Jim Dudley: Rearranging the deck chairs

Our health care payment model is not working. Current discussions are similar to rearranging the deck chairs on the Titanic. I think the chairs should be on the starboard side, you think they should be near the stern. Everyone forgets that the problem is the hole in the hull.

Congress argues over who pays for care, not the reality that the cost is too much. Not until all parties work together to cut costs will there be a solution. It is not just the pharmaceuticals, the greedy doctors, the insurance companies. It is all of those and we, the consumers.

Americans have an inflated view of what medicine can accomplish. Competition is not the answer — medicine is different. I can make patients very happy — give them antibiotics for a cold, a CT scan for a mild concussion narcotics for their sprained ankle.

I’ll have all the patients I can handle. Good medical care often requires tough talks, and patients are often not happy. Speed and convenience are nice but, frequently, not necessary for good care and good outcomes. Yet, immense resources are spent to be competitive by being convenient and fast.

I see many arguments about the Constitution — medical care is not a “right.” I will concede that, but I do believe, as a caring society, we have some obligation to help those who are less fortunate. I will acknowledge there are those who will take advantage (as they will in any given social situation). But I don’t think I am one to judge which ill person deserves to have help and which one does not. Our current system allows politicians and insurance executives to do just that. People have noted “everyone can get care — all they have to do is go to the ER.”

Unfortunately, that leads to huge numbers of bankruptcy — only in America. I really hope we are enough of a caring society to not allow that to happen on such a regular basis.

I readily admit to supporting a single payer system (not socialized medicine; there is a difference). It will not be perfect, but all other developed societies cannot be wrong. It does not matter what system, there will be disgruntled people — the doc was mean, the nurse was rough, the wait was long, etc. — but overall, people in France, England, Australia, New Zealand and other countries spend much less and are much happier with their care then in the U.S..

Can there be a combination system? Possibly. But as long as I only fight to make you pay, and you only fight to make me pay, none of us will come out of this happy.

We need a system to care for all Americans. Current legislative discussions don’t debate how to provide medical care to Americans, but instead, “who can we deny coverage to” and “who can I make pay?”

I realize there are many who say “I’m healthy; I do not need insurance.” But make no mistake — a percentage of those people will have a catastrophic illness or injury, and you and I will pay for them as they go to the ER for care and end up on Medicaid.

I certainly do not have the absolute answer but 535 congressmen and women (and thousands of staffers) are currently spending their time discussing ways to get someone else to pay, not how to solve the problem. We all need to step back and tell members of Congress to solve the cost problem and not fight to make the other guy pay.

Jim Dudley

Steamboat Springs

Community comments

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(Lock McShane) Lock_McShane says...

Thanks Dr. Dudley, for shedding some light on our horrible system. Would you be willing to publish your complete price list, with all the different prices for all the different payers? You don't have to identify the payers, just show us how many different charges there are for each procedure. This will show how messed up the current, controlled by insurance, system is. And all other providers can also disclose their price structures, so we can have transparency of pricing and can shop like the Administration wants us to do.

Posted 13 March 2017, 9:31 p.m. Suggest removal

(Jim Dudley) jimdudley says...

Hi Lock, I'm in Hawaii working at a rural federally funded clinic. I'll talk to some people at Steamboat medical and see if I can get that. I'll also check out here to see (but doubtful) In reality it is almost like industrial espionage to actually find out what is actually paid for a procedure. When I was still at SMG we hired people to do our negotiating with insurance companies and I really never knew what got paid for a procedure. It was an incredibly complex system. Again, without a single payer system I'm not sure you could get a true cost (what is actually paid) for a procedure as EVERY practice and EVERY insurance company may have a different amount paid for EVERY procedure. Incredible number of permutations

Posted 13 March 2017, 10:37 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...


I think it would be informative to take some random unnamed procedure and describe all of the different amounts paid by different insurance companies for that procedure and compared to what patient is told is the cost for that procedure.

Posted 13 March 2017, 11:15 p.m. Suggest removal

(Eric J. Bowman) Eric_J_Bowman says...

I miss having Jim as my Dr. Without divulging the details of my medical situation, being forced by the powers-that-be to have regular, basically pointless checkups, Dr. D always charged me the minimum rate for a visit. Unfortunately, SMG hasn't kept up with his example since he left.

