published Wednesday, October 6th, 2010

Health: big issue, big cost

Everyone is appropriately interested in good health care. We want good medical attention to be assured for everyone who really needs it.

There’s a saying that “If you have your health, you have just about everything.”

The big questions, however, are how much medical care should be provided, who will pay for it — and how much it will cost.

Most people depend upon medical insurance, often provided by their employers in concert with some employee payments. Some people buy medical insurance personally. And much is paid for, in one way or another, by some level of government, meaning the taxpayers.

In the Chattanooga area, it is reported that not even one-third of our people admitted to Hamilton County hospitals have private insurance. In round numbers for 2008, for example, a few more than 20,000 patients reportedly had private insurance, while a few more than 46,000 people had government insurance, more than 4,000 were uninsured, and nearly 2,000 were in “other” situations.

Hospitals provided almost $91 million locally in “charity” medical care.

Employers, individuals and taxpayers are having to foot big bills, with costs rising as more care and more advanced medical procedures are provided in efforts to assure good health.

How are we going to balance cost and care?

Congress recently enacted ObamaCare. It is expected to cost taxpayers over a trillion dollars! Nobody can realistically say how much “over.”

With the federal government already annually running in the red, ObamaCare costs unfortunately will be added to the big deficits, increasing the $13.6 trillion national debt, on which the taxpayers must pay interest.

Will ObamaCare “work,” financially or medically?

Chattanooga’s very able Sen. Bob Corker says: “I don’t think there is anybody in this industry who thinks this law is going to work. The funding just won’t work, and there are a lot of unintended consequences.”

Watch out: The “consequences” are yet to be fully revealed. But they will come — painfully and expensively — in the years ahead.

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whatever said...

How many of those people even had the chance to get health insurance at a reasonable cost?

What ideas did Corker offer instead?

October 6, 2010 at 12:22 a.m.
fairmon said...

Is there anyone that has health care at a reasonable cost?

We will only know the full impact and implications including the so called unintended consequences as scheduled changes occur.

The vast majority of people have not attempted to understand the bill and the future affect. The shock and outrage will be expensive entertainment but interesting to watch. Most just mouth their favorite parties news bites and support or objection. Blind loyalty is not healthy.

It is unfortunate that our legislatures will not require a pay as you go cost process but will obligate future generations with more and more debt. It is easy to spend other peoples money or use a credit card when no bill or at worst a discounted bill or an interest only bill is the only cost.

The intent and philosophy of a national all encompassing health care provision is noble. The pork filled, politicized, poorly written bill we got is ridiculous.

I resent paying for or assisting those that can provide for their self but won't. I resent paying for or assisting those that participate in unnecessary "extreme risk" activities. Sky dive on week ends, bungee jump and race your motorcycle but I won't pay your medical bills if you hurt yourself. Get drunk and get shot or cut but don't expect me to pay for your emergency room expenses.

I also resent those bleeding hearts that don't know what they have but talk about it as though it is the best thing since the washing machine.

I resent those like Corker that criticize but have little to offer other then mucking around with and rearranging the junk.

October 6, 2010 at 8:12 a.m.
whatever said...

Is there anyone that has health care at a reasonable cost?

The inhabitants of many other nations in this world.

Not that that stops them from complaining, mind you, but that's life.

It seems people are natural born complainers.

October 6, 2010 at 8:16 a.m.
BigRidgePatriot said...

What nation specifically do you want to copy whatever?

October 6, 2010 at 11:19 a.m.
nucanuck said...

A notable strength of a single payer system would be that we would all be in it together,building the best affordable system possible for all Americans. Yes,the rich could still buy additional coverage,but the least would no longer be marginalized and forgotten.

That's the path the country needs. Are there any pathfinders out there?

October 6, 2010 at 11:24 a.m.
BigRidgePatriot said...

A single payer system is a government run monopoly. That is the worst possible environment to build the best of anything for anyone.

Our health care system will start to look like our education system; declining quality, unionized caregivers, and spiraling costs. In this case we can expect to add declining availability to the list.

October 6, 2010 at 3:59 p.m.
whatever said...

