Part 3 - Why Incentives are Important
The goals of my solution to the healthcare crisis are as follows:
1) Restore the free market system to the medical industry
2) Incentives should encourage personal responsibility
3) Increase access to medical care for all groups
Instead of eliminating the concept of multi-tiered medical services, I suggest that we nurture and develop it. The different groups of people I discussed in my last post do not all need the same sort of coverage, and they do not all deserve identical healthcare services just because they happen to have a social security number and a pulse (or not). Some people bring more to the table than others, and I believe that whoever makes the coffee should get to enjoy the first cup. In order for our society to excel we must encourage success, discourage abuse, and protect the helpless.
Achievement of success requires proper encouragement. While some people have a natural drive to excel, most of us will be as lazy and useless as we can possibly get away with. This is why the welfare system is a failure and why all Socialist programs are doomed to mediocrity: if excellence goes unrewarded, then excellence ceases to exist. This can be considered a corollary to the concept of entropy.
The Problem with Medicare/Medicaid
Our present socialized medicine experiment, otherwise known as the CMS, is a perfect example of what happens when incentives are poorly conceived. Currently, payments to physicians for their services are standardized across the nation without regards to outcomes, quality of care, or years of experience. These payments seemingly decrease every year and are burdened with stifling bureaucratic regulations which complicate and restrict the provision of medical care.
When patients are not personally responsible for payment of services, they have no incentive to question or limit the medical services that they seek or that are recommended. The stroked-out granny might as well have that feeding tube placed so that she can be tuned up a little bit in between ICU visits. When they don't have to pay anything for their ICU admission, patients have no financial incentive to go to their dialysis appointment instead of the crack house. When patients pay nothing for their medications, there is no incentive to choose cheaper ones.
Furthermore, the incentive for physicians (since their payments are fixed) is to spend less time with these patients and to perform better-reimbursed (even if questionably necessary) procedures. How can costs not continue to escalate in such a system? The incentives are all wrong!
My proposed solution for this problem is to restore the free market to medicine by allowing balance-billing of Medicare services and copays for Medicaid patients. Only when physicians are allowed to charge market price for their services will the proper incentives be restored. Not only will more physicians be likely to accept Medicare patients, but they will be able to spend more time with them as well. When Medicare patients are given the choice of paying $50 extra to see a physician this week or waiting 4-6 weeks until the "free" doc has an opening, then they are empowered. When families are faced with the prospect of actually paying for some of granny's end-of-life care, then they will likely make more reasonable decisions. And that's money in the budget that can be used for more appropriate indications.
Access of the Medicare population to medical services is already becoming difficult for some, but a true crisis looms in the next couple of decades as the baby-boomers reach retirement age. Those patients who are able to spend some of their extra money to obtain premium medical services should be allowed to do so. Those who cannot may have to rely on the safety net I will propose in my next post.
As far as Medicaid goes, I would institute other reforms in addition to requiring copays for medical care and medications. Although I think it would be difficult to implement, I think mothers on Medicaid should be required to take mandatory depoprovera shots as long as they are receiving public assistance. If they can't support their current family then they shouldn't keep popping out more of them.
Medical insurance
HSAs are the best option for most people, particularly if they are begun early. These plans cost much less than traditional medical insurance, although they feature much higher deductibles and limited prescription benefits. The monthly savings from such a plan can be invested on a pretax basis, and these savings are used to pay for most routine medical needs. These plans encourage both personal and fiscal responsibility, because they essentially reward healthy lifestyles and punish overuse of medical services. These are the proper sorts of incentives we need in this country if we are going to reduce our overall healthcare expenditures. Contrast these incentives with those of the typical Medicaid patient, who gets a bigger monthly check for every extra kid she pumps out that she cannot afford, who gets three free prescriptions per month, and who pays nothing whatsoever to visit the ER as often as she wishes, signing in all of her kids whether they are symptomatic or not. Do you think that would happen if she were responsible for paying the bills? Hell no, it wouldn't.
