54 replies »

1. “Every family, on some level, is a barter between the generations…If I care for you when you’re young so you’ll care for me when I’m old…”
   Great Words. True Meaning of life

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7. I just want to be able to get treatments and pay a monthly fee based on my salary. Shall surgeries be needed, getting a discount would be nice too.

8. Who cares!

9. BTW where is Maggie Mahar?

10. i don’t write the stupid lol crap, I just write it as it is:

    HA HA HA HA HA

    Gotta love how the partisan hacks in the media, even when reporting something that really is bad, still try to spin it as a basic “no big deal” with words like “glitch”. Umm, is being told you are due money that you don’t get, or worse, told you don’t owe anything and then are handed a bill a “glitch” to most on the receiving end of such idiocy?

    the link: http://articles.philly.com/2014-03-22/news/48443001_1_tax-credit-insurance-premium-healthcare-gov

    the “problem”: “Nearly six months after the disastrous launch of Healthcare.gov, with the website running smoothly and more than five million people signed up as open enrollment heads to a close, a new glitch has come to light: Incorrect poverty-level guidelines are automatically telling what could be tens of thousands of eligible people they do not qualify for subsidized insurance.”

    Gee, which could affect which group of potential enrollees the most? Perhaps, the Millennials who are literally banking on this to allow them to get the coverage.

    How about this one in the article as well: “It also highlights what some public policy experts say is a troubling lack of transparency in the marketplace’s eligibility determinations.”

    Wow, what a surprise, a revelation, a discovery! The Obama administration and his minions trying to force this sewage down our throats is still screwing up this legislative application. And hiding it as voraciously as possible!

    Oh, and I read last night the White House is now considering delaying the mandate end date of March 31 to what, November 5 2014? Just to insure those 7 million finally enroll?

    Face it, if any republican did this, the media howls would make 50mph winds sound quiet. So many commenters here redefine “disingenuous and dishonest”, it is nothing less than hideous and disgusting how partisan interests trump public welfare every frickin’ time.

    I’ll finish with this from a usual post and comment author here in the article: “I have to say, I probably would have made the same mistake if I were in charge,” said [Robert Laszewski, a former insurance-industry executive who is president of Health Policy and Strategy Associates] Laszewski, the former industry executive. “But they’re not supposed to make that mistake.”

11. Make sure to look at the data from palliative care studies. Those who opt not to use aggressive care end up living (on average) longer than those who don’t. And have lower costs and higher quality of life. So those relatives who “can’t let go” may actually be hastening their loved ones’ demise.

12. Bob,

    There are slightly over 10 million seniors who are eligible for both Medicare and Medicaid. They are referred to as Medicare / Medicaid eligible (MME), dual eligible or duals, take your pick. Anyway, they account for $350 billion of health system spending per year. Interestingly, if you look at the most expensive 10% of this population that have their bills paid by Medicaid and the top 10% with bills paid by Medicare, there is almost no overlap at all. It turns out that the expensive Medicaid patients are those who need long term care in a skilled nursing facility or lots of home healthcare. The expensive Medicare patients are frequent flyers in hospital emergency rooms with many suffering from congestive heart failure (CHF) and / or mental illness.

    In any given year, the healthiest 50% of seniors (26 million people) account for only 4% of Medicare costs though they are not exactly the same people from year to year. Healthcare has always been referred to as a 5-50 business meaning that in any given year, the most expensive 5% of the population accounts for 50% of costs. The most expensive 10% account for about 65% of costs and the most expensive 1% drive 20% of costs.

    My impression is that there is lots of futile care at or near the end of life except that doctors can’t predict exactly when the end of life will occur though, in the case of cancer, they often can at the very end. On the positive side, more people are choosing hospice and/or palliative care at the end of life in recent years. Often it’s the adult children that can’t let go but the patient can no longer communicate. That’s why we need more people to execute living wills and advance directives or at least prepare an informal memo for the kids that describe their wishes if it’s too uncomfortable to have an actual conversation with them.

13. Thanks Barry.

    Using your categories of basic vs catastrophic, my impression is that basic care is relatively cheap.

