How Much Is Too Much For Health Insurance?

"Now I work with people from Nepal and Turkey and other countries where the healthcare system is less developed. I've heard stories of bartering with a doctor while a child lay sick, not that this happens all the time, but it happens."

Yes, the big difference is here (in FL) we don't get to barter with the doctor, unless we own a Mercedes dealership....

I am self-employed and for me and my son (14 years old) with no adverse medical history, the least expensive insurance which covers only catastrophic medical conditions (that occur no less than 6 months after you begin to pay for the insurance and doesn't cover AIDS and some other illnesses) cost me just under $400.00 per month. That's almost $5000 per year. $50,000 in ten years. My entire family and their families haven't spent that much in 70 years in health care. But a friend of mine went through $50K in less than 2 weeks whilst in the hospital for an operation.

How much is too much?

How much can you spend?

Too much? How about the initial quote from BCBS of slightly less than $600/month ballooning to almost $1200/month. We're both in our mid fifties and nothing's really falling off, but my hemorrhoids are really flaring up right now. OBTW, my contract is through Adecco and their idea of health insurance would cost even more.

No wonder the US got a grade of D in the recent rating of healthcare. Is it time for a national medical plan? God help us because it's not going to be painless.

"Yes, the big difference is here (in FL) we don't get to barter with the doctor, unless we own a Mercedes dealership...."

I definitely wouldn't want to barter while a family member or myself was seriously ill.

I read somewhere, I'm not sure where, that medical bills account for over half of bankruptcies. Now I don't know if that is true, but I do know that someone working for minimum wage can't afford 400 dollars a month in insurance bills (which would be the minimum they'd have to pay).

I don't know why health-care costs are not the Single Most Important Issue in the minds of the US citizens. (Ok, I guess I do know why, but it seems short-sighted.)

How can an economy support costs that go up like this? Where does it end? Where does the money go, and how is that fair? I could see myself picking a candidate based on this single issue if I thought they had a decent plan of action and could make it happen.

Something to consider: Would you support the lowering the high-end of medical treatment and/or research if you could trade that for a new system of medical payment/insurance? (I'm not trying to say that those two things are directly tied together... but you always hear about the "high cost of drug research", etc, so it seems like a good question to ask once in a while.)

The issue strikes me as a subset of a larger issue, that of unrestrained capitalism. I think there has to be some sort of weath gap in order to promote innovations in business and progress, however I don't think its healthy for a society to allow unrestrained capitalism, in other words, to allow that wealth gap to get gigantic. I think in the same way, some inequality in Healthcare services is good for promoting innovation, but if we allow a giant "healthcare gap", it ends up being bad ultimately for society.

So in regards to your question, I do think that if narrowing the healthcare gap in this country means lowering the high-end medical treatment, I would be in favor of it. In no way am I advocating equal healthcare for everyone in the same way I wouldn't advocate communism, I don't think either works. I do think that poorer americans should be entitled to some basic benefits though, and I don't think they get them now.

Who knows, if everyone had basic health insurance to cover visits, screenings and such, maybe the early diagnosis and education that comes with those trips might save money for the industry in the long run. I wouldn't list this as a reason to do it, just a possible happy side effect.

"The issue strikes me as a subset of a larger issue, that of unrestrained capitalism. I think there has to be some sort of weath gap in order to promote innovations in business and progress, however I don't think its healthy for a society to allow unrestrained capitalism, in other words, to allow that wealth gap to get gigantic."

Come now! That is just gobbly-gook. The issue is not capitalism nor is it the wealth gap. Both are used as political weapons and neither are as they are portrayed. At least you didn't use the adjective 'BIG'.

However, having some connection with the health industry, I can speak with some authority on the subject. The raising costs you feel are to a significant amount due to the work of trial lawyers and the awards generated from countless lawsuits. It is death from a thousand cuts.

You are no doubt aware of the difficulty in finding prenatal physicians. That is simply a response to the lawsuits generated by the system killing the medical practice. Why spend 12 years of your life specializing in a field where your career and financial life can end at a moment due to a decision of 12 citizens or just paying a huge percentage of your income to shield you from being financially wiped out. These physicians are simply moving on to lower risk practices leaving a shortage of physcians.

