Universal Healthcare

[bluelifer]

non-profit doesn't mean people don't get paid, work for free. Non-profit hospitals exist today and in fact up until the late 60's when Tom First founded HCA and started the for-profit hospital model.

The actual number of people benefiting from for-profit medicine is small in relation to the number of people that work in the industry. HCA alone has over 200,000 employees. The people that profit from the business are the stockholders.

For-profit industries will consume every dollar they can extract from the system. Healthcare is a human necessity. If your child is diagnosed with cancer are you asking how much treatment is going to cost? It is what it is. You're going to pay whatever it takes because it is the life of your child at steak. For-profit medicine knows it.
If you break your leg...what are you going to do? Make a splint out of a couple of 2x4s and try to set the bone yourself?

What incentive does the medical community have to cut prices? Ever go to the doctor and not have to wait? For essential services the system operates pretty much at capacity. The only places competition has brought down prices is with elective procedures. Breast augmentations and other elective plastic surgeries, E.D. treatments...that care that is elective in nature.

In the end it comes down to whether or not you think healthcare is a basic human right or a luxury that should only be available to those who can afford it. The rest of the world has determined that it is a basic human right. We spend 40% more per capita, have less favorable outcomes and still leave a sizable portion of our population without access to basic care.

It is what it is. Yeah, of course it is right now, but I thought we were discussing how to do it differently. The problem with your entire post is you're looking at it that way. My point from the beginning is, open it up completely and allow normal business competition at every point in the industry. You would see far different results.

Choice is the most powerful weapon a consumer has.

The poorest of the poor should still receive assistance, just like they do with the other basic neccessaties (food and shelter etc.). But the rest of us should be able to choose between companies openly competing for our business, just like we do with literally everything else we spend money on.

 

[Moopyj]

It is what it is. Yeah, of course it is right now, but I thought we were discussing how to do it differently. The problem with your entire post is you're looking at it that way. My point from the beginning is, open it up completely and allow normal business competition at every point in the industry. You would see far different results.

Choice is the most powerful weapon a consumer has.

The poorest the poor should still receive assistance, just like they do with the other basic neccessaties (food and shelter etc.). But the rest of us should be able to choose between companies openly competing for our business, just like we do with literally everything else we spend money on.

I agree with this. LEss regulation. Let people who want to medically help others do it. Americans are very charitable. IF we are given the chance to take care of others without the supreme central command dictating everything without their finger on the pulse , then more will be accomplished. imo

 

[warrior-cat]

so you mean you wonder why the U.S. can't achieve what the Aussies have by insuring their 23 million person population vs our 300 million plus? it is laughable when you libs try to compare the countries with national healthcare to our system when you are talking about countries with populations less than that of many states in our country. insuring 20 to 30 million with relatively no defense budget compared to insuring 300 million plus while having to be the defender of freedom all over the world doesn't compare in terms of cost and scale

It has always been the liberal rallying cry, "Europe or what ever country is doing this." When looking into it further we find that many of them are not doing so good and have a lot of their people coming here for care. Also, you cannot compare/equate much of anything others countries do to the U.S. it just doesn't work.

 

[warrior-cat]

But that depends on what criteria you use to judge it. If you judge it based on the quality of care I would agree with you, but if you judge it based on the number of citizens that are covered and on the per capita cost, we fall far short of countries like France or Canada.

Actually we spend our winters in Florida and have several Canadian neighbors and friends down there and they would not dream of trading their health care system for ours. In fact when the topic comes up, they usually seem quite puzzled and ask why we don't have a comprehensive system like everyone else has.

They have known no other system as I had said before. A dog will still stay with its owner that beats them rather than taking off with someone who would treat them better simply because they do not know any better.

 

[cat_in_the_hat]

So does government not provide our police and fire protection? Provide public schools. Provide our water and sewer systems? Our power grids? Our roadways on which we drive?

Healthcare was never a for-profit industry until 1960s when employers started offering healthcare insurance for their employees. I have the hospital bill from when I was born in 1959. Mom spent a week in the hospital for a grand total of $187. My parents has no insurance, they had never had health insurance. Yes, $187 was more than $187 today but still... dad was earning $6000/yr so a week in the hospital was a little more than a week's pay. Today a normal delivery will costs between $30,000 and $50,000.

We don't have to buy cars, ovens, refrigerators, washers and dryers or even bread. None of those things are essential services.

Aside from interstate highways, the federal government provides none of the things you mentioned. Some water is provided by quasi governmental water districts (mainly in more rural areas and not by the federal government), etc., some is provided by private companies. Power grids are generally not provided by government except for organizations like TVA, etc. Most power grids are constructed by investor owned utilities, rural electric cooperatives, or transmission companies.

