And on tort reform, I’m certainly not suggesting that it is the complete solution- but taking several steps to reduce overal medical costs and improve efficiency will have an additive effect. If you need to cut household expenses, buying cheaper brands at the grocery store isn’t going to balance your budget but it can be part of an overall strategy to make ends meet.

And tort/malpractice reforms also need to be examined from the standpoint of physician supply; if the current rate increases continue, it’s likely that certain high risk specialties will experience declines so that there will be shortages in some areas. As we are trying to expand healthcare coverage, a decrease in supply as demand increases could be disastrous, leading either to exhorbitant costs or long waiting lists, or both.

Allow the poor access to preventative care? I don’t see any market based solution that’s going to allow that. And since you bring up the bromide of having individuals shop for insurance (and wade through all that lovely small type that explains the loopholes the insurance company counts on) I assume your primary interest is in market based solutions. Pardon if it’s an unwarranted assumption.

Especially in light of your name you sure seem to have a coastal bias.

I’m not exactly sure what you mean by this. The NYT article singled out California, New York, and New Jersey because they wanted to raise the threshold way about 250%. They were singled out because of the high cost of living (relatively speaking) of those places. MY POINT is that even in higer cost of living states like California and New York, there are cheaper communities for whom raising the threshold above 250% seems pointless, or a waste of resources. Obviously, cheap places like Missouri do not need it raised way above 250%. If you make $70,000 a year in St. Louis you are doing WAY alright.

I guess irony is unfamilirar to some.

As for the rest of the wait for this, wait for that, I would point out that real people are tired of waiting for all the idealogical ducks to line up in a row. They have to deal with their family’s health care needs NOW.

Should the country come to its senses and adopt a healthcare system availabe to everyone, the need to expand existing and narrowly defined programs would disappearwithout fanfare. In the meantime, the need is there, but the available avenues for addressing them are exceedingly narrow. Provide a wider avenue first, and then we can talk about which lane everyone should take.

BTW. ‘reforming’ the bankrupcy laws did a lot to narrow the options for hard pressed families faced with insurmountable medical bills. There are political ideals, and then there are families stomped on by those ideals

And why are they living in less expensive regions?

If you are going to think in these terms at all (as though everyone’s place of residence can really be determined strictly on issues of cost), then a more apt question would be the reverse. To channel the late Sam Kinison, for people who feel that their region’s cost of housing makes it impossible to meet the costs of health coverage, WHY DON’T THEY GO WHERE THE AFFORDABLE HOUSES ARE?!?!?!?!?

[Note: I am well aware that this is a silly question, but much less silly than asking why people live in LESS expensive areas IMO]

Jim S: Yet the assumption on the part of the conservatives here is that a family of four with a gross income of $51,000 has that much money left over to cover health insurance and medical bills after covering other expenses like housing, food, clothing and transportation. Somehow I just don’t buy it.

I made no such assumption, Jim. But if the purpose of SCHIP is to provide coverage for low income kids, then it seems to me that the program’s funds should be used to cover low income kids rather than letting middle class families take advantage of it while many poor kids and families are left out.

There is a need to address middle class families who still can’t afford healthcare coverage, but that needs to be addressed in a much different way (like working toward lowering overall costs of healthcare-which requires comprehensive and multifactorial changes such as increasing supply of physicians(and other providers) and healthcare technology, tort reform to reduce malpractice costs, and allowing the poor access to preventative healthcare instead of just the emergency room- since the costs of that gets passed along to every healthcare consumer), and making it possible for people to shop indepdently for insurance instead of giving a competitive edge to employers.

Trying to solve the affordability problem by bringing more and more people under the umbrella of coverage by the federal government is a disaster in the making. Medicare itself is a ticking time bomb; now we’re going to make health care into a nuclear bomb because the costs will become so astronomical when we increasingly bring the middle class into the programs.

Especially in light of your name you sure seem to have a coastal bias. As far as affordable places, why not, oh, virtually anywhere in the midwest? Out here, a true “middle class” family could fall under SCHIP, especially at 250% of poverty. I think that is a reasonable increase. 350% plus, not so much.

The Bush administration sent a letter to state health officials last Friday outlining new standards for the Children’s Health Insurance Program (CHIP), which is designed to help states insure low-income uninsured children. Why is this such a big deal?…

And why are they living in less expensive regions?

You have any idea how that sounds?

Maybe folks LIKE Oswego or Albany, maybe they were born and raised in Fish Camp, California, or Fresno.

I would say that the unexpected is part of ordinary life: a broken leg, a trip to the emergency room for an asthma attack, etc. The reason for buying any insurance is to have a cushion for those times when the unexpected happens.