+1 to single payer for everyone. I've run a succession of small businesses, none of which had as a core competency, a HR dept. capable of taking the point on all my employees' healthcare. In the rest of the First World this wouldn't even be an issue, but for some reason here, the GOP insists on this, to the detriment of every small business in the country.

Posted 20 March 2017, 11:36 p.m. Suggest removal

(Jeff Kibler) JeffKibler says...

Lock, did you ever get a price for your X-ray?

I had a physical in 2015, Doctor says you should consider a colonoscopy. I ask "how much?" Doctor leaves and returns after 5 minutes and says "$3,000."

2016, two weeks after my physical, a nurse from the same practice calls me and very aggressively pushes me to schedule a colonoscopy with Dr. M. I ask "how much?" I'm on hold for 3 minutes and then she says "$6,000." I said "you're nuts" and hung up.

All-inclusive colonoscopies are common in Denver or Grand Junction for $1,500.
Caveat emptor.

Posted 13 March 2017, 10:49 p.m. Suggest removal

(Matt Hannon) mtbmxcr says...

Jim I agree that cost or lack of cost regulations is the reason our coverage here in US is so pricey. I noticed something else though. You very casually note that prescribing narcotics for a sprained ankle is commonplace. That is unnecessary and is definitely a contributing factor to a few big US problems, like cost of meds, opioid addiction, and trusting the medical profession.

Posted 14 March 2017, 6:46 a.m. Suggest removal

(Jim Dudley) jimdudley says...

Hi Matt, That was the point I was trying to make. People have a very difficult time actually knowing what is appropriate medical care for even a simple thing like a sprain ankle. You would be surprised how many people ask for and are angry when they are not prescribed narcotics or antibiotics. But if I "please" them then I have won the competitive battle for a patient. NOT to the benefit of society. Now increase the complexity to heart surgery, knee surgery, etc and you begin to understand why "competition" is not a significant way to decrease medical costs.

Posted 14 March 2017, 11:37 a.m. Suggest removal

(Jim Dudley) jimdudley says...

and I don't prescribe narcotics or antibiotics -- just an example of how a "competitive, free market provider" might increase his market share.

Posted 14 March 2017, 12:58 p.m. Suggest removal

(Matt Hannon) mtbmxcr says...

Thanks Jim. I do see your point and agree. My family sees a D.O. rather than an M.D. and we try stay away from the products the prescription drug cartels sell, though we do all get a good kick out of the commercials and the odd side effects disclosures. Which begs another related question. When will people do the math and realize the shameless marketing from the drug pushers leads to the angry pill popping patients who need to be "please(d)" as you say?

Posted 15 March 2017, 7:54 a.m. Suggest removal

(Martha D Young) marthalee says...

There was a big difference between what insurance companies paid me for one hour of psychotherapy. Oddly enough, Medicaid became the most consistent and reliable payer. Some of the private insurance companies spent more time and money not paying me than it would have cost them to pay me. You get the picture?

Posted 14 March 2017, 7:11 a.m. Suggest removal

(Nancy Spillane) NSpillane says...

Dr. Dudley, thank you for writing this letter. It is informative and disturbing. I sincerely appreciate (and always have appreciated) your compassion for your patients and for the world in general. We continue to fight the fight for a single payer system. Again, thank you for continuing to enlighten all of us.

Posted 14 March 2017, 7:41 a.m. Suggest removal

(Dan Shores) dshores says...

I just don't see any way to contain costs within the capitalist free market system. Those on the right continue to complain that health care is not a right guaranteed by the constitution. It doesn't matter whether or not this right is enumerated in the constitution, it is a human right and should be the right anyone living in a modern civilized society.

Health care is a public good and does not fit, nor belong, in the free market for profit system. The only answer is a single payer system, as exists in every other advanced nation in the world. We are the exception, not the rule.

Posted 14 March 2017, 8:39 a.m. Suggest removal

(Eric Morris) ericsmorris says...

What are the laws of economics and why would or wouldn't they apply to health care?

Posted 14 March 2017, 8:47 a.m. Suggest removal

(Ken Mauldin) KenM says...

