My family physician said, “95% of what people come to me for is unnecessary.”

I have witnessed uninsured people going to the emergency room for a sinus problem and a bloody nose…no joke, yet they have: cell phones, digital cable TV, every Game Boy, Xbox and computer game imaginable. They get FOOD STAMPS, and they eat well. These people could shell out $75-100/month for their major medical insurance, but THEY CHOOSE NOT TO. The grown son could GET A JOB. He chooses not to. I take care of the adult in the home (CCS Caregiver) -totally FREE to her and paid for by WA taxpayers. And she needs very little care, though given 30 hours of ME every week.

It is unfortunate that I like my work generally because I see in front of me The Problem – it’s LAZY AMERICANS, JOHN. Why are we feeling sorry for them? Why are we going to give our medical care over to the Feds because of them?

OK…there is a small percentage of starving, ill people who need a safety net. But we know that expanding Federal programs will do nothing except bloat and bastardize the system it is trying to “improve” and make more lazy Americans.

Is there ANY light at the end of this tunnel??? Do you ever feel like Bastiat?
LN Shapely
Poulsbo, WA

First – a logical error. You mistake high *amount* of high out-of-pocket spending with high *rate* of out-of-pocket spending. Although our percentage may be lower, the *absolute value* of spending is higher.

There’s no question that our system contains rampant overinsurance, but that’s because private insurance has priced out the sick to maximize their profits. I think you would agree with the Commonwealth Fund that the incentives of the private insurance industry do not align with patients’… but instead you decided to sling mindless insults like “The Worst Study Ever”.

HRAs and HSAs are definitely not the silver bullet you think they are. Sure, if you are self-employed or make a ton of money, HSAs/HRAs are awesome. But the average person cannot afford to pay hundred of dollars every time they go to the doctor. This would almost certainly cut down on regular check-ups, preventative care, cancer screenings, etc. etc. Multiple studies have shown this is the case. Unless you think the poor deserve to be sick.

The most troubling problem with HSAs/HRAs is that they would make health care a luxury market, since the rich would basically be a captive market, willing to pay any price (similar to the college tuition phenomenon today). This would lead to rampant inflation with some doctors charging $1000 per visit and only serving those who can pay. You already see this happening with doctors going into lucrative specialties and regions. With HSAs, this effect would accelerate.

The excessive number of MRIs and tests that are done are not patients’ fault.

Excellent summation.

It gets back to the argument of who is responsible for ones own health and economics.

I vote for individuals.

The Commonwealth Fund obviously thinks that individuals are too stupid or manage their own healthcare finances.

This is just another ploy for a government takeover of healthcare. And we all know what a mess that would be!!!!!!!!

There is so much wrong with this “study” it is hard to know where to start. I know! Let’s start with one of their most blatant distortions. They say, “The United States already stands out internationally for high per person out-of-pocket spending.” In fact, the United States has one of the lowest rates of out-of-pocket spending of all the OECD countries. According to OECD, Americans spend only 13% of total national spending out-of-pocket, while the OECD average is 20%. Even Canadians spend more out-of-pocket than we do at 15%.

Next let’s consider their definition of “underinsured.” They include anyone who spends 10% or more of their annual income on medical expenses, 5% for those at 200% of poverty or lower, and anyone who has a deductible equal to 5% of their income. There is no rationale for this standard , other than “it is the level most commonly used in studies of financial stress and studies of the underinsured.” They do not take into account premium payments or taxes devoted to health care. It is somehow not stressful to pay large amounts of one’s income on insurance premiums or taxes, but just awful to reduce those payments and pay cash for health care instead.

It is curious as well that these authors confine their examination to the population under age 65, since their boss, Commonwealth Fund president Karen Davis, testified to Congress in 2001 that the average Medicare beneficiary pays 21.7% of their income on out-of-pocket medical expenses and she expected that to rise to 29.9% by 2025. If “underinsurance” is a problem, the most egregious offender is the Medicare program.

But never mind all that. The sole purpose of this strange little exercise is to undermine the growing trend of consumers taking control of their own health care by taking control of the money they spend. Lower income people obviously need additional assistance, but they will need that help whether they pay directly for services or indirectly for premiums.