Health care redux

[Norman Bernstein]

Not well, according to this report:

http://www.msnbc.msn.com/id/12480260/from/ET/

Here's a pertinent snippet:


WASHINGTON - The percentage of working-age Americans with moderate to middle incomes who lacked health insurance for at least part of the year rose to 41 percent in 2005, a dramatic increase from the 28 percent in 2001 without coverage, a study released on Wednesday found.

Moreover, more than half of the uninsured adults said they were having problems paying their medical bills, with 20 percent of working adults paying off medical debt —often $2,000 or more, according to a report by the Commonwealth Fund, a New York-based private, health care policy foundation.

The study of 4,350 adults also found that people without insurance were more likely to forgo recommended health screenings such as mammograms than those with coverage, and were less likely to have a regular doctor than their insured counterparts.

[PatCox]

The free market will produce the most efficient solution. Government intervention will reduce your freedom. You'll be forced to wait months, sit in dingy waiting rooms, to see doctors you don't like. Illegal immigrants, blacks on welfare, crack, wilding, gays getting married, boogity boogity. Hillary, Hillary, Hillary's gonna get you if you don't watch out. Uncle Milty Freidman will be our saviour. Flat tax, small government if only we could pray in schools, we could pray for medical care. And besides, I am going to get raptured up into midair any minute now and I will be treated to the joyful spectacle of watching all those elite liberal sinners who looked down on me as God tortures them.

[Katherine]

Pat, are you smoking something?

[Cuyahoga Chuck]

What "free market"?
The pharmacutical industry got a pipe line to the congress and wrote legislation that will fill their pockets for years to come without much risk to themselves.
No reason the medical insurance industry can't do likewise.
Only the up-and-comers want free markets. The folks at the top want to stay on top without having to answer to competition. That's why there are tens of thousands of lobbyists in Washington at present.

Charlie

[George Roberts]

Norman Bernstein ---

1) I expect those who are having problems paying off prior health care bills would be having problems paying off other bills even if a third party paid all of their health care expenses.

2) I suspect if we gave each person without insurance enough money to purchase insurance few would opt to purchase insurance. Most would have more urgent needs.

3) I suspect if health care were free some people would not want it.

[High C]

What "free market"?

The one we used to have back when health care was cheap. We should return to such a market. It works for dang near everything else we consume, and it could work for health care too, as it did before everybody decided they had to have insurance pay for routine health care.

[Paul Fitzgerald]

One driver of health care costs is defensive practice because of medical litigation. It has been going on so long in the US that its now endemic. Doctors make clinical decisions which keep them out of court, not which treat the patient.
We are going the same way in Oz now, our health care costs are rocketing up as a proportion of GDP, past 9% last year and climbing.
We will be at the US level of 13% within a decade at this rate.
New Zealand has a no fault medical compensation scheme which helps keep their costs down.
If you look at the flow on effects of medical litigation, it is probably cheaper to put all the ambulance chasing lawyers on a permanent holiday, paid out of the health budget.

[Peter Malcolm Jardine]

George Jung must be too busy treating Canadians for free to help Americans. :D

[Meerkat]

One driver of health care costs is defensive practice because of medical litigation.
Well, that's what the insurance companies would like you to believe. They drive the smoke and mirrors on that issue. The facts argue otherwise.

[Chris Coose]

The bride got a job where we can pay in $100/ week and get coverage. Up till now we have been uninsured for nealy 5 years. We have been borderline Medicaid eligeable. We have fairly significant real estate assets.

I went for a physical yesterday and got about $10,000 worth of referrals and that is just a maintenance list I've been keeping until I got insured.

It feels better to be insured but not a lot. To think I get to keep my house now, if I got catastrophic brings some comfort.... I guess.

It is a system that requires attention and how much has this administration paid to what is a huge middle class problem? They made it more difficult to get bankrupt when you get sick.