Basic economics explains that supply and demand (a.k.a. reality), determines costs regardless of the system of allocation. Single-payer healthcare would be a inefficient disaster and cause even more harm than the ACA caused. My family, and many other families, were in much better condition before the disastrous ACA and many Americans prefer a complete repeal.

Posted 14 March 2017, 8:52 a.m. Suggest removal

(Eric Morris) ericsmorris says...

Dan, is the current or was the pre-existing (ha!) system capitalism or the free-market?

Doesn't government already cover close to 40-50% of spending?

Here's one proposed solution to lower costs.


Posted 14 March 2017, 9:17 a.m. Suggest removal

(Carl Steidtmann) CarlSteidtmann says...

We are now 50 years into an experiment with government intervention into the health care market place. The government take over of health care is almost complete.

The Federal government will spend $2.1 trillion this year on health care. Total health care spending reached $3.2 trillion in 2015. Only 21% of all health care facilities are for profit. The rest are either government owned or non profit. To blame the problems with the US health care delivery system on capitalism is to miss the forest for the trees.

Health care is no different than any other good or service. Like every other marketable product, it exists in a world of scarcity. A free market is the best and really the only mechanism for providing the appropriate incentives to increasing supply, improving quality while reducing costs.

The result of that growing government intervention into the health care market has been runaway inflation, widespread personal bankruptcy and massive unfunded government entitlement programs coupled with massive fraud.

I do hope that when a complete take over of the health care system by the government takes place that it includes a generous mental health provision. The very definition of insanity is to continue to do the same thing over and over again while expecting a different outcome.

Posted 14 March 2017, 10:09 a.m. Suggest removal

(j mcginnis) JMcGinnis says...

Dr. Dudley,
Thank you for your letter about health care. You are more knowledgeable than most of us in this regard and you demonstrate compassion for human rights and the well being of all. I wish we had someone like you representing us in Congress.

Posted 14 March 2017, 11:33 a.m. Suggest removal

(Jim Dudley) jimdudley says...

I do have a differnt take on the economics of health care. Most things we buy we have significant time to research, we understand what we are buying, there are very clear cut parameters on what we are looking for.
When you become ill, have an accident the time line is incredibly shortened. You generally do not have a good understanding or knowledge of the product (medical service) you are buying. Shopping around is quite difficult and often impossible.
I agree that the cost of many services (lasik for example) have come down due to competition. But understand it is a very technologically driven procedure (computer cost, instrument cost) and there is ample time to decide where to go.
A free market means some go without. As a citizen and caring person I can not in good faith allow a 3 year with cancer to go without treatment because the parents did not get insurance, and I can list examples for pages. Sure, eventually she will end up in the ER (multiple times) amd guess who pays for that. You and I in our insurance. Why not simple agree she needs care, provide a method for payment that is assured and people do not spend their lives in fear of an impending medical disaster that will ruin their lives and family.

Posted 14 March 2017, 11:52 a.m. Suggest removal

(Carl Steidtmann) CarlSteidtmann says...

That there is scarcity with respect to medical resources and services means that some will go without. How we as a society choose to allocate those scarce resources is an economic, political and ethical decision.

By using a market mechanism with real competition to allocate those scarce resources we create a system that rewards increasing supply, reducing costs, while improving the quality of service. It means that as time goes by, more people can be served at a lower cost and at a higher level of quality.

By leaving an ever larger share of the allocation of those scarce resources to government our experience of the past 50 years shows you get a system that squanders resources, creates massive debt, fraud and unfunded future entitlements even as it creates a mediocre result. It means that as time goes by, fewer people can be served at an ever higher cost and at a lower level of quality.

I too care about that 3 year old with cancer. I am willing to bet dollars to donuts that all of the future 3 years olds who have the misfortune to contract this terrible disease will get better care and have better outcomes in a market driven system.

Posted 14 March 2017, 1:35 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

Healthcare is poorly suited for free market. As a society we are not willing to say that lack of health insurance means no medical treatment when showing up in an emergency room.

The Republican plan does nothing for costs and it's projected future smaller that otherwise increase in costs (not savings as still well above current costs) is primarily due to older Americans simply not being able to afford health insurance.