To be clear, I have no problem with local governments assisting with access to healthcare. If government is going to be involved it should be at the local, even state level, not the federal level.

 

[Chuckinden]

Thanks to all that have responded so far and kept it clean. Lots of good replies pro and cons about universal healthcare that have been debated the way is should be.

A few additional points I want to respond to:

"Don't want government involved in our healthcare". As long as we are a country, the government will be involved in our lives. With healthcare, allowing monopolies in the insurance industry is hurting our choices as personal consumers. As someone pointed out, we only have a few options here in KY...that is by design. Most companies will only go where they can make the most money and states like KY aren't one of them that makes them a lot of money, mostly due to personal habits of citizens. That limits our choices drastically.

Big health insurance companies are trying to buy up their competition and politicians allow it because of cash flow to their election campaigns or PACS that support them. This creates a monopoly that allows companies to set whatever rates they want. Remember, individual states control how these companies operate, not the federal government and again, politics come into play because the State Insurance Commissioner is appointed by the Governor.

I remember being in a meeting a few years ago with the President and actuaries of an insurance company that was proposing a large rate increase in 12 states. We Agency owners were livid as it would cause a lot of clients to drop their coverage if we couldn't get them into a cheaper plan. I ask the President if the states had approved of this large increase, he replied, "No, but they will". He was right, all 12 states approved it.

I have been in the insurance business for over 30 yrs and my Agency's market is vastly Senior Citizen insurance and Medicare Supplements are our biggest seller, by far.
This system works pretty well with the coexistence of government and private insurance companies. Medicare only pays a portion of the beneficiaries health costs and supplements pick up the difference allowing for virtually 100% coverage with certain plans AND the insured has a CHOICE as to whether they want to purchase the "supplement".

I don't know why this system wouldn't work with the general populus. Sure, Medicare has it's problems (fraud from providers and/or companies are the biggest problems), but any system will, but the Medicare system seems to work as well as any that includes government and private insurance companies. Initial funding would have to be found, but that is the problem with any system, including what we have now.

Agains, thanks for some great points on both sides of the ledger.

 

[UnfrozenCatfanLawyer]

This has been a good thread. Appreciate the posts.

 

[Mojocat_rivals48469]

8. Why are hospitals "not for profit" but insurance is "for profit?" Insurance makes a ton of money in the health care space; but unlike doctors or pharmaceutical companies or medical equipment manufacturers, they don't provide any service or do anything positive. Money should be made in medicine, but why is so much of that money made by insurance companies that add nothing to our care?

I understand everyone hates the insurance carriers - they are on the front line, they are the ones who say "no." But this is a fallacy. Insurance companies typically make 4-6% profit margin. They are the middle man, and an easy target. The pharma companies, by comparison, really do "make a ton of money"......

I just looked, and the profit margins of Aetna, Cigna and Humana were 3.6%, 4.6% and 3.2% for 2016. Eli Lilly made 13% and Pfizer made 13.7%. An extra 10% on 50 billion of revenues comes in handy. heh. What most don't understand about insurance is that the government tells carriers what they can charge and they tell them how much they have to spend on claims - so there is a pretty tight box there. And on top of that Obamacare included an "industry fee" which is a tax on the top line - for the big guys, that one line item is in excess of a billion dollars a year. So, take a billion right off the top and you have to spend, say, 85% on claims. There simply isn't a lot of fat. Which explains why they were all trying to merge last year.

My aim isn't to defend large insurance companies. The point is, focusing on health insurance - when people really want to fix "health care" - is a distraction. We have to get costs/spending under control, or else we're spinning wheels.

 

[starchief]

Good observations...
Medical billings is the most f#cked up industry in the world.
Billed rates and negotiated rates are apples and zebras from one insurance company to another. Wife had surgery, billed $35,000 for an out-patient procedure. The insurance negotiated rate was $9,200. For your hospital A and B... you can be sure that while one procedure is less at one, another procedure will be more. Your doctor may only practice at hospital A so if you want your doctor...it's hospital A for you.

Not all hospitals are not-for-profit. I work right next to the two largest for profit hospital chains in the country, HCA and CHS. As you can see below 6 of the largest 9 for-profit hospital systems are HQed in Nashville/Franklin/Brentwood all shoot offs from HCA which was founded by Tom Frist and made the Frist family billionaires.