So how would a family with $1000 deductible on their insurance making $60,000 a year be undone by someone breaking their leg? It might very well hurt the budget for awhile, but isn;t that life as well?

I would say that the unexpected is part of ordinary life: a broken leg, a trip to the emergency room for an asthma attack, etc. The reason for buying any insurance is to have a cushion for those times when the unexpected happens. If ‘ordinary’ means constantly healthy and accident immune, then there is no need for insurance of any kind. All health care needs would be covered by a yearly physical in the G.P.’s office, something many of those we are discussing could afford even easier than the ‘affordable’ health insurance plans.

But that’s not how life works, and those with families have to plan for the unexpected,. If they’re lucky, they won’t face the catastrophic level, but many have to face even that.

It used to be the basic principle of insurance that risk is spread out among the population of consumers. If one policy holder incurred greater costs, those would be balanced out by the premiums collected from those who incur less than their share.
With ‘affordable’ plans, the tendency is to expect each policy holder to underwrite his own costs in real time. It’s done with deductibles and excludables and pre-condition prohibitions. That’s the shift that is undermining the whole system.

If you can’t afford NYC or the suburbs, the SCHIP provides a cushion for you to take a pay cut and live somewhere more within your means. Writ large, lower-middle class communities get added investment and a much-needed shot in the arm – after all, that’s presumably where many of the subprime foreclosures are takling place.

And why are they living in less expensive regions?
I doubt there are too many people with good incomes who choose to invest in a home with a low equity potential. Working plus living in a cheap area already points to families in economic difficulties.
BTW, I’d be interested to know where the areas of NY with cheap housing are. Even in the worst areas, rents are exhorbitant and taxes for homeowners sky-high. In fact, he housing crisis should be right up there with health care as a growing problem for the not extremely wealthy.

It takes an understanding of overall healthcare costs (insurance + out of pocket payments) to grasp what is at stake for many families, and I’m not talking only about families with extraordianry health challenges. An ordinary middle class family can easily find itself up against the ropes, and the ‘affordable’ plans don’t answer their needs.

How?

What you are saying is that a family of four, with no unusual health issues, making say $60,000 a year, will be in dire financial straits because of everyday normal health care concerns?

How?

If you want to check it out yourself go to the Blue Cross page and get a quote yourself. (I used the 94117 Zip Code for the Haight, had a married couple 38 and 37 years old with two kids aged 6 and 4.)

I just talked about the options under $400. There were a bunch of plans in the $400 to $500 range as well.

It takes an understanding of overall healthcare costs (insurance + out of pocket payments) to grasp what is at stake for many families, and I’m not talking only about families with extraordianry health challenges. An ordinary middle class family can easily find itself up against the ropes, and the ‘affordable’ plans don’t answer their needs.

Also, this program is such a blunt instrument that it simply casts too wide a net. Sure a family living in the Haight in San Francisco lives in a pretty expensive place…but what about people living in far less expensive palces in California? Or New Jesey? Or New York? What is the rationale for subsidizing THEIR insurance?

Just for giggles I looked at the health insurance plans offered by Blue Cross in California. For a family of four living in the Haight there were ten plans offered with monthly premiums of between $209 to $384. Of course, health insurance needs vary from family to family, but it doesn’t seem impossible to get affordable coverage in principle, especially for a family bringing home between $4000 and $5000 a month income. I’m not saying some folks might not need help with prescription drug costs or catastrophic care, but dealing with such costs is not the point of the SCHIP program.

Jim, it looks like you were being hosed. (Of course your family might have other costs because fo chronic conditions I don’t know about, OR you payed extra for a plan with less out of pockets exspense…I don’t know.)

1.We ignore the poor for too long.
2. Now, some are willing to focus on the poor, but only at the price of ignoring those one step up.

The reality of a wide range of individuals and families without adequate healtcare coverage is just not sinking in. It’s a wait for this or wait for that game.

IWhile worrying obsessively about the cost of healthcare coverage, not one of the “principled’ thinkers is calculating the cost of not having adequate coverage. It’s huge. Untreated conditions turn into long term disabilities. What does it cost in terms of what these disabled are NOT contributing to society added to what they cost to just sustain life?

It’s also a mischaracterization to talk about what is being provided to THEM, whichever one;s favorite suspect and undeserving group is. Whatever is done for THEM results in a gain for all of us, when correctly put in the context of adding to the ranks of healthy, productive fellow citizens and tax payers.

There is an immediate consequence, but there are also long-term consequences. The latter can be much more serious and costly, if ignored yet again.