HEALTH COVERAGE FOR ALL CALIFORNIANS (Commonwealth Club Speech)

Thank you for that kind introduction. It's a pleasure to be here this evening to address the Commonwealth Club about an issue that profoundly affects all of us.

You know, it's not easy being a health plan CEO these days. If you watched many commercials from the recent political campaign, you would think HMO's are responsible for every problem in California except Winona Ryder's shoplifting.

Given the way many people feel about HMO's, you might conclude that embracing universal health care is part of a clever public relations campaign to spruce up our image. But Blue Shield of California has for 63 years been committed to a mission of providing access to quality, affordable health care - so presenting this plan to make sure every Californian has health coverage is a natural step for us.

Sarah sells advertising for a travel magazine based in San Jose. Sarah's employer subsidizes the cost of health coverage for its employees, but she has always declined it. She can count on one hand the number of times since college she's been to the doctor. She prefers to spend her money on snowboarding vacations. Last winter, Sarah broke her leg in three places snowboarding in Tahoe. The billed charges for the surgery, hospitalization and physical therapy came to over $50,000. Sarah had to liquidate her modest 401K account to pay part of her debt. Sarah's new economic reality means she won't be going skiing anytime soon. Joe works a press at a printing company. Joe has participated in the company's health plan since he joined four years ago. After facing 40% premium increases amidst a sluggish economy, Joe's boss pulled the plug on the company's health insurance. This left the firm's 16 employees and their dependents to fend for themselves. Joe makes too much money to qualify for Medi-Cal and since his son Danny has asthma, he couldn't afford to buy a family insurance policy that has high rates for people with pre-existing conditions. While Joe is perfectly healthy, he has struggled to secure treatment for Danny's asthma, which had been held in check with an inhaler and regular pulmonary tests. But without insurance, Joe has not been able to keep his son on the program. Now Joe routinely takes Danny to the emergency room when he has an acute attack, and he is being hounded by collection agencies to pay bills he can't afford.
Anna cleans offices in a high rise downtown. Her employer does not offer health insurance. She's eligible for Medi-Cal, but when she tried to enroll once, she couldn't figure out how to navigate the system. She hasn't seen a doctor since her last child was born. She hadn't been feeling well for months, so, she finally went to see a physician at a community clinic. She was referred to a gynecologist's office, where she was ultimately diagnosed with advanced cervical cancer. Had she been insured Anna could have had an annual Pap smear that would have identified the cancer long before it became life-threatening.

While these stories are fictional, the truth is that many Californians are one illness and one job away from never being able to get health insurance again. And not having health insurance and access to good health care when we need it can be a life-altering tragedy. California can do better and we must do better in preventing these tragedies.

In a report to the President last month recommending changes to the current healthcare system, the National Academy of Sciences said, "The health care delivery system is incapable of meeting the present, let alone future needs of the American public." According to the Academy, the cost of private health insurance is increasing at an annual rate in excess of 12% and individuals are paying more out of pocket while receiving fewer benefits. One in seven Americans is uninsured and that number is rising.

We all know that America has the best medicine money can buy. Thousands of people with serious illnesses are well and leading productive lives thanks to the genius of high-tech medicine and well trained medical professionals. Yet in a paradox of our times, too many people still lack access to basic healthcare services, like that Pap smear that could have saved Anna's life.

Health insurance is the key that unlocks the door to the health care system. For too many Americans, including more than six million in California, that key is missing.

We need to find solutions that provide coverage for people like Anna who are eligible for public programs but can't penetrate the bureaucracy; for Joe and his son, who want coverage but can't afford it; and for Sarah, who represents what I like to call the "young immortals"- those healthy people who can afford health insurance but choose not to purchase it.

Forty-one million Americans lack coverage even though we spend $5,000 per person - more than 14% of our gross domestic product - on health care.

Some say we can't afford to cover the uninsured, but the fact of the matter is - we already pay for them. Americans - even many uninsured Americans - now spend thousands of dollars a year for the health care of others. According to a recent study, the average family of four pays over $7,000 in health care expenses for themselves, plus more than $9,000 to cover the costs of others through taxes that finance Medicare, Medicaid, and other health-related subsidies.

Moreover, private insurance premiums paid by employers and individuals are higher than necessary because they subsidize other, unfunded or underfunded care. Doctors and hospitals charge higher rates to private insurers to compensate for the inadequate payments they receive from Medicare and especially Medicaid, as well as to subsidize the safety net that provides uncompensated care in emergency rooms, community clinics and elsewhere. In essence, we are charging the private healthcare system a hidden tax-a tax that can't be sustained-by employers, the middle class, or the working poor. And this cost shift is likely to get worse.

