I saw Karen on Washington Week last night and I applaud her and her brother for making their real world struggle with the system an example. I’ll be listening on Monday.

“A paradox of medical costs is that people who can least afford them — the uninsured — end up being charged the most. Insurance companies, with large numbers of customers, have the financial muscle to negotiate low rates from health-care providers; individuals do not.”

This is one of the most important points in your article. I have a high deductible plan, and often have to pay significant out-of-pocket costs. However, my insurer, while not paying these costs, at least negotiates them down radically so I pay less. They make it a point on their statements to show me how much they are saving me through this negotiating, and it is appalling how much more it would have cost if I didn’t have this coverage. Congress should and could fix this by requiring health care providers to bill the uninsured, underinsured and others who have no bargaining power at the same rate they bill Medicare. It probably wouldn’t cost hospitals much since a lot of hospitals already have to write off these amounts anyway. But if you are given a $2000 bill, you might actually try to pay, whereas if you get a $12,000 bill, you probably won’t even bother to try.

Thank you for writing this story and publicizing this important issue.

As a supplemental insurance broker, and a self employed individual, i see this every day.

by tying insurance to a job people get “kicked while down”.

they lose their job (for whatever reason) then with less income their health insurance costs rise dramatically forcing many to go without coverage or forcing them into personal bankruptcy.

until this country gets serious about establishing a national baseline of coverage for all citizens, our hands are tied as a nation to move forward, innovate and compete in a global economy.

for the conservatives who claim this will ruin business i challenge them to find an employer, large or small, not struggling with the cost and complexity of offering health insurance to the employees.

God Morning,

I am a listener in Canada.

I don’t understand why Americans would not want a Canadian style health care system. It’s not perfect, but it’s much better than the American system. America needs a single-payer system like Canada, where there is one payer for health care services, the government, which would then have the upper hand in controling costs. Under the curent system in the U.S. the health-care industry in U.S. has the upper hand in the marketplace, as there are multiple payers for health-care services.

The health insurance industry would not like such a radical change, but Americans need to stand up to the healty insurance industry. American consumers don’t owe them anything.

The solution: SINGLE payer!

Retail vs what insurance companies pay.

After the birth of my daughter in 2004, Harvard Pilgrim (love them, btw) sent me a copy of the bill they received from Brigham (and what HP Paid). The bill was for 12k; HP paid about 3k. Considering I only took motrin, that was one expensive birth! How do people do it if they don’t have insurance?

I am a person who has lived in both Canada and the US. For routine medical problems and prescriptions, I would choose the Canadian system any day.

I think there are some real opportunities in Canada to make use of some of the disease management used in the US. The US needs to get to a single payer, perhaps with multiple plans, if there is any hope.

This summer my wife and I both got colonoscopies. We went to different facilities, as scheduled by our doctors. My procedure cost a total of $900, of which our insurance paid $650. My wife’s cost close to $2600, of which our insurance $1600.
This was for the same procedure!!!!!
When I called my insurance company to check the discrepancy, I was told they were different codes, therefor different billings.
Code, schmode it was the same procedure. My insurance company paid almost twice as much for my wife’s procedure than mine billed in total.

Consumers need to have easy!! access to prices before procedures.

Insurance companies need to be a little more diligent in what they let medical bill them for.

The only way to control health care costs in the long-run is to ration health care. This means less drug innovation, less medical device innovation, lower health care salaries, longer lines and waiting times except for those who can afford to avoid this by paying more out-of-pocket.

As an American living abroad for the last15 years, in both Austria and Switzerland, I have never heard of these health care insurance problems from anyone. It constantly amazes me that the American public have put up with this shame all these years. Many people seem to believe the myth that Americans have the best health care in the world and that is far from being true. Until there is complete heath care reform in the United States, the quality and coverage of health care will continue to fall for most citizens. What a joke to tie the health of the country to the place where they work! Wake up people and let your Congressperson know you want change and want it now or they will be voted out of office.

My wife, a harvard employee, suffered an anurism during child birth leaving her sevearly disabled. We have, despite world renowned employee benefit, been systematically pushed onto the medicaid/medicare system which is underfunded understaffed.
Insurance company’s do not pay there responsibilities and we are really living in a state medical system already. Taxpayers paying already for marginal quality care.
All consumers should pay an equal regulated insurance policy. No group discounts.

Insurance companies will figure out how to bring down health cost while maintaining a high quality.

I think the cost of health care would be reduced if the privacy laws at least did not discourage people from finding solutions that do NOT create huge profits somewhere in the health industries. I lost a 20-year job after a decade of dealing with sick-building syndrome, which left me allergic to basically everything (except green peppers and sweet potato), and with immune problems and soon thereafter breast cancer that had spread. COBRA was nice, in the early ’90s, and I had nurtured my own business that held up, sort of. I got Blue Cross, which has spiked, but has not covered the kinds of things I have needed. I have to lead the doctors, not vice versa. For example, a decade of shoulder problems that turned into a year of frozen shoulder, it turns out it is cured by putting those Chinese detox foot patches on the shoulder. It has worked since last June, daily, without fail, at about $1.00 a day, and is probably taking down my load of toxic metals. I have found other things that one would wish doctors would know, and I am wishing doctors could be more a portal to patients cooperating and experimenting for themselves, understanding that they cannot take certain risks for legal reasons.

I think there is some variation in how much medical providers charge private payers. I have a $2000 deductible on my insurance and I find that here in the Buffalo, NY area, I am charged less, and not more, for tests and most doctors’ visits. And, in the last year, the cost of at least one test – a mammogram – has gone down significantly. Best, Joanna

No Price Transparency

How can we be good consumers of health care without knowing how much services cost at different institutions?

If there was price transparency, hospitals couldn’t get away with charging individuals 7 times what they charge companies.

Interesting show! While I have what’s considered to be good health insurance (I’m a Virginia State employee), I find I can’t take advantage of my plan as much as I should because of the co pays and deductibles. If I were to get really sick I’d be only a few paychecks away from loosing everything. I believe we need a single payer system, like Medicare for All, HR 676.