Once the savings account is well-funded, the financial stress of paying a high deductible for an unexpected medical disaster is eliminated. And of course the expenses in excess of the deductible are covered, preventing financial ruin. Furthermore, the higher cost of medications forces the insured (or their physician) to carefully examine the med list and choose specific medications which balance affordability and efficacy, rather than passing the cost of the latest and greatest medication onto their fellow citizens as in traditional or "single payer" plans.
Of course HSAs do not fit the needs of many chronically ill patients, but in reality such patients are not good candidates for any insurance plan if cost-containment is the goal. And make no mistake, cost-containment is always a goal of anyone who oversees a budget. The unspoken purpose of healthcare rationing is to delay the diagnosis and treatment of the sick in the hope that some of them will tire of jumping through hoops and either get better on their own, give up, or die before they run up the bill. While a healthy patient infuses money into the system, a chronically ill patient who requires expensive tests or therapies is bleeding dollars, no matter whether the coverage is single-payer or private insurance. To the bureaucrats, a cancer patient who dies before starting expensive chemotherapy and bone marrow transplantation only means more money for next year's budget (or their yearly bonus). Therefore if anyone but yourself is paying the bills, you should be aware that they will NEVER have your best interests in mind.
That's why I think that most people should pay for their own medical care whenever possible, depending on outside coverage only as a last resort. Whew, I've still got a lot more to say, but that's enough for now. In the next post, I'll discuss the safety nets I have in mind as well as some ideas that might improve the access of care for many.
Part 4 - The Safety Net
1) Restore the free market system to the medical industry
2) Incentives should encourage personal responsibility
3) Increase access to medical care for all groups
Instead of eliminating the concept of multi-tiered medical services, I suggest that we nurture and develop it. The different groups of people I discussed in my last post do not all need the same sort of coverage, and they do not all deserve identical healthcare services just because they happen to have a social security number and a pulse (or not). Some people bring more to the table than others, and I believe that whoever makes the coffee should get to enjoy the first cup. In order for our society to excel we must encourage success, discourage abuse, and protect the helpless.
Achievement of success requires proper encouragement. While some people have a natural drive to excel, most of us will be as lazy and useless as we can possibly get away with. This is why the welfare system is a failure and why all Socialist programs are doomed to mediocrity: if excellence goes unrewarded, then excellence ceases to exist. This can be considered a corollary to the concept of entropy.
The Problem with Medicare/Medicaid
Our present socialized medicine experiment, otherwise known as the CMS, is a perfect example of what happens when incentives are poorly conceived. Currently, payments to physicians for their services are standardized across the nation without regards to outcomes, quality of care, or years of experience. These payments seemingly decrease every year and are burdened with stifling bureaucratic regulations which complicate and restrict the provision of medical care.
When patients are not personally responsible for payment of services, they have no incentive to question or limit the medical services that they seek or that are recommended. The stroked-out granny might as well have that feeding tube placed so that she can be tuned up a little bit in between ICU visits. When they don't have to pay anything for their ICU admission, patients have no financial incentive to go to their dialysis appointment instead of the crack house. When patients pay nothing for their medications, there is no incentive to choose cheaper ones.
Furthermore, the incentive for physicians (since their payments are fixed) is to spend less time with these patients and to perform better-reimbursed (even if questionably necessary) procedures. How can costs not continue to escalate in such a system? The incentives are all wrong!
My proposed solution for this problem is to restore the free market to medicine by allowing balance-billing of Medicare services and copays for Medicaid patients. Only when physicians are allowed to charge market price for their services will the proper incentives be restored. Not only will more physicians be likely to accept Medicare patients, but they will be able to spend more time with them as well. When Medicare patients are given the choice of paying $50 extra to see a physician this week or waiting 4-6 weeks until the "free" doc has an opening, then they are empowered. When families are faced with the prospect of actually paying for some of granny's end-of-life care, then they will likely make more reasonable decisions. And that's money in the budget that can be used for more appropriate indications.