Facing serious budget shortfalls from declining tax revenues, many states are cutting Medicaid spending, the second-largest item in most state budgets. States are changing eligibility rules so that fewer people qualify for coverage, reducing benefits for those who are eligible, and increasing copayments for prescription drugs and other services.

The combined effects of a prolonged economic slowdown and rising healthcare costs also threaten to dump more middle-class Americans who currently have health insurance into the ranks of the uninsured. Studies show that for every 1% increase in health insurance costs, 300,000 more people join the ranks of the uninsured. And many of those people are far from poor. As an article in last month's New York Times pointed out, of the 1.4 million Americans who lost their health insurance last year, more than half had incomes in excess of $75,000.

And healthcare costs are rising dramatically. Propelled by new technology, an aging population and a demanding populace, most studies project double-digit increases in healthcare costs for the foreseeable future, doubling the nation's healthcare costs within five years and bringing healthcare spending to as much as 18 or 19% of GDP by the end of the decade.

So let's talk about our great state. The novelist Wallace Stegner, who taught at Stanford for many years, once said, "California is like the rest of the country, only more so."

That insight is painfully true regarding health care in California. We're on the bleeding edge, with bigger-than-life problems that are getting worse every day.

One in five, or 6.3 million Californians, lack coverage. Only two states, New Mexico and Texas, have higher rates of uninsured.

In addition, California's Medi-Cal program ranks dead last among all states in Medicaid spending per enrollee. It pays physicians less than half of what they receive from a private payer. As a result, fewer than 50% of the state's physicians participate in the Medicaid program.

In an ominous sign, California now leads the country in the growth of hospital inpatient costs, which have supplanted prescription drug spending as the largest driver of overall healthcare spending. Between 1998 and 2001, California inpatient hospital costs rose by 11.3% annually - four times the rate of inflation and double the national medical inflation rate.

California also has the lowest rate of employer-sponsored insurance in the country: only 61% of the state's businesses offer coverage.

And what are the consequences of being uninsured? Pretty grim. A number of studies confirm that the uninsured are more likely to live sicker and die sooner than the insured. According to the Institute of Medicine, as many as 18,000 people die prematurely every year due to lack of health coverage. Uninsured newborns are one-and-a-half times more likely to die than infants with insurance. The uninsured are less likely to receive routine preventive screening and testing that can lead to early detection of serious, life-threatening illnesses such as cancer, heart disease and diabetes. Without a regular physician, the uninsured don't get the benefit of coordinated care and disease management programs, which improve outcomes and save money on chronic conditions such as asthma and diabetes.

While not having coverage can compromise a person's health, having dependable access to health care can impart benefits that go beyond health. New research from California's Healthy Families program found that children who were covered by the program improved their performance by 68% on educational measures such as paying attention in class and keeping up with school activities. And there is some evidence that lack of health insurance contributes to increased homelessness and even crime.

Who are the uninsured in California? In broad terms, the uninsured fall into three categories.

Thirty percent of the uninsured are eligible for public programs but are not enrolled. In California, approximately 14% of uninsured adults (700,000) are eligible for Medi-Cal and two thirds of uninsured children (930,000) are eligible for Medi-Cal or Healthy Families. Another 100,000 or so are high-risk individuals who have been denied coverage by a private plan, so they are likely eligible for coverage under the state's "Major Risk Medical Insurance Program."

The second category of the uninsured have annual incomes above 250% of the federal poverty level and may be able to afford coverage. Many choose not to buy it because they think they don't need it - the "young immortals," or free riders.

The final group of uninsured can't afford coverage and don't qualify for public programs. As I noted earlier, the vast majority of them are part of working families - the so-called working poor.

Further, the lack of insurance is not an "equal opportunity" problem. In 2001, 28% of Latinos were uninsured, compared with 13% of Asians and 10% of whites and African-Americans. So one-third of the state's population, its fastest growing segment, is disproportionately uninsured.

As we know, family insurance coverage is strongly related to family income. Nine out of ten families whose income is more than 200% of the federal poverty level have all members insured. Among families with the lowest income, only six in ten are able to obtain insurance for their entire family.

The financial consequences of not having insurance are equally stark. Uninsured families pay more than 40% of their medical costs by themselves, including 88% of prescription drug costs.