For-Profit Hospital Systems

1. Community Health Systems (Franklin, Tenn.)—188 s
2. Hospital Corporation of America (HCA) (Franklin, Tenn.)— 166
3. Tenet Healthcare (Dallas) — 74
4. LifePoint Health (Brentwood, Tenn.) — 56
5. Prime Healthcare Services (Ontario, Calif.) — 32
6. Universal Health Services (King of Prussia, Pa.) — 28
7. IASIS Healthcare (Franklin, Tenn.) — 18
8. Ardent Health Services (Nashville, Tenn.) — 12
9. Capella Healthcare (Franklin, Tenn.) — 9

#5 is spot on. I mean at some point we get to a critical mass but what incentive does a medical provider have to control cost when most of the bill is going to be paid by insurance? I have a high deductible plan but have already met my MOOP (maximum out of pocket) expense. Everything is covered 100% the rest of the year. I have no incentive to save my insurance company money.

I have a granddaughter who went to college for a year to become a medical biller. Graduated top of her class. When she got her first job she was shocked at the underhanded things she was expected to do. She would naively mention that what she was told to do was immoral and dishonest. Because she had a smidgen of integrity she couldn't do that and was out of that field in less than a month. That little episode cost me more than $10K to pay that school bill off and to not have that debt hanging over her head.

*Don't get me started on these schools that entice students, get them to borrow large sums of money they will have great difficulty ever repaying just because it's available, to train them for jobs that only theoretically exist.

 

[BlueRaider22]

....individual states control how these companies operate, not the federal government

This is something that should remain and unfortunately history tells us that it won't. During the inception of the country, state gov't power was quite substantial. We were a collection of different states with different thoughts, ideologies, priorities, etc......and we just happened to be united in a few respects. Little by little state power has been stripped. Now, we have a HUGE central gub'ment that tries to force all state gub'ments to follow the company line.

I think whenever somebody talks about not allowing gov't to run healthcare they are merely reflecting this. They recognize the danger it provides.

 

[Ahnan E. Muss]

I understand everyone hates the insurance carriers - they are on the front line, they are the ones who say "no." But this is a fallacy. Insurance companies typically make 4-6% profit margin. They are the middle man, and an easy target. The pharma companies, by comparison, really do "make a ton of money"......

I just looked, and the profit margins of Aetna, Cigna and Humana were 3.6%, 4.6% and 3.2% for 2016. Eli Lilly made 13% and Pfizer made 13.7%. An extra 10% on 50 billion of revenues comes in handy. heh. What most don't understand about insurance is that the government tells carriers what they can charge and they tell them how much they have to spend on claims - so there is a pretty tight box there. And on top of that Obamacare included an "industry fee" which is a tax on the top line - for the big guys, that one line item is in excess of a billion dollars a year. So, take a billion right off the top and you have to spend, say, 85% on claims. There simply isn't a lot of fat. Which explains why they were all trying to merge last year.

My aim isn't to defend large insurance companies. The point is, focusing on health insurance - when people really want to fix "health care" - is a distraction. We have to get costs/spending under control, or else we're spinning wheels.

OK. But keep in mind that those insurance companies are making 3.6%, 4.6%, and 3.2% off of tens of millions of people. And those people are paying thousands a year. So you're talking pretty big money there.

And the way the system is set up now, the only entities that can pressure doctors, hospitals, suppliers, and pharma companies to reign in costs are the insurance companies. The government isn't doing it. We the consumers can't do it because the system purposefully hides pricing and cost info. So it's left to the insurance companies. And they don't do it either. They just raise rates, when they can, or threaten to leave a market when they can't raise rates.

 

[Anon1640710541]

[eyeroll] at discussing profit margin. Y'all must not understand basic accounting.

 

[Anon1640710541]

It's no wonder why costs are spiraling out of control. It's the only industry on the planet where you consume first, then get a bill months later with no real negotiation or awareness of the cost. It's government controlled and corporately ran.

Innovation, technology, awareness, transparency, negotiation.....that's what fixes this mess. Not a provider or carrier or politician.


Give everyone a catastrophic plan that covers absolutely nothing until you've spent 10 or 20 thousand dollars. Strip beauracracy and regulation. Costs would plummet.

 

[bluelifer]

At my job, I literally work everyday at trying to figure out how to keep prices down, be more efficient, take care of my staff, and provide the best products and services to my customers.

Can anyone guess which industry I'm not in?

 

[Anon1640710541]

At my job, I literally work everyday at trying to figure out how to keep prices down, be more efficient, take care of my staff, and provide the best products and services to my customers.

Can anyone guess which industry I'm not in?

You work for the post office?

 

[bluelifer]

I wish

 

[starchief]

You work for the post office?

[roll]

 

[dgtatu01]

I'm absolutely in favor of incentivizing good behavior and would love to see it done.