If a single payer system MEDICARE is okay for Americans over 65 why is a single payer system “MEDICARE-LIKE” not?

I would like to hear the opinions about self insured health care. Self insured is a system in which insurance companies do not pay directly for the member’s services – the employer does – ie Boston Scientific or BU…..

Most people do not realize that your employer ends up footing the bill and decides your benefits directly and not the insurance companies.

Listening from work in CT.

I also feel that insurance companies are misleading customers from the start.

I lost my ins. coverage after I was laid off last year. My new employer will cover a contribution but we have no formal policy.

Trying to apply for BCBS, and the agent was trying to “sell” me a “hip new policy for young people” (because i am 26) – This has less coverage and a higher deductible, however a very catchy very flashy website. The agent kept insisting it was better, even though it clearly is not.

I fear for my generation….

I hear that a senator has threatened that health care will work like other agencies like DMV. If health care worked as well as the DMV is Virginia life would be good. The state of Virginia demonstrates time and again that governmental agencies can work well. Sure I wait in line at the DMV, but its calm, orderly and efficient. Even with insurance, I could not see a doctor without an appointment nearly as quickly as I can see a DMV rep.

How about actually getting the insurance companies paying what they are suppose to pay? I have theoretical great coverage, but I am constantly fighting with the company to pay what they are suppose to pay.

Recent examples, they cover physical therapy at 100% following surgery but only pay 80% instead of 100%. Many phones later I can get some of the visits covered at 100%, but of course they never cover all of them at one time and it takes several more calls to get the rest of the visits paid.

This is routine policy for them, I’ve had 3 knee surgeries in the last 18 months and I’ve had the same problem each time. The insurance company blames the orthopedic surgeon for not “billing correctly”. Despite the fact that the insurance company paid for the surgery. The surgeon’s office blames the insurance company!

I propose that until all Americans have government-funded healthcare, we should repeal taxpayer-supported healthcare insurance for our “representatives” in the House and Senate.
Let them deal with the same horror stories that regular citizens endure daily with our cruel, profit-driven system.

(Thanks for the show, Tom.)

I am a Canadian. The conservatives in the USA tell me that the government is telling my doctor how to treat me. I don’t know what they’re talking about. Mr. Blunt is pushing the big lie. I don’t go to a government office to see my doctor. Insurance companies in the United States pay employees bonuses if they can find ways to deny treatrment. It would be funny if it was not so serious.

Karen, As a lawyer who has had extensive cancer surgery and treatment as well as cognitive issues from that treatment,(incl. all the resulting financial problems) I would like to get involved in health care reform.

SPECIFICALLY, CAN THE GOV’T. OR A NON-PROFIT ESTABLISH A PLAN FOR THE UN/UNDER INSURED THAT REQUIRES PROVIDERS TO CHARGE SIMILAR NEGOTIATED RATES TO THOSE WHO CARRY THIS NEW “CARD”?

I have thought of this for some time and believe that this should be a first step until we have single payer insurance for all. I would like to apply myself to this and need diretion. Audrey: rfk192868@aol.com

I am a solo, family physician. When I have a patient who has no health insurance and pays their own way I am REQUIRED to charge them the full fee schedule. If I discount their bill all of the insurance companies that are contracted with me can ask for an audit and can require that I REFUND the insurance company whatever has EVER been paid to me by all of the companies over the rate I may have offered one patient, once. Please make it more clear that it ISN’T the doctors who are not being compassionate about the cost. We are REQUIRED to do this.

Health care is the ONLY business in this country where a fee is charged and every consumer (insurance company) pays whatever they want to pay; and those of us providing the system have to say,”Sure, I’ll take 50% or 30% or 70% of my fee for my services.” This is always less than the fee schedule. But individual consumers, without a big company end up UNDERWRITING the cost of providing health care for the insurance companies’ customers. I can’t pay my overhead at the rate some companies pay for my services. It’s only the mix of higher payors and lesser payors that I can make ends meet.

I think the new plan should lead to a single payer like we have in Canada. In an president Obama’s second term he should have a referendum on a single payer system. We still have employer sponsored supplemental insurance for medication, dental etc…. So the private insurers will have role but limited.

How long do we have to suffer the fools who keep yelling “socialism!”, “DMV incompetence!”? All developed nations, as well as many second tier, have had that dread “single payer” system for decades. I haven’t seen any of them crumble. On the contrary, their health statistics are far better than ours while their costs are much lower. This stupid employer-based system is an accident, anyway. After WWII, in order to lure workers, companies included health care along with their salaries. Harry Truman proposed universal coverage in the forties. It was shot down by special interests and Republicans in congress.

How long do the American people have to be hit over the head with disastrous health care before they wake up to the fact that the special interests and right wing ideologues have done us a criminal disservice.

For crying out loud, wake up, American saps!

Why not a system that would give all Americans cradle to grave complete coverage? Give us all the same wonderful coverage that federal employees get, after all they do woek for us and we pay for it.
Greed and fear is what drives capitalist. It is those who are capitalizing on the health industries that will continue to provide the fear of single payer universal coverage. Michael Moore touches on it very well in “Sicko”.

As a Helpline Counselor at a consumer-based health care advocacy organization in Boston, I take calls from folks throughout the state still struggling to understand their health insurance options even after our state’s successful passing of a health reform law that has now covered over 400,000 folks. Every single day I hear from folks that are one illness away from financial ruin or have already fallen into the ugly black hole of medical debt. We can and must do more at a national level to ensure that people are able to lead healthy lives!

Dear Audrey,
Go to “Simple Care” (.org or .com). This is like what you are describing.

How can any elected official say that they represent their constituency and not be for nationalized health care. the real issue in this debate it the poisonous lobbying system which derails our governments interest from the people to private industry and puts our “representatives” in the pocket of insurance and pharmaceutical companies.

I think the members of congress should no longer be covered by the comprehensive plan that the tax payers pay for. Then they can go out to buy their own health insurance, and really experience what they are proposing for the rest of the American citizens. This would be a valuable experiment for the whole country!