Access of the Medicare population to medical services is already becoming difficult for some, but a true crisis looms in the next couple of decades as the baby-boomers reach retirement age. Those patients who are able to spend some of their extra money to obtain premium medical services should be allowed to do so. Those who cannot may have to rely on the safety net I will propose in my next post.
As far as Medicaid goes, I would institute other reforms in addition to requiring copays for medical care and medications. Although I think it would be difficult to implement, I think mothers on Medicaid should be required to take mandatory depoprovera shots as long as they are receiving public assistance. If they can't support their current family then they shouldn't keep popping out more of them.
Medical insurance
HSAs are the best option for most people, particularly if they are begun early. These plans cost much less than traditional medical insurance, although they feature much higher deductibles and limited prescription benefits. The monthly savings from such a plan can be invested on a pretax basis, and these savings are used to pay for most routine medical needs. These plans encourage both personal and fiscal responsibility, because they essentially reward healthy lifestyles and punish overuse of medical services. These are the proper sorts of incentives we need in this country if we are going to reduce our overall healthcare expenditures. Contrast these incentives with those of the typical Medicaid patient, who gets a bigger monthly check for every extra kid she pumps out that she cannot afford, who gets three free prescriptions per month, and who pays nothing whatsoever to visit the ER as often as she wishes, signing in all of her kids whether they are symptomatic or not. Do you think that would happen if she were responsible for paying the bills? Hell no, it wouldn't.
Once the savings account is well-funded, the financial stress of paying a high deductible for an unexpected medical disaster is eliminated. And of course the expenses in excess of the deductible are covered, preventing financial ruin. Furthermore, the higher cost of medications forces the insured (or their physician) to carefully examine the med list and choose specific medications which balance affordability and efficacy, rather than passing the cost of the latest and greatest medication onto their fellow citizens as in traditional or "single payer" plans.
Of course HSAs do not fit the needs of many chronically ill patients, but in reality such patients are not good candidates for any insurance plan if cost-containment is the goal. And make no mistake, cost-containment is always a goal of anyone who oversees a budget. The unspoken purpose of healthcare rationing is to delay the diagnosis and treatment of the sick in the hope that some of them will tire of jumping through hoops and either get better on their own, give up, or die before they run up the bill. While a healthy patient infuses money into the system, a chronically ill patient who requires expensive tests or therapies is bleeding dollars, no matter whether the coverage is single-payer or private insurance. To the bureaucrats, a cancer patient who dies before starting expensive chemotherapy and bone marrow transplantation only means more money for next year's budget (or their yearly bonus). Therefore if anyone but yourself is paying the bills, you should be aware that they will NEVER have your best interests in mind.
That's why I think that most people should pay for their own medical care whenever possible, depending on outside coverage only as a last resort. Whew, I've still got a lot more to say, but that's enough for now. In the next post, I'll discuss the safety nets I have in mind as well as some ideas that might improve the access of care for many.
Part 4 - The Safety Net
Labels: health care crisis
posted by scalpel at 4:00 AM
22 Comments:
When I blogged about this (here and here) one thing that impressed me was the thoughtfulness of the comments I got. It's an issue that serious people (as pundits like to say) can disagree on strongly. As complex as it is -- and given the realities of American politics -- it's hard to imagine any solution making it into action without getting loaded down by disingenuous compromise. One thing you and I clearly agree on: the perversity of the system which prevents docs from charging based on value, and with no regard to who's doing a good job and who isn't, and no allowance for "market forces." HSAs, like tax credits for insurance premiums, have not much relevance to people who can't afford to save, or who make so little as to pay hardly any tax. That's a place in which you and I part company.
Dude, you need to publish this in Annals or something when you're done with it.
