Are People Satisfied With Their Health Care?

My family has great coverage, an HSA, etc. I hate it. I never feel comfortable knowing what's covered, what will be applied to the deductible, what providers are in my plan, emergency versus scheduled, etc. I hate having to address those issues. A few years ago, my primary care guy was fighting with my insurance company and sent out letters that he wouldn't take Aetna anymore. I spent hours trying to find a local internist who was accepting new patients and it was torture. Ultimately, he settled with Aetna, but what a show...

We were on Kaiser Perm a while back, and I liked that the best. One big building where we went for everything. Very little, if any, cash outlay.

I'd like a Brit system...

I think you've hit the nail on the head. people "like" their health insurance now because they don't use it, they don't really pay for it and they don't have to mess around with doing it themselves. if health care was decoupled from employment and people felt the true cost of premiums the numbers would be vastly different.

Ezra,

You leave out one of the most important parts. People are satisfied with insurance – when they have it – and when nothing too bad happens to their health.

But they aren't satisfied with living with the very substantial risk that they will lose their insurance due to job loss (and that includes illness causing job loss and then insurance loss), or their employer stopping coverage, and then their family's finances and/or health is devastated. 1/3 of Americans under 65 had no health insurance at some time in the last two years (see: http://money.cnn.com/2009/03/05/news/economy/health_uninsured/index.htm).

And they aren't satisfied that if they get really sick they can be financially ruined even if they have insurance from the deductibles, lifetime limits, and technicalities and mistakes in paperwork that insurers often use to not pay. According to Dr. David Himmelstein of Harvard Medical School, "Our most recent study found that nearly two-thirds of Americans who declared bankruptcy cited illness or medical bills as a significant cause of their bankruptcies. And of the medically bankrupt, three-quarters of that group had insurance, at least when they first got sick." (at: http://prescriptions.blogs.nytimes.com/2009/09/07/insured-but-bankrupted-anyway/)

I'm 6 years older than my wife and am planning to be forced to work until she is 65 and can get on Medicare. The good thing is by then I'll be drawing a bigger Soc Sec benefit. The bad thing is I'll be 71 and my employer may force me out sooner.

I was self-employed and had a private policy which was bad and expensive. I took a job with a company which provided a very nice HMO - $15 copay and no other charges. 3 years later I was laid off and now the original company won't take me because I'm slightly anemic (I have been for 20 years - no symptoms - letter from doctor saying it's not a problem - and I had and disclosed this condition when they accepted me before). I've now tried multiple insurance agents and CANNOT get a private policy - COBRA ran out - now on CalCOBRA - very expensive ($450/month) but not as expense as the CalHIPA ($750 with only 70% coverage and 5K deductible) which I'll have to get in 18 months.

I am NOT HAPPY with my health coverage.

Ezra gets part of the picture correct here.

More of why it is exactly that reform is difficult:

http://findingourdream.blogspot.com/2009/10/real-reason-reform-is-so-difficult.html

Sad that the only people in America happy with their health care coverage are those who don't need it right now.

If you're sick, however, completely different story. Arguments to get covered expenses paid; the discovery that the major medical treatment is not covered; all those little things that surprise us when we fall ill...

The reform won't really change any of that, however. It WILL drive more people to the insurance companies by penalizing those who don't have insurance.

Sad that after all this debate, we may very well come up with nothing for our efforts. But the insurance companies will have lots more customers to bleed....

Nor do people like the fact that their coverage is only as secure as their job. Lose their job, COBRA runs out---have a pre-existing condition? You are in trouble. Likewise retirees (<65 especially) don't like the idea their coverage can be terminated if the employer decides to do so.

But people are satisfied because they don't use their health insurance

Ezra are you serious? Don't use it? Where is the 2.3 TRILLION per year going then? You're normally very very good but this was a really dumb statement to make. YOu need one of those lines through it to realize you made a mistake.

lots of people don't use their insurance. i know i dont and i know my father doesn't.

a lot (maybe even most) of the costs come from end of life care. the other major expense is the increase in pharmaceuticals. most people barely use their insurance and are thus "somewhat satisfied" (which id like to point out was the majority response in the polls the pols are using. the "satisfied" option had less people than "unsatisfied" iirc).

Ezra: You write "wage stagnation, which is largely a function of compensation dollars going to fund health-care premiums." Huh? What studies prove your point, where is the evidence? How strong was the negotiating position of labor when it "chose" health-care over compensation dollars?

What makes you think workers were ever going to get better compensation? Please. Over the last thirty years, time and again, workers agreed to pay stagnation in contract negotiations because management forced them to accept it. Period. Workers signed agreements with managemnent favorable to shareholders, (in order for their companies to stay competitive in an international marketplace and to simply keep their jobs), and agreed to lower pay increases as long as they got good health and retirement benefits. Management decided this type of strategy was a better deal for competitiveness reasons, workers were barely hanging on. Workers often got a take it or leave it deal.

You're smart guy, Ezra. But I'd be interested to see what you'd find out if you spoke with a number of labor economists and labor historians, instead of those employed by the GOP, AEI, CATO, or the Heritage Foundation. Do some more homework and let us know what you come up with.

Ezra, please read between the lines. When people say they are satisfied with their health insurance, that is AFTER they have heard enough about what the politicians are trying to do. (They don't trust politicians).

lots of people don't use their insurance. i know i dont and i know my father doesn't.

a lot (maybe even most) of the costs come from end of life care. the other major expense is the increase in pharmaceuticals. most people barely use their insurance and are thus "somewhat satisfied" (which id like to point out was the majority response in the polls the pols are using. the "satisfied" option had less people than "unsatisfied" iirc).