Kids 18 – 25 are the highest poverty group in Idaho, if not the US. And they have the least medical coverage. My college attending daughter just lost her coverage due to my divorce, and now as she waits for her college coverage to begin on March 23, she has developed diabetes insipidus. We don’t yet know the cause, but it could be catastrophic – electrolyte imbalance or kidney disease or a tumor on her pituitary gland…
My other daughter at 26 has no insurance. Of course, if she gets sick, the whole family will try to take care of the bills, but it could take us all down.

Four words: “Universal coverage, single payer.”

It’s the only real solution. Anything else is half stepping.

None of the potential problems with such a system come anywhere near the scale and severity of the mess we have now.

Republican and corporate opposition to such plans are often disingenous, as the government does not—as they claim— “run” such programs, it funds them, and they are privately administered.

Health for people, not for profit. Pardon me, but screw the insurance companies. Let them find real work.

Sharpen the pitchforks, join groups supporting single payer, write, protest, demonstrate.

It’s time to make it clear to the politicicans that continuing to oppose single payer/universal coverage will be hazardous to *their* health!

Karen Tumulty said that the private insurers would fight reform and regulation. She may well be wrong. Look at Massachusetts. I have been told the following story by one of Obama’s senior health care advisers. When the private insurers were told by the State of Massachusetts “You will be regulated, you will be required to offer mandated types of policies with no discrimination against pre-existing conditions and a reasonable package of coverages, and there will be no exceptions to these rules,” they went along without objection!

As he put it, they were willing to compete on delivery of real health insurance, when they were required to give up their practice of trying to deny coverage at every turn and trying to insure the only healthy.

I continue to see the absurdity of an employer based health care system if the goal is to cover everyone. Let’s bite the bullet and sever our healthcare from the workplace.

One of the main problems with getting healthcare reform pushed through Congress is that beneficiaries are not those serving in Congress. If a Congressman or Senator was shelling out $20,000 of his own funds every year for medical insurance to cover his family until the end of his life he would see that this is a more immediate need. But he does not have this problem staring at him. Rather, he is covered for life. When you don’t have a problem staring you down it is usually not an immediate need. Maybe Congress would pass an act to take themselves off the dole – but I don’t think this would fly either.

I would like to respond to Roy Blunt’s comparison of a gov’t run insurance company to “taking a number” at the DMV. Am I the only one who has spent hours over the course of months talking both with the provider and the insurance company over a claim? In contrast, one adult member of our family is covered by the Massachusetts Health care system and treatment has been FLAWLESS and effective.

Hello –

Karen has mentioned cost of healthcare during the program. Addressing why costs of procedures, tests, drugs have been allowed to inflate as they have is essential.

I had a CAT scan last fall, I have insurance (COBRA now) so I did not pay for this – the insurance company sent me a statement showing the procedure. The CAT scan cost almost $6,000 – WHY? I was shocked at how expensive this was, at how much the hospital billed the insurance company. Addressing the over-inflated cost of care – inflated because it is a for-profit system – is fundamental to reform. Thank you.

I note that several of the comments (as well as the article itself) point out the wildly disparate charges for the same medical provision based on the insurer (or lack thereof). This of course is only one element of the vast administrative overhead (many people estimate as much as 30%) inherent in our current health care system. Reducing this administrative overhead with a single payer system would I daresay provide much more in the way of savings than the oft-cited hope for savings to be had with adoption of more electronic medical records. (And I say this as a practicing MD and designer of an EMR used in an emergency department and urgent care setting who believes in the EMR). It is very unfortunate that political reality makes a single payer system unrealistic at this time. We need, at the least, a nonprofit low cost plan with some official imprimatur that is untethered to the workplace (portable), as well as some national oversight (similar to Great Britain’s NHS) that provides guidelines about which heath care interventions are actually of benefit.

re: “standing in line”

When americans complain that in “socialist” systems, you have to wait forever for surgeries, I think they over look the reason why they don’t have to wait in the US:
People who need surgery are not getting it!

once you actually help everyone who needs help, the lines will get longer, but at least sick people get healthy. And um,, isn’t that sort of what it’s supposed to be about?

followup comment: my experience “negotiating” and chasing down payment has been through private insurance companies while the experience our family has had through MA Commonwealth health has required NO administrative follow-up.

When you have employer sponsored insurance you can’t rely on it. I was in HR in a company in Utah and a young employee, earning about $12/hr, had purchased our best most expensive insurance plan. When his baby was born with serious medical problems, as the bills mounted, our HR manager changed the plan mid-year to lower the limit for all plan members, effectively cutting off the baby. This is completely legal in Utah. After we excluded the baby, I, as a benefits administrator, took it upon myself to help the family find public assistance.

I might mention that since I retired before reaching Medicare age and was unable to buy coverage at under $800/month, I’ve gone back to school and have student health insurance.

Watch Frontline’s “Sick Around the World” for a serious and eye-opening comparison of health care systems in other free market democracies. Everyone of them does it better than the US and has so for decades.

In 2000 my husband had heart by-pass surgery which was covered by private insurance. The review sent to us by the insurance company indicated that the charges were $83,000+ which was reduced to $13,000+ which the insurance company paid; we paid nothing. This is when I really figured out what what Ms. Tumulty is finally writing about. If we had not had insurance, we would have paid $83,000+ — what extremely poor people without insurance would have been billed. I’m glad this travesty is finally being discussed openly.

My husband retired and was on medicare when he was being treated for cancer last year. I found that medicare was clear, straight-forward and easy to access. My husband never was not treated immediately because he was on medicare. I think all the comments about “government run” are false myths put forward by people who have no experience with the system or are simply prejudiced. Government has been open and honest in telling us what he could/could not have and, as far as the patient is concerned, efficient.

I’ve waited longer at a doctor’s office when I was under private insurance than I ever did at the DMV. The public is subjected way too much to false statements by prejudiced people. We need to start revealing the lies as lies. Thanks to all the people above who are countering the lies.