[Paul Fitzgerald]

Meer, in the late '80's I was actively involved in medical education. We couldn't use US education programs then because the practice patterns were so different from Oz.
We once set the programs up at a meeting of senior clinicians, who were receiving scores of around 50%. We then told them the game had changed, and their task was to stay out of court. They started scoring around 90%.
Unfortunately the medicolegal climate in Oz is now as bad as the US. A few years ago there was more medical litigation per head of population in New South Wales than in California.
I have worked as a clinician throughout these changes, and there is no doubt my decision making process is contaminated by legal concerns.
I am not alone, and our health care costs are climbing rapidly.
The problem for me is that there is no link between successful litigation and negligence, it is now a random event. If the case is emotional enough, the doctor is insured, and the magistrate or jury is looking to compensate the patient, they will find some excuse to call the doctor negligent.
In other words, there is no link between the definition of negligence used by a medical tribunal for deregistration and that used by a civil court.
The result is random intermittent reinforcement, a process psychologists say is very effective at changing behaviour.
Its a subtle process, but it eventually contaminates the whole health care system.

[Norman Bernstein]

It feels better to be insured but not a lot. To think I get to keep my house now, if I got catastrophic brings some comfort.... I guess.

Chris, if you should become seriously ill, it will feel a LOT better. There's a psychology associated with folks who remained uninsured, and healthy, for an extended period of time... I think it's similar to the sensation of immortality we usueally find in 19-year-olds. Beating the odds is always satisfying.... but finding yourself on the wrong side of those odds is probably the best lesson in humility any of us can learn.

[Tristan]

Solution to health care problems, outlaw health insurance. Make it a true "market." Pretty much the way it was 45 years ago when my three older daughters were born. I paid out of pocket, fairly easily, though i was making very little money by the standards of those days. At the moment there are three levels of health care costs, 1. poor people often pay little or nothing because they simply can't pay 2. insurance payments, which are all the market can bear, and 3. charges to people with money but no insurance. They are charged astronimical fees which partly at least, make up for those who can't pay.

[John Bell]

Solution to health care problems, outlaw health insurance.

Make that "outlaw employer paid", and I'm down with it.

[Norman Bernstein]

Solution to health care problems, outlaw health insurance. Make it a true "market." Pretty much the way it was 45 years ago when my three older daughters were born. I paid out of pocket, fairly easily, though i was making very little money by the standards of those days. At the moment there are three levels of health care costs, 1. poor people often pay little or nothing because they simply can't pay 2. insurance payments, which are all the market can bear, and 3. charges to people with money but no insurance. They are charged astronimical fees which partly at least, make up for those who can't pay.

Suppose, Tristan, you were unfortunately struck with some extraordinary adverse medical event... perhaps one of your daughters might have been born with some birth defect requiring multiple surgeries (at legitimate adstronomical expense) to correct. Would you still be suggesting that health insurance should be outlawed?

What if you were diagnosed with Parkinson's disease, as my wife was, just six months ago.... and couldn't afford the $5400/year that the drugs cost? (that's just the start, by the way... her symptoms are minor... the drug costs will easily exceed $10,000, a few years down the road).

I hear this kind of thing all the time... at least a half dozen bilge participants have made similar statements: "I never had health insurance, and paid what minimal medical care I needed out of pocket"..... and none of them ever acknowledge that they were simply lucky; either they never got seriously ill, or they could afford whatever care they needed.... and not a single one of them would acknowledge that some day, they might be struck with some serious and expensive medical consition they could not pay for... or, that someone else who couldn't afford it would suffer the same fate.

These are the people who think their own life situations are the appropriate model for everyone.

[High C]

Norman, you make a good case for high deductible policies, rather than the low deductible type most folks have.

True insurance, not prepaid routine health care managed through third and fourth parties, that's the solution.

[Norman Bernstein]

Norman, you make a good case for high deductible policies, rather than the low deductible type most folks have.

True insurance, not prepaid routine health care managed through third and fourth parties, that's the solution.

Yes and no, HighC.