It would appear that other countries which set or negotiate standardized pricing are successful at reducing administration costs.

It also appears that if medical students are less in debt then it is easier to pay them less as doctors. Going in debt to become a doctor makes it a huge financial commitment so the expected rewards also has to be large. Countries that largely cover the costs of medical training are able to train enough doctors willing to work at lower than US doctor salaries.

All of the ads for prescription drugs is also an indication of a broken system. If the patient has a condition, visits a doctor and any medically appropriate prescription is given then there is no benefit to advertising. Advertising creates customers seeking to use a prescription drugs.

Posted 14 March 2017, 11:53 a.m. Suggest removal

(j mcginnis) JMcGinnis says...

I agree that the level of medical school debt is outrageous. Medical school should be free to enable all qualified students to pursue a medical career without going into decades of debt. I don't agree that this should be to pay doctors less; it should be to enable more doctors to go into general practice and to rural areas where they are needed but are not constrained by debt.

Posted 14 March 2017, 12:49 p.m. Suggest removal

(Ken Mauldin) KenM says...

Economics doesn't care what industries are "suited for." Math and economics don't have feelings. Because I also care about people and want the best for my family, community and country; I will advocate against any economically unsustainable system that will cause predictable, irreparable harm to our country, like a single-payer or socialized healthcare scheme.<br><Br>While it's crucial that some of us chose to study medicine, it is also crucial for a society that some will study economics and learn that it's not possible to create any system that allocates scarce resources without experiencing limits. Any culture that is foolish enough to believe that emotions and good intentions can outweigh the reality of basic economics is headed for spectacular failure.

Posted 14 March 2017, 12:25 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

The dynamics of a market certainly do dictate whether it is well suited for a free market solution. Natural monopolies are poorly suited to a free market at that market's natural situation is a monopoly and no competition.

Likewise, healthcare is a market for which a simple free market is a poor solution. That people will be treated in an emergency room regardless of ability to pay is a massive distortion of the free market. The free market solution would be to refuse to treat millions of people and let them die of treatable medical conditions.

Posted 14 March 2017, 1:14 p.m. Suggest removal

(Eric Morris) ericsmorris says...

Dr. Dudley, could charity help ensure that the poor receive appropriate care and actual catastrophic insurance (like life insurance) help protect against bankruptcy for others?

Posted 14 March 2017, 12:34 p.m. Suggest removal

(Fred Duckels) fredduckels says...

Free healthcare is being bantered about as the cure all for our predicament. Most of the proponents would in the same breath advocate open borders. Maybe we should start with a math class followed up with Econ-101.

Posted 14 March 2017, 12:48 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

Universal health care would not be free, as you state. It would be paid for by taxes. Unfortunately, for many, taxes are evil and should be eliminated whenever found.

Posted 15 March 2017, 8:25 a.m. Suggest removal

(Jim Dudley) jimdudley says...

Ken, I have a serious doubt that our current system is ecomically sustainable. There do need to be limits to costs. We currently set those by a persons economic situation. Can limits be set in a single payer system? I believe so and think it can be done in a much more fair manner.
Eric, there is already a significant amount of charity that is helping. But understand the incredible stress and anxiety that occur with the discovery of a major medical problem. Not just the major medical issue, but the concern and worry about payment, bankruptcy, etc. Charity can NOT fill the void when there is a major injury and months and years are spent in the hospital.
Fred I did not say "free" medical care. It has to be paid for somehow. There are many models that are working in other developed societies. Co pays, etc are a very reasonable part of those systems. The big question is do we as a society want to help those less fortunate or just say "tough luck"

Posted 14 March 2017, 1:36 p.m. Suggest removal

(Ken Mauldin) KenM says...