Our health care system already looks that way.

October 6, 2010 at 4:03 p.m.
BigRidgePatriot said...

Most of what is wrong with our healthcare is due primarily to government meddling.

It started with wage and price controls during the war that were supposed to contain inflation. These controls caused employers to use new benefit tricks like health insurance to attract employees, creating the employer provided health care that we live with today. This turned us from health care consumers to health insurance consumers. The free market forces were to a great degree removed from the healthcare system.

In markets where insurance is not a driving factor, costs come down and quality goes up. Lasik is a prime example. Cosmetic surgery is another.

October 6, 2010 at 4:21 p.m.
nucanuck said...

BRP,

For what it's worth,the single payer system I use has private providers that are paid by the government,similar to medicare. Doctors are independant contractors,just like in the US. Labs are private,hospitals are like Erlanger with municipal involvement.

The big difference is that everyone is covered here and the cost of the system is 11% of GDP instead of 18% in the US.

I have just been diagnosed with kidney stones and unless they become painful I will have to wait my turn to have them blasted. That may be as soon as December or maybe several more months. Should it become critical,I would move to the head of the line and they would be removed immediately. That all seems fair and reasonable to me.

October 6, 2010 at 4:25 p.m.
whatever said...

I would say Lasik and Cosmetic surgery costs and results are improving more because of technology than anything else.

I'm not entirely convinced of the rest of your argument though, what corroboration can you offer? Which war, and which wage and price controls? And really, the incentives health insurance companies offer, while they do indeed create a buffer between the consumer and the provider, are part of the free market too. Would you rather the government meddle them out of business?

October 6, 2010 at 4:40 p.m.
BigRidgePatriot said...

A big difference between the US and Canada is that GDP per capita is quite a bit higher (~46,000 verses 38,000) so we can afford spend more on just about everything, including health care.

October 6, 2010 at 4:51 p.m.
BigRidgePatriot said...

Technology only affects Lasik and Cosmetic surgery and not the rest of the healthcare system?

Wage & price controls were put in place during World War II. There was fierce competition for able bodied employees so nearly all big manufacturing employers started offering health insurance as part of the total compensation package to draw and retain people.

October 6, 2010 at 4:59 p.m.
BigRidgePatriot said...

nucanuk,

Why do you visit the CTFP pages? Did you used to live in Chattanooga?

October 6, 2010 at 5:11 p.m.
whatever said...

Technology only affects Lasik and Cosmetic surgery and not the rest of the healthcare system?

I was explaining part of why improvements you alleged (but didn't specify) in those particular fields were happening.

We could certainly work on determining how much of an impact technology has overall had on the health care field, but that would require a rather comprehensive effort. Sometimes it would increase the costs, but increase the results, other times it might be more negative.

Do you think that would help advance the discussion?

Wage & price controls were put in place during World War II. There was fierce competition for able bodied employees so nearly all big manufacturing employers started offering health insurance as part of the total compensation package to draw and retain people.

Well, that's an interesting perspective. I'm not sure how what happened 50-60 years ago reflects on the problems of today though. Can you explain what the government did besides spend a lot of money and take away a good amount of the labor force, and how it had such a long term impact?

October 6, 2010 at 5:12 p.m.
Sailorman said...

How Did Employer-Based Health Insurance Become the Norm in the United States?

".....in 1942, the U.S. government passed the Stabilization Act to keep workers' wages stable.

The act limited wage increases, so that no one employer could outbid all others for the limited number of civilian employees. But the act did not prevent employers from offering health insurance to their prospective employees. Clever employers, quickly realizing that decent health insurance could be a real incentive for an employee to accept one job over another, began offering health insurance coverage.

How Government Made the Rules

A series of government rulings soon solidified the role of employment-based health insurance in the United States. In 1945, the National War Labor Board ruled that companies could not change insurance terms in the middle of the contract period. This meant that once insurance was offered for the year, the company could not drop or lower the coverage.

In 1949, the National Labor Relations Board ruled that insurance was part of wages. As such, it could be included in union contract negotiations. Finally, in 1954, the Internal Revenue Service sealed the deal. It ruled that health insurance payments were not taxable income."