I'm going to address the chronically ill and the indigent patients who don't fit into the HSA model (or any other insurance model for that matter)in my next post.
The healthcare problem in this country can’t be solved until you are able to correctly identify it. The two “problems” that you state in your first piece [1) The poor folks in America have limited access to health care services 2) Health insurance (and American medical care in general) costs too much] are really only symptoms of a larger more endemic problem. The true problems are far more complex but stated as simply as I can the basic dilemma stems from the fact that our health care system is designed to treat illness.
What is wrong with that? Nothing if you don’t mind getting ill before the system does anything for you, but as I stated it is a bit more complicated then that. In our system we have built in rewards for the practitioners if we stay sick longer or are sick more often. These rewards are called profits.
It is more profitable not to cure me of my illness and it would ruin the system completely if it were possible for everyone to be in good health for the rest of their lives. That isn’t the best motivation for the drug industry to find a real and permanent cure, nor is it an incentive for the medical system to provide help to its clients to stay well. There have been moves in that direction but the disincentive of the system has a limiting effect. Who will spend the time and resources on wellness when there is no return on investment and in fact it reduces profits in the long run
If we attempt to apply the same rules to the economics of healthcare that we do to our capitalist economy in general we find some major problems. 1) The profit motive, as stated above, is favoring the wrong outcomes. 2) The standard business model produces a reverse effect when applied to a healthcare business such as a hospital, clinic, or MRI facility. 3) The insurance system, even with the attempts that have been made in recent years to “reform it,” still effectively causes much of the inflation we experience in healthcare costs.
One way to approach the problems described above (this is by no means a solution) would be to eliminate the profit motive by legislatively forcing most healthcare and pharmaceutical organization, including private practitioners, to operate as non-profit companies. I have several concerns about this concept not the least of which is the difficulty in attraction sufficient numbers of the “me generation” and all of those educated in our existing system to replace those fleeing the system to more lucrative careers.
The external motivation of high monetary rewards has enticed many into careers in medicine. If the rewards decrease we would be left with only those motivated by the desire to help others. I’m not optimistic about the result in the short term. We might have to wait for a new generation and we would definitely have to change our educational system to one based on internal motivation, rather than the current methods which rely on the misdirection of external rewards. I’m sorry if that sounds cynical.
Catholics would throw a hyper spazz with your birth control proposal.
When I did my public health rotation, all Medicaid patients with newborns received at least one visiting nurse visit to check up on the mother and baby. During that visit, the mother received birth control education. Pitching birth control was pretty easy at that stage of the game. We'd talk about each kind and they'd select something for the most part and we'd write that on a plan of care document that they could take to their follow-up OB appointment.
Of course, rarely, they'd say they didn't want information or didn't believe in birth control and that was that.
I can't even begin to address in a reasonable number of words the number of times you've proven you don't understand economics.
I'll just address the biggest one.
If a government sponsorship is paying whatever they are billed without serious question, that is NOT "free market".
Government sponsorship, and insurance companies are part of what has driven costs up, by being willing to pay it. If all of your patients had to pay on their own, their would be far fewer patients in your waiting room. And far more people would die younger than they needed to.
AND your (and your cohorts) would suffer a serious loss of lifestyle.
Before Medicaid and wide-spread health insurance, doctors lived lower-middle class lifestyles, and nurses lived lives of poverty.
Now I wish I hadn't killed my blog. I could go on for 2000 or more words on this subject.
Mage
You just proved that you don't understand medical billing or third party reimbursement.
Neither government programs nor insurance companies pay us "whatever we bill them, without question."
The government pays us a meager sum that is the lowest they think we will possibly accept, then lowers it the next time they revise the fee schedule. We are forbidden from billing the patient the difference between our customary charges and what the government pays us.
Insurance companies limit how much we can charge their patients as well; we essentially discount our rates with them to obtain their business. We often have trouble getting these patients to pay their portion of their bill, because they think the company is supposed to pay for everything.