I do agree, in a limited sense. Ordinary health care would certainly benefit from eliminating the middleman, for most (but not all) people. I honestly don't think it would result in any savings due to 'free market' forces, since people don't shop for routine medical services in the same way that they shop for a VCR; continuity and a relationship to a primary care doctor tends to override those decisions, so nobody would be pricing a tetanus shot by shopping ('let's see, Doctor A charges $27.95 for the shot, but Doctor B has a tetanus shot on sale for $19.95 this week, with a coupon from the paper').

Unfortunately, most high-deductible policies actually don't cut out the middleman at all... they simply change the overall actuarial terms of the equation. The plans I've seen don't really permit services-shopping at all; you still go to a PCP, who reports the ordinary charges to the insurance company, so they can total the payments to determine when the high deductible is exceeded, and compensation kicks in. Whether these plans are good or not, in comparison to low deductible plans, is an actuarial issue, not a medical one. They do absolutely nothing to encourage any meaningful competition. Worse, they perpetuate the same problem as low-deductible insurance: cherry picking of patients.

The problem with all of this is the same: high deductible plans still do nothing to eliminate waste and inefficiency in insurance-administered plans, and they do nothing to improve access to health care for lower income people and those without access to a 'lumped risk' employer-administered plan.

[PatCox]

HighC, medical care was cheap back when medical care amounted to putting a cold compress on your head. As I posted elsewhere, its during the lifetime of some of us that surgery went from rare, painful, and often unsuccesful, to common and safe, and that antibiotics were invented. The good old days when the doc came with his black bag and you gave him a $5 or a chicken were also the bad old days when he really couldn't do squat for you. Its way more than a little simplistic to pine for primitivism.

[John Bell]

Yes and no, HighC.

I do agree, in a limited sense. Ordinary health care would certainly benefit from eliminating the middleman, for most (but not all) people. I honestly don't think it would result in any savings due to 'free market' forces, since people don't shop for routine medical services in the same way that they shop for a VCR; continuity and a relationship to a primary care doctor tends to override those decisions, so nobody would be pricing a tetanus shot by shopping ('let's see, Doctor A charges $27.95 for the shot, but Doctor B has a tetanus shot on sale for $19.95 this week, with a coupon from the paper').

Look what's happened to the cost of vision correction surgery, something that is not routinely covered by insurance. What started out as a $10,000 procedure is now less than $1,000. Orthodontia is another area that is largely driven by free market forces, and cost to consumers are better as a result.

[Norman Bernstein]

Look what's happened to the cost of vision correction surgery, something that is not routinely covered by insurance. What started out as a $10,000 procedure is now less than $1,000. Orthodontia is another area that is largely driven by free market forces, and cost to consumers are better as a result.

Both of those are elective procedures. I had Lasik myself (and didn't choose the low bidder, by the way... I figured that I'd want a genuine expert to do it, and paid $5,000 for the privelege).

Elective procedures like those you mentioned are most certainly amenable to true free market competition.... but when you're gasping for breath on a hospital gurney with advanced heart disease, and need a bypass, you won't be clipping coupons from a newspaper.

[High C]

Yes and no, HighC.
...The plans I've seen don't really permit services-shopping at all...

Mine does, and every competing product I looked at does as well. I never saw a plan that used a PCP. Rather, they were all PPOs with nearly unlimited lists of participating providers.

The opportunites to inject market forces, to "shop", are there if an individual policy holder chooses to take advantage of them. I've done it. There is no question that it is possible, even easy. It's not automatic, the consumer has to take on a degree of responsibility, but that's true of most other products we consume as well. The Toyota dealer will happily take sticker price for that new Avalon, but most consumers know better. It's a matter of choice.

You're right about a couple of things with these policies, claims do still travel through the third party maze, even though the patient ultimately pays the bill directly. This is an administrative waste. It's done as an enforcement mechanism to assure that the provider charges the correct, prenegotiated fee. There must be a better way to accomplish this.