The American public seems to be of two minds regarding universal coverage. In poll after poll, there is support for expanding health insurance to reduce the number of uninsured. But when it comes time to foot the bill - and it's an expensive tab - support wavers. The recent election sent conflicting signals.

In Oregon, a single payer universal healthcare ballot measure failed by a 4 to 1 margin.

In Los Angeles, we had a different result. L.A. County voters approved a tax increase - with 73% voting in favor - to help the county's disintegrating trauma care system. And while the vote was only about trauma care, the overwhelming margin indicates a public willingness to support expanding access to health care.

We believe there would be public support for a practical plan that doesn't break the bank.

As the facts clearly indicate, the current system for covering the uninsured is inefficient and unfair. Americans say they vehemently oppose health care rationing, but care is already rationed based on one's ability to pay. The uninsured delay seeking medical treatment, receive inadequate care when they do, and often cannot afford to fill the prescriptions they are given.

Still, you might ask, why should I care about the Sarah's, Joe's and Anna's of the world who have the misfortune to lack health insurance at crucial times in their lives? Living in America doesn't guarantee economic equality and no one is ultimately denied care. There are charity hospitals, clinics that operate on sliding scales, and Medicaid for those who can't afford or can't get insurance. The system may not be perfect, but it works, right?

No, not right. Anna, Sarah and Joe's stories aren't unique or rare. And they indicate a breakdown in the principle of social insurance. Health insurance is built on an implicit communal social contract. Unequal access to health care represents a breach of that social contract - a breach that threatens to further widen the gap between the haves and have nots, between the "worried well" and the "suffering sick" - and undermines the economic balance necessary to sustain the system.

Novelist Susan Sontag stated it well when she wrote, "Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged to at least identify ourselves as citizens of that other place."

The existing system of employer-based health insurance, which dates back to just after the Second World War, is the foundation of our health insurance system. Like all insurance, everyone shares the risk of paying for the misfortune of others.

With health insurance, those who are young or well and who utilize medical care infrequently, subsidize the care needed by the sick. In fact, a mere 10% of patients consume 70% of the nation's healthcare dollars. And of course this preserves the system that takes care of the young and healthy when they need it.

Just like other forms of insurance - auto, home, life - we may gripe about paying for something we don't use, but deep down we know that all it takes is one capricious change to shift us from one side of the ledger to the other.

This system, which has functioned fairly well all these years, is now in danger of unraveling due to three factors:

First, rising costs threaten the affordability of private insurance for millions of Americans;

Third, underfunded public programs don't enroll all who are eligible and pay too little for those who do enroll.

If these trends continue, wealthier, older and sicker people will be left in an insurance pool that is prohibitively expensive - drained of the "good risks" that keep health insurance in balance. Countless others who want insurance will be unable to afford it. Eventually, the employer-sponsored health insurance system as we know it will collapse.

If we're going to solve the healthcare crisis in California, we need to do it ourselves. We can't wait for a national program because the problems and the politics are even more complex at the federal level. We need to be the "first responders" to our state's healthcare crisis, crafting a solution that fits California's needs.

Our challenge is to preserve the best elements of the current public and private system, while extending benefits to those who fall between the cracks.

So what are the pillars of a plan that guarantees access to health care for all Californians? It is based on two principles: universal coverage and universal responsibility.

Under our program, the health benefits that the vast majority of Californians enjoy today wouldn't be diminished. The system of universal coverage that we are proposing would build upon the existing employer-based system, through which 60% of Californians currently receive their health coverage. So here are the details of our plan.

First: Employers (with the exception of the smallest companies) would be required either to offer coverage or contribute the financial equivalent toward an essential benefit package for all their employees. Employees of a firm that offers coverage would be permitted to opt out and purchase coverage on the individual market, as they can today.

Second: Every eligible Californian would be enrolled in Medi-Cal or Healthy Families. The state needs to work with the private sector on creative and effective marketing and outreach strategies to achieve this goal.

Third: All other uninsured Californians would be required to purchase coverage in the individual market on a "guaranteed issue" basis, with no one denied coverage based on a pre-existing condition. Those who couldn't afford the full cost would pay their fair share and be subsidized for the rest.

Fourth: An essential benefits package defined by independent medical professionals would specify the minimum level of coverage, which would include preventive care, physician services, hospital care, and prescription drugs. Some health plans today offer products that don't meet this level of coverage and those products would be eliminated, either voluntarily or through regulation.