My issue is that the current system is so schizophrenic that no one actually knows what is going on. Costs are unsupportably high. There is no transparency nor real choice in insurance options (chiefly because it is tied to employment) so the consumer has almost no bargaining power. There is absolutely a ****-ton of waste caused in large part by the uninsured who abuse the system and that cost is foisted off on the responsible users of the system, as well as a ****-ton of waste caused by medical providers having perverted incentives that lead to more care rather than more health.

It is just a disaster and needs a legitimate fix, even if imperfect, that can be improved upon rather than having **** change all the time with political whims. That, frankly, is why I'm for Obamacare and hope the Senate kills this new healthcare bill.

Basically I'm arguing that we have a polished turd currently on the books, but I'd rather improve rather than destroy unless I see an actual workable solution.

When I have friends on Facebook who start railing the evil insurance companies I always laugh. Who has more interest in you being healthy? The party who pays money when you get sick or the party who gets money when you get sick? Listen to either of the 5 large health insurers quarterly earnings reports and they are all 5 talking about improving member health, getting treatment with better outcomes, staying in contact with their members. Listen to HCA's (largest hospital owner in US) quarterly report. Their goals are increased admissions per location. Increasing services per admission, increasing supply sells. Not one goal they had directly tied to making people healthier.

 

[Chuckinden]

When I have friends on Facebook who start railing the evil insurance companies I always laugh. Who has more interest in you being healthy? The party who pays money when you get sick or the party who gets money when you get sick? Listen to either of the 5 large health insurers quarterly earnings reports and they are all 5 talking about improving member health, getting treatment with better outcomes, staying in contact with their members. Listen to HCA's (largest hospital owner in US) quarterly report. Their goals are increased admissions per location. Increasing services per admission, increasing supply sells. Not one goal they had directly tied to making people healthier.

Yet, both entities are doing it for the same reason.......money. The hospital scenario is self explanatory. The insurance companies wants to cut down on paying claims.

 

[backbeatcat_rivals376595]

When I have friends on Facebook who start railing the evil insurance companies I always laugh. Who has more interest in you being healthy? The party who pays money when you get sick or the party who gets money when you get sick? Listen to either of the 5 large health insurers quarterly earnings reports and they are all 5 talking about improving member health, getting treatment with better outcomes, staying in contact with their members. Listen to HCA's (largest hospital owner in US) quarterly report. Their goals are increased admissions per location. Increasing services per admission, increasing supply sells. Not one goal they had directly tied to making people healthier.

Bingo. Game, set, match. The name of the game with healthcare PROVIDERS is also maximizing profits. The hospitals around here have been building palaces nicer than any hotel and then jacking up prices to cover the cost. We need healthcare Kroger...we get healthcare Whole Foods and there are no low-cost options for healthcare because you can't shop on price. Maybe insurance should be private and care facilities should all be taken over by the government...

 

[fuzz77]

OK. But keep in mind that those insurance companies are making 3.6%, 4.6%, and 3.2% off of tens of millions of people. And those people are paying thousands a year. So you're talking pretty big money there.

And the way the system is set up now, the only entities that can pressure doctors, hospitals, suppliers, and pharma companies to reign in costs are the insurance companies. The government isn't doing it. We the consumers can't do it because the system purposefully hides pricing and cost info. So it's left to the insurance companies. And they don't do it either. They just raise rates, when they can, or threaten to leave a market when they can't raise rates.

Yes, 3,4,5% of billions of dollars is a lot of money but it is still only 3,4,5% of your bill. If you are paying $10,000/year for health insurance only $300-$500 of that money is going into the insurance company's pocket. Are you really better off if your premium is "only" $9500 vs $10,000 a year? It's a ~buck a day.

BTW, why should it be on the insurance companies to control healthcare costs? They do work to limit their costs (payouts) and avoid what they deem unnecessary treatments. It behooves the insurance company that you remain as healthy as possible because healthy people = lower payouts = higher profits = the ability to price their product more competitively vs other insurance companies. So it is advantageous that you get the treatment you need to become healthy. To insurance companies healthy people are like drivers with good driving records or home owners who have never filed a claim.

 

[Dig Dirkler]

What's unbelievable to me is that there are people that view my health as a commodity no different than a washer or a car, that should be marked up and sold at a profit.

Why is that so unbelievable and why do you take it so personally? Fundamentally, economically, every patient encounter is a transaction where the patient trades money for either the doctor's time or a product the doctor is selling. How could it not be considered a commodity?

 

[fuzz77]

At my job, I literally work everyday at trying to figure out how to keep prices down, be more efficient, take care of my staff, and provide the best products and services to my customers.

Can anyone guess which industry I'm not in?

I work in the healthcare insurance industry and we do the very same things. We negotiate with providers to accept the lowest payouts they will take. We have literally more than 1000 nurses who daily contact our members, member's caretakers and see that people take the medications they are prescribed. Make their doc appointments even if it means we send transportation to get them there and back...we even do house calls!! The healthier our members, the more profitable our business.

