Hey Sabrina,

My daughter had RSV and was admitted to Children's Memorial when she was two weeks old. I don't know if she was given Synagis, but I don't think so, as she was too young to receive anything.

Synagis is made by MedImmune of Gaithersburg, MD and was acquired by international pharma company AstraZeneca. It has been administered to over 1 million children (multiple times, no doubt) according to their website. Here are some financial statistics for Synagis as stated by the company:

MedImmune, LLC, headquartered in Gaithersburg, Maryland, became a wholly-owned subsidiary of AstraZeneca in 2007. Since being acquired, MedImmune has remained a Maryland-based biotechnology development enterprise. It produces Synagis, a drug for the prevention of respiratory infections in infants, which accounted for US$ 1.06 billion of its US$ 1.2 billion in revenue for 2005

A great example of why insurance rates go up.

Hey Sabrina,

Thanks for your reply and I hope you keep reading to see what happens along with the care/pricing/evaluation I go through. And let your readers know, too. As we, will keep tabs on how your lovely daughter is doing - http://lunaandwe.blogspot.com/

As for the purchase behavior towards health care v. home/car/food, we all have to seek other points of view - no matter how ingrained, silly or supposedly wrong - just like Mr. Keating taught in "Dead Poet's Society".....which I shall have to post.

Save the catastrophic for a moment, but how much does a doctor visit cost? How many doctors are in Portsmouth or Chicago or San Jose? What do they charge? And for what? And how long? Where is it printed? In their office? In the paper? Are they really competing for our business? Or do we just pay the $20 copay with no regard? How much is the insurance company paying over and above the $20? And, you can walk away from a doctor - I certainly have and lived to tell about it. There are lots of doctors out there to choose from.

Regarding the drug to keep you alive, which is certainly a difficult situation (and my heart goes out to you, your family and lovely daughter, and with many prayers) - that is what insurance is for. Insurance serves to transfer the risk of financial burden due to a catastrophic loss.

Free market practices are not completely out the window with a drug that you need to keep you alive. Patent protections certainly keep competition at bay for 17 years, but besides manufacturing cost, what other costs can be driven lower by market forces? And what can you as a consumer do to lower the price you pay? Certainly, this life saving drug must be available through many distribution points. Where are they? How much does the doctor/hospital charge to administer the drug? Where is all of this information? Is it readily available, in print, in many different mediums? The answer is that information is sorely lacking - which ensures health care's high costs, ergo health insurance's high cost.

Elective v. Emergency is part of the equation, as well. Emergency is, again, what insurance is for. Elective care allows everyone the chance to prudently shop and compare.

Also, please take a look at my post regarding the unknowing way that everyone hands their insurance money over to the provider by contractually assigning (giving away) your insurance benefits. Keep your insurance and don't sign away your rights (and money) to the doctor or hospital.

Metatrader, that is the question. Why do we have to pay for insurance? I believe it is a choice. A choice that everyone needs to make and on their own terms and particular to their own situation.

We shouldn't have to pay for insurance, but in certain instances the government, federal/state/local require it. If you hold a mortgage on property, your contract to hold such property likely requires insurance. If you own a car, the local/state government requires you to have auto insurance. Now, President Obama and the Democrat led Congress are requiring you to have health insurance.

You can choose to avoid two of these, but you can't avoid the third. You can choose to not own an automobile and you can choose not to have a mortgage. Thus, you need no insurance. But, you just can't choose to not live as an American in America (well you can, but you wouldn't be here) – so you are now being required to purchase health insurance.

Further, if you read my post on Medicarehttp://www.insuranceinthelight.com/?p=86 you will see that prior to 1966 when Medicare started, patients paid doctors out of their own pocket. Insurance reimbursed patients after the doctor was paid. There was no such thing as Major Medical insurance.

Next time you see the doctor, don't sign the papers they require. Tell the doctor that you will pay him from your own pocket. See my post on changing your health care purchasing behaviorhttp://www.insuranceinthelight.com/?p=73. Once patients refuse assignment en masse, providers will need to compete and costs will drop for insurance and care.

As for your comment about insurers making money and fooling them, I can't say that I agree. Insurance is a product to transfer the risk of financial burden due to catastrophic loss. It is a product just like any other that you purchase. The maker of the product is entitled to make a profit. The government aside, you are free to choose the product from whomever you wish at whatever price you are willing to pay. Further, health insurance profits are among the lowest in any industry at 4% return on invested capital.

As for people without the money to pay, since the federal government is forcing health insurance on everyone, those that cannot pay will receive subsidies from the rest of the taxpayers. However, at what point is one's health not important. Is it more important to own a house and a car? How big of a house? How nice of a car? Where does insurance fall in the budget? Between the cable bill and the monthly payment on the 52 inch HDTV? Should we go to dinner and a movie every Saturday night? Budget decisions need to be made every day by everyone. Where does the transfer of risk of financial burden fall?