This process is running unchecked and fueled by politics. It is also being used to ramrod universal health care as an agenda and a means to fix the problem. However, that is not the fix because it does not address the root issue and the root issue is out of control lawsuits.

The benefactors of this are mainly the lawyers and politicians with a few lucky (or unlucky) victims hitting the legal lottery. Meanwhile the rest of us foot the bill with spiraling health costs.

Where will end? I don't really know, but something will break at some point. It has to. We have more lawyers waiting to graduate than we have lawyers practicing law right now. So if you think the number of suits is bad now, it will only get worse, much worse.

This is not unrestrained capitalism; it is unrestrained politics! We have only ourselves to blame. How many of us really study the facts when we vote? How many of us vote? Sadly, we got what we "paid" for by not keeping a check on our representatives.

Concerned in Utah

My turn? Capitalism is a benefit to those who can capitalize on something small and come out big - politicians [politics] is an area where as for sure most do not know enough about - the rise in medical care? Now here is a subject worth arguing - which way do you argue for good coverage? or for the cost of good coverage? We are not Nepal or China [to name a couple out of thought] we are American - Americans that believe and have come to understand for the most part what in means to live in a time of the best of the best and the worst of the worst? Agree? Health care is another painful area for everyone not just the capatilist but for the human poor and the rich, you can not buy good health!! In todays society we have come to rely on programs that will nuture our needs - folks wake up! Uncle Sam is not going to develope a program tomorrow to fix our "bills for the ills" We are 65% over weight in America - are we doing enough that we may not need the health care - sorry wrong subject - It is not an easy answer for the question how much is to much? I have been there before at a rate of $1500 per day for a week - without insurance at all..

I'm surprised at the amount of peope here who seem to blame this problem on a LACK of government regulation in this industry. I would hardly call the health insurance industry in this country an example of "unrestrained capitalism." In my opinion this industry is one of the MOST regulated. It's probably even up there with alcohol, tobacco and firearms.

If you as me the biggest problem (but not the only one) is the enormous amount of power that the FDA has. Innovation is where cheaper health care is going to come from, and no organization has more power to squelch innovation. They regularly hold back drugs after the trials for them have been more than sufficient.

This is anectodal, but I saw a television program a few months back about an entrepeneurial doctor who had a new form of prosthetic made of titanium. Titanium has a unique property where it will actually form bonds with bones, making for a much more comfortable, more permenant replacement for your limb when it is inserted into the "stump." The FDA, however, forbade him from practicing this procedure in the US, citing "risk of infection." (Translation: A major prosthetic company has a friend in the FDA. Obviously I don't know that for sure, but it wouldn't surprise me.)

Don't get me wrong though, I don't think there should be zero oversight in these matters, I just think the FDA's abilities should be limited to releasing public statements on drug trials and such. They should not have the ability to arbitrarily knock down drugs and procedures. Essentially, they have that power now.

In summary, if we're looking for cheaper health care we should be turning TOWARDS free market capitalism, not AWAY from it.

Maybe a look at the big picture would help us to see where the problem lies. We may not like it, and perhaps we can't really do anything to stop it.

An interesting statement by Richard Hooker on the Washington State University's web site about Capitalism as a way of thinking; basically that Capitalism is fundamentally individualistic, the individual is at the center of capitalistic endeavor....

In our society where "Nice guys don't finish last, they don't finish", how many on the road to success allow an unfortunate one to "cut in line"? Indeed, it is the opposite.

Now, if you have some bad circumstances affect your life, either because of poor judgement or just poor circumstances beyond your control, and you cannot pay your debtors, and eventually, they mark your credit (and they will), the mark they leave now affects everything from insurance to dating, and yes...health insurance.

There are a few doctors from the old school where the Hippocratic oath was more than an oath said on the way to "practice" for dollar$$. These still will treat the unfortunate and poor and are not so concerned about the income aspects of their practice. But these are a dying breed and are the exception rather than the rule.