We are also in a competitive business and a publicly traded company. We have to bid against other insurers on service and costs and we also have to make money to return to our shareholders. All of our salaried staff are incentivized to control costs and enhance profitability, provide the highest level of service to members, managers are measured on employee turnover and satisfaction. The insurance industry is no different than any other industry.

What we have with healthcare is what the market creates. If you're a "keep government out of healthcare person"...what we have is what you get with the exception that without government (Medicare/Medicaid), fewer people would get care. Healthcare costs are subject to the laws of supply and demand and what the market will bear.

 

[Deeeefense]

Why is that so unbelievable and why do you take it so personally? Fundamentally, economically, every patient encounter is a transaction where the patient trades money for either the doctor's time or a product the doctor is selling. How could it not be considered a commodity?

Dig - I didn't take CIAH's response personal - he and I have had many debates in the past which have been intense at times but never personal.

I think your second question touches a subject that is deeper than economics. I think in a most basic sense, health care becomes a morals and values issue (not necessarily a "right") as well as an economic one. As a country and as a society how do we view the health of our citizens? Most all industrialized countries have placed health care in the same category as education, transportation and national security. That is, it is something that every citizen should have access to, not just those that can afford it. Your example illustrates people purchasing medical products and services directly as opposed to most of those costs being covered by insurance. That suggests health care products and services should only be made available to those that can afford to pay for them. I personally don't adhere to that ideal. I think we should be just as vigilant about protecting our citizens from cancer and lymphoma as we are against a terrorist attack. In either instance the end result can be death. As I told CIAH I think a person's health is vastly different and not even comparable to a washing machine or a microwave oven.

 

[bluelifer]

I work in the healthcare insurance industry and we do the very same things. We negotiate with providers to accept the lowest payouts they will take. We have literally more than 1000 nurses who daily contact our members, member's caretakers and see that people take the medications they are prescribed. Make their doc appointments even if it means we send transportation to get them there and back...we even do house calls!! The healthier our members, the more profitable our business.

We are also in a competitive business and a publicly traded company. We have to bid against other insurers on service and costs and we also have to make money to return to our shareholders. All of our salaried staff are incentivized to control costs and enhance profitability, provide the highest level of service to members, managers are measured on employee turnover and satisfaction. The insurance industry is no different than any other industry.

What we have with healthcare is what the market creates. If you're a "keep government out of healthcare person"...what we have is what you get with the exception that without government (Medicare/Medicaid), fewer people would get care. Healthcare costs are subject to the laws of supply and demand and what the market will bear.

The price of healthcare relative to wages earned has quadrupled in the last 50 yrs. So, thanks for all you do, I guess.

Look, I have no doubt that you and those you work with do the things you said. It's your job. However, the fact is the exorbitant cost of medical procedures and prescriptions is enabled by insurance, instead of being held in check. With the threat of a 6 figure hospital stay that would bankrupt the average American looming, they will be much more willing to pay a $1000/month premium than the $250/month they actually should be paying.

What incentive do the insurance companies truly have to help lower costs? They're getting 3-5% of $1000 instead of 3-5% of $250.

 

[Mojocat_rivals48469]

[eyeroll] at discussing profit margin. Y'all must not understand basic accounting.

I need to hide that CPA license, I think......

 

[Dig Dirkler]

Dig - I didn't take CIAH's response personal - he and I have had many debates in the past which have been intense at times but never personal.

I meant "take it personally" in the abstract, not that you actually took it personally. In other words, it's not personal that someone considers your health/healthcare as a commodity. I guess I take more of a Milton Friedman approach towards the problem and view it in terms of economics -- which brings us to your next points...

I think your second question touches a subject that is deeper than economics. I think in a most basic sense, health care becomes a morals and values issue (not necessarily a "right") as well as an economic one. As a country and as a society how do we view the health of our citizens? Most all industrialized countries have placed health care in the same category as education, transportation and national security. That is, it is something that every citizen should have access to, not just those that can afford it. Your example illustrates people purchasing medical products and services directly as opposed to most of those costs being covered by insurance. That suggests health care products and services should only be made available to those that can afford to pay for them. I personally don't adhere to that ideal. I think we should be just as vigilant about protecting our citizens from cancer and lymphoma as we are against a terrorist attack. In either instance the end result can be death. As I told CIAH I think a person's health is vastly different and not even comparable to a washing machine or a microwave oven.

Fundamentally, it doesn't matter whether the patient is purchasing the service/product directly, or whether their "insurance" is covering the cost -- the transaction is, at it's core, an economic one. Insurance simply pools assets and spreads the risk. But, when you get right down to it, money is still being exchanged for goods/services whether it's paid directly by the consumer or indirectly by their insurance.

