents in the position of not seeing to their kids health properly. If this is a way to have population control, and scare people out of having kids, I'm convinced it would work. No one would be able to come up with that kind of money, esp after having kids.
As a woman myself, who was pregnant and had to visit a doctor more than I'd like to actually discuss, how many pregnant women wouldn't get proper care? How would emergency C-Sections be paid for if you had a harrasment free pregnancy up to the point? You wouldn't have used 1k or 2k just to go to checkups at that point.
How irresponsible of people to make the decision for the masses of how they will be taken care of.
Nitpicking: If you were in a car accident, your car insurance, in theory, should cover your medical expenses. The only way your health insurance would have to pick up the slack is if it was a no-fault accident (the PIP limit is $10K), or if your medical expenses continued because of permanent injuries, beyond the amount of coverage.
With rising healthcare costs, I can see why employers would be tempted to scrap traditional health insurance coverage and instead switch to an HSA or HDHP. And that's fine for someone who's single, healthy and "unlikely" to have any impending health problems. Sure, you never know when you're going to suddenly develop an illness or health condition, but overall, a single person in his twenties or thirties, of a healthy weight, non-smoker, who eats right and exercises regularly, can take that chance.
However, Tina's right, it's when you have children that such plans are a terrible idea. Kids constantly catch stuff from one another. They break arms, legs, need stitches. It would be a terrible idea for a family to have such a plan. Or someone who has a health condition that needs maintenance medication or continued treatment.
My firm pays for single coverage health insurance, but last year there was a huge price increase for them, and they had to lower the coverage. So I now have a $1000 deductible, because I didn't want to pay the $40 a month to upgrade the plan. People with family plans and the upgrade pay nearly $700 a month for health insurance coverage (the firm pays approximately $300 per month for each of us, which is the cost of the standard single plan.) But I figure it's really unlikely that I would need to be hospitalized, so I decided to take a chance. (And 1 year later, no hospitalization.) I'm lucky because I have insurance, and even luckier, because I don't pay for it. It's not fantastic, but it covers the yearly gyno exam, and cuts down the price of my allergy meds considerably. If I were planning on having children, I would upgrade the plan so I would have no deductible.
Also, just like car repairmen, doctors will suggest a whole slew of tests and exams in order to diagnose a problem, that will often come as an expense to the patient, not just the insurance company. While that's being thorough, it's also being really expensive. And if you as the patient have to, say, pay 20% of those diagnostics, you stop and think, geez, nevermind, I'll just suffer! But I think with improvement in technology, there will be a decrease in mass testing, and easier recognition of a condition from the onset. I've heard of new software that doctors can use to help them diagnose conditions based on symptoms, giving them the most likely conditions the patient might have. Things like that can help to reduce costs for unnecessary testing and diagnostics.
The HSA or HDHP plans might be good for some of us, but there is still a need for traditional plans for those who are more likely to need medical care. I'm all for a combination of socialized medicine and privatized medicine. Most western nations have a hybrid system of medicine. And for all of our advances in medical technology, the U.S. still has the highest infant mortality rate of all western nations. (Oh, but our doctors get paid significantly higher than doctors in any other country. Heh.)
Socialized medicine? Are you NUTS????
From Canada, "After his "occasional upper abdominal discomfort" evolved into continuous pain, Rev. Lehotsky went to an Urgent Care facility on Easter Sunday. After six hours, the doctor reported that he "wasn't sure what was causing the pain" and Rev. Lehotsky would have to be referred for further tests, a barium X-ray and an appointment with a gastroenterologist. Shortly afterward, Rev. Lehotsky was shocked to learn that the wait for the x-ray would be five months and the first appointment with a gastroenterologist would be in seven months."
And the follow up, "Two weeks ago, we reported on the plight of Rev. Harry Lehotsky of Winnipeg who was suffering from abdominal pain and was told he had to wait five months for a barium x-ray and seven months for an appointment with a gastroenterologist (See 'Health Care: Paying to be on a waiting list').
According to the article in today's Winnipeg Free Press (link available for a limited time), "...the minister was insistent they [the tests] be moved up". The diagnosis? "...the ulcer doctors had been treating isn't an ulcer at all. It's pancreatic cancer. It has spread to his liver, spleen and lymph nodes. And it's inoperable." Doctors have given Rev. Lehotsky six weeks to nine months to live."