Many of us here are gifted, intelligent, scientists and engineers. Would we be in our trade if it was considered an economically "challenged" vocation? Perhaps. Perhaps not. But isn't that why capitalism grows?

Lets see our pie (cake) chart:

Insurance companies: It costs money to administrate funds, account for fraud, make profit for the shareholders and the CEO. A little slice of the cake.

Politicians: License to lie (and get away with it), tickle the fancy of the public and get elected, get power and capital and help or hinder real people with real issues, paid by taxes. A little slice of the cake.

Doctors: Go to pre-med, med and post-med (for specialists). Spend thousands being educated, (with money not likely earned cutting grass on the weekends during high school) and then it's internship for a few years and then some sort of practice. They charge a price for their services (helping the body heal itself) and when the COL and malpractice insurance goes up, so do their rates. A little slice of the cake.

Patients: Some abuse the system. Freebies, Hypochondriacs, illegal aliens and those who never pay for services rendered. A little slice of the cake.

Hospitals, Crisis Care centers: Need to pay high salaries to get decent help, or charge for decent help anyway and ask for contributions. Need to charge outrageous prices because they pay those prices for the stuff they sell you ($5.00 for a Q-tip) or at least they do so because they have to make enough money to cover costs not directly charged to the patient for services used. Anyway they still get - A little slice of the cake.

Us: (As in all of us) In the USA and some other places have benefitted from Capitalism in a very Capitalistic way: We have become wealthier individually and more so than our counterparts in other lands. Being in a Democracy and Capitalistic country we, by being individually concerned about increasing our capital as a majority, have become wealthier. However, the poor are still with us. Thanks to this same system where the rich get richer and the poor get poorer, the poorer you get, the worse your credit score (is making everything cost more including the attorney's fees to sue the person or company who made you poor in the first place). Forget trying to deal with the almighty credit bureaus.

So let's just pucker up and cry because we ALL know that nobody can or will change the situation. We all cried "foul" when gas prices went sky high, but they knew we would dig deep and pay through the nose.

The same holds true of health insurance. We need it. They got it. You want it? You pay the price. The poor don't really care how much health insurance costs keep going up. They couldn't afford it 10 years ago when it was "cheap"! Some of my wealthy friends (multi millionaires) complain like they were doling out viles of their own blood when they have to pay more than they anticipated for something. My rich uncle (deceased) once said, "I didn't get rich by helping people". As far as I know, and I could be wrong about this, but, taking someone's money isn't really helping them, is it? I mean, that's the opposite of capitalism. Does anyone think a modern day Robin Hood will become popular and even become elected. It is not popular or even politically correct to take from the rich and give to the poor. Even the poor are greedy. They don't want to be well off, they want to be filthy rich. Check the statistics for those buying lotto tickets! Check their idols (rap videos, bling bling!)

The one gentleman here mentioned waiting while a young child was seiously ill to barter with a doctor. It's plain he hasn't been to an emergency room lately. People could die in there. Sometimes they do, they die waiting. Most of us couldn't run our businesses this way. But then again, would our customers "die" if they couldn't do business with us?

Maybe a business that deals with the peoples' lives and their health should be based on a different premise. (This whole post is allowing for honest business dealings between industry and consumer, there is a whole "dark side" that may be for another thread)

Capitalism is a two edged sword. When it comes to healthcare insurance, you better bring some band aids and first aid creme, it could cut pretty deep!

Reference: http://www.wsu.edu/~dee/GLOSSARY/CAPITAL.HTM

I'd like to be clear about my position on this issue:

I would at least like to see a guaranteed minimal healthcare coverage for all Americans. Americans who wish to have more than this coverage (and they will because I really mean minimal) are free to continue insurance in the way it is handled today.

There is an organization called the National Coalition on Healthcare which counts among its chairs the former Presidents George Bush, Jimmy Carter, and Gerald Ford. The group is non-partisan and non-profit (check their "about us" to see).

