George Bush tried to tackle Social Security, but got nowhere. In fact, he got his hands badly slapped for it.
I do agree with you,though: I think there are many things that could have been done but weren't. The steps to raise the eligibility age for Social Security and Medicare are good, and I have argued for those and written my Congresspersons about them for years, but I think they were implemented too late and too timidly, although I do understand that folks who are close to retirement age no longer have the flexibility to change their plans as much as those who have ten or fifteen years to plan. Nevertheless, at 61 I could cheerfully contemplate deferring the collection of my Social Security for a year, two years, even three years if necessary.
Because I buy my insurance in the private marketplace as an individual, I probably pay a lot more than the average person -- my monthly premiums are in the range of $750, with my MSA contribution on top of that. I'd like to enjoy the same tax advantages, as my own employer, as other employers, and I'd like to benefit from the additional bargaining power of group insurance. My insurance company does negotiate with providers on my behalf, though, so that alone reduces my out-of-pocket costs for routine health care. I'd like to see more portability in health care and I'd like to see a level playing field between employer-provided and individually-purchased health care. These things can probably be accomplished more effectively by lifting some regulations than by imposing new ones.
On the Medicare front and on the health care front in general, I know there's a lot of waste in the system. Part of it is a mindset brought about by lack of accountability/responsibility. I think the six words most damaging to the system are: "Your insurance will pay for it." Until I trained my current primary care guy, which took some time, that would be the first thing I'd hear if I asked how much something cost. I always ask whether this drug, this procedure, this test are actually necessary, whether there is a less expensive but possibly effective alternative, and what is the downside of a course of a plan of action that involves watchful waiting. Part of this is sheer cussedness. The other part is that I have a medical savings account with a high deductible. Between my deductible and my 20% copay for the first $15,000 of care, I could be on the hook for $6,000 in medical expenses in any given year (oh, I don't get drugs, eyes, or teeth, so there are those as well). I'm saving in my MSA for my next colonoscopy and don't want to pay for defensive medicine or other "do it by the book rather than the patient" procedures.
But these are decisions made by me with the expert assistance of my physician. I don't want them mandated for me by the government. And make no mistake, this bill is intended as the first step on the path to single-payer. I don't want to go there.
Finally, there's the whole issue of defensive medicine and fraud. If both of those could be tackled through tort reform and better controls, the cost of Medicare would decrease substantially.
When I am approaching my own health care, I do it in incremental steps -- let's try these exercises first, and if that doesn't work let's try something else. I'd like to see us approach health care reform in the same spirit. And for starters, I'd like to see the majority party at least listen to some of the ideas put out as alternatives. But you'll recall that Mr. Obama's response to them is very simple: "I won."
(I have determined my own health care strategy, by the way: I am eating carefully and exercising to keep myself as healthy as possible for as long as possible. If/when I develop a nasty expensive condition I will shift gears and drink myself to death.)
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Date: 2009-08-24 12:16 pm (UTC)I do agree with you,though: I think there are many things that could have been done but weren't. The steps to raise the eligibility age for Social Security and Medicare are good, and I have argued for those and written my Congresspersons about them for years, but I think they were implemented too late and too timidly, although I do understand that folks who are close to retirement age no longer have the flexibility to change their plans as much as those who have ten or fifteen years to plan. Nevertheless, at 61 I could cheerfully contemplate deferring the collection of my Social Security for a year, two years, even three years if necessary.
Because I buy my insurance in the private marketplace as an individual, I probably pay a lot more than the average person -- my monthly premiums are in the range of $750, with my MSA contribution on top of that. I'd like to enjoy the same tax advantages, as my own employer, as other employers, and I'd like to benefit from the additional bargaining power of group insurance. My insurance company does negotiate with providers on my behalf, though, so that alone reduces my out-of-pocket costs for routine health care. I'd like to see more portability in health care and I'd like to see a level playing field between employer-provided and individually-purchased health care. These things can probably be accomplished more effectively by lifting some regulations than by imposing new ones.
On the Medicare front and on the health care front in general, I know there's a lot of waste in the system. Part of it is a mindset brought about by lack of accountability/responsibility. I think the six words most damaging to the system are: "Your insurance will pay for it." Until I trained my current primary care guy, which took some time, that would be the first thing I'd hear if I asked how much something cost. I always ask whether this drug, this procedure, this test are actually necessary, whether there is a less expensive but possibly effective alternative, and what is the downside of a course of a plan of action that involves watchful waiting. Part of this is sheer cussedness. The other part is that I have a medical savings account with a high deductible. Between my deductible and my 20% copay for the first $15,000 of care, I could be on the hook for $6,000 in medical expenses in any given year (oh, I don't get drugs, eyes, or teeth, so there are those as well). I'm saving in my MSA for my next colonoscopy and don't want to pay for defensive medicine or other "do it by the book rather than the patient" procedures.
But these are decisions made by me with the expert assistance of my physician. I don't want them mandated for me by the government. And make no mistake, this bill is intended as the first step on the path to single-payer. I don't want to go there.
Finally, there's the whole issue of defensive medicine and fraud. If both of those could be tackled through tort reform and better controls, the cost of Medicare would decrease substantially.
When I am approaching my own health care, I do it in incremental steps -- let's try these exercises first, and if that doesn't work let's try something else. I'd like to see us approach health care reform in the same spirit. And for starters, I'd like to see the majority party at least listen to some of the ideas put out as alternatives. But you'll recall that Mr. Obama's response to them is very simple: "I won."
(I have determined my own health care strategy, by the way: I am eating carefully and exercising to keep myself as healthy as possible for as long as possible. If/when I develop a nasty expensive condition I will shift gears and drink myself to death.)