Friday, September 18, 2009

Question: Medical Math

For me what is missing in all the debate about health care reform, including the Baucus bill, is a plain explanation as to how you balance the books.

Take the case of Otto Raddatz, for example. Forget the fact that Mr. Obama took a swipe at the insurance companies by manipulating his story to make it sound like Raddatz died because his coverage was terminated over undiagnosed gall stones.

Let's just look at the balance sheet of Otto's treatment.

Add up all the premiums he paid, the co-pays, the deductibles, the out-of-pocket...everything he actually shelled out for treatment of his cancer.

Then add up every dime paid by the insurance company for doctors, hospitals, pharmacies, radiologists. Remember, he had chemo and a stem-cell transplant.

Now, look at those numbers side-by-side. There is no doubt a difference of hundreds of thousands of dollars.

Suddenly, the government is going to manage that equation. Every plan promises that the level of care will be the same. Doctors, nurses, hospital workers, pharmacists will all be paid the same as they are now.

We are promised that the same expensive equipment and appliances will all continue to be made available.

And another 30 million or so people will have access to that same care who don't have it now.

We all know that managed-care is not a new concept. Insurance companies have been trying to control costs right along. They review the necessity of a procedure. They negotiate with doctors and hospitals over fees. They contract with some for fixed rates.

So, someone explain to me how the government is going to do it. What will have to give?

They talk about mandatory health insurance. Everyone will have to be on a plan and pay their premiums. If you're living here, you must have health insurance. That's how I understand the proposal.

So...about 12 million non-citizens want to live here but are uninsured. Forget for the moment that some of them are illegal aliens. Obama will take care of that by making them legal. Now, they must buy some health insurance coverage.

Recall that there was much noise a couple of years ago about raising the fee for processing naturalization papers by a few hundred dollars. They can't afford it. That was a one-time charge. Imagine now that we are requiring them to have health insurance to the tune of ...say $400 a month for the family. They can't afford something like that.

Or the squawking we heard from Bush and Kennedy about the costs associated with amnesty, or path to citizenship as they call it. Fees, back taxes...anything more than a couple thousand bucks total and it was too much. Require that bunch to pay $5K a year for health insurance.

In summary, the costs don't suddenly drop just because the government steps in. Risk doesn't stop. The actuarial tables don't suddenly change.

And every person who is given insurance for free or at a reduced rate simply adds to the problem.

Someone please explain how this whole thing balances. I just can't fathom it.

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