BLOGS: Open thread

Now I feel like a real blogger.  Between HSA maverick Ron, the Gadfly, Sue, TheoraJones, Abby, Graham et al, the comments in the last week have got bigger than the blog….and I’ve been real busy and unable to monitor.

That’s great but today’s were mostly way off topic from my pithy attack on Karen Ignagni’s letter.  So how about an open thread (like they do on the real big blogs) so that you can all chat about whatever you like.  My suggestion is that Ron tries to explain the maths behind everyone in America paying $130 a month in insurance premiums, while health care costs as a whole are closer to an average of $500 a month, and those costs are not distributed equally. But you can all talk about whatever you like!

Now I’ve lit the blue touch paper, I’m retiring

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  1. I’m a 49 year old female that has been in excellent health for 15 years. Well I thought I was anyway, so since my divorce in 2004, I haven’t had health insurance. I had a heart attack on 7/31/2006. They said I had 100% blockage of the Ramus (whatever that is) and when the went in to put in the stent they found 95% blockage. Is there a program that can cover me for these medical bills, and, is there an insurance company that I can get insured with from this point forward?

  2. I have fairly good insurance through BlueCross-BlueSheild of Kansas City, but have rencently discovered I am pregnant with my second child, and have not been insured with them for two years, so I have been informed they will not be paying for Pre-Natal care, or the delivery. My first delivery resulted in my inability to deliver vaginally in the future, so I must have a C-Section, which would be in the tens of thousands. I am a healthy, normal risk pregnancy, is there any resource to save me from this impending debt?

  3. It seems like this conversation is dead, but I just wanted to add one question for Ron in case anybody is still listening.
    The thing that makes me skeptical of your analysis of all of these people winning on the HSA is you tell the winner’s side of the story but don’t tell the loser’s side. With the way healthcare works today, everything is a zero-sum game. If one person is winning, another person is losing, because in healthcare, nobody is interested in actually adding value. All of the improvements are about “increasing negotiating power” and “moving risk”.
    So in the scenarios you describe above, the employer is happy and the member is happy, but the healthplan is losing about $5000 per year. Where is the healthplan getting that extra $5000 from? And if they’re not getting it from anywhere, what makes you think that’s a stable situation?

  4. Well I could advertise read “Business Week – It’s enough to make you sick.” on WJR in Detroit during drive time for $500 a minute and thousands of their clients would go crazy. What about their agents.
    Yes, I think losing thousands of clients paying hundreds a month is pain. Imagine that poor manager taking questions from his agents about that article being advertised. It’s enough to make me laugh.
    The same company is high lighted here under Individual health insurance problems at the Health Care Blog.
    I haven’t yet advertised against them but their clients are too easy to switch when I pull out my colored copy of the article.
    The CEO is writing about negative articles to the stock holders. He said this could effect the bottom line. In my book that’s called pain.
    Many times my commercials butt up to UICIs and then a commercial about them would have added punch. Currently, I don’t go after the competition much. However, I do say: Paying way too much for health insurance, got the Blues, seeing Red? I did go after Representative Greg Ganske in commercials on WHO, so sometimes I do get personal. I know for a fact it caused Greg Ganske pain and now he is in the private sector where he belongs. Jan Mickelson was interviewing Ganske when he was running for the Senate and played my commercial and asked Ganske to respond.
    Senator Grassley used a variation of that commercial and the Des Moines Register wrote about it. Mine was better than Grassley’s, more pain.

  5. Ron,
    You write things like “Hey Nick – your worst nightmare has just come true. I can cause you pain and make it last. I’m as dangerous to you as a heart attack.” And I’m the loon?