You, and others, make a good point about a big part of the problem is how we, as a society, should view healthcare. Is it a right or a privilege? Even if someone doesn't consider it to be a right, but rather a moral/ethical ideal to which we should aspire, then where do we draw the line?

Furthermore, who gets to decide where that line is drawn in terms of the level of care that each citizen receives if we make the leap to "single-payer"? Basic, yearly exams? Fine, great, ounce of prevention and all that. But what if someone needs a $750,000.00 liver transplant because of years of alcohol abuse? Should that cost be passed on to non-drinking taxpayers? "Single-payer" sounds great until the government has to decide who gets what.

 

[Bill@ModernThirst]

The problem with healthcare isn't who has insurance, it's the cost of healthcare, much of which is due to the insurance-based system we've created.

Insurance, by nature, SHOULD be a hedge against catastrophic healthcare expenses, not regular the regular month-to-month costs of seeing a doctor. When it becomes necessary to use insurance for every visit and preventative care, it's no longer insurance, it's a private subsidy. Insurance CANNOT be the instrument to provide healthcare to the entire population- that's the fallacy with the ACA. When you begin forcing insurers to cover EVERYONE, regardless of pre-existing conditions, you break the insurance system.

If five neighbors start pooling a little money, say $50 per neighbor each month into an account to pay for any of their potential driveway repairs (i.e. driveway insurance), and a year later, a new neighbor wants to join the plan, knowing his driveway is already falling into a sinkhole and he will need $15,000 on day 1 to fix it, the system breaks. That's insurance.

The fact that insurance, for many/most, pays for a part of ALL healthcare costs means that healthcare providers can charge more, because the end expense to the consumer is a fraction of the overall cost. The insurance company can argue to keep the cost down, but if they're paying for the procedure at all, the cost is already going to be artificially inflated. It's become a subsidy, which is NOT the point of insurance. I don't blame insurance companies for this...this is what a system with insurance and out of control costs looks like. And it's not free market- this isn't a case of consumers determining the value of services, it's insurance companies negotiating the value of necessary services that, at some point, the consumer really can't forego. So long as the end cost to the consumer is low, there is no overarching market force keeping the prices low. It becomes a circular system of inflating prices and ballooning insurance companies.

And it becomes a system in which insurance is no longer a safety net, but a necessary subsidy for most consumers.

Our healthcare system is broken. I don't know the ultimate solution. I don't think Canada is the way to go and don't want government provided single-payer healthcare, but our current setup is equally bad for different reasons. Our government already spends more in healthcare on each citizen than Canada/Germany/etc- and Canadians/Germans/Brits don't pay private insurance and medical expenses on top of it. Something is broken.

 

[starchief]

Yet, both entities are doing it for the same reason.......money. The hospital scenario is self explanatory. The insurance companies wants to cut down on paying claims.

My wife is a real tiger dealing with health insurance providers. She'll spend hours on the phone patiently (I would be screaming and yelling) dealing with the reps and almost always ends up convincing them she is right. She just did this yesterday afternoon and this morning. She won the dispute about what was covered.

The problem, I find, is incompetent phone reps (many hospitals have done away with billing departments where you can make your case face-to-face). Policies can be complicated, yes, but some of the phone reps don't have a clue and tell you anything (truth or a plain lie) just to get you off the line.

The wise old adage is: "Don't waste your time talking with people who only have the authority to tell you no (most phone reps). Keep going until you talk to someone who knows the facts and has the authority to say yes."

That is what my wife does.

She literally dealt with a provider in a dispute for two years. And finally won. And they admitted they screwed up.

 

[Dig Dirkler]

She literally dealt with a provider in a dispute for two years. And finally won. And they admitted they screwed up.

Just out of morbid curiosity, how much was the amount in question and how many hours did she spend arguing her case?

 

[UKGrad93]

Looking at Centers for Medicare and Medicaid data, it is simple. The problem can be solved by getting rid of people 65 and older.

Age Spending per capita
0-18 $3698 m / $3399 f
19-64 $7430 f / $5822 m
65+ $19558 f / $18251 m

It creates lots of problems in the system. They are old, worn out, bad lifestyles have caught up and diseases of age such as cancer start showing up and cost lots of money to try and fix. It also causes shortages of doctors, nurses and other medical professions, which causes the price for these workers to go up (supply & demand).

It's not drug companies and insurance companies. It's old people. Mom, dad, grandma, and papaw. They are the 800 lb gorilla in the room that no one really wants to talk about. (well, some do, but it's not popular, won't get you elected, etc...).