My concern with single payer is that a lot of people would lose their jobs. I am a medical biller for a large clinic in Boston and I work specifically on claims that have different criteria per payer. If not for job loss then yes, definitely single payer.

>>I don’t understand why Americans would not want a Canadian style health care system.

Agreed! The last caller hits the nail on the head – for-profit medicine just makes no sense. People want single payer. Bought-and-paid-for politicians don’t.

I find the argument against allowing the government to OFFER an ALTERNATIVE to the private sector to be completely false.

Obama is not offering to REPLACE employer based insurance which is provided privately, but is merely offering to have government COMPETE with the private sector in providing national health care for those who do not have coverage.

Is the private sector AFRAID that those who are given such an option will find it PREFERABLE and SUPERIOR to what is already offered.

The argument of the political right is that government health care would be completely INFERIOR to what is now offered by the private sector. If this is the case, Obama’s experiment will fail, as only those who do not have access to the better alternative they claim exists in the private sector will select it, OR if the government insurance is found to be BETTER than that which is offered by the private sector, then in order to remain competitive, the private sector will have improve its product to compete.

The political right rails against government programs, but also prevents government agencies from FREELY COMPETING with the private sector.

After all, an example of this already exists. We have a GOVERNMENT Postal Service, but this has not put The United Parcel Service and other private delivery companies out of business. The lines at the Post Office are no longer than those at UPS or DHL if you use any of these services to send packages.

After years of sending packages, I finally selected the U.S. Post office for all my business, because in the end, I found the GOVERNMENT RUN Postal Service superior to any other delivery service, at least for MY purposes.

I think the real fear the political right has is not that the government service will be inferior, but more efficient and better than private health insurance is,for many, just as the Postal Service is the choice of many.

The argument against what Obama is offering, to have government COMPETE with the private sector, is the best way to prove once and for all, which method of providing health care in the United States is superior.

Could I refer everyone to a very wise article by Atul Gawande in “The New Yorker,” for January 26, 2009? http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande.
The burden of the article is that the end result of health insurance reform in almost every industrial country was heavily influenced, maybe completely determined, by the situation at the start of the reform process. Our mixed system today will probably lead to a mixed reformed system tomorrow.
Now let’s push forward, trying to remember that the perfect is the enemy of the good!

Thanks to Karen for writing the article and giving a compelling personal face to this national disgrace.

Thanks also to the caller – I didn’t catch his name – with the disabled daughter who has never been eligible for health insurance. He made the points I’d make – as a former UK resident and long-time user of the National Health Service there.

Free markets don’t work in health care.

For-profit systems make money by EXCLUDING sick people and DENYING health care.

Politicians of both parties are deeply indebted to groups with vested interests in keeping the present cruel, inefficient, expensive and unjust system in place.

To everyone out there who wants to see this mess cleared up – and that must be most of us – I say: Don’t give up on the vision of universal coverage provided by some kind of national insurance. Tinkering round the edges of the present system is not going to deliver the kind of change we need.

It’s frankly depressing to hear from your guests that the single payer option is not even on the table. But at least two representatives of Physicians for a National Health Program (PNHP) were admitted to last week’s Health Care summit at the White House, thanks to intense last-minute lobbying.

PNHP, founded in 1987, is a network of physicians, health professionals and other supporters of single payer national health insurance. For information, see their website: http://www.pnhp.org. Then watch Michael Moore’s “Sicko” to remind you why we need radical reform.

“Of all the forms of inequality, injustice in health care is the most shocking and most inhuman.” Rev. Martin Luther King, Jr.

The show suggests that rapidly rising cost of healthcare was a major reason to develop a national healthcare system. However, the propaganda did not address why costs of procedures, tests, drugs have inflated. In case you were not aware, the major reason for the increase cost of healthcare is primarily the skyrocketing costs of medical malpractice litigation in the United States. Litigation costs have steadily increased at almost 12 percent annually along with malpractice insurance costs. Medical care providers must pass this increased cost back to the patient. In addition, medical care providers must subject patients to tests and procedures, often unnecessary, in anticipation of possible later malpractice questions. If this country truly wants to lower health care costs let’s work to eliminate meritless lawsuits which clog up the courts, increase health care costs and cause our physicians to practice defensive medicine. I’m sorry if this would reduce the earning power of plaintiff lawyers. This issue seems to being purposely omitted from the national conversation on the healthcare system.

It is a disgrace that people pay for coverage that disappears when they get ill. Problems are compounded by individual states’ so-called “insurance laws”. No “insurance laws” govern HMO’s or self-insured corporations. The hodge podge of rules, regulations, covered and uncovered medical bills, has sick people developing mental problems just trying to negotiate this land mine, worried about losing their homes, their life savings, etc. Enough. Single payer or bust.

I would like to comment on the “cost containment” aspect of health care not the various delivery models.
Transformation of a business always begins with the cost model.
Most discussions of health care do not address the business model: HEALTH CARE DOES NOT OPERATE ON A MARKET
DRIVEN COMPETITIVE MODEL. Health care providers differentiate themselves through superficial differences (beauty contests) i.e. new facilities, more facilities, broader range of offerings, outstanding doctors/staff, attractively decorated rooms, but never through quantified cost and quality comparatives. In the current environment, lacking competitive forces based on cost and quality, the present health care cost paradigm offers little incentive for cost reduction and is actually biased toward cost increase. Not only is the high cost provider not pressured to adjust pricing toward that of the low cost provider, but the low cost provider all too often responds to the market by increasing his pricing to match the competition, the high cost provider. This paradigm also allows providers to expend large sums of capital for equipment and services, however redundant and destined for only partial utilization, because the costs can so easily be passed on to payors. The current health care system rewards, not punishes, poor investment plans. We have huge excess health care capacity in this country. This is one of the reasons that high technology investment does not produce cost savings.