You're probably thinking, "that sounds great, but how on earth are we going to pay for it?" Good question. While we don't have all the numbers tallied, we believe there are a variety of acceptable ways to finance this program. But we recognize the burden of proof is on us to make the economic case for our proposal. That is why the Blue Shield of California Foundation will finance an independent academic study designed to evaluate various financing options and release that analysis in the spring. In the meantime, we look forward to a vigorous debate on the financing question, as well as how our program would be structured and implemented.

What we can say is why we think this will work. With new contributions from both individuals and companies that are not currently paying for insurance, the need for new taxes is not as great as we might think. This plan encourages personal financial responsibility. It's designed to ensure that individuals who can pay for a substantial part of their care, do so. It also ensures that cost-sharing doesn't become a significant barrier to getting needed care.

We expect to see additional savings from expanded preventive care, earlier and therefore less costly treatment for the formerly uninsured, reduced use of emergency rooms, and administrative efficiencies resulting from more secure financing.

With everyone enrolled in the system, we should also see reduced costs through the expanded use of disease management programs that rely upon evidence-based care. These programs enable many patients, particularly the chronically ill, to receive more effective preventive and treatment therapies derived from the most current clinical research.

While new individual premium payments and better, more efficient care will help pay for expanded access, this proposal is not fully self-funded. With that in mind, let's address our second principle - universal responsibility.

The fairest and most politically palatable way to finance universal health care is through a broad-based tax or fee. This would assure that the rate increase is relatively small and that everyone contributes. Among the logical alternatives are the personal income tax, the sales tax, a health insurance premium tax or a healthcare provider fee. While it may make sense to use a combination of these approaches, perhaps supplemented by a tobacco tax increase, my instinct is that keeping it simple by relying on one source of revenue may prove to be the best tactic.

So that's it. A framework for universal coverage that we hope will contribute toward a solution for what often seems an intractable problem.

I suspect that some among you are skeptical about our concern for the uninsured. You're wondering, "what's in it for Blue Shield?"

Our company will clearly benefit from the infusion of more money into the system. If six million more Californians are insured, we will enroll our fair share.

That said, Blue Shield is doing well under the current paradigm. Like many health plans, we are having a good year and our profits are sufficient to enable us to reinvest in the technology and capital reserves we need to grow our business. We succeed in the current environment, which allows us to decline to cover individuals with poor health histories and increase premiums to cover our costs. And our premiums have increased as fast as anyone's as costs have skyrocketed over the last several years. So Blue Shield doesn't today need radical change to do well. In fact, some changes we are recommending will likely reduce our income in certain areas.

There are also profound uncertainties associated with creating a very different healthcare system-uncertainties that may have negative consequences for us. We could very well help to instigate a process that we can't control and will sweep aside some elements of the current system that are important to our company's success. In addition, advocating employer and individual mandates and new taxes may concern our constituents-businesses and individuals who would have to pay more, for example. Some of my peers in the industry may be disappointed with this approach, as well - although I expect others will support it.

We are willing to take these risks for a simple reason: the current system and its underlying economics are unsustainable. Our path leads to greater efficiency and fairness in obtaining a service that is essential to a decent life. Good health coverage should not be restricted to those few who are privileged by wealth or healthy genes. So, dedicated to our mission of increasing access to quality health care, we invite a bold and constructive dialogue designed to preserve the best of the public and private systems of health care.

We are devoting significant financial and human resources to this endeavor and will continue to do so, including my personal commitment. Achieving universal coverage is a goal that I care deeply about. With health care at a crossroads, it is the right thing to do and the right time to do it.

We are not alone in raising this issue. Many others have announced proposals to help achieve universal coverage in California. We welcome these efforts and pledge to work with any individual or group genuinely committed to making universal coverage a reality.

Universal access to health care is no panacea for all of society's health ills. Poverty, poor nutrition, lack of exercise, violence, smoking and a host of other factors that cost billions of dollars every year won't disappear. This proposal doesn't address them.

But expanding access is a critical first step in improving the health and well-being of all Californians and reaffirming the social contract that is the underpinning of employer-based health insurance, a system that has served three generations of American workers and their families quite well.

California has long been a trendsetter for the rest of the country. From food, music and movies to environmental safety and technological innovation. Now is the time for us to lead the rest of the country toward achieving universal coverage. It is a daunting challenge, but we can't wait. We can no longer afford to leave Anna, Sarah, Joe or any other Californian behind.