 

[Dig Dirkler]

Looking at Centers for Medicare and Medicaid data, it is simple. The problem can be solved by getting rid of people 65 and older.

Fortunately for mankind, in another hundred years we finally figure this out...

 

[fuzz77]

The price of healthcare relative to wages earned has quadrupled in the last 50 yrs. So, thanks for all you do, I guess.

Look, I have no doubt that you and those you work with do the things you said. It's your job. However, the fact is the exorbitant cost of medical procedures and prescriptions is enabled by insurance, instead of being held in check. With the threat of a 6 figure hospital stay that would bankrupt the average American looming, they will be much more willing to pay a $1000/month premium than the $250/month they actually should be paying.

What incentive do the insurance companies truly have to help lower costs? They're getting 3-5% of $1000 instead of 3-5% of $250.

Yes, but our risks are much higher too. We have people that costs us $500,000...that's our payouts at negotiated rates! Don't recall the exact ratio but it's something like 5% of the people that create 80% of the costs.

I agree that exorbitant cost of procedures is enabled by insurance...just as it does with the high costs of collision repairs on automobiles, as does the availability of student loans increase the cost of education. The more money there is chasing goods, the higher the price will be. It also allows the healthcare industry to research and invest in patient care and has fueled the great advancements in medicine that we've seen over the last 40 years. It's a two edged sword.

That sword creates the great societal and humanistic question...do we allow people to die or suffer more than medically necessary because of their economic situation?

The argument is made that I don't necessarily disagree with that insurance should only be for catastrophic care. Well, define the line of catastrophic care or better...when the cost of care exceeds some threshold. That line will vary greatly from household to household. Then, what do you do with the people that cannot pay for care?

Homeless guy gets hit by a car and is laying in the street alive but badly injured. Does he get care? If so, who pays for it?
If homeless guy has a car and that car gets destroyed, he's out of a car and nobody is paying for a new one. I'm guessing that an ambulance was called...depending on where it happens even lifeflight could be called...he is hauled to an ER somewhere and they do the best they can to nurse him back to health regardless of possibly the 6 figure expense he has created.

What if its a family that has a good income but manages it poorly and have no real assets to speak of. I've known guys with 6 figure salaries who are $25K deep in credit card debt, have a $50K car note and live in an apartment with their wife and 2 kids. Kid is diagnosed with leukemia...are you denying treatment to the kid because their parents are irresponsible? Or it could be one of the parents... what do you do with those cases because those cases are everywhere.

The insurance market gave consumers what they wanted...better stated...employers gave employees the benefits they needed to give to be competitive in the market. Employers asked for lower deductibles, more coverage because it made their benefits package, their jobs more attractive. Plus a healthier workforce is a more productive workforce. If 40+ years ago when this snowball got rolling had there only been high deductible plans then perhaps costs might not have risen as fast, progress in care wouldn't have progressed as fast. But we would still be asking the same questions because there will always be those who cannot afford to pay for care.

People gripe about Obamacare high deductible plans because they can't afford the deductible...yet didn't some suggest that insurance should only be for catastrophic care? Isn't that essentially what high deductible plans do? (depends on your definition of catastrophic care). Bottom line, there will always be those who cannot pay. Be it because they live in poverty, unemployed, working poor or they poorly manage their earnings. How those people get treated by the healthcare system is the dilemma you have to solve. It's a much larger population than most anyone wants to admit. You can't have an expectation that those people receive care but then advocate a free market. The two are diametrically opposed. They will claim that charity will handle those people but that simply isn't the case because charity can't handle them all. Charity is no guarantee, charity is subject to the actions of others and at no point in history has charity ever handled the need. Plenty of need exists today and certainly it certainly doesn't come close to filling the need.

 

[fuzz77]

Looking at Centers for Medicare and Medicaid data, it is simple. The problem can be solved by getting rid of people 65 and older.

Age Spending per capita
0-18 $3698 m / $3399 f
19-64 $7430 f / $5822 m
65+ $19558 f / $18251 m

It creates lots of problems in the system. They are old, worn out, bad lifestyles have caught up and diseases of age such as cancer start showing up and cost lots of money to try and fix. It also causes shortages of doctors, nurses and other medical professions, which causes the price for these workers to go up (supply & demand).

It's not drug companies and insurance companies. It's old people. Mom, dad, grandma, and papaw. They are the 800 lb gorilla in the room that no one really wants to talk about. (well, some do, but it's not popular, won't get you elected, etc...).

Over half of Medicare dollars are spent on people who die within two months of receiving care.

 

[fuzz77]

My wife is a real tiger dealing with health insurance providers. She'll spend hours on the phone patiently (I would be screaming and yelling) dealing with the reps and almost always ends up convincing them she is right. She just did this yesterday afternoon and this morning. She won the dispute about what was covered.