  6. Rick you are a loon.
    You said don’t try and tell us HSA can be free, that insults our intelligence. I said, “Sorry Rick our HSA is free, there are no fees.”
    Rick said, “Fight the urge, Ron, to tell me HSAs are sustainable just because the unused balance rolls over, I get it.” I am sorry Rick but I have no idea what you said there.
    Rick once I enroll someone into an HSA and they get, say $10,000 HSA balance, they can change their HSA fiduciary at any time. It is their account. Our main function is their HSA low cost health insurance.
    We don’t make any money on the HSA Rick, we don’t care if they want to move their account from the free one, you loon.
    Rick, make more sense when you blab.
    I am not setting myslf up as an evangelist, geesh.

  7. //unending sales pitch is taking on the character of a late-night infomercial//
    That seems to be the point. Whether he’s profiting from the sale of HSAs or not, Ron is setting himself up as an evangelist. He’s eyeing a slice of Newt’s 50k per public speaking engagement. Testimonials and press (re: the guy who hasn’t been helping Ron publicize his HSAs) are probably more effective than dry facts and statistics when it comes to proving one’s ability to lead a tent revival.

  8. Ron,
    Nice rope-a-dope you’re trying to play there. If you can get me a “free” HSA without buying a health plan (and thus, more likely than not, having to be underwritten), or being on a qualifying health plan already, then I’ll be the first to your door. We both know you can’t deliver that because the law requires the qualified health plan first.
    I don’t mind you trying to sell HSAs, or whatever is your flavor-of-the-month. I mind the dishonesty and insult of fronting them as free, while dodging discussion of the qualifiers. To be fair, I’d trade my FSA for an HSA. But I say that with eyes wide open, knowing fully that it only satisfies selfish needs for the short term, when what I, and most others, really want is a sustainable solution. (Fight the urge, Ron, to tell me HSAs are sustainable just because the unused balance rolls over. I get it.)
    I know full well that HSAs are gimmick-of-the-month, are too complex for most people to wrap their arms around (as proven over-and-over on this thread), and have an unsustainable financial structure on the supplier side should they actually gain broad acceptance. For years, I’ve used an FSA, and my ex-wife, who had training in medical office billing, never understood it. She’s as average-American as it gets, and for her, the concept was like an Aborigine looking at a ferris wheel.
    This unending sales pitch is taking on the character of a late-night infomercial. The audience knows what’s being sold doesn’t work over the long haul. So whaddaya say we change the channel (I mean, really, Ron: don’t you tire of trying to explain the unexplainable?)

  9. //I wonder if this is too evil for the current administration to consider, or if it’s just evil enough?//
    I think the toe in the water here was the suggestion that chips be injected into children to protect them from kidnapping. That pitted the parents worst nightmares against the chip. If I remember correctly, the ACLU amazingly managed to fight it off despite the playing of the Lurking Child Molester card.
    //smallest single deductible is $1,000//
    I still think forcing the “real cost” of health care onto individuals will result in people skimping on care they actually need and create undo added stress when they do finally seek it. Nothing like a preteen with a burst appendix afraid to say anything because her single working Mom is barely making rent. Not to mention that in an emergency, people have to pay whatever the provider demands: it’s a captive market.
    From what I’ve read, HSAs aren’t confronting people with “real” costs at all, they are chaining them to fake costs. On the other hand if costs were shared in the form of taxation, people would realize their common interests and work together to keep the costs down.

  10. //any facts – any – to back up what you have said?//
    Only the experience of having watched the MBAs in action while working in a business division of Kaiser. Kaiser was snapping up the people that BofA sloughed off during their numerous realignments.

  11. Abby,
    What happens with a $450 a month RX charge?
    The deductible for a single HSA is $2,600 a year, usually. After covered expenses, including RX, hit $2,600 all covered claims are covered 100%. And of course the deductible can be paid with pretax dollars with an HSA.
    A single can move the deductible down but the premium will go up and HSA deposits will be restricted to the size of the deductible. The smallest single deductible is $1,000 adjusted to inflation.