Access to comparative data on provider cost and quality is essential to sound health care decision making by government and corporate plan evaluators as well as consumers. Assessment of this data is currently impossible because such data is not available. A purchaser-driven model is a remedy for this shortcoming in our health care sourcing. Under such a model, the major purchasers of health care, government, corporations and health insurance companies would demand from health care providers the development of a compatible/comparable set of metrics upon which sound sourcing could be achieved. Behind this simple statement is full recognition that the development of meaningful metrics in health care is a monumental task. It can be done and it must be done to accomplish the containment of health care costs, possibly the most essential ingredient of successful health care reform.

We will not have containment of health care costs until every evaluator of health care and every user of health care has the potential of answering these two critical questions:

(1) What is the relative quality of care of a particular provider when compared to that of other providers offering the same services in the community?

(2) What are the costs of this provider when compared to those of other providers offering the same services to the community?

If you would like to discuss this and would like to include these concepts in a future program, I would enjoy being a participant.

RE: The problems with Massachusetts “model”
I become alarmed when I hear people recommend the Massachusetts approach as a model for a new national health care policy. It may look good on paper, allowing goverment officials to say that nearly everyone is covered, but in fact, the Massachusetts plan has done NOTHING to contain costs. I’m a freelancer who pays 100 percent of my insurance coverage, and since this plan was put in place, the cost of my coverage has risen so much that I’ve been forced to downgrade my coverage. Now my deductibles are so high that I won’t be able to afford preventative care. My monthly payments are as much as a mortgage payment. Moreover, there seems to be no provision for independent contractors, whose income fluctuates, who may be unable to find work for several months at a time, and who aren’t even eligible for unemployment insurance.

Thank you for continuing to explore the real issues underlying health care problems. As a consumer, uninsured-by-choice single parent, and self-employed provider of health care services, I have seen and heard enough; there is no way I will do business with the smarmy, crooked insurance industry as it is today. Insurance companies and Big Pharma have the medical industry completely in their pocket, and most of the policies of medical industry encourage this “Triangle of Disease and Death”. They keep us sick and they keep us paying, so they have no incentive to change until we demand a change.

Yes medical care and technology (especially imaging technology and emergency care) are amazing and life-saving, and my hat’s off to the individuals who study medicine and nursing, and do the real research that makes these technologies possible. But, due to the wheeling and dealing between medical industry’s big players, the delivery of care is incomplete for most patients.

Too often, pharmaceutical companies and conventional medical education misrepresent and discredit the wide variety of non-medical treatments and manual therapies available to consumers. In truth, these many therapies can help relieve pain and restore function for a significant number of ill or injured people. (There is also a great deal of peer-reviewed research every year that validates these therapies.) Of course every person is different and there is no guarantee of results from *any* treatment, surgical or otherwise; but overall, we in the integrative care/complementary therapies field see noticeable improvement in our clients, who report varied and often surprisingly positive results we could not have predicted.

These complementary therapies are not just pleasant and relieving, they are more cost-efficient, in many cases, than medical-only approaches. And even for those who really do need surgery, complementary care pre- and post-surgery can improve outcomes and reduce recovery times and drug use. For example, a few thousand dollars worth of structural integration, craniosacral therapy, and chiropractic, in combination, can (to some degree) relieve the pain and misalignment (yes, skeletal alignment can change) of conditions like scoliosis, chronic migraines, sciatica, etc. (My own scoliosis is gone, after just such a protocol.) This is much less expensive, much less risky, and much more satisfying for the client than medical interventions like surgery and drugs. Also, the client doesn’t have to miss a lot of work for this type of approach, as opposed to the long intense recovery required for, say, spinal surgery.

When you need surgery, there is no substitute for a well-trained, well-equipped surgeon, of course. When you really need pain meds, you *really* need them, and we are lucky to have that choice also. But there is an expanding field of less invasive and less expensive options, appropriate for some conditions. Our health care reform must include these cost-saving health-promoting choices, as well as a NON-PROFIT organizational structure. The government shouldn’t have to fund it, just require it to be ethically and efficiently run, with the well-being of the patient as the top priority. There is no room for profit in the field of health care. Fair wages, good salaries, rewards for expensive education, yes – there is room for these considerations, but NOT for huge profits skimmed off the top of people’s experiences of disease and disability.

As for insurance itself: Some day, I hope, I will purchase catastrophic medical insurance from a company that offers me the same deal my life insurance provider offered. The healthier I am, the lower my premium. The better I manage my own health, paying out of pocket for whatever therapies work for me, the less risk I present to my insurer, so they should cheerfully share the benefit with me (based on an annual complete checkup, bloodwork, stress test, etc. – measures of genuine health and resistance to disease – I’ll happily pay for the checkup).

A non-profit insurance company that will completely cover catastrophic costs, and keep premiums low by putting the responsibility for health maintenance on the individual, and evaluate the individual regularly, will be more cost-effective for the company and less expensive to the individual. It might take a generation to get *all* people on board with this level of responsibility, but I believe many would welcome this change immediately. Those of us who already invest in our own health care based on what works (and on what will keep us working), can really appreciate the honesty and efficiency of this model of health care.

Please continue to bring us in-depth discussions about the real issues of health care: cost-effectiveness, competition and complementary care, genuine wellness care, and the deep and tangled web of dishonest dealings in the pharmaceutical and insurance industries.

Thank you all for your comments. This has been a very enlightening discussion, which I look forward to continuing as the national health care debate moves forward.

I am an economist, and have looked into the economics of health care. The main reason health care is so expensive, is that since there is a third party payer, the patient does not compare costs. Why should they, they do not have to pay it (in theory). That is why you get very diverse prices for the same thing. Obama’s plan (while I applaude any attempt) will not change that.

Robert Lebow, M.D. and C. Rocky White, M.D. in their book Health Care Meltdown: Confronting The Myths and Fixing Our Failing System advocate for systemic changes, one of which would be to create a single risk pool vs. the controversial single payer concept. This would address universal coverage AND take some of the gamemanship out of what and who are covered. It’s an informative read.

Re: Mitchell Harwitz

Your take on MA programs is overly optimistic. While some progress has been made on getting people insurance, the utility of that insurance is not great for those who make too much to qualify for subsidized care (ie MassHealth). And private insurers are certainly still making money by denying care and making patients and doctors spend hours on the phone arguing about claims and payments.