Metatrader, that is the question. Why do we have to pay for insurance? I believe it is a choice. A choice that everyone needs to make and on their own terms and particular to their own situation.

We shouldn't have to pay for insurance, but in certain instances the government, federal/state/local require it. If you hold a mortgage on property, your contract to hold such property likely requires insurance. If you own a car, the local/state government requires you to have auto insurance. Now, President Obama and the Democrat led Congress are requiring you to have health insurance.

You can choose to avoid two of these, but you can't avoid the third. You can choose to not own an automobile and you can choose not to have a mortgage. Thus, you need no insurance. But, you just can't choose to not live as an American in America (well you can, but you wouldn't be here) - so you are now being required to purchase health insurance.

Further, if you read my post on Medicarehttp://www.insuranceinthelight.com/?p=86 you will see that prior to 1966 when Medicare started, patients paid doctors out of their own pocket. Insurance reimbursed patients after the doctor was paid. There was no such thing as Major Medical insurance.

Next time you see the doctor, don't sign the papers they require. Tell the doctor that you will pay him from your own pocket. See my post on changing your health care purchasing behaviorhttp://www.insuranceinthelight.com/?p=73. Once patients refuse assignment en masse, providers will need to compete and costs will drop for insurance and care.

As for your comment about insurers making money and fooling them, I can't say that I agree. Insurance is a product to transfer the risk of financial burden due to catastrophic loss. It is a product just like any other that you purchase. The maker of the product is entitled to make a profit. The government aside, you are free to choose the product from whomever you wish at whatever price you are willing to pay. Further, health insurance profits are among the lowest in any industry at 4% return on invested capital.

As for people without the money to pay, since the federal government is forcing health insurance on everyone, those that cannot pay will receive subsidies from the rest of the taxpayers. However, at what point is one's health not important. Is it more important to own a house and a car? How big of a house? How nice of a car? Where does insurance fall in the budget? Between the cable bill and the monthly payment on the 52 inch HDTV? Should we go to dinner and a movie every Saturday night? Budget decisions need to be made every day by everyone. Where does the transfer of risk of financial burden fall?

Ron, if we do get to single-payer, the result will be a system of providers that operate much like public (nee government) schools and private/religious (non-government) schools do today in the K-12 education space. All tax payers will pay into the system and have access public provided care. Those that choose to pay for care over and above what is offered by the government, will pay for that care from their own pocket (including a market for private insurance). Prices for the non-government system will be well out of reach of the average American. Those doctors and hospitals that seek a higher return for their services will migrate to the private model and be completely shut off from access to the government system. Those docs and hospitals that choose to stay in the government system will not be motivated by vast sums of money - unless they convince the government bureaucrats that they deserve more or, more likely, they organize and collectively bargain for their vast sums of money and accompanying membership dues.

You are most welcome, Mr. Genise.

As to whether or not we need Single Payer/Medicare For All/Public Option, that will be a good topic for my next post.

Regarding profit motive for services, you will want to visit the blog of The Century Foundation Fellow, Maggie Mahar, www.healthbeatblog.org. Maggies' book, "Money Driven Medicine" takes a good look as to how medical costs got out of hand following the advent of Medicare.

Just as there exists a clear distinction between health insurance and health care, there exists a clear distinction of profit from health insurance companies bearing risk and health care providers delivering services. The two forms of profit are separate and distinct.

Thanks, Mr. Genise, for your comments and your suggestion for a future post!

Keep them coming!

Well said, Brandon.

Insurance companies are not angels and certainly need reform. Transparency will solve all issues on both sides of the equation. See my post on Loss Ratios http://www.insuranceinthelight.com/?p=18. Insurance companies can certainly explain how pricing is created and remove the shroud of secrecy.

I do not see the insurance companies as wielding omnipotent power over providers. Before Medicare insurance companies had no power.

With the advent of Medicare, providers saw a profit center with no limits. By having patients sign assignment agreements, thereby claiming the legal rights to the insured's insurance benefits, providers knowingly put themselves at the discretion of the insurance company to pay them. This all worked well while Medicare paid whatever the market would bear. Now, it's a different story.

See Maggie Mahar's Health Beat Blog <a href="http://www.healthbeatblog.org" target="_blank">www.healthbeatblog.org and read her book, "Money Driven Medicine". Medicine did not used to be a money making industry. Medicare was the goose that laid the golden egg.

When purchasing a car, we negotiate for the car first, then look to pay or finance it.

We can do the same with health care right now. We just have to choose to do it.

Thanks for your comment.

Keep them coming.

I just revamped Insurance In The Light with Word Press. I am still in the building stage, but haven't seen the bloatware factor, but then again, haven't tried to look, either. I went with third-party application, Thesis, and seem reasonably satisfied, but still getting into it. Typepad's captive template, the one I used to use, seemed a little constraining and confusing, but like I said, I'm still getting into it on Word Press. When is too big, too big?