  12. Matthew,
    $50K speaking fees and the $200K memberships and don’t forget the book sales.
    You said, //Please don’t try to sell us on the notion that HSAs are free. That borders on insulting.//
    Sorry Rick, our HSA has no fees and only pays interest. Our insurance company is the only company with the insurance and the HSA. Most insurance companies partner with banks and usually they charge $4 a month and the client gets a debit card. HSA clients may also place their balance in mutual funds with these banks.
    Because we have both the insurance and the HSA we can do some things that nobody else can. We can have the claim department send the claim to the HSA department and the provider is automatically paid. Then some employees say, “I didn’t pay a co-pay or nothing, it was just paid.” Of course their HSA balance was just debited but you know how some people think.
    It figures you have an HSA Matthew.

  13. AAARGH! I’ve been reading these comments for the past couple of days, and I think I just had a stroke…of genius!
    EMRs, HSAs and now Real ID. All of this adds up to a single, technological solution to provide the quickest, largest possible addition to the healthcare margin AND will act as a boon to Homeland Security as well. How? Simple:
    Real ID is nothing more than a National ID card, but who wants to carry one of those around? Not me! And what good is an EMR if it’s not accessible (lack of interoperability, network downtime ect.)? Not much good at all!
    Combining the Real ID and my EMR into one, easy to read RFID chip implanted into center of my forehead will not only ease the burden of helping emergency workers determine who I am and what is wrong with me, but give me piece of mind as well. No more pesky Mexicans stealing my tax money sucking up vital free market dollars with their little “life threatening aliments”.
    Think about it. It’s portable, cost effective, interoperable (just spit out a stream of HL7 with my past diagnosis, travel history, allergies, political affiliation…), AND – and this is the kicker – we can tie it into my Health Savings Account! With a little work, we could get denials transmitted from my health plan before any costly medical care is given away for free.
    Think about it, there’s been a terrorist attack (not that this will ever happen again because were safe now) and the emergency workers are going over the moaning mass of victims doing triage. With handheld scanners they could asses not only how well I am doing right now, but also access my EMR to determine if I have any pre-existing conditions which might warrant treating me sooner. At the same time they could run a credit check on my account and see how much I was worth, effectively bumping me down on the list of viable patients.
    Wow, my head is spinning with the possibilities. I know that this is somewhat off-topic, but when inspiration strikes you’ve got to go for it, besides – this is an open thread.
    I wonder if this is too evil for the current administration to consider, or if it’s just evil enough? I should float the idea to someone who makes these kinds of decisions. If it’s too evil we could always put a little spin on it like “Not getting chipped helps the terrorists” or “Health care delivery is in CRISIS!!”.
    Man, I am so going to make a boatload of cash with this.

  14. Ron,
    Please don’t try to sell us on the notion that HSAs are free. That borders on insulting. That’s like saying that the tires are free when you buy a car to go with them. One must be enrolled in a qualifying health plan to get an HSA. The running gag around here is that CDHP stands for “consultant-directed health plans” because administering them is very complicated and makes lots of money for consultants.

  15. I’m sure that Newt’s 50K speaking fees and the 200K memberships his center gets from big health care companies are purely driven by the quality of his research into HSAs and EMRs.

  16. //I think they are grandstanding to get more funding. This is the same thing the L.A. ERs did. While these ERs may or may not need more money to keep their doors open, I think the public’s going to regret it if they allow these tactics to become successful. It’s like negotiating with terrorists. And the leverage is a bunch of critically injured people who are left standing on the sidewalk. This is what we get when hospitals are run by MBAs: it’s all one big game to them.//
    Yes, but you are ignoring the medical concerns of those who have been abducted by aliens. [sarcasm ].
    Do you have any facts – any – to back up what you have said?

  17. Ron,
    I apologize. My comments weren’t called for.
    Here’s my biggest concern about HSAs.
    Let’s say that you have someone with a chronic condition who will need to take drugs regularly for 50 or 60 years. List price on those drugs is around $450/month. How does an HSA give someone pricing power to negotiate down the price of pharmaceuticals?