    I recently read that the individuals on Medicaid who do NOT require transplants, dialysis ,AIDS drugs, etc have an average annual insurance cost of $564.
    (Harold Pollack quote)

    And that is without any deductibles or coinsurance, which are supposedly so important to cost control.

    If our goal is get cheaper health insurance, then more preventive care will not do the job. Denying certain back surgeries will not do the job.

    We have to confront what is spent on hail-mary treatments that actually work.

    .

14. Bob –

    I think basic care is anything that isn’t catastrophic or rescue care. In the latter category, I would include trauma care, organ transplants, kidney dialysis, cancer treatment and sophisticated surgeries including cardiac and orthopedic procedures. In the former, I would include standard imaging and lab tests, stiches for relatively minor injuries and management of chronic disease including diabetes, asthma, hypertension, COPD, CHF, ischemic heart disease and depression. Preventive care is open to debate as even the tests that earn an A or B from the Preventive Services Task Force may do as much harm as good due to false positives which trigger additional testing and interventions.

    legacyflyer,

    The National Association of Insurance Commissioners (NAIC) was the group that did most of the work on developing the criteria that defined how the minimum medical loss ratios were to be calculated as both the components of the numerator and denominator that go into the calculation had to be precisely defined and determined. There was a lot of complexity there. There is no reason why the same group, working with the insurers, could not develop more uniform rules, procedures and forms related to defining and verifying coverage and filing claims to make life simpler and easier for providers. No anti-trust exemption would be needed.

    Insurers could also do more to standardize and simply their insurance plans into a good, better, best approach along with a bare bones catastrophic offering. There is no reason why pricing, especially for hospital based care, can’t be reduced to a conversion factor that would be a simple multiple of the local Medicare rate and then publicly disclosed. For teaching hospitals and safety net hospitals, this rate would exclude the add-ons intended to cover the cost of medical education and providing care to a large number of uninsured patients. Those last two pools nationally come to about $19-$20 billion per year, I believe.

15. The ACA was designed to give every American the chance to buy a health insurance policy.

    (or get a free policy from Medicaid)

    We can see how well that is working.

    Trying to guarantee access to basic health care creates two problems:

    a. There is wide disagreement on what constitutes basic health care.
    All would agree that a broken leg is basic health care.

    But what about diabetes care for someone who has overeaten for 30 years?

    b. Even to guarantee treatment for broken legs, some method must be found to pay the safety net hospitals for anyone they take in.

    Personally I think this should be easy to solve. Just raise taxes by about $20 billion to cover EMTALA admissions for anyone who is poor and uninsured.

    But for the last 28 years Congress has never gotten around to this easy solution.

16. Barry,

    I would have to guesstimate the effect of Medicare for all rather than the current system.

    Generally commercial insurers pay more than Medicare, Medicaid pays much less than Medicare and we have a significant number of no pay/uncollectible in our hospitals – particularly in the ER.

    My guesstimate is that going to all Medicare would be a wash.

    I will say that billing Medicare is relatively straightforward compared to the pre-auths, denials, loop holes and other nonsense involved in billing some of the commercial insurers (Particularly United Healthcare).

    As to whether a government single payor or an organized system of insurers is better – I really don’t care. But what we have is a disorganized mish-mash of different payors, all with different rules and different coverage.

    I believe every American should have access to decent BASIC health care regardless of who they work for – or even if they are unemployed. The ACA was supposed to provide this but just seems to have made things more complicated rather than solving the problem.

17. Bob and legacyflyer,

    I’m not a big fan of covering lots of preventive care as part of health insurance for several reasons. First, it doesn’t save money for the system over the long term. Second, it results in plenty of false positives that trigger additional interventions which subject patients to risk and potential harm. Third, Leonard Schaeffer, in his 2007 Shattuck Lecture, told us that an individual’s health status is determined 40% by personal behavior (diet, exercise, smoking, drinking, etc.), 30% by genetic factors, 20% by socioeconomic status and environmental factors (sub-standard housing, dangerous neighborhoods and the like) and only 10% by the quality of healthcare one has access to. Finally, I see prevention as a matter of personal responsibility. I don’t need an insurer to encourage me to maintain my car and my home. I shouldn’t need one to help me maintain my body either though I wouldn’t have a problem with non-profit hospitals and community health clinics offering free blood and urine chemistry screenings once a year as part of their community service mission.