I recognize the fight for healthcare equity may continue the rest of my working life. Indeed, we may be in the early miles of a marathon. Nonetheless, as someone wiser than I once said, "A man has made a start on discovering the meaning of human life when he plants shade trees under which he knows full well he will never sit." In regard to universal access to healthcare, tonight has been an opportunity to sow the seeds of those trees for ourselves and for the generations of Californians to come.

Not once was it mentioned that because of the millions of illegal aliens in California alone, private pay insured families are facing rising costs, and loss of local hospitals! Not once did I here, "if employers of the massive illegal alien population were forced to insure their illegal employees, we wouldn't be in this mess"!!!
Best wishes...

Neither my kids nor I have health insurance. Can't afford it and pay the bills. I served in the Marine Corps for six years yet I'm not eligible for any programs - the same programs my tax dollars pay for to give health and dental care to all the G-da** illegals that cross the border for a free handout. What the f am I supposed to do if one of us gets sick? Pretend not to speak english, carry no ID, and pretend to be an illegal. That's BS. Hospitals and care units are closing right and left because of unreimbursed costs for caring for illegals. Maybe if we took care of the borders and kicked these CRIMINALS out insurance wouldn't cost $400 per month!!

Interesting speech-- he makes some good points.He is correct there are many inequities in the current system. I have always heard how bad "socialized medicine" would be---it is a conservative mantra.But all industrialized countries other than the USA have some form of it.

Reportedly Germany has had a federal health paid plan ever since the days of Bismarck.UK rationalized theirs for strategic reasons after two World Wars and observed better health of German enemy.If we envision a State or Federal plan we should carefully study other country's methods/experiences--- copy the best and discard the worst.

California's growing indigent illegal med costs and (related)problems will spread unless we establish control of our country's borders.We must do this no matter what med pay system develops.Border control is simply axiomatic with sovereignty imo.

Interesting speech-- he makes some good points.

And a stopped clock is right twice a day.

What's germane is not whether he made some good points, but rather whether his overall point is good. On that score, he's miserably bad.

There are medical discount programs that can save you substantial percentages (30-60%) on prescriptions, physicians, hospital stays, lab work, x-rays, eyeglasses and dental. They are not insurance and, as such, there are no pre-exisiting conditions or waiting periods. They cost a fraction of health insurance (fraction = $20-$40 per month) and are available to everyone. E-v-e-r-y-o-n-e. Right now. No government programs needed. No huge outlay required.

While you and the rest of the seekers are off tilting at public universal coverage windmills, these private programs are growing and improving. They are where the solutions and the future lie, not another bloated bureaucracy that over-promises, under-delivers and sucks up more tax dollars and personal freedoms.

My regards to Dulcinea.

I had a couple of Canadian friends touting their gov. paid for "free" health care system the other day. I said it isn't free, it is paid for by taxpayers, the government has no money of its own. They turned pale, white as ghosts, their faces dropped... they are young men, in their mid to late thirties, they had never thought of it that way!

Plus, I forgot to mention, these two guys don't even have to pay the high tax for their "free" gov. healthcare. Their employer pays it for them! If they no longer worked for that company I think they said their annual tax for healthcare would be $7,000.oo. To me that is a lot of money.

If you live in California there are lots of ways you and your kids can have some coverage.

1) If your family's income is below $20,000 per year you qualify for Medi-CAL and most of your basic care is paid for.

2) If your family's income is between 20,000 and 48,000 you qualify for "Healthy Families" and your kids can be covered on a guarantee issue HMO for less than $20 per month.

3) If your family makes more than 48,000 per year, you are on your own. However, there are numerous low cost hospital discount plans available from companies like Blue Cross of California and Health Net. For instance, a family of any size with the youngest spouse being 54 years old would have a premium of $109 per month in Los Angeles County.

While this would not pay for all services up front, it would guarantee all family members the negotiated discounts from Blue Cross for doctors and hospitals. It would also have a stop loss of $3,500 (with a $1,000 deductable) for any medical stay. After that, you and any member of your family would have up to 5 million life time benefits. The coverage with Blue Cross would be contingent on the good health of your family to qualify but as you can see, it is very affordable to acquire basic coverage.