Karen Tumulty mistakenly stated that the hospital bill her brother received was the “retail cost”. The truth is the insurance companies and the hospitals negotiate a contract for how much each procedure will be reimbursed by the insurance policy. Hospitals are forced to negotiate overinflated charges (400-600%)in order to secure better reimbursements from the insurance companies…reimbursements more in line with their actual costs and a profit. Nationally, it’s about 10% to 30% over actual cost. Because of stipulations in the contract, the hospital is obligated to bill patients the inflated charges used during negotiations, or the contract is null. Insurance companies benefit from these inflated hospital bills because they generate enough fear in the consumer that we are willing to pay the high cost of insurance premiums.
For example, in Ventura County, the average Medicare 2006 hospital payment for “open heart surgery with complication” was between $32,673 and $34,931. This is less than the hospital would have liked from Medicare, but it is a reasonable example of how much this procedure costs. The hospital’s bill to you for this same procedure would be closer to $250,000. In turn, under the contract with the hospital, your insurance with your co-pay would end up paying something closer to $36,000. The hospital is happy and makes a profit. The insurance company receives heartfelt thanks and continued premiums from the patent. Pity the person that does not have insurance, he’s obligated to pay the full inflated amount.
This problem of lack of transparency, and an industry based on smoke and mirrors to manipulate their customers (the insured), is no different then an old-fashion snake-oil scam.

A lot of it is about marketing the reform. If our government deployed half of the energy and resources it used to push its Iraq adventure the health care would have a good chance for being adopted.

This is the law:
Connector Board job description-

“The exercise by the authority of the powers conferred by this chapter shall be considered to be the performance of an essential public function. The purpose of the authority is to implement the commonwealth health insurance connector, the purpose of which is to facilitate the availability, choice and adoption of PRIVATE HEALTH INSURANCE PLANS to eligible individuals and groups…” – http://www.mass.gov/legis/laws/mgl/176q-2.htm – General Laws of Massachusetts –

Connector ADMINISTRATIVE budget = over $39 million for 2009. How many people could see a doctor for that amount of money alone?

Bobbie you’ll have to be kidding. Your being selfish.
So by your figuring, because you’ll lose your job as medical administrator. Well if you have skills that are needed you’ll find a new job, if not you wont.

I don’t care about the people who work for insurance companies. The system stinks, period. We pay far to much for to little care.

re: Mitchell Harwitz,

The Massachusetts model has been teetering on the brink of financial disaster since its very inception. It is far less than universal, has done nothing to lower the cost of care, and has not improved the quality of treatment. The primary beneficiaries of the MA model have been the health insurers and some large clinical systems (i.e. Partners Healthcare). The Bay State experiment is prohibitively expensive, highly inefficient, and mandates everyone into a wasteful expansion of the status quo. We can do far better; most of the world already has.

Thanks, Ron, Beth, and Maryann, for sharing the sorry details of the MA Plan that boils down to mandated purchase of private insurance under threat of tax penalties.

As a Mass. resident and a health professional in MA I am furious beyond words about the fake reform foisted upon MA residents, and that this example is being held out to the nation.

Readers and journalists such as Karen Tumulty and TOm Ashbrook should know that one of MA state senators rose to the occasion and shared the truth about the MA Plan with members of Congress and other attendees of the 2/25/09 Congressional Briefing on the MA Plan recently. Too bad there was a main stream media blackout on the event. Excerpts from Senator Eldridge’s testimony follow.

James B. Eldridge, STATE SENATOR, MIDDLESEX & WORCESTER DISTRICT STATE HOUSE, ROOM 213A, BOSTON, 02133-1054, TEL. (617) 722-1120, FAX (617) 722-1089, email James.Eldridge@state.ma.us

Massachusetts Health Care Reform: Not a Model for the Nation

Testimony of Senator Jamie Eldridge (D-Acton)

“… 3) Greater Costs to Cities and Towns:

Many cities and towns in Massachusetts are being driven to bankruptcy because of rising costs for public employees’ and retirees’ health insurance. As a result, cities and towns are having to either cut back benefits or make other service cuts, affecting every resident who uses public services. Public employees, who generally earn a more modest income compared to their private sector colleagues, are increasingly being targeted by local elected officials to be the victims of a “death by a thousand cuts.”

4) No Help for Small Businesses:

Another hope for health care reform was that, as the costs of health insurance went down, small businesses would have an easier time insuring their workers. Health care costs have gone up, not down, however – which means the law has provided no relief to small businesses that would like to insure their workers, but can’t afford to.

How Did We Get There?

As a legislator, I had the opportunity to closely observe the process the legislature went through to create the health care reform bill – and I’m of the opinion that the many flaws of the process led to the many flaws in the legislation.

1. The major impetus for creating the health reform legislation came from the actions of the Bush Administration – which insisted that Massachusetts reduce the block funding of indigent care through our free care pool, or forfeit $385 million in federal Medicaid funds.

This had both positive and negative effects. Because there was a deadline attached, we got something done. But it also meant that the process was driven almost entirely by the need to keep those federal dollars, instead of a broader discussion about what universal health care as state legislation should really look like.

It also meant that the initial focus was on reducing the number of people getting free care – rather than on improving health care access for all. This was enforced by local media coverage, which focused on health care as an individual, rather than collective, responsibility. A single-payer system, or any notion of health care as a human right, was taken off the table — thus limiting the options for expanding access from the very start. A debate that could have started comparing health care as a right, just like public education, which Massachusetts history had a deep connection to, instead allowed a Republican governor preparing to run for President to trumpet the deeply cynical notion of “personal responsibility” as a component of health care reform.