Perry, if we don't get paid for actually treating your illness despite our best efforts to prevent it, you aren't going to live very long either.
Scalpel off topicbut I hope it is alright that I linked your hilarious Veggie Tales post to my Bajingoland brochure. :)
Also Your first post in this series was great an I am looking forward to coming back to read all posts and comments on this topic. most important topic!
NOBODY understands medical billing, except for a handful of specialists. I'm completely familiar with 3rd party reimbursement, however, having made a large portion of my life's income from repair contracting for insurance companies.
I didn't suggest that you currently were able to bill whatever you want, or at least I didn't mean to. I was objecting to you stating that medicine should return to a state of free economy, then describing a circumstance in which doctors could bill any amount that another doctor was managing to get (to Medicare/Medicaid).
So let me try again. Let's take a simple, even juvenile example of what a true "free economy" is.
As a young boy, I would go door-to-door with a lawnmower in tow. Knock on a door, "Ma'am, I'll mow and trim your lawn for $3." (it was a long time ago.)
Ma'am says, "That's not a bad deal, and the lawn really needs mown. But I only have $2."
I think to myself, "That'll buy a week's chips and Pepsi." Then say, "deal."
There are other factors in the background here, such as how many boys knocked on her door and offered to mow the lawn for a fee, how much THEIR fee was, how willing Ma'am was to ignore the shaggy lawn...
The point is, in a free market economy, there are no "third party reimbursements." There is a customer and a producer, and a major factor in the negotiations is the customers' willingness and ABILITY to pay.
Doctors are one of, if not THE highest compensated trade. Family practitioners (one of the lowest-paid categories of medical doctors) make an average of over 140,000 dollars per year.
This is nearly 10 times the poverty level. In the tiny town where I live, nearly all of us live at or just barely above this level, and for the most part we are comfortable. I, for one, was EXTREMELY comfortable at 36k/yr until I was semi-disabled by a medical condition that should have been forseen, as often as I've been seeing doctors.
For many of us, the second largest debts we have, next to mortgages, are medical debts. And they stand head and shoulders above the next debts in line. (Automobiles and Consumer Credit.)
And Perry has some very good points. Why should I pay you 3 times as much for emergency treatment of a cardiovascular problem 3 months after you told me my heart was completely healthy? (Then the Angio Surgeon said, "two arteries were so blocked I couldn't really see where they were.")
I'll happily pay you (and have for 25 years, from my own pocket) to keep me healthy, I would have happily paid for stents and angioplasty at 1/3 the emergency price as a preventive for major problems. But, fail to keep me healthy, and I resent paying extra for your failure.
Many American Aboriginal tribes followed an interesting practice. All healthy members of the tribes contributed to the household of the healer. No sick member did.
You want to talk about incentives to help maintain health? That's got to be the best one available.
Your proposal means that, for those of us uninsured, the minute we actually need your services to stay alive, we can't get them.
So, yes, I did show I don't understand medical billing. But you don't understand a free market economy either.
Mage
You can pay all you want to try to stay healthy, but there is no guarantee that you will. Even the best preventive medical care is often unsuccessful at preventing complications, and the law of entropy guarantees that our bodies will eventually deteriorate despite the best of intentions.
Stents don't improve mortality, btw; they are marginally better at relieving angina symptoms, but they don't affect mortality except in (drumroll.....) acute MI.
We buy insurance against acute catastrophic events like car accidents, fires, disability (oops!), and heart attacks. Once someone is already disabled, then they don't need insurance anymore....but they may need assistance from their fellow citizens. That's where our taxes come in.
I would add that if you go through life worrying about how much money other people are making, you will never be happy.
You are apparently the one who doesn't understand capitalism. If I would have been happy making $36,000 per year, I could have gotten that much right out of college at age 22 and enjoyed my prime years.
I chose a profession with a higher earning potential that required me to work 100+ hour weeks during the prime years of my life, and I'll be damned if I'm going to feel guilty about how much money I earn.