    One issue that I disagree with legacyflyer on is the desirability of a single payer healthcare system. While advocates put way too much emphasis on keeping administrative costs down, there is likely to be too much fraud, at least in the U.S. and a lack of innovation on the delivery side. Liberal health economist Uwe Reinhardt says that single payer systems basically just pay bills. I would also prefer to keep politicians largely out of determining what’s covered and what’s not. There is a lot more that insurers can do to standardize administrative processes to make billing and documentation easier for providers and there is likely to be lots of consolidation in the health insurance industry over the next 5-10 years that should help reduce administrative complexity.

    Only Canada and the UK have pure single payer systems in North America and Western Europe. Taiwan has one as well and France has what amounts to Medicare for all but it only covers 70% of the bills and the French people pay 13% of income on average in taxes to finance that. Most of the population also needs and buys a robust supplemental plan to cover the other 30% of charges. Germany, Switzerland and Netherlands use insurers. Sweden used to have a single payer system but went back to using insurers.

    In Switzerland, insurers all have to cover the same mandated benefits package but are allowed to vary the deductible between 300 and 2,300 CHF per person (about $350 to $2,650 at current exchange rates). I would allow the deductible to vary between about $500 and $10,000 per person.

    Finally, I would be curious about how legacyflyer’s radiology group’s revenue and net income would be affected if it were paid Medicare rates from all comers including Medicaid patients but there was no uncompensated care.

18. Bob,

    You raise a very good point. Health insurance in the minds of some people has expanded to include a lot more than just insurance. And perhaps the more expansive view is a better way to look at it …

    But in a situation like that of some millennials, where being able to afford any insurance at all is in doubt, I would say that a limited policy is better than none.

19. You might enjoy the writings of Alison Hoffman on health insurance.
    She says that in America there are two profoundly different views on what insurance is meant to do.

    One view is that insurance should actually make us healthier. Thus the push for free preventive care, damn the cost in premiums…kind of an HMO for all.

    The other view is that insurance should focus on financial catastrophes….which I think is more or less your position. If we do not use our own money for preventive care, tough.

    I am not wise enough to know which is right. I do know that the two sides in this debate often seem to be talking past each other.

20. Bob Hertz,

    You assume correctly, I am male.

    Yes all those mandated forms of coverage could be of value to certain people at certain times. However, the inclusion of all of them raises the price of insurance making it less affordable. In my estimation, for a 27 y.o. millennial with limited income and educational debt, the ability to insure against an unlikely catastrophic accident is more important than having an insurance company pay for check ups, prescriptions, etc.

    And by running routine costs like prescriptions, check ups, etc. through insurance, you add at least 20% overhead on top of the cost. (Why are people so anxious to sell extended warranties on cars – is it because it is a good deal for you or profitable to them?)

    As I have said before, I am in favor of a single payor system. The ACA is an complicated Rube Goldberg way of paying for health care that, as far as I am concerned, is a re-arrangement of the deck chairs on the Titanic.

21. Note to Legacy Flyer:

    I assume you are a male. No harm in that, but you miss the drift of the ACA.
    Most of the 65 new mandates are in fact quite valuable to women, contraceptive care being only one of them.

    Barry C is correct that in most advanced nations, the old pay more than their true share for schools, and the young pay more than their true share for health care.

    And this is not really felt as disruptive. I wonder if it is a grassroots issue at all as opposed to a debate topic for us policy wonks.

    I agree with Jeff Goldsmith that the ACA was distorted to fit into 10 year oost “neutrality.” Yet historians may decide that the Democrats had no choice.
    Some bloggers have suggested that the ACA itself was a just a draft version that the Democrats would improve on after Al Franken became the 60th Democratic Senator. But then Scott Brown pulled the Dems back to 59 when he defeated the awful Eliz Coakley, and that reawakened the threat of a filibuster.

    I still go back to Joseph White’s comments in Competing Solutions. He said that Americans envision health reform as people choosing to buy something.
    Most other nations just tax the populace as a whole, and then more or less give health insurance to everyone. They do not wait around for low rates to attract the young.