Posted by: PindarPushkin | October 8, 2009 8:38 PM | Report abuse

WOW. 2 out of 300,000,000+ people don't use their healthcare. There's a great stat.

You know I used to think i didn't use my healthcare a lot and then I realized over the last 13 years my wife and I had 3 kids and we'd made the annual check-ups and sick visits for the kids and then i realized, WHOA, I did use my healthcare. Anybody know what the average maternity costs are nowadays? When all goes well? (one of my three kids were in neo-natal for 2 days due to merconium (sp). I'm thinking that the regular deliveries were about $10,000-$15,000 and the neo natal delivery was about $30,000. Add in the sick visits, the prescriptions and the ones I'm sure I'm forgetting and I'm betting I put in what I got out (and I'm healthy and not taking many prescriptions.

I'll bet a more telling statistic is that most people don't realize what they spend in their healthcare.

oh and actually its nice to blame it on "old people" but actually everyone whose paying attention knows that 75% of healthcare costs come from three chronic diseases. Obesity, Diabetes and Heart Disease and the second two can be directly attributed in many cases to the first, Obesity. Americans are twice as obese as ANY COUNTRY IN THE WORLD. That's what drives our costs. See reuters.com for proof if you don't believe me. Also check the CDC's website as well.

http://www.reuters.com/article/pressRelease/idUS149865+02-Jul-2009+PRN20090702

http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm

http://www.cdc.gov/obesity/data/trends.html

it wasn't a statistic. it was a statement of fact. there ARE people who don't use their health insurance and there are lots who barely use it. many americans, especially single men choose to suffer through whatever day to day problems they have and that value judgment (which is ingrained in a particular strain of old school american) is just as valid as any other and it's a lot more common than you think. there's a reason why insurance premiums are higher for married people than single people (and it's not just childbirth). it's because the single person is more apt to stay at home and "tough" it out while the married person is more apt to go see the doctor. i can guarantee i've put way more into the system than i've taken out (since the only thing ive taken out is a prescription for anti-malarials that i shouldnt have even needed to see a doctor for).

this whole mandate obsession is just a hissy fit from the comfortable middle class married yuppies who have bought the canard of the single man and lower class bogeyman.

we all do things that are unhealthy (and no i am not at all overweight. im probably a little bit underweight) whether it's eating processed foods, smoking, drinking what have you. it all evens out in the end. this obsession with trying to legislate behavior will not fix the problem. the cost problem (or at least the outrageous growth) is entirely one of pure economics and not behavioral economics. there is no choice, there is a virtual monopoly, there is no true pricing, there is information disparity and people dont feel the true costs. don't blame the fat people there is more than enough blame to go around.

i'll promise you this though. if i am forced (i work for a small business so im stuck with whatever crap they pass while i assume you are not) to spend $10k+ a year on health care i will use it to the fullest. im talking about costly surgeries on my knees and ankles, prescriptions for pain, mood disorders, add, the works. i am fine with paying a little bit for catastrophic care but if im forced to pay for full coverage i will consider it wasted money if i dont avail myself of all them good pharmaceuticals. and that's why you're not getting behavior patterns. you are assuming that everyone currently uses health care to its full potential and im telling you thats not true. costs will go up big time under the plan (as currently constructed) because there is nothign to fix the systemic cost problems (such as providers creating artificially high list prices because insurance pays a percentage of the list price instead of a flat fee) and everyone who is currently out of the system (and barely using) will use it to its fullest when they are forced to have it.

just 5% of americans take up 50% of costs. are you really gonna argue that most people dont really use their health care?

I know there are some that don't use it and its not just single men. I'm a married man and I don't really use it much myself. I get migranes and instead of seeing a doctor, running batteries of tests that would cost into the thousands I take Excedrin Migrane and it resolves the issue. I know many people don't use it but many do and most (as Ezra correctly points out) don't even know what it costs when they do use it.

I have to confess that I'm in the healthcare industry. I'm an insurance agent. I see what things cost every day and its the costs that are choking us all. Its also the obession with finding the cause of an issue through needless testing. You want a secret to the next big craze. Its genetic testing. Its growing by leaps and bounds over the last several years and it costs a fortune.

And don't assume I'm not affected because I am. I'm a small business owner and I have an HSA plan that may be in danger with this legislation. In seeing the cost i know that is what saves me money. I saved $6000 a year in premium two years ago by switching my company to that plan. I now pay for me and my two employees the entire cost of a potential out of pocket into the HSA. I've built up about $13,000 now over three years in my own HSA account (see I've used a little) and my premium has gone up 3% after year one, 4% after year two and 3% this coming year (it renews in November).

As far as costs going up under the plan I don't think so. Once you get everyone in the marketplace (assuming an individual mandate survives and isn't watered down) then costs have to come down at least short term. In my state of NJ we have everything that federal reform has to offer except the individual mandate and a small window of pre-ex. Our pre-ex clause is one of the best in the country (really only MASS is better with no pre-ex.) So when we do national reform we'll just add people to the system who have gone without care because they know of EMTALA.

The problem is that costs may go down in the short run but until we get utilization down and unnecessary procedures down then costs will continue to rise. I have a client who had testicular cancer 10 years ago and he still has quarterly MRI's and catscans. I'm sorry but that's overtreatment. Its examples like that which show why our system is screwed up while people without coverage go untreated until its more costly for them and many times unfortunately too late to save them.