2. Giving certain groups a seat at the table greatly hurt efforts to include several key elements in the bill. For example, because health insurance companies had such a large voice in the crafting of the reform, efforts to control the costs of health insurance premiums were eliminated. The question should have been, “what would be best for the people of Massachusetts?” Instead, there was a general sense during the year-long debate that whatever health care reform the Legislature proposed, it couldn’t be something that upset the health insurance industry. In addition, the health care industry’s significant involvement in crafting the Massachusetts health care law virtually guaranteed that when it came to controlling health care costs, the government was willing to cede that control to HMOs.
3. The fact that the Massachusetts health care discussion never strayed from the notion of being employer-based meant that it was very easy for the big business community to attack plans to fund a more universal health care model. As a result, even when proposals came up to increase the amount that employers who did not provide health insurance had to pay, they were immediately squelched by these business leaders. As a result, the penalty to companies that don’t provide insurance is a miniscule $295/employee – far, far less than they would have to pay in insurance premiums. This mindset kept the media focused on the notion that health care was a mere employee benefit, as opposed to a basic human right.

As Congress turns its attention to health care reform, I urge you to consider the lessons we’ve learned in Massachusetts – particularly when it comes to the process involved in creating the reform and which groups have that all-important “seat at the table.”

As someone who has long advocated for universal health care, I had hoped the Massachusetts model would prove to be a success, even as I had concerns about the process. But after observing the effects the law has had, I strongly urge you not to adopt the Massachusetts model on a national scale.” [end]

news that mec is creating a mearger, one the biggest in a long time, who also has and getting a bigger hand in health care now, remember this for when we get these health care HMO and Pharmacy companies that become to big to fail.

Just look at mass. health system, no matter what u make even if u have other bills, laid off, they have a set amount on what u should have to atleast pay for it, and will fine u for not.

I wonder what cobra profit margins currently are, along with the health companies in mass that lobbied and are doing so for other states to get a nice piece of the pie at our expense, along with nurses, doctors. and know that u have no choice. even when u get that health care u cant use it cause it covers nothing and high co-pays.

please tell me that if anyone seen the pills adverts on tv about helping a headache, running nose, sleep, etc, but can cause gain green, blood couts, thin blood, blindness,
I saw even one that helped with depression, but than stated at the end if u are having suicidal thoughts please stop taking it.

I just wish the rest of the county does not follow in mass health care system. even higher cost now, with plans that dont allow u to even use it but just to have to pay.

The question is what kind of country do we want?
This will not happen as long as there are the Roy Blunts taking money from the insurance companies and from all the other special interest.

To say it’s to expensive and who should pay for this is a non stater. The McCain plan is complete BS, and it’s a joke. We sit around blabbing and doing nothing.

You need more money, how about reducing waste in military spending.

It’s all very well for the Roy Blunts to make false comments when he and his family have national health care.

Thank you for this excellent program on health care.
I have a heriditary kidney disease and have, with the help of good insurance, experienced dialysis and a transplant. I have a child in his mid-thirties who has been diagnosed with this disease (PKD) but is still healthy. He is an artist who has not been able to afford health insurance, so out of profound fear for him, I have paid for minimal catastrophic private insurance for the last 16 years. What I hear from you on this program is that these 16 years of payments may do nothing for my child, should he develop the disease. I am so very worried.

What I have learned after being covered by United Healthcare is that the most important thing is to follow the money when it comes to health-care. There were so many problems with United Healthcare, that I went online to research them. I learned about their former CEO, William McGuire who not only received $124 million in 2005 as compensation, but also received $1.6 billion(yes you read that correctly) in stock options, and something like $1 billion in a golden parachute. All the health insurance companies have a big vested financial interest in keeping the system as it is, so the media need to begin to really follow the money not only with insurance companies, but also with hospitals and other medical providers.

I was listening to your program on the new proposed National Health Care system and the negative comments by Roy Blunt. I live in Columbia, Missouri and have had to suffer under Roys’ son Matt as our govenor for the last 4 years. Thank God he has been voted out because he wasd the worst governor in memory. We are now working to rid ourselves of Roy and his opinion( bought and paid for by the medical insurance HMO’s) and hope the Democrats will do what they promised and vote in a medicare program for everyone. Thanks for your program and your station. I listen every night on my computer.

To understand why we need universal health care we need to agree that “insurance company” is a misnomer. The companies we refer to with that expression are risk-avoidance mechanisms that only want your business if they can make money on you. The only way health insurance can continue in the United States is if the pool includes everyone, I mean EVERYONE, so the risk is spread universally. That means the well subsidize the sick, and sharing that responsibility is what being a nation is about.

The US doesn’t have a health care system. It has a sickness management system. It doesn’t cure. It feeds on chronic illness. It’s designed on a predatory model with all incentives serving to keep people sick, create more, and enrich certain groups at their expense. If one’s interest is in health, focusing on how to pay for what we have is pointless. It isn’t worth paying for.

This is so much hogwash about the DMV and the IRS. What about the VA? I was under the impression that until the Bush Administration screwed things up, the VA Hospital system was the finest in the world.

Charles Miller
Brooklyn, NY

As a pro-lifer, I see the traces of abortion here also: if we hadn’t aborted fifty million human beings, there would be plenty of health people buying health care insurance to pay for our elderly. The disaster in the system could have been predicted.

I believe more and more insurance companies will go the way of United Healthcare. One of the ways that United Healthcare makes money is by having no in-network providers of a certain type in the network. For instance, I needed a cystoscopy which is a very routine urological outpatient procedure to look inside the bladder. ALL the urologists in the medium sized town where I lived used an outpatient facility next door to their offices in order to do cystoscopies. But this facility was not contracted with Unitedhealthcare and I am guessing because UHC pays so poorly and is such a hassle to its providers. So in order to have a cystoscopy in my town, I would have to pay hundreds of dollars because the ONLY facility in town was out-of-network. My husband recently went to his doctor who removed a small growth and sent it to the main pathology lab in our town. This lab was also not contracted with UHC and so we are now having to pay the bill as out-of-network. So this is how the insurance companies make their money, by not having contracts with important providers of services in your area which means the consumer has to pay these costs because they are out-of-network. Unless the public somehow puts a stop to it, this is the wave of the future. You think you have good coverage, you pay a fortune for your insurance, but when you actually go to use it, you end up paying bills that you should not have to pay. My advice is to stay away like the plague from United Healthcare.