  18. //Newt get’s paid $50,000 a speech for his HSA knowledge//
    Ron, we found some common ground. It disgusts me that Newt transformed himself into a “Health Care expert”. He’s also one of the movers and shakers behind the EMR: it makes me wonder who helped Newt establish himself as a health care consultant. To me, this is like the ex-CEO of Citibank setting up as an art purchasing expert after he retired. People work for years, invest in their educations, survive years of bad “entry level” jobs for bad managers, just to establish themselves as experts in their fields. However, people with money and power just get to declare themselves experts, and the rest of the world gets in line to throw more money and power at them. The whole system makes me nauseous.
    // important that the public understands that this medical school is in jeopardy//
    I think they are grandstanding to get more funding. This is the same thing the L.A. ERs did. While these ERs may or may not need more money to keep their doors open, I think the public’s going to regret it if they allow these tactics to become successful. It’s like negotiating with terrorists. And the leverage is a bunch of critically injured people who are left standing on the sidewalk. This is what we get when hospitals are run by MBAs: it’s all one big game to them.

  19. Treating Uninsured Patients Threatens Medical School
    [url] http://www.shreveporttimes.com/apps/pbcs.dll/article?AID=/20050510/NEWS01/505100318/1002 [/url]
    BATON ROUGE — A lack of money for treating the uninsured could force LSU Health Sciences Center in Shreveport to declare a financial emergency and lay off some of its tenured physicians and scientists, Dr. John McDonald warned the House Appropriations Committee Monday.
    While the layoffs would have an obvious and immediate impact, there would be a long-term impact that could last a generation.
    The proposed state budget allocates $26.5 million less to LSU Hospital-Shreveport than it will spend on treating patients without Medicaid, Medicare or private insurance, the third year in a row there has been a shortage.
    That means the Shreveport-based medical school, which by law derives about 40 percent of its income from the Shreveport hospital, must absorb the loss and there’s no means to do so in the coming fiscal year, said McDonald, chancellor/dean of the Shreveport campus.
    “We have no reserves to take care of the loss,” McDonald told the committee.
    “The hospital will survive, but the medical school will have to take financial exigency, and we will lose 20 to 25 percent of our faculty, and it will take 20 to 25 years to recover,” he said.
    “It is important that the public understands that this medical school is in jeopardy,” McDonald said after his testimony to the budget-writing committee.
    Gosh, and that socialized medicine in Canada means that you have to wait a few months before getting a tummy tuck. [sarcasm]

  20. My HSA is FREE Abby. There is no fee. To this day I’ve never made a penny on an HSA. And yes, I have driven 5 hours, each way, to enroll a single for $34 a month on HSA insurance. I lost money after expenses so I am really pulling in the big bucks like Newt. But because I am discussing HSAs, for FREE, here, I can’t be trusted?
    Abby I picked the above example because it’s hard to argue against it. Good luck, let’s hear your expertise, please. The best way to fight the HSA is to not discuss it. I can’t wait to hear your twisted logic. You better stick with attacking someone’s ethic’s. But Matthew asked me about the numbers and you were suppose to come up with valid counterpoints, geeesh.

  21. Yup, I knew that Ron worked in the insurance field. See, if we had single-payer, his line of work would disappear, or at least be drastically reformed. Ron is, what they call, a special interest.

