Health insurance debate

Ken C.

Didn't get much response from the thread/survey I posted about employee health insurance, so maybe this subject will stir up more interest. Simply, what do you, the small business owner/contractor/tradesman think should be done to fix the health care crisis?

David DeFord

In the words of ...

the Bard of Avon....first we kill all of the lawyers. Seriously, a large part of the healthcare crisis in this country is caused by patients, lawyers and THE COURTS expecting perfection from healthcare professionals. I realize that if a doctor or nurse makes a mistake it can cost someone their life - I also realize that is the case with most people on this board - is anyone out there perfect? I know I'm not. This fear of being sued also leads to many more tests than are necessary and extremely high insurance rates. Another problem is the mentality that we must save every life at any cost. If you look at the statistics something like 90% of most peoples lifetime healthcare costs are incurred in their last 6 months of life. But there are no easy answers here. I know that I'm not willing to tell my doctor - OK I know that I have lung cancer just let me die since it is almost always fatal. I think you see my point. However, I do have a problem with the fact that many doctors get RICH by essentially telling their patients - either you pay me or you die. Not that doctors don't deserve a good living - they do. But so do alot of other people in this country that are going broke paying doctor and hospital bills. In my opinion we are headed to nationalized health care as sure a God made little green apples. The healthcare industry is taking a larger and larger share of the gross national product and it will stop somewhere - I don't know where but we can't all be doctors and nurses and survive as a nation. This is probably the toughest question that we as a nation will face of the next 25 years. Just my 2 cents.

rod robbins

I think its the insurance companys making big profits.Health care is a business for profit.Its the american way.If I could charge anything i wanted and know i did not have to have a costomer base or costomer service since i would have a supply of new costomers every day i would make a killing.I would not want that business but a lot of folks do.
Rod

Paul Mitchell

I want

a better deal on health insurance. I am willing to pay a fair price for it. But the games they play are crazy. We get a decent rate for a year or so then the "call" comes from the insurance guy..."rates are going up" and here we go looking at new plans, trying to make sure we can still see our doctors etc. How about reasonable rates with normal yearly increases? All insurance in NJ is crazy, But it sounds like health insurance is the same everywhere. I could pay another good tech with our health costs. Problem also is that sometimes employees take the benefits for granted...especially the younger guys. They would rather have the cash than the benefits..sometimes.
In Nj also or maybe everywhere...we have to offer the same deal to all employees. Example...We can not pay 100% for one employee and only 40% for another. We have to offer all employees benefits, not just some. We make new people wait 6mo. for benefits. We have found that you can not figure out a new employee before that time period, nor can they figure us out.

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Constantin

Several changes I would like to see:

1) How about instituting a rule of law in the US? Court battles should be paid for by whoever loses the case. That not only puts an incentive on reducing lawyer fees, it also ensures that folks pretty much only sue when they stand a good chance of winning, as opposed to the current "let's spin the wheel" lottery system. Furthermore, once lawyer fees reach sub-stratospheric levels, companies and individuals can take a more principled stand instead of acquiescing to the (typically lower) cost of a greenmail payout.

In Boston, it not unusual to see attorney fees in the $600/hr range. Think about the financial impact that any legal action has...

2) Put a cap on punitive damages. I can understand large payouts to ensure that the plaintiff be taken care of for the rest of his life (hospital care is expensive) but this "sending a message" hooey is simply yet another means for tort lawyers to enrich themselves. If a pattern of intentional misdeeds is uncovered, put the responsible behind bars, a much more effective deterrent than a simple payout.

For example, there are a number of individuals in the tobbacco industry that claimed for years that smoking is not addicitive, does not harm,etc. even though they had internal research claiming otherwise. Now states and a select few tort lawyers are gorging themselves on the settlement money while the real issue (folks perjuring themselves re: the dangers of tobbacco) has gone away quietly.