The whole article at

http://everylearner.com/bm/knowledgenews/americana/health-insurance-history-2~print.shtml

An excellent article, much more in depth, can be found here:

http://eh.net/encyclopedia/article/thomasson.insurance.health.us

Interesting history

October 6, 2010 at 5:15 p.m.
whatever said...

Still not following the connection to the problems of today, but let's hear what you would do instead.

October 6, 2010 at 5:32 p.m.
rolando said...

Why don't YOU answer BigRidgePatriot's question way up there instead, whatever?

Oh...you can't defend your position with just a one-liner, so you ignore it.

It appears one-liners are "better" for you than true debate.

October 6, 2010 at 6:21 p.m.
nucanuck said...

BRP,

I grew up in Chattanooga,moved away for ten years,then moved back for the next forty years. At age 65 and retirement my wife and I sought out a cool temporate climate and decided on a lovely town on the water in western Canada. Some like the Florida sunshine,but not us.

I comment on this board because Chattanooga and the USA were my life for 65 years and I hope that one more perspective is useful to the CTFP readers. I try to stay positive,thoughtful,and constructive in my comments,and think that with a few exceptions,I have done that.

October 6, 2010 at 7:58 p.m.
whatever said...

Well, there's a pot calling a kettle black.

Or do you think you're somehow contributing to the discussion?

Believe it or not, I actually did write a reply, but perhaps it got deleted because of the link in it or maybe I just closed the window without actually posting it. Dunno.

But to answer the person who, unlike you, is part of the discussion, my answer was that copying is the wrong way to put it. We should learn from every country, some of whom are doing better, some of whom are doing worse. Lessons to be learned either way. At the least I'd like to examine the system France has for medical information storage. The Carte Vitale is quite nice.

October 6, 2010 at 8:16 p.m.
whatever said...

I comment on this board because Chattanooga and the USA were my life for 65 years and I hope that one more perspective is useful to the CTFP readers.

A reasonable position, one that's hardly out of bounds in terms of behavior. Nothing wrong with checking back on where you've been.

And I'm sure you've offered something to those willing to listen.

Me, I think I'll leave when my paper subscription runs out...which is today!

Later then.

October 6, 2010 at 8:47 p.m.
SCOTTYM said...

NN, "I have just been diagnosed with kidney stones and unless they become painful I will have to wait my turn to have them blasted."

Best wishes on a quick and painless resolution. The pain can get INTENSE, and I truly hope you miss out on that part.

October 7, 2010 at 12:17 a.m.
nucanuck said...

SCOTTYM,

I should have added the word "again". I have had many bouts with kidney stones over the years. This time the urologist said my kidney looked like a rock garden. Thanks for the warning however.

October 7, 2010 at 1:09 a.m.
BigRidgePatriot said...

whatever,

Sorry I had other things to do and had to disengage.

When healthcare consumers became insulated by the cost of healthcare with the advent of employer based health insurance we lost our appreciation for cost and value. Whenever that happens there is no longer a free market. In the absense of a free market natural supply and demand price pressures disappear.

That is why I think the Lasik and cosmetic surgery example is relevent. Most insurance does not cover these procedures so the industry has had to find ways to increase value, decrease price in order to attract customers. In that environment, capitalism can shine.

October 7, 2010 at 11:08 a.m.
BigRidgePatriot said...

nucanuck,

I work for a Canadian owned company and spend quite a bit of time in and around Toronto. I am in Toronto right now waiting to get on a plane back to the nooga.

(How cool is it that the Toronto airport has free WIFI)

October 7, 2010 at 11:11 a.m.
nucanuck said...

BRP,

You wouldn't think the WIFI was free if you bought an airline ticket that originated in Canada. The air travel taxes here are pretty steep,but less so if your point of origin is out-of-country.

October 7, 2010 at 11:30 a.m.
BigRidgePatriot said...

It is still pretty steep. It costs about twice as much to fly to Toronto from Chattanooga as Buffalo or Mexico City.

October 7, 2010 at 4:33 p.m.
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