  22. A 30 Year Old Nurse Who Is A Single Mother
    Pick Any Des Moines Hospital
    Annual Income: $50,000
    A single parent mother making $50,000 a year is not rich. Many employers will pay $400 a month for single coverage but the employee must pay the additional $400 a month to add on their child, out of their paycheck. Now the Mother has deductibles and co-pays on both her and the child. Probably, knowing health insurance like I do, the employee insurance has swithched from co-pays on RX to co-insurance ($10 co-pay for Generics and $25 co-pay on Brand Name PLUS Co-Insurance of 50% on Brand Name). Remember, some people when they get sick have RX bills of $1,500 a month, ask Montel Williams. So if the mother or the child got sick we have no idea what will be the out of pocket annual expense for just RX. PLUS, If the mother got ovarian cancer and could not work, a requirement for keeping her insurance, she would be put to COBRA for insurance termination. Everybody, including people who sell group insurance, say they can’t comprehend why that makes even the slightest difference in the world. To me it’s simple, I would prefer a contract that can’t be singled out for termination because of my relationship to some employer.
    The HSA Individual Option
    The Mother pays the total family premium of $78.68 per month. Now she saves $400 a month coming out of her paycheck that she can save or spend on her baby. The $400 a month, that the employer is currently spending on the Mother’s single insurance, is redirected to the bank, in the Mother’s Tax Free Health Savings Account or HSA. The bank must be FDIC insured, it’s the law.
    Annual Deposit From Employer: $4,800
    Maximum Annual Out-Of-Pocket (OOP) for the family: $5,200
    So the maximum annual OOP expense for this Mother and child is capped at $400 a year and she is currently paying $400 a month, out of her check, with no idea how much she could owe with co-pays and co-insurances.
    No FICA Tax on HSA deposits. The FICA tax is 15.3% and is split between employer and employee. Now the hospital won’t pay 7.65% on every dollar the mother earns. Employers love the HSA when they figure it out.
    The Hospital is depositing $4,800 a year in the mother’s HSA. She or her employer may maximise her HSA annual deposit and save on taxes, another $400 or a maximum of $5,200 may be deposited each year.
    When the mother goes to the doctor everything is the same. The doctor’s bill is $80 for example. The first thing is the charge is run it through the PPO, exactly like they are doing it now, and the charge is sent to the insurance company. The insurance company then sends an Explaination Of Benefits (EOB) that says, your $80 charge has been deminsished to Example: $50. Do you want to pay the $50 with personal funds or would you prefer to have it deducted from your HSA? Once covered charges hit the deductible they are paid at 100%.
    If the mother put the max in her HSA and didn’t use any HSA funds, which some people do, at 65 years of age she would have over $400,000 at 4% interest. If she uses average $1,300 a year she will have over $300,000. If she uses $2,600 a year she will have over $200,000 at 65 years of age. Also she has the freedom to place her HSA balance in mutual funds for the possibility of a higher return.
    I tell clients to max out their HSAs because 30 years of retirement health care expenses will be expensive. HSA funds dedicated to retirement health care expenses are never taxed and money that is never taxed will last longer in retirement.
    Next month retirement will be high lighted when the House throws it’s retirment bill on the table.
    Who thinks this Mother should keep her present employer’s insurance at $400 a month out of her check?