Hi Jim - Thanks for your reply. The current system is most certainly unsustainable and will collapse, sooner rather than later, if not either repealed or dramatically altered. We agree on that matter completely. I appreciate that you recognize there will be resource limits to the provision of healthcare and hope you also recognize the inherent inefficiencies related to such a heavily regulated market as it relates to costs and quality.<br><Br>Since we're stuck with resource limitations that must be addressed, I think a person's financial condition (including their financial planning as-it relates to health insurance coverage) is a better method of determining these limits rather than an unaccountable bureaucrat deciding what level of care a person may receive. Scarcity requires that every person cannot, and will not, receive the highest quality level of care. At some point, a decision must be made that a specific level of care will not be provided. Those difficult, sometimes 'end-of-life' type decisions, are best left to individuals and families, not government.<br><br>Government acting on these inherent limitations and imposing significant and/or end-of-life healthcare decisions that determines who lives and who dies is a uniquely terrible idea.

Posted 14 March 2017, 4:31 p.m. Suggest removal

(Dan Shores) dshores says...

In 1949, Albert Einstein argued that unrestrained capitalism produced great disparities of wealth, cycles of boom and bust and depression, and festering levels of unemployment.The system encouraged selfishness instead of cooperation, and acquiring wealth rather than serving others. People were educated for careers rather than love of work and creativity. And political parties became corrupted by political contributions and owners of capital.

What prophetic words! Ken M., etal., I am not arguing about your opinion of the merits of the capitalist model and it's roll in the allocation of scarce resources. Health care is not a commodity that one can decide whether or not to purchase. Heath care is not a luxury item that some can simply "do without" for lack of resources. Heath care is a "common good" and quite necessary to sustain life.

This is the debate we should be having, is health care the right of every citizen, or a privilege available only to those who can afford it? Virtually every advanced nation in the world believes it is the right of every citizen and has developed practical cost effective ways to deliver quality medical care to everyone. There is simply no reason, other than greed and selfishness, that we, the richest nation on earth, don't provide quality health care to every citizen at the same level of care, regardless of ones ability to pay!!!

Posted 15 March 2017, 8:40 a.m. Suggest removal

(Ken Mauldin) KenM says...

Hi Dan - I agree completely that the concept of healthcare as a Right is crucial to the conversation. Because Rights are exercised by individuals without any imposition on another person, healthcare can never be defined as a Right. You have a First Amendment Right to express yourself, but the Pilot has no obligation to facilitate the exercise of that Right by printing your Letter to the Editor. Your neighbor has a Right to have a shotgun in their home for self-defense, but you have no obligation to buy it for them.<br><br>How our Rights are defined and exercised explains why healthcare is not a Right.

Posted 15 March 2017, 9:09 a.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

It is widely recognized that basic human rights include food, shelter and medical care. It may not be a right with a capital "R", but every society has a basic responsibility to attempt to be a livable place for all. That does not mean that basic human rights have to be provided for free by government. It does mean that there should be a workable plan on how everyone gets food, shelter and medical care.

The AHCA "works" by making health insurance too expensive for low and middle income people 50-65 so that their healthcare costs are not part of the program.

Posted 15 March 2017, 11:14 a.m. Suggest removal

(Dan Shores) dshores says...

Ken M. what do you mean by imposition on another person? If you are suggesting that I think medical personnel should work for free or be forced to work, that is a ridiculous assumption and equally ridiculous notion. We all pay taxes for things that are for the common good of all and health care should be one of those things. You can't expect there to be a private for profit military, or private for profit police and fire services that are dolled out only to those who can pay. If your neighbors house catches fire and he cannot pay, it could burn down you house as well, and the entire neighborhood. Medical personnel would be paid by some form of National Health Service that is tax payer funded, just as in virtually every advanced nation in the world.

If a persons sole desire is to make wads of money they should consider investment banking, or a business degree perhaps, not a medical degree or the health insurance business. Medicine is a common good and should not be considered just another way to get rich. Treating patients, saving lives and improving the quality of life should be the goal, not how much money one can make. I believe this is what is at the heart of the disagreement, not the validity of capitalism or some economic theory on the allocation of scarce resources.

Posted 15 March 2017, 4:23 p.m. Suggest removal

(Fred Duckels) fredduckels says...

Got notified today that our company health costs are going up by a hefty margin. We were told that all the extras mandated by social engineers are wreaking havoc with the rates.

Posted 15 March 2017, 4:35 p.m. Suggest removal

(Jim Kelley) jksparky says...

Yeah, I got that one too Fred.
Almost the exact notification as we got in 1999.
And in 2001, 2002, 2005, 2007, 2009, 2012, 2014, also.