22. Wow! I’d have thought the following would be way higher!

    “51% of Millennials do not think there will be any money for them in the Social Security system by the time they retire.”

    “39% believe they’ll get reduced benefits”

    Hell! I’m 53 and I’m positive MY benefits will be reduced. Watch for some inter-generational conflict on this over next decade or two.

23. I think the rate bands were a really bad idea.

    We should have used tax dollars to subsidize the boomers instead of asking millennials to do it thru their premiums. The headline rates should have been $50 a month. But that would have pushed the (phony) “cost” of the ACA over a trillion dollars (phony because six years of cost/ten years of revenues).

    And it’s their PARENTS who were going to pay the premiums anyway.
    What’s the “real” cost of health coverage for a 26 year old? And how do you enforce a mandate on someone who isn’t even paying taxes, etc., etc.

    But the 3:1 rate bands was “community ratings” dogma of the utopians who wrote this law. They really wanted 1:1- everyone gets charged the same.

24. Barry,

    Frankly, I think it is hard to sell young healthy people high priced insurance – regardless of whether it is 3:1 or 5:1. Changing it to a more accurate number won’t make that much difference.

    I also think that most young people just need catastrophic coverage for a car accident or other relatively rare occasions. In this sense I think the Republicans have a point (for the most part, they have nothing useful to add) – the idea that every health plan must include a multitude of specified elements probably doesn’t make sense for a 25 y.o. barrista with college debt.

25. legacyflyer,

    Do you think lots more young people would sign up for health insurance if premiums were based on a more actuarially neutral 5:1 age rating band? If they would, I certainly would have no problem with it. However, there would still be a significant transfer of taxpayer dollars from young people to older folks to finance the much higher subsidies needed to cap premiums at 9.5% of modified adjusted gross income for those above 300% of the FPL and equal to or below 400%.

    It’s worth noting that employer based health insurance, which covers roughly 150 million people including family members, is effectively based on a 1:1 age rating band or pure community rating. Many employees don’t realize or understand that they are paying for the employer contribution in the form of lower wages than they would otherwise be paid but even if they do know explicitly or implicitly, they accept it and perceive it as reasonable. They are also paying for the employer share of FICA taxes as well as most economists will tell you.

    In every country that finances their health insurance and healthcare system with payroll or other taxes, the young heavily subsidize the old. In Switzerland, where people buy individual insurance policies, the premium in a given canton is the same for everyone 26 years old and older for the same set of benefits and deductible.

    I’m not sure what younger people want and expect when it comes to health insurance. They can’t have guaranteed issue with no mandate because the system will quickly fall apart due to adverse selection. The choices boil down to guaranteed issue with a mandate, either individual or employer or both, and medical underwriting coupled with heavily subsidized high risk pools which would be enormously expensive per person covered. Politicians historically have been reluctant to support robust high risk pools at a level that would cap individual premiums at a reasonable percentage of income. There is room to argue over what should make up the essential benefits package.

26. Barry,

    You and I are usually in agreement on most issues.

    I don’t have any heartache over what the “Greatest Generation” received. My Mom and Dad (both deceased) were children of the Depression and my Dad was a WWII vet. However, from the perspective of what they received from Soc Sec and Medicare, they did get a better deal that I will and also better than what my children will get.

    You are right, there are inter-generational transfers going on with respect to property taxes and school funding. Never the less, I would maintain that older people are doing better now vis a vis younger people than they did in the past. And a disproportionate number of the poor are children.

    The decision to cap the ACA at 3:1, not only is another transfer from young to old, but problematic from a practical perspective. It means that young people are paying more than they “should” (actuarially) and as a consequence have a strong incentive not to sign up – which they are not doing in droves.

    I remember watching the debates on the ACA and how Senators Kerry and Schumer pushed for the rate to be 3:1. And I suspect neither Senator had any good idea about the economics and unintended consequences of this decision.

27. legacyflyer,

    While I agree with most of the thrust of your comment, I would note that the Greatest Generation came of age during the Great Depression and went off to fight in World War II for the duration of uncertain length. Given that relatively bad hand, I don’t begrudge them the “good deal” they got from Social Security and, later, Medicare.