The problem, I find, is incompetent phone reps (many hospitals have done away with billing departments where you can make your case face-to-face). Policies can be complicated, yes, but some of the phone reps don't have a clue and tell you anything (truth or a plain lie) just to get you off the line.

The wise old adage is: "Don't waste your time talking with people who only have the authority to tell you no (most phone reps). Keep going until you talk to someone who knows the facts and has the authority to say yes."

That is what my wife does.

She literally dealt with a provider in a dispute for two years. And finally won. And they admitted they screwed up.

Not knowing anything about your wife's case...it's quite probable that they finally wrote the claim off to charity care regardless of who was right or wrong. It costs money to argue plus most companies want to keep their customers happy and will cave in here and there to do so.

 

[fuzz77]

Furthermore, who gets to decide where that line is drawn in terms of the level of care that each citizen receives if we make the leap to "single-payer"? Basic, yearly exams? Fine, great, ounce of prevention and all that. But what if someone needs a $750,000.00 liver transplant because of years of alcohol abuse? Should that cost be passed on to non-drinking taxpayers? "Single-payer" sounds great until the government has to decide who gets what.

Insurance companies make those calls every day. There is no material difference between a doctor working for an insurance company making that call and a doctor working for the government making that same call. With insurance, you have zero control over your risk pool.

I will say that I have to LOL over the question when the narrative used to be about "death panels" and the government denying you care because of age, drug uses or whatever. You can't be worried that they will pay too much and too little at the same time.

The bottom line is regardless if it is private insurance or government...decisions are made by human beings that care about outcomes because they have a soul and most likely have KPIs that are dependent upon those outcomes.

 

[Dig Dirkler]

The bottom line is regardless if it is private insurance or government...decisions are made by human beings that care about outcomes because they have a soul

[laughing]

 

[dgtatu01]

Yet, both entities are doing it for the same reason.......money. The hospital scenario is self explanatory. The insurance companies wants to cut down on paying claims.

It's fine to make money, but someone has to be there to hold the providers accountable for their actions. Humana where I work has to call Medicare patients after a hospital stay to make sure the drugs the hospital gave them Rx's for don't interact adversely with other drugs they are taking. This should be the hospitals job not ours. We shouldn't be forcing Doctors to do their job right. I just get tired of the evil health insurer bit. Often it's over some service we denied that you never needed, but your doctor talked you into.

 

[dgtatu01]

The bottom line is regardless if it is private insurance or government...decisions are made by human beings that care about outcomes because they have a soul and most likely have KPIs that are dependent upon those outcomes.

This is the kind of thinking that has to stop in policy talk. We can't make policy that depends on people doing the right thing. We need to make policy that aligns financial incentives with the desired outcomes, then people will do what you want. Make it where doing that earns a profit. Setting it up to do the right thing will just leave loopholes that people exploit or work around.

 

[Deeeefense]

I meant "take it personally" in the abstract, not that you actually took it personally. In other words, it's not personal that someone considers your health/healthcare as a commodity. I guess I take more of a Milton Friedman approach towards the problem and view it in terms of economics -- which brings us to your next points...


Fundamentally, it doesn't matter whether the patient is purchasing the service/product directly, or whether their "insurance" is covering the cost -- the transaction is, at it's core, an economic one. Insurance simply pools assets and spreads the risk. But, when you get right down to it, money is still being exchanged for goods/services whether it's paid directly by the consumer or indirectly by their insurance.

You, and others, make a good point about a big part of the problem is how we, as a society, should view healthcare. Is it a right or a privilege? Even if someone doesn't consider it to be a right, but rather a moral/ethical ideal to which we should aspire, then where do we draw the line?

Furthermore, who gets to decide where that line is drawn in terms of the level of care that each citizen receives if we make the leap to "single-payer"? Basic, yearly exams? Fine, great, ounce of prevention and all that. But what if someone needs a $750,000.00 liver transplant because of years of alcohol abuse? Should that cost be passed on to non-drinking taxpayers? "Single-payer" sounds great until the government has to decide who gets what.

Great point about the extent of health care that should be covered. I have always thought that the fatal flaw of the ACA was removing the provision that allowed for limitation of liability for insurers. Having an open ended liability requires insurers to raise the rates or move out of markets. The Canadian system, which I know a little bit about due to my Canadian friends, does have a limit on coverage. If you want coverage beyond the statutory limits you buy an additional policy from a private insurer.

I think we need stuatory limits on coverage regardless if it's medicare or private insurance and we also need legalized euthanasia in all 50 states. The government should not force people to stay alive against their will. Hospice should be covered in any case.