Obama was an Illinois State senator in 99'. ----I suppose that somehow he is still to blame for our 50% premium increase in 99' and our deductible jump in 2005 from 500.00 to 5,000.00.
Or should I just fall in line and blame Benghazi for this mess?

Posted 16 March 2017, 3:30 p.m. Suggest removal

(Ken Mauldin) KenM says...

Hi Dan Shores - You advance the false notion that profit is bad and causes harm. In reality, the profit motive in healthcare, as with every single other marketplace of goods and/or services, results in increased access to services, lower costs and higher quality of care. Scarcity requires a system of allocation, no matter how much you dislike that concept. Free markets and the profit motive will produce the best, most efficient allocation model possible of scarce resources, regardless of the marketplace. Our natural feelings of compassion have no affect on that reality.<Br><Br>Ignoring basic economics and our traditional definition of Rights in order to impose some nationwide ideal of fairness that creates a new, bottomless entitlement program is a terrible idea.

Posted 15 March 2017, 5:36 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

BASIC health care should not be a scarcity, even as specialized health care is less available. Profit motives in health care has not resulted in lower prices; only optional procedures like Lasik have gone down. If it is vital for life, they charge the max, like EpiPens.

Posted 15 March 2017, 8:03 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

No country has developed a truly free market system for healthcare that comes close to working well.

Germany's system and others are not single payer so a multi-payer system can largely work.

Two things are present in all working systems.

First, that everyone must have health insurance. No more uninsured showing up at a hospital emergency room needing treatment and no means to pay. This is where ACA is failing as too many younger healthier people are not buying leaving the resulting in the less healthy to participate which raises average costs.

Second, the healthier and younger have to pay more than their share. The average costs of older people is just too high for them to pay. It isn't fundamentally unfair to have younger pay more than their share so the older can pay less than their share because the younger will soon enough become the older.

Posted 15 March 2017, 9:09 p.m. Suggest removal

(Chris Hadlock) chadlock says...

Fred, I got those letters every single time that the insurance company found out I was a cancer survivor. Those premium increases started a very long time before we elected President Obama and they have slowed dramatically since the passage of the ACA in spite of what you might hear on Faux News.

Ken, basic economics would have those that cannot pay dying in the street or passing away without heatlthcare in the privacy of the apartment that replaced their once nice home. Once our country decided that hospitals must treat those in need we were set into this current path.
I agree with the conservative manta about selling across state lines with a caveat. We should break the tie between health insurance and employment, break up ALL special groups and force insurance companies to treat their entire pool of insured as a single group. As long as insurance companies are allowed to break us into ever smaller groups, premiums will continue to rise.

Posted 16 March 2017, 6:58 a.m. Suggest removal

(Jeff Kibler) JeffKibler says...

Didn't you disclose to your health insurance company that previously you had cancer when you applied for coverage? They found out after the fact and didn't cancel you?

And no, for millions, premiums have increased dramatically along with deductibles.

Posted 16 March 2017, 10:13 a.m. Suggest removal

(Chris Hadlock) chadlock says...

Jeff, yes. Their questioneer asked about cancer in the last 10 years and I had been cancer free for longer than that. When the Doctor ordered the normal blood tests to be sure the cancer had not returned I received those letters within 3 months of those tests being done. Those tests were run every 2-3 years at that time, and I had been on the same plan for just over 2 years.

Posted 16 March 2017, 5:03 p.m. Suggest removal

(Larry Desjardin) LarryDesjardin says...

The issue we face on the western slope is that there may be no insurance carriers next year for ACA at all. Co-ops are gone, and there is one carrier Blue Cross/Blue Shield left. With all its good intentions, ACA has destabilized the individual insurance market to the point of breaking. Employer mandates have taken healthy people out of the individual market and into the group market. The 26-year old requirement has done the same. The 3:1 maximum pricing ratio for age has caused premiums to rise for young people so much that they aren't signing up in the numbers required. (only 26% of ACA enrollees are <35 years, while the ACA planners originally said ~40% was required). The worse part for us was the geographical gerrymandering that concentrates high-cost rural regions together. This could be changed by our state representatives and insurance commissioner, but declined, because they predicted front range premiums would be 8% higher. Since our insurance was cancelled due to ACA, we are paying double now just 2 years later for a worse plan. That's >100% increase. The current death spiral is real, and a result of the specific rules in ACA.