    As for Social Security, it will take me about nine years to recover my own and my employer’s combined lifetime contribution in nominal dollars without any regard for potential investment returns on that money during the years since those contributions were made. I started collecting it at 66. As part of the Greenspan Commission reforms of 1983, FICA taxes were raised several times over eight years with the intention of having the baby boomers pre-fund their retirement by building up a large surplus in the so-called trust fund though the Congress spent that money on other government programs and filled the trust fund with IOU’s that will have to be converted to government bonds, notes and bills to be sold to public investors including foreign investors to actually pay for those promises.

    It’s also worth noting that every generation of the elderly pays local property taxes, which are especially high here in NJ, most (at least two-thirds) of which goes to fund the K-12 public school system. The average household in NJ pays 11% of its income in property taxes with many elderly residents paying well north of 20% even though their own children have long since aged out of the school system.

    As for the burden on the young caused by the ACA’s 3 to 1 age rating limit, I think the Congress could have extended the option to buy a lower cost catastrophic insurance plan up to at least age 35 and possibly 40 and made it eligible for subsidies as well.

28. I am a boomer not a millennial, but I have 3 children in their 20’s and a grandchild.

    I do think that various social welfare programs; Medicare, Medicaid, Social Security, etc. do shift a lot of revenue from the young to the old. And a very large percent of the poor are young people and children. Conversely, the elderly represent a lower percent of the poor than they did in the past.

    In the face of this, the authors of the ACA made the arbitrary decision to cap expenses for “boomers” to 3 times that of millennials when the actuarially correct ratio should be about 5:1. Hence, another form of cross generational subsidy going from young to old.

    I don’t blame the millenials. On top of a bad job market (which should be improving) and heavy student debt, they are subsidizing a group which is generally more wealthy than they are. I think our society has it backwards and older people should be “paying it forward” more and receiving fewer subsidies.

    And as for who made out the best on “the deal”, the answer is probably “The Greatest Generation”. If you take a look at Social Security taxes paid and Medicare taxes paid versus benefits received, older people (older than the boomers) got the best deal by far. And because of the ratio of working people to retired it is only going to get worse.

    So count me as a boomer who thinks the young punks have a point.

29. Denial (also dubbed “de-Nile”) is a very powerful defense, until, you wade into the proverbial waters of reality and aren’t prepared for the uneven bottom to that river!

    Millennials have as much if not more characterological struggles as a group as their Boomer parents do, and the primitive defenses that usually coincide with personality rigidity and inflexibility do not lead to resolution, but often dissolution.

    They want a free ride, just like their parents did. See George Carlin’s rant about the Boomers in the last 10 minutes of his 1996 show “Back in Town”, I think he was fairly accurate in noting what the Boomer generation wrought on this society.

    From “sex drugs and rock n roll” to “just say no” and “no pain no gain”. Yeah, staring down that barrel of entrenched middle age, it is a bitch, ain’t it all you progressives and liberals who want everyone ELSE to do the work?! Oh, and check out the AMA’s warning to physicians being reported today, another one of those trivial details Nancy Pelosi did not get a chance to read about until recently. Or, perhaps she didn’t want you, the public and physicians, to read at all!

    Wow, tyranny never has been so fun, eh, Obamacare supporter!?

30. I think these expectations are reasonable. I would say it is time for healthcare providers to step up and do their part to prove their worth! Otherwise, we may have a generation of defeatists.

31. Pretty good statistical analysis shows 80,000,000 (coincidence?) American responded that the Sun revolves around the Earth.

    http://www.nationaljournal.com/tech/26-percent-of-americans-say-the-sun-revolves-around-the-earth-20140217

    “Those who choose to dismiss their views as naïve or ill-informed should reconsider.”

    My comments are not a reflection of being disgruntled or agitated. They are attempts to expedite the transformation of a generation from naïve and ill informed to realistic and pragmatic. I understand a huge chunk of a generation can perceive things that are not true. It happens regularly. I believe it is a good idea to open these people’s eyes sooner rather than later because these are the people that will be screwed the most by these false perceptions.

32. This reply is once again merely showing a disgruntled agitation with the way millions of people view –and by the way, have experienced — the health care system as it stands.