The other thing is that these policies do little or nothing about providing health care for the poor. But low deductible policies are even worse in this regard. They are far less affordable.

Actuarially, the math is quite simple and obvious, even for people who have high ongoing expenses. The lower the deductible, the greater the total cost.

[High C]

HighC, medical care was cheap back when medical care amounted to putting a cold compress on your head. As I posted elsewhere, its during the lifetime of some of us that surgery went from rare, painful, and often unsuccesful, to common and safe, and that antibiotics were invented. The good old days when the doc came with his black bag and you gave him a $5 or a chicken were also the bad old days when he really couldn't do squat for you. Its way more than a little simplistic to pine for primitivism.

Jeez, Pat, I'm not going that far back! Maybe twenty some years ago was when this all started to blow up.

[High C]

One more point with regard to Norman's post, the cherry picking issue.

Cherry picking goes on to the same degree regardless of deductible. Group policy holders have an easier time of this because of the size of the group, not because of the size of the deductible.

[Norman Bernstein]

Mine does, and every competing product I looked at does as well. I never saw a plan that used a PCP. Rather, they were all PPOs with nearly unlimited lists of participating providers..

I don't quite see this. Since the participating doctor (whether it's a PPO or HMO) is under agreement with the insurance company, his effective rate is fixed by the inurance company, not by his own decision as to what to charge. How, and under what circumstances, would 'shopping' do for you? If you need an annual physical, the insurance company provides the negotiated rate... all doctors who participate in that plan would be obligated to charge the same thing.

Regardless, what about the value of continuity and developing a relationship with a specific doctor as the primary care-giver?

I could see the argument, in the case where you're going to see a specialist, in terms of deciding who is the most competent, etc.. but since they also have negotiated rates with the insuror, how does 'shopping' result in a lower price?


You're right about a couple of things with these policies, claims do still travel through the third party maze, even though the patient ultimately pays the bill directly. This is an administrative waste. It's done as an enforcement mechanism to assure that the provider charges the correct, prenegotiated fee. There must be a better way to accomplish this.

Agreed, although I don't think that's the only reason. Insurance rates are primarily based on actuarial statistics. The only way an insuror can guarantee a profit is by knowing what the actuarial realities are... it also gives them 'leverage'; if a particular doctor seems to be running up the services higher than average, the insuror knows that the patients of this doctor are likely to reach their deductible sooner.... so the insuror has leverage to coerce the doctor to be less aggressive.


The other thing is that these policies do little or nothing about providing health care for the poor. But low deductible policies are even worse in this regard. They are far less affordable. .

The distintion in affordability is utterly meaningless to the poor. Arguing that they can slightly more 'not afford' a high deductible policy, as opposed to a low deductible policy, is mere chin music.


Actuarially, the math is quite simple and obvious, even for people who have high ongoing expenses. The lower the deductible, the greater the total cost.

... and the greater the potential benefit, for the 'unlucky' ones. One of the big problems with high deductible policies is that they provide an even greater incentive for insurance companies to 'cherry pick' customers.... and this is one of the biggest problems. People whose ongoing medical conditions preclude them from being able to buy insurance privately, and who are not covered by the 'lumped risk' group policies of an employer, are simply screwed.

You and I may not fit this profile, but judging from the statistics presented at the beginning of the thread, millions are. Unless one is dedicated to a sociologically Darwinist perspective about health care, this is an intolerable situation. As I've said before, I'm all for disparities in wealth and income as a function of a free market democracy... but I draw the line at a few things like health care.

[John Bell]

Elective procedures like those you mentioned are most certainly amenable to true free market competition.... but when you're gasping for breath on a hospital gurney with advanced heart disease, and need a bypass, you won't be clipping coupons from a newspaper.


And you make yet another argument in favor of high deductible catastrophic insurance... If non-emergency, routine, and ongoing care were shopped, the pressure to be more efficient would have postive benefit on costs.

[Norman Bernstein]

And you make yet another argument in favor of high deductible catastrophic insurance... If non-emergency, routine, and ongoing care were shopped, the pressure to be more efficient would have postive benefit on costs.