I recently switched insurances and now have Regence healthcare. I tried to read through through their booklet in order to educate myself about what they cover and what don’t cover and what my benefits are. I am educated and intelligent, but their policy is so complicated, so many twists and turns and exclusions, it is very hard to grasp. The whole medical insurance thing is way too complicated for the average consumer. The consumer has no idea really what they are paying for. One last thing. I require a small amount of sleep medication in order to be able to sleep at night. When I went to the pharmacy to get my prescription filled, I was told that Regence only pays for 14 days out of every 29 days. I guess I am not supposed the sleep on the other nights. The pharmacist told me that lots of insurance companies do the same. They will pay for only 1/2 months prescription even though prescription coverage is part of your benefits.

I have more than one friend that has a good salary, but refuses to buy medical insurance. Too many people just refuse to buy a basic medical policy and think it’s “the other guys” problem.

david re: your “other guys problem” is a favorite argument by scapegoaters who try to claim the “uninsured” are responsible for our souring health care costs. However, despite all those anecdotes about unpaid emergency room bills, the big money driving health care inflation is from insured patients especially medicare and medicaid. When a patient doesn’t see what it costs to treat him he consumes more.

Surely you heard and read about the much higher retail price charged uninsured patients “health care providers”. $7000 for $900 worth of lab tests?

Last summer politicians were calling for windfall taxes on oil companies when oil approached $200 per barrel. Meanwhile the standard policy for health care providers IS gouging.

Before we continue the scapegoating of uninsured taxpayers ala Massachusetts how about we put in place a policy that a hospital cannot charge an uninsured patient any more than the lowest or highest or average (pick your number) insurance payment for a service.

I woke up this morning still thinking Karen Tumult’s surprise by her findings about the reality of health insurance (or lack thereof). She claimed to be “sophisticated” about the topic. It was just another example of how lazy journalists have become. Or is it that when it comes to most of the crisis topics e.g. finance, housing, healthcare reporters cannot put aside their assumptions and biases about the “great” American system and the supremacy of the private sector? Besides, all Karen had to do is watch “Sicko” and much of her surprise would have been muted.

REALITY CHECK:
1) Insurance companies need doctors and hospitals, they want them to be profitable. Without them, why would we buy health insurance from them.

2) Insurance companies reimburse doctors and hospital at a realistic rate for their services. The majority of doctors and hospitals income come from insurance and medicare, and they still make a profit.

3) The rate you are charged by your doctor or hospital does not represent the real cost of healthcare, but is the inflated rate used in negotiating their contracts with the insurance companies.

4) Hospital and doctors have to bill their patients at the inflated rate used in the negotiations or they will be penalized by the insurance company.

5) Individuals without insurance have to be charged the the inflated rate or insurance companies will penalize the healthcare provider.

6) We have a 2 tie pricing system. One, is designed to keep the American public in fear of being without insurance. The other, is the realistic reimbursement for the actual cost of healthcare.

7) If everyone was charged the actual cost for their healthcare. Most people would not need the insurance they now have, but only a supplemental insurance for catastrophic health events.

The money saved by making healthcare providers charge the real cost for their services, which would eliminate the need for full coverage health insurance, would save Americans billions every year.

Universal health care is a terrible solution. Giving the government greater control of health care is putting a corrupt bloated bureaucracy, with a hundred conflicting agendas in charge of one of largest parts of our economy. It will result in higher costs, politically based decisions and another huge drain on taxpayers.

But I don’t know of a better solution.

“Universal Healthcare” is, by itself, a meaningless phrase. Please educate yourself and then fight for what you believe we need. A huge fight is brewing. It pits healthcare for people (represented by a public insurance option in a national reform bill) against healthcare for profit (mostly a continuation of the status quo). Which side are you on?

Learn more and then take action at http://www.insurancecompanyrules.org

I was born and lived in India and Ireland, in India one can get easily a CABG done under 5 grand and in Ireland its free however if you want to get Private Care you can easily with the help of Insuarance.

But NOWHERE else, I have seen a person being charged 900 USD on top of the Insurance Coverage for a Doctor’s Visit for a small neck pain (by the way, that went away just by sleeping on the right pillow)!!!

This is nothing but ROBBERY!!

I just heard the podcast of this show.
I was interested in what Roy Blunt said about comparing a single payer system to a trip to the Department of Motor Vehicles.
Having lived in Missouri for the last 27+ years I can say without a doubt that trips to the DMV have gotten worse the last couple of years.
Amazing enough it got a lot worse after the previous Matt Blunt, Roy’s son, privatized all the DMV offices and auctioned them off to what I assume were his political supporters.

To Mark @

>Universal health care is a terrible solution. Giving >the government greater control of health care is >putting a corrupt bloated bureaucracy, with a hundred >conflicting agendas in charge of one of largest parts >of our economy. It will result in higher costs, >politically based decisions and another huge drain on >taxpayers.

Do you work as a CEO for any of the Health Insurance companies sir?

If the US Govt is not the best, then why is the USPS, US Air Force, DoD, US Army, US Navy, DHS, USCIS etc are the best in the World???

Let’s face it, Health Care is expensive and the price just keeps going up. Even with some type of discount already in place through PPOs or discount cards, members often remain unable to pay the balance. Worst case scenario, the member seeks medical care outside of the discount network and is faced with undiscounted charges with no support, no assistance and mounting dept.
A little over a year ago I saw a growing need to help individuals with their medical debt. My company Independent Health Care Advisors works with HealthCare Mediation’s for the sole purpose of helping individuals with their medical debt. So until a system is in place to ensure individuals customary and reasonable charges, contact my company and we can negotiate your medical bills.

Denny – great info on Missouri DMVs.

Not sure which is worse, Roy Blunt’s distortions and lies about single-payer, or his hypocrisy given that belongs to the best health insurance plan in the country.

As the spouse of someone with a chronic illness I am very fearful of what the future holds for us. Even though we live frugally and have good incomes I’m afraid will get dragged into debt by medical expenses. I hope there is universal coverage in the US soon.