    Perhaps it is true that the majority of those taxing the system are 60-70s, as the original post indicated, but that doesn’t mean that millennials don’t use it. Millennials are parents. Millenials have health conditions. Millenials are generally more self-aware about their health (and mental health) than their Boomer parents.

    However, this reply belies a grumpy annoyance about what people think or perceive about the current health care system and its flaws. Discussions like this are wasted on people who lack the curiosity or the ability to think of new approaches. This is once again a partisan blockage of a discussion about how a new generation of Americans will likely determine health care utilization and demand in the future. Good luck with that.

33. “Better adapt”
    __

    Because you too will soon be old, likely ailing, and in need.

    “and yet health care ISN’T a given right of the citizens of this country”

    Correct. More broadly, there are powerful forces hard at work who sincerely believe — sincerely so — that even Democracy should not be a right, much less health care. That certain people are intrinsically better and more “deserving” than others, that the entire notion of “one person, one vote” is populist rabble crap. “One Dollar, One Vote” is more like it — dollars being a correlative proxy for moral worth.

    Don’t count me among them.

    http://bgladd.blogspot.com/2009/05/us-health-care-policy-morass.html

34. “I am at the upper end of the millennial spectrum, I am well educated, and I have a huge pile of student loan debt that has put limits on my life. I am limited by my health care options, and I am disgusted with the system. So yes, I think this author has hit the nail on the head. I have to say that every single point in this post accords with my perspective and those of likely every single one of my peers.”

    “Millennials are not a homogenous population, but their voices about healthcare seem consistent and in unison.”

    So the only thing Millennials agree upon is their unhappiness with a system they almost never access. You believe you are well educated. I believe you are not well educated, specifically about education and health care. Can we not pretty well agree that there is something terribly flawed in the way we have let government intrude upon our educational and health care systems? Please step back and attempt to actually educate yourself on the educational and health care systems and understand that the more government involvement, the more huge pile of debt you will have and the more you will be limited in the future.

35. It’s irrelevant whether or not you think it is stupid. The point is that this is the actual perception of a huge, and critically important, portion of the population. And no, it doesn’t mean that today’s youth are “dumb and uninformed”. It means that the debate on social security has been misleading, perhaps, and confusing, and that many millennials feels some level of despair about what they can expect to receive in terms of benefits, if anything. We see a chunk of cash coming out of our paychecks and we wonder if we are really just going to have to work until we drop dead anyway.

36. I am a little surprised by the vitriolic defensiveness of some of these comments. What are people defending? Our health care system as it now stands? Can we not pretty well agree that there is something terribly flawed in the way we provide care and approach health? The author is looking at data that reflects the views of a generation of young adults, whether individuals happen to “agree” or not with these views. Whether or not you agree is completely irrelevant. The innovators who are able to change the way health is viewed and care is provided will be the ones who ultimately “win”, both in terms of profit and approval. Fighting your upcoming consumers is like a corporation saying “well, it’s too bad you don’t like this product; this is what you are going to get”. Political gridlock seems to be the worst sort of barrier to creating a system that Americans can get behind, a system that actually accords with how people want to live their lives. The thing I don’t understand is that we live in the richest country in the world, we live in a civilized nation, and yet health care ISN’T a given right of the citizens of this country, but instead a deep morass that creates barriers to entrepreneurship (e.g., people are afraid of losing employer-provided insurance) and creates deeper financial crises (e.g., lack of transparent costs, little choice in providers, and virtually no support for complementary therapies that can improve health in myriad ways).

    I am at the upper end of the millennial spectrum, I am well educated, and I have a huge pile of student loan debt that has put limits on my life. I am limited by my health care options, and I am disgusted with the system. So yes, I think this author has hit the nail on the head. I have to say that every single point in this post accords with my perspective and those of likely every single one of my peers.

    Stop being defensive about a broken system or protesting the way the young “think”. It is just the reality. Better adapt.

37. The Millennials are just the Boomer Jrs, they will expect an even greater free ride and party harder with all this legalization effort of Marijuana and other illicits to come, and lack of accountability even the Boomer Srs accepted in their younger days, to some degree, there were boundaries.