There would have to be a meaningful mechanism to actually 'shop'. For reasons pointed out in otrher posts, high deductible policies don't reqally provide for this.

[High C]

I don't quite see this. Since the participating doctor (whether it's a PPO or HMO) is under agreement with the insurance company, his effective rate is fixed by the inurance company, not by his own decision as to what to charge. How, and under what circumstances, would 'shopping' do for you?

Good question. The shopping is primarily for things not covered by the policy, but which can be paid for out of the HSA account, like RX, glasses, and dentistry. Especially with dentistry, I have negotiated significant savings.

Even with products which are covered, the fact that I'm going to have to write a check for a test or for RX causes me to ask "how much?" Sometimes I say "no thanks". This is a tremendously effective "market force". When potential customers refuse your product because it is too costly, the market self corrects. If enough customers say "no thanks", the price comes down.

Also, see my post above re. "cherry picking".

[Norman Bernstein]

Good question. The shopping is primarily for things not covered by the policy, but which can be paid for out of the HSA account, like RX, glasses, and dentistry. Especially with dentistry, I have negotiated significant savings.

OK, then... in a sense, it confirms my point: you really have no way to shop competitively for most medical services, just the peripheral ones that happen to be lumped into the HSA regs. With drugs, your ability to shop is at least somewhat constrained, because if your doctor decides you need some relatively expensive medication (like Lipitor, which I take myself), and you decide not to simply ignore or refuse his advice, your competitive shopping is extremely constrained; the deep discount pharmacies are all very competitive, so the price differences tend to be very small. Glasses and dentistry are at least partially elective, in terms of the dynamic range of their expense.


Even with products which are covered, the fact that I'm going to have to write a check for a test or for RX causes me to ask "how much?" Sometimes I say "no thanks". This is a tremendously effective "market force". When potential customers refuse your product because it is too costly, the market self corrects. If enough customers say "no thanks", the price comes down.

If the basis of this constraint were truly elective, then yes, having to write the check does indeed inhibit people and reduces their cost. However, there's a big difference between declining an expense that you could potentially afford, versus one you can't. If your doctor recommends a colonoscopy, and you can afford the $1500 but just don't want to part with the cash, then you're actually gambling with the insurance company's money, not your own: a colon resection for cancer, like my mother had two years ago (due to lack of regular colonoscopies) costs $35,000+.

Aside from the variable/elective procedures, treatments, medications, etc., I simply don't see 'self restraint' in terms of scrimping on medical care to be a truly effective way of limiting costs. It's really a form of gambling, in which, if you lose, someone else pays the bill.


Also, see my post above re. "cherry picking".

Yes, it's true that large groups don't suffer from the problem because the risks are lumped. However, we're not talking about people who, by virtue of employment or similar affinity, can get insurance on that basis... the problem ,as the first post of the thread illustrates, is the folks who don't qualify for 'lumped risk' admittance to a policy.

[High C]

...Yes, it's true that large groups don't suffer from the problem because the risks are lumped. However, we're not talking about people who, by virtue of employment or similar affinity, can get insurance on that basis... the problem ,as the first post of the thread illustrates, is the folks who don't qualify for 'lumped risk' admittance to a policy.

Right, this is a problem of group versus individual insurance. It has nothing to do with deductible size or HSA/non-HSA.

[George Roberts]

Norman Bernstein ---

"and not a single one of them would acknowledge that some day, they might be struck with some serious and expensive medical consition they could not pay for.."

Actually I said that WHEN it happened I was willing to die rather than saddle anyone else with the expense. I even set a cost of $100/month or $5000/incident as too much for medical care.

As far as cherry picking ---

People who expect to be healthy do not buy insurance. People who expect to not be healthy do buy insurance. The purchasers are doing the picking.

As far as group policies ---

They are always poor choices. A group policy is required to insure anyone and everyone at the same rate. A healthy group always pays too much and often forgoes the insurance so that unhealthy groups need to pay more for their insurance.