Here are some of the facts they've gathered about healthcare in the US.

45 Million Americans are uninsured

80 Million Americans spend part of the year uninsured (Anybody who knows people in construction or other seasonal jobs can understand this statistic)

Employment based insurance has dropped from 70 percent to 60 percent the last 20 years.

27 million workers are uninsured

Also keep in mind that minimum wage in this country is $5.15 per hour, which amounts to $824 dollars per month. Health insurance for a single adult starts at $400 a month. How can we ask anyone to try to live on $824 a month and expect them to spend half their salary on health insurance.

Also consider the following earnings from 4 major pharma companies last two years:

Johnson and Johnson -$10 Billion Profit FY05 $8.5 Billion Profit FY04

Bristol-Myers Squibb - $3 Billion Profit FY05 $2.4 Billion Profit FY04

Merck - $4.6 Billion Profit FY05 $5.8 Billion Profit FY04

Pfizer - $8 Billion Profit FY05 $11 Billion Profit FY04

So between 4 Pharma companies there was a profit of $53 Billion over the past two years.

There is already a guaranteed minimal healthcare coverage for all Americans, as well as all illegal immigrants, when you are sick or injured, just show up at an emergency room, or go to jail and get free health care.

I agree that health care costs are too high, but I do not agree that it should be supplied by the government. Everything they regulate turns to crap, not that healthcare is far from that, but there are facilities out there that I would not take my dog to.

If I had gone to school for 12 years to become an engineer and I had to pay most of my salary to protect my career and personal assets, I would probably reconsider my field of practice. Isn't it ironic that we spend a good portion of our income to have health insurance (my premium is $700/month) to protect our health, thus our career and earning potential, and doctors spend a good portion of their income on malpractice insurance to protect their career and earning potential. Insurance companies are the common denominator.

As far as drug companies go, I worked for one, not a large one, but a genric drug manufacturer. These companies are drooling for the expiration of patents. The large companies spend the money on research and development, the generic companies ride their coattails to reap the profit on something they did not develop. By the time the patent expires, the drug has a market and if not recalled like Vioxx, has a good reputation with the doctors and pharmacists. Of course, the insurance companies push the generics also.

Although the big drug companies make huge profits, they also take all of the risk, and spend all the money in research and development, and marketing. For instance the Merck Vioxx recall:

"After Merck's decision to take Vioxx off the market, its stock price plunged from $45.07 a share on September 30 to $33 the next day and has hovered at that price ever since. Analysts quoted in The Wall Street Journal have already speculated that Vioxx litigation could create liability risks in excess of $10 billion for the company, though other analysts have predicted much lower numbers. Nearly everyone seems to agree that the Vioxx liability issues will probably not approach the scale of suits associated with the failed diet-drug combination known as fen-phen, which resulted in 100,000 lawsuits against Wyeth and settlements to date in excess of $16 billion."

So Merck made $4.6 billion in profit, but faces possibly $10 billion in liability. Who do you think benefits from that liability lawsuit? And also with Wyeth, $16 billion to date with a diet drug. After the lawyers get fat off of these lawsuits they will be looking for a new diet drug.

In my opinion the high cost of health care insurance is like other luxuries in this country, driven by supply and demand. If no one bought it the price would come down, but like gas we have to have it. Compared to car insurance, years ago, when the states first passed laws requiring liability insurance, the price of liability insurance went up, why? Because it was mandatory, illegal not to have it. The insurance companies know that we have to have health insurance, and they know that poor people will not buy their policies, so their prices are geared toward the middle class, and they charge us till we bleed.

The moral of the story, lawyers and insurance companies suck.

Source: http://biotech.about.com/b/a/117248.htm

Lets say that Merck has to pay 10 billion dollars (I've been seeing that number too). Please consider these three things;

1. Vioxx has been on the market for 5 years and profits for the drug were around 8 billion over that time ($2.5 billion in 2004)

2. Vioxx is a worst case scenario for a pharma comapany, an arthritis drug that makes you 4 times more likely to have a heart attack and was on the market long enough to be widely used.