  23. Graham,
    I wear a Fortis ring because I used to run the largest agency in America for Fortis Insurance Company from 1993 thru 1996. Fortis has over 150,000 appointed agents. When President Clinton signed the MSA “Original Pilot Test”, in August of 1996, Fortis was the first with a qualifying plan, in just 8 weeks, and my agency wrote it. We wrote 3 of the first 5 MSAs in America. The first clients had to wait till 1/1/97 to make an MSA deposit. I got the 7-Eleven national account for their Franchisees and started enrolling them in January 1997, the first month. The first 7-11 owner is named Mike and he is the one who had a heart attack and quit smoking and his premiums diminished. Mike is 55 years old now and is married and today his premiums just went over $300 a month. The first employee of 7-11 to enroll was a single mother with two children who was uninsured because the lowest cost they could find was over $400 a month. MSA coverage for her and her boys was $78 a month and she paid the entire premium. The female 7-11 owner put $100 a month in the employee’s MSA for 1st dollar coverage for medical, vision and dental expenses.
    I have never enrolled a group plan because I believe the 30 hour required working clause doesn’t work with sick cancer patients. But Fortis was the first with group MSAs as well. So I contacted Greg Ganske’s office, Iowa member of the House, to enroll his employees and get the honor of the first group MSA too. I didn’t enroll them but I did become Ganske’s MSA consultant. Ganske learned too much and fired his staff, flipped sides, and sponsored the Democrats “Patient Bill of Rights”, the Ganske – Dingle Bill. Ganske brought in contributions from the insurance industry hand over fist when he went against the MSA. So I don’t think much of politicians.
    Fortis and Golden Rule had most of the market share on MSAs. The insurance industry was against dropping their high costs and fought the MSA tooth and nail. The MSA changed it’s name to HSA and was opened up to all Americans, under the age of 65, on 1/1/04. This is my 9th year of enrollments and we have thousands and thousands of clients. So I have examples coming out of my ears.
    I never said health insurance costs $130 a month per person. A 30 year old woman in Des Moines is currently $61.43 a month and a 63 year old woman is $206.01 a month with the most popular plan with a $2,600 deductible that pays 100% thereafter. Premiums go up about 3% a year for getting older. Anything other than single coverage is called “Family” coverage. The most popular family HSA plan has a $5,200 deductible then pays 100% of covered charges, including RX. HSA family insurance has one deductible for the entire family. If the 30 year old woman above adds on a child the cost would be $78.68 per month.
    Many single mothers’ employers will pay the cost of single insurance for the employee of $400 a month but for the mother to add on a child the mother must pay that expense, of another $400 a month, and many times the mother can’t afford that expense, so the child is uninsured. I suggest the mother pay 100% of her family premium of $78.68 a month and let the employer’s cost for single insurance, of $400 a month, be redirected to the mother’s HSA for first dollar coverage for her and the child. $400 a month is $4,800 a year or only $400 short of the HSA family deductible. $400 maximum Out-Of-Pocket (OOP) for her family is smaller than her OOP on her single coverage at present. Yesterday I enrolled a family and the employer was charging $600 a month to add the child onto the father’s employer plan.
    Knowledge is very small on the HSA. Those who say they support the HSA usually don’t. I have tried for 9 years to get the Des Moines Register to write an article on the HSA but they refuse. David Yepsen, their famous political reporter told me, “The MSA will never be “put to print”. I said, “But the President of the United States supports MSAs and you are the political reporter.” Yepsen said, “I don’t care, if it’s passed for everyone then I’ll discuss it.” Well it was passed for everyone and he still won’t, the jerk. Newt Gingrich did get an HSA article in the Register but it made no sense. Newt said that in the future everyone in America will buy their insurance from Iowa because they have the lowest rates. Well of course that’s insane. People are charged the rates of their home zip code so New Yorkers will never get Iowa rates. I contacted Newt’s expert Anne, what a joke, and at least he has hidden all those articles at his website centerforhealthtransformation.org but he can’t take back his stupidity with those published articles in IA, PA and Maine. To this day Newt’s so-called “Center” has the wrong deductibles on HSA insurance under “common HSA questions”. Newt says the smallest HSA deductibles for a single is $1,000 for a single and $2,500 for a family. The truth is the family deductibles are double the single or $2,000.
    And Newt get’s paid $50,000 a speech for his HSA knowledge and he has none. Bone up on HSAs Matthew and take away Newt’s speaking fees. I asked Newt’s expert Anne, “I bet if one of Newt’s employees were too sick and couldn’t work they would be put to COBRA for insurance termination, is that not true?” Anne said, “That’s one option.” I said, “Oh really, what are the other options?” She said, “I’m not going to discuss this anymore.” Then she tried to tell me that an HRA is as good as an HSA, pitiful.
    I predict a lot of Americans are going to learn about the HSA when Matthew gets onboard. Matthew is a lot smarter than that goofy Newt.

  24. Second post. I’ve got nothing much to say, except for happy Digestive Disease Week. Oh, that’s happy Digestive Disease Week®.

  25. First post!
    Sorry, I had to. I’m very curious as to Ron’s background in health care administration/policy/etc. A lot of times it seems like I’m coming from a completely different perspective on what I’ve read/learned/been taught about health care financing and policy. Cheers!

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