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COTA Thoughts

Change of Heart

Published October 11, 2009 10:02 PM by Tim Banish
 

Well, I must admit that talking to others with different experiences and listening to the other side of the story is one good way to learn. This past weekend my thoughts were changed on the health care reform issues, and simply by listening to another opinion from someone who sees another side of the story.

            Medicare as we know it is failing. Government is blamed for it, and people don't want their healthcare operated by big brother thinking the same results will happen. A new thought was presented to me concerning Medicare versus private insurance though, and it makes sense.

            Medicare recipients are almost all elderly, and most are already in failing or poor health. In other words, they are what are known as high risk clients in the private sector.  So yes, if every person you insured used more medical dollars than the premiums you are bound to operate in the red.     

Private insurance companies have the luxury of selecting clients to insure, hoping to pick the ones that use fewer medical services. This will keep their overhead lower, and leave more profit. Of course that's what they want. The average overhead operating costs of private companies typically run 28% or more. The overhead operating costs of Medicare average 3% of total revenue.

A private insurer can also place people in high risk categories, forcing them to pay higher premiums. For some this is impossible. Consider this scenario; you have just been diagnosed with cancer. Treatments and medicine run well over $2,000 per month but the company healthcare plan covers that. Until you get so sick that you can no longer work. COBRA coverage is so expensive due to pre-existing conditions that it is unaffordable, especially when you are unemployed. So where do you go for coverage? Many run up huge hospital bills and eventually are forced to file bankruptcy or lose their home and savings. One such person sought help by moving to a foreign country for treatment where her medicine costs decreased from $120 per dose to 5¢. I'm sure the additional $119.95 difference in price per dose here in America goes towards advertising and research costs. Oh, and probably a few big bonus checks too.

So am I now in support of healthcare reform? Not completely, but it makes sense that if all Americans were in the same plan the cost of insurance would be shared between the healthy as well as the ill. With everyone under one umbrella, costs could be more fairly shared. This larger insurer would also have more leverage when purchasing services, setting rates and reimbursements. Maybe if congress can conjure up a good piece of legislation for once, healthcare reform could be an affordable possibility.

             

Until next time, hope all your "Thoughts" are Good-

Tim

2 comments

Katherine-

Thanks for your comment. I agree with your point about capitalism and business having to be profitable to stay open. However by the same token much of this profit is spent on huge bonuses and inflated salaries, especially in the insurance business. For the government to dictate health care is not the answer in my book either, but it makes more sense than only the working rich to have medical care.

My thought has always been that no one be allowed to earn more money per year than the highest position in the country, which is the president. Right now 1% of America's richest people have more money than 95% of the population, combined.

Not fair in my book either.

Tim Banish, LTC - COTA/L October 22, 2009 4:17 PM
Cincinnati OH

Hey, fellow blogger!  Great blog!  I, too, think it's great to share ideas and keep our minds open.  I have been looking at both sides of this heath care story and admit that it is very confusing.  There are two points that keep rearing their heads for me, however.  (1) Capitalism is what our economy is based upon; therefore, in order for insurance companies - which are private endeavors - to continue to participate in our economy, they need to make a profit.  Business 101 - not rocket science.  (2)  If these companies are forced by government (a so-called not-for-profit industry) to go against that business model, then their customers - all of them - will experience much higher premiums.  In the end, those with pre-existing conditions may not be able to afford health care anyway - especially if they are no longer able to work.  Is it really realistic to allow our government to dictate our health care choices?  Especially in light of the lack of success this type of arrangement has experienced in other countries.  Again, Tim, thanks for giving us more food for thought!

Katherine Collmer, Pediatrics - OTR/L October 15, 2009 9:24 AM
Sandwich MA

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