3. The heart attack risk was determined in 2000, but Merck fought to keep Vioxx on the market and succeeded for 4 years.

So in the worst case scenario, Merck might lose 2 Billion dollars on that drug, of course they have many other drugs that make up for that loss.

What if tomorrow you found out that using Windex increases your chance of lung cancer by 4 times. Then you find out that the company knew this for 4 years but fought the FDA to keep it on the market. Would you really feel bad that they are taken to court and didn't make a profit on that product?

If there were no lawyers or class action lawsuits, what would happen? If there was no FDA, what would happen? Would the drug companies forego profits to do the right thing?

Drug companies are not evil, they are good. They provide thousands of cures everyday. Still, they need to be regulated. Thats what the FDA and lawyers do.

You said there is minimum coverage, jail and welfare. You're correct. Some people are proud though, hard working and law abiding (21 Million at last count). Are these people not entitled to coverage?

In our current system, no they are not.

Points well taken.

No one likes lawyers until they need one, then they want the best (worst) they can find, as with insurance, no one like to pay the premiums until they need it, and then it is looked upon as a great deal.

Twenty one million uninsured workers in the USA. That sound like a market that could use the services of a new corporation selling cheap health insurance. Then again, half of those or more would still not purchase it because they live paycheck to paycheck, and are up to their eyeballs in debt on stuff they bought on credit that they couldn't afford in the first place.

To me it is a personal economic decision, and I may be the one driving health insurance costs up. My premiums are a little more than $700/month, but if I had to pay full price for just my prescriptions, I would have to pay $1800 a month. To me it is a no brainer.

I agree with you that drug companies are not evil, thank God for Wyeth and Enbrel, $1305/month, $50 co-pay, for 4 syringes filled with their miracle drug. For a few years now I can walk almost completely pain free.

I have been lucky that I have the opportunity to have insurance provided at a reduced cost to me by my employer, but before these last few jobs, I worked as a pipe welder during my engineering job search. That was one of the few jobs where I could make enough money to pay COBRA insurance premiums of $809/month. When it becomes a high enough priority for the 21 million uninsured workers, they will find a way to pay the premiums. Until then, they will play the odds, and gamble that they will stay healthy.

Maybe you could factor in pre-existing condition exclusions. People with pre-existing conditions can't get insurance for the treatment they need unless they are hired by someone who has group insurance and sometimes even they have exclusions. Also, people will live with a sickness and not seek treatment because they don't want this on their medical record in case they do try to get health insurance.

Doctors sometimes give discounts for cash payments. These people will work out a deal for a particular treatment or operation and start by saving money or selling something of value. Why pay an insurance premium for coverage that will keep you from becoming financially ruined, when you are already financially ruined?

The down side of the effect of all this is that health organizations that track the spread of disease have inconclusive data and have trouble finding the genesis of certain diseases because people do not seek treatment. If there is a good reason for everyone to have access to health insurance or treatment, it is to be able to assess the disease potential and level of health of a better section of the population. There could be diseases brewing out there waiting to be disseminated to the public in general. The children of these families go to school etc. Of course, this doesn't mean that they will get treated. But there is some screening taking place.

The data gathered by insurance companies as to risk management is a backwards scope of disease, accident and other things treated by the medical community at large excluding electives such as cosmetic "glamour" surgery.

So you have their data, hospital, doctor's office and clinic data and data gathered by coroners when they can. This includes homeless and others who die with unknown medical history. But it is far from comprehensive.

How many of us will finally seek treatment when, at last, we think we are going to die if we don't? Usually people have a level of comfort they live with. Some are pretty whimpy, some arent as whimpy. But many uninsured people are sick and have to learn to live with it. The stress of being financially unable to improve their health actually makes it worse. How much disease is spread by these?

When the realization of this threat starts to affect everyone else, maybe someone will look harder at the benefits to those already insured (of making health insurance available to everyone else). Or maybe not. Either way total cost IS total cost. I wonder if anyone has done a study on how healthy the uninsured actually are and how their health or lack thereof affects the rest of us?