3) Realize that the human condition is not perfect. We all make mistakes, some with grave consequences. We are not entitled to a perfect life either and bad things, do, and will continue to happen on a daily basis.

4) Lastly, force insurances to pool their resources throughout a profession, not by sub-category. Ever wonder why there are almost no doctors left willing to bring kids into this world? (CA is the exception to the rule, because they have a $200,000 tort cap) You'd hold back too when the cost of insurance starts at $70,000 a year. Once insurance costs are reined in, the cost of doctors can drop also.

5) I haven't even started with the hospital care yet. Nor the rise of pharma costs with which we subsidize drug development for the rest of the world.

Ken C.

I believe health care should be a non-profit industry. But getting lawmakers to do that would be an uphill battle, since the healthcare industry lobbyists would strong-arm the legislators. The dominant health insurer in my state (which has a virtual monopoly) also does a poor job of keeping expenses low. They constantly advertise on television (why, God only knows). They spend money on newsletters, which, although nice, are not really necessary. They've built up a huge surplus, instead of electing to keep premiums down. Its CEO received a personal loan from the company to build himself a swank new house. At first, the company said he didn't have to repay the money (around $600K). Then, after public outrage, he said he would pay some back. But, it just doesn't end with this company. Today's local paper reports that their board of directors takes annual junkets to a world-class resort. And decent, hardworking people have to go without health insurance and risk financial ruin. Something's wrong when your health insurance premium is more than your rent. When is the situation going to come to a head?

Mad Dog

Loser pays...a good first step

and I like what you said. Mad Dog

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Ken C.

Constantin,
You make several excellent points. Presciption drug costs are likewise out of control. Why is it the same drug sells for significantly less in Canada? I saw a report recently from a local television news station, that featured a small business that was hooking people up with prescription drugs from Canada. The response was overwhelming, but state officials ordered them to cease and desist. The business owner vowed to ignore the order. I didn't hear what happened to the business after the report.

Mike T., Swampeast MO

Health Insurance

Am in business and pay health benefits for some employee--just not heat-related.

As to what you (as an employer) can do to control costs:

1) Check out various companies/plans. Beware though that some may not be well "accepted" in your area. I had a great individual policy for years from a very good company--problem was that it never became well-accepted in my area for best benefits I had to travel over 100 miles!

2) Personally, I can't even begin to offer paid family coverage--and I have to require some employees to reimburse just for individual coverage. (I have one with mild epilepsy and another with a heart condition and their rates are absurd compared to others as they have to have special "high risk" policies through a special "group").

3) Offer different plans at various levels of employee reimbursement--your young, strong, healthy employees will likely gamble on low coverage while older or less healthy probably don't want to take the risk. Those with families may well have their spouse working and they might get better coverage for them (and kids) anyway.

4) Discuss the matter with employees. Unless they've been under a rock they realize that rising health care costs are or have reached the crisis level. Unless they naive or callous to the extreme they realize that their employer is affected as well. Discuss reasonable use of their benefits. While you should never discourage age-appropriate checks/screenings/tests, there really are a lot of matters that can be safely handled with common sense instead of a trip to the doctor/hospital.

------------------------

All of us are going to have to accept some form of managed care in the future. It's not just a crisis in medicine--it is a crisis in all of the "traditional" professions--medicine, law and accounting. Even more broadly it is a crisis in the attitude of the people--WAY too many expect WAY too much while paying WAY too little.

Unknown

What if

What if doctors charged a reasonable amount so that you could pay the bill yourself, like auto repair or heating repair.

Cut the lawyers, the insurance companies, the lobbyists, legislators, the courts, and all of the rest of the leeches that enable us to pay doctors what they think they deserve.

That's a lot of baggage the medical proffession has caused us to bear.

I don't think doctors would pay $600.00 a month for insurance against the heat going out, even in their office.

I don't think I want to buy 50 aspirins at hospital prices, either.

