Tuesday, July 03, 2007

Dem Health: Dictated by Big Labor

If there is ANY health-plan initiative which Big Labor hates, it is the Health Savings Account.

That animus explains DarthDoyle's refusal to tax-preference HSAs in Wisconsin.

Most likely it also explains Nurse Judy's failure to include them in the health-care red herring she rammed into the State Budget.

Torinus saw that quickly:

...The Senate Democrats based their proposal on the conceptual work of David Riemer, the intellectual who was instrumental in getting the City of Milwaukee and Employee Trust Fund (ETF) to adopt what's called "managed competition," in which public employees individually choose between several health plans.

...The only way costs will ever be controlled in any plan is to engage every American adult as a proactive consumer and proactive patient. Riemer knows that. He had built a high deductible and co-insurance into his original model, offset by a health saving account [HSA]. That put incentives into place for individuals to take control and responsibility for their own health and health spending.

Unfortunately and fatally, the Democrats scrapped that part of Riemer's model.

The other big flaw Torinus spotted was the huge difference in cost/employee between the State employee plan and well-managed private plans--and it is huge--about $3-4K/employee/year.

HT: Charlie


M.Z. Forrest said...

I think we are still awaiting to see if health outcomes (the purpose of healthcare, not cost) are improved under HSA's. The evidence so far seems to suggest that the cost transfer to the employee is decreasing expenditures across the board rather than for discretionary items. In short, we have a cheaper but not wiser consumer. How sustainable this is in the long run is an open question.

I'm not completely convinced of any solution yet, but my own feeling is that HSA are probably not part of the solution.

Dad29 said...

I think that the "purpose" you postulate is seriously flawed.

For if we embark on a path which promises (e.g.) to provide excellent teeth to someone who is 80+ years old, it's $20K or so in a VERY short-term investment.

The difficulty here is simple: one cannot define "adequate" health care so long as the standard is 'extension of life.'

People do not make rational decisions in some circumstances...and this will be costly.

I know someone who was diagnosed with a terminal condition, albeit that he would have 4-5 years to go before he died from the condition.

The fellow was 76 when it was diagnosed. He asked the doc what the costs were (near $75K,) and turned down the remedial procedure, based on the fact that he would not go much further than 80 under ANY circumstances, surgery or no.

His wife would have decided differently, had she the power of attorney.

But tell me: which decision would have been best?

Remember that God has something to say about life and death. I'm not advocating the Christian Science position here--but some questions are NOT answered best by the State, whether they save money or spend it.

Dad29 said...

By the way, the fellow who turned down the procedure died of a heart attack (not related to the condition) at age 78.

M.Z. Forrest said...

Certainly I have no issue with the gentleman refusing treatment. My concern with State healthcare isn't with the elderly. For better or worse, they are already covered by the State.

My concern more lies with such things as infant mortality and cancer in the sub 40 and sub 50 population. Cancer is very treatable and relatively inexpensive if detected early. A discerning consumer would receive a mamogram yearly starting at a certain age. The key of course is that the consumer must be discerning. If a consumer simply refuses the mamogram, the cost in the long run to society may and probably will be significantly higher. Even under HDHP, there will not be signficant differentiation for the patient finance wise if they start cancer treatment in state 1 versus stage 4.

In the end, dividing the problem may be the better solution. For example:
Immunization - This is pretty much covered by the State presently, and I don't think there is much debate over whether this should be covered.
Epidemiology - This is often covered by the State due to this commonly occuring past age 65. Be it cancer or heart disease, this puts real strain on the system.
Acute Care - This is often covered privately. Broken legs, emergency rooms, and such. This part of the system is seeing extreme stress in the inner cities. It is one of the few areas mandated by law that treatment must be given.
Palliative Care - This is almost universally paid for by government.
Wellness and Diagnostic care - This is covered typically by the private sector for those under 65. This is where a lot of the 'savings' for HDHP are coming. This is where we have a ridiculous amount of specialization. This is an area that has become largely inaccessible to the poor.

Anonymous said...

HSAs will help in the long-run in many ways.

Individuals build up large amounts of savings if they start young and then the money can be used to offset higher costs as they get older.

There is a more delicate balance in older age groups - say after 50, but that doesn't negate the benefits of the approach moving forward.

This is the mistake of the critics.

We have to transition to an understanding that health insurance as it is used today, is not insurance at all for most people most of the time. Rather it is simply prepaid care.

HSAs repair that understanding.