Posted 16 March 2017, 9:55 a.m. Suggest removal

(Jim Dudley) jimdudley says...

I think Scott says it best and most concisely -- everyone is covered ( everyone has health insurance) and younger and healthier do have to pay more than their share (for that time of life).
Health premiums have been going up by double digits for most of the 30 years I have been purchasing insurance for our practice. ACA did not "fix" that but it also did not "cause" it.
The only solution is for both sides to get serious, quit playing to their more radical bases and figure out a way to cover everyone (and I'm sorry but that will require some mandates). At the same time begin to truly look at why costs are so high, what we can do to decrease them and how to place some limits.

Posted 16 March 2017, 12:02 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

As for why costs are so high, one problem is that too few people actually care about costs. I grew up under Kaiser care which made serious efforts to have lower costs. Meanwhile, other providers "competed" by advertising on how they provided goodies To remain "competitive", Kaiser added goodies such as designer maternity rooms, easier to get branded prescriptions over low cost generic equivalents and so on.

The current system needs to be tweaked so that there is transparent pricing and patients have incentives to select the lower cost options.

Posted 16 March 2017, 12:41 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

One of the reasons premiums have been rising for decades is the decline of the unions. Unions, since WW2, have negotiated for health insurance benefits in their contracts. This put a large number of healthy, young adults into the insurance pools, who paid into the system without taking much out. This made premiums less expensive for the rest. As Big Business and politicians fought the unions, membership declined, and there were less healthy people enrolled in insurance. The penalties under ACA were not large enough for younger, healthier people to get into the game. The new AHCA will make it even worse.

Posted 16 March 2017, 6:29 p.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

I think it is more persuasive that unions were weakened by their legislative success. With work rules as federal law reduced the need for unions. Unions were also poorly suited for tech changes with changing job descriptions. Robotics in assembly lines basically forced automakers to move away from Detroit to get nonunion employees without archaic work rules defining each type of assembly line job that no longer made any sense.

And unions never found any traction in the tech industry. Workers saw work changing too quickly and their skills advancing that union job descriptions weren't seen as being helpful to the workers.

Posted 17 March 2017, 1:20 a.m. Suggest removal

(Larry Desjardin) LarryDesjardin says...

Actually, I think you can make the case that union negotiations and tax preferences increased the cost of health care in the US. This has to do to the fact that tax law favors spending on health care, since it is untaxed, over wages. Because of this, unions and employers agreed to lavish health care plans ("Cadillac") with zero deductibles, zero copays, and sky-is-the-limit benefits. Since health insurance is a payment-in-kind, it was a win-win: more worker benefits without taxes, so worker "pay" shifted to these benefits. However, these plans remove all incentives for cost savings, and coincided when US health care costs rose the most.

Posted 17 March 2017, 9:48 a.m. Suggest removal

(Scott Wedel) Scott_Wedel says...


Though, that tax advantage applies to all employer health plan providing benefits to workers. That tax advantage encouraging lavish health care plans also applies to non-union workers.

Posted 17 March 2017, 10:59 a.m. Suggest removal

(bill schurman) expublicdefender says...

Dr. Dudley,

If in light of Trump's budget proposal, if passed. will your federally funded rural clinic be on the chopping block like so many other programs for the poor and needy ? I hope that's not the case.
Guess we'll see what Congress does with the actual and final budget.

Posted 19 March 2017, 9:25 p.m. Suggest removal

(Brian Kotowski) Sep says...

My premiums and deductibles have nearly tripled under Obamacare, and my reward is inferior coverage. On the bright side, my policy *does* cover prenatal care and drug counseling. All I need now is a uterus and an addiction, and I'll be in like Flynn. Thanks, Obamacare!

Obamacare is a lame horse. Put a bullet in its head already.

Posted 20 March 2017, 5:13 p.m. Suggest removal

(Lock McShane) Lock_McShane says...

It is not the pre-natal and addiction coverage that is causing your rise in premiums. It is the lack of healthy people in your insurance pool.