A group that wishes to insure its members is almost always better off offering individual policies with a cap on the groups contribution.

---

About HSAs: My HSA allows me to go anywhere to obtain treatment. They are notified about the costs after my treatment. They are free at that time to negotiate their payment. Only their payment goes against my lifetime benefits - not the billing amount.

Perhaps the insured should negotiate with their insurers better.

[Tristan]

I did carry major medical when I was young, never used it and it was pretty cheap. Our current health insurance, including my medicare A,B, and D (or whatever the drug ins. is called) is about $$17,000 per year. About a third of our income. (much of that is my wife's self insurance through her sole propritor business). Seems like major medical is a good idea. My understanding is that insurance tends to be a huge headache for MD's. A GP father of a friend never took any insurance, charged three to ten dollars for an office call until his fairly recent death, made a very good living, had no insurance hassles, handled entire office with one nurse and one lady working as a secretary, etc. Seems like there's a huge amount of waste, padding, and leeway in the medicine/ medical insurance business (observation from four years employment in a hospital). An interesting note, a friend, who recently underwent a laproscopic CA operation, self paid the surgery. When she talked to the oncologist re. follow-up chemo she was quoted $47,000 for the chemo. When the oncologist discovered how low her income was he modified her charges to $7,000. Re. doing away with medical insurance (major is a good idea actually), seems like there's got to be a more cost effective way.

[Norman Bernstein]

I did carry major medical when I was young, never used it and it was pretty cheap. Our current health insurance, including my medicare A,B, and D (or whatever the drug ins. is called) is about $17,000 per year. About a third of our income. (much of that is my wife's self insurance through her sole propritor business).

Yes, the costs are indeed astronomical. I paid it myself, until about 5 years ago... it was $12,000/yr at the time, and I have no doubt it would be $17,000 by now. A high-deductible policy wouldn't have helped; my wife's Parkinson's medication alone costs $5400/yr, and my Lipitor and Tricor are another $2000 or so, if I was paying for them directly.


Seems like major medical is a good idea. My understanding is that insurance tends to be a huge headache for MD's.

Two doctors I am close freinds with personally, have attested to that. The dermatologist, who is in a group practice with 5 other partners, has a staff of 60 F.T. and P.T. to administer the office... he says that if it weren't for the inurance headaches, his support staff could be much smaller. My gastroenterologist friend has regaled me of the tales of having to argue with insurors to cover necessary medications and procedures.


A GP father of a friend never took any insurance, charged three to ten dollars for an office call until his fairly recent death, made a very good living, had no insurance hassles, handled entire office with one nurse and one lady working as a secretary, etc. .

As others have pointed out, it wasn't all that long ago that the practice of medicine was like that... but, to be completely fair, advances in medicine (expensive advances) have changed that. Your father's GP friend may have ended his days practicing the way he always did... but I don't think we'd want to return to those days.... when heart disease, for example, menat almost certain death, or when most cancers were incurable and/or inpoerable. There's a perfectly valid reason why medical costs are higher these days... why the should be.... and why it's worth paying more


Seems like there's a huge amount of waste, padding, and leeway in the medicine/ medical insurance business (observation from four years employment in a hospital).

Undeniable.

A lot of people like to make the assumption that any governmental social program is, by definition, inefficient and wasteful. However, medicare is actually three times as efficient as the average HMO, in terms of cents per dollar delivered as actual medical services.


An interesting note, a friend, who recently underwent a laproscopic CA operation, self paid the surgery. When she talked to the oncologist re. follow-up chemo she was quoted $47,000 for the chemo. When the oncologist discovered how low her income was he modified her charges to $7,000. Re. doing away with medical insurance (major is a good idea actually), seems like there's got to be a more cost effective way.

I think your example is probably more indicative of doctors who take into consideration the financial resources of the patient when independently setting a charge, much like lawyers who perform reduced fee or 'pro bono' work for poor and indigent clients. I don't think it's an example of competitive market forces at work here; most people are insured.