    The Net has given false hope and expectations that everything should and has to be free, easy, and without sacrifice. And their Boomer parents are just getting demented if not distracted with their own hardened selfishness and narcissism to responsibly step in and say, “well, wait a second, there is time, money, and effort to be expended to make something of your lives”

    And sites like this do NOTHING to dispel these myths of the” free ride”.

    Because as Barnum said and this Democrat monolith is greatly depending on to sell, “there is one born every minute”, and they need those Millennial minutes to extend the lives of the Boomer Srs who won’t accept that death is part of the contract of life. Frankly, the ignorance and entitlement of the Millennials will get them exactly what they deserve, prolonged servitude and lack of fair representation from the exact representatives the Boomers have banked on with their (Sr) politicians, who interestingly are exactly the same ages and attitudes selling this lie of “health care for all”.

    Oh, and I am a late Boomer, so I have the right to make these charges, thus all the usual suspect trolls can take a breath or two before your reflexive typing ensues!

38. “in any given year, half of the population uses essentially no healthcare”
    __

    80%.

    Of course, unsurprisingly, that’s skewed by age strata.

    The actuarial medical risk envelope for adults is ~60-70 yrs, skewing inexorably higher as a function of age. We KNOW this. Selling health “insurance” in one-year chunks utterly fails to address that reality.

39. It’s important to understand that in any given year, half of the population uses essentially no healthcare. For many young and healthy people, that’s their experience virtually every year. If they think about health insurance at all, they probably just want a very cheap policy that covers a few doctor visits and little else. They don’t think they need traditional health insurance until they do but then it’s too late if they don’t already have it.

    Assuming a reasonable price, a high deductible or at least a catastrophic coverage plan is one of those things that’s better to have and not need than to need and not have. Unfortunately, too many people don’t believe in taking enough personal responsibility to plan ahead for events that may be have a low but far from zero probability of occurring but are extremely costly if they do. That’s mainly what health insurance is for. Isn’t it?

40. It hovers around 26% (and growing slowly) as of late, which is lower than lots of analysts would like to see, but to use that as representative is to ignore at least 3 million young adults who happily stayed on their parents’ plan through the ACA.

41. I would pin Millennial focus on a ‘health’ system as a way of promoting a proactive mindset towards health so that we might stave off the major causes of hospital care as long as possible. As for the system being built to profit off the young, it is, in part, as it relies on subsidizing expensive procedures with healthy patients. “Young” gets substituted for “healthy” in most media coverage. I can’t remember the last article I read that discussed health issues for “Millennials” or “Young Invincibles” instead of displaying them as an example of the ideal insurance consumer.

    I’ve never heard anyone who honestly believes they’ll live forever, but a lot of us are putting off having kids or expecting to delay retirement because, as the article mentions, it’s hard to imagine how we’ll be able to afford it.

42. Exactly! Greatest Generation was promised by Roosevelt, not the government. Sure Roosevelt and his administration promised and lied and seriously misrepresented the program (sounds familiar) to get it implemented, (3% of your first $3,000 is all you and your employer will ever pay) but now it is the government (i.e. taxpayers) that is expected to honor Roosevelt’s false promise.

    http://www.ssa.gov/history/ssn/ssb36.html

    I wonder if the tech savvy, informational, transparency, honesty, hungry Millennials have bothered to Google the fraudulent SSI sales campaign and compared and contrasted it with The ACA. What is that saying about studying history?

43. Barack didn’t promise them Social Security, Franklin Roosevelt did.

44. Great article! You hit on a lot of great points, I hadn’t fully recognized the vast difference of perspectives between generations. Our health system is going to need to be much more flexible, responsive, and streamlined to satisfy the needs of the millennial generation.

45. If most millenials want to pay a single reasonable amount with no copays or deductibles, this sounds like they want an inexpensive HMO.

    But I do not think there are any cheap HMO’s. Certainly not on the ACA exchanges in almost all states.

    I do not know the reason, can anyone address this?

46. If you are correct about the minds of the millennials, it would make more sense for the millennials to focus on the educational system before the health care system. It is the educational system that they did not bother to google before they (or their parents) purchased. Yet, with the educational system there is little transparency in pricing or quality metrics that really matter to them. If they want honest, unbiased perspective on the educational system, they are probably out luck. And, I do not believe the millennials got cost information before they indebted themselves at the government loan trough that has unnaturally raised the cost of their “education”. Do millenmials not believe education “should be the same for all; (or do) they believe profits should be subordinate to its purpose.”?