If you think you can find someone that can keep you healthy for schoolteachers' wages then you have my best wishes. Perhaps that is another solution to our healthcare crisis; let anyone practice medicine, regardless of training.
Then only the wealthy will have access to MDs.
"If you think you can find someone that can keep you healthy for schoolteachers' wages then you have my best wishes." Completely true. Unless you can appreciate the immense sacrifice it takes to become a physician you will always think that they are overpaid. Mage is obviously a victim, yet somehow I manage to work full time, go to school and support a family of four with full health coverage.
Rule #1: the cream will always rise to the top and there will always be the haves and the have nots, but in a capitalist society the have nots have a fighting chance of rising to the top. Yes, it is infinitely more complicated, but for the most part that is why bright, motivated young people choose well compensated fields. Doctor's salaries are a pittance of the overall health care costs in the US (see comment in NY Times August 5th letters to the editor).
Yes, let's cut physician's wages; we could end up with a nation of bright, motivated, 'altruistic' litigators. Imagine...
"and the law of entropy guarantees that our bodies will eventually deteriorate despite the best of intentions."
I am 45, vigorously active, (even with Congestive Heart Failure) have eaten a low-fat low-sodium diet since I was 24.
"Stents don't improve mortality, btw; they are marginally better at relieving angina symptoms, but they don't affect mortality except in (drumroll.....) acute MI."
I was in the ER with dangerously high blood pressure and acute angina just a short time before my (drumroll...) acute MI. This ER visit cost me over $9k over a 16-hour period. The one test that mattered was left out... the one that would have spotted the blockages in three of my major heart arteries, the most severe in the RV artery.
And you want me to pay your brethren more for fixing a problem they should have spotted early?
I don't worry a bit about how much money other people make. My best friend is the son of a multi-millionare, and his father is among the "second-best" list. But when someone who makes too much money wines that they could fix the problems of the world if only they made more, it bothers me a bit.
"You are apparently the one who doesn't understand capitalism. If I would have been happy making $36,000 per year, I could have gotten that much right out of college at age 22 and enjoyed my prime years."
Um, hmm... I have been self-employed since the age of 10, and one of my degrees is in economics. I guess I DON'T understand capitalism. And you openly admit profit as your motive for becoming a doctor? God, I hope I'm not ever treated by you.
"I chose a profession with a higher earning potential that required me to work 100+ hour weeks during the prime years of my life, and I'll be damned if I'm going to feel guilty about how much money I earn."
I chose a profession with a somewhat low earning potential that required me to devote all of my waking hours and some of my sleeping hours to it, and found a way to make it pay well enough to pay doctor's bills to explore my many potential (most turned out eventually to be real) health concerns. I don't want you to feel guilty about it. But you should be ashamed to think that increasing it will fix everything.
I DID make $36k/year at 22, right out of the military, and before I began my college career, and I eventually worked my way up to 6 figures. It is the incompetence of doctors that prevents me from making that now, at the age of 45.
I don't think I can find anyone that can keep me healthy for schoolteachers wages. I don't think I can find them for ANY price. So why should I support your wealthy life? Now I only struggle to pay the minimum necessary to keep the medications coming that will marginally prolong my life, and hope desperately that I can outlive my mother, so she doesn't have to bury her son.
Medicine is not a profession, it is a religion. And I no longer believe, if you haven't guessed by now.
Mage
'scuse me, I meant LV artery
"Medicare Granny" is living on $700 a month you ass!!! figure that out will ya? You probably spend more than that on groceries. How the HELL is she supposed to give you another $50?? you would take the food out her mouth? Why do you assume she has family or that are willing to pay for her? There are no laws saying you have to pay your grandmothers expenses or mothers or fathers expenses you fool. Have you tried living on $700-1100 a month? Lets see -rent (do you know how much it costs to rent a place to live?), utilities , food, oh yeah lets not forget the fact that they CHARGE you for you medicare, think shes got an extra $50 and lets nitpick the fact she gets her meds free, If she didnt , she wouldnt have any. Or she might already be paying for prescription insurance thru medicare and be paying co-pays. Either way - SHE HAS NO MONEY TO GIVE YOU!!