Noel

joel_19

costs

capping law suits is a good idea I agree with the other posters above. I would add that Mass is loosing many good doctors because the cost of insurance for them and the cost of living is so high.
What gets me that wasn't mentioned is I frequently compete with companies that don't offer insurance this makes it very difficult if not immpossable to compete. If the goverment doesn't take it over I think they should just pass a law that says you MUST have insurance for your people even if it's just two guys. This would insure everyone has insurance and level the playing field between contractors. They'd just have to charge like the rest of us or go out of biusness. Seems simple enough! Problem now is all companies are running scared thier competition cut back on benifits or even might cut back and they know they have to or else they are sunk cost wise so it is just snowballing out of controll!
Of course you guys do realize that our goverment will do knothing no matter which one you vote for in the fall right?? The U.S. is compltely controlled by PACS not the average person.

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Ken C.

Great idea, Joel

Just like there's a law (not sure if state or federal) that requires companies with even one employee (besides the owner) to have workmans comp insurance. The cost of that insurance, like any other, is prohibitive, so some companies try to get by without it, but then get nailed if a worker gets hurt. Yes, I would like to see government require any business with one or more employees provide health insurance. The small business owners would complain that they can't afford it, but at least this would put businesses on a level playing field. It's a shame that more and more companies in the plumbing and heating industry don't provide their employees with health insurance (or else provide less coverage than previously) because they feel they have to keep up with the lowball companies that don't give a crap about their employees. Like you said, plumbing and heating companies should see this as a cost of running a professional business, and pass this cost along to their customers. But, there will always be lowball companies out there willing to undercut the more professional, ethical companies. Then there are the fly-by-nighters, unlicensed hacks and handymen always ready to undercut established plumbing and heating companies. I switched to plumbing from another career mainly because I like the trade, but the other main reason was the potential for good income and benefits. Now I'm not so sure.

David DeFord

Level playing fields

don't exist. The larger companies will negotiate lower rates due to their larger premiums and thus have a competitive advantage. Legislation almost never has the intended consequences. If you require that all companies with employees have health insurance then companies won't have employees they'll have subcontractors. What you are proposing will inevitably end up with mandatory government-sponsored healthcare. Ask your friends in Canada why so many of them come to the U.S. and pay for their care out of their own pockets. As I said above it's not an easy question.

Mike T., Swampeast MO

But what if...

...your two employees have conditions that make them difficult and expensive to insure--even though it really doesn't affect their work?

What's the little guy to do? Not hire those people so they're forced to get health coverage from the public?

We can already detect genetic pre-dispositions to certain diseases--I can assure you that the insurance companies are doing their utmost to get hold of this information--even require that tests be done--and use it to assess risks and rates.

There are some deep and fundamental problems that aren't going to be addressed until the absolute crisis point is reached--then congress will make their typical knee-jerk "fixes" that only add to the problem... Let's see: we're solving the crisis in prescription medicine expenses by paying out yet more money from a fund already near crisis level--great idea...

jackchips_2

Ken,

> Constantin, You make several excellent points.

> Presciption drug costs are likewise out of

> control. Why is it the same drug sells for

> significantly less in Canada? I saw a report

> recently from a local television news station,

> that featured a small business that was hooking

> people up with prescription drugs from Canada.

> The response was overwhelming, but state

> officials ordered them to cease and desist. The

> business owner vowed to ignore the order. I

> didn't hear what happened to the business after

> the report.

jackchips_2

Ken,

drugs are regulated in Canada.

Robert O'Connor_7

Health Care..

Not to circumvent the topic but why if we abide by NAFTA and ship the jobs overseas is it then in fact illegal to purchase Rx via mail order from Canada or Mexico? If the drugs can be certified safe why can't we all buy from the cheapest vendor.... Robert O'Connor/NJ

\"Maine\" doug

Because the drug companies

control can overide the "rules". The US drug companies are currently cutting off sales to the Canadian internet outlets. So the internet companies are looking to Ireland and other countries overseas for supplies to then resell in the US.