From the Healthy Families website:

Qualify for MediCal - income of $938/month or less ($11,256 or less annually)

Qualify for Healthy Familes - income of $939-2344/month ($11,268-28,128 annually)

As fas as private, I have done the research (I don't consider health insurance optional) and it was a struggle to pay premiums of $226 for Blue Cross coverage. When it increased to $340 (a 50.4% increase- I turned 40) it got harder. 6 months later, after the first of the year, the rates increased to $520 (a 52.9% increase; 131% higher than six months previously) and it became impossible. At this level Blue Cross/Blue Shield was still the best deal compared to Kaiser, Health Net etc.

My point is that citizens of the United States should not have to go without or pay higher premiums so that CRIMINALS who are not citizens can get free health care.

When that issue is addressed it will be easier to discuss and possibly implement a broadening of programs like Healthy Families to include more citizens (parents too).

Well, early on he said this:

"Some say we can't afford to cover the uninsured, but the fact of the matter is - we already pay for them."

There you go -- we're already paying. But wait, he said it's going to cost even more? How can that be if we're already paying?

I'm so confused. A spokesman for Blue Cross/Blue Shield wouldn't mislead us about the need for insurance would he? He wouldn't have an agenda, would he?

"...you would think HMO's are responsible for every problem in California except Winona Ryder's shoplifting."

I bet this one had them rolling in the aisles.

Just curious. Have you looked into just catastrophic care insurance, and pay cash for all other services? If you can afford $400/month now, you would have $4800/year to play with. If catastrophic insurance is $100/month, you would have $3600/year left for office visits, prescriptions, etc.

I have no idea if my numbers are even close, since I haven't looked into it myself. But I would be interested in being educated about it.

According to the article having health insurance is not "an equal opprtunity problem", because 28% lacking are Latinos compared to 10% White.Even Asians are more insured than Latinos.

Does that imply discrimination toward Latinos? I guess the higher number of illegal aliens from Mexico is just a coincidence.

Somehow I just don't feel guilty about that statistic.

"Had she been insured Anna could have had an annual Pap smear that would have identified the cancer long before it became life-threatening."

This is a bunch of bunk. Had Anna valued her health enough to pay $80 for a pap smear at a low-income clinic, the cancer would have been identified long before it became life-threatening.

The world is full of Annas who believe that it is their employer's responsiblity to see that they get health care. It is the individual's responsibility, period. Anna could have given up 2 months of cable TV and gone to the doctor, but she did not. Too bad for Anna.

Qualify for Healthy Familes - income of $939-2344/month ($11,268-28,128 annually)

This would be true for a "small" family. For a family of 4 or larger the income guidelines are more generous. The qualifications are graded. There is a grid which lays it out for you on the site.

In any event, I agree with you about the illegals. It has screwed things up here royally.

This is nonsense. Just another way to mess with taxpayers. I have no sympathy for Sarah (and let me say that I had a similar problem when I was in my immortal 20's and went skiing) or Anna (she had access to health care. If she thought it was too complicated to get, do we have to give her a babysitter?). And probably not much sympathy for Joe, either. I don't know about CA, but many states have children's clinics. They're cheap enough for routine care, and they don't ask about income.

All of this kind of report is just the Liberal agenda to scare us into accepting hillarycare. I hope it doesn't work.

Socialized medicine in Spain, at least, doesn't work! Just try getting an appointment for a specialist, and you only recieve medical if you work! Everybody pays in. Unless you ARE somebody though, good luck on finding a cancer specialist, cardiac or any other. It is a nightmare! No thanks, I would rather pay my $650.oo and go where I please. The threat to our family is the illegals bankrupting our local services... we will have to go farther and farther to find doctors and hospitals. Hell, we are already looking to move to a place where there is no agriculture. That way, we know services won't become bankrupted; no industry, no immigrants!

It depends on the country apparently.Several engineers I worked with at one of our overseas mfg.plants in the UK continuously bragged about their system.One of them (now retired)had two bypass heart surgeries---then a state of art stint(sp?) installed to keep heart arteries open several years ago.He reported prompt excellent care for these major services(last saw him he was busily building himself a solid masonry garage).

As previously stated I'm in total agreement with you and other posters about indigent illegals' med costs being an outrageous fraud.But the basic problem is we don't control our borders as other sovereign countries do.Then we offer amnesty to them if they stay here illegally long enough.This situation if not corrected will eventually bankrupt any med plan be it pre-pay,HMO, or Federal.

I'd personally benefit under a medical savings plan which rewards healthy responsible living habits.The ethical problem with this is folks favored with good health genes like myself make out--- whereas those less fortunate thru no fault pay dearly for their bad luck.

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