The sad thing about Medicare patients is that they believed the lies they were told by well-meaning socialist politicians so many years ago....that if they worked all their lives and paid money into the system that the government would take care of their medical needs into eternity.
Well guess what? Socialism doesn't work, and it's not my fault. Just because you have Medicare doesn't guarantee that you will be able to find a physician to treat you for the amount the government has decreed they will pay.
I'm not saying granny has to pay an extra $50 to see a doctor. She can wait in line behind all the entitled Medicare baby boomers who also expect their benefits will cover their medical needs. The next open appointment is in 3 months....I hope she lives that long.
All I'm saying is that if she wants to pay extra for better service, then she should be allowed to do so.
This is all so interesting and I wish I had something intelligent to contribute.
Silly scalpel, it wasn't till very recently in Texas that we started giving birth control for free to anyone who makes less than 35 grand a year-as half of babies born in texas were medicaid babies.
It should be interesting to see if it affects birth rates.
Depo is a poor choice-how about an IUD as an additional option
Loved your comment about women on medicaid with kids - yes I believe they have to have some form of birth control too - like depo.
Plus the reimbursment on a medicaid patient sucks - not to mention if they don't get the proper authorization/referral (on the hmo medicaids) you're screwed - (in our case being radiology vendors not seeing the patient we don't know this till after the fact so it's too bad, so sad for us!) Medicaid states can't bill the patients - well they should make it manditory that the patients follow their insurance guidelines in order to have the exams!
Don't even get me started on Charity care - (healthcare for the uninsured). Most of them that get it (in our area at least) can't afford to go to the doctor - but they can afford their cocaine everyday! Explain that one!
Great post!
I'm a little late to the discussion.
Depo does have some side effects and there are some people who can't use it. I do think that free birth control and contraceptive counseling would be a great way to look at decreasing costs.
I'm a physician, so I have fairly decent insurance. I also have an expensive chronic medical condition (UC with pancolitis) which requires periodic colonoscopies, expensive drugs (as close as I can figure out, my drugs cost my insurer about $500+/month), and has come close to requiring hospitalization a couple of times. There's also the frequent gi doc visits, labs, etc.
The thing is, without my expensive drugs I would have been too sick to work for most of the past 6 months. As it is, my productivity has been affected because I can't work more than 60-80 hours/week and manage to stay well.
The problem with HSAs is that not all employers offer them (mine does not). Also, if you live a life as a medical student where you live on $700-$1100/month, you have no money to put away for later. You just have to survive the now. Although now, I'm putting some money away, it doesn't account for much, yet.
I just can't figure out what people without insurance would do in my situation. I'm pretty lucky. It's an annoying disease, but I can get all the care and drugs I want for a $15-25 copay. If I didn't have insurance that covered meds? I'd be hosed.
Just found your blog today. My small employer (40 employees) switched to high deductible-HSA insurance 3 years ago. The HSA rules require the employees to pay a small premium. Our employer makes a matching contribution to the employees HSA account equal to the premium. IOW, the employer is paying the equivalent of 100% of the insurance premium for all of the employees, and their spouses and their children.
Yes the deductible is high, $3500 per person, $7000 per family. Some employees have chronic problems and haven't been thrilled, but most have growing HSA accounts. My HSA is growing and healthy. I am providing the dental care and vision care my family needs from my HSA as well.
The Insurance is there in case something bad happens, I can take care of the small stuff myself now.
I adored this post, thank you Scalpel! It was very Ayn Rand of you. I am quite the fan of your blog, please maintain it!
I truly loved reading your post. Thanks!
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