    Millenials have been screwed by the educational system much more than by the health care system, so far. That is until the realization sinks in (after the next election or two) that they have already seen all the up front goodies and now will have to pay the piper through a lifetime of higher premiums, deductibles, and taxes.

47. Please consider giving examples of what “the government” promised to the millennials. I suspect virtually everything millennials would recall as “government promises” were actually Obama campaign promises. May I offer an observation that the millennials were not fiercely suspicious of anything Obama promised but have, until recently, believe a lot of the popular press (liberal) about what they are told is wrong with the US health care system.

48. I recently heard one from this group say that they thought they were on the “right side of the innovation curve” and would live forever because causes of death are being eliminated. Maybe that’s what they mean when they say they don’t want a “sick system” but want a “health system”. I couldn’t help wondering what “person” would live forever – the 30 year old, the 50 year old, the 70 year old, or the 90 year old? If this is a concept that people in this age group commonly hold, how does that affect the rest of their lives? Not having children? Not planning on retiring? Just wondering.

49. What millennials want: Transparency.

    They’re used to informing themselves online about issues, news, purchases — so why can’t they do this in the health-care marketplace?

    They’re used to Googling before they go to buy a laptop, and they want to Google before they go to the doctor too. But a couple of big things are missing: there’s little or no transparency in pricing, and little or no transparency in quality metrics.

    They want to know from an honest, unbiased perspective: What is this (condition-treatment-procedure) all about? What are my choices? What’s the desired outcome? These questions they can start to get at online.

    What’s harder to find: What will it cost? What will it cost me? And about this provider: what’s (her-his-its) record of performance up to this point?

    Millennials get it when they’re presented with fake price transparency, and with false quality metrics.

    Actually, non-millennials feel the same way.

    Make no mistake: culture change is here. Millennials –and non-millennials — are unhappy about our broken system, and they are choosing providers who offer transparency.

50. “Millennials think the U.S. healthcare system is fundamentally flawed. They believe it is purposely geared toward the sickest and oldest, and structured to profit from their treatment. They want a system of health that balances resources for the young and healthy with compassionate care for the elderly and sick.”
    __

    It’s a shame that youth is wasted on the young. Time passes quickly. Millennials will be old and infirm sooner than they think. At which time their views regarding the relative allocation of health care resources will have “evolved” in utterly predictable fashion.

51. May I offer another explanation: that they are fiercely suspicious of anything the government promises them and believe a lot of the popular press about how the boomers have stripped the pantry of anything edible, and haven’t bothered actually doing the math. Stupid isn’t the word I’d use.

52. The statistic that 50+% of individuals think social security won’t be available to them when they retire is astoundingly stupid. Even if the trust fund is exhausted by 2033, payroll taxes still would cover 75% of benefits. So the poll did nothing other than reinforce what we already know – that the majority of people are dumb and uninformed.

53. I’m a millennial. I work in a major hospital in an urban setting. Here’s something which happened a couple of Fridays ago:

    As I was making the rounds in the waiting rooms for work, I spoke with a lady waiting to be seen in the diabetes clinic at 11am.

    When I came back to the same waiting room at 4pm, she was still sitting there. Just waiting. Didn’t have her vitals checked yet. Hadn’t heard much either, except for the periodic announcements from nurses asking for patience.

    But she was glad to be waiting; her daughter was about to get off work and was getting paid that day so she might be able to help cover the co-pay/save her from the embarrassment of not having enough money.

    Unabashed shock and the word “unacceptable” spread across my face and flew through my mind.

    So yeah- maybe it takes Zack Galifianakis for us to even hit the Healthcare.gov webpage, but eventually things click.

    Something tells me next year’s enrollment period will look a little more promising. Just a hunch.

    Keckley’s right: We may not have all of the specifics down. But we’re certainly an impressionable bunch. So make it count.

54. Millennials want healthcare? Really? Do we have any idea what % of the new signups are millennials. I am guessing it is much lower than experts were predicting