Or another! "The family of a 57-year-old Meath Park woman says it will take at least three months before their mother gets to see a Saskatchewan oncologist who can tell her if her cancer is treatable or fatal.
And while Health Minister Len Taylor says three months is too long to wait, he offered little Wednesday to indicate wait times to see cancer specialists in this province will soon be getting shorter.
Emily Morley has already waited a month to see an oncologist since receiving her biopsy results that identified her secondary cancer, but were inconclusive in determining the primary source. Until that primary source is identified, her treatment cannot begin.
And even though the cancer is now in Morley's lungs, liver, pancreas and spine, the Saskatoon Cancer Clinic has advised her it will still take at least three months to see an oncologist."
This is in Canada, often viewed as the poster child for socialized medicine. My father went into the doctor with a slight shortness of breath, and within a week found out it was cancer. Within another week, he had surgery to remove his lung. They caught it before it could spread to his lymph nodes, but it was a close thing. If we lived under the system described in the above stories, HE WOULD BE DEAD.
Yes, the rising cost of health care worries me a great deal. It seems out of control, and has for some time. But socialization is SO NOT THE ANSWER. HSAs were created in an attempt to find an answer to the short-term problem. Will they work? Perhaps, perhaps not. But they sure as hell beat out YOUR solution!
Will they work? Well let's see... the middle class who already have regular health insurance will be slowly transitioned to the HSA/HDHP combination resulting in continued coverage at a much higher out of pocket expense. As for the poor? The ones without health care at all? Ben would argue that the HSA is a good thing because those people now have choice. But what good is choice if you cannot afford to take it? Where are the poor, the uninsured, going to get the extra money to fund an HSA and pay the premium of the HDHP?
I'm sure if they want the insurance bad enough they will find some way to sacrifice for it, after all who really needs to eat three times a day? Perhaps instead of making contributions to whatever meager retirement savings they have (assuming that they can even afford any retirement savings) they will redirect that money to an HSA. Sacrifices will be made but at least now they have the choice of insurance if they are willing or able to make those sacrifices to pay for it.
But why should they have to make those sacrifices? Why should they have to struggle and sacrifice to fund a plan that will save the rich money? The poor, the working class, they struggle enough. Why should we add to their struggle?
This country has a very disturbing habit of shifting burdens away from the rich to the working stiff. Look at CEO compensation, they currently make about 30x that of their average employee plus other perks like the so-called "golden parachute." Back in the 60's they made about 3x what their average employee did. More and more corporate profits, instead of trickling down to the workers (as the wonderful trickle-down theory of economics said they will), are finding their way into the pockets of the executives. They people who need the extra money the least.
For years companies have been moving away from Pensions to employee funded 401(k)s. Now more of the burden for saving for retirement is shifted to the working person and away from the corporation. 401(k)s shift more of the burden to the individual but they also have some benefits, it's harder for a company to raid a 401(k) as an example that was given to me. That's true. But isn't there any other way to protect retirement savings other then more the burden toward the individual? How about give the Pension Benefit Guaranty Corporation more oversight and more teeth? Make them a regulatory body with the power to go after companies that raid pensions. Make the penalties for pension raiding stiffer, make it easier to prosecute. There are other options aside from shifting the burden to those with the least.
Now with social security struggling along the Bush administration proposed a solution to again shift the burden away from social security to the administration. Instead of finding ways to bring more money into the system (there was a time, only a few years ago, when the social security system was running a surplus!) they want to, once again, move the burden to the individual least likely to be able to afford it.
Now the rich and powerful are doing it to health care. Move the burden of health care onto those who can least afford it with these blasted HSAs! Are there no other solutions? How about importing cheap drugs from Canada? How about requiring companies to take a portion of their profits and use it for free health care for the uninsured? How about tort reform to reduce malpractice costs? How about closing off all the loopholes the rich use to avoid taxes such as funneling money through an s-corp? Use the additional tax revenue to fund a health care program for the poor or put it into social security.
There are tons of options that haven't even been tried that don't involve burdening those in our society least able to pay that burden.
"Consumer-driven" is just a Republican euphemism for "Poor pay more, rich pay less." These HSA's are just another in a long line of examples of the rich trying to make themselves richer on the backs of the workers.
so much for MORE POSTS...
come on Chris.
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