Posted 20 March 2017, 10:35 p.m. Suggest removal

(Eric J. Bowman) Eric_J_Bowman says...

"My premiums and deductibles have nearly tripled under Obamacare, and my reward is inferior coverage."

Boo Hoo. You may not realize, but despite my best efforts, I am STILL uninsured, so I promise you you're better off than I am... at least you HAVE premiums and deductibles, whereas I would have even more inferior coverage if I was even ALLOWED to pay four times what you pay for half what you have. Quit whining and suggest an ALTERNATIVE to Obamacare, something that might, you know, make it possible for me to be INSURED in AMERICA in the 21ST CENTURY.

Wow, I just hate listening to those who want to make it even harder for me to even HAVE insurance, whine about the state of their ACTUAL COVERAGE. Any other first-world country on Planet Earth, we wouldn't even be HAVING this discussion. We only fight about repealing a broken system, so we can go back to an even-more-broken previous status quo. Fess up -- you think I just don't deserve health insurance, which is what this "debate" really comes down to -- you have what you feel you're entitled to, everyone else can please die ASAP, right?

Posted 20 March 2017, 11:48 p.m. Suggest removal

(Eric J. Bowman) Eric_J_Bowman says...

Kudos to Dr. D for participating here. Hope the degenerate denizens of this forum (myself included, if only occasionally) don't scare him and others away from trying to set to rights the standard disinformation and politically-motivated hyperbole which infect this place, with actual knowledge and facts garnered from experience inside the system. If this sort of thing continues, maybe we'll even find some common ground going forwards?

Which will never happen if it becomes even harder for me to get health insurance that's still unobtainable (without mortgaging everything I own) even with Obamacare. It's actually quite absurd that as a small businessman, I'm required to provide healthcare for my employees (or just not grow large enough to be required to do so, but that's anti-capitalism) when I can't get coverage for myself. SINGLE PAYER, **PLEASE**.

Bernie 2020. :)

Posted 20 March 2017, 11:57 p.m. Suggest removal

(Brian Kotowski) Sep says...

Bowman's reply perfectly encapsulates the American left. Big Bro is shafting people and they don't like it? Boo hoo. Bonus points since the people grabbing their ankles are the degenerates we disagree with. Your 11 yr old is suspended for bringing kindergarten cutlery to school? Boo hoo. Conservative speakers are [bullied, assaulted, and hospitalized][1]? Boo hoo, crybabies.

You want more Trump, gang? *That's* how you get more Trump.

In other news, Trump & the GOP seem bent on screwing the pooch with their steaming pile of ObamacareLite. Meet the new boss. Same as the old boss.

[1]: https://www.bostonglobe.com/metro/201...

Posted 21 March 2017, 7:42 a.m. Suggest removal

(Lock McShane) Lock_McShane says...

Brian, would you accept Single Payer as the only rational health care system that has proven to work around the world? If not, then describe how our current, broken system can work for everyone.

Posted 21 March 2017, 8:24 a.m. Suggest removal

(Scott Wedel) Scott_Wedel says...

Though, there are national health care systems such as in Germany that have multiple payers. What other developed countries have are universal coverage systems in which everyone has health insurance for catastrophic conditions.

The trouble with ObamaCare and made far worse by the Republican proposed bill is that are trying to provide good overall health insurance and that is expensive.

What threatens the stability of the health care system are the uninsured needing life saving treatment because society is not willing to let uninsured people die for lack of treatment, but then is making those with insurance pay for that treatment. That creates a downward spiral of health insurance being too expensive and fewer people being insured.

Posted 21 March 2017, 11:24 a.m. Suggest removal

(Brian Kotowski) Sep says...

It is rare that I react to [an NYT op-ed][1] with anything other than knee-jerk contempt and dismissal. But Mr. Domenech's musings contain elements that are worth considering. Given Trump's bonafides as a an establishment big-government whore, I could see him going along with a good deal of this. It may be the least malignant most politically feasible proposal I've seen. Which is not to be construed as an endorsement.

[1]: https://www.nytimes.com/2017/03/21/op...

Posted 21 March 2017, 1:33 p.m. Suggest removal

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