Saturday, October 3, 2009

Health care: Empty arguments

Last week at a birthday dinner, I was talking health care reform with a newly licensed Physician's Assistant who works at a clinic where most of the patients are on Medi-Cal or Medicare. She has some stories to tell, mostly of client abuse of the system. We were having a nice talk...

Unfortunately for me, there were others at the table. I don't mind a good discussion, but I dislike empty arguments. I especially dislike arguments that are not well researched.

To make matters worse, the dissenter was militant and offensive.

I don't know whether he listened to me or not, but I suspect not.

I, on the other hand, mulled a bit over his comments. Here's the gist of them:

1) My premiums go up every year.
2) What is covered is less every year.
3) Insurance companies add no value.
4) Insurance companies are profiteers, gouging the populace.

As I mentioned in my last post... I research things. I even research the militant spoutings of those who don't listen.

Here's what I found:

1) Premiums are generally going up for health insurance: costs are rising.
2) In order to keep costs from rising even faster, insurance companies look for ways to reduce risk. One way is not insure it. The insurance companies work with their clients, especially the large ones, like the California teachers program (CalPers) to achieve an affordable trade-off. CalPers understands risk management.
3) This argument is just silly. It demonstrates a lack of understanding about the nature of what insurance is: pooled risk. My health insurance company negotiates with doctors and other health care providers over price per procedure. My wife recently had some routine work done that was billed at $500. The insurance company disallowed $185 in charges. My wife had a $20 co-pay. That's something.

Once upon-a-time, I was charged about $200,000 for a month-long stay in the hospital for a family member. The charges with the three surgeries pushed the figure up to $250,000ish. Because I was in a risk pool: I had insurance... the out-of-pocket limit was $3,500. Whew. (One of the reasons I had insurance was because I didn't change jobs for seven years. Why? Because I knew that insurance companies generally don't cover pre-exisiting conditions. I knew what the rules were, and I stayed in the pool.

I've discovered that insurance companies do things: they negotiate prices, they screen practitioners, and they provide a cushion against catastrophic expense.

4) Are insurance companies gouging consumers? I didn't know, so I did some research. I googled things. I found out that insurance companies profit margins are ranked 87th. (See the link to CNN Money.)One of California's largest insurance companies is Kaiser: a non-profit corporation.

I don't pretend to know-it-all, but at least I've done some digging. I've looked at what various experts say, and I've looked at their biases.

Is there a problem: yes, health care costs are rising.

But I'm not convinced that more government involvement is the solution. I think the government has a role, and they are playing it. However, most decisions about wellness, quality of life, fitness, nutrition, and health risks are personal.

Life is risky. There are financial risks, health risks, emotional risks, and even spiritual risks. What's a person to do?

Me? I'm doing the best I can by actively participating in life. I ponder the problems. I muse. Then, I do the best I can. I readjust as necessary as I navigate through life towards the goals I've set. I enjoy the journey and weather the storms.

And I try not to offer empty arguments.


  1. Thanks for the research. I try to be a participant in society but, on the political level, there is so much game-playing. But one does what one can.

  2. Thanks once again Don. I need to save your posts to share with friends and family. There is a good deal of important information here.

  3. Keep speaking the truth, Don. I really, really enjoyed reading this post and will read it again before long.

    BTW - was that some SoCal beat poetry you left on my winter post....? ;)

  4. @Dennis: Glad you found the post helpful, and you are definitely a participant.

    @September: It's not always easy to arrive at an informed opinion. That's what I've tried to do... and share. Now, hopefully, you're in the position to have and share one too. (Maybe you'll upgrade that opinion with new info? Let me know!)

    @Saphron: Glad you liked the post, and yes, that was SoCal beat poetry, ala Don. SeptemberMom is also a poet and provokes an occasional poetic jam as well.