[Norman Bernstein]

Norman Bernstein ---
Actually I said that WHEN it happened I was willing to die rather than saddle anyone else with the expense. I even set a cost of $100/month or $5000/incident as too much for medical care.

I've always believed suicide should be a personal choice, so I wouldn't object. However, presuming that anyone else ought to adopt that same attitude is utterly ludicrous!


As far as cherry picking ---

People who expect to be healthy do not buy insurance. People who expect to not be healthy do buy insurance. The purchasers are doing the picking..

Does anyone actually expect to contract cancer? Get into a serious auto accident requiring hundreds of thousands of dollars of surgery and rehabilitation? Develop a debilitating chronic disease like muscular dystrophy? Granted, there are some lifestyle choices which predispose a person to illness... but is that always true?


As far as group policies ---

They are always poor choices. A group policy is required to insure anyone and everyone at the same rate. A healthy group always pays too much and often forgoes the insurance so that unhealthy groups need to pay more for their insurance...

If anyone knows how to identify a 'healthy group' as opposed to an 'unhealthy group', they could make a fortune as an actuary.

[Tristan]

Re: The friend who was quoted 47,000 for chemo, I should have added that when the Drs. office discovered SHE HAD NO INSURANCE and her low income, the price was dropped to $7,000. I wonder which discovery played the bigger part. My own CA treatment implant (every three mos.) is billed at $2100, the doc accepts medicare which pays about half. Before the drug medicare benefit I had to pay out of pocket, $445/mo for CA treatment pills (solved that problem by getting them from Canada for about $220). I certainly have NO complaints about medicare. Yes, the effectiveness of treatments has truly improved. INterestingly, the advent of arthroscopic, laproscopic , and various virtually outpatient treatments for heart problems has greatly reduced the total costs of a big variety of surgeries. I always wonder what the average cost of individual medical care would be if it were truly competitive. The hospital I worked in was really blatent about padding bills and adding on stuff. When I (unfortunately) had two major surgeries there I was once offered meds for another patient, was hooked following surgery to a drug dispensing macine which they forgot to turn on, and given a pre-op EKG the day after the surgery! The latter, which the nurse said was ordered by my physician (and was NOT) took weeks to have removed from my bill. I'll never forget going to my (then) allergist for a routine asthma problem. She wanted to give me an expensive breathing test which I didn't need. When I protested she said, "don't worry about it, your insurance will pay for it." She had nothing to say when I told her I had no insurance. Good luck with your respective health problems. A good attitude and reasonable exercise will go a long way (I hope)

[George Roberts]

Norman Bernstein ---

Health insurance companies do a very good job of assessing risk - identifying healthy and unhealthy groups - body mass index, tobacco/drug/alchol use.

You really need to learn to argue better - your equating an inability to pay for medical care to suicide seems a bit much. I suppose you endorse forced medical procedures on the sick. The government and most of the population seem to prefer to allow the patient to decide.

[Norman Bernstein]

Norman Bernstein ---
You really need to learn to argue better - your equating an inability to pay for medical care to suicide seems a bit much. I suppose you endorse forced medical procedures on the sick. The government and most of the population seem to prefer to allow the patient to decide.

Wait a minute.... aren't you the guy who has said, on several occasions, that you'd rather die than spend as much as $100/month, or $5000, in the event you got sick?

And you're telling me to 'argue better'?

At the risk of being perceived as being 'uncivil', I humbly suggest, George, that your apparently low opinion of the value of your own life indicates a rather severe psychological problem.... for which you ought to seek therapy.

(by the way, suggesting that I somehow endorse 'forced medical procedures on the sick' is utterly and totally without foundation. I never said, implied, or even hinted at such a thing... it's purely an invention of your own mind.

And you think I ought to 'argue better? :) )

[Peter Malcolm Jardine]

The American health care system is ranked 37th in the world. You're not winning.